Virtual guidance as a tool to obtain diagnostic ultrasound for spaceflight and remote environments.

PubMed

Martin, David S; Caine, Timothy L; Matz, Timothy; Lee, Stuart M C; Stenger, Michael B; Sargsyan, Ashot E; Platts, Steven H

2012-10-01

With missions planned to travel greater distances from Earth at ranges that make real-time two-way communication impractical, astronauts will be required to perform autonomous medical diagnostic procedures during future exploration missions. Virtual guidance is a form of just-in-time training developed to allow novice ultrasound operators to acquire diagnostically-adequate images of clinically relevant anatomical structures using a prerecorded audio/visual tutorial viewed in real-time. Individuals without previous experience in ultrasound were recruited to perform carotid artery (N = 10) and ophthalmic (N = 9) ultrasound examinations using virtual guidance as their only training tool. In the carotid group, each untrained operator acquired two-dimensional, pulsed and color Doppler of the carotid artery. In the ophthalmic group, operators acquired representative images of the anterior chamber of the eye, retina, optic nerve, and nerve sheath. Ultrasound image quality was evaluated by independent imaging experts. Of the studies, 8 of the 10 carotid and 17 of 18 of the ophthalmic images (2 images collected per study) were judged to be diagnostically adequate. The quality of all but one of the ophthalmic images ranged from adequate to excellent. Diagnostically-adequate carotid and ophthalmic ultrasound examinations can be obtained by previously untrained operators with assistance from only an audio/video tutorial viewed in real time while scanning. This form of just-in-time training, which can be applied to other examinations, represents an opportunity to acquire important information for NASA flight surgeons and researchers when trained medical personnel are not available or when remote guidance is impractical.

Integrated medical school ultrasound: development of an ultrasound vertical curriculum.

PubMed

Bahner, David P; Adkins, Eric J; Hughes, Daralee; Barrie, Michael; Boulger, Creagh T; Royall, Nelson A

2013-07-02

Physician-performed focused ultrasonography is a rapidly growing field with numerous clinical applications. Focused ultrasound is a clinically useful tool with relevant applications across most specialties. Ultrasound technology has outpaced the education, necessitating an early introduction to the technology within the medical education system. There are many challenges to integrating ultrasound into medical education including identifying appropriately trained faculty, access to adequate resources, and appropriate integration into existing medical education curricula. As focused ultrasonography increasingly penetrates academic and community practices, access to ultrasound equipment and trained faculty is improving. However, there has remained the major challenge of determining at which level is integrating ultrasound training within the medical training paradigm most appropriate. The Ohio State University College of Medicine has developed a novel vertical curriculum for focused ultrasonography which is concordant with the 4-year medical school curriculum. Given current evidenced-based practices, a curriculum was developed which provides medical students an exposure in focused ultrasonography. The curriculum utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science within the medical school curriculum. The objectives of the course are to develop student understanding in indications for use, acquisition of images, interpretation of an ultrasound examination, and appropriate decision-making of ultrasound findings. Preliminary data indicate that a vertical ultrasound curriculum is a feasible and effective means of teaching focused ultrasonography. The foreseeable limitations include faculty skill level and training, initial cost of equipment, and incorporating additional information into an already saturated medical school curriculum. Focused ultrasonography is an evolving concept in medicine

Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals.

PubMed

Smith, Jay; Finnoff, Jonathan T

2009-01-01

Musculoskeletal ultrasound involves the use of high-frequency sound waves to image soft tissues and bony structures in the body for the purposes of diagnosing pathology or guiding real-time interventional procedures. Recently, an increasing number of physicians have integrated musculoskeletal ultrasound into their practices to facilitate patient care. Technological advancements, improved portability, and reduced costs continue to drive the proliferation of ultrasound in clinical medicine. This increased interest creates a need for education pertaining to all aspects of musculoskeletal ultrasound. The primary purpose of this article is to review diagnostic ultrasound technology and its potential clinical applications in the evaluation and treatment of patients with neurologic and musculoskeletal disorders. After reviewing this article, physicians should be able to (1) list the advantages and disadvantages of ultrasound compared with other available imaging modalities, (2) describe how ultrasound machines produce images using sound waves, (3) discuss the steps necessary to acquire and optimize an ultrasound image, (4) understand the different ultrasound appearances of tendons, nerves, muscles, ligaments, blood vessels, and bones, and (5) identify multiple applications for diagnostic and interventional musculoskeletal ultrasound in musculoskeletal practice. Part 1 of this 2-part article reviews the fundamentals of clinical ultrasonographic imaging, including relevant physics, equipment, training, image optimization, and scanning principles for diagnostic and interventional purposes.

Enhanced ultrasound for advanced diagnostics, ultrasound tomography for volume limb imaging and prosthetic fitting

NASA Astrophysics Data System (ADS)

Anthony, Brian W.

2016-04-01

Ultrasound imaging methods hold the potential to deliver low-cost, high-resolution, operator-independent and nonionizing imaging systems - such systems couple appropriate algorithms with imaging devices and techniques. The increasing demands on general practitioners motivate us to develop more usable and productive diagnostic imaging equipment. Ultrasound, specifically freehand ultrasound, is a low cost and safe medical imaging technique. It doesn't expose a patient to ionizing radiation. Its safety and versatility make it very well suited for the increasing demands on general practitioners, or for providing improved medical care in rural regions or the developing world. However it typically suffers from sonographer variability; we will discuss techniques to address user variability. We also discuss our work to combine cylindrical scanning systems with state of the art inversion algorithms to deliver ultrasound systems for imaging and quantifying limbs in 3-D in vivo. Such systems have the potential to track the progression of limb health at a low cost and without radiation exposure, as well as, improve prosthetic socket fitting. Current methods of prosthetic socket fabrication remain subjective and ineffective at creating an interface to the human body that is both comfortable and functional. Though there has been recent success using methods like magnetic resonance imaging and biomechanical modeling, a low-cost, streamlined, and quantitative process for prosthetic cup design and fabrication has not been fully demonstrated. Medical ultrasonography may inform the design process of prosthetic sockets in a more objective manner. This keynote talk presents the results of progress in this area.

Discussion of the quality control and performance testing of ultrasound diagnostic equipment

NASA Astrophysics Data System (ADS)

Jiang, Junjie

2018-03-01

In recent years, with the rapid development of ultrasonography, the application and popularization of new technology used in ultrasound equipment, the level of providing diagnostic information for doctors enhances unceasingly, which has become the indispensable diagnostic tool for medical institutions. The performance of equipment is directly related to the doctor’s diagnosis and the patient’s health, therefore, it is very important to choose a good method for quality control and performance testing.

Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications.

PubMed

Smith, Jay; Finnoff, Jonathan T

2009-02-01

Musculoskeletal ultrasound involves the use of high-frequency sound waves to image soft tissues and bony structures in the body for the purposes of diagnosing pathology or guiding real-time interventional procedures. Recently, an increasing number of physicians have integrated musculoskeletal ultrasound into their practices to facilitate patient care. Technological advancements, improved portability, and reduced costs continue to drive the proliferation of ultrasound in clinical medicine. This increased interest creates a need for education pertaining to all aspects of musculoskeletal ultrasound. The primary purpose of this article is to review diagnostic ultrasound technology and its potential clinical applications in the evaluation and treatment of patients with neurological and musculoskeletal disorders. After reviewing this article, physicians should be able to (1) list the advantages and disadvantages of ultrasound compared to other available imaging modalities; (2) describe how ultrasound machines produce images using sound waves; (3) discuss the steps necessary to acquire and optimize an ultrasound image; (4) understand the difference ultrasound appearances of tendons, nerves, muscles, ligaments, blood vessels, and bones; and (5) identify multiple applications for diagnostic and interventional musculoskeletal ultrasound. Part 2 of this 2-part article will focus on the clinical applications of musculoskeletal ultrasound in clinical practice, including the ultrasonographic appearance of normal and abnormal tissues as well as specific diagnostic and interventional applications in major body regions.

Unilateral Opening of Rat Blood-Brain Barrier Assisted by Diagnostic Ultrasound Targeted Microbubbles Destruction.

PubMed

Xu, Yali; Cui, Hai; Zhu, Qiong; Hua, Xing; Xia, Hongmei; Tan, Kaibin; Gao, Yunhua; Zhao, Jing; Liu, Zheng

2016-01-01

Objective. Blood-brain barrier (BBB) is a key obstacle that prevents the medication from blood to the brain. Microbubble-enhanced cavitation by focused ultrasound can open the BBB and proves to be valuable in the brain drug delivery. The study aimed to explore the feasibility, efficacy, and safety of unilateral opening of BBB using diagnostic ultrasound targeted microbubbles destruction in rats. Methods. A transtemporal bone irradiation of diagnostic ultrasound and intravenous injection of lipid-coated microbubbles were performed at unilateral hemisphere. Pathological changes were monitored. Evans Blue extravasation grades, extraction from brain tissue, and fluorescence optical density were quantified. Lanthanum nitrate was traced by transmission electron microscopy. Results. After diagnostic ultrasound mediated microbubbles destruction, Evans Blue extravasation and fluorescence integrated optical density were significantly higher in the irradiated hemisphere than the contralateral side (all p < 0.01). Erythrocytes extravasations were demonstrated in the ultrasound-exposed hemisphere (4 ± 1, grade 2) while being invisible in the control side. Lanthanum nitrate tracers leaked through interendothelial cleft and spread to the nerve fiber existed in the irradiation side. Conclusions. Transtemporal bone irradiation under DUS mediated microbubble destruction provides us with a more accessible, safer, and higher selective BBB opening approach in rats, which is advantageous in brain targeted drugs delivery.

Visualizing and Measuring the Temperature Field Produced by Medical Diagnostic Ultrasound Using Thermography

ERIC Educational Resources Information Center

Vachutka, J.; Grec, P.; Mornstein, V.; Caruana, C. J.

2008-01-01

The heating of tissues by diagnostic ultrasound can pose a significant hazard particularly in the imaging of the unborn child. The demonstration of the temperature field in tissue is therefore an important objective in the teaching of biomedical physics to healthcare professionals. The temperature field in a soft tissue model was made visible and…

MO-AB-210-03: Workshop [Advancements in high intensity focused ultrasound

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Z.

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrationsmore » with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant

MO-AB-210-02: Ultrasound Imaging and Therapy-Hands On Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sammet, S.

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrationsmore » with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant

MO-AB-210-01: Ultrasound Imaging and Therapy-Hands On Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Z.

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrationsmore » with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant

Ethical analysis of non-medical fetal ultrasound.

PubMed

Leung, John Lai Yin; Pang, Samantha Mei Che

2009-09-01

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

Comparison of Thermal Safety Practice Guidelines for Diagnostic Ultrasound Exposures.

PubMed

Harris, Gerald R; Church, Charles C; Dalecki, Diane; Ziskin, Marvin C; Bagley, Jennifer E

2016-02-01

This article examines the historical evolution of various practice guidelines designed to minimize the possibility of thermal injury during a diagnostic ultrasound examination, including those published by the American Institute of Ultrasound in Medicine, British Medical Ultrasound Society and Health Canada. The guidelines for prenatal/neonatal examinations are in general agreement, but significant differences were found for postnatal exposures. We propose sets of thermal index versus exposure time for these examination categories below which there is reasonable assurance that an examination can be conducted without risk of producing an adverse thermal effect under any scanning conditions. If it is necessary to exceed these guidelines, the occurrence of an adverse thermal event is still unlikely in most situations because of mitigating factors such as transducer movement and perfusion, but the general principle of "as low as reasonably achievable" should be followed. Some limitations of the biological effects studies underpinning the guidelines also are discussed briefly. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Diagnostic Imaging in the Medical Support of the Future Missions to the Moon

NASA Technical Reports Server (NTRS)

Sargsyan, Ashot E.; Jones, Jeffrey A.; Hamilton, Douglas R.; Dulchavsky, Scott A.; Duncan, J. Michael

2007-01-01

This viewgraph presentation is a course that reviews the diagnostic imaging techniques available for medical support on the future moon missions. The educational objectives of the course are to: 1) Update the audience on the curreultrasound imaging in space flight; 2) Discuss the unique aspects of conducting ultrasound imaging on ISS, interplanetary transit, ultrasound imaging on ISS, interplanetary transit, and lunar surface operations; and 3) Review preliminary data obtained in simulations of medical imaging in lunar surface operations.

Ultrasound diagnostic of mesonephric paraovarian cyst - case report

PubMed Central

Bohîlțea, RE; Cîrstoiu, MM; Turcan, N; Ionescu, CA

2016-01-01

Paraovarian cysts are a rare pathology, constituting 10-20% of the adnexal masses. The origin can be represented by paramesonephric ducts (Hydatid cysts of Morgagni), vestiges of mesonephric ducts also represented by mesothelium, or neoplastic (cystadenomas or cystadenofibromas) that are mostly benign. Borderline or malignant paraovarian tumors are encountered less often. This article presents a case of paraovarian cyst in a 37-year-old patient, with a history of 2 pregnancies, completed by cesarean. The patient sought medical attention for an asymptomatic voluminous ovarian cyst, detected in a routine ultrasound scan. Laboratory tests and tumor markers were within normal limits. Transvaginal ultrasound and color Doppler revealed a cystic adnexal mass with 10 cm transonic, smooth, homogeneous content, avascular walls with no internal papillary projections, with a “hyperechoic line” sign of delimitation from the ovarian capsule, mostly visible when the adnexa was mobilized. The diagnostic and curative laparoscopic surgery was successful, followed by a quick recovery. The histopathological exam confirmed the benignity and the origin of the paraovarian cyst. The case was discussed in the context of the literature review concerning this pathology, drawing attention to the real possibility of differentiating ovarian from paraovarian cysts by ultrasound. PMID:27974934

American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.

PubMed

Finnoff, Jonathan T; Berkoff, David; Brennan, Fred; DiFiori, John; Hall, Mederic M; Harmon, Kimberly; Lavallee, Mark; Martin, Sean; Smith, Jay; Stovak, Mark

2015-02-01

The American Medical Society for Sports Medicine (AMSSM) developed a musculoskeletal ultrasound curriculum for sports medicine fellowships in 2010. As the use of diagnostic and interventional ultrasound in sports medicine has evolved, it became clear that the curriculum needed to be updated. Furthermore, the name 'musculoskeletal ultrasound' was changed to 'sports ultrasound' (SPORTS US) to reflect the broad range of diagnostic and interventional applications of ultrasound in sports medicine. This document was created to outline the core competencies of SPORTS US and to provide sports medicine fellowship directors and others interested in SPORTS US education with a guide to create a SPORTS US curriculum. By completing this SPORTS US curriculum, sports medicine fellows and physicians can attain proficiency in the core competencies of SPORTS US required for the practice of sports medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

WE-AB-206-02: ACR Ultrasound Accreditation: Requirements and Pitfalls

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walter, J.

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification.

PubMed

Jiang, Jue; Shang, Xu; Wang, Hua; Xu, Yong-Bo; Gao, Ya; Zhou, Qi

2015-03-01

The aim of this study was to investigate the diagnostic values of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in benign and malignant thyroid nodules with calcification. Conventional ultrasound and CEUS were performed in 122 patients with thyroid nodules with calcification. The thyroid nodules were characterized as benign or malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of the two imaging methods were determined. The area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic values of the two imaging methods. In 122 cases of thyroid nodules with calcification, 73 benign nodules and 49 malignant nodules were verified by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of conventional ultrasound were 50%, 77%, 59%, 69%, and 66%, respectively, and those of CEUS were 90%, 92%, 88%, 93%, and 91%, respectively. There were significant differences between the two imaging methods. AUCs of conventional ultrasound and CEUS were 0.628 ± 0.052 and 0.908 ± 0.031, suggesting low and high diagnostic values, respectively. CEUS has high diagnostic values, being significantly greater than those of conventional ultrasound, in differential diagnosis of benign and malignant thyroid nodules with calcification. Copyright © 2014. Published by Elsevier Taiwan.

Enabling the mission through trans-atlantic remote mentored musculoskeletal ultrasound: case report of a portable hand-carried tele-ultrasound system for medical relief missions.

PubMed

Kirkpatrick, Andrew W; Blaivas, Michael; Sargsyan, Ashot E; McBeth, Paul B; Patel, Chirag; Xiao, Zhengwen; Pian, Linping; Panebianco, Nova; Hamilton, Douglas R; Ball, Chad G; Dulchavsky, Scott A

2013-07-01

Modern medical practice has become extremely dependent upon diagnostic imaging technologies to confirm the results of clinical examination and to guide the response to therapies. Of the various diagnostic imaging techniques, ultrasound is the most portable modality and one that is repeatable, dynamic, relatively cheap, and safe as long as the imaging provided is accurately interpreted. It is, however, the most user-dependent, a characteristic that has prompted the development of remote guidance techniques, wherein remote experts guide distant users through the use of information technologies. Medical mission work often brings specialist physicians to less developed locations, where they wish to provide the highest levels of care but are often bereft of diagnostic imaging resources on which they depend. Furthermore, if these personnel become ill or injured, their own care received may not be to the standard they have left at home. We herein report the utilization of a compact hand-carried remote tele-ultrasound system that allowed real-time diagnosis and follow-up of an acutely torn adductor muscle by a team of ultrasonographers, surgeons, and physicians. The patient was one of the mission surgeons who was guided to self-image. The virtual network of supporting experts was located across North America, whereas the patient was in Lome, Togo, West Africa. The system consisted of a hand-carried ultrasound, the output of which was digitized and streamed to the experts within standard voice-over-Internet-protocol software with an embedded simultaneous videocamera image of the ultrasonographer's hands using a customized graphical user interface. The practical concept of a virtual tele-ultrasound support network was illustrated through the clinical guidance of multiple physicians, including National Aeronautics and Space Administration Medical Operations remote guiders, Olympic team-associated surgeons, and ultrasound-focused emergentologists.

Ultrasound as Diagnostic Tool for Diaphragmatic Myoclonus

PubMed Central

Llaneza Ramos, Vesper Fe Marie; Considine, Elaine; Karp, Barbara I.; Lungu, Codrin; Alter, Katharine; Hallett, Mark

2015-01-01

Background Diaphragmatic myoclonus is a rare disorder of repetitive diaphragmatic contractions, acknowledged to be a spectrum that includes psychogenic features. Electromyography has been the diagnostic tool most commonly used in the literature. Methods To test if we could perform a noninvasive technique to delineate the diaphragm as the source of abnormal movements and demonstrate distractibility and entrainability, we used B-mode ultrasound in a patient with diaphragmatic myoclonus. Results Ultrasound imaging clearly delineated the diaphragm as the source of her abdominal movements. We were able to demonstrate entrainability of the diaphragm to hand tapping to a prescribed rhythm set by examiner. Conclusion We recommend the use of ultrasound as a noninvasive, convenient diagnostic tool for further studies of diaphragmatic myoclonus. We agree with previous findings that diaphragmatic myoclonus may be a functional movement disorder, as evidenced by distractibility and entrainability demonstrated on real-time video with ultrasonography. PMID:27430001

Assessing the Risks for Modern Diagnostic Ultrasound Imaging

NASA Astrophysics Data System (ADS)

William, Jr.

1998-05-01

Some 35 years after Paul-Jacques and Pierre Curie discovered piezoelectricity, ultrasonic imaging was developed by Paul Langevin. During this work, ultrasonic energy was observed to have a detrimental biological effect. These observations were confirmed a decade later by R. W. Wood and A. L. Loomis. It was not until the early 1950s that ultrasonic exposure conditions were controlled and specified so that studies could focus on the mechanisms by which ultrasound influenced biological materials. In the late 1940s, pioneering work was initiated to image the human body by ultrasonic techniques. These engineers and physicians were aware of the deleterious ultrasound effects at sufficiently high levels; this endeavored them to keep the exposure levels reasonably low. Over the past three decades, diagnostic ultrasound has become a sophisticated technology. Yet, our understanding of the potential risks has not changed appreciably. It is very encouraging that human injury has never been attributed to clinical practice of diagnostic ultrasound.

Evaluation of chest ultrasound integrated teaching of respiratory system physiology to medical students.

PubMed

Paganini, Matteo; Bondì, Michela; Rubini, Alessandro

2017-12-01

Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term concept retention. A lecture about respiratory physiology was integrated with ultrasound and delivered to third-year medical students. It included basic concepts of ultrasound imaging and the physiology of four anatomic sectors of the body of a male volunteer, shown with a portable ultrasound device (pleural sliding, diaphragmatic movement, inferior vena cava diameter variations, cardiac movements). Students' perceptions of the integrated lecture were assessed, and attendance recorded. After 4 mo, four multiple-choice questions about respiratory physiology were administered during the normal human physiology examinations, and the results of students who attended the lesson and those of who did not were compared. One hundred thirty-four students attended the lecture. Most of them showed encouragement for the study of the subject and considered the ultrasound integrated lecture more interesting than a traditional one and pertinent to the syllabus. Exposed students achieved a better score at the examination and committed less errors than did nonexposed students. The chest ultrasound integrated lecture was appreciated by students. A possible association between the exposure to the lecture and short-term concept retention is shown by better performances of the exposed cohort at the examination. A systematic introduction of ultrasound into physiology traditional teaching will be promoted by the Ultrasound-Based Medical Education movement. Copyright © 2017 the American Physiological Society.

[Occupational risk caused by ultrasound in medicine].

PubMed

Magnavita, N; Fileni, A

1994-01-01

Ultrasound (US) is extensively used in the medical field for its therapeutic and diagnostic applications. US units are commonly found in hospitals and clinics of all sizes, and a growing number of medical staff such as doctors and nurses are exposed to hand-transmitted ultrasound waves in their work-place. This review discusses the available information on the occupational risk of the operators using diagnostic and therapeutic ultrasound devices. The new occupational groups of medical workers who use ultrasound (diagnostic, surgical, sterilization, and physiotherapeutic) equipment are exposed to contact ultrasound waves. Contact ultrasound -- i.e., no airspace between the energy source and the biological tissue -- is much more hazardous than exposure to airborne ultrasound because air transmits less than one percent of this kind of energy. In spite of being a non-ionizing radiation with an excellent safety record, US is likely to induce some changes in the exposed organ. Recent Russian studies indicate that the hospital workers who have been long exposed to ultrasound at work may develop neurovascular dose-dependent disorders of the peripheral nervous system in the form of the angiodystonic syndrome of vegetative polyneuritis of the hands. In some Scandinavian studies, female physiotherapists (exposed to ultrasound and short waves) exhibit increased rate of spontaneous abortions and congenital malformations, but no definite conclusion can be drawn on the basis of these results alone. Trends in exposure for diagnostic ultrasound equipment over the last two decades show a continuous increase. While there is no reason for alarm, there is a growing need for avoiding unnecessary exposure to medical workers.

The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review.

PubMed

Dones, Valentin C; Grimmer, Karen; Thoirs, Kerry; Suarez, Consuelo G; Luker, Julie

2014-03-03

Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler

WE-AB-206-00: Diagnostic QA/QC Hands-On Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis.

PubMed

So, Sokpoleak; Patel, Rita M; Orebaugh, Steven L

2017-03-01

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real-time visualization of anatomic structures and relationships in vivo, holds potential for pre-clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound-based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176-189. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

Ultrasound in Space Medicine

NASA Technical Reports Server (NTRS)

Dulchavsky, Scott A.; Sargsyan, A.E.

2009-01-01

This slide presentation reviews the use of ultrasound as a diagnostic tool in microgravity environments. The goals of research in ultrasound usage in space environments are: (1) Determine accuracy of ultrasound in novel clinical conditions. (2) Determine optimal training methodologies, (3) Determine microgravity associated changes and (4) Develop intuitive ultrasound catalog to enhance autonomous medical care. Also uses of Ultrasound technology in terrestrial applications are reviewed.

High-resolution, low-delay, and error-resilient medical ultrasound video communication using H.264/AVC over mobile WiMAX networks.

PubMed

Panayides, Andreas; Antoniou, Zinonas C; Mylonas, Yiannos; Pattichis, Marios S; Pitsillides, Andreas; Pattichis, Constantinos S

2013-05-01

In this study, we describe an effective video communication framework for the wireless transmission of H.264/AVC medical ultrasound video over mobile WiMAX networks. Medical ultrasound video is encoded using diagnostically-driven, error resilient encoding, where quantization levels are varied as a function of the diagnostic significance of each image region. We demonstrate how our proposed system allows for the transmission of high-resolution clinical video that is encoded at the clinical acquisition resolution and can then be decoded with low-delay. To validate performance, we perform OPNET simulations of mobile WiMAX Medium Access Control (MAC) and Physical (PHY) layers characteristics that include service prioritization classes, different modulation and coding schemes, fading channels conditions, and mobility. We encode the medical ultrasound videos at the 4CIF (704 × 576) resolution that can accommodate clinical acquisition that is typically performed at lower resolutions. Video quality assessment is based on both clinical (subjective) and objective evaluations.

High-Accuracy Ultrasound Contrast Agent Detection Method for Diagnostic Ultrasound Imaging Systems.

PubMed

Ito, Koichi; Noro, Kazumasa; Yanagisawa, Yukari; Sakamoto, Maya; Mori, Shiro; Shiga, Kiyoto; Kodama, Tetsuya; Aoki, Takafumi

2015-12-01

An accurate method for detecting contrast agents using diagnostic ultrasound imaging systems is proposed. Contrast agents, such as microbubbles, passing through a blood vessel during ultrasound imaging are detected as blinking signals in the temporal axis, because their intensity value is constantly in motion. Ultrasound contrast agents are detected by evaluating the intensity variation of a pixel in the temporal axis. Conventional methods are based on simple subtraction of ultrasound images to detect ultrasound contrast agents. Even if the subject moves only slightly, a conventional detection method will introduce significant error. In contrast, the proposed technique employs spatiotemporal analysis of the pixel intensity variation over several frames. Experiments visualizing blood vessels in the mouse tail illustrated that the proposed method performs efficiently compared with conventional approaches. We also report that the new technique is useful for observing temporal changes in microvessel density in subiliac lymph nodes containing tumors. The results are compared with those of contrast-enhanced computed tomography. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Enhanced cytotoxic effect of cisplatin using diagnostic ultrasound and microbubbles in vitro

NASA Astrophysics Data System (ADS)

Sasaki, Noboru; Nakamura, Kensuke; Murakami, Masahiro; Lim, Sue Yee; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

2012-10-01

Diagnostic ultrasound has accomplished drug and gene delivery by ultrasound targeted microbubble destruction (UTMD). However, the efficacy of delivery is still relatively low. Therefore, we optimized conditions of UTMD using diagnostic ultrasound and ultrasound contrast agent microbubbles. Canine thyroid adenocarcinoma cells were cultured in a 96-well plate. After addition of cisplatin and Sonazoid®, the plate was inverted to raise microbubbles near cells and incubated. Cells were exposed to diagnostic ultrasound using a linear probe operated in the contrast harmonic imaging mode. The center frequency was 2.5 MHz with a mechanical index of 1.33 and a frame rate of 48 frames/sec. Cytotoxic effect of cisplatin was evaluated 24h after exposure using trypan blue dye exclusion test. We optimized incubation duration, cisplatin concentration, and the relationship between microbubble concentration and exposure duration. The optimum enhancement was observed at incubation duration of 5min, cisplatin concentration of 1 μg/ml, and microbubble concentration of 2.4 × 105 microbubbles/ml. Exposure duration did not influence the enhancement at the microbubble concentration of 2.4 × 105 microbubbles/ml. Our results suggest that relative low concentrations of drug and microbubbles with short exposure duration might be sufficient for drug delivery by UTMD using diagnostic ultrasound.

Chest Ultrasound Integrated Teaching of Respiratory System Physiology to Medical Students: A First Experience

ERIC Educational Resources Information Center

Paganini, M.; Rubini, A.

2015-01-01

Ultrasound imaging is a useful diagnostic technique that has spread among several different medical specialties within the last few years. Initially restricted to radiology, cardiology, obstetrics, and gynecology, today it is widely used by many specialists, especially in critical care. New graduate physicians will need to be comfortable with…

Using Ultrasound to Teach Medical Students Cardiac Physiology

ERIC Educational Resources Information Center

Bell, Floyd E., III; Wilson, L. Britt; Hoppmann, Richard A.

2015-01-01

Ultrasound is being incorporated more into undergraduate medical education. Studies have shown that medical students have positive perceptions about the value of ultrasound in teaching courses like anatomy and physiology. The purpose of the present study was to provide objective evidence of whether ultrasound helps students learn cardiac…

Diagnostic ultrasound and telemedicine utilization in the international space station

NASA Astrophysics Data System (ADS)

Carter, Stephen J.; Stewart, Brent K.; Kushmerick, Martin J.; Langer, Steve G.; Schmiedl, Udo P.; Winter, Thomas C.; Conley, Kevin E.; Jubrias, Sharon A.

1999-01-01

Clinical diagnostic ultrasound (US) is experiencing an expanding role that is well suited to application on the International Space Station (ISS). Diagnostic US can be used to reduce the risks associated with long duration human space flight by providing a non-invasive tool with head-to-toe diagnostic capability in both biomedical research and crew health care. General health care of the astronauts will be diagnosed with US, e.g., kidney stones, gall bladder disease, appendicitis, etc. Initial studies will focus on detection of ``ureteral jets'' in the bladder. This is a non-invasive test to rule out obstructive uropathy from kidney stones with minimal requirements for crew training. Biomedical research experiments, focusing on the effects of the microgravity environment, will be performed using both the HHU and the HDI 5000. US will be used to evaluate bone density and muscle mass in this environment. Prolonged or emergency EVAs may occur with the ISS. The hand-held ultrasound unit (HHU) and its telemedicine capability will be used in EVA settings to monitor events such as decompression sickness (DCS) microbubble formation in the cardiovascular system. There will be telemetry links between the HHU and the ATL/Lockheed Martin rack mounted HDI 5000 in the ISS Human Research Facility (HRF), as well as between the HRF and medical expertise on the ground. These links will provide the ISS with both real-time and store-and-forward telemedicine capabilities. The HHU can also be used with the existing telemedicine instrument pack (TIP).

Using ultrasound to teach medical students cardiac physiology.

PubMed

Bell, Floyd E; Wilson, L Britt; Hoppmann, Richard A

2015-12-01

Ultrasound is being incorporated more into undergraduate medical education. Studies have shown that medical students have positive perceptions about the value of ultrasound in teaching courses like anatomy and physiology. The purpose of the present study was to provide objective evidence of whether ultrasound helps students learn cardiac physiology. In this study, 20 medical students took a pretest to assess their background knowledge of cardiac physiology. Next, they acquired ultrasound video loops of the heart. Faculty members taught them nonelectrical aspects of cardiac physiology using those loops. Finally, students took a posttest to evaluate for improvements in their knowledge. Students also completed an anonymous questionnaire about their experience. The mean pretest score was 4.8 of 9 (53.3%). The mean posttest score was 7.35 of 9 (81.7%). The mean difference was significant at P < 0.0001. Student feedback was very positive about the ultrasound laboratory. Ninety-five percent of the students agreed or strongly agreed that the ultrasound laboratory was a valuable teaching tool and that it improved their understanding of cardiac physiology. All students agreed or strongly agreed the laboratory was helpful from a visual learning standpoint. A hands-on ultrasound laboratory can indeed help medical students learn the nonelectrical components of cardiac physiology. Copyright © 2015 The American Physiological Society.

Systematic evaluation of a secondary method for measuring diagnostic-level medical ultrasound transducer output power based on a large-area pyroelectric sensor

NASA Astrophysics Data System (ADS)

Zeqiri, B.; Žauhar, G.; Rajagopal, S.; Pounder, A.

2012-06-01

A systematic study of the application of a novel pyroelectric technique to the measurement of diagnostic-level medical ultrasound output power is described. The method exploits the pyroelectric properties of a 0.028 mm thick membrane of polyvinylidene fluoride (PVDF), backed by an acoustic absorber whose ultrasonic absorption coefficient approaches 1000 dB cm-1 at 3 MHz. When exposed to an ultrasonic field, absorption of ultrasound adjacent to the PVDF-absorber interface results in heating and the generation of a pyroelectric output voltage across gold electrodes deposited on the membrane. For a sensor large enough to intercept the whole of the acoustic beam, the output voltage can be calibrated for the measurement of acoustic output power. A number of key performance properties of the method have been investigated. The technique is very sensitive, with a power to voltage conversion factor of typically 0.23 V W-1. The frequency response of a particular embodiment of the sensor in which acoustic power reflected at the absorber-PVDF interface is subsequently returned to the pyroelectric membrane to be absorbed, has been evaluated over the frequency range 1.5 MHz to 10 MHz. This has shown the frequency response to be flat to within ±4%, above 2.5 MHz. Below this frequency, the sensitivity falls by 20% at 1.5 MHz. Linearity of the technique has been demonstrated to within ±1.6% for applied acoustic power levels from 1 mW up to 120 mW. A number of other studies targeted at assessing the achievable measurement uncertainties are presented. These involve: the effects of soaking, the influence of the angle of incidence of the acoustic beam, measurement repeatability and sensitivity to transducer positioning. Additionally, over the range 20 °C to 30 °C, the rate of change in sensitivity with ambient temperature has been shown to be +0.5% °C-1. Implications of the work for the development of a sensitive, traceable, portable, secondary method of ultrasound output power

Medical Imaging with Ultrasound: Some Basic Physics.

ERIC Educational Resources Information Center

Gosling, R.

1989-01-01

Discussed are medical applications of ultrasound. The physics of the wave nature of ultrasound including its propagation and production, return by the body, spatial and contrast resolution, attenuation, image formation using pulsed echo ultrasound techniques, measurement of velocity and duplex scanning are described. (YP)

[Abdominal ultrasound course an introduction to the ultrasound technique. Physical basis. Ultrasound language].

PubMed

Segura-Grau, A; Sáez-Fernández, A; Rodríguez-Lorenzo, A; Díaz-Rodríguez, N

2014-01-01

Ultrasound is a non-invasive, accessible, and versatile diagnostic technique that uses high frequency ultrasound waves to define outline the organs of the human body, with no ionising radiation, in real time and with the capacity to visual several planes. The high diagnostic yield of the technique, together with its ease of uses plus the previously mentioned characteristics, has currently made it a routine method in daily medical practice. It is for this reason that the multidisciplinary character of this technique is being strengthened every day. To be able to perform the technique correctly requires knowledge of the physical basis of ultrasound, the method and the equipment, as well as of the human anatomy, in order to have the maximum information possible to avoid diagnostic errors due to poor interpretation or lack of information. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.

PubMed

Finnoff, Jonathan T; Berkoff, David; Brennan, Fred; DiFiori, John; Hall, Mederic M; Harmon, Kimberly; Lavallee, Mark; Martin, Sean; Smith, Jay; Stovak, Mark

2015-01-01

The following sports ultrasound (SPORTS US) curriculum is a revision of the curriculum developed by the American Medical Society for Sports Medicine (AMSSM) in 2010. Several changes have been made to the curriculum with the primary aim of providing a pathway by which a sports medicine fellow can obtain sufficient SPORTS US training to become proficient in the core competencies of SPORTS US. The core competencies of SPORTS US are outlined in the learning objectives section of this document. The term "SPORTS US" was purposefully chosen rather than "musculoskeletal ultrasound" (MSK US) because it was recognized by the panel that the evolving field of SPORTS US encompasses non-MSK applications of ultrasound such as the FAST examination (focused assessment with sonography for trauma). Although the SPORTS US core competencies in this curriculum are all MSK in nature, they represent the minimum SPORTS US knowledge a sports medicine fellow should acquire during fellowship. However, additional training in more advanced MSK and non-MSK applications of ultrasound can be provided at the fellowship director's discretion. Completion of this SPORTS US curriculum fulfills the American Institute of Ultrasound in Medicine's (AIUM) requirements to perform an MSK US examination and the prerequisites for the American Registry for Diagnostic Medical Sonography's (ARDMS) MSK sonography certification examination.

How 3D immersive visualization is changing medical diagnostics

NASA Astrophysics Data System (ADS)

Koning, Anton H. J.

2011-03-01

Originally the only way to look inside the human body without opening it up was by means of two dimensional (2D) images obtained using X-ray equipment. The fact that human anatomy is inherently three dimensional leads to ambiguities in interpretation and problems of occlusion. Three dimensional (3D) imaging modalities such as CT, MRI and 3D ultrasound remove these drawbacks and are now part of routine medical care. While most hospitals 'have gone digital', meaning that the images are no longer printed on film, they are still being viewed on 2D screens. However, this way valuable depth information is lost, and some interactions become unnecessarily complex or even unfeasible. Using a virtual reality (VR) system to present volumetric data means that depth information is presented to the viewer and 3D interaction is made possible. At the Erasmus MC we have developed V-Scope, an immersive volume visualization system for visualizing a variety of (bio-)medical volumetric datasets, ranging from 3D ultrasound, via CT and MRI, to confocal microscopy, OPT and 3D electron-microscopy data. In this talk we will address the advantages of such a system for both medical diagnostics as well as for (bio)medical research.

Comparison of a pocket-size ultrasound device with a premium ultrasound machine: diagnostic value and time required in bedside ultrasound examination.

PubMed

Stock, Konrad Friedrich; Klein, Bettina; Steubl, Dominik; Lersch, Christian; Heemann, Uwe; Wagenpfeil, Stefan; Eyer, Florian; Clevert, Dir-Andre

2015-10-01

Time savings and clinical accuracy of a new miniature ultrasound device was investigated utilizing comparison with conventional high-end ultrasound instruments. Our objective was to determine appropriate usage and limitations of this diagnostic tool in internal medicine. We investigated 28 patients from the internal-medicine department. Patients were examined with the Acuson P10 portable device and a Sonoline Antares instrument in a cross-over design. All investigations were carried out at the bedside; the results were entered on a standardized report form. The time for the ultrasound examination (transfer time, setting up and disassembly, switching on and off, and complete investigation time) was recorded separately. Mean time for overall examination per patient with the portable ultrasound device was shorter (25.0 ± 4.5 min) than with the high-end machine (29.4 ± 4.4 min; p < 0.001). When measuring the size of liver, spleen, and kidneys, the values obtained differed significantly between portable device and the high-end instrument. In our study, we identified 113 pathological ultrasound findings with the high-end ultrasound machine, while 82 pathological findings (73%) were concordantly detected with the portable ultrasound device. The main diagnostic strengths of the portable device were in the detection of ascites (sensitivity 80%), diagnosis of fatty liver, and identification of severe parenchymal liver damage. The clinical utility of portable ultrasound machines is limited. There will be clinical roles for distinct clinical questions such as detection of ascites or pleural effusion when used by experienced examiners. However, sensitivity in detecting multiple pathologies is not comparable to high-end ultrasound machines.

First-year medical students use of ultrasound or physical examination to diagnose hepatomegaly and ascites: a randomized controlled trial.

PubMed

Arora, Samantha; Cheung, Angela C; Tarique, Usman; Agarwal, Arnav; Firdouse, Mohammed; Ailon, Jonathan

2017-09-01

To compare point-of-care ultrasound and physical examination (PEx), each performed by first-year medical students after brief teaching, for assessing ascites and hepatomegaly. Ultrasound and PEx were compared on: (1) reliability, validity and performance, (2) diagnostic confidence, ease of use, utility, and applicability. A single-center, randomized controlled trial was performed at a tertiary centre. First-year medical students were randomized to use ultrasound or PEx to assess for ascites and hepatomegaly. Cohen's kappa and interclass coefficient (ICC) were used to measure interrater reliability between trainee assessments and the reference standard (a same day ultrasound by a radiologist). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were compared. A ten-point Likert scale was used to assess trainee diagnostic confidence and perceptions of utility. There were no significant differences in interobserver reliability, sensitivity, specificity, accuracy, PPV, or NPV between the ultrasound and PEx groups. However, students in the ultrasound group provided higher scores for perceived utility (ascites 8.38 ± 1.35 vs 7.08 ± 1.86, p  = 0.008; hepatomegaly 7.68 ± 1.52 vs 5.36 ± 2.48, p  < 0.001) and likelihood of adoption (ascites 8.67 ± 1.61 vs 7.46 ± 1.79, p  = 0.02; hepatomegaly 8.12 ± 1.90 vs 5.92 ± 2.32, p  = 0.001). When performed by first-year medical students, the validity and reliability of ultrasound is comparable to PEx, but with greater perceived utility and likelihood of adoption. With similarly brief instruction, point-of-care ultrasonography can be as effectively learned and performed as PEx, with a high degree of interest from trainees.

Hazards, risks and safety of diagnostic ultrasound.

PubMed

Duck, Francis A

2008-12-01

The safety of exposure to diagnostic ultrasound is evaluated using a structured approach to risk assessment, based on the acoustic output of present ultrasound scanners. Thermal hazard is described, the magnitude and probability of temperature rise is reviewed, and the severity of harm from any outcome is reviewed. Similar assessments are made separately for acoustic cavitation and gas-body effects, which have previously been considered together. Finally, radiation pressure is considered in a similar manner. In each case, means to minimize the risk are suggested where appropriate. The highest risks are associated with the use of gas-bubble contrast agents. It is concluded that there is a medium risk associated with trans-cranial Doppler use, and that this use of ultrasound deserves more detailed safety review. The risks associated with the current practice of obstetric ultrasound are low. Whilst the severity of radiation pressure as a hazard is low, it is always present. Little is known about any associated cell responses and so the associated risk cannot be evaluated.

Evaluation of Human Research Facility Ultrasound With the ISS Video System

NASA Technical Reports Server (NTRS)

Melton, Shannon; Sargsyan, Ashot

2003-01-01

Most medical equipment on the International Space Station (ISS) is manifested as part of the U.S. or the Russian medical hardware systems. However, certain medical hardware is also available as part of the Human Research Facility. The HRF and the JSC Medical Operations Branch established a Memorandum of Agreement for joint use of certain medical hardware, including the HRF ultrasound system, the only diagnostic imaging device currently manifested to fly on ISS. The outcome of a medical contingency may be changed drastically, or an unnecessary evacuation may be prevented, if clinical decisions are supported by timely and objective diagnostic information. In many higher-probability medical scenarios, diagnostic ultrasound is a first-choice modality or provides significant diagnostic information. Accordingly, the Clinical Care Capability Development Project is evaluating the HRF ultrasound system for its utility in relevant clinical situations on board ISS. For effective management of these ultrasound-supported ISS medical scenarios, the resulting data should be available for viewing and interpretation on the ground, and bidirectional voice communication should be readily available to allow ground experts (sonographers, physicians) to provide guidance to the Crew Medical Officer. It may also be vitally important to have the capability of real-time guidance via video uplink to the CMO-operator during an exam to facilitate the diagnosis in a timely fashion. In this document, we strove to verify that the HRF ultrasound video output is compatible with the ISS video system, identify ISS video system field rates and resolutions that are acceptable for varying clinical scenaiios, and evaluate the HRF ultrasound video with a commercial, off-the-shelf video converter, and compare it with the ISS video system.

Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis

PubMed Central

Douma-den Hamer, Djoke; Blanker, Marco H.; Edens, Mireille A.; Buijteweg, Lonneke N.; Boomsma, Martijn F.; van Helden, Sven H.; Mauritz, Gert-Jan

2016-01-01

Study Objective To determine the diagnostic accuracy of ultrasound for detecting distal forearm fractures. Methods A systematic review and diagnostic meta-analysis was performed according to the PRISMA statement. We searched MEDLINE, Web of Science and the Cochrane Library from inception to September 2015. All prospective studies of the diagnostic accuracy of ultrasound versus radiography as the reference standard were included. We excluded studies with a retrospective design and those with evidence of verification bias. We assessed the methodological quality of the included studies with the QUADAS-2 tool. We performed a meta-analysis of studies evaluating ultrasound to calculate the pooled sensitivity and specificity with 95% confidence intervals (CI95%) using a bivariate model with random effects. Subgroup and sensitivity analysis were used to examine the effect of methodological differences and other study characteristics. Results Out of 867 publications we included 16 studies with 1,204 patients and 641 fractures. The pooled test characteristics for ultrasound were: sensitivity 97% (CI95% 93–99%), specificity 95% (CI95% 89–98%), positive likelihood ratio (LR) 20.0 (8.5–47.2) and negative LR 0.03 (0.01–0.08). The corresponding pooled diagnostic odds ratio (DOR) was 667 (142–3,133). Apparent differences were shown for method of viewing, with the 6-view method showing higher specificity, positive LR, and DOR, compared to the 4-view method. Conclusion The present meta-analysis showed that ultrasound has a high accuracy for the diagnosis of distal forearm fractures in children when used by proper viewing method. Based on this, ultrasound should be considered a reliable alternative, which has the advantages of being radiation free. PMID:27196439

Outcomes of an Advanced Ultrasound Elective: Preparing Medical Students for Residency and Practice.

PubMed

Prats, Michael I; Royall, Nelson A; Panchal, Ashish R; Way, David P; Bahner, David P

2016-05-01

Many medical specialties have adopted the use of ultrasound, creating demands for higher-quality ultrasound training at all levels of medical education. Little is known about the long-term benefit of integrating ultrasound training during undergraduate medical education. This study evaluated the effect of a longitudinal fourth-year undergraduate medical education elective in ultrasound and its impact on the future use of ultrasound in clinical practice. A cross-sectional survey of medical graduates from The Ohio State University College of Medicine (2006-2011) was done, comparing those who participated and those who did not participate in a rigorous ultrasound program for fourth-year medical students. A 38-item questionnaire queried graduates concerning ultrasound education in residency, their proficiency, and their current use of ultrasound in clinical practice. Surveys were completed by 116 respondents, for a return rate of 40.8% (116 of 284). The participants of the undergraduate medical education ultrasound elective (n = 61) reported more hours of ultrasound training after graduation (hands-on training, bedside scanning, and number of scans performed; P < .001), higher ultrasound proficiency (proficiency in using ultrasound for clinical decision making, use in emergency settings, and use of novel techniques; P< .001), and higher rates of ultrasound use in clinical practice (P < .001). The longitudinal undergraduate medical education ultrasound elective produced physicians who were more likely to seek additional training in residency, evaluate themselves as more proficient, and use ultrasound in their clinical practice. Early training in bedside ultrasound during undergraduate medical education yields physicians who are better prepared for integration of ultrasound into clinical practice. © 2016 by the American Institute of Ultrasound in Medicine.

Evaluating the risk of appendiceal perforation when using ultrasound as the initial diagnostic imaging modality in children with suspected appendicitis.

PubMed

Alerhand, Stephen; Meltzer, James; Tay, Ee Tein

2017-08-01

Ultrasound scan has gained attention for diagnosing appendicitis due to its avoidance of ionizing radiation. However, studies show that ultrasound scan carries inferior sensitivity to computed tomography scan. A non-diagnostic ultrasound scan could increase the time to diagnosis and appendicectomy, particularly if follow-up computed tomography scan is needed. Some studies suggest that delaying appendicectomy increases the risk of perforation. To investigate the risk of appendiceal perforation when using ultrasound scan as the initial diagnostic imaging modality in children with suspected appendicitis. We retrospectively reviewed 1411 charts of children ≤17 years old diagnosed with appendicitis at two urban academic medical centers. Patients who underwent ultrasound scan first were compared to those who underwent computed tomography scan first. In the sub-group analysis, patients who only received ultrasound scan were compared to those who received initial ultrasound scan followed by computed tomography scan. Main outcome measures were appendiceal perforation rate and time from triage to appendicectomy. In 720 children eligible for analysis, there was no significant difference in perforation rate between those who had initial ultrasound scan and those who had initial computed tomography scan (7.3% vs. 8.9%, p = 0.44), nor in those who had ultrasound scan only and those who had initial ultrasound scan followed by computed tomography scan (8.0% vs. 5.6%, p = 0.42). Those patients who had ultrasound scan first had a shorter triage-to-incision time than those who had computed tomography scan first (9.2 (IQR: 5.9, 14.0) vs. 10.2 (IQR: 7.3, 14.3) hours, p = 0.03), whereas those who had ultrasound scan followed by computed tomography scan took longer than those who had ultrasound scan only (7.8 (IQR: 5.3, 11.6) vs. 15.1 (IQR: 10.6, 20.6), p < 0.001). Children < 12 years old receiving ultrasound scan first had lower perforation rate (p = 0.01) and

Ultrasound Detection of Soft Tissue Abscesses Performed by Non-Physician U.S. Army Medical Providers Naïve to Diagnostic Sonography.

