Diagnostic Ultrasound System Research Articles

Comparative Approach to Performance Estimation of Pulsed Wave Doppler Equipment Based on Kiviat Diagram

Quality assessment of ultrasound medical systems is a demanding task due to the high number of parameters to quantify their performance: in the present study, a Kiviat diagram-based integrated approach was proposed to effectively combine the contribution of some experimental parameters and quantify the overall performance of pulsed wave Doppler (PWD) systems for clinical applications. Four test parameters were defined and assessed through custom-written measurement methods based on image analysis, implemented in the MATLAB environment, and applied to spectral images of a flow phantom, i.e., average maximum velocity sensitivity (AMVS), velocity measurements accuracy (VeMeA), lowest detectable signal (LDS), and the velocity profile discrepancy index (VPDI). The parameters above were scaled in a standard range to represent the four vertices of a Kiviat plot, whose area was considered the overall quality index of the ultrasound system in PWD mode. Five brand-new ultrasound diagnostic systems, equipped with linear array probes, were tested in two different working conditions using a commercial flow phantom as a reference. The promising results confirm the robustness of AMVS, VeMeA, and LDS parameters while suggesting further investigations on the VPDI.

Clinical, Safety, and Engineering Perspectives on Wearable Ultrasound Technology: A Review.

Wearable ultrasound has the potential to become a disruptive technology enabling new applications not only in traditional clinical settings, but also in settings where ultrasound is not currently used. Understanding the basic engineering principles and limitations of wearable ultrasound is critical for clinicians, scientists, and engineers to advance potential applications and translate the technology from bench to bedside. Wearable ultrasound devices, especially monitoring devices, have the potential to apply acoustic energy to the body for far longer durations than conventional diagnostic ultrasound systems. Thus, bioeffects associated with prolonged acoustic exposure as well as skin health need to be carefully considered for wearable ultrasound devices. This article reviews emerging clinical applications, safety considerations, and future engineering and clinical research directions for wearable ultrasound technology.

CELASTO (Cervical ELASTOgraphy) pilot study — the use of cervical elastography during pregnancy

BACKGROUND: Ultrasound assessment of cervical length is an integral part of a comprehensive examination during pregnancy, but it does not provide a complete picture of structural changes in the cervix. The use of E-Cervix elastography is a promising method to assess cervical remodeling throughout the gestation period. AIM: The aim of this study was to evaluate the possibility of using automated cervical elastography in clinical practice to analyze the main parameters of cervical elasticity and hardness in pregnancy. MATERIALS AND METHODS: This prospective pilot study included 136 patients with singleton pregnancies at gestational ages ranging from 7+0 to 41+0 weeks. Cervical elastography was performed using E-Cervix software of the W10 diagnostic ultrasound system (Samsung Medison Co., Ltd., South Korea) with evaluation of quantitative parameters such as hardness ratio, elasticity contrast index, internal os, external os. RESULTS: Correlation analysis showed that hardness ratio decreased with increasing gestational age (ρ = −0.439) and decreasing cervical length (ρ = 0.408; p 0.001). In the group of patients with cervical length less than 25 mm, there was a decrease in hardness ratio compared to the control group (48.0 vs. 63.8%, respectively; p 0.001). The elasticity contrast index score, which reflects cervical tissue heterogeneity, increased with gestational age and cervical shortening (ρ = 0.368 and −0.450, respectively), the parameter being higher in patients with cervical length less than 25 mm [4.73 (IQR 4.21–5.90); p 0.001]. The increase in internal os and external os with gestational age (ρ = 0.433 and ρ = 0.365, respectively; p 0.001) indicates softening of the cervix and is accompanied by its shortening. CONCLUSIONS: Results indicate decreased hardness and increased elasticity of the cervix with increasing gestational age and decreased cervical length. E-Cervix technology allows for assessing structural changes in the cervix throughout pregnancy, starting from early gestation.

#540 Investigation of vascular sound visualization system using electronic stethoscope

