“I can see clearly now.” fundamentals of breast ultrasound optimization

Unlike other modalities in breast imaging, breast ultrasound is very operator dependent. Proper characterization and management of breast lesions depends on the knowledge and skill of the radiologist performing the exam. Breast ultrasound optimization continues to evolve as the technology of ultrasound machines improves. The American College of Graduate Medical Education (ACGME) program requirements for graduate medical education in diagnostic radiology recently updated requirements to include competency in ultrasound physics, knobology, and image generation. As trainees are held to high ultrasound optimization standards, practicing radiologists who perform breast ultrasound exams must keep up to date on current breast ultrasound optimization techniques to avoid mischaracterizing and mismanaging breast ultrasound findings. In this paper, ultrasound optimization techniques, including patient positioning, transducer frequency, transducer contact and pressure, depth, gain, focus, tissue harmonic imaging, spatial compounding, dynamic range, speed of sound imaging, Doppler evaluation, and elastography will be described. Multiple ultrasound case examples will be used to illustrate application of these skills. After reading this paper, the reader will be able to apply these techniques to their own breast ultrasound practice, improving characterization and management of breast lesions in their patients.     

Application of deep learning to establish a diagnostic model of breast lesions using two-dimensional grayscale ultrasound imaging

PurposeThere are currently few specific artificial intelligence (AI) studies for Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions. This study aimed to establish an AI diagnostic model of breast lesions using two-dimensional grayscale ultrasound imaging and to compare its performance with that of radiologists.MethodsThe ultrasound images of 1311 lesions were evaluated by radiologists according to the BI-RADS categories, using pathology results as reference. Two classification standards (standards 1 and 2) for benign and malignant lesions were defined and used to calculate the diagnostic performance of radiologists, altogether and individually. The breast lesion images were also used to develop an AI diagnostic model.ResultsThe diagnostic performance of AI and that of the radiologists were compared using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). All parameters of diagnostic performance, except for sensitivity and NPV, improved with standard 2. For the 202 lesions in the test set, the diagnostic performance of the AI model had 77.0% accuracy, 82.0% sensitivity, 71.7% specificity, 79.3% PPV, 75.1% NPV, and an AUC of 0.846. When the AI model was used to analyze category 4A lesions, the PPV was 9.3%, which was better than that of the radiologists, although not significantly.ConclusionsDeep learning technology shows a good performance in classifying benign and malignant breast lesions. It may be potentially used in practice to improve diagnostic accuracy and reduce unnecessary biopsies of breast lesions.     

Professional issues in the use of diagnostic ultrasound biofeedback in physiotherapy of the female pelvic floor

The usage of diagnostic ultrasound equipment has expanded into physiotherapy. The aim of this paper is to deliver to both the ultrasound and physiotherapy professions an understanding of the use of diagnostic ultrasound for biofeedback in physiotherapy of the female pelvic floor and the issues related to competent and safe practice, including accessing suitable training. This has been evaluated using a qualitative research paradigm with data gathered via focus groups of Australian physiotherapists. The target group were pelvic floor physiotherapists as this is one of the main uses of diagnostic ultrasound within physiotherapy and the main area physiotherapists would like to be trained in. Two focus groups were run with a total of sixteen physiotherapists. Focus group participants reported their training in diagnostic ultrasound to be largely self directed. They also reported they were learning on their patients. Despite very limited training, participants demonstrated some familiarity with images and equipment settings. Participants felt the modality had a role within physiotherapy as an adjunct to their current practices. The main need raised by participants during the focus groups was related to patient expectations and the fact that the physiotherapist may miss evidence of pathology.     

职业性放射性疾病诊断标准在全国部分省市放射工作人员中的实施评估分析

目的对常见职业性放射性疾病诊断标准在放射工作人员中应用情况进行调查, 为卫生标准的修订、宣贯和标准化管理提供依据。方法采用整群随机抽样的方法, 在2021年1～5月对国家职业性放射性疾病上报系统信息中有上报病例的1市、7省、1集团的放射工作人员开展对标准的知晓、辐射健康效应和职业性放射性疾病诊断的认知情况及对诊断工作建议的调查并分析。结果 2 839名被调查放射工作人员, 对不同诊断标准的知晓率、知晓标准的途径、复杂诊断标准中内容的知晓率、电离辐射不同效应概念的知晓率、申请职业性放射性疾病诊断所需材料的知晓情况存在差异(χ2=416.06、2 924.14、83.45、895.67、815.94, P<0.001)。对电离辐射确定性效应和随机性效应的正确理解率分别为80.63%和43.64%。对申请职业性放射性疾病诊断需要提供资料中职业病危害因素接触史、职业健康监护档案、个人剂量监测等资料认可率较高, 分别为96.79%、94.72%、93.55%。参加过上岗前相关知识培训率80.20%, 在岗期间培训率81.19%, 未参加过任何培训3.77%。对职业性放射性疾病诊断工作建议较...     