PubMed

LaDuke, Mike; Monti, Jon; Cronin, Aaron; Gillum, Bart

2017-03-01

Patients commonly present to emergency rooms and primary care clinics with cellulitic skin infections with or without abscess formation. In military operational units, non-physician medical personnel provide most primary and initial emergency medical care. The objective of this study was to determine if, after minimal training, Army physician assistants and medics could use portable ultrasound (US) machines to detect superficial soft tissue abscesses. This was a single-blinded, randomized, prospective observational study conducted over the course of 2 days at a military installation. Active duty military physician assistants and medics with little or no US experience were recruited as participants. They received a short block of training on abscess detection using both clinical examination skills (inspection/palpation) and US examination. The participants were then asked to provide a yes/no answer regarding abscess presence in a chicken tissue model. Results were analyzed to assess the participants' abilities to detect abscesses, compare the diagnostic accuracy of their clinical examinations with their US examinations, and assess how often US results changed treatment plans initially on the basis of clinical examination findings alone. 22 participants performed a total of 220 clinical examinations and 220 US scans on 10 chicken tissue abscess models. Clinical examination for abscess detection yielded a sensitivity of 73.5% (95% confidence interval [CI], 65.3-80.3%) and a specificity of 77.2% (95% CI, 67.4-84.9%), although US examination for abscess detection yielded a sensitivity of 99.2% (95% CI, 95.4-99.9%) and a specificity of 95.5% (95% CI, 88.5-98.6%). Clinical examination yielded a diagnostic accuracy of 75.0% (95% CI, 68.9-80.3) although US examination yielded a diagnostic accuracy of 97.7% (95% CI, 94.6-99.2%), a difference in accuracy of 22.7% favoring US (p < 0.01). US changed the diagnosis in 56 of 220 cases (25.4% of all cases, p = 0.02). Of these 56

Uncertainty evaluation of dead zone of diagnostic ultrasound equipment

NASA Astrophysics Data System (ADS)

Souza, R. M.; Alvarenga, A. V.; Braz, D. S.; Petrella, L. I.; Costa-Felix, R. P. B.

2016-07-01

This paper presents a model for evaluating measurement uncertainty of a feature used in the assessment of ultrasound images: dead zone. The dead zone was measured by two technicians of the INMETRO's Laboratory of Ultrasound using a phantom and following the standard IEC/TS 61390. The uncertainty model was proposed based on the Guide to the Expression of Uncertainty in Measurement. For the tested equipment, results indicate a dead zone of 1.01 mm, and based on the proposed model, the expanded uncertainty was 0.17 mm. The proposed uncertainty model contributes as a novel way for metrological evaluation of diagnostic imaging by ultrasound.

Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

NASA Technical Reports Server (NTRS)

Hurst, Victor; Dulchavsky, Scott; Garcia, Kathleen; Sargsyan, Ashot; Ebert, Doug

2009-01-01

To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance.

Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis.

PubMed

Koegelenberg, Coenraad Frederik N; Bolliger, Christoph Thomas; Theron, Johan; Walzl, Gerhard; Wright, Colleen Anne; Louw, Mercia; Diacon, Andreas Henri

2010-10-01

Tuberculous pleuritis remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological and/or microbiological confirmation on pleural tissue is the gold standard for its diagnosis. Uncertainty remains regarding the choice of closed pleural biopsy needles. This prospective study compared ultrasound-assisted Abrams and Tru-Cut needle biopsies with regard to their diagnostic yield for pleural tuberculosis. 89 patients (54 men) of mean ± SD age 38.7 ± 16.7 years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo ≥ 4 Abrams needle biopsies followed by ≥ 4 Tru-Cut needle biopsies or vice versa. Medical thoracoscopy was performed on cases with non-diagnostic closed biopsies. Histological and/or microbiological proof of tuberculosis on any pleural specimen was considered the gold standard for pleural tuberculosis. Pleural tuberculosis was diagnosed in 66 patients, alternative diagnoses were established in 20 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 81 patients (91.0%) and were diagnostic for tuberculosis in 54 patients (sensitivity 81.8%), whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 70 patients (78.7%, p=0.015) and were diagnostic in 43 patients (sensitivity 65.2%, p=0.022). Ultrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleura and have a significantly higher diagnostic sensitivity for pleural tuberculosis.

Medical ultrasound - From inner space to outer space

NASA Technical Reports Server (NTRS)

Rooney, J. A.

1984-01-01

During the last decade, medical ultrasound has rapidly become a widely accepted imaging modality used in many medical specialties. It has the advantages that it is noninvasive, does not use ionizing radiation, is relatively inexpensive and is easy to use. Future trends in ultrasound include expanded areas of use, advanced signal processing and digital image analysis including tissue characterization and three-dimensional reconstructions.

Successful strategies for integrating bedside ultrasound into undergraduate medical education.

PubMed

Palma, James K

2015-04-01

Nearly all physician specialties currently utilize bedside ultrasound, and its applications continue to expand. Bedside ultrasound is becoming a core skill for physicians; as such, it should be taught during undergraduate medical education. When ultrasound is integrated in a longitudinal manner beginning in the preclerkship phase of medical school, it not only enhances teaching the basic science topics of anatomy, physiology, and pathology but also ties those skills and knowledge to the clerkship phase and medical decision-making. Bedside ultrasound is a natural bridge from basic science to clinical science. The Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine is currently in its fourth year of implementing an integrated ultrasound curriculum in the school of medicine. In our experience, successful integration of a bedside ultrasound curriculum should: align with unique focuses of a medical schools' mission, simplify complex anatomy through multimodal teaching, correlate to teaching of the physical examination, solidify understanding of physiology and pathology, directly link to other concurrent content, narrow differential diagnoses, enhance medical decision-making, improve procedural skills, match to year-group skillsets, develop teaching and leadership abilities, and have elective experiences for advanced topics. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Diagnostic Criteria and Accuracy of Categorizing Malignant Thyroid Nodules by Ultrasonography and Ultrasound Elastography with Pathologic Correlation.

PubMed

Elsayed, Naglaa Mostafa; Elkhatib, Yasser Atta

2016-03-01

Thyroid nodules are a common medical and surgical concern. Thyroid ultrasound (US) is the primary imaging modality used for initial evaluation and assortment of nodules for fine needle aspiration (FNA) cytology/biopsy. Ultrasound elastography (USE) is believed to improve the diagnostic accuracy of US in distinguishing benign from malignant nodules. The aim of the work described here is to evaluate the diagnostic criteria and accuracy of US and USE in the diagnosis of malignant thyroid nodules. A prospective study of 88 patients who have thyroid nodules was performed. US, color Doppler, and USE were evaluated using a Philips iU22 equipped with a 5 to 12 MHz, linear transducer, followed by FNA of the each scanned nodule. The most sensitive US criteria for malignant nodules were a height-to-width ratio greater than one and the absence of a halo sign (sensitivity 0.875% and 1.000%, respectively). The most specific criteria for malignancy were a spiculated/blurred margin and the presence of microcalcifications (specificity 0.968% and 0.888%, respectively). The receiver operating characteristic curve showed that the cutoff diagnostic criteria of malignancy are two US characteristics and an elastography score of 4. The diagnostic accuracy of US for malignant thyroid nodules increases by combining US and USE. © The Author(s) 2015.

Introduction of basic obstetrical ultrasound screening in undergraduate medical education.

PubMed

Hamza, A; Solomayer, E-F; Takacs, Z; Juhasz-Boes, I; Joukhadar, R; Radosa, J C; Mavrova, R; Marc, W; Volk, T; Meyberg-Solomayer, G

2016-09-01

Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized ultrasound teaching to our undergraduates. Medical students received an additional theoretical and practical course involving hands-on ultrasound screening during their mandatory practical training week in obstetrics and gynecology. The students' theoretical knowledge and fetal image recognition skills were tested before and after the course. After the course, the students were asked to answer a course evaluation questionnaire. To standardize the teaching procedure, we used Peyton's 4-Step Approach to teach the skills needed for a German Society of Ultrasound in Medicine Level 1 ultrasound examiner. The multiple-choice question scores after the course showed statistically significant improvement (50 vs. 80 %; P < 0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased their ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both obstetrics and gynecology and other medical fields. Using practical, hands-on medical teaching is an emerging method for undergraduate education that should be further evaluated, standardized, and developed.

EFSUMB Statement on Medical Student Education in Ultrasound [long version

PubMed Central

Cantisani, V.; Dietrich, C. F.; Badea, R.; Dudea, S.; Prosch, H.; Cerezo, E.; Nuernberg, D.; Serra, A. L.; Sidhu, P. S.; Radzina, M.; Piscaglia, F.; Bachmann Nielsen, M.; Ewertsen, C.; Săftoiu, A.; Calliada, F.; Gilja, O. H.

2016-01-01

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1. PMID:27689163

Can hand-carried ultrasound devices be extended for use by the noncardiology medical community?

PubMed

Duvall, W Lane; Croft, Lori B; Goldman, Martin E

2003-07-01

Echocardiography (echo) is a powerful, noninvasive, inexpensive diagnostic imaging technique that provides important information in a variety of cardiovascular diseases. Echo provides rapid information regarding ventricular and valvular function in the clinical management of patients. Smaller, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become commercially available, which can be used for diagnostic cardiac imaging. Because of their relative ease of use, portability, and affordable cost, these new hand-held systems have made point-of-care (bedside) echocardiography available to all medical personnel. The rate-limiting step to the widespread use of this technology is the lack of personnel with echo training at the immediate contact point with patients. Although extensive training and experience are needed to acquire and interpret a complete echo, training medical personnel to perform and interpret a limited echo (defined as a brief, diagnosis focused exam) may fully exploit the potential of echo as a point-of-care diagnostic tool and may be accomplished in a short period of time. Presently there are guidelines for independent competency in echocardiography and HCU echo established by several professional organizations and as a result of these rigorous guidelines, other noncardiology medical professionals who could practically derive the greatest benefit are discouraged and virtually precluded from utilizing echo during the initial encounter with the patient. However, there is now a growing body of literature in a diverse group of noncardiology medical personnel that demonstrates that it is possible to quickly and effectively train them to perform and interpret limited echocardiograms. Medical students, medical residents, cardiology fellows with limited experience, emergency department physicians, and surgical intensive care unit staff have all been evaluated after only brief, focused training periods, and investigators found that HCU

Trained simulated ultrasound patients: medical students as models, learners, and teachers.

PubMed

Blickendorf, J Matthew; Adkins, Eric J; Boulger, Creagh; Bahner, David P

2014-01-01

Medical educators must develop ultrasound education programs to ensure that future physicians are prepared to face the changing demands of clinical practice. It can be challenging to find human models for hands-on scanning sessions. This article outlines an educational model from a large university medical center that uses medical students to fulfill the need for human models. During the 2011-2012 academic year, medical students from The Ohio State University College of Medicine served as trained simulated ultrasound patients (TSUP) for hands-on scanning sessions held by the college and many residency programs. The extracurricular program is voluntary and coordinated by medical students with faculty supervision. Students receive a longitudinal didactic and hands-on ultrasound education program as an incentive for serving as a TSUP. The College of Medicine and 7 residency programs used the program, which included 47 second-year and 7 first-year student volunteers. Participation has increased annually because of the program's ease, reliability, and cost savings in providing normal anatomic models for ultrasound education programs. A key success of this program is its inherent reproducibility, as a new class of eager students constitutes the volunteer pool each year. The TSUP program is a feasible and sustainable method of fulfilling the need for normal anatomic ultrasound models while serving as a valuable extracurricular ultrasound education program for medical students. The program facilitates the coordination of ultrasound education programs by educators at the undergraduate and graduate levels.

The role for peer-assisted ultrasound teaching in medical school.

PubMed

Dickerson, Jonathan; Paul, Katie; Vila, Pierre; Whiticar, Rebecca

2017-06-01

Bedside ultrasonography has an increasing role in medicine yet medical students have limited exposure. Although countless hours are devoted to plain radiograph and electrocardiogram (ECG) interpretation, ultrasound is frequently glossed over. Yet this imaging modality could enhance students' understanding of anatomy, physiology and pathology, and may increase their integration into hospital teams. We aimed to investigate whether a peer-assisted ultrasound course has a place within the undergraduate medical curriculum. We describe the implementation of a course and discuss its acceptability and utility in student education. Bedside ultrasonography has an increasing role in medicine yet medical students have limited exposure METHODS: Following consultation with the medical school, an improved ultrasonography course was developed with expert guidance from an ultrasonographer and with new equipment. Sessions involved peer-tutors teaching ultrasonography techniques to medical students during emergency medicine placements. Tutees completed questionnaires to assess the quality and perceived benefits of the course and of learning ultrasonography. Both quantitative and thematic analyses of the responses were conducted by the authors. Over a period of 8 months, 105 medical students received teaching across four sessions. A total of 103 students (98%) returned questionnaires on their evaluation of the course and tutors, and on their confidence in using ultrasound. Ninety-eight per cent felt that the teaching was well delivered, 100 per cent felt that their knowledge of ultrasound had improved and 100 per cent would recommend the course. The peer-assisted ultrasound course described here enabled the majority of students to feel confident gaining elementary ultrasound views, and performing abdominal aneurysm screening and trauma assessments: techniques that they could hopefully put to use during their placements. The peer-assisted model has an acceptable role in teaching

The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: A case-control study.

PubMed

Segev, Lior; Segev, Yakir; Rayman, Shlomi; Nissan, Aviram; Sadot, Eran

2016-10-01

Ultrasonography is frequently used to diagnose acute appendicitis in women of reproductive age, but its diagnostic value in pregnant patients remains unclear. This study sought to compare the diagnostic performance of ultrasound in pregnant and young nonpregnant women with suspected acute appendicitis. The database of a single tertiary medical center was reviewed for all women of reproductive age who underwent appendectomy either during pregnancy (2000-2014) or in the nonpregnant state (2004-2007) following ultrasound evaluation. The performance of ultrasound in terms of predicting the final pathologic diagnosis was compared between the pregnant and non pregnant groups using receiver operating characteristic curve analysis. Of 586 young women treated for appendicitis during the study periods (92 pregnant, 494 non-pregnant), 200 underwent preoperative ultrasound [67 pregnant, and 133 nonpregnant young women]. The pregnant and nonpregnant groups were comparable in age and presenting symptoms. There was no significant difference in the predictive performance of ultrasound between the two groups (AUC 0.76 and 0.73 respectively, p = 0.78) or within the pregnant group, by trimester [first (n = 23), AUC 0.73; second (n = 32), AUC 0.67; third (n = 12), AUC 0.86; p = 0.4]. Ultrasound had a positive predictive value of 0.94 in the pregnant group and 0.91 in the nonpregnant group; corresponding negative predictive values were 0.40 and 0.43. There appears to be no difference in the ability of ultrasound to predict the diagnosis of acute appendicitis between pregnant women and nonpregnant women of reproductive age. Therefore, similar preoperative imaging algorithms may be used in both patient populations. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

PubMed

Kim, Mi Sung; Kwon, Heon-Ju; Kang, Kyung A; Do, In-Gu; Park, Hee-Jin; Kim, Eun Young; Hong, Hyun Pyo; Choi, Yoon Jung; Kim, Young Hwan

2018-02-01

To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.

Ultrasound: medical imaging and beyond (an invited review).

PubMed

Azhari, Haim

2012-09-01

Medical applications of ultrasound were first investigated about seventy years ago. It has rapidly evolved since then, becoming an essential tool in medical imaging. Ultrasound ability to provide real time images with frame rates exceeding several hundred frames per second allows one to view rapid anatomical changes as well as to guide minimal invasive procedures. By, combining Doppler techniques with anatomical images ultrasound provides real time quantitative flow information as well. It is portable, versatile, cost effective and considered sufficiently hazardless to monitor pregnancy. Moreover, ultrasound has the unique capacity to offer therapeutic capabilities in addition to its outstanding imaging abilities. It can be used for physiotherapy, lithotripsy, and thermal ablation, and recent studies have demonstrated its usefulness in drug delivery, gene therapy and molecular imaging. The purpose of this article is to provide an introductory review of the field covering briefly topics from basic physics through current imaging methods to therapeutic applications.

Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills.

PubMed

Ahn, Justin S; French, Andrew J; Thiessen, Molly E W; Browne, Vaughn; Deutchman, Mark; Guiton, Gretchen; Madigosky, Wendy; Kendall, John L

2015-10-01

To determine whether the addition of ultrasound to traditional physical examination instruction improves junior medical students' abilities to locate the femoral pulse. Initially, 150 second-year medical students were taught the femoral pulse examination using traditional bedside teaching on standardized patients and online didactic videos. Students were then randomized into 2 groups: group 1 received ultrasound training first and then completed the standardized examination; and group 2 performed the standardized examination first and then received ultrasound training. On the standardized patients, the femoral artery was marked with invisible ink before the sessions using ultrasound. Compared to these markers, students were then evaluated on the accuracy of femoral artery pulse palpation and the estimated location of the femoral vein. All students completed a self-assessment survey after the ultrasound sessions. Ultrasound training improved the students' ability to palpate the femoral pulse (P= .02). However, ultrasound did not facilitate correct estimation of the femoral vein's anatomic location (P = .09). Confidence levels in localizing the femoral artery and vein were equal between groups at baseline, and both increased after the ultrasound sessions. The addition of ultrasound teaching to traditional physical examination instruction enhanced medical student competency and confidence with the femoral vascular examination. However, understanding of anatomy may require emphasis on precourse didactic material, but further study is required. © 2015 by the American Institute of Ultrasound in Medicine.

Ultrasound-guided medical thoracoscopy in the absence of pleural effusion.

PubMed

Marchetti, Giampietro; Valsecchi, Alberto; Indellicati, Davide; Arondi, Sabrina; Trigiani, Marco; Pinelli, Valentina

2015-04-01

Medical thoracoscopy (MT) is a diagnostic and therapeutic procedure that permits the study of the pleural space. The presence of pleural adhesions is the most important contraindication to performing MT. Lesions of the pleura in absence of pleural effusion are usually studied in video-assisted thoracoscopic surgery (VATS) with preoperative ultrasound evaluation. No data are available about ultrasound-guided MT in the absence of pleural effusion. From January 2007 to June 2013, 622 consecutive MTs were performed under ultrasound guidance without inducing a pneumothorax. A retrospective cohort of 29 patients affected by pleural diseases without fluid was reviewed. The fifth or sixth intercostal spaces along the midaxillary line with a good echographic "sliding sign" and normal appearance of the pleural line were chosen as the entry site. The pleural cavity was explored, and biopsies were performed. The mean age of the patient cohort was 62.8 years; there were 20 male patients and nine female patients. Pleural adherences were avoided, and adequate number of pleural biopsies were performed. No parenchymal lung injuries, bleeding, or hematoma occurred. Seventeen patients had a completely free pleural cavity, four patients had a single pleural adhesion, and eight had multiple pleural adhesions; in all cases, however, endoscopic exploration was possible and biopsy specimens were adequate. The most frequent histopathologic diagnosis was malignant pleural mesothelioma. We have shown that thoracic ultrasound accurately identifies intrathoracic adhesions and, in experienced hands, can guide MT access, replacing the VATS approach, even in the complete absence of pleural effusion.

Contrast-Enhanced Ultrasound as a New Investigative Tool in Diagnostic Imaging of Muscle Injuries-A Pilot Study Evaluating Conventional Ultrasound, CEUS, and Findings in MRI.

PubMed

Hotfiel, Thilo; Heiss, Rafael; Swoboda, Bernd; Kellermann, Marion; Gelse, Kolja; Grim, Casper; Strobel, Deike; Wildner, Dane

2018-07-01

To emphasize the diagnostic value of contrast-enhanced ultrasound (CEUS) in the imaging of muscle injuries with different degrees of severity by comparing findings to established imaging modalities such as conventional ultrasound and magnetic resonance imaging (MRI). Case series. Institutional study. Conventional ultrasound and CEUS were performed in the Department of Internal Medicine. Magnetic resonance imaging was carried out in the Department of Radiology within the Magnetom Avanto 1.5T and Magnetom Skyra fit 3T (Siemens Healthineers, Erlangen, Germany) and in the Institution of Imaging Diagnostics and Therapy (Magnetom Avanto 1.5T; Siemens, Erlangen, Germany). Fifteen patients who underwent an acute muscle injury were recruited. The appearance and detectable size of muscle injuries were compared between each imaging modality. The injuries were assessed by 3 independent observers and blinded between imaging modalities. All 15 injuries were identified on MRI and CEUS, whereas 10 injuries showed abnormalities in conventional ultrasound. The determination and measurement revealed significant differences between conventional ultrasound and CEUS depending on injury severity. Contrast-enhanced ultrasound revealed an impairment of microcirculation in grade I lesions (corresponding to intramuscular edema observed in MRI), which was not detectable using conventional ultrasound. Our results indicate that performing CEUS seems to be a sensitive additional diagnostic modality in the early assessment of muscle injuries. Our results highlight the advantages of CEUS in the imaging of low-grade lesions when compared with conventional ultrasound, as this was the more accurate modality for identifying intramuscular edema.

Watermarking of ultrasound medical images in teleradiology using compressed watermark

PubMed Central

Badshah, Gran; Liew, Siau-Chuin; Zain, Jasni Mohamad; Ali, Mushtaq

2016-01-01

Abstract. The open accessibility of Internet-based medical images in teleradialogy face security threats due to the nonsecured communication media. This paper discusses the spatial domain watermarking of ultrasound medical images for content authentication, tamper detection, and lossless recovery. For this purpose, the image is divided into two main parts, the region of interest (ROI) and region of noninterest (RONI). The defined ROI and its hash value are combined as watermark, lossless compressed, and embedded into the RONI part of images at pixel’s least significant bits (LSBs). The watermark lossless compression and embedding at pixel’s LSBs preserve image diagnostic and perceptual qualities. Different lossless compression techniques including Lempel-Ziv-Welch (LZW) were tested for watermark compression. The performances of these techniques were compared based on more bit reduction and compression ratio. LZW was found better than others and used in tamper detection and recovery watermarking of medical images (TDARWMI) scheme development to be used for ROI authentication, tamper detection, localization, and lossless recovery. TDARWMI performance was compared and found to be better than other watermarking schemes. PMID:26839914

Computer-aided diagnostic system for detection of Hashimoto thyroiditis on ultrasound images from a Polish population.

PubMed

Acharya, U Rajendra; Sree, S Vinitha; Krishnan, M Muthu Rama; Molinari, Filippo; Zieleźnik, Witold; Bardales, Ricardo H; Witkowska, Agnieszka; Suri, Jasjit S

2014-02-01

Computer-aided diagnostic (CAD) techniques aid physicians in better diagnosis of diseases by extracting objective and accurate diagnostic information from medical data. Hashimoto thyroiditis is the most common type of inflammation of the thyroid gland. The inflammation changes the structure of the thyroid tissue, and these changes are reflected as echogenic changes on ultrasound images. In this work, we propose a novel CAD system (a class of systems called ThyroScan) that extracts textural features from a thyroid sonogram and uses them to aid in the detection of Hashimoto thyroiditis. In this paradigm, we extracted grayscale features based on stationary wavelet transform from 232 normal and 294 Hashimoto thyroiditis-affected thyroid ultrasound images obtained from a Polish population. Significant features were selected using a Student t test. The resulting feature vectors were used to build and evaluate the following 4 classifiers using a 10-fold stratified cross-validation technique: support vector machine, decision tree, fuzzy classifier, and K-nearest neighbor. Using 7 significant features that characterized the textural changes in the images, the fuzzy classifier had the highest classification accuracy of 84.6%, sensitivity of 82.8%, specificity of 87.0%, and a positive predictive value of 88.9%. The proposed ThyroScan CAD system uses novel features to noninvasively detect the presence of Hashimoto thyroiditis on ultrasound images. Compared to manual interpretations of ultrasound images, the CAD system offers a more objective interpretation of the nature of the thyroid. The preliminary results presented in this work indicate the possibility of using such a CAD system in a clinical setting after evaluating it with larger databases in multicenter clinical trials.

Diagnostic Performance of Wells Score Combined With Point-of-care Lung and Venous Ultrasound in Suspected Pulmonary Embolism.

PubMed

Nazerian, Peiman; Volpicelli, Giovanni; Gigli, Chiara; Becattini, Cecilia; Sferrazza Papa, Giuseppe Francesco; Grifoni, Stefano; Vanni, Simone

2017-03-01

Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated. We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators. Signs of deep venous thrombosis (DVT) at venous ultrasound and signs of pulmonary infarcts or alternative diagnoses at lung ultrasound were considered to recalculate two items of the Ws: signs and symptoms of DVT and alternative diagnosis less likely than PE. The diagnostic performances of the ultrasound-enhanced Ws (USWs) and Ws were then compared after confirmation of the final diagnosis. A total of 446 patients were studied. PE was confirmed in 125 patients (28%). USWs performed significantly better than Ws, with a sensitivity of 69.6% versus 57.6% and a specificity of 88.2% versus 68.2%. In combination with D-dimer, USWs showed an optimal failure rate (0.8%) and a significantly superior efficiency than Ws (32.3% vs. 27.2%). A strategy based on lung and venous ultrasound combined with D-dimer would allow to avoid CT pulmonary angiography in 50.5% of patients with suspected PE, compared to 27.2% when the rule without ultrasound is applied. A pretest risk stratification enhanced by ultrasound of lung and venous performs better than Ws in the early diagnostic process of PE. © 2016 by the Society for Academic Emergency Medicine.

Implementation of a 4-Year Point-of-Care Ultrasound Curriculum in a Liaison Committee on Medical Education-Accredited US Medical School.

PubMed

Wilson, Sean P; Mefford, Jason M; Lahham, Shadi; Lotfipour, Shahram; Subeh, Mohammad; Maldonado, Gracie; Spann, Sophie; Fox, John C

2017-02-01

The established benefits of point-of-care ultrasound have given rise to multiple new and innovative curriculums to incorporate ultrasound teaching into medical education. This study sought to measure the educational success of a comprehensive and integrated 4-year point-of-care ultrasound curriculum. We integrated a curriculum consisting of traditional didactics combined with asynchronous learning modules and hands-on practice on live models with skilled sonographers into all 4 years of education at a Liaison Committee on Medical Education-accredited US Medical School. Each graduating student was administered an exit examination with 48 questions that corresponded to ultrasound milestones. Ninety-five percent (n = 84) of fourth-year medical students completed the exit examination. The mean score was 79.5% (SD, 10.2%), with mean scores on the ultrasound physics and anatomy subsections being 77.1% (SD, 11.0%) and 85.9% (SD, 21.0%), respectively. A comprehensive 4-year point-of-care ultrasound curriculum integrated into medical school may successfully equip graduating medical students with a fundamental understanding of ultrasound physics, anatomy, and disease recognition. © 2016 by the American Institute of Ultrasound in Medicine.

Medical Ultrasound Video Coding with H.265/HEVC Based on ROI Extraction

PubMed Central

Wu, Yueying; Liu, Pengyu; Gao, Yuan; Jia, Kebin

2016-01-01

High-efficiency video compression technology is of primary importance to the storage and transmission of digital medical video in modern medical communication systems. To further improve the compression performance of medical ultrasound video, two innovative technologies based on diagnostic region-of-interest (ROI) extraction using the high efficiency video coding (H.265/HEVC) standard are presented in this paper. First, an effective ROI extraction algorithm based on image textural features is proposed to strengthen the applicability of ROI detection results in the H.265/HEVC quad-tree coding structure. Second, a hierarchical coding method based on transform coefficient adjustment and a quantization parameter (QP) selection process is designed to implement the otherness encoding for ROIs and non-ROIs. Experimental results demonstrate that the proposed optimization strategy significantly improves the coding performance by achieving a BD-BR reduction of 13.52% and a BD-PSNR gain of 1.16 dB on average compared to H.265/HEVC (HM15.0). The proposed medical video coding algorithm is expected to satisfy low bit-rate compression requirements for modern medical communication systems. PMID:27814367

Medical Ultrasound Video Coding with H.265/HEVC Based on ROI Extraction.

PubMed

Wu, Yueying; Liu, Pengyu; Gao, Yuan; Jia, Kebin

2016-01-01

High-efficiency video compression technology is of primary importance to the storage and transmission of digital medical video in modern medical communication systems. To further improve the compression performance of medical ultrasound video, two innovative technologies based on diagnostic region-of-interest (ROI) extraction using the high efficiency video coding (H.265/HEVC) standard are presented in this paper. First, an effective ROI extraction algorithm based on image textural features is proposed to strengthen the applicability of ROI detection results in the H.265/HEVC quad-tree coding structure. Second, a hierarchical coding method based on transform coefficient adjustment and a quantization parameter (QP) selection process is designed to implement the otherness encoding for ROIs and non-ROIs. Experimental results demonstrate that the proposed optimization strategy significantly improves the coding performance by achieving a BD-BR reduction of 13.52% and a BD-PSNR gain of 1.16 dB on average compared to H.265/HEVC (HM15.0). The proposed medical video coding algorithm is expected to satisfy low bit-rate compression requirements for modern medical communication systems.

Diagnostic medical physicists and their clinical activities.

PubMed

Cypel, Yasmin S; Sunshine, Jonathan H

2004-02-01

The primary objective of this study was to obtain basic, descriptive information about medical physicists involved in diagnostic radiology-related activities, the diagnostic-related activities that they performed, and the time spent on these activities. A survey was sent to a randomly selected sample of 1511 medical physicists from July through October 2001 using primarily e-mail methods; a total of 851 surveys was received, for a response rate of 56%. Of these, 427 were responses from physicists who do partly or only clinical diagnostic medical physics; it is this group for which results are presented. Fifty-four percent of the physicists who reported doing any clinical diagnostic medical physics performed clinical activities only in diagnostic medical physics. Fourteen percent of all those doing clinical diagnostic medical physics were women. Over 97% of the physicists doing clinical diagnostic medical physics reported having graduate degrees in physics; 53% had PhDs. The mean total weekly hours worked by physicists doing clinical diagnostic medical physics was 42. Medical physicists doing only clinical diagnostic activities reported working approximately 40 hours weekly, whereas those doing partly clinical diagnostic medical physics reported working 14 hours weekly in the field (approximately one-third of their work time). Radiography and fluoroscopy, computed tomography, nuclear medicine, and mammography are all fields in which the majority of those doing any clinical diagnostic medical physics are active. Full-time physicists working only in diagnostic medical physics were responsible for a median of 25 units of equipment, compared with a median of 10 units for those working only partly in the field. Number of units evaluated, frequency of evaluation, and hours per evaluation were reported for almost 20 types of equipment. Medical physicists performing diagnostic clinical activities typically are responsible for a large number and wide variety of imaging

Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

PubMed Central

2011-01-01

Background: New transbronchial needle aspiration (TBNA) technologies have been developed, but their clinical effectiveness and determinants of diagnostic yield have not been quantified. Prospective data are needed to determine risk-adjusted diagnostic yield. Methods: We prospectively enrolled patients undergoing TBNA of mediastinal lymph nodes in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) multicenter database and recorded clinical, procedural, and provider information. All clinical decisions, including type of TBNA used (conventional vs endobronchial ultrasound-guided), were made by the attending bronchoscopist. The primary outcome was obtaining a specific diagnosis. Results: We enrolled 891 patients at six hospitals. Most procedures (95%) were performed with ultrasound guidance. A specific diagnosis was made in 447 cases. Unadjusted diagnostic yields were 37% to 54% for different hospitals, with significant between-hospital heterogeneity (P = .0001). Diagnostic yield was associated with annual hospital TBNA volume (OR, 1.003; 95% CI, 1.000-1.006; P = .037), smoking (OR, 1.55; 95% CI, 1.02-2.34; P = .042), biopsy of more than two sites (OR, 0.57; 95% CI, 0.38-0.85; P = .015), lymph node size (reference > 1-2 cm, ≤ 1 cm: OR, 0.51; 95% CI, 0.34-0.77; P = .003; > 2-3 cm: OR, 2.49; 95% CI, 1.61-3.85; P < .001; and > 3 cm: OR, 3.61; 95% CI, 2.17-6.00; P < .001), and positive PET scan (OR, 3.12; 95% CI, 1.39-7.01; P = .018). Biopsy was performed on more and smaller nodes at high-volume hospitals (P < .0001). Conclusions: To our knowledge, this is the first bronchoscopy study of risk-adjusted diagnostic yields on a hospital-level basis. High-volume hospitals were associated with high diagnostic yields. This study also demonstrates the value of procedural registries as a quality improvement tool. A larger number and variety of participating hospitals is needed to verify these results and to further

Pulmonary Capillary Hemorrhage Induced by Different Imaging Modes of Diagnostic Ultrasound.

PubMed

Miller, Douglas L; Dong, Zhihong; Dou, Chunyan; Raghavendran, Krishnan

2018-05-01

The induction of pulmonary capillary hemorrhage (PCH) is a well-established non-thermal biological effect of pulsed ultrasound in animal models. Typically, research has been done using laboratory pulsed ultrasound systems with a fixed beam and, recently, by B-mode diagnostic ultrasound. In this study, a GE Vivid 7 Dimension ultrasound machine with 10 L linear array probe was used at 6.6 MHz to explore the relative PCH efficacy of B-mode imaging, M-mode (fixed beam), color angio mode Doppler imaging and pulsed Doppler mode (fixed beam). Anesthetized rats were scanned in a warmed water bath, and thresholds were determined by scanning at different power steps, 2 dB apart, in different groups of six rats. Exposures were performed for 5 min, except for a 15-s M-mode group. Peak rarefactional pressure amplitude thresholds were 1.5 MPa for B-mode and 1.1 MPa for angio Doppler mode. For the non-scanned modes, thresholds were 1.1 MPa for M-mode and 0.6 MPa for pulsed Doppler mode with its relatively high duty cycle (7.7 × 10 -3 vs. 0.27 × 10 -3 for M-mode). Reducing the duration of M-mode to 15 s (from 300 s) did not significantly reduce PCH (area, volume or depth) for some power settings, but the threshold was increased to 1.4 MPa. Pulmonary sonographers should be aware of this unique adverse bio-effect of diagnostic ultrasound and should consider reduced on-screen mechanical index settings for potentially vulnerable patients. Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Signal processing in ultrasound. [for diagnostic medicine

NASA Technical Reports Server (NTRS)

Le Croissette, D. H.; Gammell, P. M.

1978-01-01

Signal is the term used to denote the characteristic in the time or frequency domain of the probing energy of the system. Processing of this signal in diagnostic ultrasound occurs as the signal travels through the ultrasonic and electrical sections of the apparatus. The paper discusses current signal processing methods, postreception processing, display devices, real-time imaging, and quantitative measurements in noninvasive cardiology. The possibility of using deconvolution in a single transducer system is examined, and some future developments using digital techniques are outlined.

Development of a reliable simulation-based test for diagnostic abdominal ultrasound with a pass/fail standard usable for mastery learning.

PubMed

Østergaard, Mia L; Nielsen, Kristina R; Albrecht-Beste, Elisabeth; Konge, Lars; Nielsen, Michael B

2018-01-01

This study aimed to develop a test with validity evidence for abdominal diagnostic ultrasound with a pass/fail-standard to facilitate mastery learning. The simulator had 150 real-life patient abdominal scans of which 15 cases with 44 findings were selected, representing level 1 from The European Federation of Societies for Ultrasound in Medicine and Biology. Four groups of experience levels were constructed: Novices (medical students), trainees (first-year radiology residents), intermediates (third- to fourth-year radiology residents) and advanced (physicians with ultrasound fellowship). Participants were tested in a standardized setup and scored by two blinded reviewers prior to an item analysis. The item analysis excluded 14 diagnoses. Both internal consistency (Cronbach's alpha 0.96) and inter-rater reliability (0.99) were good and there were statistically significant differences (p < 0.001) between all four groups, except the intermediate and advanced groups (p = 1.0). There was a statistically significant correlation between experience and test scores (Pearson's r = 0.82, p < 0.001). The pass/fail-standard failed all novices (no false positives) and passed all advanced (no false negatives). All intermediate participants and six out of 14 trainees passed. We developed a test for diagnostic abdominal ultrasound with solid validity evidence and a pass/fail-standard without any false-positive or false-negative scores. • Ultrasound training can benefit from competency-based education based on reliable tests. • This simulation-based test can differentiate between competency levels of ultrasound examiners. • This test is suitable for competency-based education, e.g. mastery learning. • We provide a pass/fail standard without false-negative or false-positive scores.

Diagnostic Ultrasound High Mechanical Index Impulses Restore Microvascular Flow in Peripheral Arterial Thromboembolism.

PubMed

Porter, Thomas R; Radio, Stanley; Lof, John; Everbach, Carr; Powers, Jeffry E; Vignon, Francois; Shi, William T; Xie, Feng

2016-07-01

We sought to explore mechanistically how intermittent high-mechanical-index (MI) diagnostic ultrasound impulses restore microvascular flow. Thrombotic microvascular obstruction was created in the rat hindlimb muscle of 36 rats. A diagnostic transducer confirmed occlusion with low-MI imaging during an intravenous microbubble infusion. This same transducer was used to intermittently apply ultrasound with an MI that produced stable or inertial cavitation (IC) for 10 min through a tissue-mimicking phantom. A nitric oxide inhibitor, L-Nω-nitroarginine methyl ester (L-NAME), was pre-administered to six rats. Plateau microvascular contrast intensity quantified skeletal microvascular blood volume, and postmortem staining was used to detect perivascular hemorrhage. Intermittent IC impulses produced the greatest recovery of microvascular blood volume (p < 0.0001, analysis of variance). Nitric oxide inhibition did not affect the skeletal microvascular blood volume improvement, but did result in more perivascular hemorrhage. IC inducing pulses from a diagnostic transducer can reverse microvascular obstruction after acute arterial thromboembolism. Nitric oxide may prevent unwanted bio-effects of these IC pulses. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Non-invasive estimation of temperature using diagnostic ultrasound during HIFU therapy

NASA Astrophysics Data System (ADS)

Georg, O.; Wilkens, V.

2017-03-01

The use of HIFU for thermal ablation of human tissues requires safe real-time monitoring of the lesion formation during the treatment to avoid damage of the surrounding healthy tissues and to control temperature rise. Besides MR imaging, several methods have been proposed for temperature imaging using diagnostic ultrasound, and echoshift estimation (using speckle tracking) is the most promising and commonly used technique. It is based on the thermal dependence of the ultrasound echo that accounts for two different physical phenomena: local change in speed of sound and thermal expansion of the propagating medium due to changes in temperature. In our experiments we have used two separate transducers: HIFU exposure was performed using a 1.06 MHz single element focusing transducer of 64 mm aperture and 63.2 mm focal length; the ultrasound diagnostic probe of 11 MHz operated in B-mode for image guidance. The temperature measurements were performed in an agar-based tissue-mimicking phantom. To verify the obtained results, numerical modeling of the acoustic and temperature fields was carried out using KZK and Pennes Bioheat equations, as well as measurements with thermocouples were performed.

Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education.

PubMed

Dinh, Vi Am; Frederick, Jon; Bartos, Rebekah; Shankel, Tamara M; Werner, Leonard

2015-01-01

Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall effects of ultrasound curriculum implementation on the traditional physical examination skills of medical students are still unknown. We studied the effects on the Objective Standardized Clinical Examination (OSCE) scores of year 1 medical students before and after ultrasound curriculum implementation. An ultrasound curriculum was incorporated into the physical diagnosis course for year 1 medical students in the 2012-2013 academic year. We performed a prospective observational study comparing traditional OSCE scores of year 1 medical students exposed to the ultrasound curriculum (post-ultrasound) versus historic year 1 medical student controls (pre-ultrasound) with no ultrasound exposure. Questionnaire data were also obtained from year 1 medical students and physical diagnosis faculty to assess attitudes toward ultrasound implementation. The final overall OSCE scores were graded with a 5-point Likert-type scale from unsatisfactory to outstanding. There was a significant increase in outstanding scores in the post-ultrasound compared to the pre-ultrasound group (27.0% versus 10.9%; P< .001). The post-ultrasound group had significantly (P< .05) increased first-time pass rates on blood pressure measurements, the abdominal examination, and professionalism. Student and physical diagnosis faculty questionnaire data showed an overall positive response, with most agreeing or strongly agreeing that ultrasound should be included in the future year 1 medical student curriculum. Ultrasound implementation into a physical diagnosis curriculum for year 1 medical students is feasible and may improve their overall traditional physical examination skills. © 2015 by the American Institute of Ultrasound in Medicine.

Feasibility of a focused ultrasound training programme for medical undergraduate students.

PubMed

Wong, Ivan; Jayatilleke, Thilina; Kendall, Richard; Atkinson, Paul

2011-03-01

Although ultrasound is a core skill for many clinical specialties, UK medical schools are not currently required to teach this skill. The College of Emergency Medicine (CEM) has championed the use of ultrasound to answer focused clinical questions in emergency settings. We have designed and piloted an ultrasound training course for undergraduate medical students addressing one important indication: ultrasound assessment of the abdominal aorta. Fourteen clinical students, who had no prior experience of using ultrasound, received focused ultrasound training in the form of didactic instruction, a short bedside practical workshop and self-directed learning over a 20-day period. At the end of this period, the students were assessed by a structured viva and an observed structured clinical examination (OSCE) used for accreditation by the CEM. The primary endpoint was the number of students who passed the assessment. The secondary endpoint was the accuracy of the students' anatomical measurements. Thirteen of the 14 (93%) students completed the training and assessment. Eight of the 13 (62%) students passed both the viva and OSCE, and were deemed to have achieved the CEM standard. The measurements by the competent students were not statistically different from those of experienced practitioners. We have shown for the first time that it is feasible to train inexperienced undergraduate students to scan the abdominal aorta to a professional standard using a focused training course. It is time for the medical education community to address whether focused ultrasound training should accompany traditional clinical skills, such as using a stethoscope, in UK medical school curricula. © Blackwell Publishing Ltd 2011.

CUQI: cardiac ultrasound video quality index

PubMed Central

Razaak, Manzoor; Martini, Maria G.

2016-01-01

Abstract. Medical images and videos are now increasingly part of modern telecommunication applications, including telemedicinal applications, favored by advancements in video compression and communication technologies. Medical video quality evaluation is essential for modern applications since compression and transmission processes often compromise the video quality. Several state-of-the-art video quality metrics used for quality evaluation assess the perceptual quality of the video. For a medical video, assessing quality in terms of “diagnostic” value rather than “perceptual” quality is more important. We present a diagnostic-quality–oriented video quality metric for quality evaluation of cardiac ultrasound videos. Cardiac ultrasound videos are characterized by rapid repetitive cardiac motions and distinct structural information characteristics that are explored by the proposed metric. Cardiac ultrasound video quality index, the proposed metric, is a full reference metric and uses the motion and edge information of the cardiac ultrasound video to evaluate the video quality. The metric was evaluated for its performance in approximating the quality of cardiac ultrasound videos by testing its correlation with the subjective scores of medical experts. The results of our tests showed that the metric has high correlation with medical expert opinions and in several cases outperforms the state-of-the-art video quality metrics considered in our tests. PMID:27014715

75 FR 35439 - Medical Diagnostic Equipment Accessibility Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-22

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Medical Diagnostic Equipment... accessibility standards for medical diagnostic equipment to ensure that such equipment is accessible to, and... respect to medical diagnostic equipment and existing guidance for designing accessible medical diagnostic...

Principles of Billing for Diagnostic Ultrasound in the Office and Operating Room.

PubMed

Grasu, Beatrice L; Wolock, Bruce S; Sedgley, Matthew D; Murphy, Michael S

2018-05-08

Ultrasound is becoming more prevalent as physicians gain comfort in its diagnostic and therapeutic uses. It allows for both static and dynamic evaluation of conditions and assists in therapeutic injections of joints and tendons. Proper technique is necessary for successful use of this modality. Appropriate coding for physician reimbursement is required. We discuss common wrist and hand pathology for which ultrasound may be useful as an adjunct to diagnosis and treatment and provide an overview of technique and reimbursement codes when using ultrasound in a variety of situations. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Do Anesthetic Techniques Influence the Threshold for Glomerular Capillary Hemorrhage Induced in Rats by Contrast-Enhanced Diagnostic Ultrasound?

PubMed

Miller, Douglas L; Lu, Xiaofang; Fabiilli, Mario; Dou, Chunyan

2016-02-01

Glomerular capillary hemorrhage can be induced by ultrasonic cavitation during contrast-enhanced diagnostic ultrasound (US) exposure, an important nonthermal US bioeffect. Recent studies of pulmonary US exposure have shown that thresholds for another nonthermal bioeffect of US, pulmonary capillary hemorrhage, is strongly influenced by whether xylazine is included in the specific anesthetic technique. The objective of this study was to determine the influence of xylazine on contrast-enhanced diagnostic US-induced glomerular capillary hemorrhage. In this study, anesthesia with ketamine only was compared to ketamine plus xylazine for induction of glomerular capillary hemorrhage in rats by 1.6-MHz intermittent diagnostic US with a microsphere contrast agent (similar to Definity; Lantheus Medical Imaging, Inc, North Billerica, MA). Glomerular capillary hemorrhage was measured as a percentage of glomeruli with hemorrhage found in histologic sections for groups of rats scanned at different peak rarefactional pressure amplitudes. There was a significant difference between the magnitude of the glomerular capillary hemorrhage between the anesthetics at 2.3 MPa, with 45.6% hemorrhage for ketamine only, increasing to 63.2% hemorrhage for ketamine plus xylazine (P < .001). However, the thresholds for the two anesthetic methods were virtually identical at 1.0 MPa, based on linear regression of the exposure response data. Thresholds for contrast-enhanced diagnostic US-induced injury of the microvasculature appear to be minimally affected by anesthetic methods. © 2016 by the American Institute of Ultrasound in Medicine.

Establishing an Ultrasound Curriculum in Undergraduate Medical Education: How Much Time Does It Take?

PubMed

Siegel-Richman, Yonaton; Kendall, John

2018-03-01

Over the years, the use of ultrasound in the medical profession has become a common occurrence. As a result, many medical schools are considering an ultrasound curriculum for first- and second-year medical students. The question posed by many of these programs is how much time and effort are required to establish such a curriculum. We at the University of Colorado School of Medicine sought to quantify the resources and time required. We conducted a cohort study that analyzed the time spent teaching, as well as the types of instructors (eg, faculty, resident, and peer student) that contributed to our ultrasound curriculum. The study population consisted of instructors who participated in the curriculum during the 2014-2015 academic year. We analyzed the amount of time that facilitators spent teaching and tabulated these data using their specialty. Our data revealed that within an academic year, a combined total of 484 hours were spent teaching ultrasound to first- and second-year medical students combined. A total of 6 days were required to teach ultrasound to first-year medical students, and a total of 5 days were required for second-year medical students. It required 1 instructor for every 8 students, and most the faculty who volunteered time were from the field of emergency medicine, followed by family medicine and radiology. We describe the number of hours and instructors required to implement an ultrasound curriculum for undergraduate medical education. © 2017 by the American Institute of Ultrasound in Medicine.

Blood-brain barrier disruption induced by diagnostic ultrasound combined with microbubbles in mice

PubMed Central

Liu, Jinfeng; Zhang, Li; Wang, Jing; Yang, Yali; Lv, Qing; Xie, Mingxing

2018-01-01

Objective To investigate the effects of the microbubble (MB) dose, mechanism index (MI) and sonication duration on blood-brain barrier (BBB) disruption induced by diagnostic ultrasound combined with MBs as well as to investigate the potential molecular mechanism. Results The extent of BBB disruption increased with MB dose, MI and sonication duration. A relatively larger extent of BBB disruption associated with minimal tissue damage was achieved by an appropriate MB dose and ultrasound exposure parameters with diagnostic ultrasound. Decreased expression of ZO-1, occludin and claudin-5 were correlated with disruption of the BBB, as confirmed by paracellular passage of the tracer lanthanum nitrate into the brain parenchyma after BBB disruption. Conclusions These findings indicated that this technique is a promising tool for promoting brain delivery of diagnostic and therapeutic agents in the diagnosis and treatment of brain diseases. Methods The extent of BBB disruption was qualitatively assessed by Evans blue (EB) staining and quantitatively analyzed by an EB extravasation measurement. A histological examination was performed to evaluate tissue damage. Expression of tight junction (TJ) related proteins ZO-1, occludin and claudin-5 was determined by western blotting analysis and immunohistofluorescence. Transmission electron microscopy was performed to observe ultrastructure changes of TJs after BBB disruption. PMID:29435150

Blood-brain barrier disruption induced by diagnostic ultrasound combined with microbubbles in mice.

PubMed

Zhao, Bingxia; Chen, Yihan; Liu, Jinfeng; Zhang, Li; Wang, Jing; Yang, Yali; Lv, Qing; Xie, Mingxing

2018-01-12

To investigate the effects of the microbubble (MB) dose, mechanism index (MI) and sonication duration on blood-brain barrier (BBB) disruption induced by diagnostic ultrasound combined with MBs as well as to investigate the potential molecular mechanism. The extent of BBB disruption increased with MB dose, MI and sonication duration. A relatively larger extent of BBB disruption associated with minimal tissue damage was achieved by an appropriate MB dose and ultrasound exposure parameters with diagnostic ultrasound. Decreased expression of ZO-1, occludin and claudin-5 were correlated with disruption of the BBB, as confirmed by paracellular passage of the tracer lanthanum nitrate into the brain parenchyma after BBB disruption. These findings indicated that this technique is a promising tool for promoting brain delivery of diagnostic and therapeutic agents in the diagnosis and treatment of brain diseases. The extent of BBB disruption was qualitatively assessed by Evans blue (EB) staining and quantitatively analyzed by an EB extravasation measurement. A histological examination was performed to evaluate tissue damage. Expression of tight junction (TJ) related proteins ZO-1, occludin and claudin-5 was determined by western blotting analysis and immunohistofluorescence. Transmission electron microscopy was performed to observe ultrastructure changes of TJs after BBB disruption.

The Thrombolytic Effect of Diagnostic Ultrasound-Induced Microbubble Cavitation in Acute Carotid Thromboembolism.