Abstract Background and Aims The routine evaluation of VA involves visual, palpatory, and auscultatory examinations, as well as monitoring of venous pressure and other parameters. Surveillance indices include Flow Volume (FV) and Resistance Index (RI) obtained by Doppler ultrasound (DU) and Access Blood Flow (Qa) obtained by the Ultrasound Dilution Method (UDM) are well known. On the other hand, the MSS-U11C electronic stethoscope (Fig. 1) and dedicated application (Fig. 2) developed by Pioneer Inc. converts vascular sound into digital data and calculates the INDEX value obtained from the sound intensity (dB) analyzed by the vascular sound visualization system. In this study, we examined the correlation between INDEX values and conventional surveillance indices. Method 1. Eighty-three cases in which INDEX, FV, RI, and Qa were simultaneously measured in hemodialysis patients with AVF at the Artificial Kidney Department of Osaka Metropolitan University Hospital were included. 2. The measurement site for INDEX was just above the anastomosis of the AVF. 3. FV and RI were measured using a KONICA MINOLTA SONIMAGE HS2 diagnostic ultrasound system with the brachial artery as the measurement site. 4. Measurements were expressed in Median [IQR], and for statistical examination, Pearson's correlation coefficient was used for the correlation of each measurement, transformed to the natural logarithm to satisfy the assumption of normality of the residuals. The significance level for all hypothesis tests was 5%. For statistical analysis, R version 4.2.1 (https://www.r-project.org/foundation/) with the “rms” and “RcmdrPlugin.EZR ” packages were used. 5. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent. Results INDEX showed a significant positive correlation with Qa and FV (R = 0.449, P = 0.002 / R = 0.484, P < 0.001, respectively), INDEX showed a significant negative correlation with RI (R = −0.336, P = 0.002). Conclusion INDEX measurement using an electronic stethoscope is a monitoring index and showed a positive correlation with FV and Qa, which are established surveillance indices, and a weak negative correlation with RI. In Japan, FV and RI are commonly used as surveillance indices, but it has been reported that these indices can be underestimated or overestimated depending on the skill of the examiner, and that Qa requires specialized equipment and cannot be measured depending on the puncture site. We believe that monitoring by stethoscope is influenced by subjective factors of staff members, which may lead to differences in evaluation, but INDEX could become a more quantitative and standardized indicator. In addition, the electronic stethoscope could be used without any difference compared to the stethoscope currently in clinical use.

Effects of muscle contraction induced by electrical stimulation on fascial gliding: Evaluation by ultrasonography

PurposeThis study investigates the effects of neuromuscular electrical stimulation (NMES)-induced muscle contraction on fascial gliding between the muscle and adjacent tissues and identifies factors that affect fascial gliding. MethodsThe gliding between the epimysium of the vastus lateralis muscle and the subcutaneous tissue was measured using a diagnostic ultrasound system during the subject's knee joint was flexed passively. The deep temperature, deep blood flow, and tissue hardness of the vastus lateralis muscle were measured to identify factors contributing to the changes in fascial gliding. ResultsFascial gliding significantly increased after NMES. The deep temperature was significantly higher when NMES was not applied. There were no significant differences in deep blood flow or tissue hardness. ConclusionFascial gliding increased when NMES was applied. However, deep temperature, blood flow, and muscle hardness were not affected by NMES. Shear force caused by muscle contraction may play a role in the increase in fascial gliding due to NMES.

Prospective use of O-RADS and ADNEX ultrasound systems for risk stratification of ovarian malignancies

Objectives. A prospective study of the diagnostic value of ultrasound ovarian cancer risk stratification systems ADNEX and O-RADS in the differential diagnosis of benign and malignant ovarian tumors.Material and methods. 59 patients with 43 benign and 25 with malignant ovarian tumors were prospectively examined. The ultrasound diagnostic systems IOTA ADNEX (installed on the device) and O-RADS (ACR Guidance smartphone application) were used to assess the risk of ovarian cancer. An ultrasound report on the presence of a malignant tumor with appropriate routing of the patient was given when the risk of malignancy according to ADNEX was ≥10%, as well as when the risk of malignancy was ≥4 points according to O-RADS. All patients underwent surgical treatment at the Regional Clinical Hospital (Vladimir) and the Regional Clinical Oncology Hospital (Vladimir).Results. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve (AUC) were respectively for ADNEX: 96, 81, 75, 97 and 87%, AUC 0.933; for O-RADS: 100, 74, 69, 10% and 90%, AUC 0.926.Conclusion. Both ultrasound diagnostic systems demonstrated very high sensitivity in the prospective differential diagnosis of benign and malignant ovarian tumors. At the same time, O-RADS made it possible to make the correct diagnosis in all 25 cases of malignant tumors. At the same time, both systems showed low specificity, with ADNEX having a slightly higher specificity (p > 0.05). AUC values were high for both diagnostic systems. In connection with the results of the study, we currently consider it advisable to simultaneously use the ADNEX and O-RADS systems for ultrasound examination in gynecology, reflecting the results of calculating the risk of malignant neoplasms of the adnexal mass in the ultrasound examination protocol

Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds

Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds. Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A). Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354). Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturing stimulated wound healing and accelerated wound-healing process as evidenced by a significant decrease in the wound defect area and volume on the 11th–14th day post-injury in the main group compared to the comparison group. The method for treatment of gunshot shrapnel wounds developed by us reduced the frequency of postoperative complications since 24 (80.00 %) patients were diagnosed with complications in the comparison group, while only 2 (6.67 %) patients in the main group (U = 120.00, p = 0.00001). The use of platelet-rich autoplasma made it possible to reduce the length of hospital stay for patients at the third stage of medical evacuation: in the comparison group, this period was 30.0 ± 2.3 days, and in the main group, 12.0 ± 3.1 days (U = 290.00, p = 0.0354).