The long and winding road to achieving professional registration for sonographers

The rapid growth in the use of ultrasound as a diagnostic imaging technology over the past forty years, has led to a demand for a workforce with the appropriate skills to perform and interpret the scans. In the UK, ultrasound investigations now comprise the largest group of all diagnostic imaging examinations.¹ However, there remains no statutory regulation of the practice of sonography in the UK, and little recognition of the considerable training that many practitioners have undertaken to obtain the skills to become safe and competent sonographers. Many in the field consider that this should change, and are working to obtain professional status for the practice of sonography.2, 3, 4, 5 Although the Health Care Professions Council (HCPC) has recommended regulation of sonography practice, this is unlikely to happen in the near future. This paper discusses the evolution of sonography practice and explores some of the complex issues associated with the professionalisation of sonography.     

Ultrasound imaging of bowel pathology: technique and keys to diagnosis in the acute abdomen

OBJECTIVE: This article illustrates the normal and pathologic sonographic appearances of bowel, with an emphasis on diagnostic ultrasound techniques. CONCLUSION: The current role of ultrasound for adult bowel evaluation is limited in the United States, with CT emerging as the primary modality for evaluation of the acute abdomen. However, mounting concerns regarding diagnostic radiation and health care costs may affect practice patterns and shift utilization back toward sonography, which is widely available and relatively inexpensive.     

Endoscopic approach to the treatment of gastrointestinal bleeding

Gastrointestinal endoscopy is the primary diagnostic and therapeutic modality in the management of gastrointestinal bleeding. Esophagogastroduodenoscopy, small bowel enteroscopy, and colonoscopy are well-established standards for initial evaluation of gastrointestinal bleeding, and have been used effectively for diagnosis, prognosis, and therapy. Although thermal, injection, and mechanical methods have been the mainstay of endoscopic therapy, promising new technologies such as endoscopic ultrasound and wireless capsule endoscopy will further advance our ability to improve morbidity and mortality from severe gastrointestinal hemorrhage. Herein we review current standards and recent advances in the endoscopic management of upper, lower, and obscure gastrointestinal bleeding.     

高频超声对军训肌肉运动损伤的诊断价值

 目的 探讨高频超声对军训肌肉运动性损伤的诊断价值.方法 选择军训肌肉损伤68例作为研究对象,采用美国PHILIPS公司生产HD15000彩色多普勒超声诊断仪,高频变频探头L12-5,频率5～12 MHz,取合适体位,在病变部位行纵、横等多方位扫查,并用彩色多普勒血流成像观察其内部血流状况.结果 完全性断裂伴血肿15例,超声诊断符合率100％;部分断裂血肿23例中检出21例,超声诊断符合率91.30％;一般性肌肉损伤30例中初次检出28例,超声诊断符合率93.33％,复诊检出率100％.结论 高频超声检查对诊断军训肌肉损伤具有较好的应用价值.     

Unusual new signs of pneumothorax at lung ultrasound

Background

The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the B lines, the lung point and the lung pulse. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. However, the widespread application of sonographic methodology in clinical practice has brought out unusual cases which raise new sonographic signs. The purpose of this article was to introduce some of these new signs that are described after the analysis of unusual and complex cases encountered during the clinical daily practice in an emergency department.

Findings

The double lung point consists of the alternating patterns of sliding and non-sliding lung intermittently appearing at the two opposite sides of the scan. The septate pneumothorax allows B lines and lung pulse to be still visible in a condition of pneumothorax with absent sliding. In hydropneumothorax, the air/fluid border is imaged by lung ultrasound as the interposition between an anechoic space and a non-sliding A-pattern, a sign that may be named hydro-point.

Conclusions

In bedside lung ultrasound, the operator should be aware and interpret double lung point, septate pneumothorax and hydro-point. The conventional diagnostic protocol of bedside lung ultrasound for pneumothorax should be occasionally adapted to such complex cases.     