PubMed

Porter, Thomas R; Xie, Feng; Lof, John; Powers, Jeffry; Vignon, Francois; Shi, William; White, Matthew

2017-08-01

Acute ischemic stroke is often due to thromboembolism forming over ruptured atherosclerotic plaque in the carotid artery (CA). The presence of intraluminal CA thrombus is associated with a high risk of thromboembolic cerebral ischemic events. The cavitation induced by diagnostic ultrasound high mechanical index (MI) impulses applied locally during a commercially available intravenous microbubble infusion has dissolved intravascular thrombi, especially when using longer pulse durations. The beneficial effects of this in acute carotid thromboembolism is not known. An oversized balloon injury was created in the distal extracranial common CA of 38 porcine carotid arteries. After this, a 70% to 80% stenosis was created in the mid common CA proximal to the injury site using partial balloon inflation. Acute thrombotic CA occlusions were created just distal to the balloon catheter by injecting fresh autologous arterial thrombi. After angiographic documentation of occlusion, the common carotid thrombosis was treated with either diagnostic low MI imaging alone (0.2 MI; Philips S5-1) applied through a tissue mimicking phantom (TMP) or intermittent diagnostic high MI stable cavitation (SC)-inducing impulses with a longer pulse duration (0.8 MI; 20 microseconds' pulse duration) or inertial cavitation (IC) impulses (1.2 MI; 20 microseconds' pulse duration). All treatment times were for 30 minutes. Intravenous ultrasound contrast (2% Definity; Lantheus Medical) was infused during the treatment period. Angiographic recanalization in 4 intracranial and extracranial vessels downstream from the CA occlusion (auricular, ascending pharyngeal, buccinator, and maxillary) was assessed with both magnetic resonance 3-dimensional time-of-flight and phase contrast angiography. All magnetic resonance images were interpreted by an independent neuroradiologist using the thrombolysis in cerebral infarction (TICI) scoring system. By phase contrast angiography, at least mild recanalization (TICI 2a

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging.

PubMed

McCarthy, C L; Wilson, D J; Coltman, T P

2008-03-01

The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study.

PubMed

Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W; Arokoski, Jari P; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T; Tervonen, Osmo; Koski, Juhani M; Saarakkala, Simo

2016-03-01

Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.

CT and Ultrasound Guided Stereotactic High Intensity Focused Ultrasound (HIFU)

NASA Astrophysics Data System (ADS)

Wood, Bradford J.; Yanof, J.; Frenkel, V.; Viswanathan, A.; Dromi, S.; Oh, K.; Kruecker, J.; Bauer, C.; Seip, R.; Kam, A.; Li, K. C. P.

2006-05-01

To demonstrate the feasibility of CT and B-mode Ultrasound (US) targeted HIFU, a prototype coaxial focused ultrasound transducer was registered and integrated to a CT scanner. CT and diagnostic ultrasound were used for HIFU targeting and monitoring, with the goals of both thermal ablation and non-thermal enhanced drug delivery. A 1 megahertz coaxial ultrasound transducer was custom fabricated and attached to a passive position-sensing arm and an active six degree-of-freedom robotic arm via a CT stereotactic frame. The outer therapeutic transducer with a 10 cm fixed focal zone was coaxially mounted to an inner diagnostic US transducer (2-4 megahertz, Philips Medical Systems). This coaxial US transducer was connected to a modified commercial focused ultrasound generator (Focus Surgery, Indianapolis, IN) with a maximum total acoustic power of 100 watts. This pre-clinical paradigm was tested for ability to heat tissue in phantoms with monitoring and navigation from CT and live US. The feasibility of navigation via image fusion of CT with other modalities such as PET and MRI was demonstrated. Heated water phantoms were tested for correlation between CT numbers and temperature (for ablation monitoring). The prototype transducer and integrated CT/US imaging system enabled simultaneous multimodality imaging and therapy. Pre-clinical phantom models validated the treatment paradigm and demonstrated integrated multimodality guidance and treatment monitoring. Temperature changes during phantom cooling corresponded to CT number changes. Contrast enhanced or non-enhanced CT numbers may potentially be used to monitor thermal ablation with HIFU. Integrated CT, diagnostic US, and therapeutic focused ultrasound bridges a gap between diagnosis and therapy. Preliminary results show that the multimodality system may represent a relatively inexpensive, accessible, and simple method of both targeting and monitoring HIFU effects. Small animal pre-clinical models may be translated to large

Automated assessment of joint synovitis activity from medical ultrasound and power doppler examinations using image processing and machine learning methods.

PubMed

Cupek, Rafal; Ziębiński, Adam

2016-01-01

Rheumatoid arthritis is the most common rheumatic disease with arthritis, and causes substantial functional disability in approximately 50% patients after 10 years. Accurate measurement of the disease activity is crucial to provide an adequate treatment and care to the patients. The aim of this study is focused on a computer aided diagnostic system that supports an assessment of synovitis severity. This paper focus on a computer aided diagnostic system that was developed within joint Polish-Norwegian research project related to the automated assessment of the severity of synovitis. Semiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Synovitis is estimated by ultrasound examiner using the scoring system graded from 0 to 3. Activity score is estimated on the basis of the examiner's experience or standardized ultrasound atlases. The method needs trained medical personnel and the result can be affected by a human error. The porotype of a computer-aided diagnostic system and algorithms essential for an analysis of ultrasonic images of finger joints are main scientific output of the MEDUSA project. Medusa Evaluation System prototype uses bone, skin, joint and synovitis area detectors for mutual structural model based evaluation of synovitis. Finally, several algorithms that support the semi-automatic or automatic detection of the bone region were prepared as well as a system that uses the statistical data processing approach in order to automatically localize the regions of interest. Semiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Activity score is estimated on the basis of the examiner's experience and the result can be affected by a human error. In this paper we presented the MEDUSA project which is focused on a computer aided diagnostic system that supports an assessment of synovitis severity.

Effect of Watermarking on Diagnostic Preservation of Atherosclerotic Ultrasound Video in Stroke Telemedicine.

PubMed

Dey, Nilanjan; Bose, Soumyo; Das, Achintya; Chaudhuri, Sheli Sinha; Saba, Luca; Shafique, Shoaib; Nicolaides, Andrew; Suri, Jasjit S

2016-04-01

Embedding of diagnostic and health care information requires secure encryption and watermarking. This research paper presents a comprehensive study for the behavior of some well established watermarking algorithms in frequency domain for the preservation of stroke-based diagnostic parameters. Two different sets of watermarking algorithms namely: two correlation-based (binary logo hiding) and two singular value decomposition (SVD)-based (gray logo hiding) watermarking algorithms are used for embedding ownership logo. The diagnostic parameters in atherosclerotic plaque ultrasound video are namely: (a) bulb identification and recognition which consists of identifying the bulb edge points in far and near carotid walls; (b) carotid bulb diameter; and (c) carotid lumen thickness all along the carotid artery. The tested data set consists of carotid atherosclerotic movies taken under IRB protocol from University of Indiana Hospital, USA-AtheroPoint™ (Roseville, CA, USA) joint pilot study. ROC (receiver operating characteristic) analysis was performed on the bulb detection process that showed an accuracy and sensitivity of 100 % each, respectively. The diagnostic preservation (DPsystem) for SVD-based approach was above 99 % with PSNR (Peak signal-to-noise ratio) above 41, ensuring the retention of diagnostic parameter devalorization as an effect of watermarking. Thus, the fully automated proposed system proved to be an efficient method for watermarking the atherosclerotic ultrasound video for stroke application.

Improvement of diagnostic efficiency in distinguishing the benign and malignant thyroid nodules via conventional ultrasound combined with ultrasound contrast and elastography

PubMed Central

Liu, Mei-Juan; Men, Yan-Ming; Zhang, Yong-Lin; Zhang, Yu-Xi; Liu, Hao

2017-01-01

We aimed to evaluate the diagnostic values of conventional ultrasound (US), ultrasound contrast (UC) and ultrasound elastography (UE) in distinguishing the benign and malignant thyroid nodules. A total of 100 patients with thyroid nodules receiving operative treatment were selected; they underwent the conventional US, UE and UC examinations before operation, respectively. The nodules received pathological examination after operation to distinguish benign from malignant lesions. The sensitivity, specificity and diagnostic accordance rate of each diagnostic method was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC) of ROC was calculated. The manifestations of malignant thyroid nodules in conventional US examination were mostly the hypoecho, heterogeneous echo, irregular shape, unclear boundary, aspect ratio <1, microcalcification and irregular peripheral echo halo, and there were statistically significant differences compared with the benign nodules (P<0.05). UE showed that the differences between benign and malignant nodules in 2, 3 and 4 points were statistically significant (P<0.05). The manifestations of malignant nodules in UC were mostly the irregular shape, obscure boundary, no obvious enhancement, heterogeneous enhancement and visible perfusion defects, and there were statistically significant differences compared with the benign nodules (P<0.05). ROC curve showed that both sensitivity and specificity of UE and UC were superior to those of conventional US. AUC was the largest (AUC = 0.908) and the diagnostic value was the highest in the conventional US combined with UE and UC. Conventional US combined with elastography and UC can significantly improve the sensitivity, specificity and accuracy of diagnosis of benign and malignant thyroid nodules. PMID:28693244

Improvement of diagnostic efficiency in distinguishing the benign and malignant thyroid nodules via conventional ultrasound combined with ultrasound contrast and elastography.

PubMed

Liu, Mei-Juan; Men, Yan-Ming; Zhang, Yong-Lin; Zhang, Yu-Xi; Liu, Hao

2017-07-01

We aimed to evaluate the diagnostic values of conventional ultrasound (US), ultrasound contrast (UC) and ultrasound elastography (UE) in distinguishing the benign and malignant thyroid nodules. A total of 100 patients with thyroid nodules receiving operative treatment were selected; they underwent the conventional US, UE and UC examinations before operation, respectively. The nodules received pathological examination after operation to distinguish benign from malignant lesions. The sensitivity, specificity and diagnostic accordance rate of each diagnostic method was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC) of ROC was calculated. The manifestations of malignant thyroid nodules in conventional US examination were mostly the hypoecho, heterogeneous echo, irregular shape, unclear boundary, aspect ratio <1, microcalcification and irregular peripheral echo halo, and there were statistically significant differences compared with the benign nodules (P<0.05). UE showed that the differences between benign and malignant nodules in 2, 3 and 4 points were statistically significant (P<0.05). The manifestations of malignant nodules in UC were mostly the irregular shape, obscure boundary, no obvious enhancement, heterogeneous enhancement and visible perfusion defects, and there were statistically significant differences compared with the benign nodules (P<0.05). ROC curve showed that both sensitivity and specificity of UE and UC were superior to those of conventional US. AUC was the largest (AUC = 0.908) and the diagnostic value was the highest in the conventional US combined with UE and UC. Conventional US combined with elastography and UC can significantly improve the sensitivity, specificity and accuracy of diagnosis of benign and malignant thyroid nodules.

The way to universal and correct medical presentation of diagnostic informations for complex spectrophotometry noninvasive medical diagnostic systems

NASA Astrophysics Data System (ADS)

Rogatkin, Dmitrii A.; Tchernyi, Vladimir V.

2003-07-01

The optical noninvasive diagnostic systems are now widely applied and investigated in different areas of medicine. One of the such techniques is the noninvasive spectrophotometry, the complex diagnostic technique consisting on elastic scattering spectroscopy, absorption spectroscopy, fluorescent diagnostics, photoplethismography, etc. Today a lot of real optical diagnostic systems indicate the technical parameters and physical data only as a result of the diagnostic procedure. But, it is clear that for the medical staff the more convenient medical information is needed. This presentation lights the general way for development a diagnostic system"s software, which can produce the full processing of the diagnostic data from a physical to a medical level. It is shown, that this process is a multilevel (3-level) procedure and the main diagnostic result for noninvasive spectrophotometry methods, the biochemical and morphological composition of the tested tissues, arises in it on a second level of calculations.

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients*,**

PubMed Central

Dexheimer, Felippe Leopoldo; de Andrade, Juliana Mara Stormovski; Raupp, Ana Carolina Tabajara; Townsend, Raquel da Silva; Beltrami, Fabiana Gabe; Brisson, Hélène; Lu, Qin; Dalcin, Paulo de Tarso Roth

2015-01-01

Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema. PMID:25750675

Diagnostic utility of three-dimensional power Doppler ultrasound for postmenopausal bleeding.

PubMed

Kim, Ari; Lee, Ji Young; Chun, Sungwook; Kim, Heung Yeol

2015-06-01

We evaluated the role of three-dimensional power Doppler ultrasound (3D PD-US) to detect endometrial lesions in women with postmenopausal endometrial bleeding. In this prospective observational study, from January 2009 to November 2012, we recruited 225 postmenopausal women with postmenopausal uterine bleeding who met the study criteria. Women who had hematologic disease, chronic medical diseases, or nonuterine pelvic diseases were excluded. Prior to endometrial biopsy, the patients underwent a baseline transvaginal ultrasound screening. The vascular indices and endometrial volumes were calculated with 3D PD-US and compared with the endometrial histopathology. Among the endometrial histopathologic findings of 174 women, atrophic endometrium was the most common finding (30.5%). Endometrial malignancy was confirmed in 28 cases (16.1%), and endometrial hyperplasia was diagnosed in 17 cases (9.8%). The prevalence of endometrial cancer was high in patients who had endometrial thickness >9.5 mm (p < 0.001) and volume greater than 4.05 mL (p < 0.001). For the endometrial carcinoma only, the cutoff values of vascular index, flow index, and vascular flow index for predicting malignancy were 13.070, 12.610, and 3.764, respectively. For endometrial hyperplasia, endometrial thickness and vascular flow index were significant findings. Endometrial vasculature and volume can be obtained using 3D PD-US. The diagnostic usefulness of 3D PD-US for endometrial diseases is promising in women with postmenopausal endometrial bleeding. Copyright © 2015. Published by Elsevier B.V.

The effects of transducer geometry on artifacts common to diagnostic bone imaging with conventional medical ultrasound.

PubMed

Mauldin, F William; Owen, Kevin; Tiouririne, Mohamed; Hossack, John A

2012-06-01

The portability, low cost, and non-ionizing radiation associated with medical ultrasound suggest that it has potential as a superior alternative to X-ray for bone imaging. However, when conventional ultrasound imaging systems are used for bone imaging, clinical acceptance is frequently limited by artifacts derived from reflections occurring away from the main axis of the acoustic beam. In this paper, the physical source of off-axis artifacts and the effect of transducer geometry on these artifacts are investigated in simulation and experimental studies. In agreement with diffraction theory, the sampled linear-array geometry possessed increased off-axis energy compared with single-element piston geometry, and therefore, exhibited greater levels of artifact signal. Simulation and experimental results demonstrated that the linear-array geometry exhibited increased artifact signal when the center frequency increased, when energy off-axis to the main acoustic beam (i.e., grating lobes) was perpendicularly incident upon off-axis surfaces, and when off-axis surfaces were specular rather than diffusive. The simulation model used to simulate specular reflections was validated experimentally and a correlation coefficient of 0.97 between experimental and simulated peak reflection contrast was observed. In ex vivo experiments, the piston geometry yielded 4 and 6.2 dB average contrast improvement compared with the linear array when imaging the spinous process and interlaminar space of an animal spine, respectively. This work indicates that off-axis reflections are a major source of ultrasound image artifacts, particularly in environments comprising specular reflecting (i.e., bone or bone-like) objects. Transducer geometries with reduced sensitivity to off-axis surface reflections, such as a piston transducer geometry, yield significant reductions in image artifact.

77 FR 14706 - Medical Diagnostic Equipment Accessibility Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-13

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards AGENCY: Architectural and... for medical diagnostic equipment and issues raised in the public comments on the NPRM. The Access... accessibility standards for medical diagnostic equipment, in consultation with the Commissioner of the Food and...

Diagnostic ultrasound imaging for lateral epicondylalgia: a case-control study.

PubMed

Heales, Luke James; Broadhurst, Nathan; Mellor, Rebecca; Hodges, Paul William; Vicenzino, Bill

2014-11-01

Lateral epicondylalgia (LE) is clinically diagnosed as pain over the lateral elbow that is provoked by gripping. Usually, LE responds well to conservative intervention; however, those who fail such treatment require further evaluation, including musculoskeletal ultrasound. Previous studies of musculoskeletal ultrasound have methodological flaws, such as lack of assessor blinding and failure to control for participant age, sex, and arm dominance. The purpose of this study was to assess the diagnostic use of blinded ultrasound imaging in people with clinically diagnosed LE compared with that in a control group matched for age, sex, and arm dominance. Participants (30 with LE and 30 controls) underwent clinical examination as the criterion standard test. Unilateral LE was defined as pain over the lateral epicondyle, which was provoked by palpation, resisted wrist and finger extension, and gripping. Controls without symptoms were matched for age, sex, and arm dominance. Ultrasound investigations were performed by two sonographers using a standardized protocol. Grayscale images were assessed for signs of tendon pathology and rated on a four-point ordinal scale. Power Doppler was used to assess neovascularity and rated on a five-point ordinal scale. The combination of grayscale and power Doppler imaging revealed an overall sensitivity of 90% and specificity of 47%. The positive and negative likelihood ratios for combined grayscale and power Doppler imaging were 1.69 and 0.21, respectively. Although ultrasound imaging helps confirm the absence of LE, when findings are negative for tendinopathic changes, the high prevalence of tendinopathic changes in pain-free controls challenges the specificity of the measure. The validity of ultrasound imaging to confirm tendon pathology in clinically diagnosed LE requires further study with strong methodology.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

PubMed

Kowalczyk, David M; Jordan, J Randall; Stringer, Scott P

2018-03-30

The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. Literature review and cost-effectiveness analysis. A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. NA. Laryngoscope, 2018. © 2018 The American

Measured acoustic intensities for clinical diagnostic ultrasound transducers and correlation with thermal index.

PubMed

Retz, K; Kotopoulis, S; Kiserud, T; Matre, K; Eide, G E; Sande, R

2017-08-01

To investigate if the thermal index for bone (TIB) displayed on screen is an adequate predictor for the derated spatial-peak temporal-average (I SPTA .3 ) and spatial-peak pulse-average (I SPPA .3 ) acoustic intensities in a selection of clinical diagnostic ultrasound machines and transducers. We calibrated five clinical diagnostic ultrasound scanners and 10 transducers, using two-dimensional grayscale, color Doppler and pulsed-wave Doppler, both close to and far from the transducer, with a TIB between 0.1 and 4.0, recording 103 unique measurements. Acoustic measurements were performed in a bespoke three-axis computer-controlled scanning tank, using a 200-μm-diameter calibrated needle hydrophone. There was significant but poor correlation between the acoustic intensities and the on-screen TIB. At a TIB of 0.1, the I SPTA .3 range was 0.51-50.49 mW/cm 2 and the I SPPA .3 range was 0.01-207.29 W/cm 2 . At a TIB of 1.1, the I SPTA .3 range was 19.02-309.44 mW/cm 2 and the I SPPA .3 range was 3.87-51.89 W/cm 2 . TIB is a poor predictor for I SPTA .3 and I SPPA .3 and for the potential bioeffects of clinical diagnostic ultrasound scanners. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Twofold processing for denoising ultrasound medical images.

PubMed

Kishore, P V V; Kumar, K V V; Kumar, D Anil; Prasad, M V D; Goutham, E N D; Rahul, R; Krishna, C B S Vamsi; Sandeep, Y

2015-01-01

Ultrasound medical (US) imaging non-invasively pictures inside of a human body for disease diagnostics. Speckle noise attacks ultrasound images degrading their visual quality. A twofold processing algorithm is proposed in this work to reduce this multiplicative speckle noise. First fold used block based thresholding, both hard (BHT) and soft (BST), on pixels in wavelet domain with 8, 16, 32 and 64 non-overlapping block sizes. This first fold process is a better denoising method for reducing speckle and also inducing object of interest blurring. The second fold process initiates to restore object boundaries and texture with adaptive wavelet fusion. The degraded object restoration in block thresholded US image is carried through wavelet coefficient fusion of object in original US mage and block thresholded US image. Fusion rules and wavelet decomposition levels are made adaptive for each block using gradient histograms with normalized differential mean (NDF) to introduce highest level of contrast between the denoised pixels and the object pixels in the resultant image. Thus the proposed twofold methods are named as adaptive NDF block fusion with hard and soft thresholding (ANBF-HT and ANBF-ST). The results indicate visual quality improvement to an interesting level with the proposed twofold processing, where the first fold removes noise and second fold restores object properties. Peak signal to noise ratio (PSNR), normalized cross correlation coefficient (NCC), edge strength (ES), image quality Index (IQI) and structural similarity index (SSIM), measure the quantitative quality of the twofold processing technique. Validation of the proposed method is done by comparing with anisotropic diffusion (AD), total variational filtering (TVF) and empirical mode decomposition (EMD) for enhancement of US images. The US images are provided by AMMA hospital radiology labs at Vijayawada, India.

Medical students benefit from the use of ultrasound when learning peripheral IV techniques.

PubMed

Osborn, Scott R; Borhart, Joelle; Antonis, Michael S

2012-03-06

Recent studies support high success rates after a short learning period of ultrasound IV technique, and increased patient and provider satisfaction when using ultrasound as an adjunct to peripheral IV placement. No study to date has addressed the efficacy for instructing ultrasound-naive providers. We studied the introduction of ultrasound to the teaching technique of peripheral IV insertion on first- and second-year medical students. This was a prospective, randomized, and controlled trial. A total of 69 medical students were randomly assigned to the control group with a classic, landmark-based approach (n = 36) or the real-time ultrasound-guided group (n = 33). Both groups observed a 20-min tutorial on IV placement using both techniques and then attempted vein cannulation. Students were given a survey to report their results and observations by a 10-cm visual analog scale. The survey response rate was 100%. In the two groups, 73.9% stated that they attempted an IV previously, and 63.7% of students had used an ultrasound machine prior to the study. None had used ultrasound for IV access prior to our session. The average number of attempts at cannulation was 1.42 in either group. There was no difference between the control and ultrasound groups in terms of number of attempts (p = 0.31). In both groups, 66.7% of learners were able to cannulate in one attempt, 21.7% in two attempts, and 11.6% in three attempts. The study group commented that they felt they gained more knowledge from the experience (p < 0.005) and that it was easier with ultrasound guidance (p < 0.005). Medical students feel they learn more when using ultrasound after a 20-min tutorial to place IVs and cannulation of the vein feels easier. Success rates are comparable between the traditional and ultrasound teaching approaches.

Novel design of low noise preamplifier for medical ultrasound transducers.

PubMed

Amer, Mashhour Bani

2011-02-01

A novel design of low noise amplifier for medical ultrasound transducers is described in this paper. Unlike conventional low noise preamplifiers, this design proposes a new circuit configuration which has electronically adjustable matching resistance that allows the preamplifier to be compatible with a variety of medical ultrasound transducers. The design employs current feedback operational amplifier to enhance the gain-bandwidth independence and improve the design slew rate. Simulation results show that the proposed design has very low output noise voltage spectral density and the level of this noise does not increase when its tunable matching resistance is increased or decreased.

Medical Ultrasound Imaging.

ERIC Educational Resources Information Center

Hughes, Stephen

2001-01-01

Explains the basic principles of ultrasound using everyday physics. Topics include the generation of ultrasound, basic interactions with material, and the measurement of blood flow using the Doppler effect. (Author/MM)

[Subclinical findings in the knees of taekwondo athletes: diagnostic ultrasound study].

PubMed

Martínez Hernández, Luis Enrique; Hernández Díaz, Cristina; Pegueros Pérez, Andrea; Franco Sánchez, José Gilberto; Pineda Villaseñor, Carlos

2014-12-01

Taekwondo is associated with an increased incidence of musculoskeletal injuries such as tendinopathy, synovitis, chondropathy, and ligament and meniscus injuries that may have an asymptomatic course in their initial stages, especially those located in the knee. To describe the presence of morphostructural abnormalities in asymptomatic taekwondo athletes' (TKD) knees through the use of diagnostic ultrasound (US). A cross-sectional, descriptive and comparative study. We evaluated 32 knees of 16 subjects (8 TKD and 8 recreational athletes). All subjects underwent sport-medical history and knee US. A variety of intra- and extra-articular morphostructural abnormalities were observed; the most frequent were synovitis, meniscal extrusion, and enthesopathy. The practice of Taekwondo abnormalities associated with an increased risk of knee injuries that may go unnoticed in the early stages. The use of US as an auxiliary tool in the diagnosis of these injuries and/or advisable since it can define in detail the anatomical structures subject to overuse, biomechanical stress, or repetitive trauma, and contribute to early detection of asymptomatic morphostructural alterations that may ensure timely preventive and therapeutic interventions.

Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

PubMed

Ellington, Laura E; Gilman, Robert H; Chavez, Miguel A; Pervaiz, Farhan; Marin-Concha, Julio; Compen-Chang, Patricia; Riedel, Stefan; Rodriguez, Shalim J; Gaydos, Charlotte; Hardick, Justin; Tielsch, James M; Steinhoff, Mark; Benson, Jane; May, Evelyn A; Figueroa-Quintanilla, Dante; Checkley, William

2017-07-01

Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia. Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset. Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96). Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights

Tuberculosis and the pancreas: a diagnostic challenge solved by endoscopic ultrasound. A case series.

PubMed

Chatterjee, Suvadip; Schmid, Matthias L; Anderson, Kirsty; Oppong, Kofi W

2012-03-01

Pancreatic tuberculosis is a rare disease. It can be easily confused with malignancy or pancreatitis on imaging. This could result in unnecessary surgery. As this is a treatable disease it is imperative to diagnose this condition pre-operatively. We report three cases of pancreatic tuberculosis that were diagnosed by endoscopic ultrasound. In conclusion, endoscopic ultrasound is the diagnostic modality of choice for pancreatic tuberculosis facilitating high resolution imaging, as well as sampling of tissue for staining, cytology, culture and polymerase chain reaction assay.

Might telesonography be a new useful diagnostic tool aboard merchant ships? A pilot study.

PubMed

Nikolić, Nebojsa; Mozetić, Vladimir; Modrcin, Bob; Jaksić, Slaven

2006-01-01

Developments of new, ultra-light diagnostic ultrasound systems (UTS) and modern satellite telecommunication networks are opening new potential applications for diagnostic sonography. One such area is maritime medicine. It is our belief that ship officers can be trained to use diagnostic ultrasound systems with the aim to generate ultrasound images of sufficient quality to be interpreted by medical professionals qualified to read sonograms. To test our thesis we included lectures and hands on scanning practice to the current maritime medicine curriculum at the Faculty of Maritime Studies at the University of Rijeka. Following the didactic and practical training all participating students examined several patients, some with pathology some without. Images obtained by students were then submitted for interpretation to a qualified physician (specialist of general surgery trained in UTS) who was unaware of the patient's pathology. In total, 37 students performed 37 examinations and made 45 ultrasound images, on 3 patients. In this paper, results on this pilot study are presented. It is possible to teach ship officers to produce diagnostically usable ultrasound pictures aboard ships at sea. But before reaching final conclusion about applicability of telesonography on board merchant ships, further studies are necessary, that would include studies of economic feasibility, and on validity of introducing such a diagnostic tool to the maritime medical practice.

Diagnostic accuracy of point-of-care ultrasound for evaluation of early blood-induced joint changes: Comparison with MRI.

PubMed

Foppen, W; van der Schaaf, I C; Beek, F J A; Mali, W P T M; Fischer, K

2018-05-23

Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding. The aim of this study was to investigate whether point-of-care ultrasound (POC-US) is an accurate alternative for MRI for the detection of early joint changes. In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X-rays were scanned using POC-US and 3 Tesla MRI. POC-US was performed by 1 medical doctor, blinded for MRI, according to the "Haemophilia Early Arthropathy Detection with Ultrasound" (HEAD-US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI). Knees and ankles of 24 haemophilia patients (96 joints), aged 18-34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC-US for synovial tissue was correct (overall accuracy) in 97% (CI: 91-99) with a positive predictive value of 94% (CI: 73-100) and a negative predictive value of 97% (CI: 91-100). The overall accuracy of POC-US for cartilage abnormalities was 91% (CI: 83-96) and for bone surface irregularities 97% (CI: 91-99). POC-US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC-US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes. © 2018 The Authors. Haemophilia published by John Wiley & Sons Ltd.

Diagnostic image quality in gynaecological ultrasound: Who should measure it, what should we measure and how?

PubMed Central

Knapp, Karen

2013-01-01

Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r = 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p = 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners. PMID:27433192

Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy.

PubMed

Boon, Andrea J; Sekiguchi, Hiroshi; Harper, Caitlin J; Strommen, Jeffrey A; Ghahfarokhi, Leili S; Watson, James C; Sorenson, Eric J

2014-09-30

To determine the sensitivity and specificity of B-mode ultrasound in the diagnosis of neuromuscular diaphragmatic dysfunction, including phrenic neuropathy. A prospective study of patients with dyspnea referred to the EMG laboratory over a 2-year time frame for evaluation of neuromuscular respiratory failure who were recruited consecutively and examined with ultrasound for possible diaphragm dysfunction. Sonographic outcome measures were absolute thickness of the diaphragm and degree of increased thickness with maximal inspiration. The comparison standard for diagnosis of diaphragm dysfunction was the final clinical diagnosis of clinicians blinded to the diaphragm ultrasound results, but taking into account other diagnostic workup, including chest radiographs, fluoroscopy, phrenic nerve conduction studies, diaphragm EMG, and/or pulmonary function tests. Of 82 patients recruited over a 2-year period, 66 were enrolled in the study. Sixteen patients were excluded because of inconclusive or insufficient reference testing. One hemidiaphragm could not be adequately visualized; therefore, hemidiaphragm assessment was conducted in a total of 131 hemidiaphragms in 66 patients. Of the 82 abnormal hemidiaphragms, 76 had abnormal sonographic findings (atrophy or decreased contractility). Of the 49 normal hemidiaphragms, none had a false-positive ultrasound. Diaphragmatic ultrasound was 93% sensitive and 100% specific for the diagnosis of neuromuscular diaphragmatic dysfunction. B-mode ultrasound imaging of the diaphragm is a highly sensitive and specific tool for diagnosis of neuromuscular diaphragm dysfunction. This study provides Class II evidence that diaphragmatic ultrasound performed by well-trained individuals accurately identifies patients with neuromuscular diaphragmatic respiratory failure (sensitivity 93%; specificity 100%). © 2014 American Academy of Neurology.

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia

PubMed Central

Ismail, Catheeja; Zabal, Johannah; Hernandez, Haniel J.; Woletz, Paula; Manning, Heather; Teixeira, Carla; DiPietro, Loretta; Blackman, Marc R.; Harris-Love, Michael O.

2015-01-01

Introduction: Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance. Methods: Twenty community-dwelling female subjects participated in the study (age = 43.4 ± 20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht2), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m2 determined participant assignment into the Normal LBM and Low LBM subgroups. Results: The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht2 (adj. R2 = 0.61, p < 0.001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R2 = 0.85, p < 0.001). Scaled peak force was associated with age and echogenicity (adj. R2 = 0.53, p < 0.001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p < 0.05). Conclusions: Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht2 in women. In addition, ultrasound proxy measures of muscle quality are more

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia.

PubMed

Ismail, Catheeja; Zabal, Johannah; Hernandez, Haniel J; Woletz, Paula; Manning, Heather; Teixeira, Carla; DiPietro, Loretta; Blackman, Marc R; Harris-Love, Michael O

2015-01-01

Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance. Twenty community-dwelling female subjects participated in the study (age = 43.4 ± 20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht(2)), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m(2) determined participant assignment into the Normal LBM and Low LBM subgroups. The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht(2) (adj. R (2) = 0.61, p < 0.001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R (2) = 0.85, p < 0.001). Scaled peak force was associated with age and echogenicity (adj. R (2) = 0.53, p < 0.001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p < 0.05). Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht(2) in women. In addition, ultrasound proxy measures of muscle quality are more strongly associated with

Diagnostic Accuracy and Clinical Implications of Translabial Ultrasound for the Assessment of Levator Ani Defects and Levator Ani Biometry in Women With Pelvic Organ Prolapse: A Systematic Review.

PubMed

Notten, Kim J B; Vergeldt, Tineke F M; van Kuijk, Sander M J; Weemhoff, Mirjam; Roovers, Jan-Paul W R

The aim of this study was to assess the diagnostic accuracy and clinical implications of translabial 3-dimensional (3D) ultrasound for the assessment of levator ani defects and biometry in women with pelvic organ prolapse (POP). We performed a systematic literature search through computerized databases including MEDLINE (via PubMed), EMBASE (via OvidSP), and the Cochrane Library using both medical subject headings and text terms from January 1, 2003, to December 25, 2015.We included articles that reported on POP status and diagnostic accuracy measurements with translabial 3D ultrasound or transperineal ultrasound for the detection of levator ani defects or for measuring pelvic floor biometry, that is, levator ani hiatus, or reported on the clinical relevance of using translabial 3D ultrasound for levator ani defects or measuring pelvic floor biometry in women with POP. Thirty-one articles were selected in accordance with parts of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that can be applied to studies of diagnostic accuracy. Twenty-two articles (71%) are coauthored by 1 expert in this field. Detecting levator ani defects with translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to good agreement, whereas measuring hiatal biometry on translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to very good agreement.The interobserver agreement for diagnosing levator ani defects and measuring the levator hiatal area showed a moderate to very good agreement. Furthermore, levator ani defects increase the risk of cystocele and uterine prolapse, and levator ani defects are associated with recurrent POP.Finally, a larger hiatus was associated with POP and recurrent POP. Translabial 3D ultrasound is reproducible for diagnosing levator ani defects and ballooning hiatus. Both levator ani defects and a larger hiatal area are, in a selected population of patients with pelvic floor

Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and ¹⁸F-FDG PET/CT.

PubMed

You, S; Kang, D K; Jung, Y S; An, Y-S; Jeon, G S; Kim, T H

2015-08-01

To evaluate the diagnostic performance of ultrasound, MRI and fluorine-18 fludeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT for the diagnosis of metastatic axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC) and to find out histopathological factors affecting the diagnostic performance of these imaging modalities. From January 2012 to November 2014, 191 consecutive patients with breast cancer who underwent NAC before surgery were retrospectively reviewed. We included 139 patients with ALN metastasis that was confirmed on fine needle aspiration or core needle biopsy at initial diagnosis. After NAC, 39 (28%) patients showed negative conversion of ALN on surgical specimens of sentinel lymph node (LN) or ALN. The sensitivity of ultrasound, MRI and PET/CT was 50% (48/96), 72% (70/97) and 22% (16/73), respectively. The specificity of ultrasound, MRI and PET/CT was 77% (30/39), 54% (21/39) and 85% (22/26), respectively. The Az value of combination of ultrasound and PET/CT was the highest (0.634) followed by ultrasound (0.626) and combination of ultrasound, MRI and PET/CT (0.617). The size of tumour deposit in LN and oestrogen receptor was significantly associated with the diagnostic performance of ultrasound (p < 0.001 and p = 0.009, respectively) and MRI (p = 0.045 and p = 0.036, respectively). The percentage diameter decrease, size of tumour deposit in LN, progesterone receptor, HER2 and histological grade were significantly associated with the diagnostic performance of PET/CT (p = 0.023, p = 0.002, p = 0.036, p = 0.044 and p = 0.008, respectively). On multivariate logistic regression analysis, size of tumour deposit within LN was identified as being independently associated with diagnostic performance of ultrasound [odds ratio, 13.07; 95% confidence interval (CI), 2.95-57.96] and PET/CT (odds ratio, 6.47; 95% CI, 1.407-29.737). Combination of three imaging modalities showed the highest sensitivity, and PET

Ultrasound-based teaching of cardiac anatomy and physiology to undergraduate medical students.

PubMed

Hammoudi, Nadjib; Arangalage, Dimitri; Boubrit, Lila; Renaud, Marie Christine; Isnard, Richard; Collet, Jean-Philippe; Cohen, Ariel; Duguet, Alexandre

2013-10-01

Ultrasonography is a non-invasive imaging modality that offers the opportunity to teach living cardiac anatomy and physiology. The objectives of this study were to assess the feasibility of integrating an ultrasound-based course into the conventional undergraduate medical teaching programme and to analyse student and teacher feedback. An ultrasound-based teaching course was implemented and proposed to all second-year medical students (n=348) at the end of the academic year, after all the conventional modules at our faculty. After a brief theoretical and practical demonstration, students were allowed to take the probe and use the ultrasound machine. Students and teachers were asked to complete a survey and were given the opportunity to provide open feedback. Two months were required to implement the entire module; 330 (95%) students (divided into 39 groups) and 37 teachers participated in the course. Student feedback was very positive: 98% of students agreed that the course was useful; 85% and 74% considered that their understanding of cardiac anatomy and physiology, respectively, was improved. The majority of the teachers (97%) felt that the students were interested, 81% agreed that the course was appropriate for second-year medical students and 84% were willing to participate to future sessions. Cardiac anatomy and physiology teaching using ultrasound is feasible for undergraduate medical students and enhances their motivation to improve their knowledge. Student and teacher feedback on the course was very positive. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Comparison of the Diagnostic Performance of Power Doppler Ultrasound and a New Microvascular Doppler Ultrasound Technique (AngioPLUS) for Differentiating Benign and Malignant Breast Masses.

PubMed

Jung, Hae Kyoung; Park, Ah Young; Ko, Kyung Hee; Koh, Jieun

2018-03-12

This study was performed to compare the diagnostic performance of power Doppler ultrasound (US) and a new microvascular Doppler US technique (AngioPLUS; SuperSonic Imagine, Aix-en-Provence, France) for differentiating benign and malignant breast masses. Power Doppler US and AngioPLUS findings were available in 124 breast masses with confirmed pathologic results (benign, 80 [64.5%]; malignant, 44 [35.5%]). The diagnostic performance of each tool was calculated to distinguish benign from malignant masses using a receiver operating characteristic curve analysis and compared. The area under the curve showed that AngioPLUS was superior to power Doppler US in differentiating benign from malignant breast masses, but the difference was not statistically significant. © 2018 by the American Institute of Ultrasound in Medicine.

Mapping the literature of diagnostic medical sonography.

PubMed Central

Walcott, B M

1999-01-01

Diagnostic medical sonography has been evolving as a recognized allied health occupation since the early 1970s, but no bibliometric studies of the literature of the field have been published. This study, part of the Medical Library Association Nursing and Allied Health Resources Section's Project for Mapping the Literature of Allied Health, attempted to identify the core journals in diagnostic medical sonography and determine how well these journals are indexed by MEDLINE, EMBASE/Excerpta Medica, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Citation analysis was done using the three journals listed for the field by the Brandon/Hill list. Characteristics of two of these three journals affected the results to the extent that more data should be gathered to reach conclusions about the literature of diagnostic medical sonography as a whole. Results of the analysis do suggest that the literature of echocardiography, which is a special area of diagnostic medical sonography, is indexed much more completely by MEDLINE and EMBASE/Excerpta Medica than by CINAHL. Suggestions are made for librarians making collection development decisions in this area of allied health. PMID:10427429

77 FR 62479 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee (Committee) will hold... Proposed Rulemaking (NPRM) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee...

77 FR 53163 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-31

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee (Committee) will hold... previously published Notice of Proposed Rulemaking (NPRM) on Medical Diagnostic Equipment Accessibility...

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea.

PubMed

Sforza, Alfonso; Mancusi, Costantino; Carlino, Maria Viviana; Buonauro, Agostino; Barozzi, Marco; Romano, Giuseppe; Serra, Sossio; de Simone, Giovanni

2017-06-19

The availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD). We included 68 patients presenting to the ED of "Maurizio Bufalini" Hospital in Cesena (Italy) for AD. All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The series was divided into patients with dyspnea of cardiac or non-cardiac origin. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive value and negative predictive value of the three ultrasonic methods and their various combinations for the diagnosis of cardiogenic dyspnea (CD), comparing with the final diagnosis made by an independent emergency physician. LUS alone exhibited a good sensitivity (92.6%) and specificity (80.5%). The highest accuracy (90%) for the diagnosis of CD was obtained with the combination of LUS and one of the other two methods (heart or IVC). The IUE with PUD is a useful extension of the clinical examination, can be readily available at the bedside or in ambulance, requires few minutes and has a reliable diagnostic discriminant ability in the setting of AD.

Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment.

PubMed

Nightingale, Kathryn R; Church, Charles C; Harris, Gerald; Wear, Keith A; Bailey, Michael R; Carson, Paul L; Jiang, Hui; Sandstrom, Kurt L; Szabo, Thomas L; Ziskin, Marvin C

2015-07-01

The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher-order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term "conditionally" is included to indicate that CIP would be considered on a per-patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3-tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)-monitored clinical studies investigating CIP in specific tissues. © 2015 by the American Institute of

Strain elastography of abnormal axillary nodes in breast cancer patients does not improve diagnostic accuracy compared with conventional ultrasound alone.

PubMed

Park, Young Mi; Fornage, Bruno D; Benveniste, Ana Paula; Fox, Patricia S; Bassett, Roland L; Yang, Wei Tse

2014-12-01

The purpose of this study was to determine the diagnostic value of strain elastography (SE) alone and in combination with gray-scale ultrasound in the diagnosis of benign versus metastatic disease for abnormal axillary lymph nodes in breast cancer patients. Patients with breast cancer and axillary lymph nodes suspicious for metastatic disease on conventional ultrasound who underwent SE of the suspicious node before ultrasound-guided fine-needle aspiration biopsy (FNAB) were included in this study. On conventional ultrasound, the long- and short-axis diameters, long-axis-to-short-axis ratio, cortical echogenicity, thickness, and evenness were documented. The nodal vascularity was assessed on power Doppler imaging. Elastograms were evaluated for the percentage of black (hard) areas in the lymph node, and the SE-ultrasound size ratio was calculated. Two readers assessed the images independently and then in consensus in cases of disagreement. ROC AUCs were calculated for conventional ultrasound, SE, and both methods combined. Interreader reliability was assessed using kappa statistics. A total of 101 patients with 104 nodes were examined; 35 nodes were benign, and 69 had metastases. SE alone showed a significantly lower AUC (62%) than did conventional ultrasound (92%) (p<0.001). There was no difference between the AUC of conventional ultrasound and the AUC of the combination of conventional ultrasound and SE (93%) (p=0.16). Interreader reliability was moderate for all variables (κ≥0.60) except the SE-ultrasound size ratio (κ=0.35). Added SE does not improve the diagnostic ability of conventional ultrasound when evaluating abnormal axillary lymph nodes.

78 FR 10582 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-14

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee will hold its fourth...) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee will meet on February...

Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine.

PubMed

Bahner, David P; Royall, Nelson A

2013-02-01

Ultrasound training and education in medical schools is rare, and the foci of current ultrasound curricula are limited. There is a significant need for advanced ultrasound training models in medical school curricula to reduce educational burdens for physician residency programs and improve overall physician competency.The authors describe and evaluate the advanced ultrasound training program developed at The Ohio State University College of Medicine (OSU COM). The OSU COM program is a longitudinal advanced ultrasound curriculum for fourth-year medical students pursuing specialties that require frequent use of focused ultrasound. One hundred fifty student participants have completed the yearlong program to date. Participants engage in didactic lectures, journal club sessions, hands-on training, teaching and patient-modeling activities, and complete a final project. Experienced Ohio State University Medical Center faculty are recruited from specialties that frequently use ultrasound (e.g., emergency medicine, internal medicine, obstetrics-gynecology). A multimodal instructional assessment approach ensures that ultrasound training yields experience with cognitive, behavioral, and constructive learning components. The authors discuss the benefits of the program as well as its challenges and future directions.The advanced ultrasound training program at OSU COM demonstrates a novel approach to providing ultrasound training for medical students, offering a feasible model for meeting training guidelines without increasing the educational requirements for residency programs.

Potential of coded excitation in medical ultrasound imaging.

PubMed

Misaridis, T X; Gammelmark, K; Jørgensen, C H; Lindberg, N; Thomsen, A H; Pedersen, M H; Jensen, J A

2000-03-01

Improvement in signal-to-noise ratio (SNR) and/or penetration depth can be achieved in medical ultrasound by using long coded waveforms, in a similar manner as in radars or sonars. However, the time-bandwidth product (TB) improvement, and thereby SNR improvement is considerably lower in medical ultrasound, due to the lower available bandwidth. There is still space for about 20 dB improvement in the SNR, which will yield a penetration depth up to 20 cm at 5 MHz [M. O'Donnell, IEEE Trans. Ultrason. Ferroelectr. Freq. Contr., 39(3) (1992) 341]. The limited TB additionally yields unacceptably high range sidelobes. However, the frequency weighting from the ultrasonic transducer's bandwidth, although suboptimal, can be beneficial in sidelobe reduction. The purpose of this study is an experimental evaluation of the above considerations in a coded excitation ultrasound system. A coded excitation system based on a modified commercial scanner is presented. A predistorted FM signal is proposed in order to keep the resulting range sidelobes at acceptably low levels. The effect of the transducer is taken into account in the design of the compression filter. Intensity levels have been considered and simulations on the expected improvement in SNR are also presented. Images of a wire phantom and clinical images have been taken with the coded system. The images show a significant improvement in penetration depth and they preserve both axial resolution and contrast.

78 FR 32612 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee will hold its seventh...) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee will meet on June 17...

78 FR 1166 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-08

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee will hold its third...) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee will meet on January 22...

78 FR 23872 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-23

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee will hold its sixth...) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee will meet on May 7...

78 FR 16448 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee will hold its fifth...) on Medical Diagnostic Equipment Accessibility Standards. DATES: The Committee will meet on March 26...

[Ultrasound diagnostics of muscle and tendon injuries].

PubMed

Stević, Ruza; Masulović, Dragan

2009-01-01

Sonography is a useful technique for the investigation of a number of musculoskeletal disorders. The most common indication for ultrasonography of muscles and tendons is the diagnosis of traumatic lesions, distinguishing them from other disorders and follow- up of healing process. The purpose of this paper is to show the importance of ultrasound in the diagnosis of muscle and tendon injuries. The study included 170 patients (148 male and 22 female), mean age 29.6 years (range 14-60 years). All examinations were performed by linear transducer of 7.5-10 MHz, with longitudinal and transverse scanning. Ultrasound examination followed physical examination. Traumatic lesions of muscles were diagnosed in 113 patients (66.7%) and tendon injuries in 57 cases (33.2%). The muscle changes detected by ultrasonography were the following: 70 (61.9%) partial and two (1.76%) complete ruptures, 22 (19.46%) haematoma, 9 (7.96%) strains grade I, 4 fibroses and 4 ossifying myositis 4 (3.5%, respectively). Complications of muscle injuries were diagnosed in two cases, a muscular hernia and an arteriovenous fistula. Among tendon injuries, 21 (33.8%) ruptures and 36 (66.1%) tendinitis were diagnosed. Accompanying effusion in the bursa of patients with tendon injuries was found in 9 cases. Ultrasonography allowed visualization and objective assessment of the type and the extent of traumatic pathomorphological changes of muscles and tendons. Such diagnostic possibilities of ultrasonography are especially important in the choice of appropriate therapy.

Does the Use of Diagnostic Technology Reduce Fetal Mortality?

PubMed

Grytten, Jostein; Skau, Irene; Sørensen, Rune; Eskild, Anne

2018-01-19

To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests. The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent. The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century. © Health Research and Educational Trust.

Application of Ultrasound Energy as a New Drug Delivery System

NASA Astrophysics Data System (ADS)

Tachibana, Katsuro; Tachibana, Shunro

1999-05-01

Ultrasound has been in use for the last three decades as amodality for diagnostic imaging in medicine. Recently, there have beennumerous reports on the application of nonthermal ultrasound energyfor targeting or controlling drug release. This new concept oftherapeutic ultrasound combined with drugs has led to much excitementin various medical fields. Ultrasound energy can enhance the effectsof thrombolytic agents such as urokinase. Therapeutic ultrasoundcatheters are currently being developed for treatment ofcardiovascular diseases. Devices with ultrasound transducers implantedin transdermal drug patches are also being evaluated for possibledelivery of insulin through the skin. Chemical activation of drugs byultrasound energy for treatment of cancers is another new fieldrecently termed “Sonodynamic Therapy”. Various examples of ultrasoundapplication are under investigation which could lead to revolutionarydrug delivery systems in the future.

Teaching point of care ultrasound skills in medical school: keeping radiology in the driver's seat.

PubMed

Webb, Emily M; Cotton, James B; Kane, Kevin; Straus, Christopher M; Topp, Kimberly S; Naeger, David M

2014-07-01

Ultrasound is used increasingly in medical practice as a tool for focused bedside diagnosis and technical assistance during procedures. Widespread availability of small portable units has put this technology into the hands of many physicians and medical students who lack dedicated training, leaving the education and introduction of this key modality increasingly to physicians from other specialties. We developed a radiology-led program to teach ultrasound skills to preclinical medical students. To develop this new ultrasound program we 1) established a program leader, 2) developed teaching materials, 3) created a hands-on interactive program, and 4) recruited the necessary instructors. The program was piloted with the first-year medical student class of 154 students. The introductory session was assessed by pre- and post-activity Likert scale-based surveys. Of 154 (68.8%) students, 106 completed a voluntary online survey before starting the program and 145 students (94.2%) completed a voluntary survey after the session. Students found the program educationally valuable (4.64 of 5) and reported that it improved their understanding of ultrasound imaging (4.7 of 5). Students' reported confidence in identifying abdominal organs, intra-abdominal fluid, and Morison pouch that was significantly higher on the postactivity survey compared to the presurvey (P < .001 for all). We piloted a radiology-led program to teach ultrasound skills to preclinical medical students. Students found the experience enjoyable and educationally valuable. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Integration of Medical Imaging Including Ultrasound into a New Clinical Anatomy Curriculum

ERIC Educational Resources Information Center

Moscova, Michelle; Bryce, Deborah A.; Sindhusake, Doungkamol; Young, Noel

2015-01-01

In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the…

[Contrast-enhanced Ultrasound in Diagnostic Imaging of Muscle Injuries: Perfusion Imaging in the Early Arterial Phase].

