Diagnostic Ultrasound Examination Research Articles

Needling and Lavage in Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Technique.

Rotator cuff calcific tendinitis (RCCT) is a commonly occurring disease, with a prevalence of up to 42.5% in patients with shoulder pain1,2. RCCT is characterized by hydroxyapatite deposits in the tendons of the rotator cuff and is considered a self-limiting disease that can be treated nonoperatively3. However, in a substantial group of patients, RCCT can have a very disabling and long-lasting course1,4, requiring additional treatment. Ultrasound-guided percutaneous needling and lavage (i.e., barbotage) is a safe and effective treatment option for RCCT5. In the present article, we focus on the 1-needle barbotage technique utilized in combination with an injection of corticosteroids in the subacromial bursa. It must be emphasized that symptomatic RCCT should be confirmed before barbotage is performed. Therefore, we recommend a diagnostic ultrasound and/or physical examination prior to the barbotage. Barbotage is performed under ultrasound guidance with the patient in the supine position. After sterile preparation and localization of the calcified deposit(s), local anesthesia in the soft tissue (10 mL lidocaine 1%) is administered. Next, the subacromial bursa is injected with 4 mL bupivacaine (5 mg/mL) and 1 mL methylprednisolone (40 mg/mL) with use of a 21G needle. The deposit(s) are then punctured with use of an 18G needle. When the tip of the needle is in the center of the deposit(s), they are flushed with a 0.9% saline solution and the dissolved calcium re-enters the syringe passively. This process is repeated several times until no more calcium enters the syringe. In the case of solid deposits, it may not be possible to aspirate calcium; if so, an attempt to fragment the deposits by repeated perforations, and thus promote resorption, can be made. Postoperatively, patients are instructed to take analgesics and to cool the shoulder. RCTT can initially be treated nonoperatively with rest, nonsteroidal anti-inflammatory drugs, and/or physiotherapy3. If the initial nonoperative treatment fails, extracorporeal shockwave therapy (ESWT), corticosteroid injections, and/or barbotage can be considered8. In severe chronic recalcitrant cases, arthroscopic debridement and/or removal can be performed as a last resort. Both barbotage and ESWT result in a reduction of calcific deposits, as well as significant pain reduction and improvement of function8. No standard of care has been established until now; however, several prior meta-analyses concluded that barbotage is the most effective treatment option, with superior clinical outcomes after 1 to 2 years of follow-up9-11. No difference in complication rates has been reported between the various minimally invasive techniques. The purpose of barbotage is to stimulate the resorption process, which is promoted by the perforation of the deposits. Clinical outcomes are not associated with the success of the aspiration7,12. Patients with ≥1 larger deposit show greater improvement following barbotage than patients with small deposits12, in contrast with ESWT, in which larger deposits have been associated with worse outcomes. The inferior outcome of barbotage in patients with small deposits remains the subject of debate, but outcomes may be confounded by the fact that patients with smaller deposits might be less symptomatic at baseline and are therefore less likely to demonstrate improvement4. In the first weeks after barbotage, there is generally a substantial reduction in symptoms. Symptoms can recur at around 3 months, presumably because the effect of the corticosteroids is temporary5. After 6 months and 1 year, patients show substantial improvement in pain, shoulder function, and quality of life, with results superior to those shown for subacromial injections and ESWT9,10,13,14. At 5 years postoperatively, there are no significant differences in outcomes between barbotage and subacromial injections15. This may demonstrate a self-limiting course in the long term. Good candidates for barbotage are those with RCCT who have ≥1 large calcific deposit.If a patient has a solid deposit, the physician can gently rotate and repeatedly puncture the deposit to promote disaggregation and fragmentation.Barbotage generally results in adequate pain relief and functional improvement even in patients in whom calcium deposits cannot be aspirated12. SAI = injection in the subacromial bursaNSAIDs = nonsteroidal anti-inflammatory drugs.