Aktuelle Entwicklungen in der vaskulären Sonographie

Ultrasound plays a central role in the diagnostic imaging of venous and arterial vessels, especially for the assessment or exclusion of arteriosclerotic vessel obstructions as well as venous or arterial thrombosis. Due to its excellent patient acceptance and its broad availability, ultrasound is considered the standard method of choice for vascular imaging. New techniques and methods have greatly enhanced its diagnostic accuracy, the most notable of which are the B-flow technique, a variant of Doppler signal read-out for reduction of artifacts in duplex sonography, as well as other techniques, such as tissue harmonic imaging, the cross-beam technique and the speckle-reduction technique, which employ different echo processing methods for contrast improvement and enhanced delineation of body structures adjacent to the vessels. The introduction of contrast enhanced ultrasound represents an important advancement and has brought a substantial improvement in sensitivity. This article describes and discusses these new techniques and methods of vascular ultrasound diagnostics with respect to their diagnostic value.     

常规超声联合超声弹性成像在诊断甲状腺占位性病变中的应用价值

目的：对于常规超声联合超声弹性成像在诊断患者甲状腺占位性病变的效果进行评价。方法选取我院自2010年5月至2013年7月间在我院接受甲状腺手术诊断的68例患者,115个病灶当中,良性占位性病变69例,恶性占位性病变为46例。根据患者采用常规超声以及超声联合弹性成像技术的不同情况进行诊断指标和评分标准的分析对比。结果常规超声联合超声弹性成像的诊断结果比单纯采用常规超声诊断的准确率大大提升。结论常规超声联合超声弹性成像可以大大提升甲状腺占位性病变的诊断准确率,在临床应用中有着重要价值,值得推广运用。     

Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound

The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. Over the past few years several reports have shown that contrast ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. The advent of second-generation agents and low mechanical index real-time scanning techniques has been instrumental in improving the easiness and the reproducibility of the examination. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast ultrasound enters into clinical practice. The guidelines define the indications and recommendations for the use of contrast ultrasound in focal liver lesion detection, characterization, and follow-up after tumor ablation procedures. We discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging.     

Postoperative acute cholecystitis: sonographic diagnosis

This paper discusses ten patients who developed acute cholecystitis during the postoperative period following surgery which did not involve the gall bladder. All were examined with ultrasound during the first two weeks after surgery and were diagnosed as acute cholecystitis. Six (60%) had complications such as empyema, gangrene, perforation, pericholecystic abscess or localized peritonitis; four (40%) had no evidence of complications. The authors highlight the importance of ultrasound (US) as the technique of choice for a first screening if this entity is suspected because of its speed and high diagnostic reliability.     

Dosimetry in diagnostic radiology

Dosimetry is an area of increasing importance in diagnostic radiology. There is a realisation amongst health professionals that the radiation dose received by patients from modern X-ray examinations and procedures can be at a level of significance for the induction of cancer across a population, and in some unfortunate instances, in the acute damage to particular body organs such as skin and eyes.The formulation and measurement procedures for diagnostic radiology dosimetry have recently been standardised through an international code of practice which describes the methodologies necessary to address the diverging imaging modalities used in diagnostic radiology. Common to all dosimetry methodologies is the measurement of the air kerma from the X-ray device under defined conditions. To ensure the accuracy of the dosimetric determination, such measurements need to be made with appropriate instrumentation that has a calibration that is traceable to a standards laboratory.Dosimetric methods are used in radiology departments for a variety of purposes including the determination of patient dose levels to allow examinations to be optimized and to assist in decisions on the justification of examination choices. Patient dosimetry is important for special cases such as for X-ray examinations of children and pregnant patients. It is also a key component of the quality control of X-ray equipment and procedures.     

超声联合功能检查对甲状腺结节的诊断效果

 目的 探索超声联合功能检查对甲状腺结节的诊断价值。方法 收集126例甲状腺结节患者的临床资料,按照诊断结果将患者分为两组,结果为良性结节的84例为观察组,结果为恶性结节的42例为对照组。观察并比较两组患者的超声结果、甲状腺功能指标及诊断符合率。结果 观察组形态不规则、边界不清、回声不均匀、钙化及淋巴肿大的发生率显著低于对照组;观察组促甲状腺素水平显著高于对照组;观察组和对照组促甲状腺激素联合甲状腺彩超诊断符合率,显著高于单独应用促甲状腺激素、甲状腺彩超的诊断符合率;促甲状腺激素联合甲状腺彩超敏感度、特异度、阳性预期值分别为85.17%、93.08%、78.94%,显著高于单独促甲状腺激素、甲状腺彩超检查。结论 甲状腺超声可以对良性结节和恶性结节进行有效区分,促甲状腺激素联合甲状腺彩超诊断价值较高。     

