Remote out-of-hours ultrasound live supervision in pediatrics – improvement of diagnostics and training

The aim of our study was to compare the accuracy of lung sliding identification for the left and right hemithoraxes, using prerecorded short US sequences, in a group of physicians with mixed clinical and US training. A total of 140 US sequences of a complete respiratory cycle were recorded in the operating room. Each sequence was divided in two, yielding 140 sequences of present lung sliding and 140 sequences of absent lung sliding. Of these 280 sequences, 40 were randomly repeated to assess intraobserver variability, for a total of 320 sequences. Descriptive data, the mean accuracy of each participant, as well as the rate of correct answers for each of the original 280 sequences were tabulated and compared for different subgroups of clinical and US training. A video with examples of present and absent lung sliding and a lung pulse was shown before testing. Two sessions were planned to facilitate the participation of 75 clinicians. In the first group, the rate of accurate lung sliding identification was lower in the left hemithorax than in the right (67.0% [interquartile range (IQR), 43.0-83.0] versus 80.0% [IQR, 57.0-95.0]; P < .001). In the second group, the rate of accurate lung sliding identification was also lower in the left hemithorax than in the right (76.3% [IQR, 42.9-90.9] versus 88.7% [IQR, 63.1-96.9]; P = .001). Mean accuracy rates were 67.5% (95% confidence interval, 65.7-69.4) in the first group and 73.1% (95% confidence interval, 70.7-75.5) in the second (P < .001). Lung sliding identification seems less accurate in the left hemithorax when using a short US examination. This study was done on recorded US sequences and should be repeated in a live clinical situation to confirm our results.

The following musculoskeletal ultrasound (MSK US) curriculum was developed by the American Medical Society for Sports Medicine (AMSSM) to provide a pathway by which a sports medicine fellow can obtain...

SummarySurgery has begun to evolve as a result of the intense use of technological innovations. The result of this is better services for patients and enormous opportunities for the producers of biomedical instruments. The surgeon and the technologist are fast becoming allies in applying the latest developments of robotics, image treatment, simulation, sensors and telecommunications to surgery, in particular to the emerging field of minimally-invasive surgery. Ultrasonography is at present utilised both for diagnostic and therapeutic purposes in various fields. Intraoperative US examination can be of primary importance, especially when dealing with space-occupying lesions. The widening use of minimally-invasive surgery has furthered the development of US for use during this type of surgery. The success of a US examination requires not only a correct execution of the procedure, but also a correct interpretation of the images. We describe two projects that combine robotics and telecommunication systems to provide better access to US expertise in the operating room. The Midstep project has as its object the realisation of two robotic arms, one for the distant control of the US probe during laparoscopic surgery and the second to perform tele-interventional US. The second project, part of the Strategic CNR Project - ‘Robotics in Surgery’, involves the realisation of a common platform for tracking and targeting surgical instruments in video-assisted surgery.

BackgroundMusculoskeletal ultrasound (MSUS) is dependent on sensitivity of the machine used and the skills of the operator. Additional specificities are unique features of the growing skeleton, which include age-related variation...

The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice. A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work. Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG. These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes.

Experiments reported in this paper clarify and extend results of previous research into the impact of reference points on valuation judgment. The value judgments of expert commercial appraisers from the USA who were not familiar with the geographical setting of the subject property were influenced by a variety of reference points. In order of significance of impact, these influential reference points were: the uncompleted contract price of a comparable property; the uncompleted contract price of the subject property; and the value opinions of other experts. This hierarchy of impact is consistent with both the degree to which each reference point is sanctioned by normative US training and the degree to which each reference point is generally available to US experts. Comparison with previous research suggests that market uncertainty as reflected by geographical unfamiliarity has a role in triggering reference point anchoring.