PubMed

Hotfiel, T; Carl, H D; Swoboda, B; Engelhardt, M; Heinrich, M; Strobel, D; Wildner, D

2016-03-01

Ultrasound is a standard procedure widely used in the diagnostic investigation of muscle injuries and widely described in the literature. Its advantages include rapid availability, cost effectiveness and the possibility to perform a real-time dynamic examination with the highest possible spatial resolution. In the diagnostic work-up of minor lesions (muscle stiffness, muscle strain), plain ultrasound has so far been inferior to MRI. The case presented by us is an example of the possibilities offered by contrast-enhanced ultrasound (CEUS) in the imaging of muscle injuries compared with plain B-mode image ultrasound and MRI imaging of the affected region. This case report is about a high-performance football player who sustained a muscle injury. He underwent an ultrasound examination (S 2000, 9L4 Probe, Siemens, Germany), which was performed simultaneously in the conventional and contrast-enhanced mode at the level of the lesion. An intravenous bolus injection of 4.8 ml of intravascular contrast agent (SonoVue(®), Bracco, Italy) was given via a cubital intravenous line. After that, the distribution of contrast agent was visualised in the early arterial phase. In addition, a plain magnetic resonance imaging scan of both thighs was performed for reference. On conventional ultrasound, the lesion was not clearly distinguishable from neighbouring tissue, whereas contrast-enhanced ultrasound demonstrated a well delineated, circumscribed area of impaired perfusion with hypoenhancement compared with the surrounding muscles at the clinical level of the lesion in the arterial wash-in phase (0-30 sec, after intravenous administration). The MRI scan revealed an edema signal with perifascial fluid accumulation in the corresponding site. The use of intravascular contrast agent enabled the sensitive detection of a minor injury by ultrasound for the first time. An intramuscular edema seen in the MRI scan showed a functional arterial perfusion impairment on ultrasound, which was

Integrated photoacoustic, ultrasound and fluorescence platform for diagnostic medical imaging-proof of concept study with a tissue mimicking phantom.

PubMed

James, Joseph; Murukeshan, Vadakke Matham; Woh, Lye Sun

2014-07-01

The structural and molecular heterogeneities of biological tissues demand the interrogation of the samples with multiple energy sources and provide visualization capabilities at varying spatial resolution and depth scales for obtaining complementary diagnostic information. A novel multi-modal imaging approach that uses optical and acoustic energies to perform photoacoustic, ultrasound and fluorescence imaging at multiple resolution scales from the tissue surface and depth is proposed in this paper. The system comprises of two distinct forms of hardware level integration so as to have an integrated imaging system under a single instrumentation set-up. The experimental studies show that the system is capable of mapping high resolution fluorescence signatures from the surface, optical absorption and acoustic heterogeneities along the depth (>2cm) of the tissue at multi-scale resolution (<1µm to <0.5mm).

Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique.

PubMed

Ellis, Richard; Hing, Wayne; Dilley, Andrew; McNair, Peter

2008-08-01

Diagnostic ultrasound provides a technique whereby real-time, in vivo analysis of peripheral nerve movement is possible. This study measured sciatic nerve movement during a "slider" neural mobilisation technique (ankle dorsiflexion/plantar flexion and cervical extension/flexion). Transverse and longitudinal movement was assessed from still ultrasound images and video sequences by using frame-by-frame cross-correlation software. Sciatic nerve movement was recorded in the transverse and longitudinal planes. For transverse movement, at the posterior midthigh (PMT) the mean value of lateral sciatic nerve movement was 3.54 mm (standard error of measurement [SEM] +/- 1.18 mm) compared with anterior-posterior/vertical (AP) movement of 1.61 mm (SEM +/- 0.78 mm). At the popliteal crease (PC) scanning location, lateral movement was 6.62 mm (SEM +/- 1.10 mm) compared with AP movement of 3.26 mm (SEM +/- 0.99 mm). Mean longitudinal sciatic nerve movement at the PMT was 3.47 mm (SEM +/- 0.79 mm; n = 27) compared with the PC of 5.22 mm (SEM +/- 0.05 mm; n = 3). The reliability of ultrasound measurement of transverse sciatic nerve movement was fair to excellent (Intraclass correlation coefficient [ICC] = 0.39-0.76) compared with excellent (ICC = 0.75) for analysis of longitudinal movement. Diagnostic ultrasound presents a reliable, noninvasive, real-time, in vivo method for analysis of sciatic nerve movement.

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine.

PubMed

Finnoff, Jonathan T; Hall, Mederic M; Adams, Erik; Berkoff, David; Concoff, Andrew L; Dexter, William; Smith, Jay

2015-02-01

The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. Systematic review of the literature. USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Survey of the prevalence and methodology of quality assurance for B-mode ultrasound image quality among veterinary sonographers.

PubMed

Hoscheit, Larry P; Heng, Hock Gan; Lim, Chee Kin; Weng, Hsin-Yi

2018-05-01

Image quality in B-mode ultrasound is important as it reflects the diagnostic accuracy and diagnostic information provided during clinical scanning. Quality assurance programs for B-mode ultrasound systems/components are comprised of initial quality acceptance testing and subsequent regularly scheduled quality control testing. The importance of quality assurance programs for B-mode ultrasound image quality using ultrasound phantoms is well documented in the human medical and medical physics literature. The purpose of this prospective, cross-sectional, survey study was to determine the prevalence and methodology of quality acceptance testing and quality control testing of image quality for ultrasound system/components among veterinary sonographers. An online electronic survey was sent to 1497 members of veterinary imaging organizations: the American College of Veterinary Radiology, the Veterinary Ultrasound Society, and the European Association of Veterinary Diagnostic Imaging, and a total of 167 responses were received. The results showed that the percentages of veterinary sonographers performing quality acceptance testing and quality control testing are 42% (64/151; 95% confidence interval 34-52%) and 26% (40/156: 95% confidence interval 19-33%) respectively. Of the respondents who claimed to have quality acceptance testing or quality control testing of image quality in place for their ultrasound system/components, 0% have performed quality acceptance testing or quality control testing correctly (quality acceptance testing 95% confidence interval: 0-6%, quality control testing 95% confidence interval: 0-11%). Further education and guidelines are recommended for veterinary sonographers in the area of quality acceptance testing and quality control testing for B-mode ultrasound equipment/components. © 2018 American College of Veterinary Radiology.

Detection of intracavitary uterine pathology using offline analysis of three-dimensional ultrasound volumes: interobserver agreement and diagnostic accuracy.

PubMed

Van den Bosch, T; Valentin, L; Van Schoubroeck, D; Luts, J; Bignardi, T; Condous, G; Epstein, E; Leone, F P; Testa, A C; Van Huffel, S; Bourne, T; Timmerman, D

2012-10-01

To estimate the diagnostic accuracy and interobserver agreement in predicting intracavitary uterine pathology at offline analysis of three-dimensional (3D) ultrasound volumes of the uterus. 3D volumes (unenhanced ultrasound and gel infusion sonography with and without power Doppler, i.e. four volumes per patient) of 75 women presenting with abnormal uterine bleeding at a 'bleeding clinic' were assessed offline by six examiners. The sonologists were asked to provide a tentative diagnosis. A histological diagnosis was obtained by hysteroscopy with biopsy or operative hysteroscopy. Proliferative, secretory or atrophic endometrium was classified as 'normal' histology; endometrial polyps, intracavitary myomas, endometrial hyperplasia and endometrial cancer were classified as 'abnormal' histology. The diagnostic accuracy of the six sonologists with regard to normal/abnormal histology and interobserver agreement were estimated. Intracavitary pathology was diagnosed at histology in 39% of patients. Agreement between the ultrasound diagnosis and the histological diagnosis (normal vs abnormal) ranged from 67 to 83% for the six sonologists. In 45% of cases all six examiners agreed with regard to the presence/absence of intracavitary pathology. The percentage agreement between any two examiners ranged from 65 to 91% (Cohen's κ, 0.31-0.81). The Schouten κ for all six examiners was 0.51 (95% CI, 0.40-0.62), while the highest Schouten κ for any three examiners was 0.69. When analyzing stored 3D ultrasound volumes, agreement between sonologists with regard to classifying the endometrium/uterine cavity as normal or abnormal as well as the diagnostic accuracy varied substantially. Possible actions to improve interobserver agreement and diagnostic accuracy include optimization of image quality and the use of a consistent technique for analyzing the 3D volumes. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

[Diagnostic ultrasound in pneumothorax].

PubMed

Maury, É; Pichereau, C; Bourcier, S; Galbois, A; Lejour, G; Baudel, J-L; Ait-Oufella, H; Guidet, B

2016-10-01

For a long time the lung has been regarded as inaccessible to ultrasound. However, recent clinical studies have shown that this organ can be examined by this technique, which appears, in some situations, to be superior to thoracic radiography. The examination does not require special equipment and is possible using a combination of simple qualitative signs: lung sliding, the presence of B lines and the demonstration of the lung point. The lung sliding corresponds to the artefact produced by the movement of the two pleural layers, one against the other. The B lines indicate the presence of an interstitial syndrome. The presence of lung sliding and/or B lines has a negative predictive value of 100% and formally excludes a pneumothorax in the area where the probe has been applied. The presence of the lung point is pathognomonic of pneumothorax but the sensitivity is no more than 60%. Ultrasound is therefore a rapid and simple means of excluding a pneumothorax (lung sliding or B lines) and of confirming a pneumothorax when the lung point is visible. The question that remains is whether ultrasound can totally replace radiography in the management of this disorder. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Seeing Is Believing: Evaluating a Point-of-Care Ultrasound Curriculum for 1st-Year Medical Students.

PubMed

Nelson, Bret P; Hojsak, Joanne; Dei Rossi, Elizabeth; Karani, Reena; Narula, Jagat

2017-01-01

Point-of-care ultrasound has been a novel addition to undergraduate medical education at a few medical schools. The impact is not fully understood, and few rigorous assessments of educational outcomes exist. This study assessed the impact of a point-of-care ultrasound curriculum on image acquisition, interpretation, and student and faculty perceptions of the course. All 142 first-year medical students completed a curriculum on ultrasound physics and instrumentation, cardiac, thoracic, and abdominal imaging. A flipped classroom model of preclass tutorials and tests augmenting live, hands-on scanning sessions was incorporated into the physical examination course. Students and faculty completed surveys on impressions of the curriculum, and all students under-went competency assessments with standardized patients. The curriculum was a mandatory part of the physical examination course and was taught by experienced clinician-sonographers as well as faculty who do not routinely perform sonography in their clinical practice. Students and faculty agreed that the physical examination course was the right time to introduce ultrasound (87% and 80%). Students demonstrated proper use of the ultrasound machine functions (M score = 91.55), and cardiac, thoracic, and abdominal system assessments (M score = 80.35, 79.58, and 71.57, respectively). Students and faculty valued the curriculum, and students demonstrated basic competency in performance and interpretation of ultrasound. Further study is needed to determine how to best incorporate this emerging technology into a robust learning experience for medical students.

A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review.

PubMed

Rao, Sishir; van Holsbeeck, Lodewijk; Musial, Joseph L; Parker, Alton; Bouffard, J Antonio; Bridge, Patrick; Jackson, Matt; Dulchavsky, Scott A

2008-05-01

Ultrasound is a versatile diagnostic modality used in a variety of medical fields. Wayne State University School of Medicine (WSUSOM) is one of the first medical schools in the United States to integrate an ultrasound curriculum through both basic science courses and clinical clerkships. In 2006, 25 portable ultrasound units were donated to WSUSOM. First-year medical students were provided an ultrasound curriculum consisting of 6 organ-system sessions that addressed the basics of ultrasound techniques, anatomy, and procedural skills. After the last session, students were administered 2 anonymous and voluntary evaluations. The first assessed their overall experience with the ultrasound curriculum, and the second assessed their technical skills in applying ultrasound techniques. Eighty-three percent of students agreed or strongly agreed that their experience with ultrasound education was positive. On the summative evaluation, nearly 91% of students agreed or strongly agreed that they would benefit from continued ultrasound education throughout their 4 years of medical school. Student performance on the technical assessment was also very positive, with mean class performance of 87%. As residency programs adopt ultrasound training, medical school faculty should consider incorporating ultrasound education into their curriculum. Portable ultrasound has the potential to be used in many different settings, including rural practice sites and sporting events. The WSUSOM committee's pilot ultrasound curriculum will continue to use student feedback to enhance the ultrasound experience, helping students prepare for challenges that they will face in the future.

Mechanisms for Induction of Pulmonary Capillary Hemorrhage by Diagnostic Ultrasound: Review and Consideration of Acoustical Radiation Surface Pressure.

PubMed

Miller, Douglas L

2016-12-01

Diagnostic ultrasound can induce pulmonary capillary hemorrhage (PCH) in rats and other mammals. This phenomenon represents the only clearly demonstrated biological effect of (non-contrast enhanced) diagnostic ultrasound and thus presents a uniquely important safety issue. However, the physical mechanism responsible for PCH remains uncertain more than 25 y after its discovery. Experimental research has indicated that neither heating nor acoustic cavitation, the predominant mechanisms for bioeffects of ultrasound, is responsible for PCH. Furthermore, proposed theoretical mechanisms based on gas-body activation, on alveolar resonance and on impulsive generation of liquid droplets all appear unlikely to be responsible for PCH, owing to unrealistic model assumptions. Here, a simple model based on the acoustical radiation surface pressure (ARSP) at a tissue-air interface is hypothesized as the mechanism for PCH. The ARSP model seems to explain some features of PCH, including the approximate frequency independence of PCH thresholds and the dependence of thresholds on biological factors. However, ARSP evaluated for experimental threshold conditions appear to be too weak to fully account for stress failure of pulmonary capillaries, gauging by known stresses for injurious physiologic conditions. Furthermore, consideration of bulk properties of lung tissue suggests substantial transmission of ultrasound through the pleura, with reduced ARSP and potential involvement of additional mechanisms within the pulmonary interior. Although these recent findings advance our knowledge, only a full understanding of PCH mechanisms will allow development of science-based safety assurance for pulmonary ultrasound. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Use of diagnostic imaging procedures and fetal monitoring devices in the care of pregnant women.

PubMed

Moore, R M; Jeng, L L; Kaczmarek, R G; Placek, P J

1990-01-01

Medical devices and diagnostic imaging procedures such as ultrasound, X-rays, and electronic fetal monitoring devices are used in the medical care of many pregnant women today. The responsibility for the safety and effectiveness of these diagnostic technologies is shared by a number of Public Health Service agencies, one of which is the Center for Devices and Radiological Health (CDRH), a unit within the Food and Drug Administration. The CDRH collaborated with the National Center for Health Statistics (NCHS) in conducting a study of recent trends in the uses of diagnostic ultrasound, medical X-rays, and electronic fetal monitoring devices in the medical care of pregnant women. This study used data from the 1980 National Natality and Fetal Mortality Surveys and the 1987 pretest to the National Maternal and Infant Health Survey. Hospitals and prenatal care providers of the pregnant women contributed information regarding the use of these medical devices. Between 1980 and 1987, ultrasound use more than doubled, increasing from 33.5 percent of pregnancies in 1980 to 78.8 percent in 1987 (P less than 0.001). More ultrasound examinations were performed earlier in gestation in 1987 than in 1980, with 10.1 percent being performed during the first trimester in 1987, compared with 6.9 percent in 1980 (P less than 0.001). Use of external electronic fetal monitoring devices during delivery also increased significantly between 1980 and 1987, from 33.5 percent to 74.6 percent (P less than 0.001). Use of medical X-rays among women with live births remained relatively unchanged, 15.0 percent in 1980 and 15.3 percent in 1987 (P = .282). The implications of these trends are discussed.

Influence of Scan Duration on Pulmonary Capillary Hemorrhage Induced by Diagnostic Ultrasound.

PubMed

Miller, Douglas L; Dong, Zhihong; Dou, Chunyan; Raghavendran, Krishnan

2016-08-01

Diagnostic ultrasound can induce pulmonary capillary hemorrhage (PCH) in rats and display this as "comet tail" artifacts (CTAs) after a time delay. To test the hypothesis that no PCH occurs for brief scans, anesthetized rats were scanned using a 6-MHz linear array for different durations. PCH was characterized by ultrasound CTAs, micro-computed tomography (μCT), and measurements of fixed lung tissue. The μCT images revealed regions of PCH, sometimes penetrating the entire depth of a lobe, which were reflected in the fixed tissue measurements. At -3 dB of power, PCH was substantial for 300-s scans, but not significant for 25-s scans. At 0 dB, PCH was not strongly dependent on scan durations of 300 to 10 s. Contrary to the hypothesis, CTAs were not evident during most 10-s scans (p > 0.05), but PCH was significant (p = 0.02), indicating that PCH could occur without evidence of the injury in the images. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Ultrasound applications in mass casualties and extreme environments.

PubMed

Ma, O John; Norvell, Jeffrey G; Subramanian, Srikala

2007-05-01

A mass-casualty incident is one in which the number of patients with injuries exceeds the available medical resources to care for them in a timely manner. In such a situation, the numerous advantages of ultrasonography make it an ideal triage tool for helping clinicians rapidly screen patients. Experiences during the 1988 Armenian earthquake and the 1999 Turkish earthquake demonstrated the proficiency of ultrasound in providing rapid clinical data to the physicians caring for the mass-casualty patients. Wireless and satellite transmission of ultrasound images also has been shown to be feasible and may be applied to mass-casualty situations. In addition, ultrasound applications have been demonstrated to aid in the diagnosis of various conditions, including pneumothorax, in the International Space Station. Ultrasound's portability, reproducibility, accuracy, and ease of use will make it an important diagnostic instrument for future space missions.

Performance analysis of medical video streaming over mobile WiMAX.

PubMed

Alinejad, Ali; Philip, N; Istepanian, R H

2010-01-01

Wireless medical ultrasound streaming is considered one of the emerging application within the broadband mobile healthcare domain. These applications are considered as bandwidth demanding services that required high data rates with acceptable diagnostic quality of the transmitted medical images. In this paper, we present the performance analysis of a medical ultrasound video streaming acquired via special robotic ultrasonography system over emulated WiMAX wireless network. The experimental set-up of this application is described together with the performance of the relevant medical quality of service (m-QoS) metrics.

Iterative Minimum Variance Beamformer with Low Complexity for Medical Ultrasound Imaging.

PubMed

Deylami, Ali Mohades; Asl, Babak Mohammadzadeh

2018-06-04

Minimum variance beamformer (MVB) improves the resolution and contrast of medical ultrasound images compared with delay and sum (DAS) beamformer. The weight vector of this beamformer should be calculated for each imaging point independently, with a cost of increasing computational complexity. The large number of necessary calculations limits this beamformer to application in real-time systems. A beamformer is proposed based on the MVB with lower computational complexity while preserving its advantages. This beamformer avoids matrix inversion, which is the most complex part of the MVB, by solving the optimization problem iteratively. The received signals from two imaging points close together do not vary much in medical ultrasound imaging. Therefore, using the previously optimized weight vector for one point as initial weight vector for the new neighboring point can improve the convergence speed and decrease the computational complexity. The proposed method was applied on several data sets, and it has been shown that the method can regenerate the results obtained by the MVB while the order of complexity is decreased from O(L 3 ) to O(L 2 ). Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles.

PubMed

Mathias, Wilson; Tsutsui, Jeane M; Tavares, Bruno G; Xie, Feng; Aguiar, Miguel O D; Garcia, Diego R; Oliveira, Mucio T; Soeiro, Alexandre; Nicolau, Jose C; Lemos, Pedro A; Rochitte, Carlos E; Ramires, José A F; Kalil, Roberto; Porter, Thomas R

2016-05-31

Pre-clinical trials have demonstrated that, during intravenous microbubble infusion, high mechanical index (HMI) impulses from a diagnostic ultrasound (DUS) transducer might restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to test the safety and efficacy of this adjunctive approach in humans. From May 2014 through September 2015, patients arriving with their first STEMI were randomized to either DUS intermittent HMI impulses (n = 20) just prior to emergent percutaneous coronary intervention (PCI) and for an additional 30 min post-PCI (HMI + PCI), or low mechanical index (LMI) imaging only (n = 10) for perfusion assessments before and after PCI (LMI + PCI). All studies were conducted during an intravenous perflutren lipid microsphere infusion. A control reference group (n = 70) arrived outside of the time window of ultrasound availability and received emergent PCI alone (PCI only). Initial epicardial recanalization rates prior to emergent PCI and improvements in microvascular flow were compared between ultrasound-treated groups. Median door-to-dilation times were 82 ± 26 min in the LMI + PCI group, 72 ± 15 min in the HMI + PCI group, and 103 ± 42 min in the PCI-only group (p = NS). Angiographic recanalization prior to PCI was seen in 12 of 20 HMI + PCI patients (60%) compared with 10% of LMI + PCI and 23% of PCI-only patients (p = 0.002). There were no differences in microvascular obstructed segments prior to treatment, but there were significantly smaller proportions of obstructed segments in the HMI + PCI group at 1 month (p = 0.001) and significant improvements in left ventricular ejection fraction (p < 0.005). HMI impulses from a diagnostic transducer, combined with a commercial microbubble infusion, can prevent microvascular obstruction and improve functional outcome when added to the contemporary PCI management of acute STEMI. (Therapeutic Use of Ultrasound in

Mechanisms for Induction of Pulmonary Capillary Hemorrhage by Diagnostic Ultrasound: Review and Consideration of Acoustical Radiation Surface Pressure

PubMed Central

Miller, Douglas L.

2016-01-01

Diagnostic ultrasound can induce pulmonary capillary hemorrhage (PCH) in rats and other mammals. This phenomenon represents the only clearly demonstrated biological effect of (non-contrast enhanced) diagnostic ultrasound and thus presents a uniquely important safety issue. However, the physical mechanism responsible for PCH remains uncertain more than 25 y after its discovery. Experimental research has indicated that neither heating nor acoustic cavitation, the predominant mechanisms for bioeffects of ultrasound, is responsible for PCH. Furthermore, proposed theoretical mechanisms based on gas body activation, on alveolar resonance and on impulsive generation of liquid droplets all appear unlikely to be responsible for PCH, owing to unrealistic model assumptions. Here, a simple model based on the acoustic radiation surface pressure (ARSP) at a tissue-air interface is hypothesized as the mechanism for PCH. The ARSP model seems to explain some features of PCH, including the approximate frequency independence of PCH thresholds, and the dependence of thresholds on biological factors. However, ARSP evaluated for experimental threshold conditions appear to be too weak to fully account for stress failure of pulmonary capillaries, gauging by known stresses for injurious physiological conditions. Furthermore, consideration of bulk properties of lung tissue suggests substantial transmission of ultrasound through the pleura, with reduced ARSP and potential involvement of additional mechanisms within the pulmonary interior. Although these recent findings advance our knowledge, only a full understanding of PCH mechanisms will allow development of science-based safety assurance for pulmonary ultrasound. PMID:27649878

Focused ultrasound in ophthalmology

PubMed Central

Silverman, Ronald H

2016-01-01

The use of focused ultrasound to obtain diagnostically significant information about the eye goes back to the 1950s. This review describes the historical and technological development of ophthalmic ultrasound and its clinical application and impact. Ultrasound, like light, can be focused, which is crucial for formation of high-resolution, diagnostically useful images. Focused, single-element, mechanically scanned transducers are most common in ophthalmology. Specially designed transducers have been used to generate focused, high-intensity ultrasound that through thermal effects has been used to treat glaucoma (via ciliodestruction), tumors, and other pathologies. Linear and annular transducer arrays offer synthetic focusing in which precise timing of the excitation of independently addressable array elements allows formation of a converging wavefront to create a focus at one or more programmable depths. Most recently, linear array-based plane-wave ultrasound, in which the array emits an unfocused wavefront and focusing is performed solely on received data, has been demonstrated for imaging ocular anatomy and blood flow. While the history of ophthalmic ultrasound extends back over half-a-century, new and powerful technologic advances continue to be made, offering the prospect of novel diagnostic capabilities. PMID:27757007

Focused ultrasound in ophthalmology.

PubMed

Silverman, Ronald H

2016-01-01

The use of focused ultrasound to obtain diagnostically significant information about the eye goes back to the 1950s. This review describes the historical and technological development of ophthalmic ultrasound and its clinical application and impact. Ultrasound, like light, can be focused, which is crucial for formation of high-resolution, diagnostically useful images. Focused, single-element, mechanically scanned transducers are most common in ophthalmology. Specially designed transducers have been used to generate focused, high-intensity ultrasound that through thermal effects has been used to treat glaucoma (via ciliodestruction), tumors, and other pathologies. Linear and annular transducer arrays offer synthetic focusing in which precise timing of the excitation of independently addressable array elements allows formation of a converging wavefront to create a focus at one or more programmable depths. Most recently, linear array-based plane-wave ultrasound, in which the array emits an unfocused wavefront and focusing is performed solely on received data, has been demonstrated for imaging ocular anatomy and blood flow. While the history of ophthalmic ultrasound extends back over half-a-century, new and powerful technologic advances continue to be made, offering the prospect of novel diagnostic capabilities.

Distributed Network, Wireless and Cloud Computing Enabled 3-D Ultrasound; a New Medical Technology Paradigm

PubMed Central

Meir, Arie; Rubinsky, Boris

2009-01-01

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people. PMID:19936236

Distributed network, wireless and cloud computing enabled 3-D ultrasound; a new medical technology paradigm.

PubMed

Meir, Arie; Rubinsky, Boris

2009-11-19

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people.

Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis.

PubMed

Giljaca, Vanja; Nadarevic, Tin; Poropat, Goran; Nadarevic, Vesna Stefanac; Stimac, Davor

2017-03-01

To determine the diagnostic accuracy of abdominal ultrasound (US) for the diagnosis of acute appendicitis (AA), in terms of sensitivity, specificity and post-test probabilities for positive and negative result. A systematic search of MEDLINE, Embase, The Cochrane library and Science Citation Index Expanded from January 1994 to October 2014 was performed. Two authors independently evaluated studies for inclusion, extracted data and performed analyses. The reference standard for evaluation of final diagnosis was pathohistological report on tissue obtained at appendectomy. Summary sensitivity, specificity and post-test probability of AA after positive and negative result of US with corresponding 95% confidence intervals (CI) were calculated. Out of 3306 references identified through electronic searches, 17 reports met the inclusion criteria, with 2841 included participants. The summary sensitivity and specificity of US for diagnosis of AA were 69% (95% CI 59-78%) and 81% (95% CI 73-88%), respectively. At the median pretest probability of AA of 76.4%, the post-test probability for a positive and negative result of US was 92% (95% CI 88-95%) and 55% (95% CI 46-63%), respectively. Abdominal ultrasound does not seem to have a role in the diagnostic pathway for diagnosis of AA in suspected patients. The summary sensitivity and specificity of US do not exceed that of physical examination. Patients that require additional diagnostic workup should be referred to more sensitive and specific diagnostic procedures, such as computed tomography.

Temperature measurement by thermal strain imaging with diagnostic power ultrasound, with potential for thermal index determination.

PubMed

Liang, Hai-Dong; Zhou, Li-Xia; Wells, Peter N T; Halliwell, Michael

2009-05-01

Over the years, there has been a substantial increase in acoustic exposure in diagnostic ultrasound as new imaging modalities with higher intensities and frame rates have been introduced; and more electronic components have been packed into the probe head, so that there is a tendency for it to become hotter. With respect to potential thermal effects, including those which may be hazardous occurring during ultrasound scanning, there is a correspondingly growing need for in vivo techniques to guide the operator as to the actual temperature rise occurring in the examined tissues. Therefore, an in vivo temperature estimator would be of considerable practical value. The commonly-used method of tissue thermal index (TI) measurement with a hydrophone in water could underestimate the actual value of TI (in one report by as much as 2.9 times). To obtain meaningful results, it is necessary to map the temperature elevation in 2-D (or 3-D) space. We present methodology, results and validation of a 2-D spatial and temporal thermal strain ultrasound temperature estimation technique in phantoms, and its apparently novel application in tracking the evolution of heat deposition at diagnostic exposure levels. The same ultrasound probe is used for both transmission and reception. The displacement and thermal strain estimation methods are similar to those used in high-intensity focused ultrasound thermal monitoring. The use of radiofrequency signals permits the application of cross correlation as a similarity measurement for tracking feature displacement. The displacement is used to calculate the thermal strain directly related to the temperature rise. Good agreement was observed between the temperature rise and the ultrasound power and scan duration. Thermal strain up to 1.4% was observed during 4000-s scan. Based on the results obtained for the temperature range studied in this work, the technique demonstrates potential for applicability in phantom (and possibly in vivo tissue

Diagnostic value of ultrasound indicators of neoplastic risk in preoperative differentiation of adnexal masses

PubMed Central

Bachanek, Michał; Trojanowski, Seweryn; Cendrowski, Krzysztof; Sawicki, Włodzimierz

2013-01-01

Aim To assess the diagnostic value of the risk of malignancy indices and simple ultrasound- based rules in preoperative differentiation of adnexal masses. Material and methods Retrospective examination of 87 patients admitted to hospital due to adnexal tumors. The lesions were evaluated on the basis of international ultrasound classification of ovarian tumors and four risk of malignancy indices were calculated based on ultrasound examination, concentration of CA 125 and menopausal status. Results The patients were aged between 17 and 79, the mean age was 44.5 (standard deviation SD=16.6). Most of the patients (60.91%) were before their menopause. The sensitivity of the simple ultrasound-based rules in the diagnosis of malignancies equaled 64.71% and the specificity constituted 90.00%. A significant statistical difference in the presence of the malignant process was demonstrated in relation to age, menopausal status, CA 125 concentration and analyzed ultrasound score. All indices were characterized by similar sensitivity and specificity. The highest specificity and predictive value of malignant lesions out of the assessed ones was demonstrated by the risk of malignancy index proposed by Yamamoto. The risk of malignancy index according to Jacobs, however, showed the highest predictive value in the case of non-malignant lesions. Conclusions The multiparametric ultrasound examination may facilitate the selection of patients with adnexal tumors to provide them with an appropriate treatment – observation, laparotomy and laparoscopy. These parameters constitute a simple ambulatory method of determining the character of adnexal masses before recommending appropriate treatment. PMID:26674849

Ultrasound and stethoscope as tools in medical education and practice: considerations for the archives

PubMed Central

Fakoya, Francis A; du Plessis, Maira; Gbenimacho, Ikechi B

2016-01-01

Objectives In recent years, the use and portability of ultrasound has threatened the utility of the stethoscope, with many debating and even advocating its replacement. The authors set out to assess opinions in this regard among faculty within a medical school and specifically within an anatomy department where ultrasound is incorporated into the curriculum from the first term. Methods A debate was elicited during a biweekly Anatomy Journal Club session and was centered on three published papers presented. Several questions were raised regarding the possible replacement of stethoscope – the value of early exposure to students as well as how ultrasound and stethoscope should be considered by physicians, students, and teachers. Results The general consensus was that the stethoscope should not be replaced but should be used in conjunction with emerging portable ultrasound. Caution was given that technology could “overcomplicate” diagnosis and lead to increased tests resulting in increased cost of care. In terms of exposing students to ultrasound, just as the stethoscope requires practice to use effectively, so does the ultrasound and should be introduced as early on as possible. As is the case with the stethoscope, students may not initially appreciate all the finer details on ultrasound; however, continual use would improve skill. Conclusion The stethoscope should always remain part of the physical examination and ultrasound should be used in addition to, not replacement of. As technology advances the need for apprenticeship, training increases and students of the medical profession should be exposed to these technologies as early as possible. Hence, it is not yet time to archive the stethoscope. Perhaps never. PMID:27471420

The feasibility of non-contact ultrasound for medical imaging.

PubMed

Clement, G T; Nomura, H; Adachi, H; Kamakura, T

2013-09-21

High intensity focused ultrasound in air may provide a means for medical and biological imaging without direct coupling of an ultrasound probe. In this study, an approach based on highly focused ultrasound in air is described and the feasibility of the technique is assessed. The overall method is based on the observations that (1) ultrasound in air has superior focusing ability and stronger nonlinear harmonic generation as compared to tissue propagation and (2) a tightly focused field directed into tissue causes point-like spreading that may be regarded as a source for generalized diffraction tomography. Simulations of a spherically-curved transducer are performed, where the transducer's radiation pattern is directed from air into tissue. It is predicted that a focal pressure of 162 dB (2.5 kPa) is sufficient to direct ultrasound through the body, and provide a small but measurable signal (∼1 mPa) upon exit. Based on the simulations, a 20 cm diameter array consisting of 298 transducers is constructed. For this feasibility study, a 40 kHz resonance frequency is selected based on the commercial availability of such transducers. The array is used to focus through water and acrylic phantoms, and the time history of the exiting signal is evaluated. Sufficient data are acquired to demonstrate a low-resolution tomographic reconstruction. Finally, to demonstrate the feasibility to record a signal in vivo, a 75 mm × 55 mm section of a human hand is imaged in a C-mode configuration.

Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED.

PubMed

Bolandparvaz, Shahram; Moharamzadeh, Payman; Jamali, Kazem; Pouraghaei, Mahboob; Fadaie, Maryam; Sefidbakht, Sepideh; Shahsavari, Kavous

2013-11-01

Long bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED). The study assessed 80 injured patients with multiple trauma from February 2011 to July 2012. The patients were older than 18 years and triaged to the cardiopulmonary resuscitation ward of the ED. Bedside ultrasound and radiography were conducted for them. The findings were separately and blindly assessed by 2 radiologists. Sensitivity, specificity, the positive and negative predictive value, and κ coefficient were measured to assess the accuracy and validity of ultrasound as compared with radiography. The sensitivity of ultrasound for diagnosis of limb bone fractures was not high enough and ranged between 55% and 75% depending on the fracture site. The specificity of this diagnostic method had an acceptable range of 62% to 84%. Ultrasound negative prediction value was higher than other indices under study and ranged between 73% and 83%, but its positive prediction value varied between 33.3% and 71%. The κ coefficient for diagnosis of long bone fractures of upper limb (κ = 0.58) and upper limb joints (κ = 0.47) and long bones of lower limb (κ = 0.52) was within the medium range. However, the value for diagnosing fractures of lower limb joints (κ = 0.47) was relatively low. Bedside ultrasound is not a reliable method for diagnosing fractures of upper and lower limb bones compared with radiography. © 2013 Elsevier Inc. All rights reserved.

Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination.

PubMed

Stokke, Thomas M; Ruddox, Vidar; Sarvari, Sebastian I; Otterstad, Jan E; Aune, Erlend; Edvardsen, Thor

2014-11-01

Physical examination and auscultation can be challenging for medical students. The aim of this study was to investigate whether a brief session of group training in focused cardiac ultrasound (FCU) with a pocket-sized device would allow medical students to improve their ability to detect clinically relevant cardiac lesions at the bedside. Twenty-one medical students in their clinical curriculum completed 4 hours of FCU training in groups. The students examined patients referred for echocardiography with emphasis on auscultation, followed by FCU. Findings from physical examination and FCU were compared with those from standard echocardiography performed and analyzed by cardiologists. In total, 72 patients were included in the study, and 110 examinations were performed. With a stethoscope, sensitivity to detect clinically relevant (moderate or greater) valvular disease was 29% for mitral regurgitation, 33% for aortic regurgitation, and 67% for aortic stenosis. FCU improved sensitivity to detect mitral regurgitation (69%, P < .001). However, sensitivity to detect aortic regurgitation (43%) and aortic stenosis (70%) did not improve significantly. Specificity was ≥89% for all valvular diagnoses by both methods. For nonvalvular diagnoses, FCU's sensitivity to detect moderate or greater left ventricular dysfunction (90%) was excellent, detection of right ventricular dysfunction (79%) was good, while detection of dilated left atrium (53%), dilated right atrium (49%), pericardial effusion (40%), and dilated aortic root (25%) was less accurate. Specificity varied from 57% to 94%. After brief group training in FCU, medical students could detect mitral regurgitation significantly better compared with physical examination, whereas detection of aortic regurgitation and aortic stenosis did not improve. Left ventricular dysfunction was detected with high sensitivity. More extensive training is advised. Copyright © 2014 American Society of Echocardiography. Published by

Super-Resolution Image Reconstruction Applied to Medical Ultrasound

NASA Astrophysics Data System (ADS)

Ellis, Michael

Ultrasound is the preferred imaging modality for many diagnostic applications due to its real-time image reconstruction and low cost. Nonetheless, conventional ultrasound is not used in many applications because of limited spatial resolution and soft tissue contrast. Most commercial ultrasound systems reconstruct images using a simple delay-and-sum architecture on receive, which is fast and robust but does not utilize all information available in the raw data. Recently, more sophisticated image reconstruction methods have been developed that make use of far more information in the raw data to improve resolution and contrast. One such method is the Time-Domain Optimized Near-Field Estimator (TONE), which employs a maximum a priori estimation to solve a highly underdetermined problem, given a well-defined system model. TONE has been shown to significantly improve both the contrast and resolution of ultrasound images when compared to conventional methods. However, TONE's lack of robustness to variations from the system model and extremely high computational cost hinder it from being readily adopted in clinical scanners. This dissertation aims to reduce the impact of TONE's shortcomings, transforming it from an academic construct to a clinically viable image reconstruction algorithm. By altering the system model from a collection of individual hypothetical scatterers to a collection of weighted, diffuse regions, dTONE is able to achieve much greater robustness to modeling errors. A method for efficient parallelization of dTONE is presented that reduces reconstruction time by more than an order of magnitude with little loss in image fidelity. An alternative reconstruction algorithm, called qTONE, is also developed and is able to reduce reconstruction times by another two orders of magnitude while simultaneously improving image contrast. Each of these methods for improving TONE are presented, their limitations are explored, and all are used in concert to reconstruct in

Fundamental Study on One-Dimensional-Array Medical Ultrasound Probe with Piezoelectric Polycrystalline Film by Hydrothermal Method: Experimental Fabrication of One-Dimensional-Array Ultrasound Probe

NASA Astrophysics Data System (ADS)

Endo, Akito; Kawashima, Norimichi; Takeuchi, Shinichi; Ishikawa, Mutsuo; Kurosawa, Minoru Kuribayashi

2007-07-01

We deposited a lead zirconate titanete (PZT) polycrystalline film on a titanium substrate by the hydrothermal method and fabricated a transducer using the PZT film for use as an ultrasound probe. A 10 MHz miniature one-dimensional-array medical ultrasound probe containing the PZT film was developed. After sputtering titanium on the surface of a hydroxyapatite substrate, the titanium film on the substrate was etched by the photolithography to form a one-dimensional titanium film electrode array. We could thus fabricate a miniature one-dimensional-array ultrasound probe by the hydrothermal method. Transmitted ultrasound pulses from a 10 MHz commercial ultrasound probe were received by the newly fabricated one-dimensional-array ultrasound probe. The fabrication process of the probe and the results of experiments on receiving waveforms were reported in this paper.

Ultrasound Use in Urinary Stones: Adapting Old Technology for a Modern-Day Disease.

PubMed

Tzou, David T; Usawachintachit, Manint; Taguchi, Kazumi; Chi, Thomas

2017-04-01

Ultrasound has become a mainstay tool in urologists' armamentarium for the diagnosis and management of nephrolithiasis. From starting as a rudimentary form of imaging, it has come to play a more prominent role over time, paralleling evolution in ultrasound technology. Throughout the medical community there is a growing emphasis on reducing the amount of ionizing radiation delivered to patients during routine imaging. As such there has been a resurgence of interest in ultrasound given its lack of associated radiation exposure and proven effectiveness as a diagnostic and therapeutic imaging modality. Herein, we provide a review of the history of ultrasound, how the use of ultrasound is expanding in both diagnosis and treatment of urinary stone disease, and finally how promising applications of ultrasound are shaping the future of kidney stone management.

Ultrasound Use in Urinary Stones: Adapting Old Technology for a Modern-Day Disease

PubMed Central

Tzou, David T.; Usawachintachit, Manint; Taguchi, Kazumi

2017-01-01

Abstract Ultrasound has become a mainstay tool in urologists' armamentarium for the diagnosis and management of nephrolithiasis. From starting as a rudimentary form of imaging, it has come to play a more prominent role over time, paralleling evolution in ultrasound technology. Throughout the medical community there is a growing emphasis on reducing the amount of ionizing radiation delivered to patients during routine imaging. As such there has been a resurgence of interest in ultrasound given its lack of associated radiation exposure and proven effectiveness as a diagnostic and therapeutic imaging modality. Herein, we provide a review of the history of ultrasound, how the use of ultrasound is expanding in both diagnosis and treatment of urinary stone disease, and finally how promising applications of ultrasound are shaping the future of kidney stone management. PMID:27733052

Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment

PubMed Central

Nightingale, Kathryn R.; Church, Charles C.; Harris, Gerald; Wear, Keith A.; Bailey, Michael R.; Carson, Paul L.; Jiang, Hui; Sandstrom, Kurt L.; Szabo, Thomas L.; Ziskin, Marvin C.

2016-01-01

The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher-order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term “conditionally” is included to indicate that CIP would be considered on a per-patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3-tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)-monitored clinical studies investigating CIP in specific tissues. PMID:26112617

Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

PubMed

Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

2014-12-01

Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

Diagnostic accuracy of 3D-transvaginal ultrasound in detecting uterine cavity abnormalities in infertile patients as compared with hysteroscopy.

PubMed

Apirakviriya, Chayanis; Rungruxsirivorn, Tassawan; Phupong, Vorapong; Wisawasukmongchol, Wirach

2016-05-01

To assess diagnostic accuracy of 3D transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women. This prospective observational cross-sectional study was conducted during the July 2013 to December 2013 study period. Sixty-nine women with infertility were enrolled. In the mid to late follicular phase of each subject's menstrual cycle, 3D transvaginal ultrasound and hysteroscopy were performed on the same day in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated. Hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 22 of 69 cases (31.8%). There were 18 endometrial polyps, 3 submucous myomas, and 1 septate uterus. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 84.1% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma and uterine anomaly. For detection of endometrial polyps, 3D-TVS had 61.1% sensitivity, 91.5% specificity, and 83.1% diagnostic accuracy. 3D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of infertile patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Munchausen Syndrome by Proxy: medical diagnostic criteria.

PubMed

Rosenberg, Donna Andrea

2003-04-01

Medical diagnostic criteria for Munchausen Syndrome by Proxy are presented. The strength of the known facts may vary from case to case, and thus there may be different degrees of diagnostic conviction. Therefore, diagnostic criteria for a definitive diagnosis, and a possible diagnosis of Munchausen Syndrome by Proxy are provided. Because the gathering of evidence in a case may, ultimately, diminish or exclude the diagnosis of Munchausen Syndrome by Proxy, diagnostic criteria for the inconclusive determination and the definitely excluded diagnosis are also enunciated.

Non-stationary blind deconvolution of medical ultrasound scans

NASA Astrophysics Data System (ADS)

Michailovich, Oleg V.

2017-03-01

In linear approximation, the formation of a radio-frequency (RF) ultrasound image can be described based on a standard convolution model in which the image is obtained as a result of convolution of the point spread function (PSF) of the ultrasound scanner in use with a tissue reflectivity function (TRF). Due to the band-limited nature of the PSF, the RF images can only be acquired at a finite spatial resolution, which is often insufficient for proper representation of the diagnostic information contained in the TRF. One particular way to alleviate this problem is by means of image deconvolution, which is usually performed in a "blind" mode, when both PSF and TRF are estimated at the same time. Despite its proven effectiveness, blind deconvolution (BD) still suffers from a number of drawbacks, chief among which stems from its dependence on a stationary convolution model, which is incapable of accounting for the spatial variability of the PSF. As a result, virtually all existing BD algorithms are applied to localized segments of RF images. In this work, we introduce a novel method for non-stationary BD, which is capable of recovering the TRF concurrently with the spatially variable PSF. Particularly, our approach is based on semigroup theory which allows one to describe the effect of such a PSF in terms of the action of a properly defined linear semigroup. The approach leads to a tractable optimization problem, which can be solved using standard numerical methods. The effectiveness of the proposed solution is supported by experiments with in vivo ultrasound data.

Tacit knowledge and visual expertise in medical diagnostic reasoning: implications for medical education.

PubMed

Heiberg Engel, Peter Johan

2008-01-01

Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored. To show that the concept of tacit knowledge is important in medical education-at all levels and in medical diagnostic reasoning. Describing how tacit knowledge according to Michael Polany, is experienced and expressed in day-to-day life, it is shown that there is a tacit dimension to all knowledge. Reviewing recent literature on medical diagnostic reasoning, it is shown that tacit knowledge is recognized in connection with concepts such as "non-analytical reasoning" and "dual process of reasoning." It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties.

Abdominal ultrasound (image)

MedlinePlus

Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

Prenatal Sex Selection and Missing Girls in China: Evidence from the Diffusion of Diagnostic Ultrasound

ERIC Educational Resources Information Center

Chen, Yuyu; Li, Hongbin; Meng, Lingsheng

2013-01-01

How much of the increase in sex ratio (male to female) at birth since the early 1980s in China is attributed to increased prenatal sex selection? This question is addressed by exploiting the differential introduction of diagnostic ultrasound in the country during the 1980s, which significantly reduced the cost of prenatal sex selection. We…

Droplets, Bubbles and Ultrasound Interactions.

PubMed

Shpak, Oleksandr; Verweij, Martin; de Jong, Nico; Versluis, Michel

2016-01-01

The interaction of droplets and bubbles with ultrasound has been studied extensively in the last 25 years. Microbubbles are broadly used in diagnostic and therapeutic medical applications, for instance, as ultrasound contrast agents. They have a similar size as red blood cells, and thus are able to circulate within blood vessels. Perfluorocarbon liquid droplets can be a potential new generation of microbubble agents as ultrasound can trigger their conversion into gas bubbles. Prior to activation, they are at least five times smaller in diameter than the resulting bubbles. Together with the violent nature of the phase-transition, the droplets can be used for local drug delivery, embolotherapy, HIFU enhancement and tumor imaging. Here we explain the basics of bubble dynamics, described by the Rayleigh-Plesset equation, bubble resonance frequency, damping and quality factor. We show the elegant calculation of the above characteristics for the case of small amplitude oscillations by linearizing the equations. The effect and importance of a bubble coating and effective surface tension are also discussed. We give the main characteristics of the power spectrum of bubble oscillations. Preceding bubble dynamics, ultrasound propagation is introduced. We explain the speed of sound, nonlinearity and attenuation terms. We examine bubble ultrasound scattering and how it depends on the wave-shape of the incident wave. Finally, we introduce droplet interaction with ultrasound. We elucidate the ultrasound-focusing concept within a droplets sphere, droplet shaking due to media compressibility and droplet phase-conversion dynamics.

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education

PubMed Central

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J.A.; Dandorf, Stewart J.; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-01-01

Introduction Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. Methods This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Results Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). Conclusion The use of this novel cadaver

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education.

PubMed

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J A; Dandorf, Stewart J; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-05-01

Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). The use of this novel cadaver model prevented extravasation of fluid

Adding New Tools to the Black Bag—Introduction of Ultrasound into the Physical Diagnosis Course

PubMed Central

Amponsah, David; Yang, James; Mendez, Jennifer; Bridge, Patrick; Hays, Gregory; Baliga, Sudhir; Crist, Karen; Brennan, Simone; Jackson, Matt; Dulchavsky, Scott

2010-01-01

INTRODUCTION Ultrasound, a versatile diagnostic modality that permits real-time visualization at the patient’s bedside, can be used as an adjunct in teaching physical diagnosis (PD). Aims: (1) to study the feasibility of incorporating ultrasound into PD courses and (2) determine whether learners can demonstrate image recognition and acquisition skills. PROGRAM DESCRIPTION Three hundred seven second-year medical students were introduced to cardiovascular and abdominal ultrasound scanning after training in the physical examination. This consisted of a demonstration of the ultrasound examination, followed by practice on standardized patients (SPs). Pre-post tests were administered to evaluate students’ knowledge and understanding of ultrasound. Students performed an ultrasound examination during the PD final examination. PROGRAM EVALUATION Pre-post test data revealed significant improvements in image recognition. On the final exam, the highest scores (98.4%) were obtained for the internal jugular vein and lowest scores (74.6%) on the Focused Assessment with Sonography for Trauma images. Eighty-nine percent of students’ surveyed felt ultrasound was a valuable tool for physicians. DISCUSSION An introductory ultrasound course is effective in improving medical students' acquisition and recognition of basic cardiovascular and abdominal ultrasound images. This innovative program demonstrates the feasibility of incorporating portable ultrasound as a learning tool during medical school. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1451-5) contains supplementary material, which is available to authorized users. PMID:20697974

Munchausen Syndrome by Proxy: Medical Diagnostic Criteria.