Estimating legal age based on fusion of The proximal humeral epiphysis

The increasing demand which requires ascertaining the legal age of undocumented individuals who reach the various countries of the European Community means that new lines of research must be developed which help respond to questions posed by the Justice Administration. For this reason, this study has been designed on the basis of fusion times of the proximal humeral epiphysis. Moreover, the ultrasound scan has been used as the diagnostic method. It is a non-invasive technique, unlike the radiograph, which is used under current standards for the forensic diagnosis of age. Used as a study sample were the ultrasound images of the proximal humeral epiphysis among 221 individuals belonging to the Spanish population, of both genders, of ages ranging from 5 to 30 years. All of the images were classified into 6 stages of fusion based on the morphology of each. The results display differences among the six age groups proposed for each of the stages of fusion and are of great interest from the perspective of enforcing the Spanish Criminal Law Act on Minors, because Stage 4 would mean that the person being studied is under the age of 16 years in the case of males and 15 years in the case of females. These results, coupled with the use of ultrasound as a non-invasive diagnostic technique, make this study a very useful method when the use of radiographs is not possible.

     

Technical errors in planar bone scanning

Optimal technique for planar bone scanning improves image quality, which in turn improves diagnostic efficacy. Because planar bone scanning is one of the most frequently performed nuclear medicine examinations, maintaining high standards for this examination is a daily concern for most nuclear medicine departments. Although some problems such as patient motion are frequently encountered, the degraded images produced by many other deviations from optimal technique are rarely seen in clinical practice and therefore may be difficult to recognize. The objectives of this article are to list optimal techniques for 3-phase and whole-body bone scanning, to describe and illustrate a selection of deviations from these optimal techniques for planar bone scanning, and to explain how to minimize or avoid such technical errors.     

Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes

The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus?. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques applicable to pathology of the shoulder, elbow, wrist, hand, hip, knee and ankle. These techniques have been applied mainly to the management of impingement syndromes, tendinopathies and arthritis. Many of these techniques have been validated and have entered clinical practice, while more recently developed techniques (such as dynamic ultrasound and platelet-rich plasma injections) will require further research to verify efficacy. Research in musculoskeletal ultrasound has also been helpful in identifying risk factors for injury and, thus, serving as a focus for developing interventions. Research in abdominal ultrasound has investigated the potential role of ultrasound imaging in assessing splenomegaly in athletes with mononucleosis, in an attempt to inform decisions and policies regarding return to play. Future research will have to demonstrate a reduction in adverse events in order to justify the application of such a technique into policy. The role of ultrasound in assessing groin pain and abdominal pain in ultraendurance athletes has also been investigated, providing promising areas of focus for the development of treatment interventions and physical therapy. Finally, preliminary research has also identified the role of ultrasound in addressing vascular disease, bone density and volume status in athletes. The potential applications of ultrasound in athletes are broad, and continuing research, including larger outcome studies, will be required to establish the clinical utility of these techniques in the care of athletes.     

The American Society for Testing Materials F-30 Committee on EMS

The American Society for Testing Materials (ASTM) F-30 Committee on Emergency Medical Services (EMS) began creating voluntary consensus standards for EMS including air medical transport in 1984. The F-30 Committee is composed of more than 200 members who represent both the "producers" and the "users" of EMS. Approximately 10 of the 39 standards published by the F-30 Committee either deal directly or indirectly with air medical programs. The standards are refined through yearly evaluation and reviewed in detail every four years. Due to concerns with the ASTM process, several of the initial members resigned in 1988. Changes made to the scope and practice of the F-30 Committee have resulted in some of these participants returning to the process. New standards must be developed only after a "needs assessment" demonstrates that such a standard should exist. Relevant pre-existing standards must be reviewed. Clinical practice has been excluded from the work of the F-30 Committee. Air medical programs may participate as members of the F-30 Committee for a nominal yearly fee, which provides members with an updated book of standards. Meetings are held biannually. The Guide for Establishing the Qualifications, Education and Training of EMS Aeromedical Patient Care Providers is approaching its four-year review, and a number of other standards, which are of particular interest to the air medical community, are currently under development.