Evaluation of cortisol, thyroxine (T3) and triiodothyronine (T4) concentrations in preovulatory follicles in jennies.

Reference values of follicular fluid components at different stages of follicular development in jennies are unknown. It is important to estimate such values because the biochemical composition of follicular fluid provides a suitable microenvironment for oocyte development, growth and maturation. The experimental protocol was carried out in the Equine Reproduction Clinic of the FMVZ-UNAM and was approved by an Institutional Sub-committee for the Care and Use of Experimental Animals (SICUAE.MMVZ-2020/4-2). Seven healthy female donkeys “Mexican burro” with average body condition score of 3 on a scale of 1 to 5 (Svendsen et al. The professional Handbook of the Donkey. 2008), were monitored by transrectal ultrasonography through the Veterinary Digital Diagnostic Ultrasound System 5 MHz (Model, DUS 60 VET) with a multi-frequency linear transducer. The ovum pick up (OPU) by transvaginal aspiration (TVA) was performed in a total of 70 preovulatory follicles, 10 for each jenny using a real- time B- mode ultrasound vaginal 6.5 MHz (Sonovet 600) with curvilinear transducer and 12 gauge (12 G) needle. Follicular fluid components were measured and analyzed by Luminex Multiplex Assays at the Universidad Nacional Autónoma de México. The relationship between cortisol, thyroxine (T3) and triiodothyronine (T4) concentrations in preovulatory follicles and follicular size was assessed. The preovulatory follicles are classified in three groups accordingto the diameter: small (27-30 mm), medium (31-35 mm) and large (36-38 mm). Concentrations of cortisol were lower in the large follicles group (18.8 ng/ml) compared with small (721.44 ng/ml) and medium follicles (361 ng/ml). The concentrations of thyroxine were higher in the medium follicle group (49 ng/ml) than in the small (21ng/ml) and large follicle groups (15.9 ng/ml). Finally, the concentration of triiodothyronine was higher in the small follicles group (1043 ng/ml) followed by the medium (545 ng/ml) and the lowest concentration was in the large follicles group (22 ng/ml). It is concluded that thyroxine concentrations are lower than T4 concentrations in preovulatory follicles irrespective of size as reported for human follicular fluid (Wakim. et. al. Fertil Steril 1993; 59(6) 1187–1190). Furthermore, no relationship was found between preovulatory follicular size and thyroxine hormone concentrations. It has been suggested that cortisol and triiodothyronine concentrations are related to preovulatory follicle size. Cortisol concentrations are higher in preovulatory follicles that in subordinate follicles and cortisol is a mediator of apoptosis in granulosa cells, differentiation, development and maturation of tissues, specifically in the oocyte (Acosta & Miyamoto. Anim Reprod Sci 2004; 82:127-140, Scarlett. et al. Dom Anim Endocrinol 2016; 59:11-22). The role of cortisol within the different sizes of preovulatory follicles is unknown.

Determination of indications for early surgical treatment in patients with ruptured anterior communicating artery aneurysms