Diagnostic ultrasound of the chest wall in the symptomatic patient after mastectomy

BackgroundLack of standardized imaging recommendations among mastectomy patients has led to variability in how recurrences are detected. ObjectiveTo describe the findings and assess the diagnostic efficacy of ultrasound in the evaluation of symptomatic post-mastectomy patients. Materials and methodsThis single institution, retrospective study included 749 consecutive diagnostic chest wall ultrasound examinations performed in mastectomy patients, from January 2016 to June 2017. Chest wall ultrasound evaluated the mastectomy bed with or without reconstruction. Electronic health records were queried for the primary breast cancer histology prior to mastectomy, clinical symptoms prompting the diagnostic ultrasound, ultrasound findings, subsequent cytology and pathology, and follow-up data. Excluded were patients with a known recurrence, asymptomatic patients, and those with <2 years of clinical or imaging follow-up. Descriptive and comparative statistical analyses were performed. ResultsAmong the 749 ultrasounds performed, 58 malignancies were identified for a 7.7% (58/749) malignancy rate, with a median tumor size of 20 mm.Patients diagnosed with a malignancy most often presented with a palpable abnormality (79.3%, 46/58) or skin changes (13.8%, 8/58) and rarely with pain (1.7%, 1/58). Patients who underwent a biopsy yielding a benign result most often presented with a palpable abnormality (41.5%, 287/691), pain (25.6%,177/691), or postoperative swelling/suspected fluid collection (17.8%, 123/691).Diagnostic ultrasound yielded a 91.4% sensitivity (95% CI 81.0, 97.1), 96.1% specificity (95% CI 94.4, 97.4), 66.3% PPV3 (95% CI 57.4, 74.1), and 99.3% negative predictive value (95% CI 98.3, 99.7) for cancer detection. There were 5 false negative ultrasound cases after a skin punch biopsy was performed due to clinically suspicious skin changes. ConclusionsChest wall ultrasound has a high sensitivity and negative predictive value for detection of breast cancer recurrence in symptomatic patients after mastectomy. Skin changes remain an important clinical manifestation of a cancer recurrence.

Diagnosis of Pregnancy Complications Using Blind Ultrasound Sweeps Performed by Individuals Without Prior Formal Ultrasound Training.

To estimate the diagnostic accuracy of blind ultrasound sweeps performed with a low-cost, portable ultrasound system by individuals with no prior formal ultrasound training to diagnose common pregnancy complications. This is a single-center, prospective cohort study conducted from October 2020 to January 2022 among people with second- and third-trimester pregnancies. Nonspecialists with no prior formal ultrasound training underwent a brief training on a simple eight-step approach to performing a limited obstetric ultrasound examination that uses blind sweeps of a portable ultrasound probe based on external body landmarks. The sweeps were interpreted by five blinded maternal-fetal medicine subspecialists. Sensitivity, specificity, and positive and negative predictive values for blinded ultrasound sweep identification of pregnancy complications (fetal malpresentation, multiple gestations, placenta previa, and abnormal amniotic fluid volume) were compared with a reference standard ultrasonogram as the primary analysis. Kappa for agreement was also assessed. Trainees performed 194 blinded ultrasound examinations on 168 unique pregnant people (248 fetuses) at a mean of 28±5.85 weeks of gestation for a total of 1,552 blinded sweep cine clips. There were 49 ultrasonograms with normal results (control group) and 145 ultrasonograms with abnormal results with known pregnancy complications. In this cohort, the sensitivity for detecting a prespecified pregnancy complication was 91.7% (95% CI 87.2-96.2%) overall, with the highest detection rate for multiple gestations (100%, 95% CI 100-100%) and noncephalic presentation (91.8%, 95% CI 86.4-97.3%). There was high negative predictive value for placenta previa (96.1%, 95% CI 93.5-98.8%) and abnormal amniotic fluid volume (89.5%, 95% CI 85.3-93.6%). There was also substantial to perfect mean agreement for these same outcomes (range 87-99.6% agreement, Cohen κ range 0.59-0.91, P<.001 for all). Blind ultrasound sweeps of the gravid abdomen guided by an eight-step protocol using only external anatomic landmarks and performed by previously untrained operators with a low-cost, portable, battery-powered device had excellent sensitivity and specificity for high-risk pregnancy complications such as malpresentation, placenta previa, multiple gestations, and abnormal amniotic fluid volume, similar to results of a diagnostic ultrasound examination using a trained ultrasonographer and standard-of-care ultrasound machine. This approach has the potential to improve access to obstetric ultrasonography globally.