ERIC Educational Resources Information Center

Rosenberg, Donna Andrea

2003-01-01

Medical diagnostic criteria for Munchausen Syndrome by Proxy (a persistent fabrication by one individual of illness in another) are presented. Since the strength of the known facts may vary from case to case, diagnostic criteria are given for a definitive diagnosis, a possible diagnosis, an inconclusive determination, and the definitely excluded…

Hypertrophic Cardiomyopathy in Youth Athletes: Successful Screening With Point-of-Care Ultrasound by Medical Students.

PubMed

Fox, J Christian; Lahham, Shadi; Maldonado, Graciela; Klaus, Suzi; Aish, Bassil; Sylwanowicz, Lauren V; Yanuck, Justin; Wilson, Sean P; Shieh, Mason; Anderson, Craig L; English, Carter; Mayer, Ryan; Mohan, Uthara R

2017-06-01

Hypertrophic cardiomyopathy (HCM) is a life-threatening genetic cardiovascular disease that often goes undetected in young athletes. Neither history nor physical examination are reliable to identify those at risk. The objective of this study is to determine whether minimally trained medical student volunteers can use ultrasound to screen for HCM. This was a prospective enrollment of young athletes performed at 12 area high schools and three area colleges, between May 2012 and August 2013. All participants underwent point-of-care ultrasound performed screening for HCM by trained medical students and reviewed by a pediatric cardiologist. An interventricular septum to left ventricular posterior wall ratio greater than 1.25 was considered to be abnormal (positive screen). A total of 2332 participants were enrolled. There were 137 (5.8%) with a positive screening for HCM, of which 7 (5.1%) were confirmed to have HCM by a pediatric cardiologist. In a small cohort with positive screen for HCM, there was a 100% sensitivity (95% confidence interval, 59.04 to 100%) and 4.86% (95% confidence interval, 1.98 to 9.76%) positive predictive value of for having HCM. Volunteer medical students, using point-of-care ultrasound, were able to effectively screen for HCM in young athletes. © 2017 by the American Institute of Ultrasound in Medicine.

Ultrasound-guided greater occipital nerve blocks and pulsed radiofrequency ablation for diagnosis and treatment of occipital neuralgia.

PubMed

Vanderhoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-09-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves.

Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia

PubMed Central

VanderHoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-01-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves. PMID:24282778

Understanding the medical and nonmedical value of diagnostic testing.

PubMed

Lee, David W; Neumann, Peter J; Rizzo, John A

2010-01-01

To develop a framework for defining the potential value of diagnostic testing, and discuss its implications for the health-care delivery system. We reviewed the conceptual and empirical literature related to the valuing of diagnostic tests, and used this information to create a framework for characterizing their value. We then made inferences about the impact of this framework on health insurance coverage, health technology assessment, physician-patient relationships, and public health policy. Three dimensions can effectively classify the potential value created by diagnostic tests: 1) medical value (impact on treatment decisions); 2) planning value (affect on patients' ability to make better life decisions); and 3) psychic value (how test information affects patients' sense of self). This comprehensive framework for valuing diagnostics suggests that existing health technology assessments may systematically under- or overvalue diagnostics, leading to potentially incorrect conclusions about cost-effectiveness. Further, failure to account for all value dimensions may lead to distorted payments under a value-based health-care system. The potential value created by medical diagnostics incorporates medical value as well as value associated with well-being and planning. Consideration of all three dimensions has important implications for technology assessment and value-based payment.

Goal-Directed Ultrasound for the Diagnosis of Long-Bone Fractures by Crew Medical Officer Analogs

NASA Technical Reports Server (NTRS)

Marshburn, Thomas H.; Legome, Eric; Li, James; Melton, Shannon; Sargsyan, Ashot; Noble, Vickie; Sims, Carrie; Thomsen, Todd; Peralta, Ruben; Briggs, Sue

2002-01-01

Current construction activities on-board the International space Station (ISS) may increase fracture incidence in space, and ultrasound (US) is the only tm-board diagnostic imaging capability. The clinical utility of US in identifying long-bone fractures is un1aowe, particularly using non-radiologist operators. We sought to determine the accuracy of US in identifying fractures of the humerus and femur, as performed by emergency medicine physicians and surgeons with minimal experience in ultrasound image acquisition and interpretation, after a standardized taming session.

Development of a portable therapeutic and high intensity ultrasound system for military, medical, and research use

PubMed Central

Lewis, George K.; Olbricht, William L.

2008-01-01

We have developed a portable high power ultrasound system with a very low output impedance amplifier circuit (less than 0.3 Ω) that can transfer more than 90% of the energy from a battery supply to the ultrasound transducer. The system can deliver therapeutic acoustical energy waves at lower voltages than those in conventional ultrasound systems because energy losses owing to a mismatched impedance are eliminated. The system can produce acoustic power outputs over the therapeutic range (greater then 50 W) from a PZT-4, 1.54 MHz, and 0.75 in diameter piezoelectric ceramic. It is lightweight, portable, and powered by a rechargeable battery. The portable therapeutic ultrasound unit has the potential to replace “plug-in” medical systems and rf amplifiers used in research. The system is capable of field service on its internal battery, making it especially useful for military, ambulatory, and remote medical applications. PMID:19045903

Use of antihypertensive medications and diagnostic tests among privately insured adolescents and young adults with primary versus secondary hypertension.

PubMed

Yoon, Esther Y; Cohn, Lisa; Freed, Gary; Rocchini, Albert; Kershaw, David; Ascione, Frank; Clark, Sarah

2014-07-01

To compare the use of antihypertensive medications and diagnostic tests among adolescents and young adults with primary versus secondary hypertension. We conducted retrospective cohort analysis of claims data for adolescents and young adults (12-21 years of age) with ≥3 years of insurance coverage (≥11 months/year) in a large private managed care plan during 2003-2009 with diagnosis of primary hypertension or secondary hypertension. We examined their use of antihypertensive medications and identified demographic characteristics and the presence of obesity-related comorbidities. For the subset receiving antihypertensive medications, we examined their diagnostic test use (echocardiograms, renal ultrasounds, and electrocardiograms). The study sample included 1,232 adolescents and young adults; 84% had primary hypertension and 16% had secondary hypertension. The overall prevalence rate of hypertension was 2.6%. One quarter (28%) with primary hypertension had one or more antihypertensive medications, whereas 65% with secondary hypertension had one or more antihypertensive medications. Leading prescribers of antihypertensives for subjects with primary hypertension were primary care physicians (80%), whereas antihypertensive medications were equally prescribed by primary care physicians (43%) and sub-specialists (37%) for subjects with secondary hypertension. The predominant hypertension diagnosis among adolescents and young adults is primary hypertension. Antihypertensive medication use was higher among those with secondary hypertension compared with those with primary hypertension. Further study is needed to determine treatment effectiveness and patient outcomes associated with differential treatment patterns used for adolescents and young adults with primary versus secondary hypertension. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A Fast and Robust Beamspace Adaptive Beamformer for Medical Ultrasound Imaging.

PubMed

Mohades Deylami, Ali; Mohammadzadeh Asl, Babak

2017-06-01

Minimum variance beamformer (MVB) increases the resolution and contrast of medical ultrasound imaging compared with nonadaptive beamformers. These advantages come at the expense of high computational complexity that prevents this adaptive beamformer to be applied in a real-time imaging system. A new beamspace (BS) based on discrete cosine transform is proposed in which the medical ultrasound signals can be represented with less dimensions compared with the standard BS. This is because of symmetric beampattern of the beams in the proposed BS compared with the asymmetric ones in the standard BS. This lets us decrease the dimensions of data to two, so a high complex algorithm, such as the MVB, can be applied faster in this BS. The results indicated that by keeping only two beams, the MVB in the proposed BS provides very similar resolution and also better contrast compared with the standard MVB (SMVB) with only 0.44% of needed flops. Also, this beamformer is more robust against sound speed estimation errors than the SMVB.

Sounding out the future of ultrasound education

PubMed Central

Dawson, M; Goudie, A; Mallin, M

2014-01-01

As in so many other fields, the internet has revolutionised medical education. It has done this by circumventing the traditional constraints of medical education, in particular the availability of local resources such as teachers and textbooks. This “education revolution” has been most successful in the areas of theoretical knowledge. This article explores the available resources, and the challenges that arise when attempting to teach point-of-care ultrasound via the internet, such as the visuomotor and visuospatial skills required to create a diagnostic image. This article also describes the progress to date in this field. PMID:27433235

"Anterior convergent" chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study.

PubMed

Ziapour, Behrad; Haji, Houman Seyedjavady

2015-01-01

Occult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital. This diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma. Our index test (US) was used to detect pneumothorax in four pre-defined locations on the anterior of each hemi-thorax using the "Anterior Convergent" approach, and its performance was limited to the primary survey. Consecutively, patients underwent chest-computed tomography (CT) with or without chest radiography. The diagnostic findings of both chest radiography and chest ultrasounds were compared to the gold-standard test (CT). The diagnostic sensitivity was 78 % for US and 36.4 % for chest radiography (p < 0.001); the specificity was 92 % for US and 98 % for chest radiography (not significant); the positive predictive values were 74 % for US and 80 % for chest radiography (not significant); the negative predictive values were 94 % for US and 87 % for chest radiography (not significant); the positive likelihood ratio was 10 for US and 18 for chest radiography (p = 0.007); and the negative likelihood ratio was 0.25 for US and 0.65 for chest radiography (p = 0.001). The mean required time for performing the new method was 64 ± 10 s. An absence of the expected diffused dynamic view among ultrasound images obtained from patients with pneumothorax was also observed. We designated this phenomenon "Gestalt Lung Recession." "Anterior convergent" chest US probing represents a brief but efficient model that provides clinicians a safe and accurate exam and adequate resuscitation during critical minutes of the primary survey without

77 FR 67595 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY.... SUMMARY: The Medical Diagnostic Equipment Accessibility Standards Advisory Committee (Committee) will hold... Equipment Accessibility Standards. DATES: The Committee will meet on December 3, 2012, from 10:00 a.m. to 5...

Cardiac Point-of-Care Ultrasound: State of the Art in Medical School Education.

PubMed

Johri, Amer M; Durbin, Joshua; Newbigging, Joseph; Tanzola, Robert; Chow, Ryan; De, Sabe; Tam, James

2018-03-14

The development of small, user friendly, handheld ultrasound devices has stimulated the growth of cardiac point-of-care ultrasound (POCUS) for the purpose of rapid, bedside cardiac assessment. Medical schools have begun integrating cardiac POCUS into their curricula. In this review the authors summarize the variable approaches taken by several medical training programs with respect to duration of POCUS training, prerequisite knowledge, and methods of delivering these skills (including e-learning, hands-on training, and simulation). The authors also address issues related to the need for competency evaluation and the limitations of the technology itself. The studies reviewed suggest that undergraduate education is a viable point at which to introduce basic POCUS concepts. Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Ultrasound introscopic image quantitative characteristics for medical diagnosis

NASA Astrophysics Data System (ADS)

Novoselets, Mikhail K.; Sarkisov, Sergey S.; Gridko, Alexander N.; Tcheban, Anatoliy K.

1993-09-01

The results on computer aided extraction of quantitative characteristics (QC) of ultrasound introscopic images for medical diagnosis are presented. Thyroid gland (TG) images of Chernobil Accident sufferers are considered. It is shown that TG diseases can be associated with some values of selected QCs of random echo distribution in the image. The possibility of these QCs usage for TG diseases recognition in accordance with calculated values is analyzed. The role of speckle noise elimination in the solution of the problem on TG diagnosis is considered too.

[Differential diagnostic value of real-time tissue elastography and three dimensional ultrasound imaging in breast lumps].

PubMed

Li, M H; Liu, Y; Liu, L S; Li, P X; Chen, Q

2016-05-24

To investigate the real-time tissue elastography and 3D contrast-enhanced ultrasonography(CEUS) in breast lumps differential diagnostic value. A total of 126 patients (180 lumps) with breast mass were retrospectively analyzed from December 2012 to December 2014 in Tumor Hospital Affiliated To Xinjiang Medical University.All patients were divided into three groups by using stratified random method.Each group was detected by real-time tissue elastography, 3D CEUS and two joint inspection.Each group of 42 cases (60 lumps) was confirmed by the pathological results as gold standard.Diagnostic sensitivity, specificity and coincidence rate of different methods were compared. The benign masses of ultrasound contrast showed the punctate, linear and nodular enhancement, and the border of enhancement was smooth.The malignant tumors were mainly dominated by uneven and high enhancement. There was no statistical difference in sensitivity, specificity and coincidence rate between elastography group and 3D CEUS group (64.7% vs 73.5%, 69.2% vs 76.9%, 66.7% vs 75.0%, all P>0.05). The sensitivity, specificity and coincidence rate of two joint inspection group were higher than those of elastography group and 3D CEUS group, the differences were statistically significant (97.1%, 92.3% and 98.3% , all P<0.05). 3D CEUS combined with real-time tissue elastography is of high value in the diagnosis of breast masses.

Displacement analysis of diagnostic ultrasound backscatter: A methodology for characterizing, modeling, and monitoring high intensity focused ultrasound therapy

PubMed Central

Speyer, Gavriel; Kaczkowski, Peter J.; Brayman, Andrew A.; Crum, Lawrence A.

2010-01-01

Accurate monitoring of high intensity focused ultrasound (HIFU) therapy is critical for widespread clinical use. Pulse-echo diagnostic ultrasound (DU) is known to exhibit temperature sensitivity through relative changes in time-of-flight between two sets of radio frequency (RF) backscatter measurements, one acquired before and one after therapy. These relative displacements, combined with knowledge of the exposure protocol, material properties, heat transfer, and measurement noise statistics, provide a natural framework for estimating the administered heating, and thereby therapy. The proposed method, termed displacement analysis, identifies the relative displacements using linearly independent displacement patterns, or modes, each induced by a particular time-varying heating applied during the exposure interval. These heating modes are themselves linearly independent. This relationship implies that a linear combination of displacement modes aligning the DU measurements is the response to an identical linear combination of heating modes, providing the heating estimate. Furthermore, the accuracy of coefficient estimates in this approximation is determined a priori, characterizing heating, thermal dose, and temperature estimates for any given protocol. Predicted performance is validated using simulations and experiments in alginate gel phantoms. Evidence for a spatially distributed interaction between temperature and time-of-flight changes is presented. PMID:20649206

New heights in ultrasound: first report of spinal ultrasound from the international space station.

PubMed

Marshburn, Thomas H; Hadfield, Chris A; Sargsyan, Ashot E; Garcia, Kathleen; Ebert, Douglas; Dulchavsky, Scott A

2014-01-01

Changes in the lumbar and sacral spine occur with exposure to microgravity in astronauts; monitoring these alterations without radiographic capabilities on the International Space Station (ISS) requires novel diagnostic solutions to be developed. We evaluated the ability of point-of-care ultrasound, performed by nonexpert-operator astronauts, to provide accurate anatomic information about the spine in long-duration crewmembers in space. Astronauts received brief ultrasound instruction on the ground and performed in-flight cervical and lumbosacral ultrasound examinations using just-in-time training and remote expert tele-ultrasound guidance. Ultrasound examinations on the ISS used a portable ultrasound device with real-time communication/guidance with ground experts in Mission Control. The crewmembers were able to obtain diagnostic-quality examinations of the cervical and lumbar spine that would provide essential information about acute or chronic changes to the spine. Spinal ultrasound provides essential anatomic information in the cervical and lumbosacral spine; this technique may be extensible to point-of-care situations in emergency departments or resource-challenged areas without direct access to additional radiologic capabilities. Copyright © 2014 Elsevier Inc. All rights reserved.

Ultrasound Enhanced Matrix Metalloproteinase-9 Triggered Release of Contents from Echogenic Liposomes

PubMed Central

Nahire, Rahul; Paul, Shirshendu; Scott, Michael D.; Singh, Raushan K.; Muhonen, Wallace W.; Shabb, John; Gange, Kara N.; Srivastava, D. K.; Sarkar, Kausik; Mallik, Sanku

2012-01-01

The extracellular enzyme matrix metalloproteinase-9 (MMP-9) is overexpressed in atherosclerotic plaques and in metastatic cancers. The enzyme is responsible for rupture of the plaques and for the invasion and metastasis of a large number of cancers. The ability of ultrasonic excitation to induce thermal and mechanical effects has been used to release drugs from different carriers. However, majority of these studies were performed with low frequency ultrasound (LFUS) at kHz frequencies. Clinical usage of LFUS excitations will be limited due to harmful biological effects. Herein, we report our results on the release of encapsulated contents from substrate lipopeptide incorporated echogenic liposomes triggered by recombinant human MMP-9. The contents release was further enhanced by the application of diagnostic frequency (3 MHz) ultrasound. The echogenic liposomes were successfully imaged employing a medical ultrasound transducer (4 – 15 MHz). The conditioned cell culture media from cancer cells (secreting MMP-9) released the encapsulated dye from the liposomes (30 – 50%) and this release is also increased (50 – 80%) by applying diagnostic frequency ultrasound (3 MHz) for 3 minutes. With further developments, these liposomes have the potential to serve as multimodal carriers for triggered release and simultaneous ultrasound imaging. PMID:22849291

MIIP: a web-based platform for medical image interpretation training and evaluation focusing on ultrasound

NASA Astrophysics Data System (ADS)

Lindseth, Frank; Nordrik Hallan, Marte; Schiller Tønnessen, Martin; Smistad, Erik; Vâpenstad, Cecilie

2017-03-01

Introduction: Medical imaging technology has revolutionized health care over the past 30 years. This is especially true for ultrasound, a modality that an increasing amount of medical personal is starting to use. Purpose: The purpose of this study was to develop and evaluate a platform for improving medical image interpretation skills regardless of time and space and without the need for expensive imaging equipment or a patient to scan. Methods, results and conclusions: A stable web application with the needed functionality for image interpretation training and evaluation has been implemented. The system has been extensively tested internally and used during an international course in ultrasound-guided neurosurgery. The web application was well received and got very good System Usability Scale (SUS) scores.

Ultrasound criteria and guided fine-needle aspiration diagnostic yields in small animal peritoneal, mesenteric and omental disease.

PubMed

Feeney, Daniel A; Ober, Christopher P; Snyder, Laura A; Hill, Sara A; Jessen, Carl R

2013-01-01

Peritoneal, mesenteric, and omental diseases are important causes of morbidity and mortality in humans and animals, although information in the veterinary literature is limited. The purposes of this retrospective study were to determine whether objectively applied ultrasound interpretive criteria are statistically useful in differentiating among cytologically defined normal, inflammatory, and neoplastic peritoneal conditions in dogs and cats. A second goal was to determine the cytologically interpretable yield on ultrasound-guided, fine-needle sampling of peritoneal, mesenteric, or omental structures. Sonographic criteria agreed upon by the authors were retrospectively and independently applied by two radiologists to the available ultrasound images without knowledge of the cytologic diagnosis and statistically compared to the ultrasound-guided, fine-needle aspiration cytologic interpretations. A total of 72 dogs and 49 cats with abdominal peritoneal, mesenteric, or omental (peritoneal) surface or effusive disease and 17 dogs and 3 cats with no cytologic evidence of inflammation or neoplasia were included. The optimized, ultrasound criteria-based statistical model created independently for each radiologist yielded an equation-based diagnostic category placement accuracy of 63.2-69.9% across the two involved radiologists. Regional organ-associated masses or nodules as well as aggregated bowel and peritoneal thickening were more associated with peritoneal neoplasia whereas localized, severely complex fluid collections were more associated with inflammatory peritoneal disease. The cytologically interpretable yield for ultrasound-guided fine-needle sampling was 72.3% with no difference between species, making this a worthwhile clinical procedure. © 2013 Veterinary Radiology & Ultrasound.

Noninvasive Medical Diagnostics & Treatment Using Ultrasonics

NASA Technical Reports Server (NTRS)

Bar-Cohen, Y.; Siegel, R.; Grandia, W.

1998-01-01

In parallel to the industrial application of NDE to flaw detection and material property determination, the medical community has succesfully adapted such methods to the noninvasaive diagnostics and treatment of many conditions and disorders of the human body.

Finite difference modelling of the temperature rise in non-linear medical ultrasound fields.

PubMed

Divall, S A; Humphrey, V F

2000-03-01

Non-linear propagation of ultrasound can lead to increased heat generation in medical diagnostic imaging due to the preferential absorption of harmonics of the original frequency. A numerical model has been developed and tested that is capable of predicting the temperature rise due to a high amplitude ultrasound field. The acoustic field is modelled using a numerical solution to the Khokhlov-Zabolotskaya-Kuznetsov (KZK) equation, known as the Bergen Code, which is implemented in cylindrical symmetric form. A finite difference representation of the thermal equations is used to calculate the resulting temperature rises. The model allows for the inclusion of a number of layers of tissue with different acoustic and thermal properties and accounts for the effects of non-linear propagation, direct heating by the transducer, thermal diffusion and perfusion in different tissues. The effect of temperature-dependent skin perfusion and variation in background temperature between the skin and deeper layers of the body are included. The model has been tested against analytic solutions for simple configurations and then used to estimate temperature rises in realistic obstetric situations. A pulsed 3 MHz transducer operating with an average acoustic power of 200 mW leads to a maximum steady state temperature rise inside the foetus of 1.25 degrees C compared with a 0.6 degree C rise for the same transmitted power under linear propagation conditions. The largest temperature rise occurs at the skin surface, with the temperature rise at the foetus limited to less than 2 degrees C for the range of conditions considered.

[Diagnostic performance of biliary ultrasound vs. magnetic resonance cholangiogram in patients with recurrent biliary obstruction.].

PubMed

Chávez-Valencia, V; Espinosa-Ortega, H F; Espinoza-Peralta, D; Arce-Salinas, C A

2009-01-01

Obstructive jaundice in patients with previous cholecystectomy requires a precise diagnosis. In the diagnostic algorithm, biliary ultrasound (BUS) and magnetic resonance cholangiogram (MRC) are used, although the accuracy of each method is unknown in our setting. No previous comparison of US and MRC in subjects with cholecystectomy has been made. To determine diagnostic accuracy of BUS and MRC in patients with recurrent biliary obstruction. Patients with endoscopic retrograde cholangiopacreatography (ERCP) demonstrating recurrent biliary obstruction by stones were included. All patients underwent BUS and MRC. We determined the diagnostic performance of each image study compared with ERCP. Twenty-seven patients with a mean age of 62.9 +/- 17.3 years-old were included. Sensitivity and specificity of BUS were 0.12 and 0.58, respectively. Figures for MRC were 0.88 and 0.82. Diagnostic agreement between ERCP and MRC was k= 0.66 whereas BUS had a k of only 0.26. MRC had good diagnostic performance for recurrent choledocolithiasis. BUS demonstrated lower accuracy compared with previous reports, so should not be considered in the initial approach of recurrent choledocus obstruction.

Machine Learning in Ultrasound Computer-Aided Diagnostic Systems: A Survey

PubMed Central

Zhang, Fan; Li, Xuelong

2018-01-01

The ultrasound imaging is one of the most common schemes to detect diseases in the clinical practice. There are many advantages of ultrasound imaging such as safety, convenience, and low cost. However, reading ultrasound imaging is not easy. To support the diagnosis of clinicians and reduce the load of doctors, many ultrasound computer-aided diagnosis (CAD) systems are proposed. In recent years, the success of deep learning in the image classification and segmentation led to more and more scholars realizing the potential of performance improvement brought by utilizing the deep learning in the ultrasound CAD system. This paper summarized the research which focuses on the ultrasound CAD system utilizing machine learning technology in recent years. This study divided the ultrasound CAD system into two categories. One is the traditional ultrasound CAD system which employed the manmade feature and the other is the deep learning ultrasound CAD system. The major feature and the classifier employed by the traditional ultrasound CAD system are introduced. As for the deep learning ultrasound CAD, newest applications are summarized. This paper will be useful for researchers who focus on the ultrasound CAD system. PMID:29687000

Machine Learning in Ultrasound Computer-Aided Diagnostic Systems: A Survey.

PubMed

Huang, Qinghua; Zhang, Fan; Li, Xuelong

2018-01-01

The ultrasound imaging is one of the most common schemes to detect diseases in the clinical practice. There are many advantages of ultrasound imaging such as safety, convenience, and low cost. However, reading ultrasound imaging is not easy. To support the diagnosis of clinicians and reduce the load of doctors, many ultrasound computer-aided diagnosis (CAD) systems are proposed. In recent years, the success of deep learning in the image classification and segmentation led to more and more scholars realizing the potential of performance improvement brought by utilizing the deep learning in the ultrasound CAD system. This paper summarized the research which focuses on the ultrasound CAD system utilizing machine learning technology in recent years. This study divided the ultrasound CAD system into two categories. One is the traditional ultrasound CAD system which employed the manmade feature and the other is the deep learning ultrasound CAD system. The major feature and the classifier employed by the traditional ultrasound CAD system are introduced. As for the deep learning ultrasound CAD, newest applications are summarized. This paper will be useful for researchers who focus on the ultrasound CAD system.

Medical Ultrasound Technology Research and Development at the University of Washington Center for Industrial and Medical Ultrasound

DTIC Science & Technology

2003-10-02

provide a world-class, advanced research center for bioengineering development and graduate education in high-intensity, focused ultrasound ( HIFU ). This...convenient, and robust. These technological enhancements have enabled the development of HIFU arrays and image-guided ultrasound systems for greater... Ultrasound (CIMU). The many disparate facilities and technical capabilities available to CIMU staff and students were integrated and enhanced to

Comparison of Inter-Observer Variability and Diagnostic Performance of the Fifth Edition of BI-RADS for Breast Ultrasound of Static versus Video Images.

PubMed

Youk, Ji Hyun; Jung, Inkyung; Yoon, Jung Hyun; Kim, Sung Hun; Kim, You Me; Lee, Eun Hye; Jeong, Sun Hye; Kim, Min Jung

2016-09-01

Our aim was to compare the inter-observer variability and diagnostic performance of the Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast ultrasound of static and video images. Ninety-nine breast masses visible on ultrasound examination from 95 women 19-81 y of age at five institutions were enrolled in this study. They were scheduled to undergo biopsy or surgery or had been stable for at least 2 y of ultrasound follow-up after benign biopsy results or typically benign findings. For each mass, representative long- and short-axis static ultrasound images were acquired; real-time long- and short-axis B-mode video images through the mass area were separately saved as cine clips. Each image was reviewed independently by five radiologists who were asked to classify ultrasound features according to the fifth edition of the BI-RADS lexicon. Inter-observer variability was assessed using kappa (κ) statistics. Diagnostic performance on static and video images was compared using the area under the receiver operating characteristic curve. No significant difference was found in κ values between static and video images for all descriptors, although κ values of video images were higher than those of static images for shape, orientation, margin and calcifications. After receiver operating characteristic curve analysis, the video images (0.83, range: 0.77-0.87) had higher areas under the curve than the static images (0.80, range: 0.75-0.83; p = 0.08). Inter-observer variability and diagnostic performance of video images was similar to that of static images on breast ultrasonography according to the new edition of BI-RADS. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Diagnostic utility of abdominal ultrasonography in dogs with chronic vomiting.

PubMed

Leib, M S; Larson, M M; Panciera, D L; Troy, G C; Monroe, W E; Rossmeisl, J H; Forrester, S D; Herring, E S

2010-01-01

Chronic vomiting is a common problem in dogs that has many causes. Ultrasonographic descriptions of many gastrointestinal (GI) diseases have been published. However, diagnostic utility of ultrasonography in dogs with chronic vomiting has not been investigated. Diagnostic utility of abdominal ultrasound will be highest in dogs with GI neoplasia and lowest in those with inflammatory disorders. Eighty-nine pet dogs with chronic vomiting. Medical records were reviewed and the contribution of abdominal ultrasound to the clinical diagnosis was subjectively scored. In 68.5% of dogs, the reviewers thought that the same diagnosis would have been reached without performing ultrasonography. In 22.5% of dogs, the ultrasound examination was considered to be vital or beneficial to the diagnosis. Univariable analysis identified that increased diagnostic utility was associated with increasing age, a greater number of vomiting episodes per week, presence of weight loss, a greater percentage of lost body weight, and a final diagnosis of GI lymphoma or gastric adenocarcinoma. However, multivariate analysis only identified increasing age and a final diagnosis of gastric adenocarcinoma or GI lymphoma to be associated with increased diagnostic utility. In 12.4% of dogs, additional benefits of ultrasonography to case management, excluding the contribution to the vomiting problem, were identified. The diagnostic utility of abdominal ultrasonography was high in 27% of dogs. The presence of factors that are associated with high diagnostic utility is an indication to perform abdominal ultrasonography in dogs with chronic vomiting.

Point-of-Care Ultrasound: A Trend in Health Care.

PubMed

Buerger, Anita M; Clark, Kevin R

2017-11-01

To discuss the current and growing use of point-of-care (POC) ultrasound in the management and care of patients. Several electronic research databases were searched to find articles that emphasized the use of POC ultrasound by health care providers who manage and treat critically ill or injured patients. Thirty-five relevant peer-reviewed journal articles were selected for this literature review. Common themes identified in the literature included the use of POC ultrasound in emergency medicine, military medicine, and remote care; comparison of POC ultrasound to other medical imaging modalities; investigation of the education and training required for nonimaging health care professionals who perform POC ultrasound in their practices; and discussion of the financial implications and limitations of POC ultrasound. POC ultrasound provides clinicians with real-time information to better manage and treat critically ill or injured patients in emergency medicine, military medicine, and remote care. In addition to providing immediate bedside diagnostic information, use of POC ultrasound has increased because of concerns regarding radiation protection. Finally, the expansion of POC ultrasound to other specialty areas requires nonimaging health care professionals to perform bedside ultrasound examinations and interpret the resulting images. Because POC ultrasound is user-dependent, adequate training is essential for all who perform and interpret the examinations. Research involving POC ultrasound will continue as innovations and confidence in ultrasound applications advance. Future research should continue to examine the broad use of POC ultrasound in patient care and management. ©2017 American Society of Radiologic Technologists.

Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow.

PubMed

Morgan, Tara A; Jha, Priyanka; Poder, Liina; Weinstein, Stefanie

2018-04-09

Ultrasound is routinely used as the first imaging exam for evaluation of renal transplants and can identify most major surgical complications and evaluate vascularity with color Doppler. Ultrasound is limited, however, in the detection of parenchymal disease processes and Doppler evaluation is also prone to technical errors. Multiple new ultrasound applications have been developed and are under ongoing investigation which could add additional diagnostic capability to the routine ultrasound exam with minimal additional time, cost, and patient risk. Contrast-enhanced ultrasound (CEUS) can be used off-label in the transplant kidney, and can assist in detection of infection, trauma, and vascular complications. CEUS also can demonstrate perfusion of the transplant assessed quantitatively with generation of time-intensity curves. Future directions of CEUS include monitoring treatment response and microbubble targeted medication delivery. Elastography is an ultrasound application that can detect changes in tissue elasticity, which is useful to diagnose diffuse parenchymal disease, such as fibrosis, otherwise unrecognizable with ultrasound. Elastography has been successfully applied in other organs including the liver, thyroid, and breast; however, it is still under development for use in the transplant kidney. Unique properties of the transplant kidney including its heterogeneity, anatomic location, and other technical factors present challenges in the development of reference standard measurements. Lastly, B-flow imaging is a flow application derived from B-mode. This application can show the true lumen size of a vessel which is useful to depict vascular anatomy and bypasses some of the pitfalls of color Doppler such as demonstration of slow flow.

Screening esophagus during routine ultrasound: medical and cost benefits.

PubMed

Abd Elrazek, Abd Elrazek M A; Eid, Khaled A; El-Sherif, Abd Elhalim A; Abd El Al, Usama M; El-Sherbiny, Samir M; Bilasy, Shymaa E

2015-01-01

Cost-effectiveness analysis is an approach used to determine the value of a medical care option and refers to a method used to assess the costs and health benefits of an intervention. Upon the diagnosis of liver cirrhosis, the current guidelines recommend that all cirrhotic patients have to be screened for the presence of esophageal varices by endoscopy. In addition, patients with a positive family history of esophageal cancer are screened annually. These approaches place a heavy burden on endoscopy units, and repeated testing over time may have a detrimental effect on patient compliance. Following the recommendations of a recent study entitled 'Detection of risky esophageal varices using two dimensional ultrasound: when to perform endoscopy', the intra-abdominal portion of the esophagus of 1100 patients was divided into a hepatic group, which included 650 patients, and a nonhepatic group, which included 450 patients, who presented with manifestations of liver diseases and gastrointestinal symptoms, respectively, and were examined using standard two-dimensional ultrasound (US) to evaluate cost effectiveness, standard issues, and medical benefits using conventional US. The overall effectiveness analysis of 1100 patients yielded a 41% cost standard benefit calculated to be $114,760 in a 6-month study. Two-dimensional US can play an important role in screening for esophageal abnormalities, thus saving money and time. The esophagus should be screened during routine conventional abdominal US.

Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: A systematic review and meta-analysis

PubMed Central

Ablordeppey, Enyo A.; Drewry, Anne M.; Beyer, Alexander B.; Theodoro, Daniel L.; Fowler, Susan A.; Fuller, Brian M.; Carpenter, Christopher R.

2016-01-01

Objective We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared to chest radiography. Data Sources PubMed, EMBASE, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov Study Selection Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2×2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, inter-rater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Data Extraction Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Data Synthesis 15 studies with 1553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 [0.77, 0.86] and 0.98 [0.97, 0.99] respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 [14.72, 65.78] and 0.25 [0.13, 0.47]. The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Conclusions Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis.

PubMed

Ablordeppey, Enyo A; Drewry, Anne M; Beyer, Alexander B; Theodoro, Daniel L; Fowler, Susan A; Fuller, Brian M; Carpenter, Christopher R

2017-04-01

We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than

Two-dimensional airborne ultrasound real-time linear array scanner--applied to screening for scoliosis.

PubMed

Mauritzson, L; Ilver, J; Benoni, G; Lindström, K; Willner, S

1991-01-01

Diagnostic ultrasound is an established, noninvasive and harmless method for imaging the shape and appearance of organs and other tissues inside the body, and it has been used in many clinical applications for more than three decades. We have now applied some of this well-known technique together with the use of airborne ultrasound in medical applications, to build an equipment for anthropometrical investigation outside the body, e.g., measuring and registration of the shape and form of the human back. This is mostly done for screening purposes of young people in an attempt to find patients developing scoliosis, and in order to circumvent some of the disadvantages with the traditional screening method in this field of medical application.

American Institute of Ultrasound in Medicine

MedlinePlus

... Ultrasound Pediatric Ultrasound Point-of-Care Ultrasound Sonography Therapeutic Ultrasound Ultrasound in Global Health Ultrasound in Medical Education CME Center CME Tracker Annual Convention Journal Tests ...

Anniversary paper: evolution of ultrasound physics and the role of medical physicists and the AAPM and its journal in that evolution.

PubMed

Carson, Paul L; Fenster, Aaron

2009-02-01

Ultrasound has been the greatest imaging modality worldwide for many years by equipment purchase value and by number of machines and examinations. It is becoming increasingly the front end imaging modality; serving often as an extension of the physician's fingers. We believe that at the other extreme, high-end systems will continue to compete with all other imaging modalities in imaging departments to be the method of choice for various applications, particularly where safety and cost are paramount. Therapeutic ultrasound, in addition to the physiotherapy practiced for many decades, is just coming into its own as a major tool in the long progression to less invasive interventional treatment. The physics of medical ultrasound has evolved over many fronts throughout its history. For this reason, a topical review, rather than a primarily chronological one is presented. A brief review of medical ultrasound imaging and therapy is presented, with an emphasis on the contributions of medical physicists, the American Association of Physicists in Medicine (AAPM) and its publications, particularly its journal Medical Physics. The AAPM and Medical Physics have contributed substantially to training of physicists and engineers, medical practitioners, technologists, and the public.

Formulation and acoustic studies of a new phase-shift agent for diagnostic and therapeutic ultrasound.

PubMed

Sheeran, Paul S; Luois, Samantha; Dayton, Paul A; Matsunaga, Terry O

2011-09-06

Recent efforts in the area of acoustic droplet vaporization with the objective of designing extravascular ultrasound contrast agents has led to the development of stabilized, lipid-encapsulated nanodroplets of the highly volatile compound decafluorobutane (DFB). We developed two methods of generating DFB droplets, the first of which involves condensing DFB gas (boiling point from -1.1 to -2 °C) followed by extrusion with a lipid formulation in HEPES buffer. Acoustic droplet vaporization of micrometer-sized lipid-coated droplets at diagnostic ultrasound frequencies and mechanical indices were confirmed optically. In our second formulation methodology, we demonstrate the formulation of submicrometer-sized lipid-coated nanodroplets based upon condensation of preformed microbubbles containing DFB. The droplets are routinely in the 200-300 nm range and yield microbubbles on the order of 1-5 μm once vaporized, consistent with ideal gas law expansion predictions. The simple and effective nature of this methodology allows for the development of a variety of different formulations that can be used for imaging, drug and gene delivery, and therapy. This study is the first to our knowledge to demonstrate both a method of generating ADV agents by microbubble condensation and formulation of primarily submicrometer droplets of decafluorobutane that remain stable at physiological temperatures. Finally, activation of DFB nanodroplets is demonstrated using pressures within the FDA guidelines for diagnostic imaging, which may minimize the potential for bioeffects in humans. This methodology offers a new means of developing extravascular contrast agents for diagnostic and therapeutic applications. © 2011 American Chemical Society

Ultrasound-guided synovial biopsy

PubMed Central

Sitt, Jacqueline C M; Wong, Priscilla

2016-01-01

Ultrasound-guided needle biopsy of synovium is an increasingly performed procedure with a high diagnostic yield. In this review, we discuss the normal synovium, as well as the indications, technique, tissue handling and clinical applications of ultrasound-guided synovial biopsy. PMID:26581578

Diagnostic utility of abdominal ultrasonography in dogs with chronic diarrhea.

PubMed

Leib, M S; Larson, M M; Grant, D C; Monroe, W E; Troy, G C; Panciera, D L; Rossmeisl, J H; Werre, S R

2012-01-01

Chronic diarrhea is common in dogs and has many causes. Ultrasonographic descriptions of many gastrointestinal diseases have been published, but the diagnostic utility of ultrasonography in dogs with chronic diarrhea has not been investigated. Diagnostic utility of abdominal ultrasound will be highest in dogs with GI neoplasia and lowest in those with inflammatory disorders. 87 pet dogs with chronic diarrhea. Prospective study in which medical records were reviewed and contribution of abdominal ultrasound toward making diagnosis was scored. In 57/87 (66%) of dogs, the same diagnosis would have been reached without ultrasonography. In 13/87 (15%) of dogs, the ultrasound examination was vital or beneficial to making the diagnosis. Univariable analysis identified that increased diagnostic utility was associated with weight loss (P = .0086), palpation of an abdominal or rectal mass (P = .0031), diseases that commonly have mass lesions visible on ultrasound examination (P < .0001), and a final diagnosis of GI neoplasia. Multivariable regression indicated that utility of abdominal ultrasonography would be 30 times more likely to be high in dogs in which an abdominal or rectal mass was palpated (odds ratio 30.5, 95% CI 5.5-169.6) (P < .0001) versus dogs without a palpable mass. In 15/87 (17%) of dogs, additional benefits of ultrasonography to case management, independent of the contribution to the diagnosis of diarrhea, were identified. Overall, the diagnostic utility of abdominal ultrasonography was low in dogs with chronic diarrhea. Identification of factors associated with high diagnostic utility is an indication to perform abdominal ultrasonography in dogs with chronic diarrhea. Copyright © 2012 by the American College of Veterinary Internal Medicine.

Ultrasound Imaging System Video

NASA Technical Reports Server (NTRS)

2002-01-01

In this video, astronaut Peggy Whitson uses the Human Research Facility (HRF) Ultrasound Imaging System in the Destiny Laboratory of the International Space Station (ISS) to image her own heart. The Ultrasound Imaging System provides three-dimension image enlargement of the heart and other organs, muscles, and blood vessels. It is capable of high resolution imaging in a wide range of applications, both research and diagnostic, such as Echocardiography (ultrasound of the heart), abdominal, vascular, gynecological, muscle, tendon, and transcranial ultrasound.

ICNIRP Statement on Diagnostic Devices Using Non-ionizing Radiation: Existing Regulations and Potential Health Risks.

PubMed

2017-03-01

Use of non-ionizing radiation (NIR) for diagnostic purposes allows non-invasive assessment of the structure and function of the human body and is widely employed in medical care. ICNIRP has published previous statements about the protection of patients during medical magnetic resonance imaging (MRI), but diagnostic methods using other forms of NIR have not been considered. This statement reviews the range of diagnostic NIR devices currently used in clinical settings; documents the relevant regulations and policies covering patients and health care workers; reviews the evidence around potential health risks to patients and health care workers exposed to diagnostic NIR; and identifies situations of high NIR exposure from diagnostic devices in which patients or health care workers might not be adequately protected by current regulations. Diagnostic technologies were classified by the types of NIR that they employ. The aim was to describe the techniques in terms of general device categories which may encompass more specific devices or techniques with similar scientific principles. Relevant legally-binding regulations for protection of patients and workers and organizations responsible for those regulations were summarized. Review of the epidemiological evidence concerning health risks associated with exposure to diagnostic NIR highlighted a lack of data on potential risks to the fetus exposed to MRI during the first trimester, and on long-term health risks in workers exposed to MRI. Most of the relevant epidemiological evidence that is currently available relates to MRI or ultrasound. Exposure limits are needed for exposures from diagnostic technologies using optical radiation within the body. There is a lack of data regarding risk of congenital malformations following exposure to ultrasound in utero in the first trimester and also about the possible health effects of interactions between ultrasound and contrast media.

ICNIRP Statement on Diagnostic Devices Using Non-ionizing Radiation: Existing Regulations and Potential Health Risks

PubMed Central

2017-01-01

Abstract Use of non-ionizing radiation (NIR) for diagnostic purposes allows non-invasive assessment of the structure and function of the human body and is widely employed in medical care. ICNIRP has published previous statements about the protection of patients during medical magnetic resonance imaging (MRI), but diagnostic methods using other forms of NIR have not been considered. This statement reviews the range of diagnostic NIR devices currently used in clinical settings; documents the relevant regulations and policies covering patients and health care workers; reviews the evidence around potential health risks to patients and health care workers exposed to diagnostic NIR; and identifies situations of high NIR exposure from diagnostic devices in which patients or health care workers might not be adequately protected by current regulations. Diagnostic technologies were classified by the types of NIR that they employ. The aim was to describe the techniques in terms of general device categories which may encompass more specific devices or techniques with similar scientific principles. Relevant legally-binding regulations for protection of patients and workers and organizations responsible for those regulations were summarized. Review of the epidemiological evidence concerning health risks associated with exposure to diagnostic NIR highlighted a lack of data on potential risks to the fetus exposed to MRI during the first trimester, and on long-term health risks in workers exposed to MRI. Most of the relevant epidemiological evidence that is currently available relates to MRI or ultrasound. Exposure limits are needed for exposures from diagnostic technologies using optical radiation within the body. There is a lack of data regarding risk of congenital malformations following exposure to ultrasound in utero in the first trimester and also about the possible health effects of interactions between ultrasound and contrast media. PMID:28121732

Medical ultrasound education for bioengineers

NASA Astrophysics Data System (ADS)

Vaezy, Shahram

2005-04-01

The widespread adoption of ultrasound technologies in medicine has necessitated the development of educational programs to address the growing demand for trained expertise in both academia and industry. The demand has been especially great in the field of therapeutic ultrasound that has experienced a significant level of research and development activities in the past decade. The applications cover a wide range including cancer treatment, hemorrhage control, cardiac ablation, gene therapy, and cosmetic surgery. A comprehensive educational program in ultrasound is well suited for bioengineering departments at colleges and universities. Our educational program for students in Bioengineering at the University of Washington includes a year-long coursework covering theory and practice of ultrasound, conducting research projects, attending and presenting at weekly seminars on literature survey, presentations at scientific meetings, and attending specialized workshops offered by various institutions for specific topics. An important aspect of this training is its multi-disciplinary approach, encompassing science, engineering, and medicine. The students are required to build teams with expertise in these disciplines. Our experience shows that these students are well prepared for careers in academia, conducting cutting edge research, as well as industry, being involved in the transformation of research end-products to commercially viable technology.

Non-invasive assessment of negative pressure wound therapy using high frequency diagnostic ultrasound: oedema reduction and new tissue accumulation.

PubMed

Young, Stephen R; Hampton, Sylvie; Martin, Robin

2013-08-01

Tissue oedema plays an important role in the pathology of chronic and traumatic wounds. Negative pressure wound therapy (NPWT) is thought to contribute to active oedema reduction, yet few studies have showed this effect. In this study, high frequency diagnostic ultrasound at 20 MHz with an axial resolution of 60 µm was used to assess the effect of NPWT at - 80 mmHg on pressure ulcers and the surrounding tissue. Wounds were monitored in four patients over a 3-month period during which changes in oedema and wound bed thickness (granulation tissue) were measured non-invasively. The results showed a rapid reduction of periwound tissue oedema in all patients with levels falling by a mean of 43% after 4 days of therapy. A 20% increase in the thickness of the wound bed was observed after 7 days due to new granulation tissue formation. Ultrasound scans through the in situ gauze NPWT filler also revealed the existence of macrodeformation in the tissue produced by the negative pressure. These preliminary studies suggest that non-invasive assessment using high frequency diagnostic ultrasound could be a valuable tool in clinical studies of NPWT. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

The Role of Anthropomorphic Phantoms in Diagnostic Ultrasound Imaging for Disease Characterization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cannon, L. M.; King, D. M.; Browne, J. E.

2009-04-19

An anthropomorhic phantom is an object that can mimic a region of the human anatomy. Anthropomorphic phantoms have a variety of roles in diagnostic ultrasound. These roles include quality assurance testing of ultrasound machines, calibration and testing of new imaging techniques, training of sonographers, and--most importantly--use as a tool to obtain a better understanding of disease progression in the relevant anatomy. To be anthropomorphic a phantom must accurately mimic the body in terms of its ultrasonic and mechanical properties, as well as anatomically. The acoustic properties are speed of sound, attenuation, and backscatter. The mechanical properties are elasticity and density.more » Phantoms are constructed from tissue-mimicking materials (TMMs). TMMs are prepared from a variety of ingredients, such as gelatine, agar, safflower oil, and glass beads. These ingredients are then boiled and cooled under controlled conditions to produce a solid TMM. To determine if the TMM has the correct acoustic properties, acoustic measurements are performed using a scanning acoustic macroscope. Mechanical measurements are also performed to test the elasticity and density properties. TMMs with the correct properties are subsequently put through a series of moulding procedures to produce the anthropomorphic phantom.« less

Does Ultrasound-Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First-Year Medical Students?

PubMed

Walrod, Bryant J; Schroeder, Allison; Conroy, Mark J; Boucher, Laura C; Bockbrader, Marcia; Way, David P; McCamey, Kendra L; Hartz, Clinton A; Jonesco, Michael A; Bahner, David P

2018-01-01

Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills. Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests. All students performed significantly better on the knee examination, irrespective of instructional group (F = 14.9; df = 1.25; P = .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t = -3.0; df = 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t = -2.8; df = 25; P = .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures. The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks. © 2017 by the American Institute of Ultrasound in Medicine.

Evaluating Didactic Methods for Training Medical Students in the Use of Bedside Ultrasound for Clinical Practice at a Faculty of Medicine in Romania.

PubMed

Florescu, Cosmin C; Mullen, Jeffrey A; Nguyen, Vivian My; Sanders, Brooke E; Vu, Priscilla Quynh-Phuon

2015-10-01

Medical students' time is limited, so efficiency in medical education is valued. This research project aimed to determine the most effective means to teach bedside ultrasound to medical students in a 1-week training course. We hypothesized that the best method would include a combination of podcasts and hands-on teaching; therefore, there would be a statistically significant difference among the various methods of teaching. Medical students were randomly assigned to 3 groups. All groups attended a 50-minute hands-on bedside ultrasound training session. Students in the first group attended a 50-minute live lecture before the hands-on session, whereas students in the second group watched a podcast that covered the same material as the live lecture. Students in the third group served as the control and only attended the hands-on sessions. Five topics were covered during the course: (1) introduction to ultrasound, (2) pulmonary ultrasound, (3) cardiac ultrasound, (4) hepatobiliary ultrasound, and (5) focused assessment with sonography for trauma. Students completed a 20-question pre- and post-training quiz that covered basic ultrasound principles. Students also conducted a focused assessment with sonography for trauma examination for the practical portion of their evaluation. Students' pre- to post-training quiz scores increased from 33.6% to 72.6% correct in the lecture group (n = 21; P < .0001), from 40.7% to 75.5% correct in the podcast group (n = 20; P< .0001), and from 37.8% to 70.0% correct in the control group (n = 23; P< .0001). Data analysis of written and practical examination scores showed no significant differences among the groups [F(2,61) = 0.885; P = .418; F(2,60) = 1.739; P = .184, respectively]. These results suggest that all 3 methods are equally effective in teaching novice medical students basic ultrasound knowledge and skills. © 2015 by the American Institute of Ultrasound in Medicine.