Aim. To analyze and determine the optimal indications for microsurgical operative interventions in the shortest possible time from the subarachnoid hemorrhage onset to prevent anterior communicating artery (AcomA) aneurysm re-rupture and bleeding. Materials and methods. 280 patients with brain aneurysms were examined at the Uzhhorod Regional Center of Neurosurgery and Neurology and the City Hospital of Urgent and Emergency Medical Care under Zaporizhzhia City Council. Among them, 98 patients (48 males and 50 females) were diagnosed with AcomA aneurysms. The age of patients with AcomA aneurysms was from 20 to 72 years (mean age 47.8 ± 11.0 years). Aneurysms were verified using head and neck computed tomography angiography (a Toshiba Astelion scanner, 2016, No. 4СС162106), selective cerebral angiography (an angiography system General Energy Optima IGS 330, 2019, No. 80071260314), and brain magnetic resonance angiography (an i_Open 0,36 T magnetic resonance tomograph, 2005, No. Toc102633006). Cerebral hemodynamics was assessed using transcranial dopplerography (“Philips HD7” ultrasound diagnostic system, 2014, No. 69935). Results. In the first three days after the onset of subarachnoid hemorrhage, 18 (18 %) patients were admitted with ruptured aneurysms of this location, 62 (62 %) within 4–8 days, 12 (12 %) patients within 9–14 days, later than 14 days – 6 (6 %). All 98 patients underwent microsurgical clipping of AcomA aneurysms. Due to severe cerebral edema, decompressive craniectomy was performed in two patients. The results of surgical treatment were evaluated according to the modified Rankin scale at the time of hospital discharge and were as follows: in 65 (65 %) patients – good; in 18 (18 %) – moderate disability; in 4 (4 %) – serious disability. 11 (11 %) patients died. Conclusions. The treatment outcomes in patients with ruptured AcomA aneurysms were significantly dependent on factors related to increased risk of re-rupture: the presence of large-sized intracerebral hematoma, the aneurysm index exceeding 2, and multi-chamber aneurysm.

A Novel Equivalent Time Sampling-Based Method for Pulse Transit Time Estimation with Applications into the Cardiovascular Disease Diagnosis.

The increasing incidence of cardiovascular diseases (CVDs) is reflected in additional costs for healthcare systems all over the world. To date, pulse transit time (PTT) is considered a key index of cardiovascular health status and for diagnosis of CVDs. In this context, the present study focuses on a novel image analysis-based method for PTT estimation through the application of equivalent time sampling. The method, which post-processes color Doppler videos, was tested on two different setups: a Doppler flow phantom set in pulsatile mode and an in-house arterial simulator. In the former, the Doppler shift was due to the echogenic properties of the blood mimicking fluid only, since the phantom vessels are non-compliant. In the latter, the Doppler signal relied on the wall movement of compliant vessels in which a fluid with low echogenic properties was pumped. Therefore, the two setups allowed the measurement of the flow average velocity (FAV) and the pulse wave velocity (PWV), respectively. Data were collected through an ultrasound diagnostic system equipped with a phased array probe. Experimental outcomes confirm that the proposed method can represent an alternative tool for the local measurement of both FAV in non-compliant vessels and PWV in compliant vessels filled with low echogenic fluids.

Sample volume length and registration accuracy assessment in quality controls of PW Doppler diagnostic systems: a comparative study

In clinical diagnostics, Pulsed Wave (PW) Doppler is one of the most used spectral Doppler techniques since it provides quantitative information about the severity of several cardiac disorders. Therefore, routine quality control tests should be scheduled to check whether a proper level of performance is maintained over time. Despite continuous research in the field, performance evaluation of Doppler equipment is still an open issue. Therefore, the present study is focused on the comparative investigation based on a test parameter for the automatic analysis of faults in sample volume length and range gate registration accuracy. The Velocity Profile Discrepancy Index (VPDI) provides a quantitative estimation according to the agreement between the theoretical parabolic velocity profile and the measured one. The index was assessed through an automatic method that post-processes PW spectrogram images acquired at six sample volume depths with respect to the vessel radius of a Doppler reference device. Tests were repeated for three brand-new ultrasound diagnostic systems, equipped with convex and phased array probes, in two working conditions. From the analysis of the results, a lower discrepancy between the measured and the theoretical velocity profile was found for the convex array probes as well as a lower uncertainty contribution.

White matter injury detection based on preterm infant cranial ultrasound images.

White matter injury (WMI) is now the major disease that seriously affects the quality of life of preterm infants and causes cerebral palsy of children, which also causes periventricular leuko-malacia (PVL) in severe cases. The study aimed to develop a method based on cranial ultrasound images to evaluate the risk of WMI. This study proposed an ultrasound radiomics diagnostic system to predict the WMI risk. A multi-task deep learning model was used to segment white matter and predict the WMI risk simultaneously. In total, 158 preterm infants with 807 cranial ultrasound images were enrolled. WMI occurred in 32preterm infants (20.3%, 32/158). Ultrasound radiomics diagnostic system implemented a great result with AUC of 0.845 in the testing set. Meanwhile, multi-task deep learning model preformed a promising result both in segmentation of white matter with a Dice coefficient of 0.78 and prediction of WMI risk with AUC of 0.863 in the testing cohort. In this study, we presented a data-driven diagnostic system for white matter injury in preterm infants. The system combined multi-task deep learning and traditional radiomics features to achieve automatic detection of white matter regions on the one hand, and design a fusion strategy of deep learning features and manual radiomics features on the other hand to obtain stable and efficient diagnostic performance.