H-Scan Ultrasound Monitoring of Breast Cancer Response to Chemotherapy and Validation With Diffusion-Weighted Magnetic Resonance Imaging.

H-scan ultrasound (US) imaging is a novel tissue characterization technique to detect apoptosis-induced changes in cancer cells after the initiation of effective drug treatment. The objective of the proposed research was to assess the sensitivity of 3-dimensional (3D) H-scan US technique for monitoring the response of breast cancer-bearing animals to neoadjuvant chemotherapy and correlate results to diffusion-weighted magnetic resonance imaging (DW-MRI) measurements of programmed cancer cell death. Experimental studies used female mice (N=18) implanted with human breast cancer cells. Animals underwent H-scan US and DW-MRI imaging on days 0, 1, 3, 7, and 10. After imaging at day 0, breast tumor-bearing nude mice were treated biweekly with an apoptosis-inducing drug. Texture analysis of H-scan US images explored spatial relationships between local US scattering. At day 10, H-scan measurements were compared with DW-MRI-derived apparent diffusion coefficient (ADC) values and histological findings. H-scan US imaging of low and high dose cisplatin-treated cancer-bearing animals revealed changes in image intensity suggesting a progressive decrease in aggregate US scatterer size that was not observed in control animals. Longitudinal trends discovered in H-scan US result matched with texture analysis and DW-MRI (P < .01). Further, analysis of the H-scan US image intensity and corresponding DW-MRI-derived ADC values revealed a strong linear correlation (R2 =.93, P < .001). These changes were due to cancer cell apoptotic activity and consider as early detectable biomarker during treatment. The 3D H-scan technique holds promise for assisting clinicians in monitoring the early response of breast cancer tumor to neoadjuvant chemotherapy and adding value to traditional diagnostic ultrasound examinations.

Use and misuse of ultrasound in obstetrics with reference to developing countries.

Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown tobe cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of thearticle is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.

ACVR and ECVDI consensus statement for the standardization of the abdominal ultrasound examination.

This consensus statement is designed to provide a standard of care document and describes the ACVR and ECVDI definition for performing a standard abdominal ultrasound examination in dogs and cats. The ACVR and ECVDI define a standard abdominal ultrasonographic examination as a complete exam of the abdominal organs which is appropriately documented. The consensus statement intends to provide guidance to veterinary sonographers and veterinarians for the performance and documentation of high-quality diagnostic ultrasound examination. The document may also serve as a teaching aid for veterinary students, veterinarians, and residents in diagnostic imaging who seek proficiency in diagnostic ultrasound. Finally, it may serve an additional role in educating the public as to what a high-quality abdominal ultrasound examination should entail.

Diagnostic ultrasound examinations during evacuation of urgent patients by ambulance helicopters: literature review