Exploring the Case for a Global Alliance for Medical Diagnostics Initiative

PubMed Central

Mugambi, Melissa L.; Palamountain, Kara M.; Gallarda, Jim; Drain, Paul K.

2017-01-01

In recent years, the private and public sectors have increased investments in medical diagnostics for low- and middle-income countries (LMICs). Despite these investments, numerous barriers prevent the adoption of existing diagnostics and discourage the development and introduction of new diagnostics in LMICs. In the late 1990s, the global vaccine community had similar challenges, as vaccine coverage rates stagnated and the introduction of new vaccines was viewed as a distraction to delivering existing vaccines. To address these challenges, the international community came together and formed the Global Alliance for Vaccines Initiative (GAVI). Sixteen years after the formation of GAVI, we see evidence of a healthier global vaccine landscape. We discuss how GAVI’s four guiding principles (product, health systems strengthening, financing and market shaping) might apply to the advancement of medical diagnostics in LMICs. We present arguments for the international community and existing organizations to establish a Global Alliance for Medical Diagnostics Initiative (GAMDI). PMID:28134750

Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer*

PubMed Central

Fernández-Bussy, Sebastián; Labarca, Gonzalo; Canals, Sofia; Caviedes, Iván; Folch, Erik; Majid, Adnan

2015-01-01

OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions. PMID:26176519

Fetal evaluation for transport by ultrasound performed by air medical teams: A case series.

PubMed

Polk, James D; Merlino, James I; Kovach, Betty L; Mancuso, Charlene; Fallon, William F

2004-01-01

The air medical team has limited options when evaluating the obstetrical patient and assessing fetal health during air transport to a high-risk obstetrical unit. Traditionally, physical examination and a Doppler stethoscope have been used to determine fetal heart rates and movement. However, with the advent of portable ultrasound technology, new information about the mother and child are available to the air medical crew. The Fetal Evaluation for Transport with Ultrasound (FETUS) is a screening examination that consists of an evaluation of the fetal heart rate, position, and movement and general condition of the placenta. The examination can be repeated in flight with no acoustic distortion from rotor noise. The additional information can be advantageous when transport decisions need to be made or when conditions do not allow Doppler stethoscope use.

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective

PubMed Central

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed. PMID:20550724

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

PubMed

Huang, Stephen J; McLean, Anthony S

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

Integration of a Low-Cost Introductory Ultrasound Curriculum Into Existing Procedural Skills Education for Preclinical Medical Students.

PubMed

Maloney, Lauren; Zach, Kristen; Page, Christopher; Tewari, Neera; Tito, Matthew; Seidman, Peggy

2017-02-01

We evaluated integration of an introductory ultrasound curriculum into our existing mandatory procedural skills program for preclinical medical students. Phantoms consisting of olives, pimento olives, and grapes embedded in opaque gelatin were developed. Four classes encouraged progressive refinement of phantom-scanning and object identification skills. Students improved their ability to identify hidden objects, although each object type achieved a statistically significant improvement in correct identification at different time points. The total phantom cost per student was $0.76. Our results suggest that short repeated experiences scanning simple, low-cost ultrasound phantoms confer basic ultrasound skills. © 2016 by the American Institute of Ultrasound in Medicine.

Contrast-enhanced and targeted ultrasound.

PubMed

Postema, Michiel; Gilja, Odd Helge

2011-01-07

Ultrasonic imaging is becoming the most popular medical imaging modality, owing to the low price per examination and its safety. However, blood is a poor scatterer of ultrasound waves at clinical diagnostic transmit frequencies. For perfusion imaging, markers have been designed to enhance the contrast in B-mode imaging. These so-called ultrasound contrast agents consist of microscopically small gas bubbles encapsulated in biodegradable shells. In this review, the physical principles of ultrasound contrast agent microbubble behavior and their adjustment for drug delivery including sonoporation are described. Furthermore, an outline of clinical imaging applications of contrast-enhanced ultrasound is given. It is a challenging task to quantify and predict which bubble phenomenon occurs under which acoustic condition, and how these phenomena may be utilized in ultrasonic imaging. Aided by high-speed photography, our improved understanding of encapsulated microbubble behavior will lead to more sophisticated detection and delivery techniques. More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves, and have shown great promise in revealing effective tumor responses to anti-angiogenic drugs in humans before tumor shrinkage occurs. These are beginning to be accepted into clinical practice. In the long term, targeted microbubbles for molecular imaging and eventually for directed anti-tumor therapy are expected to be tested.

Contrast-enhanced and targeted ultrasound

PubMed Central

Postema, Michiel; Gilja, Odd Helge

2011-01-01

Ultrasonic imaging is becoming the most popular medical imaging modality, owing to the low price per examination and its safety. However, blood is a poor scatterer of ultrasound waves at clinical diagnostic transmit frequencies. For perfusion imaging, markers have been designed to enhance the contrast in B-mode imaging. These so-called ultrasound contrast agents consist of microscopically small gas bubbles encapsulated in biodegradable shells. In this review, the physical principles of ultrasound contrast agent microbubble behavior and their adjustment for drug delivery including sonoporation are described. Furthermore, an outline of clinical imaging applications of contrast-enhanced ultrasound is given. It is a challenging task to quantify and predict which bubble phenomenon occurs under which acoustic condition, and how these phenomena may be utilized in ultrasonic imaging. Aided by high-speed photography, our improved understanding of encapsulated microbubble behavior will lead to more sophisticated detection and delivery techniques. More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves, and have shown great promise in revealing effective tumor responses to anti-angiogenic drugs in humans before tumor shrinkage occurs. These are beginning to be accepted into clinical practice. In the long term, targeted microbubbles for molecular imaging and eventually for directed anti-tumor therapy are expected to be tested. PMID:21218081

Acoustic holography as a metrological tool for characterizing medical ultrasound sources and fields

PubMed Central

Sapozhnikov, Oleg A.; Tsysar, Sergey A.; Khokhlova, Vera A.; Kreider, Wayne

2015-01-01

Acoustic holography is a powerful technique for characterizing ultrasound sources and the fields they radiate, with the ability to quantify source vibrations and reduce the number of required measurements. These capabilities are increasingly appealing for meeting measurement standards in medical ultrasound; however, associated uncertainties have not been investigated systematically. Here errors associated with holographic representations of a linear, continuous-wave ultrasound field are studied. To facilitate the analysis, error metrics are defined explicitly, and a detailed description of a holography formulation based on the Rayleigh integral is provided. Errors are evaluated both for simulations of a typical therapeutic ultrasound source and for physical experiments with three different ultrasound sources. Simulated experiments explore sampling errors introduced by the use of a finite number of measurements, geometric uncertainties in the actual positions of acquired measurements, and uncertainties in the properties of the propagation medium. Results demonstrate the theoretical feasibility of keeping errors less than about 1%. Typical errors in physical experiments were somewhat larger, on the order of a few percent; comparison with simulations provides specific guidelines for improving the experimental implementation to reduce these errors. Overall, results suggest that holography can be implemented successfully as a metrological tool with small, quantifiable errors. PMID:26428789

Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis.

PubMed

Zengel, Pamela; Reichel, Christoph Andreas; Vincek, Teresa; Clevert, Dirk André

2017-01-01

Chronic recurrent parotitis (CRP) is a non-obstructive disease with episodes characterized by painful swelling of the parotid gland. It presents in both a juvenile and an adult form, with no clear information on its actual origin. Diagnosis is based on patient medical history and ultrasound examination but is frequently not correctly identified. Acoustic Radiation Force Impulse Imaging (ARFI) is a novel ultrasound elastography technology that has recently been implemented in the diagnostic work-up of patients with malignancies. This study aimed to answer whether ARFI can reasonably be employed in the initial examination and follow-up during therapy in patients with CRP. Mechanical tissue properties of the salivary glands were analyzed by ARFI in 37 parotid glands of patients with CRP. Having integrated ARFI into our diagnostic protocol for CRP, affected parotid glands were found to exhibit lower tissue elasticity compared to both healthy contralateral glands in the same individuals as well as those of healthy individuals. Most importantly, this method enabled us to quantitatively assess the patient benefit of therapy regarding the recovery of the glands' diseased parenchyma. ARFI provides a quick, easy, and reliable diagnostic tool for the assessment of disease severity and progression in patients with CRP that can be seamlessly implemented into preexisting ultrasound protocols.

Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru.

PubMed

Anticona Huaynate, Cynthia Fiorella; Pajuelo Travezaño, Monica Jehnny; Correa, Malena; Mayta Malpartida, Holger; Oberhelman, Richard; Murphy, Laura L; Paz-Soldan, Valerie A

2015-10-05

Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies

Medical diagnostics with mobile devices: Comparison of intrinsic and extrinsic sensing.

PubMed

Kwon, L; Long, K D; Wan, Y; Yu, H; Cunningham, B T

2016-01-01

We review the recent development of mobile detection instruments used for medical diagnostics, and consider the relative advantages of approaches that utilize the internal sensing capabilities of commercially available mobile communication devices (such as smartphones and tablet computers) compared to those that utilize a custom external sensor module. In this review, we focus specifically upon mobile medical diagnostic platforms that are being developed to serve the need in global health, personalized medicine, and point-of-care diagnostics. Copyright © 2016 Elsevier Inc. All rights reserved.

Teaching medical students ultrasound-guided vascular access - which learning method is best?

PubMed

Lian, Alwin; Rippey, James C R; Carr, Peter J

2017-05-15

Ultrasound is recommended to guide insertion of peripheral intravenous vascular cannulae (PIVC) where difficulty is experienced. Ultrasound machines are now common-place and junior doctors are often expected to be able to use them. The educational standards for this skill are highly varied, ranging from no education, to self-guided internet-based education, to formal, face-to-face traditional education. In an attempt to decide which educational technique our institution should introduce, a small pilot trial comparing educational techniques was designed. Thirty medical students were enrolled and allocated to one of three groups. PIVC placing ability was then observed, tested and graded on vascular access phantoms. The formal, face-to-face traditional education was rated best by the students, and had the highest success rate in PIVC placement, the improvement statistically significant compared to no education (p = 0.01) and trending towards significance when compared to self-directed internet-based education (p<0.06). The group receiving traditional face-to-face teaching on ultrasound-guided vascular access, performed significantly better than those not receiving education. As the number of ultrasound machines in clinical areas increases, it is important that education programs to support their safe and appropriate use are developed.

Technical Note: Development of a combined molecular breast imaging/ultrasound system for diagnostic evaluation of MBI-detected lesions.

PubMed

O'Connor, Michael K; Morrow, Melissa M; Tran, Thuy; Hruska, Carrie B; Conners, Amy L; Hunt, Katie N

2017-02-01

The purpose of this study was to perform a pilot evaluation of an integrated molecular breast imaging/ultrasound (MBI/US) system designed to enable, in real-time, the registration of US to MBI and diagnostic evaluation of breast lesions detected on MBI. The MBI/US system was constructed by modifying an existing dual-head cadmium zinc telluride (CZT)-based MBI gamma camera. The upper MBI detector head was replaced with a mesh panel, which allowed an ultrasound probe to access the breast. An optical tracking system was used to monitor the location of the ultrasound transducer, referenced to the MBI detector. The lesion depth at which ultrasound was targeted was estimated from analysis of previously acquired dual-head MBI datasets. A software tool was developed to project the US field of view onto the current MBI image. Correlation of lesion location between both modalities with real-time MBI/US scanning was confirmed in a breast phantom model and assessed in 12 patients with a breast lesion detected on MBI. Combined MBI/US scanning allowed for registration of lesions detected on US and MBI as validated in phantom experiments. In patient studies, successful registration was achieved in 8 of 12 (67%) patients, with complete registration achieved in seven and partial registration achieved in one patient. In 4 of 12 (37%) patients, lesion registration was not achieved, partially attributed to uncertainty in lesion depth estimates from MBI. The MBI/US system enabled successful registration of US to MBI in over half of patients studied in this pilot evaluation. Future studies are needed to determine if real-time, registered US imaging of MBI-detected lesions may obviate the need to proceed to more expensive procedures such as contrast-enhanced breast MRI for diagnostic workup or biopsy of MBI findings. © 2016 American Association of Physicists in Medicine.

Diagnostic ultrasound exposure in man.

PubMed

Gramiak, R

1975-09-01

In his review of the AAPM statement on ultrasound, the author feels that allowing "some" research or demonstration on normal persons in the face of cautionary statements on as yet unknown side effects is an inconsistent position. The use of videotapes and the development of simulators hacked by data banks are offered in place of tissue phantoms.

Mapping the different methods adopted for diagnostic imaging instruction at medical schools in Brazil.

PubMed

Chojniak, Rubens; Carneiro, Dominique Piacenti; Moterani, Gustavo Simonetto Peres; Duarte, Ivone da Silva; Bitencourt, Almir Galvão Vieira; Muglia, Valdair Francisco; D'Ippolito, Giuseppe

2017-01-01

To map the different methods for diagnostic imaging instruction at medical schools in Brazil. In this cross-sectional study, a questionnaire was sent to each of the coordinators of 178 Brazilian medical schools. The following characteristics were assessed: teaching model; total course hours; infrastructure; numbers of students and professionals involved; themes addressed; diagnostic imaging modalities covered; and education policies related to diagnostic imaging. Of the 178 questionnaires sent, 45 (25.3%) were completed and returned. Of those 45 responses, 17 (37.8%) were from public medical schools, whereas 28 (62.2%) were from private medical schools. Among the 45 medical schools evaluated, the method of diagnostic imaging instruction was modular at 21 (46.7%), classic (independent discipline) at 13 (28.9%), hybrid (classical and modular) at 9 (20.0%), and none of the preceding at 3 (6.7%). Diagnostic imaging is part of the formal curriculum at 36 (80.0%) of the schools, an elective course at 3 (6.7%), and included within another modality at 6 (13.3%). Professors involved in diagnostic imaging teaching are radiologists at 43 (95.5%) of the institutions. The survey showed that medical courses in Brazil tend to offer diagnostic imaging instruction in courses that include other content and at different time points during the course. Radiologists are extensively involved in undergraduate medical education, regardless of the teaching methodology employed at the institution.

Medical physics: some recollections in diagnostic X-ray imaging and therapeutic radiology.

PubMed

Gray, J E; Orton, C G

2000-12-01

Medical physics has changed dramatically since 1895. There was a period of slow evolutionary change during the first 70 years after Roentgen's discovery of x rays. With the advent of the computer, however, both diagnostic and therapeutic radiology have undergone rapid growth and changes. Technologic advances such as computed tomography and magnetic resonance imaging in diagnostic imaging and three-dimensional treatment planning systems, stereotactic radiosurgery, and intensity modulated radiation therapy in radiation oncology have resulted in substantial changes in medical physics. These advances have improved diagnostic imaging and radiation therapy while expanding the need for better educated and experienced medical physics staff.

Nonlinear acoustics in biomedical ultrasound

NASA Astrophysics Data System (ADS)

Cleveland, Robin O.

2015-10-01

Ultrasound is widely used to image inside the body; it is also used therapeutically to treat certain medical conditions. In both imaging and therapy applications the amplitudes employed in biomedical ultrasound are often high enough that nonlinear acoustic effects are present in the propagation: the effects have the potential to be advantageous in some scenarios but a hindrance in others. In the case of ultrasound imaging the nonlinearity produces higher harmonics that result in images of greater quality. However, nonlinear effects interfere with the imaging of ultrasound contrast agents (typically micron sized bubbles with a strong nonlinear response of their own) and nonlinear effects also result in complications when derating of pressure measurements in water to in situ values in tissue. High intensity focused ultrasound (HIFU) is emerging as a non-invasive therapeutic modality which can result in thermal ablation of tissue. For thermal ablation, the extra effective attenuation resulting from nonlinear effects can result in enhanced heating of tissue if shock formation occurs in the target region for ablation - a highly desirable effect. However, if nonlinearity is too strong it can also result in undesired near-field heating and reduced ablation in the target region. The disruption of tissue (histotripsy) and fragmentation of kidney stones (lithotripsy) exploits shock waves to produce mechanically based effects, with minimal heating present. In these scenarios it is necessary for the waves to be of sufficient amplitude that a shock exists when the waveform reaches the target region. This talk will discuss how underlying nonlinear phenomenon act in all the diagnostic and therapeutic applications described above.

Boosting medical diagnostics by pooling independent judgments

PubMed Central

Kurvers, Ralf H. J. M.; Herzog, Stefan M.; Hertwig, Ralph; Krause, Jens; Carney, Patricia A.; Bogart, Andy; Argenziano, Giuseppe; Zalaudek, Iris; Wolf, Max

2016-01-01

Collective intelligence refers to the ability of groups to outperform individual decision makers when solving complex cognitive problems. Despite its potential to revolutionize decision making in a wide range of domains, including medical, economic, and political decision making, at present, little is known about the conditions underlying collective intelligence in real-world contexts. We here focus on two key areas of medical diagnostics, breast and skin cancer detection. Using a simulation study that draws on large real-world datasets, involving more than 140 doctors making more than 20,000 diagnoses, we investigate when combining the independent judgments of multiple doctors outperforms the best doctor in a group. We find that similarity in diagnostic accuracy is a key condition for collective intelligence: Aggregating the independent judgments of doctors outperforms the best doctor in a group whenever the diagnostic accuracy of doctors is relatively similar, but not when doctors’ diagnostic accuracy differs too much. This intriguingly simple result is highly robust and holds across different group sizes, performance levels of the best doctor, and collective intelligence rules. The enabling role of similarity, in turn, is explained by its systematic effects on the number of correct and incorrect decisions of the best doctor that are overruled by the collective. By identifying a key factor underlying collective intelligence in two important real-world contexts, our findings pave the way for innovative and more effective approaches to complex real-world decision making, and to the scientific analyses of those approaches. PMID:27432950

Application of Ultrasound-Guided Core Biopsy to Minimal-Invasively Diagnose Supraclavicular Fossa Tumors and Minimize the Requirement of Invasive Diagnostic Surgery

PubMed Central

Chen, Chun-Nan; Lin, Che-Yi; Chi, Fan-Hsiang; Chou, Chen-Han; Hsu, Ya-Ching; Kuo, Yen-Lin; Lin, Chih-Feng; Chen, Tseng-Cheng; Wang, Cheng-Ping; Lou, Pei-Jen; Ko, Jenq-Yuh; Hsiao, Tzu-Yu; Yang, Tsung-Lin

2016-01-01

Abstract Tumors of the supraclavicular fossa (SC) is clinically challenging because of anatomical complexity and tumor pathological diversity. Because of varied diseases entities and treatment choices of SC tumors, making the accurate decision among numerous differential diagnoses is imperative. Sampling by open biopsy (OB) remains the standard procedure for pathological confirmation. However, complicated anatomical structures of SC always render surgical intervention difficult to perform. Ultrasound-guided core biopsy (USCB) is a minimally invasive and office-based procedure for tissue sampling widely applied in many diseases of head and neck. This study aims to evaluate the clinical efficacy and utility of using USCB as the sampling method of SC tumors. From 2009 to 2014, consecutive patients who presented clinical symptoms and signs of supraclavicular tumors and were scheduled to receive sampling procedures for diagnostic confirmation were recruited. The patients received USCB or OB respectively in the initial tissue sampling. The accurate diagnostic rate based on pathological results was 90.2% for USCB, and 93.6% for OB. No significant difference was noted between USCB and OB groups in terms of diagnostic accuracy and the percentage of inadequate specimens. All cases in the USCB group had the sampling procedure completed within 10 minutes, but not in the OB group. No scars larger than 1 cm were found in USCB. Only patients in the OB groups had the need to receive general anesthesia and hospitalization and had scars postoperatively. Accordingly, USCB can serve as the first-line sampling tool for SC tumors with high diagnostic accuracy, minimal invasiveness, and low medical cost. PMID:26825877

Endoscopic Ultrasound-guided Specimen Collection and Evaluation Techniques Affect Diagnostic Accuracy.

PubMed

Bang, Ji Young; Navaneethan, Udayakumar; Hasan, Muhammad K; Hawes, Robert; Varadarajulu, Shyam

2018-03-11

Outcomes of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) evaluation vary with technique, needles, and methods of specimen evaluation. We performed a direct comparison of diagnostic yields of EUS-FNA samples collected using different gauge needles (22- vs 25-gauge), with or without suction. We performed a randomized controlled study of 352 patients with suspected pancreatic masses, referred for EUS-FNA at a tertiary referral center. Patients were randomly assigned to 22-gauge needles with or without suction or 25-gauge needles with or without suction. Specimens were evaluated offsite by cell block and rapid onsite cytologic evaluation (ROSE). Final diagnoses were made based on histologic analyses or 12-month follow-up evaluations. The primary outcome was diagnostic adequacy of cell blocks. Secondary outcomes were operating characteristics of ROSE and EUS-FNA, number of passes required for accurate onsite diagnosis, and amount of blood in specimens. The final diagnoses were malignancy (81.5% of patients) and benign disease (17.0% of patients); 1.4% of patients were lost during follow up. Cell block, ROSE, and EUS-FNA led to diagnostic accuracies of 71.9%, 95.5%, and 96.6%, respectively. A 22-gauge needle with suction was associated with more passes for adequate onsite diagnosis (P = .003) and specimens contained more blood (P = .01). Diagnostic accuracy of specimens collected by transduodenal EUS-FNA was lower with 22-gauge needles with suction compared to other techniques (P = .004). In a randomized trial of patients undergoing EUS-FNA for pancreatic masses, samples collected with 22-gauge vs 25-gauge needles performed equally well for offsite specimen evaluation. Use of suction appears to increase number of passes needed and specimen bloodiness. Specimen collection techniques should be individualized based on method of evaluation. ClinicalTrials.gov no: NCT02424838. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Advanced Ultrasound Technologies for Diagnosis and Therapy.

PubMed

Rix, Anne; Lederle, Wiltrud; Theek, Benjamin; Lammers, Twan; Moonen, Chrit; Schmitz, Georg; Kiessling, Fabian

2018-05-01

Ultrasound is among the most rapidly advancing imaging techniques. Functional methods such as elastography have been clinically introduced, and tissue characterization is improved by contrast-enhanced scans. Here, novel superresolution techniques provide unique morphologic and functional insights into tissue vascularization. Functional analyses are complemented by molecular ultrasound imaging, to visualize markers of inflammation and angiogenesis. The full potential of diagnostic ultrasound may become apparent by integrating these multiple imaging features in radiomics approaches. Emerging interest in ultrasound also results from its therapeutic potential. Various applications of tumor ablation with high-intensity focused ultrasound are being clinically evaluated, and its performance strongly benefits from the integration into MRI. Additionally, oscillating microbubbles mediate sonoporation to open biologic barriers, thus improving the delivery of drugs or nucleic acids that are coadministered or coformulated with microbubbles. This article provides an overview of recent developments in diagnostic and therapeutic ultrasound, highlighting multiple innovation tracks and their translational potential. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Use of ultrasound-guided cryotherapy for the management of chronic pain states.

PubMed

Connelly, Neil Roy; Malik, Ashish; Madabushi, Lakshmi; Gibson, Charles

2013-12-01

To report the use of ultrasound for cyroablation of purely sensory nerves for long-term relief of pain because the use of ultrasound enhances accuracy while minimizing injury to surrounding structures. Case series of three patients with positive long-term outcomes. Outpatient Pain Management Clinic associated with a large, university affiliated, tertiary-care community hospital. 3 ASA physical status 2 and 3 patients who were treated for intercostal neuralgia secondary to surgical incision or vertebral fractures. These patients had failed various medical therapies but had positive responses to diagnostic intercostal nerve blocks. They underwent lesioning of the culprit nerves (with the use of ultrasound). Pain scores were recorded using a numeric rating scale (NRS), and were solicited preprocedurally and postprocedurally, and once again after longterm follow-up (> 2 mos). Longterm (> 2 mos) relief of symptoms from established, chronic pain conditions was achieved with cryotherapy with ultrasound guidance. Neuro-ablative procedures using cryotherapy have been well reported. The use of ultrasound with cryotherapy facilitates direct visualization of the anatomy and aids in avoidance of vital vascular and pleural structures. © 2013.

The Role of Anthropomorphic Phantoms in Diagnostic Ultrasound Imaging for Disease Characterization (abstract)

NASA Astrophysics Data System (ADS)

Cannon, L. M.; King, D. M.; Browne, J. E.

2009-04-01

An anthropomorhic phantom is an object that can mimic a region of the human anatomy. Anthropomorphic phantoms have a variety of roles in diagnostic ultrasound. These roles include quality assurance testing of ultrasound machines, calibration and testing of new imaging techniques, training of sonographers, and-most importantly-use as a tool to obtain a better understanding of disease progression in the relevant anatomy. To be anthropomorphic a phantom must accurately mimic the body in terms of its ultrasonic and mechanical properties, as well as anatomically. The acoustic properties are speed of sound, attenuation, and backscatter. The mechanical properties are elasticity and density. Phantoms are constructed from tissue-mimicking materials (TMMs). TMMs are prepared from a variety of ingredients, such as gelatine, agar, safflower oil, and glass beads. These ingredients are then boiled and cooled under controlled conditions to produce a solid TMM. To determine if the TMM has the correct acoustic properties, acoustic measurements are performed using a scanning acoustic macroscope. Mechanical measurements are also performed to test the elasticity and density properties. TMMs with the correct properties are subsequently put through a series of moulding procedures to produce the anthropomorphic phantom.

Outcomes of ultrasound guided renal mass biopsies.

PubMed

Sutherland, Edward L; Choromanska, Agnieszka; Al-Katib, Sayf; Coffey, Mary

2018-06-01

The purpose of this study was to evaluate the rate of nondiagnostic ultrasound-guided renal mass biopsies (RMBs) at our institution and to determine what patient, procedural, and focal renal mass (FRM) factors were associated with nondiagnostic ultrasound-guided RMBs. Eighty-two ultrasound-guided renal mass biopsies performed between January 2014 and October 2016 were included in our study. Biopsy outcomes (diagnostic vs. nondiagnostic) and patient, procedural, and FRM characteristics were retrospectively reviewed and recorded. Univariate statistical analyses were performed to identify biopsy characteristics that were indicative of nondiagnostic biopsy. Ultrasound-guided RMBs were diagnostic in 70 out of 82 cases (85%) and non-diagnostic in 12 cases (15%). Among the diagnostic biopsies, 54 (77%) were malignant cases, 94% of which were renal cell carcinoma (RCC). Of the 12 nondiagnostic cases, the final diagnosis was RCC in 4 cases and angiomyolipoma in one case; seven of the nondiagnostic cases were lost to follow-up. A weak association (p = 0.04) was found between the number of needle passes and the biopsy outcome. None of the remaining collected RMB characteristics showed a significant correlation with a diagnostic or nondiagnostic RMB. Six patients (7%) experienced complications. Ultrasound-guided renal mass biopsy is a safe and effective method for the diagnosis of renal masses with a low rate of nondiagnostic outcomes. A nondiagnostic biopsy should not be treated as a surrogate for a diagnosis since a significant number of patients with nondiagnostic biopsies have subsequently been shown to have renal malignancies. Repeat biopsy should be considered in such cases.

Mapping the different methods adopted for diagnostic imaging instruction at medical schools in Brazil

PubMed Central

Chojniak, Rubens; Carneiro, Dominique Piacenti; Moterani, Gustavo Simonetto Peres; Duarte, Ivone da Silva; Bitencourt, Almir Galvão Vieira; Muglia, Valdair Francisco; D'Ippolito, Giuseppe

2017-01-01

Objective To map the different methods for diagnostic imaging instruction at medical schools in Brazil. Materials and Methods In this cross-sectional study, a questionnaire was sent to each of the coordinators of 178 Brazilian medical schools. The following characteristics were assessed: teaching model; total course hours; infrastructure; numbers of students and professionals involved; themes addressed; diagnostic imaging modalities covered; and education policies related to diagnostic imaging. Results Of the 178 questionnaires sent, 45 (25.3%) were completed and returned. Of those 45 responses, 17 (37.8%) were from public medical schools, whereas 28 (62.2%) were from private medical schools. Among the 45 medical schools evaluated, the method of diagnostic imaging instruction was modular at 21 (46.7%), classic (independent discipline) at 13 (28.9%), hybrid (classical and modular) at 9 (20.0%), and none of the preceding at 3 (6.7%). Diagnostic imaging is part of the formal curriculum at 36 (80.0%) of the schools, an elective course at 3 (6.7%), and included within another modality at 6 (13.3%). Professors involved in diagnostic imaging teaching are radiologists at 43 (95.5%) of the institutions. Conclusion The survey showed that medical courses in Brazil tend to offer diagnostic imaging instruction in courses that include other content and at different time points during the course. Radiologists are extensively involved in undergraduate medical education, regardless of the teaching methodology employed at the institution. PMID:28298730

Prospects for telediagnosis using ultrasound.

PubMed

Dewey, C F; Thomas, J D; Kunt, M; Hunter, I W

1996-01-01

Ultrasound imaging is currently used as a primary diagnostic tool in cardiology, abdominal disorders, pulmonary medicine, trauma, and obstetrics. Because of its relatively low capital and operating costs as well as its growth potential, it represents one of the major diagnostic modalities of future health care. However, the use of ultrasonography as a mobile and powerful modality is controlled by the availability of a highly skilled technician to acquire the images and an experienced physician to interpret them. This paper discusses the technology required to increase the availability of a diagnosing physician by employing telerobotics. With this technology, the physician can guide the motion of the transducer by the technician from a remote location. Thus, the physician controls the examination and renders the diagnosis. It is shown that communication lines at 1.5 Mbits/s (T-1 speed) can, with appropriate compression, support both real-time viewing of the ultrasound images and telerobotic manipulation of the transducer. The incremental costs of telediagnosis for an examination are estimated to be a small fraction of the base charges and significantly less than the expense of bringing a physician to a remote location or transporting a patient to a regional medical center. Telediagnosis can, in addition, provide benefits from immediate interpretation and consultation that cannot be duplicated using store-and-forward scenarios.

Quantitative diagnostic method for biceps long head tendinitis by using ultrasound.

PubMed

Huang, Shih-Wei; Wang, Wei-Te

2013-01-01

To investigate the feasibility of grayscale quantitative diagnostic method for biceps tendinitis and determine the cut-off points of a quantitative biceps ultrasound (US) method to diagnose biceps tendinitis. Design. Prospective cross-sectional case controlled study. Outpatient rehabilitation service. A total of 336 shoulder pain patients with suspected biceps tendinitis were recruited in this prospective observational study. The grayscale pixel data of the range of interest (ROI) were obtained for both the transverse and longitudinal views of the biceps US. A total of 136 patients were classified with biceps tendinitis, and 200 patients were classified as not having biceps tendinitis based on the diagnostic criteria. Based on the Youden index, the cut-off points were determined as 26.85 for the transverse view and 21.25 for the longitudinal view of the standard deviation (StdDev) of the ROI values, respectively. When the ROI evaluation of the US surpassed the cut-off point, the sensitivity was 68% and the specificity was 90% in the StdDev of the transverse view, and the sensitivity was 81% and the specificity was 73% in the StdDev of the longitudinal view to diagnose biceps tendinitis. For equivocal cases or inexperienced sonographers, our study provides a more objective method for diagnosing biceps tendinitis in shoulder pain patients.

Sterile working in ultrasonography: the use of dedicated ultrasound covers and sterile ultrasound gel.

PubMed

Marhofer, Peter; Fritsch, Gerhard

2015-01-01

Ultrasound is currently an important tool for diagnostic and interventional procedures. Ultrasound imaging provides significant advantages as compared to other imaging methods. The widespread use of ultrasound also carries the risk of drawbacks such as cross-infections. A large body of literature reports this possibly life-threatening side effect and specific patient populations are particularly at risk (e.g., neonates). Various methods of ultrasound probe disinfection are described; however, none of the mechanical or chemical probe disinfection procedures is optimal and, in particular, disinfection with high concentration of alcohol might be associated with ultrasound probe damage. The preparation of ultrasound probes with dedicated probe covers is a useful alternative for sterile working conditions. One ultrasound probe cover discussed in this paper is directly glued on to the ultrasound probe without the use of ultrasound coupling gel. By the use of sterile ultrasound coupling gel at the outer surface, additional effects on aseptic working conditions can be obtained.

Thermal effects of diagnostic ultrasound in an anthropomorphic skull model.

PubMed

Vyskocil, E; Pfaffenberger, S; Kollmann, C; Gleiss, A; Nawratil, G; Kastl, S; Unger, E; Aumayr, K; Schuhfried, O; Huber, K; Wojta, J; Gottsauner-Wolf, M

2012-12-01

Exposure to diagnostic ultrasound (US) can significantly heat biological tissue although conventional routine examinations are regarded as safe. The risk of unwanted thermal effects increases with a high absorption coefficient and extended insonation time. Certain applications of transcranial diagnostic US (TC-US) require prolonged exposure. An anthropomorphic skull model (ASM) was developed to evaluate thermal effects induced by TC-US of different modalities. The objective was to determine whether prolonged continuous TC-US application results in potentially harmful temperature increases. The ASM consists of a human skull with tissue mimicking material and exhibits acoustic and anatomical characteristics of the human skull and brain. Experiments are performed with a diagnostic US device testing four different US modalities: Duplex PW (pulsed wave) Doppler, PW Doppler, color flow Doppler and B-mode. Temperature changes are recorded during 180 minutes of insonation. All measurements revealed significant temperature increases during insonation independent of the US modality. The maximum temperature elevation of + 5.25° C (p < 0.001) was observed on the surface of the skull exposed to duplex PW Doppler. At the bone-brain border a maximum temperature increae of + 2.01 °C (p < 0.001) was noted. Temperature increases within the brain were < 1.23 °C (p = 0.001). The highest values were registered using the duplex PW Doppler modality. TC-US induces significant local heating effects in an ASM. An application duration that extends routine clinical periods causes potentially harmful heating especially in tissue close to bone. TC-US elevates the temperature in the brain mimicking tissue but is not capable of producing harmful temperature increases during routine examinations. However, the risk of thermal injury in brain tissue increases significantly after an exposure time of > 2 hours. © Georg Thieme Verlag KG Stuttgart · New York.

Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound.

PubMed

Webb, Sara Jane; Garrison, Michelle M; Bernier, Raphael; McClintic, Abbi M; King, Bryan H; Mourad, Pierre D

2017-03-01

Current research suggests that incidence and heterogeneity of autism spectrum disorder (ASD) symptoms may arise through a variety of exogenous and/or endogenous factors. While subject to routine clinical practice and generally considered safe, there exists speculation, though no human data, that diagnostic ultrasound may also contribute to ASD severity, supported by experimental evidence that exposure to ultrasound early in gestation could perturb brain development and alter behavior. Here we explored a modified triple hit hypothesis [Williams & Casanova, ] to assay for a possible relationship between the severity of ASD symptoms and (1) ultrasound exposure (2) during the first trimester of pregnancy in fetuses with a (3) genetic predisposition to ASD. We did so using retrospective analysis of data from the SSC (Simon's Simplex Collection) autism genetic repository funded by the Simons Foundation Autism Research Initiative. We found that male children with ASD, copy number variations (CNVs), and exposure to first trimester ultrasound had significantly decreased non-verbal IQ and increased repetitive behaviors relative to male children with ASD, with CNVs, and no ultrasound. These data suggest that heterogeneity in ASD symptoms may result, at least in part, from exposure to diagnostic ultrasound during early prenatal development of children with specific genetic vulnerabilities. These results also add weight to on-going concerns expressed by the FDA about non-medical use of diagnostic ultrasound during pregnancy. Autism Res 2017, 10: 472-484. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Ultrasound transducer selection in clinical imaging practice.

PubMed

Szabo, Thomas L; Lewin, Peter A

2013-04-01

Many types of medical ultrasound transducers are used in clinical practice. They operate at different center frequencies, have different physical dimensions, footprints, and shapes, and provide different image formats. However, little information is available about which transducers are most appropriate for a given application, and the purpose of this article is to address this deficiency. Specifically, the relationship between the transducer, imaging format, and clinical applications is discussed, and systematic selection criteria that allow matching of transducers to specific clinical needs are presented. These criteria include access to and coverage of the region of interest, maximum scan depth, and coverage of essential diagnostic modes required to optimize a patient's diagnosis. Three comprehensive figures organize and summarize the imaging planes, scanning modes, and types of diagnostic transducers to facilitate their selection in clinical diagnosis.

Multiparametric ultrasound in the detection of prostate cancer: a systematic review.

PubMed

Postema, Arnoud; Mischi, Massimo; de la Rosette, Jean; Wijkstra, Hessel

2015-11-01

To investigate the advances and clinical results of the different ultrasound modalities and the progress in combining them into multiparametric UltraSound (mpUS). A systematic literature search on mpUS and the different ultrasound modalities included: greyscale ultrasound, computerized transrectal ultrasound, Doppler and power Doppler techniques, dynamic contrast-enhanced ultrasound and (shear wave) elastography. Limited research available on combining ultrasound modalities has presented improvement in diagnostic performance. The data of two studies suggest that even adding a lower performing ultrasound modality to a better performing modality using crude methods can already improve the sensitivity by 13-51 %. The different modalities detect different tumours. No study has tried to combine ultrasound modalities employing a system similar to the PIRADS system used for mpMRI or more advanced classifying algorithms. Available evidence confirms that combining different ultrasound modalities significantly improves diagnostic performance.

77 FR 39656 - Medical Diagnostic Equipment Accessibility Standards Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-05

...-0003] RIN 3014-AA40 Medical Diagnostic Equipment Accessibility Standards Advisory Committee AGENCY... Diagnostic Equipment Accessibility Standards. DATES: The first meeting of the committee will be held at a... Equipment Accessibility Standards. See 77 FR 14706 (March 13, 2012). Section 510 of the Rehabilitation Act...

Improved Medical Student Perception of Ultrasound Using a Paired Anatomy Teaching Assistant and Clinician Teaching Model

ERIC Educational Resources Information Center

Smith, Jacob P.; Kendall, John L.; Royer, Danielle F.

2018-01-01

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant…

Impact of the clinical ultrasound elective course on retention of anatomical knowledge by second-year medical students in preparation for board exams.

PubMed

Kondrashov, Peter; Johnson, Jane C; Boehm, Karl; Rice, Daris; Kondrashova, Tatyana

2015-03-01

Ultrasound has been integrated into a gross anatomy course taught during the first year at an osteopathic medical school. A clinical ultrasound elective course was developed to continue ultrasound training during the second year of medical school. The purpose of this study was to evaluate the impact of this elective course on the understanding of normal anatomy by second-year students. An anatomy exam was administered to students enrolled in the clinical ultrasound elective course before the start of the course and after its conclusion. Wilcoxon signed ranks tests were used to determine whether exam scores changed from the pre-test to the post-test. Scores from two classes of second-year students were analyzed. Students who took the elective course showed significant improvement in the overall anatomy exam score between the pre-test and post-test (P < 0.001). Scores for exam questions pertaining to the heart, abdomen, upper extremity, and lower extremity also significantly improved from the pretest to post-test (P < 0.001), but scores for the neck and eye showed no significant improvement. The clinical ultrasound elective course offered during the second year of medical school provided students with an important review of key anatomical concepts while preparing them for board exams. Our results suggested that more emphasis should be placed on head and neck ultrasound to improve student performance in those areas. Musculoskeletal, abdominal, and heart ultrasound labs were more successful for retaining relevant anatomical information. © 2014 Wiley Periodicals, Inc.

Hot topics in biomedical ultrasound: ultrasound therapy and its integration with ultrasonic imaging

NASA Astrophysics Data System (ADS)

Everbach, E. Carr

2005-09-01

Since the development of biomedical ultrasound imaging from sonar after WWII, there has been a clear divide between ultrasonic imaging and ultrasound therapy. While imaging techniques are designed to cause as little change as possible in the tissues through which ultrasound propagates, ultrasound therapy typically relies upon heating or acoustic cavitation to produce a desirable therapeutic effect. Concerns over the increasingly high acoustic outputs of diagnostic ultrasound scanners prompted the adoption of the Mechanical Index (MI) and Thermal Index (TI) in the early 1990s. Therapeutic applications of ultrasound, meanwhile, have evolved from deep tissue heating in sports medicine to include targeted drug delivery, tumor and plaque ablation, cauterization via high intensity focused ultrasound (HIFU), and accelerated dissolution of blood clots. The integration of ultrasonic imaging and therapy in one device is just beginning, but the promise of improved patient outcomes is balanced by regulatory and practical impediments.

Role of ultrasound in colorectal diseases.

PubMed

Bor, Renáta; Fábián, Anna; Szepes, Zoltán

2016-11-21

Ultrasound is an undervalued non-invasive examination in the diagnosis of colonic diseases. It has been replaced by the considerably more expensive magnetic resonance imaging and computed tomography, despite the fact that, as first examination, it can usefully supplement the diagnostic process. Transabdominal ultrasound can provide quick information about bowel status and help in the choice of adequate further examinations and treatment. Ultrasonography, as a screening imaging modality in asymptomatic patients can identify several colonic diseases such as diverticulosis, inflammatory bowel disease or cancer. In addition, it is widely available, cheap, non-invasive technique without the use of ionizing radiation, therefore it is safe to use in childhood or during pregnancy, and can be repeated at any time. New ultrasound techniques such as elastography, contrast enhanced and Doppler ultrasound, mini-probes rectal and transperineal ultrasonography have broadened the indication. It gives an overview of the methodology of various ultrasound examinations, presents the morphology of normal bowel wall and the typical changes in different colonic diseases. We will pay particular attention to rectal and transperineal ultrasound because of their outstanding significance in the diagnosis of rectal and perineal disorders. This article seeks to overview the diagnostic impact and correct indications of bowel ultrasound.

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review.

PubMed

Rimbaş, Mihai; Di Maurizio, Luca; Rizzatti, Gianenrico; Gasbarrini, Antonio; Costamagna, Guido; Larghi, Alberto

2018-05-01

In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vascular applications of contrast-enhanced ultrasound imaging.

PubMed

Mehta, Kunal S; Lee, Jake J; Taha, Ashraf G; Avgerinos, Efthymios; Chaer, Rabih A

2017-07-01

Contrast-enhanced ultrasound (CEUS) imaging is a powerful noninvasive modality offering numerous potential diagnostic and therapeutic applications in vascular medicine. CEUS imaging uses microbubble contrast agents composed of an encapsulating shell surrounding a gaseous core. These microbubbles act as nearly perfect intravascular reflectors of ultrasound energy and may be used to enhance the overall contrast and quality of ultrasound images. The purpose of this narrative review is to survey the current literature regarding CEUS imaging and discuss its diagnostic and therapeutic roles in current vascular and selected nonvascular applications. The PubMed, MEDLINE, and Embase databases were searched until July 2016 using the PubMed and Ovid Web-based search engines. The search terms used included contrast-enhanced, microbubble, ultrasound, carotid, aneurysm, and arterial. The diagnostic and therapeutic utility of CEUS imaging has grown exponentially, particularly in the realms of extracranial carotid arterial disease, aortic disease, and peripheral arterial disease. Studies have demonstrated that CEUS imaging is diagnostically superior to conventional ultrasound imaging in identifying vessel irregularities and measuring neovascularization to assess plaque vulnerability and end-muscle perfusion. Groups have begun to use microbubbles as agents in therapeutic applications for targeted drug and gene therapy delivery as well as for the enhancement of sonothrombolysis. The emerging technology of microbubbles and CEUS imaging holds considerable promise for cardiovascular medicine and cancer therapy given its diagnostic and therapeutic utility. Overall, with proper training and credentialing of technicians, the clinical implications are innumerable as microbubble technology is rapidly bursting onto the scene of cardiovascular medicine. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Email for communicating results of diagnostic medical investigations to patients.

PubMed

Meyer, Barbara; Atherton, Helen; Sawmynaden, Prescilla; Car, Josip

2012-08-15

As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare providers to convey increasing volumes of test results to patients is driving investigation of alternative technological solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical investigations to patients. To assess the effects of using email for communicating results of diagnostic medical investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes, including harms, for health professionals, patients and caregivers, and health services. We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions using email for communicating results of any diagnostic medical investigations to patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible. No studies met the inclusion criteria, therefore there are no results to report on the use of email for communicating results of diagnostic medical

Has 4D transperineal ultrasound additional value over 2D transperineal ultrasound for diagnosing obstructed defaecation syndrome?

PubMed

van Gruting, I M A; Kluivers, K; Sultan, A H; De Bin, R; Stankiewicz, A; Blake, H; Thakar, R

2018-06-08

To establish the diagnostic test accuracy of both two-dimensional (2D) and four-dimensional (4D) transperineal ultrasound, to assess if 4D ultrasound imaging provides additional value in the diagnosis of posterior pelvic floor disorders in women with obstructed defaecation syndrome. In this prospective cohort study, 121 consecutive women with obstructed defaecation syndrome were recruited. Symptoms of obstructed defaecation and signs of pelvic organ prolapse were assessed using validated methods. All women underwent both 2D transperineal ultrasound (Pro-focus, 8802 transducer, BK-medical) and 4D transperineal ultrasound (Voluson i, RAB4-8-RS transducer, GE). Imaging analysis was performed by two blinded observers. Pelvic floor disorders were dichotomised into presence or absence according pre-defined cut-off values. In the absence of a reference standard a composite reference standard was created from a combination of results of evacuation proctogram, magnetic resonance imaging and endovaginal ultrasound. Primary outcome measures were diagnostic test characteristics of 2D and 4D transperineal ultrasound for diagnosis or rectocele, enterocele, intussusception and anismus. Secondary outcome measures were interobserver agreement, agreement between the two techniques and correlation of signs and symptoms to imaging findings. For diagnosis of all four posterior pelvic floor disorders there was no difference in sensitivity and specificity between 2D and 4D TPUS (p= 0.131 - 1.000). A good agreement between 2D and 4D TPUS was found for the diagnosis of rectocele (ĸ 0.675) and a moderate agreement for diagnosis of enterocele, intussusception and anismus (ĸ 0.465 - 0.545). There was no difference in rectocele depth measurements between both TPUS techniques (19.9 mm vs 19.0 mm, p=0.802). Inter-observer agreement was comparable for both techniques, however 2D TPUS had an excellent interobserver agreement for diagnosis of enterocele and rectocele depth measurements. Diagnosis

The effect of nonlinear propagation on heating of tissue: A numerical model of diagnostic ultrasound beams

NASA Astrophysics Data System (ADS)

Cahill, Mark D.; Humphrey, Victor F.; Doody, Claire

2000-07-01

Thermal safety indices for diagnostic ultrasound beams are calculated under the assumption that the sound propagates under linear conditions. A non-axisymmetric finite difference model is used to solve the KZK equation, and so to model the beam of a diagnostic scanner in pulsed Doppler mode. Beams from both a uniform focused rectangular source and a linear array are considered. Calculations are performed in water, and in attenuating media with tissue-like characteristics. Attenuating media are found to exhibit significant nonlinear effects for finite-amplitude beams. The resulting loss of intensity by the beam is then used as the source term in a model of tissue heating to estimate the maximum temperature rises. These are compared with the thermal indices, derived from the properties of the water-propagated beams.

Conformal drug delivery and instantaneous monitoring based on an inverse synthesis method at a diagnostic ultrasound platform

NASA Astrophysics Data System (ADS)

Xu, Shanshan; Zong, Yujin; Liu, Xiaodong; Lu, Mingzhu; Wan, Mingxi

2017-03-01

In this paper, based on a programmable diagnostic ultrasound scanner, a combined approach was proposed, in which a variable-sized focal region wherein the acoustic pressure is above the ultrasound contrast agents (UCA) fragmentation threshold is synthesized by reasonably matching the excitation voltage and the transmit aperture of the linear array at 5MHz, the UCAs' temporal and spatial distribution before and after the microbubbles fragmentation is monitored using the plane-wave transmission and reception at 400Hz and, simultaneously, the broadband noise emission during the microbubbles fragmentation is extracted using the backscattering of focused release bursts (destruction pulse) themselves on the linear array. Then, acquired radio frequency (RF) data are processed to draw parameters which can be correlated with the indicator of broadband noise emission level, namely inertial cavitation dose (ICD) and microbubble fragmentation efficiency, namely decay rate of microbubbles.

Utilization of bedside urogenital ultrasound in an austere combat setting: enterovesicular fistula case report.

PubMed

Lunceford, Nicole; Scherl, Robert J; Elliot, Jonathan; Bechtel, Brett F; Auten, Jonathan

2013-03-01

The role of bedside ultrasound by physicians with advanced ultrasound training, such as emergency medicine providers, has been clearly established in the austere setting of combat medicine. This highly mobile, noninvasive, and versatile imaging modality has a role in evaluating battle- and nonbattle-related presentations. This case report describes a U.S. Marine reporting to an austere medical facility with the chief complaint of abdominal pain. An ultrasound of the patient's urinary tract revealed abnormalities that suggested right bladder wall thickening and an echo dense layer of sediment as the potential source of his discomfort. These findings supported patient transfer to a higher echelon of care. Further diagnostic testing revealed Crohn's disease with an associated enterovesicular fistula. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Critical Care Ultrasound: A Review for Practicing Nephrologists.