HomeRadiologyVol. 277, No. 3 PreviousNext CommunicationsFree AccessErrataProspective Comparison of MR Imaging and US for the Diagnosis of Pediatric AppendicitisRobert C. Orth, R. Paul Guillerman, Wei Zhang, Prakash Masand, George S. Bisset IIIRobert C. Orth, R. Paul Guillerman, Wei Zhang, Prakash Masand, George S. Bisset IIIRobert C. OrthR. Paul GuillermanWei ZhangPrakash MasandGeorge S. Bisset IIIPublished Online:Nov 24 2015https://doi.org/10.1148/radiol.2015154043MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:Radiology 2014;272(1):233–240 DOI: 10.1148/radiol.14132206Erratum in:Radiology 2015;277(3):927 DOI: 10.1148/radiol.2015154043Page 237, first full paragraph should read as follows: “When equivocal studies were designated positive for calculating test performance measures, there were three false-negative (3.7%) and seven false-positive (8.6%) US results, compared with two false-negative (2.5%) and one false-positive (1.2%) MR imaging results (Table 2). The seven false-positive US results were all equivocal studies. When equivocal studies were designated negative, there were four false-negative US examinations, and the specificity of US increased from 86.3% to 100% and the PPV increased from 79.4% to 100% (Table 3). The false-negative and false-positive MR examination results were the same, regardless of the designation of equivocal results.”Sensitivity, specificity, and positive and negative predictive values in the article are correct as originally published.Article HistoryPublished online: Nov 24 2015Published in print: Dec 2015 FiguresReferencesRelatedDetailsCited ByMRI of acute appendicitisBenjamin M.Mervak, Sarah B.Wilson, Brian D.Handly, ErsanAltun, Lauren M.Burke2019 | Journal of Magnetic Resonance Imaging, Vol. 50, No. 5Assessing 3D T2 FSE sequence for identification of the normal appendix: working toward a single-sequence MR appendicitis protocolNattineeLeelakanok, Andrew S.Phelps, Matthew A.Zapala, KambrieKato, MichaelOhliger, YiLi, JesseCourtier2017 | Emergency Radiology, Vol. 24, No. 6Medical RadiologyNazaninAhmadi, Johan G.Blickman2016The Influence of Age on the Diagnostic Performance of White Blood Cell Count and Absolute Neutrophil Count in Suspected Pediatric AppendicitisRichard G.Bachur, Peter S.Dayan, Nanette C.Dudley, LalitBajaj, Michelle D.Stevenson, Charles G.Macias, Manoj K.Mittal, JonathanBennett, KellySinclair, Michael C.Monuteaux, Anupam B.Kharbanda, Mark R.Zonfrillo2016 | Academic Emergency Medicine, Vol. 23, No. 11Accompanying This ArticleProspective Comparison of MR Imaging and US for the Diagnosis of Pediatric AppendicitisMar 17 2014RadiologyRecommended Articles Use of Clinical Data to Predict Appendicitis in Patients with Equivocal US FindingsRadiology2016Volume: 280Issue: 2pp. 557-567Equivocal Reporting in Pediatric US Does Not Decrease Clinical CertaintyRadiology2016Volume: 282Issue: 1pp. 303-304Effectiveness of a Staged US and Unenhanced MR Imaging Algorithm in the Diagnosis of Pediatric AppendicitisRadiology2017Volume: 286Issue: 3pp. 1022-1029MRI for First-Line Evaluation of Children Suspected of Having Acute AppendicitisRadiology2019Volume: 291Issue: 1pp. 178-179Clinical Appendicitis Scores May Lower CT Utilization and Diagnostic AccuracyRadiology2021Volume: 300Issue: 2pp. 359-360See More RSNA Education Exhibits Fat and Flow: Secondary Signs that Improve the Diagnosis of Appendicitis in the Sonographically Equivocal AppendixDigital Posters2019Right Lower-Quadrant Ultrasound Techniques, Tricks, and Pitfalls for Tenderness to PalpationDigital Posters2019All Things Appendix: Anatomy, Variant Anatomy, and Pathologies of the AppendixDigital Posters2018 RSNA Case Collection Acute appendicitis with perforationRSNA Case Collection2020Acute appendicitisRSNA Case Collection2020Appendicitis in PregnancyRSNA Case Collection2020 Vol. 277, No. 3 Metrics Altmetric Score PDF download

BackgroundTreatment of children with juvenile idiopathic arthritis (JIA) is a major challenge in paediatric rheumatology. The presence of synovitis, which is difficult to detect in children, is associated with structural...

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.