Relevance. The use of ultrasound diagnostics at the place of providing medical care to an urgent patient is one of the promising directions in the development of emergency medicine. At the same time, of particular interest is the possibility of using diagnostic ultrasound in an ambulance helicopter, given the lack of clear algorithms and standards for its application, as well as the limited number of publications on this problem.Intention. Analysis of publications on the use of urgent ultrasound examination in an ambulance helicopter.Methodology. A search was made for scientific publications on the topic on the electronic resource PubMed, in the Google Scholar search system for the period from 2000 to 2021.Results and discussion. The main algorithms used for ultrasound diagnostics of an urgent patient in an ambulance helicopter are Focused Assessment with Sonography for Trauma (FAST), point-of-care ultrasound (POCUS), Rapid Ultrasound in SHock (RUSH), Bedside Lung Ultrasound in Emergency (BLUЕ), prehospital ultrasonography (PHUS), etc. They help exclude damage to vital organs and emergency pathology – pneumo- and hemothorax, hemoperitoneum, hemopericardium, large fractures and others that affect the tactics of treatment and patient routing; there is also the possibility of ultrasound navigation for a number of medical and diagnostic procedures. According to the results of published studies and clinical observations, prehospital ultrasound examination of urgent patients is successfully used during medical evacuation by an ambulance helicopter in emergency medical services in many countries of the world (both by doctors and other medical personnel), making it possible to diagnose a number of lifethreatening conditions with a fairly high accuracy, without loss of time and without damage to patient’s health. An important aspect of the successful application of the method during flight is the training of qualified personnel. The prospects for the development of the method are the development of more advanced ultrasound scanners and sensors adapted to flight conditions, as well as the use of telemedicine technologies for remote analysis of ultrasound images.Conclusion. The experience of using prehospital diagnostic ultrasound in an ambulance helicopter requires further data accumulation and systematic analysis, but the method is already undoubtedly useful in determining the tactics of treatment and the route of hospitalization of urgent patients with acute trauma and a number of other pathological conditions.

A template for conducting a post-graduate hands-on, urologic ultrasound course.

To describe a program for post-graduate education of urologists providing urologic ultrasound services. A detailed description of the evolution of an educational program developed by the American Urological Association (AUA) Office of Education for providing the knowledge and fundamental skills necessary for urologists to provide high-quality, medically appropriate urologic ultrasound examinations. The structure of the program, as well as the training of instructors and certification of attainment of the goals and skills set forth in the program, is highlighted. Specific recommendations for providing didactic instruction and managing the logistics of the hands-on training are given. Approximately 1700 urologists have received post-graduation instruction in the performance of urologic ultrasound in some form under the auspices of the AUA Office of Education since 1993. The hands-on training course has continued to evolve in response to feedback from the attendees and the ongoing emergence of new clinical indications for urologist-performed ultrasound. A post graduate course, including didactic instruction and hands-on skill training, continues to be in demand and fully subscribed and attended. Instruction in the performance of diagnostic ultrasound examinations is not a formal component of many urologic residencies in the United States. Since many ultrasound procedures are being performed by practicing urologists, there is an ongoing need for post-graduate training in urologic ultrasound.

Diagnostic Value of Peritoneal Nodules Detected on CECT Abdomen in Management of Ascites of Unknown Origin- A Retrospective Study

Introduction: The aetiology of ascites can be established in a majority of patients with routine clinical examination and conventional laboratory and imaging investigations; but in a minority, the cause may remain undetected even after these examinations. This ascites is termed as ascites of unknown origin. The Contrast Enhanced Computed Tomography (CECT) abdomen of these patients sometimes shows peritoneal nodules which can be useful to establish diagnosis. Aim: To evaluate the diagnostic value of peritoneal nodules detected on CECT abdomen in the management of ascites of unknown origin. Materials and Methods: This retrospective study was conducted in Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India on the data retrieved from the medical records of the patients between January 2019 to January 2021. These patients had already been vainly investigated with basic clinical, laboratory and diagnostic ultrasound examinations for the aetiology of ascites. All the patients who were diagnosed to have peritoneal nodules on CECT abdomen and later underwent laparoscopic tissue diagnosis of these peritoneal nodules were included in the study. The sizes of the peritoneal nodules and the distribution of the pathology were collected from CECT abdomen reports and compared them with the histopathology findings. Statistical analysis and plotting of the Receiver Operating Characteristic (ROC) curve were done using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Fifty-two patients of ascites of unknown origin with peritoneal nodules were included in the study. Of the total, 36 (69.2%) patients were males and 16 (30.8%) were females. Mean age of the patients was 48 years (22 to 74 years). Tissue diagnosis of the peritoneal nodules revealed that majority of the patients had carcinomatosis peritonei (88.5%) while a minority had tuberculosis (11.5%). A nodule size of more than 5 mm as a sign of malignancy on CECT abdomen had a sensitivity of 93% and a specificity of 83%. Based on the tissue diagnosis of the peritoneal nodules these patients were treated with antituberculosis drugs for tuberculous abdomen and chemotherapy for carcinomatosis peritonei. Conclusion: Detection of peritoneal nodules on CECT abdomen can be helpful in guiding the clinician for further management of ascites of unknown origin.