PubMed

Wilson, Jennifer G; Breyer, Kristine E W

2016-05-01

The use of point-of-care ultrasound in the intensive care unit, both for diagnostic and procedural purposes, has rapidly proliferated, and evidence supporting its use is growing. Conceptually, critical care ultrasound (CCUS) should be considered an extension of the physical examination and should not be considered a replacement for formal echocardiography or radiology-performed ultrasound. Several CCUS applications are of particular relevance to nephrologists, including focused renal ultrasound in patients at high risk for urinary tract obstruction, real-time ultrasound guidance and verification during the placement of central venous catheters, and ultrasound-augmented assessment of shock and volume status. Each of these applications has the capacity to improve outcomes in patients with acute kidney injury. Although robust evidence regarding long-term outcomes is lacking, existing data demonstrate that CCUS has the potential to improve diagnostic accuracy, expedite appropriate management, and increase safety for critically ill patients across a spectrum of pathologies. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Incremental cancer detection of locoregional restaging with diagnostic mammography combined with whole breast and regional nodal ultrasound in women with newly-diagnosed breast cancer

PubMed Central

Candelaria, Rosalind P.; Huang, Monica L.; Adrada, Beatriz E.; Bassett, Roland; Hunt, Kelly K.; Kuerer, Henry M.; Smith, Benjamin D.; Chavez-MacGregor, Mariana; Yang, Wei Tse

2016-01-01

RATIONALE AND OBJECTIVES To determine if locoregional restaging with diagnostic mammography and ultrasound of the whole breast and regional nodes performed for quality assurance in women with newly-diagnosed breast cancer referred to a tertiary care center yields incremental cancer detection. MATERIALS AND METHODS An institutional review board-approved retrospective, single institution database review was performed on the first 1000 women referred to our center in 2010 with a provisional breast cancer diagnosis. Locoregional restaging consisted of diagnostic full-field digital mammography combined with ultrasound of the whole breast and regional nodal basins. Bilateral whole breast ultrasound was performed in women with contralateral mammographic abnormality or had heterogeneously or extremely dense parenchyma. Demographic, clinical and pathologic factors were analyzed. RESULTS Final analyses included 401 women. 34% (138/401) of women did not have their outside images available for review upon referral. Median age was 54 years, range 21–92; median tumor size was 2.9 cm, range 0.6–18, for women whose disease was upstaged and 2.2 cm, range 0.4–15, for women whose disease was not upstaged. Incremental cancer detection rates were 15.5% (62/401) in the ipsilateral breast and 3.9% (6/154) in the contralateral breast (p<0.0001). Total upstage rate was 25% (100/401). Surgical management changed from segmentectomy to mastectomy in 12% (50/401). Re-excision rate after segmentectomy was 19% (35/189). CONCLUSION Locoregional restaging with diagnostic mammography combined with whole breast and regional nodal ultrasound that is performed for standardization of the imaging workup for newly-diagnosed breast cancer patients can reduce underestimation of disease burden and impact therapeutic planning. PMID:27955877

System theory in medical diagnostic devices: an overview.

PubMed

Baura, Gail D

2006-01-01

Medical diagnostics refers to testing conducted either in vitro or in vivo to provide critical health care information for risk assessment, early diagnosis, treatment, or disease management. Typical in vivo diagnostic tests include the computed tomography scan, magnetic resonance imaging, and blood pressure screening. Typical in vitro diagnostic tests include cholesterol, Papanicolaou smear, and conventional glucose monitoring tests. Historically, devices associated with both types of diagnostics have used heuristic curve fitting during signal analysis. However, since the early 1990s, a few enterprising engineers and physicians have used system theory to improve their core processing for feature detection and system identification. Current applications include automated Pap smear screening for detection of cervical cancer and diagnosis of Alzheimer's disease. Future applications, such as disease prediction before symptom onset and drug treatment customization, have been catalyzed by the Human Genome Project.

Diagnostic sensitivity of ultrasound, radiography and computed tomography for gender determination in four species of lizards.

PubMed

Di Ianni, Francesco; Volta, Antonella; Pelizzone, Igor; Manfredi, Sabrina; Gnudi, Giacomo; Parmigiani, Enrico

2015-01-01

Gender determination is frequently requested by reptile breeders, especially for species with poor or absent sexual dimorphism. The aims of the current study were to describe techniques and diagnostic sensitivities of ultrasound, radiography, and computed tomography for gender determination (identification of hemipenes) in four species of lizards. Nineteen lizards of known sex, belonging to four different species (Pogona vitticeps, Uromastyx aegyptia, Tiliqua scincoides, Gerrhosaurus major) were prospectively enrolled. With informed owner consent, ultrasound, noncontrast CT, contrast radiography, and contrast CT (with contrast medium administered into the cloaca) were performed in conscious animals. Imaging studies were reviewed by three different operators, each unaware of the gender of the animals and of the results of the other techniques. The lizard was classified as a male when hemipenes were identified. Nineteen lizards were included in the study, 10 females and nine males. The hemipenes were seen on ultrasound in only two male lizards, and appeared as oval hypoechoic structures. Radiographically, hemipenes filled with contrast medium appeared as spindle-shaped opacities. Noncontrast CT identified hemipenes in only two lizards, and these appeared as spindle-shaped kinked structures with hyperattenuating content consistent with smegma. Hemipenes were correctly identified in all nine males using contrast CT (accuracy of 100%). Accuracy of contrast radiography was excellent (94.7%). Accuracy of ultrasound and of noncontrast CT was poor (64.3% and 63.1%, respectively). Findings from the current study supported the use of contrast CT or contrast radiography for gender determination in lizards. © 2014 American College of Veterinary Radiology.

Diagnostic evaluations of ultrasound and magnetic resonance imaging in mammary duct ectasia and breast cancer

PubMed Central

Song, Lei; Li, Liang; Liu, Bin; Yu, Dexin; Sun, Fengguo; Guo, Mingming; Ruan, Zhengmin; Zhang, Feixue

2018-01-01

The objective of the present study was to evaluate the diagnostic efficiency of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis and differential diagnosis of mammary duct ectasia (MDE) and breast cancer. This retrospective study was performed on 35 patients with MDE and 105 patients with breast cancer using US and MRI. Imaging features, semi-quantitative and quantitative parameters were analyzed to determine their diagnostic value for MDE and breast cancer. The average age of patients with breast cancer was increased compared with that of patients with MDE. There were no significant differences in local packages with or without tenderness ratio (P=0.259) and grade of color Doppler flow imaging (P=0.273) between the two groups. However, the morphological changes were significantly increased in breast cancer compared with MDE. In addition, there were significant diagnostic differences in US and MRI between breast cancer and MDE, including resistance index, US elastography, time-signal intensity curve, apparent diffusion coefficient, early-stage enhancement ratio, peak-of-enhancement ratio and Tpeak (P<0.05). However, there were no observable significant diagnostic differences between US, MRI and US with MRI for MDE and breast cancer (P=0.103, P=0.263 and P=0.403 respectively). Diagnosis of MDE and breast cancer requires full evaluation of multiple parameters and morphological changes of US and MRI to increase the diagnostic efficiency. US, MRI and US with MRI were all of diagnostic value for MDE and breast cancer, while US with MRI had the highest efficacy. PMID:29434865

Acoustic Radiation Force Elasticity Imaging in Diagnostic Ultrasound

PubMed Central

Doherty, Joshua R.; Trahey, Gregg E.; Nightingale, Kathryn R.; Palmeri, Mark L.

2013-01-01

The development of ultrasound-based elasticity imaging methods has been the focus of intense research activity since the mid-1990s. In characterizing the mechanical properties of soft tissues, these techniques image an entirely new subset of tissue properties that cannot be derived with conventional ultrasound techniques. Clinically, tissue elasticity is known to be associated with pathological condition and with the ability to image these features in vivo, elasticity imaging methods may prove to be invaluable tools for the diagnosis and/or monitoring of disease. This review focuses on ultrasound-based elasticity imaging methods that generate an acoustic radiation force to induce tissue displacements. These methods can be performed non-invasively during routine exams to provide either qualitative or quantitative metrics of tissue elasticity. A brief overview of soft tissue mechanics relevant to elasticity imaging is provided, including a derivation of acoustic radiation force, and an overview of the various acoustic radiation force elasticity imaging methods. PMID:23549529

Acoustic radiation force elasticity imaging in diagnostic ultrasound.

PubMed

Doherty, Joshua R; Trahey, Gregg E; Nightingale, Kathryn R; Palmeri, Mark L

2013-04-01

The development of ultrasound-based elasticity imaging methods has been the focus of intense research activity since the mid-1990s. In characterizing the mechanical properties of soft tissues, these techniques image an entirely new subset of tissue properties that cannot be derived with conventional ultrasound techniques. Clinically, tissue elasticity is known to be associated with pathological condition and with the ability to image these features in vivo; elasticity imaging methods may prove to be invaluable tools for the diagnosis and/or monitoring of disease. This review focuses on ultrasound-based elasticity imaging methods that generate an acoustic radiation force to induce tissue displacements. These methods can be performed noninvasively during routine exams to provide either qualitative or quantitative metrics of tissue elasticity. A brief overview of soft tissue mechanics relevant to elasticity imaging is provided, including a derivation of acoustic radiation force, and an overview of the various acoustic radiation force elasticity imaging methods.

Analysis of "dry" mesothelioma with ultrasound guided biopsies.

PubMed

Stigt, Jos A; Boers, James E; Groen, Harry J M

2012-12-01

Image-guided sampling of the thickened pleura is a sensitive approach in patients with malignant pleural mesothelioma with pleural effusion. Malignant pleural mesothelioma presenting without effusion however is more of a diagnostic challenge. In this study we report the diagnostic yield and complications of ultrasound-guided cutting needle biopsies in this particular category of patients. A retrospective database analysis from September 2007 until January 2012 was performed in 56 patients with malignant pleural mesothelioma. Clinical characteristics and results of diagnostic evaluations were analysed. Of the 56 patients with malignant pleural mesothelioma, 20 patients presented without pleural effusion of with locular effusion. Ultrasound-guided cutting needle biopsy was performed in 14/20 patients with a diagnostic accuracy of 80%. Only 1 patient had mild haemoptysis immediately following biopsies. Diagnosing patients with pleural thickenings suspect for malignant mesothelioma without pleural effusion or with loculated pleural effusion is effective and safe with ultrasound-guided cutting needle biopsies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Contrast Enhanced Diagnostic Ultrasound Causes Renal Tissue Damage in a Porcine Model

PubMed Central

Miller, Douglas L.; Dou, Chunyan; Wiggins, Roger C.

2010-01-01

Objective Glomerular capillary hemorrhage (GCH) has been reported and confirmed as a consequence of contrast-enhanced diagnostic ultrasound (CEDUS) of rat kidney. This study assessed renal tissue injury in the larger porcine model. Methods The right kidneys of anesthetized pigs were imaged in 8 groups of 4 pigs. A Vingmed System Five (General Electric Co. Cincinnati OH) was used at 1.5 MHz in B-mode to intermittently scan the kidney at 4 s intervals. A Sequoia 512 (Acuson, Mountain View CA) was used in the 1.5 MHz Cadence CPS mode with intermittent agent-clearance bursts at 4 s intervals. Kidneys were scanned transabdominally, or after laparotomy through a saline standoff. The Sequoia 512 probe was placed in contact with the kidney for one group. Definity (Lantheus Medical Imaging, N. Billerica, MA) was infused at 4 μl/kg/min (diluted 33:1 in saline) for 4 min during scanning. Results Blood-filled urinary tubules were evident on the kidney surface for all groups, except for the group with the probe in contact with the kidney. GCH was found by histology in 31.7 % ± 9.8 % of glomeruli in the center of the scan plane for 1.7 MPa transabdominal scanning and 1.5 % ± 2.9 % of glomeruli in sham samples (P<0.05). In addition, hematuria was detected after scanning, and tubular obstruction occurred in some nephrons. Conclusion Renal tissue damage was induced by CEDUS in the porcine model. This result, together with previous studies in rats, support an hypothesis that GCH would occur in humans from similar CEDUS. PMID:20876892

Breast cancer: determining the genetic profile from ultrasound-guided percutaneous biopsy specimens obtained during the diagnostic workups.

PubMed

López Ruiz, J A; Zabalza Estévez, I; Mieza Arana, J A

2016-01-01

To evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup. This is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform. The size of the tumors on ultrasound ranged from 0.6cm to 5cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples. In most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Generalized sidelobe canceler beamforming applied to medical ultrasound imaging

NASA Astrophysics Data System (ADS)

Li, Jiake; Chen, Xiaodong; Wang, Yi; Shi, Yifeng; Yu, Daoyin

2017-03-01

A generalized sidelobe canceler (GSC) approach is proposed for medical ultrasound imaging. The approach uses a set of adaptive weights instead of traditional non-adaptive weights, thus suppressing the interference and noise signal of echo data. In order to verify the validity of the proposed approach, Field II is applied to obtain the echo data of synthetic aperture (SA) for 13 scattering points and circular cysts. The performance of GSC is compared with SA using boxcar weights and Hamming weights, and is quantified by the full width at half maximum (FWHM) and peak signal-to-noise ratio (PSNR). Imaging of scattering point utilizing SA, SA (hamming), GSC provides FWHMs of 1.13411, 1.68910, 0.36195 mm and PSNRs of 60.65, 57.51, 66.72 dB, respectively. The simulation results of circular cyst also show that GSC can perform better lateral resolution than non-adaptive beamformers. Finally, an experiment is conducted on the basis of actual echo data of an ultrasound system, the imaging result after SA, SA (hamming), GSC provides PWHMs of 2.55778, 3.66776, 1.01346 mm at z = 75.6 mm, and 2.65430, 3.76428, 1.27889 mm at z = 77.3 mm, respectively.

Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction.

PubMed

Rohrich, Rod J; Ha, Richard Y; Kenkel, Jeffrey M; Adams, William P

2003-02-01

Gynecomastia, or excessive male breast development, has an incidence of 32 to 65 percent in the male population. This condition has important physical and psychological impacts. Advances in elucidating the pathophysiology of gynecomastia have been made, though understanding remains limited. Recommendations for evaluation and workup have varied and are often arbitrary. A diagnostic algorithm is suggested, with emphasis on a comprehensive history, physical examination, and minimizing unnecessary diagnostic testing. Medical management has had limited success; surgical therapy, primarily through excisional techniques, has been the accepted standard. Although effective, excisional techniques subject patients to large, visible scars. Ultrasound-assisted liposuction has recently emerged as a safe and effective method for the treatment of gynecomastia. It is particularly efficient in the removal of the dense, fibrous male breast tissue while offering advantages in minimal external scarring. A new system of classification and graduated treatment is proposed, based on glandular versus fibrous hypertrophy and degree of breast ptosis (skin excess). The authors' series of 61 patients with gynecomastia from 1987 to 2000 at the University of Texas Southwestern Department of Plastic Surgery demonstrated an overall success rate of 86.9 percent using suction-assisted lipectomy (1987 to 1997) and ultrasound-assisted liposuction (1997 to 2000). The authors have found ultrasound-assisted liposuction to be effective in treating most grades of gynecomastia. Excisional techniques are reserved for severe gynecomastia with significant skin excess after attempted ultrasound-assisted liposuction.

High-Sensitivity Fiber-Optic Ultrasound Sensors for Medical Imaging Applications

PubMed Central

Wen, H.; Wiesler, D.G.; Tveten, A.; Danver, B.; Dandridge, A.

2010-01-01

This paper presents several designs of high-sensitivity, compact fiber-optic ultrasound sensors that may be used for medical imaging applications. These sensors translate ultrasonic pulses into strains in single-mode optical fibers, which are measured with fiber-based laser interferometers at high precision. The sensors are simpler and less expensive to make than piezoelectric sensors, and are not susceptible to electromagnetic interference. It is possible to make focal sensors with these designs, and several schemes are discussed. Because of the minimum bending radius of optical fibers, the designs are suitable for single element sensors rather than for arrays. PMID:9691368

Ultrasound Elastography and MR Elastography for Assessing Liver Fibrosis: Part 2, Diagnostic Performance, Confounders, and Future Directions

PubMed Central

Tang, An; Cloutier, Guy; Szeverenyi, Nikolaus M.; Sirlin, Claude B.

2016-01-01

OBJECTIVE The purpose of the article is to review the diagnostic performance of ultrasound and MR elastography techniques for detection and staging of liver fibrosis, the main current clinical applications of elastography in the abdomen. CONCLUSION Technical and instrument-related factors and biologic and patient-related factors may constitute potential confounders of stiffness measurements for assessment of liver fibrosis. Future developments may expand the scope of elastography for monitoring liver fibrosis and predict complications of chronic liver disease. PMID:25905762

Optoelectronic tweezers for medical diagnostics

NASA Astrophysics Data System (ADS)

Kremer, Clemens; Neale, Steven; Menachery, Anoop; Barrett, Mike; Cooper, Jonathan M.

2012-01-01

Optoelectronic tweezers (OET) allows the spatial patterning of electric fields through selected illumination of a photoconductive surface. This enables the manipulation of micro particles and cells by creating non-uniform electrical fields that then produce dielectrophoretic (DEP) forces. The DEP responses of cells differ and can produce negative or positive (repelled or attracted to areas of high electric field) forces. Therefore OET can be used to manipulate individual cells and separate different cell types from each other. Thus OET has many applications for medical diagnostics, demonstrated here with work towards diagnosing Human African Trypanosomiasis, also known as sleeping sickness.

A comparison of hepatic steatosis index, controlled attenuation parameter and ultrasound as noninvasive diagnostic tools for steatosis in chronic hepatitis B.

PubMed

Xu, Liang; Lu, Wei; Li, Ping; Shen, Feng; Mi, Yu-Qiang; Fan, Jian-Gao

2017-08-01

To evaluate the value of noninvasive tools for diagnosis of hepatic steatosis in patients with chronic hepatitis B (CHB). Consecutive treatment-naïve patients with CHB with body mass index less than 30kg/m 2 who underwent liver biopsy, ultrasound and FibroScan ® were enrolled. The diagnostic performance of controlled attenuation parameter (CAP), hepatic steatosis index (HSI) and ultrasound for hepatic steatosis compared with liver biopsy was assessed. The areas under receiver operating characteristics curves (AUROCs) were calculated to determine the diagnostic efficacy, with comparisons using the DeLong test. CAP and HSI accuracies were significantly higher than that of ultrasound to detect patients with biopsy-proven mild steatosis (S1, 65.3%, 56.5%, respectively, vs. 17.7%, χ 2 =46.305, 31.736, both P<0.05)and moderate-severe (S2-3) steatosis (92.3%, 100%, respectively, vs. 53.8%, χ 2 =4.887, 7.800, P=0.037, 0.007, respectively). Both CAP and HSI had lower underestimation rates of steatosis grade than ultrasound (12%, 14.8%, respectively, vs. 29.5%, χ 2 =9.765, 6.452; P<0.05 for both), but they exhibited higher overestimation rates (30.5%, 38.2%, respectively, vs. 12.4%, χ 2 =39.222, 70.986; both P<0.05). The AUROCs of CAP and HSI were 0.780 (95% confidence intervals [CIs] 0.735-0.822) and 0.655 (95%CI 0.604-0.704) for S ≥1, 0.932 (95%CI 0.902-0.956) and 0.755 (95%CI 0.707-0.799) for S ≥2, 0.990 (95%CI 0.974-0.998) and 0.786 (95% CI 0.740-0.827) for S3, respectively. CAP might be more accurate for detecting hepatic steatosis than HSI and ultrasound in patients with CHB, but further studies are needed to reduce the overestimation rates. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Recent advances in ultrasound-triggered therapy.

PubMed

Yang, Chaopin; Li, Yue; Du, Meng; Chen, Zhiyi

2018-04-27

As a non-invasive and real-time diagnostic technique, ultrasound has provided a novel strategy for targeted treatment. With the rapid development of ultrasonic technique and ultrasound contrast agents (UCAs), spatiotemporally controllable application of ultrasound with or without UCAs makes it possible for site-specific delivery of therapeutic agents and targeted modulation with minimal side effects, which indicated a promising therapy in clinical use. This review will describe the main mechanism of targeted therapy induced by ultrasound briefly, then focus on the current application of ultrasound mediated targeted therapy in various fields including tumour, cardiovascular disease, central nervous system, skeletal muscle system diseases and stem cells therapy. In addition, ongoing challenges of ultrasound-mediated targeted therapy for further research and its clinical use are reviewed.

An effective non-rigid registration approach for ultrasound image based on "demons" algorithm.

PubMed

Liu, Yan; Cheng, H D; Huang, Jianhua; Zhang, Yingtao; Tang, Xianglong; Tian, Jiawei

2013-06-01

Medical image registration is an important component of computer-aided diagnosis system in diagnostics, therapy planning, and guidance of surgery. Because of its low signal/noise ratio (SNR), ultrasound (US) image registration is a difficult task. In this paper, a fully automatic non-rigid image registration algorithm based on demons algorithm is proposed for registration of ultrasound images. In the proposed method, an "inertia force" derived from the local motion trend of pixels in a Moore neighborhood system is produced and integrated into optical flow equation to estimate the demons force, which is helpful to handle the speckle noise and preserve the geometric continuity of US images. In the experiment, a series of US images and several similarity measure metrics are utilized for evaluating the performance. The experimental results demonstrate that the proposed method can register ultrasound images efficiently, robust to noise, quickly and automatically.

Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography.

PubMed

Vlahiotis, Anna; Griffin, Brian; Stavros, A Thomas; Margolis, Jay

2018-01-01

Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures. Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes. The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion. The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.

Microbubbles induce renal hemorrhage when exposed to diagnostic ultrasound in anesthetized rats.

PubMed

Wible, James H; Galen, Karen P; Wojdyla, Jolette K; Hughes, Michael S; Klibanov, Alexander L; Brandenburger, Gary H

2002-01-01

The generation of ultrasound (US) bioeffects using a clinical imaging system is controversial. We tested the hypothesis that the presence of microbubbles in the US field of a medical imager induces biologic effects. Both kidneys of anesthetized rats were insonified for 5 min using a medical imaging system after the administration of microbubbles. One kidney was insonified using a continuous mode (30 Hz) and the opposite kidney was insonified using an intermittent (1 Hz) technique. The microbubbles were exposed to three different transducer frequencies and four transducer output powers. After insonification, the animals were euthanized, the kidneys were removed and their gross appearance scored under "blinded" conditions using a defined scale. After the administration of microbubbles, US imaging of the kidney caused hemorrhage in the renal tissue. The severity and area of hemorrhage increased with an increase in the transducer power and a decrease in the transducer frequency. Intermittent insonification in the presence of microbubbles produced a greater degree of renal hemorrhage than continuous imaging techniques.

Establishment of ultrasound as a diagnostic aid in the referral of patients with abdominal pain in an emergency department – a pilot study

PubMed Central

Poulsen, Liv la Cour; Bækgaard, Emilie Stokholm; Istre, Per Grosen; Schmidt, Thomas Andersen; Larsen, Torben

2015-01-01

Purpose Ultrasonography is a noninvasive, cheap, and fast way of assessing abdominal pain in an emergency department. Many physicians working in emergency departments do not have pre-existing ultrasound experience. The purpose of this study was to investigate the ability of first-year internship doctors to perform a reliable ultrasound examination on patients with abdominal pain in an emergency setting. Materials and methods This study took place in an emergency department in Denmark. Following a 1-day ultrasound introduction course, three doctors without prior ultrasound experience scanned 45 patients during a 2-month period. The applicability of the examinations was evaluated by subsequent control examination: computed tomography, operation, or ultrasound by a trained radiologist or gynecologist or, in cases where the patient was immediately discharged, by ultrasound image evaluation. Results In 14 out of 21 patients with a control examination, there was diagnostic agreement between the project ultrasound examination and the control. Image evaluation of all patients showed useful images of the gallbladder, kidneys, liver, abdominal aorta, and urinary bladder, but no useful images for either the pancreas or colon. Conclusion With only little formal training, it is possible for first-year internship doctors to correctly visualize some abdominal organs with ultrasonography. However, a longer study time frame, including more patients, and an ultrasound course specifically designed for the purpose of use in an emergency department, is needed to enhance the results. PMID:27147884

Spatially Resolved MR-Compatible Doppler Ultrasound: Proof of Concept for Triggering of Diagnostic Quality Cardiovascular MRI for Function and Flow Quantification at 3T.

PubMed

Crowe, Lindsey Alexandra; Manasseh, Gibran; Chmielewski, Aneta; Hachulla, Anne-Lise; Speicher, Daniel; Greiser, Andreas; Muller, Hajo; de Perrot, Thomas; Vallee, Jean-Paul; Salomir, Rares

2018-02-01

We demonstrate the use of a magnetic-resonance (MR)-compatible ultrasound (US) imaging probe using spatially resolved Doppler for diagnostic quality cardiovascular MR imaging (MRI) as an initial step toward hybrid US/MR fetal imaging. A newly developed technology for a dedicated MR-compatible phased array ultrasound-imaging probe acquired pulsed color Doppler carotid images, which were converted in near-real time to a trigger signal for cardiac cine and flow quantification MRI. Ultrasound and MR data acquired simultaneously were interference free. Conventional electrocardiogram (ECG) and the proposed spatially resolved Doppler triggering were compared in 10 healthy volunteers. A synthetic "false-triggered" image was retrospectively processed using metric optimized gating (MOG). Images were scored by expert readers, and sharpness, cardiac function and aortic flow were quantified. Four-dimensional (4-D) flow (two volunteers) showed feasibility of Doppler triggering over a long acquisition time. Imaging modalities were compatible. US probe positioning was stable and comfortable. Image quality scores and quantified sharpness were statistically equal for Doppler- and ECG-triggering (p ). ECG-, Doppler-triggered, and MOG ejection fractions were equivalent (p ), with false-triggered values significantly lower (p < 0.0005). Aortic flow showed no difference between ECG- and Doppler-triggered and MOG (p > 0.05). 4-D flow quantification gave consistent results between ECG and Doppler triggering. We report interference-free pulsed color Doppler ultrasound during MR data acquisition. Cardiovascular MRI of diagnostic quality was successfully obtained with pulsed color Doppler triggering. The hardware platform could further enable advanced free-breathing cardiac imaging. Doppler ultrasound triggering is applicable where ECG is compromised due to pathology or interference at higher magnetic fields, and where direct ECG is impossible, i.e., fetal imaging.

Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: Comparison of radiographic, ultrasound and MRI findings.

PubMed

Faruch Bilfeld, Marie; Lapègue, Franck; Chiavassa Gandois, Hélène; Bayol, Marie Aurélie; Bonnevialle, Nicolas; Sans, Nicolas

2017-02-01

Acromioclavicular joint injuries are typically diagnosed by clinical and radiographic assessment with the Rockwood classification, which is crucial for treatment planning. The purpose of this study was to describe how the ultrasound findings of acromioclavicular joint injury compare with radiography and MRI findings. Forty-seven patients with suspected unilateral acromioclavicular joint injury after acute trauma were enrolled in this prospective study. All patients underwent digital radiography, ultrasound and 3T MRI. A modified Rockwood classification was used to evaluate the coracoclavicular ligaments. The classifications of acromioclavicular joint injuries diagnosed with radiography, ultrasound and MRI were compared. MRI was used as the gold standard. The agreement between the ultrasound and MRI findings was very good, with a correlation coefficient of 0.83 (95 % CI: 0.72-0.90; p < 0.0001). Ultrasound detected coracoclavicular ligament injuries with a sensitivity of 88.9 %, specificity of 90.0 %, positive predictive value of 92.3 % and negative predictive value of 85.7 %. The agreement between the ultrasound and radiography findings was poor, with a correlation coefficient of 0.69 (95 % CI: 0.51-0.82; p < 0.0001). Ultrasound is an effective examination for the diagnostic work-up of lesions of the coracoclavicular ligaments in the acute phase of an acromioclavicular injury. • Ultrasound is appropriate for acute acromioclavicular trauma due to its accessibility. • Ultrasound contributes to the diagnostic work-up of acute lesions of the coracoclavicular ligaments. • Ultrasound is appropriate in patients likely to benefit from surgical treatment. • Ultrasound could be a supplement to standard radiography in acute acromioclavicular trauma.

Hunger Games: Interactive Ultrasound Imaging for Learning Gastrointestinal Physiology.

PubMed

Kafer, Ilana; Rennie, William; Noor, Ali; Pellerito, John S

2017-02-01

Ultrasound is playing an increasingly important role in medical student education. Although most uses of ultrasound have focused on learning purely anatomic relationships or augmentation of the physical examination, there is little documentation of the value of ultrasound as a learning tool regarding physiology alone or in association with anatomy. We devised an interactive learning session for first-year medical students using ultrasound to combine both anatomic and physiologic principles as an integration of gastrointestinal and vascular function. The incorporation of our activity, The Hunger Games, provides the foundation for a powerful integration tool for medical student education. © 2016 by the American Institute of Ultrasound in Medicine.

Risk of cesarean delivery when second-trimester ultrasound dating disagrees with definite last menstrual period.

PubMed

Grewal, Jagteshwar; Zhang, Jun; Mikolajczyk, Rafael T; Ford, Jessie

2010-08-01

Estimates of gestational age based on early second-trimester ultrasound often differ from that based on the last menstrual period (LMP) even when a woman is certain about her LMP. Discrepancies in these gestational age estimates may be associated with an increased risk of cesarean section and low birth weight. We analyzed 7228 singleton, low-risk, white women from The Routine Antenatal Diagnostic Imaging with Ultrasound trial. The women were recruited at less than 14 weeks of gestation and received ultrasound exams between 15 and 22 weeks. Our results indicate that among nulliparous women, the risk of cesarean section increased from 10% when the ultrasound-based gestational age exceeded the LMP-based estimate by 4 days to 60% when the discrepancy increased to 21 days. Moreover, for each additional day the ultrasound-based estimate exceeded the LMP-based estimate, birth weight was higher by 9.6 g. Our findings indicate that a positive discrepancy (i.e., ultrasound-based estimate exceeds LMP-based estimate) in gestational age is associated with an increased risk of cesarean section. A negative discrepancy, by contrast, may reflect early intrauterine growth restriction and an increased risk of low birth weight. Copyright Thieme Medical Publishers.

Hybrid Photoacoustic/Ultrasound Tomograph for Real-Time Finger Imaging.

PubMed

Oeri, Milan; Bost, Wolfgang; Sénégond, Nicolas; Tretbar, Steffen; Fournelle, Marc

2017-10-01

We report a target-enclosing, hybrid tomograph with a total of 768 elements based on capacitive micromachined ultrasound transducer technology and providing fast, high-resolution 2-D/3-D photoacoustic and ultrasound tomography tailored to finger imaging. A freely programmable ultrasound beamforming platform sampling data at 80 MHz was developed to realize plane wave transmission under multiple angles. A multiplexing unit enables the connection and control of a large number of elements. Fast image reconstruction is provided by GPU processing. The tomograph is composed of four independent and fully automated movable arc-shaped transducers, allowing imaging of all three finger joints. The system benefits from photoacoustics, yielding high optical contrast and enabling visualization of finger vascularization, and ultrasound provides morphologic information on joints and surrounding tissue. A diode-pumped, Q-switched Nd:YAG laser and an optical parametric oscillator are used to broaden the spectrum of emitted wavelengths to provide multispectral imaging. Custom-made optical fiber bundles enable illumination of the region of interest in the plane of acoustic detection. Precision in positioning of the probe in motion is ensured by use of a motor-driven guide slide. The current position of the probe is encoded by the stage and used to relate ultrasound and photoacoustic signals to the corresponding region of interest of the suspicious finger joint. The system is characterized in phantoms and a healthy human finger in vivo. The results obtained promise to provide new opportunities in finger diagnostics and establish photoacoustic/ultrasound-tomography in medical routine. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Sherlock Holmes' methods of deductive reasoning applied to medical diagnostics.

PubMed

Miller, L

1985-03-01

Having patterned the character of Sherlock Holmes after one of his professors, Sir Arthur Conan Doyle, himself a physician, incorporated many of the didactic qualities of the 19th century medical diagnostician into the character of Holmes. In this paper I explore Holmes's techniques of deductive reasoning and their basis in 19th and 20th century medical diagnostics.

Open-source telemedicine platform for wireless medical video communication.

PubMed

Panayides, A; Eleftheriou, I; Pantziaris, M

2013-01-01

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings.

Open-Source Telemedicine Platform for Wireless Medical Video Communication

PubMed Central

Panayides, A.; Eleftheriou, I.; Pantziaris, M.

2013-01-01

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. PMID:23573082

Ultrasonographic diagnosis of early pregnancy in cattle using different ultrasound systems.

PubMed

Racewicz, Przemysław; Sickinger, Marlene; Włodarek, Jan; Jaśkowski, Jędrzej M

2016-06-16

To evaluate the efficiency of different ultrasound devices in achieving an early diagnosis of pregnancy in dairy herds. A total of 1976 Holstein Friesian cows and heifers were artificially inseminated (AI) according to the herd manager's regime. Pregnancy diagnostics were performed between day 26 and 35 after AI using six different types of ultrasound systems (linear vs. sector scanners). Manual rectal palpation between day 45 and 60 after AI was used as the gold standard for pregnancy diagnostics. Sensitivity (SENS), specificity (SPEC), positive (PPV) and negative predictive value (NPV) and diagnostic accuracy (ACC) of the diagnostic measures were determined. Average SENS was 82% (range 67.7-95.2%) with a mean SPEC of 73% (range 50.0-81.0%). ACC was 78.2% with a minimum of 64.6% and a maximum of 89.4%, depending on the ultrasound system. The PPV (ratio of the number of pregnant cows with a positive examination result to the number of cows actually pregnant) was 80.8% (range 59.1-88.1%), whereas the NPV (defined as the ratio of the number of cows correctly diagnosed negative to the number of cows actually open) was 74.4% (72.3-91.9%). Significant differences for these parameters were found depending on the ultrasound system used (p ≤ 0.01; Cramer's V. = 0.14). Regardless of the ultrasound device used, early pregnancy diagnostics between day 26 and 35 show a moderate diagnostic efficiency. Comparing the accuracy of the different devices, there may be a significant influence of type and technical parameters. Even though ultrasound systems with mechanical sector probes are not as convenient to use as systems with linear probes, according to this study, sector scanners are a reasonable alternative.

Ultrasound for the Anesthesiologists: Present and Future

PubMed Central

Terkawi, Abdullah S.; Karakitsos, Dimitrios; Elbarbary, Mahmoud; Blaivas, Michael; Durieux, Marcel E.

2013-01-01

Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum. PMID:24348179

Opto-acoustic breast imaging with co-registered ultrasound

NASA Astrophysics Data System (ADS)

Zalev, Jason; Clingman, Bryan; Herzog, Don; Miller, Tom; Stavros, A. Thomas; Oraevsky, Alexander; Kist, Kenneth; Dornbluth, N. Carol; Otto, Pamela

2014-03-01

We present results from a recent study involving the ImagioTM breast imaging system, which produces fused real-time two-dimensional color-coded opto-acoustic (OA) images that are co-registered and temporally inter- leaved with real-time gray scale ultrasound using a specialized duplex handheld probe. The use of dual optical wavelengths provides functional blood map images of breast tissue and tumors displayed with high contrast based on total hemoglobin and oxygen saturation of the blood. This provides functional diagnostic information pertaining to tumor metabolism. OA also shows morphologic information about tumor neo-vascularity that is complementary to the morphological information obtained with conventional gray scale ultrasound. This fusion technology conveniently enables real-time analysis of the functional opto-acoustic features of lesions detected by readers familiar with anatomical gray scale ultrasound. We demonstrate co-registered opto-acoustic and ultrasonic images of malignant and benign tumors from a recent clinical study that provide new insight into the function of tumors in-vivo. Results from the Feasibility Study show preliminary evidence that the technology may have the capability to improve characterization of benign and malignant breast masses over conventional diagnostic breast ultrasound alone and to improve overall accuracy of breast mass diagnosis. In particular, OA improved speci city over that of conventional diagnostic ultrasound, which could potentially reduce the number of negative biopsies performed without missing cancers.

Nonspherical dynamics and shape mode stability of ultrasound contrast agent microbubbles

NASA Astrophysics Data System (ADS)

Calvisi, Michael

2016-11-01

Ultrasound contrast agents (UCAs) are shell encapsulated microbubbles developed originally for ultrasound imaging enhancement. UCAs are more recently being exploited for therapeutic applications, such as for drug delivery, gene therapy, and tissue ablation. Ultrasound transducer pulses can induce spherical (radial) UCA oscillations, translation, and nonspherical shape oscillations, the dynamics of which are highly coupled. If driven sufficiently strongly, the ultrasound can induce breakup of UCAs, which can facilitate drug or gene delivery but should be minimized for imaging purposes to increase residence time and maximize diagnostic effect. Therefore, an understanding of the interplay between the acoustic driving and nonspherical shape mode stability of UCAs is essential for both diagnostic and therapeutic applications. In this work, we use both analytical and numerical methods to analyze shape mode stability for cases of small and large nonspherical oscillations, respectively. To analyze shape mode stability in the limit of small nonspherical perturbations, we couple a radial model of a lipid-coated microbubble with a model for bubble translation and nonspherical shape oscillation. This hybrid model is used to predict shape mode stability for ultrasound driving frequencies and pressure amplitudes of clinical interest. In addition, calculations of the stability of individual shape modes, residence time, maximum radius, and translation are provided with respect to acoustic driving parameters and compared to an unshelled bubble. The effects of shell elasticity, shell viscosity, and initial radius on stability are investigated. Furthermore, the well-established boundary element method (BEM) is used to investigate the dynamics and shape stability of large amplitude nonspherical oscillations of an ultrasonically-forced, polymer-coated microbubble near a rigid boundary. Different instability modes are identified based on the degree of jetting and proximity to the

Thoracic ultrasound-assisted selection for pleural biopsy with Abrams needle.

PubMed

Botana-Rial, Maribel; Leiro-Fernández, Virginia; Represas-Represas, Cristina; González-Piñeiro, Ana; Tilve-Gómez, Amara; Fernández-Villar, Alberto

2013-11-01

Closed pleural biopsy (CPB) in patients with malignant pleural effusion is less sensitive than cytology. Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where secondary spread from pleural metastases is initially more likely to be found. We analyzed whether choosing the point of entry for CPB with thoracic ultrasound assistance influences the diagnostic yield in malignant pleural effusion. This prospective study included patients who underwent CPB performed by an experienced pulmonologist in 2008-2010 (group A) and thoracic ultrasound was used to select the biopsy site. The results were compared with a historical series of CPB performed by the same pulmonologist without the assistance of thoracic ultrasound (group B). An Abrams needle was used in all cases. We analyzed the obtaining of pleural tissue and the diagnostic yield. We included 114 CPBs from group A (23% tuberculous pleural effusion, 27% malignant pleural effusion) and 67 CPBs from group B (24% tuberculous pleural effusion, 30% malignant pleural effusion) (P = .70). Pleural tissue was obtained in 96.5% of the group A CPBs and 89.6% of the group B CPBs (P = .05). The diagnostic yields of CPB for tuberculous pleural effusion and malignant pleural effusion in group A were 89.5% and 77.4%, respectively, and 91.7% and 60%, respectively, in group B (P = .80 for tuberculous pleural effusion, and P = .18 for malignant pleural effusion). Selecting the point of entry for CPB using thoracic ultrasound increases the likelihood of obtaining pleural tissue and the diagnostic yield, but without statistical significance. We recommend ultrasound-assisted CPB to investigate pleural effusion, since the diagnostic yield of a pleural biopsy with an Abrams needle increased by > 17% in subjects with malignant pleural effusion.

Diagnostic Value of Endorectal Ultrasound in Preoperative Assessment of Lymph Node Involvement in Colorectal Cancer: a Meta-analysis.

PubMed

Li, Li; Chen, Shi; Wang, Ke; Huang, Jiao; Liu, Li; Wei, Sheng; Gao, Hong-Yu

2015-01-01

Nodal invasion by colorectal cancer is a critical determinant in estimating patient survival and in choosing appropriate preoperative treatment. The present meta-analysis was designed to evaluate the diagnostic value of endorectal ultrasound (EUS) in preoperative assessment of lymph node involvement in colorectal cancer. We systematically searched PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI) databases for relevant studies published on or before December 10th, 2014. The sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR) and area under the summary receiver operating characteristics curve (AUC) were assessed to estimate the diagnostic value of EUS. Subgroup analysis and meta-regression were performed to explore heterogeneity across studies. Thirty-three studies covering 3,016 subjects were included. The pooled sensitivity and specificity were 0.69 (95%CI: 0.63-0.75) and 0.77 (95%CI: 0.73-0.82), respectively. The positive and negative likelihood ratios were 3.09 (95%CI: 2.52-3.78) and 0.39 (95%CI: 0.32-0.48), respectively. The DOR was 7.84 (95%CI: 5.56-11.08), and AUC was 0.80 (95%CI: 0.77-0.84). This meta-analysis indicated that EUS has moderate diagnostic value in preoperative assessment of lymph node involvement in colorectal cancer. Further refinements in technology and diagnostic criteria are necessary to improve the diagnostic accuracy of EUS.

An Interview with Medical Diagnostics Scientist Bernhard Weigl

ERIC Educational Resources Information Center

Sullivan, Megan

2010-01-01

Medical diagnostics help us evaluate a range of disorders, such as cancer and infectious diseases. In the United States and other developed countries, doctors have access to advanced equipment and laboratories that provide reliable diagnoses. As a result, when we are sick, we feel confident that we will get the treatment we need. Unfortunately,…

Survey of ultrasound practice amongst podiatrists in the UK.

PubMed

Siddle, Heidi J; Patience, Aimie; Coughtrey, James; Mooney, Jean; Fox, Martin; Cherry, Lindsey

2018-01-01

Ultrasound in podiatry practice encompasses musculoskeletal ultrasound imaging, vascular hand-held Doppler ultrasound and therapeutic ultrasound. Sonography practice is not regulated by the Health and Care Professions Council (HCPC), with no requirement to hold a formal qualification. The College of Podiatry does not currently define ultrasound training and competencies.This study aimed to determine the current use of ultrasound, training received and mentorship received and/or provided by podiatrists using ultrasound. A quantitative study utilising a cross-sectional, on-line, single-event survey was undertaken within the UK. Completed surveys were received from 284 podiatrists; 173 (70%) use ultrasound as part of their general practice, 139 (49%) for musculoskeletal problems, 131 (46%) for vascular assessment and 39 (14%) to support their surgical practice. Almost a quarter ( n  = 62) worked for more than one organisation; 202 (71%) were employed by the NHS and/or private sector ( n  = 118, 41%).Nearly all (93%) respondents report using a hand-held vascular Doppler in their daily practice; 216 (82%) to support decisions regarding treatment options, 102 (39%) to provide diagnostic reports for other health professionals, and 34 (13%) to guide nerve blocks.Ultrasound imaging was used by 104 (37%) respondents primarily to aid clinical decision making ( n  = 81) and guide interventions (steroid injections n  = 67; nerve blocks n  = 39). Ninety-three percent stated they use ultrasound imaging to treat their own patients, while others scan at the request of other podiatrists ( n  = 28) or health professionals ( n  = 18). Few use ultrasound imaging for research ( n  = 7) or education ( n  = 2).Only 32 (11%) respondents ( n  = 20 private sector) use therapeutic ultrasound to treat patients presenting with musculoskeletal complaints, namely tendon pathologies.Few respondents (18%) had completed formal post-graduate CASE (Consortium

Sherlock Holmes's Methods of Deductive Reasoning Applied to Medical Diagnostics

PubMed Central

Miller, Larry

1985-01-01

Having patterned the character of Sherlock Holmes after one of his professors, Sir Arthur Conan Doyle, himself a physician, incorporated many of the didactic qualities of the 19th century medical diagnostician into the character of Holmes. In this paper I explore Holmes's techniques of deductive reasoning and their basis in 19th and 20th century medical diagnostics. PMID:3887762

"On the other hand ...": the evidence does not support the use of hand-carried ultrasound by hospitalists.

PubMed

Feldman, Mitchell D; Petersen, Amy Jean; Tice, Jeffrey A

2010-03-01

In the right hands, ultrasound is a safe and helpful diagnostic imaging tool. However, evidence supporting the use of hand-carried ultrasound (HCU) by hospitalist physicians has not kept pace with expanding application of these devices. In spite of its strategic point-of-care benefit, use of this technology by hospitalists may not ultimately translate into improved efficiency and better clinical outcomes. Optimal levels of training in image acquisition and interpretation remain to be established. Novelty, availability, and the results of a few small studies lacking patient-centered outcomes remain insufficient grounds to justify the expanded clinical utilization of these medical imaging devices by nonspecialists.

WE-AB-206-03: Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, Z.

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

Effects of Student-Performed Point-of-Care Ultrasound on Physician Diagnosis and Management of Patients in the Emergency Department.

PubMed

Udrea, Daniel S; Sumnicht, Andrew; Lo, Deanna; Villarreal, Logan; Gondra, Stephanie; Chyan, Richard; Wisham, Audra; Dinh, Vi Am

2017-07-01

Despite the increasing integration of ultrasound training into medical education, there is an inadequate body of research demonstrating the benefits and practicality of medical student-performed point-of-care ultrasound (SP-POCUS) in the clinical setting. The primary purpose of this study was to evaluate the effects that SP-POCUS can have on physician diagnosis and management of patients in the emergency department, with a secondary purpose of evaluating the diagnostic accuracy of SP-POCUS. SP-POCUS examinations were performed in the emergency department by medical students who completed year one of a 4-year medical school curriculum with integrated ultrasound training. Scans were evaluated by an emergency physician who then completed a survey to record any changes in diagnosis and management. A total of 641 scans were performed on the 482 patients enrolled in this study. SP-POCUS resulted in a change in management in 17.3% of scans performed. For 12.4% of scans, SP-POCUS discovered a new diagnosis. SP-POCUS reduced time to disposition 33.5% of the time. Because of SP-POCUS, physicians avoided ordering an additional imaging study for 53.0% of the scans performed. There was 94.7% physician agreement with SP-POCUS diagnosis. This study showed that SP-POCUS is feasible and may potentially have a meaningful impact on physician diagnosis and management of patients in the emergency department. In addition, the implementation of SP-POCUS could serve as an ideal method of developing ultrasound skills in medical school while positively impacting patient care. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasound tissue analysis and characterization

NASA Astrophysics Data System (ADS)

Kaufhold, John; Chan, Ray C.; Karl, William C.; Castanon, David A.

1999-07-01

On the battlefield of the future, it may become feasible for medics to perform, via application of new biomedical technologies, more sophisticated diagnoses and surgery than is currently practiced. Emerging biomedical technology may enable the medic to perform laparoscopic surgical procedures to remove, for example, shrapnel from injured soldiers. Battlefield conditions constrain the types of medical image acquisition and interpretation which can be performed. Ultrasound is the only viable biomedical imaging modality appropriate for deployment on the battlefield -- which leads to image interpretation issues because of the poor quality of ultrasound imagery. To help overcome these issues, we develop and implement a method of image enhancement which could aid non-experts in the rapid interpretation and use of ultrasound imagery. We describe an energy minimization approach to finding boundaries in medical images and show how prior information on edge orientation can be incorporated into this framework to detect tissue boundaries oriented at a known angle.

Towards Dynamic Contrast Specific Ultrasound Tomography

NASA Astrophysics Data System (ADS)

Demi, Libertario; van Sloun, Ruud J. G.; Wijkstra, Hessel; Mischi, Massimo

2016-10-01

We report on the first study demonstrating the ability of a recently-developed, contrast-enhanced, ultrasound imaging method, referred to as cumulative phase delay imaging (CPDI), to image and quantify ultrasound contrast agent (UCA) kinetics. Unlike standard ultrasound tomography, which exploits changes in speed of sound and attenuation, CPDI is based on a marker specific to UCAs, thus enabling dynamic contrast-specific ultrasound tomography (DCS-UST). For breast imaging, DCS-UST will lead to a more practical, faster, and less operator-dependent imaging procedure compared to standard echo-contrast, while preserving accurate imaging of contrast kinetics. Moreover, a linear relation between CPD values and ultrasound second-harmonic intensity was measured (coefficient of determination = 0.87). DCS-UST can find clinical applications as a diagnostic method for breast cancer localization, adding important features to multi-parametric ultrasound tomography of the breast.

Towards Dynamic Contrast Specific Ultrasound Tomography.

PubMed

Demi, Libertario; Van Sloun, Ruud J G; Wijkstra, Hessel; Mischi, Massimo

2016-10-05

We report on the first study demonstrating the ability of a recently-developed, contrast-enhanced, ultrasound imaging method, referred to as cumulative phase delay imaging (CPDI), to image and quantify ultrasound contrast agent (UCA) kinetics. Unlike standard ultrasound tomography, which exploits changes in speed of sound and attenuation, CPDI is based on a marker specific to UCAs, thus enabling dynamic contrast-specific ultrasound tomography (DCS-UST). For breast imaging, DCS-UST will lead to a more practical, faster, and less operator-dependent imaging procedure compared to standard echo-contrast, while preserving accurate imaging of contrast kinetics. Moreover, a linear relation between CPD values and ultrasound second-harmonic intensity was measured (coefficient of determination = 0.87). DCS-UST can find clinical applications as a diagnostic method for breast cancer localization, adding important features to multi-parametric ultrasound tomography of the breast.