Kidney cysts can manifest as focal disease (simple and complex kidney cysts), affect a whole kidney (eg, multicystic dysplastic kidney or cystic dysplasia), or manifest as bilateral cystic disease (eg, autosomal recessive polycystic kidney disease [ARPKD] or autosomal dominant polycystic kidney disease [ADPKD]). In children, as opposed to adults, a larger proportion of kidney cysts are due to genetic diseases (eg, HNF1B nephropathy, various ciliopathies, and tuberous sclerosis complex), and fewer patients have simple cysts or acquired cystic kidney disease. The purpose of this consensus statement is to provide clinical guidance on standardization of imaging tests to evaluate kidney cysts in children. A committee of international experts in pediatric nephrology, pediatric radiology, pediatric US, and adult nephrology prepared systematic literature reviews and formulated recommendations at a consensus meeting. The final statement was endorsed by the European Society of Pediatric Radiology, the European Federation of Societies for Ultrasound in Medicine and Biology, the European Society of Pediatric Nephrology, and reviewed by the European Reference Network for Rare Kidney Diseases. Main recommendations are as follows: US is the method of choice when assessing pediatric kidney cysts, with selected indications for MRI and contrast-enhanced US. CT should be avoided whenever possible because of ionizing radiation. Renal US yields essential diagnostic information in many cases. In patients with ARPKD or other ciliopathies, abdominal US is needed for diagnosis and screening of portal hypertension. US is usually sufficient for follow-up kidney imaging, but MRI can be valuable for clinical trials in patients with ADPKD or in older children with tuberous sclerosis complex to evaluate both kidney cysts and angiomyolipomas.

Corrigendum

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Accurate preoperative localization is imperative for the treatment of insulinomas. Glucagon-like peptide-1 receptor (GLP-1R) imaging has demonstrated remarkable efficacy in localization of insulinomas. The aim of this study was to assess the diagnostic performance of GLP-1R PET/CT with 68Ga-exendin-4 in localization of insulinoma, and to provide evidence for clinical practice from a real-world study. This is a retrospective analysis of our prospective cohort study of 68Ga-exendin-4 PET/CT in insulinoma (NCT02560376). Patients with endogenous hyperinsulinemic hypoglycemia and definite final diagnosis were enrolled. Results of contrast-enhanced CT (CECT) with pancreatic perfusion scan, MRI, endoscopic ultrasound, and 99mTc-HYNIC-TOC SPECT/CT were collected. The gold standard for diagnosis was histopathology (for insulinoma) or a definite clinical diagnosis of the etiology of hyperinsulinemic hypoglycemia after hospitalization in the endocrinology department (for non-insulinomatous hypoglycemia). A total of 357 patients (including 296 insulinoma patients and 61 non-insulinoma patients) with were included. The overall sensitivity, specificity, accuracy, PPV, and NPV of 68Ga-exendin-4 PET/CT in localizing insulinoma were 94.93% (95%CI, 91.78%˜97.14%), 100.00% (95%CI, 94.13%˜100%), 95.79% (95%CI, 93.16%˜97.63%), 100.00% (95%CI, 98.32%˜100%), 80.26% (95%CI, 71.29%˜86.94%), respectively. The area under the ROC of 68Ga-exendin-4 PET/CT for diagnosing insulinoma was 0.975 (95%CI, 0.953 ˜ 0.988), which was superior to that of CECT (AUC = 0.873 [95%CI, 0.833 ˜ 0.906]), MRI (AUC = 0.825 [95%CI, 0.773 ˜ 0.869]), EUS (AUC = 0.746 [95%CI, 0.652 ˜ 0.825]) and 99mTc-HYNIC-TOC SPECT/CT (AUC = 0.618 [95%CI, 0.562 ˜ 0.672]). The lesion-based sensitivity of 68Ga-exendin-4 PET/CT in sporadic benign insulinoma was 95.47% (95%CI, 92.22%˜97.64%), and the PPV was 99.61% (95%CI 99.60%˜99.62%). In contrast, the diagnostic efficacy of 68Ga-exendin-4 PET/CT was found to be less effective in cases of sporadic malignant insulinoma or inherited syndromes, yielding a lesion-based detection rate of 66.43% and 68.04%, respectively. 68Ga-exendin-4 PET/CT is a preferred imaging modality in diagnosing insulinoma, particularly in sporadic benign insulinomas.

Ten-Year-Old Boy with a Recurrent Knee Effusion

A group of eight asymptomatic patients with unilateral adrenal myelolipoma are reported. All lesions were discovered incidentally during US examinations for unrelated symptoms. A series of US, CT, and MR examinations showed typical findings in seven patients, and one patient presented atypical imaging, due to the predominance of myeloid tissue. A percutaneous CT-guided biopsy confirmed the definitive diagnosis in seven patients.