Influence of Smartphone Overuse on Grip Strength, Pinch Strength, and Cross-Sectional Area of Flexor Pollicis Longus Tendon and Median Nerve

AbstractBackground and Aim The adverse effects of smartphone size and weight on the hand and hand function have not been studied extensively. This study aimed to investigate the changes to the flexor pollicis longus tendon and median nerve using diagnostic ultrasound for high and low addiction smartphone users.Methodology In this cross-sectional study, 54 healthy male university students were divided into two groups according to the Smartphone Addiction Scale: high and low users. Demographic data, hand grip strength (kg), pinch strength (kg), and smartphone weight, length and width were measured and recorded. Diagnostic ultrasound examination determined the cross-sectional area of the median nerve (mm2) and flexor pollicis longus tendon (mm2) of the dominant and non-dominant hand.Result The cross-sectional area of the median nerve was significantly higher in the high-user group (7.4±1.3 mm2) than the low-user group (6.7±1.0 mm2). The correlation of phone weight, length and width with median nerve area was respectively positive, higher and significant (0.718, 0.747, and 0.733; p&lt;0.05). The flexor pollicis longus tendon in the mid-thenar region was moderately positively correlated with phone length (0.430; p&lt;0.02) for high addiction smartphone users.Conclusion The findings of the current study demonstrates that change to the median nerve and flexor pollicis longus tendon, could be linked to the width, weight and length of the smartphone and high addiction.

Starting a Free Ultrasound Clinic for the Underserved: Considerations and Overcoming Challenges

Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students.

The value of transcutaneous ultrasound in the diagnosis of tonsillar abscess: A retrospective analysis

ObjectiveTo identify the appropriate treatment in the tonsillar region's infections, a distinction between tonsillitis with or without abscess formation is essential. Ultrasound proved to be a valuable method in identifying abscess formation in the head and neck region. However, no report described the assessment of the tonsil region. This study aims to determine the feasibility of transcervical ultrasound for abscess visualization in the palatal tonsillar region. MethodsRetrospective analysis of 354 patients presenting with clinical suspicion of tonsillar abscess to a tertiary referral center and university hospital. All patients received a transcervical ultrasound to establish a primary diagnosis. The existence of an abscess was confirmed by puncture and incision, or final tonsillectomy. If no abscess could be delineated, non-abscessing tonsillitis was supposed, and conservative primary therapy and closed follow-up examinations were performed. ResultsAfter the first diagnostic ultrasound examination, in 257 cases (72.59%), the diagnosis of an abscess could be established, but in 97 cases (27.40%), due to missing abscess formation criteria, non-abscessing tonsillitis was documented. Overall, ultrasonography demonstrated an overall accuracy of 78.8% in this selected cohort. The sensitivity, specificity, PPV, and NPV after the first ultrasound examination were calculated with 75.1%, 88.6%, 94.6%, and 57.3%, respectively. ConclusionThe presented data confirm that an abscess formation due to tonsillitis can be detected by transcervical ultrasound, enabling prompt, adequate management. As transcervical ultrasound can be conducted fast and is not associated with radiation, it can be regarded as a first-line diagnostic tool in this condition.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

AIUM Practice Parameter for the Performance of Diagnostic and Screening Ultrasound Examinations of the Abdominal Aorta in Adults.

AIUM Practice Parameter for the Performance of Diagnostic and Screening Ultrasound Examinations of the Abdominal Aorta in Adults.