Towards Dynamic Contrast Specific Ultrasound Tomography

PubMed Central

Demi, Libertario; Van Sloun, Ruud J. G.; Wijkstra, Hessel; Mischi, Massimo

2016-01-01

We report on the first study demonstrating the ability of a recently-developed, contrast-enhanced, ultrasound imaging method, referred to as cumulative phase delay imaging (CPDI), to image and quantify ultrasound contrast agent (UCA) kinetics. Unlike standard ultrasound tomography, which exploits changes in speed of sound and attenuation, CPDI is based on a marker specific to UCAs, thus enabling dynamic contrast-specific ultrasound tomography (DCS-UST). For breast imaging, DCS-UST will lead to a more practical, faster, and less operator-dependent imaging procedure compared to standard echo-contrast, while preserving accurate imaging of contrast kinetics. Moreover, a linear relation between CPD values and ultrasound second-harmonic intensity was measured (coefficient of determination = 0.87). DCS-UST can find clinical applications as a diagnostic method for breast cancer localization, adding important features to multi-parametric ultrasound tomography of the breast. PMID:27703251

Principles for new optical techniques in medical diagnostics for mHealth applications

NASA Astrophysics Data System (ADS)

Balsam, Joshua Michael

Medical diagnostics is a critical element of effective medical treatment. However, many modern and emerging diagnostic technologies are not affordable or compatible with the needs and conditions found in low-income and middle-income countries and regions. Resource-poor areas require low-cost, robust, easy-to-use, and portable diagnostics devices compatible with telemedicine (i.e. mHealth) that can be adapted to meet diverse medical needs. Many suitable devices will need to be based on optical technologies, which are used for many types of biological analyses. This dissertation describes the fabrication and detection principles for several low-cost optical technologies for mHealth applications including: (1) a webcam based multi-wavelength fluorescence plate reader, (2) a lens-free optical detector used for the detection of Botulinum A neurotoxin activity, (3) a low cost micro-array reader that allows the performance of typical fluorescence based assays demonstrated for the detection of the toxin staphylococcal enterotoxin (SEB), and (4) a wide-field flow cytometer for high throughput detection of fluorescently labeled rare cells. This dissertation discusses how these technologies can be harnessed using readily available consumer electronics components such as webcams, cell phones, CCD cameras, LEDs, and laser diodes. There are challenges in developing devices with sufficient sensitivity and specificity, and approaches are presented to overcoming these challenges to create optical detectors that can serve as low cost medical diagnostics in resource-poor settings for mHealth.

[The value of bedside lung ultrasound in emergency-plus protocol for the assessment of lung consolidation and atelectasis in critical patients].

PubMed

Wang, Xiao-ting; Liu, Da-wei; Zhang, Hong-min; He, Huai-wu; Liu, Ye; Chai, Wen-zhao; Du, Wei

2012-12-01

To investigate the effect of the bedside lung ultrasound in emergency(BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases (89.74%) had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94.87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66.67%, respectively. The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis

A new method for tracking organ motion on diagnostic ultrasound images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kubota, Yoshiki, E-mail: y-kubota@gunma-u.ac.jp; Matsumura, Akihiko, E-mail: matchan.akihiko@gunma-u.ac.jp; Fukahori, Mai, E-mail: fukahori@nirs.go.jp

2014-09-15

Purpose: Respiratory-gated irradiation is effective in reducing the margins of a target in the case of abdominal organs, such as the liver, that change their position as a result of respiratory motion. However, existing technologies are incapable of directly measuring organ motion in real-time during radiation beam delivery. Hence, the authors proposed a novel quantitative organ motion tracking method involving the use of diagnostic ultrasound images; it is noninvasive and does not entail radiation exposure. In the present study, the authors have prospectively evaluated this proposed method. Methods: The method involved real-time processing of clinical ultrasound imaging data rather thanmore » organ monitoring; it comprised a three-dimensional ultrasound device, a respiratory sensing system, and two PCs for data storage and analysis. The study was designed to evaluate the effectiveness of the proposed method by tracking the gallbladder in one subject and a liver vein in another subject. To track a moving target organ, the method involved the control of a region of interest (ROI) that delineated the target. A tracking algorithm was used to control the ROI, and a large number of feature points and an error correction algorithm were used to achieve long-term tracking of the target. Tracking accuracy was assessed in terms of how well the ROI matched the center of the target. Results: The effectiveness of using a large number of feature points and the error correction algorithm in the proposed method was verified by comparing it with two simple tracking methods. The ROI could capture the center of the target for about 5 min in a cross-sectional image with changing position. Indeed, using the proposed method, it was possible to accurately track a target with a center deviation of 1.54 ± 0.9 mm. The computing time for one frame image using our proposed method was 8 ms. It is expected that it would be possible to track any soft-tissue organ or tumor with large

In vivo demonstration of ultrasound power delivery to charge implanted medical devices via acute and survival porcine studies

PubMed Central

Radziemski, Leon; Makin, Inder Raj S.

2015-01-01

Animal studies are an important step in proving the utility and safety of an ultrasound based implanted battery recharging system. To this end an Ultrasound Electrical Recharging System (USER™) was developed and tested. Experiments in vitro demonstrated power deliveries at the battery of up to 600 mW through 10 – 15 mm of tissue, 50 mW of power available at tissue depths of up to 50 mm, and the feasibility of using transducers bonded to titanium as used in medical implants. Acute in vivo studies in a porcine model were used to test reliability of power delivery, temperature excursions, and cooling techniques. The culminating five-week survival study involved repeated battery charging, a total of 10.5 hours of ultrasound exposure of the intervening living tissue, with an average RF input to electrical charging efficiency of 20%. This study was potentially the first long term cumulative living-tissue exposure using transcutaneous ultrasound power transmission to an implanted receiver in situ. Histology of the exposed tissue showed changes attributable primarily due to surgical implantation of the prototype device, and no damage due to the ultrasound exposure. The in vivo results are indicative of the potential safe delivery of ultrasound energy for a defined set of source conditions for charging batteries within implants. PMID:26243566

Medical image computing for computer-supported diagnostics and therapy. Advances and perspectives.

PubMed

Handels, H; Ehrhardt, J

2009-01-01

Medical image computing has become one of the most challenging fields in medical informatics. In image-based diagnostics of the future software assistance will become more and more important, and image analysis systems integrating advanced image computing methods are needed to extract quantitative image parameters to characterize the state and changes of image structures of interest (e.g. tumors, organs, vessels, bones etc.) in a reproducible and objective way. Furthermore, in the field of software-assisted and navigated surgery medical image computing methods play a key role and have opened up new perspectives for patient treatment. However, further developments are needed to increase the grade of automation, accuracy, reproducibility and robustness. Moreover, the systems developed have to be integrated into the clinical workflow. For the development of advanced image computing systems methods of different scientific fields have to be adapted and used in combination. The principal methodologies in medical image computing are the following: image segmentation, image registration, image analysis for quantification and computer assisted image interpretation, modeling and simulation as well as visualization and virtual reality. Especially, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients and will gain importance in diagnostic and therapy of the future. From a methodical point of view the authors identify the following future trends and perspectives in medical image computing: development of optimized application-specific systems and integration into the clinical workflow, enhanced computational models for image analysis and virtual reality training systems, integration of different image computing methods, further integration of multimodal image data and biosignals and advanced methods for 4D medical image computing. The development of image analysis systems for diagnostic support or

Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular-cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma.

PubMed

Huang, Xiao-Wen; Huang, Yang; Chen, Li-da; Wang, Zhu; Yang, Zheng; Liu, Jin-Ya; Xie, Xiao-Yan; Lu, Ming-De; Shen, Shun-Li; Wang, Wei

2018-04-01

To evaluate the diagnostic performance of the combination of tumor markers [alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9)] and imaging features in differentiating combined hepatocellular-cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Forty consecutive patients with pathologically proven CHC were retrospectively evaluated with contrast-enhanced ultrasound (CEUS). Additionally, 40 HCC and 40 CC patients who were randomly selected from the same period served as a control group. Images were classified as HCC-like or CC-like pattern according to CEUS guidelines recommended by World and European Federation for Ultrasound in Medicine and Biology (WFUMB-EFSUMB). The diagnostic criteria of CHC were defined as follows: (1) both AFP and CA19-9 are simultaneously elevated (AFP > 20 ng/ml and CA19-9 > 100 units/ml); or (2) elevated AFP with a CC-like pattern on CEUS and without elevated CA19-9 level; or (3) elevated CA19-9 with an HCC-like pattern on CEUS and without elevated AFP level. The diagnostic tests were performed with calculation of the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). For the 40 CHC patients, the rates of elevated AFP and CA19-9 serology were 55.0 and 30.0%, respectively. Twenty-three (57.5%) patients exhibited an HCC-like pattern, and 15 (37.5%) showed a CC-like pattern. After applying the above diagnostic criteria of CHC in the 120 patients, the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 32.5, 93.8, 72.2, 73.5, 73.3, and 0.631%, respectively. When the actual prevalence rate (0.4-14.3%) was taken into account, the PPV and NPV were modified from 2.1 to 46.7% and 89.3 to 99.7%, respectively. The combination of enhancement patterns on CEUS and serum tumor markers (AFP and CA19-9) may be a potentially specific diagnostic method to differentiate CHC from HCC

Eigenspace-based minimum variance beamformer combined with Wiener postfilter for medical ultrasound imaging.

PubMed

Zeng, Xing; Chen, Cheng; Wang, Yuanyuan

2012-12-01

In this paper, a new beamformer which combines the eigenspace-based minimum variance (ESBMV) beamformer with the Wiener postfilter is proposed for medical ultrasound imaging. The primary goal of this work is to further improve the medical ultrasound imaging quality on the basis of the ESBMV beamformer. In this method, we optimize the ESBMV weights with a Wiener postfilter. With the optimization of the Wiener postfilter, the output power of the new beamformer becomes closer to the actual signal power at the imaging point than the ESBMV beamformer. Different from the ordinary Wiener postfilter, the output signal and noise power needed in calculating the Wiener postfilter are estimated respectively by the orthogonal signal subspace and noise subspace constructed from the eigenstructure of the sample covariance matrix. We demonstrate the performance of the new beamformer when resolving point scatterers and cyst phantom using both simulated data and experimental data and compare it with the delay-and-sum (DAS), the minimum variance (MV) and the ESBMV beamformer. We use the full width at half maximum (FWHM) and the peak-side-lobe level (PSL) to quantify the performance of imaging resolution and the contrast ratio (CR) to quantify the performance of imaging contrast. The FWHM of the new beamformer is only 15%, 50% and 50% of those of the DAS, MV and ESBMV beamformer, while the PSL is 127.2dB, 115dB and 60dB lower. What is more, an improvement of 239.8%, 232.5% and 32.9% in CR using simulated data and an improvement of 814%, 1410.7% and 86.7% in CR using experimental data are achieved compared to the DAS, MV and ESBMV beamformer respectively. In addition, the effect of the sound speed error is investigated by artificially overestimating the speed used in calculating the propagation delay and the results show that the new beamformer provides better robustness against the sound speed errors. Therefore, the proposed beamformer offers a better performance than the DAS, MV and

National variation of ADHD diagnostic prevalence and medication use: health care providers and education policies.

PubMed

Fulton, Brent D; Scheffler, Richard M; Hinshaw, Stephen P; Levine, Peter; Stone, Susan; Brown, Timothy T; Modrek, Sepideh

2009-08-01

Attention-deficit hyperactivity disorder (ADHD) diagnostic prevalence and medication use vary across U.S. census regions, but little is known about state-level variation. The purpose of this study was to estimate this variation across states and examine whether a state's health care provider characteristics and education policies are associated with this variation. Logistic regression models were estimated with 69,505 children aged four to 17 from the state-stratified and nationally representative 2003 National Survey of Children's Health, conducted by the Centers for Disease Control and Prevention. Diagnostic prevalence was higher in the South (odds ratio [OR]=1.42, p<.001) than in the West; among children with ADHD diagnoses, medication use was higher in the South (OR=1.60, p<.01) and the Midwest (OR=1.53, p<.01) versus the West. On these measures, several states differed from the U.S. averages, including some states that, on the basis of the regional patterns found above, would not be expected to differ: Michigan had a high diagnostic prevalence; Vermont, South Dakota, and Nebraska had low diagnostic prevalences; and Connecticut, New Jersey, and Kentucky had low medication rates. Both diagnosis and medication status were associated with the number, age, and type of physicians within a state, particularly pediatricians. However, state education policies were not significantly associated with either diagnostic prevalence or medication rates. To better understand the association between a state's health care provider characteristics and both diagnostic prevalence and medication use, it may be fruitful to examine the content of provider continuing education programs, including the recommendations of major health professional organization guidelines to treat ADHD.

12th WINFOCUS world congress on ultrasound in emergency and critical care.

PubMed

Acar, Yahya; Tezel, Onur; Salman, Necati; Cevik, Erdem; Algaba-Montes, Margarita; Oviedo-García, Alberto; Patricio-Bordomás, Mayra; Mahmoud, Mustafa Z; Sulieman, Abdelmoneim; Ali, Abbas; Mustafa, Alrayah; Abdelrahman, Ihab; Bahar, Mustafa; Ali, Osama; Lester Kirchner, H; Prosen, Gregor; Anzic, Ajda; Leeson, Paul; Bahreini, Maryam; Rasooli, Fatemeh; Hosseinnejad, Houman; Blecher, Gabriel; Meek, Robert; Egerton-Warburton, Diana; Ćuti, Edina Ćatić; Belina, Stanko; Vančina, Tihomir; Kovačević, Idriz; Rustemović, Nadan; Chang, Ikwan; Lee, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Cheng, Chi-Yung; Pan, Hsiu-Yung; Kung, Chia-Te; Ćurčić, Ela; Pritišanac, Ena; Planinc, Ivo; Medić, Marijana Grgić; Radonić, Radovan; Fasina, Abiola; Dean, Anthony J; Panebianco, Nova L; Henwood, Patricia S; Fochi, Oliviero; Favarato, Moreno; Bonanomi, Ezio; Tomić, Ivan; Ha, Youngrock; Toh, Hongchuen; Harmon, Elizabeth; Chan, Wilma; Baston, Cameron; Morrison, Gail; Shofer, Frances; Hua, Angela; Kim, Sharon; Tsung, James; Gunaydin, Isa; Kekec, Zeynep; Ay, Mehmet Oguzhan; Kim, Jinjoo; Kim, Jinhyun; Choi, Gyoosung; Shim, Dowon; Lee, Ji-Han; Ambrozic, Jana; Prokselj, Katja; Lucovnik, Miha; Simenc, Gabrijela Brzan; Mačiulienė, Asta; Maleckas, Almantas; Kriščiukaitis, Algimantas; Mačiulis, Vytautas; Macas, Andrius; Mohite, Sharad; Narancsik, Zoltan; Možina, Hugon; Nikolić, Sara; Hansel, Jan; Petrovčič, Rok; Mršić, Una; Orlob, Simon; Lerchbaumer, Markus; Schönegger, Niklas; Kaufmann, Reinhard; Pan, Chun-I; Wu, Chien-Hung; Pasquale, Sarah; Doniger, Stephanie J; Yellin, Sharon; Chiricolo, Gerardo; Potisek, Maja; Drnovšek, Borut; Leskovar, Boštjan; Robinson, Kristine; Kraft, Clara; Moser, Benjamin; Davis, Stephen; Layman, Shelley; Sayeed, Yusef; Minardi, Joseph; Pasic, Irmina Sefic; Dzananovic, Amra; Pasic, Anes; Zubovic, Sandra Vegar; Hauptman, Ana Godan; Brajkovic, Ana Vujaklija; Babel, Jaksa; Peklic, Marina; Radonic, Vedran; Bielen, Luka; Ming, Peh Wee; Yezid, Nur Hafiza; Mohammed, Fatahul Laham; Huda, Zainal Abidin; Ismail, Wan Nasarudin Wan; Isa, W Yus Haniff W; Fauzi, Hashairi; Seeva, Praveena; Mazlan, Mohd Zulfakar

2016-09-01

A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military

Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience.

PubMed

Rempell, Joshua S; Saldana, Fidencio; DiSalvo, Donald; Kumar, Navin; Stone, Michael B; Chan, Wilma; Luz, Jennifer; Noble, Vicki E; Liteplo, Andrew; Kimberly, Heidi; Kohler, Minna J

2016-11-01

Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey. All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum. POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school.

Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

PubMed Central

Rempell, Joshua S.; Saldana, Fidencio; DiSalvo, Donald; Kumar, Navin; Stone, Michael B.; Chan, Wilma; Luz, Jennifer; Noble, Vicki E.; Liteplo, Andrew; Kimberly, Heidi; Kohler, Minna J.

2016-01-01

Introduction Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. Methods This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey. Results All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum. Conclusion POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school. PMID:27833681

Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value?

PubMed

Demirel, Adnan; Baykara, Murat; Koca, Tuba Tülay; Berk, Ejder

2018-06-01

Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.

Bedside ultrasound curriculum for medical students: report of a blended learning curriculum implementation and validation.

PubMed

Blackstock, Uché; Munson, Jaclyn; Szyld, Demian

2015-03-01

Medical students on clinical rotations rarely receive formal bedside ultrasound (BUS) training. We designed, implemented, and evaluated a standardized BUS curriculum for medical students on their Emergency Medicine (EM) rotation. Teaching was aimed toward influencing four cognitive and psychomotor learning domains: BUS instrumentation knowledge, image interpretation, image acquisition, and procedural guidance. Participants viewed three instructional Web-based tutorials on BUS instrumentation, the Focused Assessment for Sonography in Trauma (FAST) examination and ultrasound-guided central venous catheter (CVC) placement. Subsequently, participants attended a 3-hour hands-on training session to discuss the same content area and practice with faculty coaches. A Web-based, multiple-choice questionnaire was administered before and after the session. During the final week of the rotation, students returned for skills assessments on FAST image acquisition and CVC placement. Forty-five medical students on an EM rotation were enrolled. Sonographic knowledge overall mean score improved significantly from 66.6% (SD ±11.2) to 85.7% (SD ±10.0), corresponding to a mean difference of 19.1% (95% CI 15.5-22.7; p < 0.001). There were high pass rates for FAST (89.0%, 40/45) and CVC (96.0%, 43/45) skills assessments. There was no significant difference between medical student posttest and EM resident test scores 85.7% (SD ±10.0) and 88.1% (SD ± 7.6) (p = 0.40), respectively. A formal BUS curriculum for medical students on EM rotation positively influenced performance in several key learning domains. As BUS competency is required for residency in EM and other specialties, medical schools could consider routinely incorporating BUS teaching into their clinical rotation curricula. © 2014 Wiley Periodicals, Inc.

Right Upper Quadrant Pain: Ultrasound First!

PubMed

Revzin, Margarita V; Scoutt, Leslie M; Garner, Joseph G; Moore, Christopher L

2017-10-01

Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis. A spectrum of RUQ pathology for which a RUQ ultrasound examination should reasonably be considered as the initial imaging modality of choice will be reviewed. © 2017 by the American Institute of Ultrasound in Medicine.

Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS.

PubMed

Schellhaas, Barbara; Görtz, Ruediger S; Pfeifer, Lukas; Kielisch, Christian; Neurath, Markus F; Strobel, Deike

2017-09-01

A comparison is made of two contrast-enhanced ultrasound (CEUS) algorithms for the diagnosis of hepatocellular carcinoma (HCC) in high-risk patients: Erlanger Synopsis of Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at Risk (ESCULAP) and American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System (ACR-CEUS-LI-RADSv.2016). Focal liver lesions in 100 high-risk patients were assessed using both CEUS algorithms (ESCULAP and CEUS-LI-RADSv.2016) for a direct comparison. Lesions were categorized according to size and contrast enhancement in the arterial, portal venous and late phases.For the definite diagnosis of HCC, categories ESCULAP-4, ESCULAP-Tr and ESCULAP-V and CEUS-LI-RADS-LR-5, LR-Tr and LR-5-V were compared. In addition, CEUS-LI-RADS-category LR-M (definitely/probably malignant, but not specific for HCC) and ESCULAP-category C [intrahepatic cholangiocellular carcinoma (ICC)] were compared.Histology, CE-computed tomography and CE-MRI served as reference standards. The reference standard among 100 lesions included 87 HCCs, six ICCs and seven non-HCC-non-ICC-lesions. For the diagnosis of HCC, the diagnostic accuracy of CEUS was significantly higher with ESCULAP versus CEUS-LI-RADS (94.3%/72.4%; p<0.01). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value for ESCULAP/CEUS-LI-RADS were 94.3%/72.4%; 61.5%/69.2%; 94.3%/94%; and 61.5%/27.3%, respectively.The diagnostic accuracy for ICC (LR-M/ESCULAP-C) was identical with both algorithms (50%), with higher PPV for ESCULAP-C versus LR-M (75 vs. 50%). CEUS-based algorithms contribute toward standardized assessment and reporting of HCC-suspect lesions in high-risk patients. ESCULAP shows significantly higher diagnostic accuracy, sensitivity and negative predictive value with no loss of specificity compared with CEUS-LI-RADS. Both algorithms have an excellent PPV. Arterial hyperenhancement is the key feature for the

Emergency physician perceptions of medically unnecessary advanced diagnostic imaging.

PubMed

Kanzaria, Hemal K; Hoffman, Jerome R; Probst, Marc A; Caloyeras, John P; Berry, Sandra H; Brook, Robert H

2015-04-01

The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high

Ultrasound image-guided therapy enhances antitumor effect of cisplatin.

PubMed

Sasaki, Noboru; Kudo, Nobuki; Nakamura, Kensuke; Lim, Sue Yee; Murakami, Masahiro; Kumara, W R Bandula; Tamura, Yu; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

2014-01-01

The aim of this study was to clarify whether ultrasound image-guided cisplatin delivery with an intratumor microbubble injection enhances the antitumor effect in a xenograft mouse model. Canine thyroid adenocarcinoma cells were used for all experiments. Before in vivo experiments, the cisplatin and microbubble concentration and ultrasound exposure time were optimized in vitro. For in vivo experiments, cells were implanted into the back of nude mice. Observed by a diagnostic ultrasound machine, a mixture of cisplatin and ultrasound contrast agent, Sonazoid, microbubbles was injected directly into tumors. The amount of injected cisplatin and microbubbles was 1 μg/tumor and 1.2 × 10(7) microbubbles/tumor, respectively, with a total injected volume of 20 μl. Using the same diagnostic machine, tumors were exposed to ultrasound for 15 s. The treatment was repeated four times. The combination of cisplatin, microbubbles, and ultrasound significantly delayed tumor growth as compared with no treatment (after 18 days, 157 ± 55 vs. 398 ± 49 mm(3), P = 0.049). Neither cisplatin alone nor the combination of cisplatin and ultrasound delayed tumor growth. The treatment did not decrease the body weight of mice. Ultrasound image-guided anticancer drug delivery may enhance the antitumor effects of drugs without obvious side effects.

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study.

PubMed

Luqmani, Raashid; Lee, Ellen; Singh, Surjeet; Gillett, Mike; Schmidt, Wolfgang A; Bradburn, Mike; Dasgupta, Bhaskar; Diamantopoulos, Andreas P; Forrester-Barker, Wulf; Hamilton, William; Masters, Shauna; McDonald, Brendan; McNally, Eugene; Pease, Colin; Piper, Jennifer; Salmon, John; Wailoo, Allan; Wolfe, Konrad; Hutchings, Andrew

2016-11-01

Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9-61% of true cases. To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Prospective multicentre cohort study. Secondary care. A total of 381 patients referred with newly suspected GCA. Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician's assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass

Ultrasound in athletes: emerging techniques in point-of-care practice.

PubMed

Yim, Eugene S; Corrado, Gianmichel

2012-01-01

Ultrasound offers sports medicine clinicians the potential to diagnose, treat, and manage a broad spectrum of conditions afflicting athletes. This review article highlights applications of ultrasound that hold promise as point-of-care diagnostics and therapeutic tools that can be used directly by clinicians to direct real-time management of athletes. Point-of-care ultrasound has been examined most in the context of musculoskeletal disorders in athletes, with attention given to Achilles tendinopathy, patellar tendinopathy, hip and thigh pathology, elbow tendinopathy, wrist pathology, and shoulder pain. More research has focused on therapeutic applications than diagnostic, but initial evidence has been generated in both. Preliminary evidence has been published also on abdominal ultrasound for splenic enlargement in mononucleosis, cardiopulmonary processes and hydration status, deep vein thrombosis, and bone mineral density. Further research will be required to validate these applications and to explore further applications of portable ultrasound that can be used in the care of athletes.

21 CFR 890.5860 - Ultrasound and muscle stimulator.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ultrasound and muscle stimulator. 890.5860 Section... Ultrasound and muscle stimulator. (a) Ultrasound and muscle stimulator for use in applying therapeutic deep heat for selected medical conditions—(1) Identification. An ultrasound and muscle stimulator for use in...

21 CFR 890.5860 - Ultrasound and muscle stimulator.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ultrasound and muscle stimulator. 890.5860 Section... Ultrasound and muscle stimulator. (a) Ultrasound and muscle stimulator for use in applying therapeutic deep heat for selected medical conditions—(1) Identification. An ultrasound and muscle stimulator for use in...

21 CFR 890.5860 - Ultrasound and muscle stimulator.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ultrasound and muscle stimulator. 890.5860 Section... Ultrasound and muscle stimulator. (a) Ultrasound and muscle stimulator for use in applying therapeutic deep heat for selected medical conditions—(1) Identification. An ultrasound and muscle stimulator for use in...

21 CFR 890.5860 - Ultrasound and muscle stimulator.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ultrasound and muscle stimulator. 890.5860 Section... Ultrasound and muscle stimulator. (a) Ultrasound and muscle stimulator for use in applying therapeutic deep heat for selected medical conditions—(1) Identification. An ultrasound and muscle stimulator for use in...

21 CFR 890.5860 - Ultrasound and muscle stimulator.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ultrasound and muscle stimulator. 890.5860 Section... Ultrasound and muscle stimulator. (a) Ultrasound and muscle stimulator for use in applying therapeutic deep heat for selected medical conditions—(1) Identification. An ultrasound and muscle stimulator for use in...

Medical diagnostics for indoor mold exposure.

PubMed

Hurraß, Julia; Heinzow, Birger; Aurbach, Ute; Bergmann, Karl-Christian; Bufe, Albrecht; Buzina, Walter; Cornely, Oliver A; Engelhart, Steffen; Fischer, Guido; Gabrio, Thomas; Heinz, Werner; Herr, Caroline E W; Kleine-Tebbe, Jörg; Klimek, Ludger; Köberle, Martin; Lichtnecker, Herbert; Lob-Corzilius, Thomas; Merget, Rolf; Mülleneisen, Norbert; Nowak, Dennis; Rabe, Uta; Raulf, Monika; Seidl, Hans Peter; Steiß, Jens-Oliver; Szewszyk, Regine; Thomas, Peter; Valtanen, Kerttu; Wiesmüller, Gerhard A

2017-04-01

In April 2016, the German Society of Hygiene, Environmental Medicine and Preventative Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin (GHUP)) together with other scientific medical societies, German and Austrian medical societies, physician unions and experts has provided an AWMF (Association of the Scientific Medical Societies) guideline 'Medical diagnostics for indoor mold exposure'. This guideline shall help physicians to advise and treat patients exposed indoors to mold. Indoor mold growth is a potential health risk, even without a quantitative and/or causal association between the occurrence of individual mold species and health effects. Apart from the allergic bronchopulmonary aspergillosis (ABPA) and the mycoses caused by mold, there is only sufficient evidence for the following associations between moisture/mold damages and different health effects: Allergic respiratory diseases, asthma (manifestation, progression, exacerbation), allergic rhinitis, exogenous allergic alveolitis and respiratory tract infections/bronchitis. In comparison to other environmental allergens, the sensitizing potential of molds is estimated to be low. Recent studies show a prevalence of sensitization of 3-10% in the total population of Europe. The evidence for associations to mucous membrane irritation and atopic eczema (manifestation, progression, exacerbation) is classified as limited or suspected. Inadequate or insufficient evidence for an association is given for COPD, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis, and cancer. The risk of infections from indoor molds is low for healthy individuals. Only molds that are capable to form toxins can cause intoxications. The environmental and growth conditions and especially the substrate determine whether toxin formation occurs, but indoor air concentrations are always very low. In the case of indoor moisture/mold damages, everyone can be affected by odor effects and

Characterization of controlled bone defects using 2D and 3D ultrasound imaging techniques.

PubMed

Parmar, Biren J; Longsine, Whitney; Sabonghy, Eric P; Han, Arum; Tasciotti, Ennio; Weiner, Bradley K; Ferrari, Mauro; Righetti, Raffaella

2010-08-21

Ultrasound is emerging as an attractive alternative modality to standard x-ray and CT methods for bone assessment applications. As of today, however, there is a lack of systematic studies that investigate the performance of diagnostic ultrasound techniques in bone imaging applications. This study aims at understanding the performance limitations of new ultrasound techniques for imaging bones in controlled experiments in vitro. Experiments are performed on samples of mammalian and non-mammalian bones with controlled defects with size ranging from 400 microm to 5 mm. Ultrasound findings are statistically compared with those obtained from the same samples using standard x-ray imaging modalities and optical microscopy. The results of this study demonstrate that it is feasible to use diagnostic ultrasound imaging techniques to assess sub-millimeter bone defects in real time and with high accuracy and precision. These results also demonstrate that ultrasound imaging techniques perform comparably better than x-ray imaging and optical imaging methods, in the assessment of a wide range of controlled defects both in mammalian and non-mammalian bones. In the future, ultrasound imaging techniques might provide a cost-effective, real-time, safe and portable diagnostic tool for bone imaging applications.

Assessment of a Novel Point-of-Care Ultrasound Curriculum's Effect on Competency Measures in Family Medicine Graduate Medical Education.

PubMed

Bornemann, Paul

2017-06-01

Point-of-care ultrasound has been shown to decrease the use of expensive diagnostic studies and improve quality outcome measures. Currently, there is a large desire for training in family medicine residencies, but very few programs have established curricula. We sought to develop a family medicine residency curriculum and evaluate it with tools we developed. We wanted our curriculum to be easy to adopt by other residency programs, even if they did not have many well-trained ultrasound faculty. We developed a curriculum in the form of a 4-week rotation in a family medicine residency program. It consisted of self-study videos, hands-on training, and image review. We followed residents in postgraduate years 1 to 3 over a 12-month period. We developed tools, including a knowledge exam, to test image interpretation and clinical decision making, an observed structured clinical exam to assess scanning skills, and a survey to assess perceptions of point-of-care ultrasound in family medicine. The assessments were administered before and after each resident's rotation. Seventeen residents completed the rotation. The average knowledge test score improved significantly, from 62 to 84%. The average observed structured clinical exam scores also improved significantly, from 41 to 85%. The average perception survey scores improved slightly from 4.4 to 4.6. We developed a point-of-care ultrasound curriculum for family medicine residency programs that improves measures of resident attitude, skills, and knowledge. This curriculum can be adopted by residency programs with few faculty members who are experienced in ultrasound. © 2017 by the American Institute of Ultrasound in Medicine.

[The diagnostic value of medical thoracoscopy for unexplained pleural effusion].

PubMed

Jiang, Shu-juan; Mu, Xiao-yan; Zhang, Song; Su, Li-li; Ma, Wei-xia

2013-05-01

To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. A retrospective analysis of 2380 patients with unexplained pleural effusion (1320 males and 1060 females; age 15-94 years) in Shandong Provincial Hospital from 1992 to 2011 were performed .The diagnosis was confirmed by medical thoracoscopy. The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules . The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray-white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows: pleural metastases in 899 (37.8%), primary pleural mesothelioma in 439 (18.4%), tuberculous pleurisy in 514 (21.6%), non-specific inflammation in 226 (9.5%), empyema in 190 (8.0%), hepatic pleural effusion in 36 (1.5%) and pleural effusion of unknown causes in 76 (3.2%) cases. The diagnostic positive rate of medical thoracoscopy was 96.8%. No serious complications were observed. Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained pleural effusion.

The Use of Enteric Contrast Media for Diagnostic CT, MRI, and Ultrasound in Infants and Children: A Practical Approach.

PubMed

Callahan, Michael J; Talmadge, Jennifer M; MacDougall, Robert; Buonomo, Carlo; Taylor, George A

2016-05-01

Enteric contrast media are commonly administered for diagnostic cross-sectional imaging studies in the pediatric population. The purpose of this manuscript is to review the use of enteric contrast media for CT, MRI, and ultrasound in infants, children, and adolescents and to share our experiences at a large tertiary care pediatric teaching hospital. The use of enteric contrast material for diagnostic imaging in infants and children continues to evolve with advances in imaging technology and available enteric contrast media. Many principles of enteric contrast use in pediatric imaging are similar to those in adult imaging, but important differences must be kept in mind when imaging the gastrointestinal tract in infants and children, and practical ways to optimize the imaging examination and the patient experience should be employed where possible.

Acoustic Waves in Medical Imaging and Diagnostics

PubMed Central

Sarvazyan, Armen P.; Urban, Matthew W.; Greenleaf, James F.

2013-01-01

Up until about two decades ago acoustic imaging and ultrasound imaging were synonymous. The term “ultrasonography,” or its abbreviated version “sonography” meant an imaging modality based on the use of ultrasonic compressional bulk waves. Since the 1990s numerous acoustic imaging modalities started to emerge based on the use of a different mode of acoustic wave: shear waves. It was demonstrated that imaging with these waves can provide very useful and very different information about the biological tissue being examined. We will discuss physical basis for the differences between these two basic modes of acoustic waves used in medical imaging and analyze the advantages associated with shear acoustic imaging. A comprehensive analysis of the range of acoustic wavelengths, velocities, and frequencies that have been used in different imaging applications will be presented. We will discuss the potential for future shear wave imaging applications. PMID:23643056

In vivo demonstration of ultrasound power delivery to charge implanted medical devices via acute and survival porcine studies.

PubMed

Radziemski, Leon; Makin, Inder Raj S

2016-01-01

Animal studies are an important step in proving the utility and safety of an ultrasound based implanted battery recharging system. To this end an Ultrasound Electrical Recharging System (USER™) was developed and tested. Experiments in vitro demonstrated power deliveries at the battery of up to 600 mW through 10-15 mm of tissue, 50 mW of power available at tissue depths of up to 50 mm, and the feasibility of using transducers bonded to titanium as used in medical implants. Acute in vivo studies in a porcine model were used to test reliability of power delivery, temperature excursions, and cooling techniques. The culminating five-week survival study involved repeated battery charging, a total of 10.5h of ultrasound exposure of the intervening living tissue, with an average RF input to electrical charging efficiency of 20%. This study was potentially the first long term cumulative living-tissue exposure using transcutaneous ultrasound power transmission to an implanted receiver in situ. Histology of the exposed tissue showed changes attributable primarily due to surgical implantation of the prototype device, and no damage due to the ultrasound exposure. The in vivo results are indicative of the potential safe delivery of ultrasound energy for a defined set of source conditions for charging batteries within implants. Copyright © 2015 Elsevier B.V. All rights reserved.

A tutorial on ultrasonic physics and imaging techniques.

PubMed

Halliwell, M

2010-01-01

Ultrasound is a widely used modality for both therapy and diagnosis in medicine and biology. Currently, in the field of medical diagnosis, ultrasound is responsible for about one in five of all diagnostic images. The physical characteristics of medical ultrasound, along with its behaviour as it interacts with biological tissues, are described in this tutorial. The role of ultrasound in therapeutic and diagnostic applications is briefly described. In view of the importance of ultrasound as a medical imaging modality, the basic technological building blocks utilized in diagnostic ultrasound scanners are also described. Many of these topics are the subjects of other papers in this special issue where they are dealt with in more detail.

Transperineal ultrasound compared to evacuation proctography for diagnosing enteroceles and intussusceptions.

PubMed

Weemhoff, M; Kluivers, K B; Govaert, B; Evers, J L H; Kessels, A G H; Baeten, C G

2013-03-01

This study concerns the level of agreement between transperineal ultrasound and evacuation proctography for diagnosing enteroceles and intussusceptions. In a prospective observational study, 50 consecutive women who were planned to have an evacuation proctography underwent transperineal ultrasound too. Sensitivity, specificity, positive (PPV) and negative predictive value, as well as the positive and negative likelihood ratio of transperineal ultrasound were assessed in comparison to evacuation proctography. To determine the interobserver agreement of transperineal ultrasound, the quadratic weighted kappa was calculated. Furthermore, receiver operating characteristic curves were generated to show the diagnostic capability of transperineal ultrasound. For diagnosing intussusceptions (PPV 1.00), a positive finding on transperineal ultrasound was predictive of an abnormal evacuation proctography. Sensitivity of transperineal ultrasound was poor for intussusceptions (0.25). For diagnosing enteroceles, the positive likelihood ratio was 2.10 and the negative likelihood ratio, 0.85. There are many false-positive findings of enteroceles on ultrasonography (PPV 0.29). The interobserver agreement of the two ultrasonographers assessed as the quadratic weighted kappa of diagnosing enteroceles was 0.44 and that of diagnosing intussusceptions was 0.23. An intussusception on ultrasound is predictive of an abnormal evacuation proctography. For diagnosing enteroceles, the diagnostic quality of transperineal ultrasound was limited compared to evacuation proctography.

Endobronchial Ultrasound (EBUS) - Update 2017.

PubMed

Darwiche, Kaid; Özkan, Filiz; Wolters, Celina; Eisenmann, Stephan

2018-02-01

Endobronchial ultrasound (EBUS) has revolutionized the diagnosis of lung cancer over the last decade. This minimally invasive diagnostic method has also become increasingly important in the case of other diseases such as sarcoidosis, thereby helping to avoid unnecessary diagnostic interventions. This review article provides an update regarding EBUS and discusses current and future developments of this method. © Georg Thieme Verlag KG Stuttgart · New York.

Bedside imaging of intracranial hemorrhage in the neonate using light: comparison with ultrasound, computed tomography, and magnetic resonance imaging.

PubMed

Hintz, S R; Cheong, W F; van Houten, J P; Stevenson, D K; Benaron, D A

1999-01-01

Medical optical imaging (MOI) uses light emitted into opaque tissues to determine the interior structure. Previous reports detailed a portable time-of-flight and absorbance system emitting pulses of near infrared light into tissues and measuring the emerging light. Using this system, optical images of phantoms, whole rats, and pathologic neonatal brain specimens have been tomographically reconstructed. We have now modified the existing instrumentation into a clinically relevant headband-based system to be used for optical imaging of structure in the neonatal brain at the bedside. Eight medical optical imaging studies in the neonatal intensive care unit were performed in a blinded clinical comparison of optical images with ultrasound, computed tomography, and magnetic resonance imaging. Optical images were interpreted as correct in six of eight cases, with one error attributed to the age of the clot, and one small clot not seen. In addition, one disagreement with ultrasound, not reported as an error, was found to be the result of a mislabeled ultrasound report rather than because of an inaccurate optical scan. Optical scan correlated well with computed tomography and magnetic resonance imaging findings in one patient. We conclude that light-based imaging using a portable time-of-flight system is feasible and represents an important new noninvasive diagnostic technique, with potential for continuous monitoring of critically ill neonates at risk for intraventricular hemorrhage or stroke. Further studies are now underway to further investigate the functional imaging capabilities of this new diagnostic tool.

Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience.

PubMed

Cantisani, Vito; Maceroni, Piero; D'Andrea, Vito; Patrizi, Gregorio; Di Segni, Mattia; De Vito, Corrado; Grazhdani, Hektor; Isidori, Andrea M; Giannetta, Elisa; Redler, Adriano; Frattaroli, Fabrizio; Giacomelli, Laura; Di Rocco, Giorgio; Catalano, Carlo; D'Ambrosio, Ferdinando

2016-05-01

To assess whether ultrasound elastography (USE) with strain ratio increases diagnostic accuracy of Doppler ultrasound in further characterisation of cytologically Thy3 thyroid nodules. In two different university diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid nodules aspirates were prospectively evaluated with Doppler ultrasound and strain ratio USE before surgery. Ultrasonographic features were analysed separately and together as ultrasound score, to assess sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic (ROC) curves to identify optimal cut-off value of the strain ratio were also provided. Diagnosis on a surgical specimen was considered the standard of reference. Higher strain ratio values were found in malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis. USE with strain ratio showed 90.6% sensitivity, 93% specificity, 82.8% PPV, 96.4% NPV, while US score yielded a sensitivity of 52.9%, specificity of 84.3%, PPV 55.6% and NPV 82.9%. The diagnostic gain with strain ratio was statistically significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864 for US score. USE with strain ratio should be considered a useful additional tool to colour-Doppler US, since it improves characterisation of thyroid nodules with indeterminate cytology. • Strain ratio measurements improve differentiation of thyroid nodules with indeterminate cytology • Elastography with strain ratio is more reliable than ultrasound features and ultrasound score • Strain ratio may help to better select patients with Thy 3 nodules candidate for surgery.

History of diagnostics in dermatovenerology on Medical Faculty in Prague.

PubMed

Kruzicová, Z

2009-01-01

The article deals with the history of diagnostics in dermatovenerology on Medical Faculty in Prague from 1875 to 1910. Medical Reports of General Hospital in Prague from those years were used as the source of data. Three dermatologic and venereal diagnoses from years 1875, 1881, 1885, 1890, 1895, 1899, 1906 and 1910 were used for a statistic comparison. The article also contains short description of institutional background of dermatovenerology in Prague during this period.

Time-resolved nanoseconds dynamics of ultrasound contrast agent microbubbles manipulated and controlled by optical tweezers

NASA Astrophysics Data System (ADS)

Garbin, Valeria; Cojoc, Dan; Ferrari, Enrico; Di Fabrizio, Enzo; Overvelde, Marlies L. J.; Versluis, Michel; van der Meer, Sander M.; de Jong, Nico; Lohse, Detlef

2006-08-01

Optical tweezers enable non-destructive, contact-free manipulation of ultrasound contrast agent (UCA) microbubbles, which are used in medical imaging for enhancing the echogenicity of the blood pool and to quantify organ perfusion. The understanding of the fundamental dynamics of ultrasound-driven contrast agent microbubbles is a first step for exploiting their acoustical properties and to develop new diagnostic and therapeutic applications. In this respect, optical tweezers can be used to study UCA microbubbles under controlled and repeatable conditions, by positioning them away from interfaces and from neighboring bubbles. In addition, a high-speed imaging system is required to record the dynamics of UCA microbubbles in ultrasound, as their oscillations occur on the nanoseconds timescale. In this work, we demonstrate the use of an optical tweezers system combined with a high-speed camera capable of 128-frame recordings at up to 25 million frames per second (Mfps), for the study of individual UCA microbubble dynamics as a function of the distance from solid interfaces.

Use of ultrasound imaging for the diagnosis of abnormal uterine bleeding in the bonnet macaque ( Macaca radiata).

PubMed

Chaudhari, Uddhav K; Imran, M; Manjramkar, Dhananjay D; Metkari, Siddhanath M; Sable, Nilesh P; Gavhane, Dnyaneshwar S; Katkam, Rajendra R; Sachdeva, Geetanjali; Thakur, Meenakshi H; Kholkute, Sanjeeva D

2017-02-01

Ultrasound is a powerful, low-cost, non-invasive medical tool used by laboratory animal veterinarians for diagnostic imaging. Sonohysterography and transvaginal ultrasound are frequently used to assess uterine anomalies in women presenting with abnormal uterine bleeding (AUB). In the present study, we have evaluated the abdominal ultrasound of bonnet monkeys ( n = 8) showing spontaneous ovulatory ( n = 5) and anovulatory ( n = 3) AUB. The ovulatory ( n = 5) macaques showed cyclic AUB for 7-8 days. The anovulatory ( n = 3) macaques had irregular AUB with menstrual cycles of 40-45 days. The B-mode abdominal, colour Doppler and 3D ultrasound scans were performed during the proliferative phase of the menstrual cycle. Ultrasound examination revealed endometrial polyps in five macaques and endometrial hyperplasia in three animals. The width and length of endometrial polyps was around 0.5-1 cm (average 0.51 ± 0.23 cm × 0.96 ± 0.16 cm) with significant increase in endometrial thickness ( P < 0.0002). 3D ultrasound also showed a homogeneous mass in the uterine cavity and colour Doppler ultrasound showed increased vascularity in the endometrial polyps. Endometrial hyperplasia characteristically appeared as a thickened echogenic endometrium ( P < 0.0002). This study demonstrates the use of non-invasive ultrasound techniques in the diagnosis of AUB in macaques.

Breast Cancer Detection by B7-H3-Targeted Ultrasound Molecular Imaging.

PubMed

Bachawal, Sunitha V; Jensen, Kristin C; Wilson, Katheryne E; Tian, Lu; Lutz, Amelie M; Willmann, Jürgen K

2015-06-15

Ultrasound complements mammography as an imaging modality for breast cancer detection, especially in patients with dense breast tissue, but its utility is limited by low diagnostic accuracy. One emerging molecular tool to address this limitation involves contrast-enhanced ultrasound using microbubbles targeted to molecular signatures on tumor neovasculature. In this study, we illustrate how tumor vascular expression of B7-H3 (CD276), a member of the B7 family of ligands for T-cell coregulatory receptors, can be incorporated into an ultrasound method that can distinguish normal, benign, precursor, and malignant breast pathologies for diagnostic purposes. Through an IHC analysis of 248 human breast specimens, we found that vascular expression of B7-H3 was selectively and significantly higher in breast cancer tissues. B7-H3 immunostaining on blood vessels distinguished benign/precursors from malignant lesions with high diagnostic accuracy in human specimens. In a transgenic mouse model of cancer, the B7-H3-targeted ultrasound imaging signal was increased significantly in breast cancer tissues and highly correlated with ex vivo expression levels of B7-H3 on quantitative immunofluorescence. Our findings offer a preclinical proof of concept for the use of B7-H3-targeted ultrasound molecular imaging as a tool to improve the diagnostic accuracy of breast cancer detection in patients. ©2015 American Association for Cancer Research.

Holistic ultrasound in trauma: An update.

PubMed

Saranteas, Theodosios; Mavrogenis, Andreas F

2016-10-01

Holistic ultrasound is a total body examination using an ultrasound device aiming to achieve immediate patient care and decision making. In the setting of trauma, it is one of the most fundamental components of care of the injured patients. Ground-breaking imaging software allows physicians to examine various organs thoroughly, recognize imaging signs early, and potentially foresee the onset or the possible outcome of certain types of injuries. Holistic ultrasound can be performed on a routine basis at the bedside of the patients, at admission and during the perioperative period. Trauma care physicians should be aware of the diagnostic and guidance benefits of ultrasound and should receive appropriate training for the optimal management of their patients. In this paper, the findings of holistic ultrasound in trauma patients are presented, with emphasis on the lungs, heart, cerebral circulation, abdomen, and airway. Additionally, the benefits of ultrasound imaging in interventional anaesthesia techniques such as ultrasound-guided peripheral nerve blocks and central vein catheterization are described. Copyright © 2016 Elsevier Ltd. All rights reserved.

Five-year Retrospective Review of Physician and Non-physician Performed Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service.

PubMed

O'Dochartaigh, Domhnall; Douma, Matthew; MacKenzie, Mark

2017-01-01

To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18-34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34-56) p = < 0.006. Incomplete PHUS scans were common and reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care.

TH-A-207B-02: QIBA Ultrasound Elasticity Imaging System Biomarker Qualification and User Testing of Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garra, B.

Imaging of tissue elastic properties is a relatively new and powerful approach to one of the oldest and most important diagnostic tools. Imaging of shear wave speed with ultrasound is has been added to most high-end ultrasound systems. Understanding this exciting imaging mode aiding its most effective use in medicine can be a rewarding effort for medical physicists and other medical imaging and treatment professionals. Assuring consistent, quantitative measurements across the many ultrasound systems in a typical imaging department will constitute a major step toward realizing the great potential of this technique and other quantitative imaging. This session will targetmore » these two goals with two presentations. A. Basics and Current Implementations of Ultrasound Imaging of Shear Wave Speed and Elasticity - Shigao Chen, Ph.D. Learning objectives-To understand: Introduction: Importance of tissue elasticity measurement Strain vs. shear wave elastography (SWE), beneficial features of SWE The link between shear wave speed and material properties, influence of viscosity Generation of shear waves External vibration (Fibroscan) ultrasound radiation force Point push Supersonic push (Aixplorer) Comb push (GE Logiq E9) Detection of shear waves Motion detection from pulse-echo ultrasound Importance of frame rate for shear wave imaging Plane wave imaging detection How to achieve high effective frame rate using line-by-line scanners Shear wave speed calculation Time to peak Random sample consensus (RANSAC) Cross correlation Sources of bias and variation in SWE Tissue viscosity Transducer compression or internal pressure of organ Reflection of shear waves at boundaries B. Elasticity Imaging System Biomarker Qualification and User Testing of Systems – Brian Garra, M.D. Learning objectives-To understand: Goals Review the need for quantitative medical imaging Provide examples of quantitative imaging biomarkers Acquaint the participant with the purpose of the RSNA Quantitative