The Effect of Patient Oral Intake Status on Abdominal Aortic Ultrasound Visualization

The standard abdominal aortic duplex ultrasound protocol requires fasting for 8-12 hours prior to examination in attempt to reduce bowel gas and improve visualization. Such practice results in frequent testing delays and patient non-compliance. The aim of this study was to determine whether fasting improves visualization of the abdominal aorta in patients undergoing duplex ultrasound or influences diagnostic properties. This was a prospective, randomized, double-blind imaging trail at a single institution. Ninety patients were randomized to one of three dietary groups, including NPO, clear liquids or control (regular diet). Diagnostic ultrasound examinations were performed by accredited Registered Vascular Technologists who remained blinded to the patients' diet. Sonographers commented on the presence of limited visualization in the study based on their ability to accurately measure aortic diameter. Examination results were randomly assigned to interpreting physicians who were also blinded to the patients' diet. Following interpretation, the reading physician was asked to comment whether they had sufficient information for a conclusive diagnostic interpretation. All ultrasound studies were deemed diagnostic by the interpreting physician regardless of the patients' dietary status. Limited visualization was reported in 19 of the 90 study patients (21.1%) with no significant difference existing between the dietary groups (P = 0.344). The NPO group contained the most patients with studies deemed to have limited visualization. Oral intake status did not affect visualization of the abdominal aorta or the rate of diagnostic studies in patients undergoing DUS at a single center. These results suggest that dietary restrictions prior to DUS evaluation of the abdominal aorta is unnecessary.

Ultrasound Diagnosed Disorders of Subacromial Shoulder Pain Patients: A Retrospective Study at a Tertiary Care Rural Hospital, Mewat, Haryana

Introduction: Shoulder pain is leading cause of disability and pain among musculoskeletal pain patients. Ultrasound is coming in a bigger way for diagnosis and management of subacromial pain due to its low cost, easy availability and accuracy in detecting soft tissues pathologies and for planning further treatment. Aim: To assess the role of diagnostic Ultrasound (US) in subacromial shoulder pathologies evaluation in shoulder pain patients. Materials and Methods: This was a retrospective observational study conducted on 98 patients who presented with subacromial shoulder pain. Diagnostic ultrasound examination was done and patients were categorised based upon underlying pathology and analysed in terms of frequency. Results: Most common ultrasound findings in subacromial shoulder pain patients were subacromial bursopathy 46 (46.93%) followed by Rotator cuff pathology including tear 38 (38.77%), mixed pathology 9 (9.18%) and Acromioclavicular (AC) joint pathology 5 (5.10%). Isolated biceps pathology was not seen in our study rather biceps pathology along with other tendon and joint involvement was observed. Conclusion: The findings in the present study imply that diagnostic ultrasound of shoulder pain patients helps to stratify them into different categories for better understanding of underlying pathology and targeted treatment approach. Ultrasound shall be used as an outpatient primary diagnostic modality for evaluation of subacromial shoulder pain patients.

Patient understanding of diagnostic ultrasound examinations in an Australian private radiology clinic.

To determine patient understanding and expectations of ultrasound imaging and its safety, sources of examination information and levels of examination anxiety. 1070 consecutive patients presenting to a private, regional radiology practice in New South Wales, Australia between 16th May and 14th June 2019, were invited to complete a survey while waiting for their non-interventional ultrasound examination. The survey included questions on demographic characteristics, knowledge such as examination risks and safety, ultrasound expectations such as dissemination of results, sources of examination information and levels of participant anxiety. Data were analysed using Kruskal-Wallis tests (SPSS v. 25) to determine statistical associations between participant demographic factors, knowledge, anxiety level and the main source of examination information. A total of 215/1070 (20%) patients voluntarily participated in the study. Most were female (74%, 159/215), with a median (range) age of 55 (18-92) years. Participant's median (range) score of ultrasound imaging knowledge was 3 (0-5) scored out of six and indicated uncertainty regarding the ultrasound procedure, result dissemination and ultrasound safety. Participants with previous personal experience had significantly higher levels of ultrasound imaging knowledge than those whose primary information source was their referring doctor (P=0.0005) or the internet (P=0.026). Significantly higher levels of ultrasound examination knowledge were also associated with lower self-reported levels of anxiety (P=0.002). Participants had incomplete ultrasound examination knowledge, including misconceptions regarding safety and result dissemination, some of which could be clarified by the sonographer at the beginning of the ultrasound examination.

Evaluation of the Scan Duration and Mechanical and Thermal Indices Applied for the Diagnostic Ultrasound Examinations.

Although epidemiological studies have failed to show the harmful effects of ultrasound in humans, as a form of energy, ultrasound has the potential to cause bio-effects in tissues. Therefore, clinical guidelines have been established for ultrasound technology related to human safety, which include Thermal (TI) and mechanical (MI) indices. The appropriate TI and MI ranges for embryonic examinations are between 0-1.0 and 0-0.4, respectively. The accepted TI and MI ranges are 0-2.0 and 0-1.9, respectively, for general ultrasound examinations. In addition, the scan duration should be kept as low as possible. Therefore, the present study aimed at evaluating the scan duration, TI, and MI as measures of acoustic output during ultrasound studies. A cross-sectional descriptive study was conducted for patients undergoing pregnancy checkups, routine checkups, and initial diagnosis ultrasound examinations. Samples were selected from imaging departments of 4 educational hospitals based on convenience sampling and 321 checklists completed by direct observation of ultrasound examinations. For pregnancy scans, the mean TI and MI were obtained as 0.32 ± 0.27 and 1.15 ± 0.13, respectively. For non-pregnancy examinations, the mean value of TI and MI were 0.30 ± 0.29 and 1.07 ± 0.35, respectively. Therefore, mean TI for pregnancy and non-pregnancy examinations and mean MI for non-pregnancy studies obtained lower than the permitted values, while the mean MI was higher than the permitted level for first trimester of pregnancy. Also, relatively suitable scan durations were seen in reviewed studies. From this study, it may be concluded that the reported ultrasound scans were safe.

ROLE OF PLATELET RICH PLASMA THERAPY ON ROTATOR CUFF DISEASE

Background: There is lack of evidence from randomized clinical trials that had assisted the efficacy of PRP in treating of rotator cuff diseases (RCD).Aim of the work: To study the effect of PRP injection on functional improvement on RCD, and to study the role of proinflammatory and angiogenesis-related cytokines as a pathogenic factor in RCD.Patients and methods:The study was conducted on 40 patients with RCD. All patients subjected to: clinical shoulder examination, clinical scoring including; (VAS and Los Angeles Shoulder score), cytokine assay of vascular endothelial growth factor (VEGF) and interleukin one beta (IL-1β), and diagnostic musculoskeletal ultrasound examination (MSU). All patients underwent two doses of ultrasound guided PRP injection with 4 weeks in-between. Re-evaluation after 4 weeks from first injection was done using clinical scoring, cytokine assay and MSU. Third assessment was done 3 months from first injection using clinical scoring and MSU.Results: There was a statistically high significant decrease in pain, improvement of range of motion (ROM), power and functional state in all participants after 2 doses of PRP injection and rehabilitation program. In addition, there was a highly statistical significant decrease of cytokines serum levels after 4 weeks. There was a highly significant improvement regarding MSU grading. There was positive correlation between the serum levels of cytokines and VAS and negative correlation between the serum levels of cytokines and other clinical scores. There was positive correlation between the serum levels of VEGF and MSU grading. Conclusion:PRP therapy is an effective treatment for RCD and lead to functional improvement. There is a strong correlation between levels of cytokines (IL-1β and VEGF) and clinical scores before injection and 4 weeks following first injection. There is strong correlation between level of VEGF and ultrasound grading of RCD.

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days.

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days.