Focused ultrasound neuromodulation of the spleen activates an anti-inflammatory response in humans

Focused ultrasound stimulation (FUS) activates mechanosensitive ion channels and is emerging as a method of noninvasive neuromodulation. In preclinical studies, FUS of the spleen (sFUS) activates an anti-inflammatory neural pathway which suppresses acute and chronic inflammation. However, the relevance of sFUS for regulating inflammatory responses in humans is unknown. Here, we used a modified diagnostic ultrasound imaging system to target the spleen of healthy human subjects with 3 min of continuously swept or stationary focused pulsed ultrasound, delivered at three different energy levels within allowable safety exposure limits. Potential anti-inflammatory effects of sFUS were assessed by measuring sFUS-elicited changes in endotoxin-induced tumor necrosis factor (TNF) production in whole blood samples from insonified subjects. We found that stimulation with either continuously swept or focused pulsed ultrasound has an anti-inflammatory effect: sFUS lowers TNF production for >2 h, with TNF returning to baseline by 24 h following sFUS. This response is independent of anatomical target (i.e., spleen hilum or parenchyma) or ultrasound energy level. No clinical, biochemical, or hematological parameters are adversely impacted. This is the first demonstration that sFUS suppresses the normal inflammatory response in humans, with potential implications for noninvasive bioelectronic therapy of inflammatory disorders.

Sononeoperfusion: a new therapeutic effect to enhance tumour blood perfusion using diagnostic ultrasound and microbubbles

BackgroundHypoperfusion or resultant hypoxia in solid tumours is a main reason for therapeutic resistance. Augmenting the blood perfusion of hypovascular tumours might improve both hypoxia and drug delivery. Cavitation is known to result in microstreaming and sonoporation and to enhance drug diffusion into tumours. Here, we report the ability to enhance both tumour blood perfusion and doxorubicin (Dox) delivery using a new sononeoperfusion effect causing a cavitation effect on tumour perfusion in subcutaneous Walker-256 tumours of rats using ultrasound stimulated microbubble (USMB).MethodsTo induce the sononeoperfusion effect, USMB treatment was performed with a modified diagnostic ultrasound (DUS) system and SonoVue® microbubbles. The therapeutic pulse was operated with a peak negative pressure of 0.26 to 0.32 MPa and a pulse repetition frequency (PRF) of 50 Hz to 2 kHz. Contrast-enhanced ultrasound (CEUS) was used for tumour perfusion assessment.ResultsThe USMB treatment of 0.26 MPa and 1 kHz could significantly enhance tumour perfusion with a 20.29% increase in the CEUS peak intensity and a 21.42% increment in the perfusion area for more than 4 hours (P < 0.05). The treatment also increased Dox delivery to tumours by approximately 3.12-fold more than that of the control (P < 0.05). Furthermore, ELISAs showed that vasodilators and inflammatory factors increased 4 hours after treatment (P < 0.05), suggesting that the inflammatory response plays an important role in the sononeoperfusion effect.ConclusionThe USMB-induced sononeoperfusion effect could significantly enhance the blood perfusion of Walker-256 tumours and promote drug delivery. It might be a novel physical method for overcoming the therapeutic resistance of hypoperfused or hypoxic tumours.

The study of the dynamics of clinical and laboratory-instrumental parameters in hypertensive patients with obesity who underwent COVID-19-associated pneumonia

BACKGROUND : According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM : The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS : Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 — 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers — concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol; echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULTS : Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-α and NRL parameters in group 2 of patients with 2–3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION : Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.

Improvement Possibilities for Nuclear Power Plants Inspections by Adding Deep Learning-based Assistance Algorithms Into a Classic Ultrasound NDE Acquisition and Analysis Software

The safety of nuclear power plants has always been one of the most important security issues in the industry in general. Numerous standards, techniques, and tools have been developed to deal specifically with the safety of nuclear power plants – one has specialised probes, robotized systems, electronics, and software. Although seen as a mature (or slowly evolving) industry, this notion about nuclear safety is a bit misleading – the area is developing in many promising new directions. Some recent global events will speed up this development even more. On the other hand, the industry is currently going through digital transformation, which brings networking of devices, equipment, computers, and humans. This fourth industrial revolution promises speed, reliability, and efficiencies not possible up until now. In the NDE sector, new production techniques and traditional manufacturing lines are getting to be lights-out operations (near-total automation). The same is most probably going to happen with the safety inspections and quality insurance. Robotics and automation are improving worker safety and reducing human error. The well-being of inspectors working in a hazardous environment is being taken care of. Most experts agree that the digitalization of NDE offers unprecedented opportunities to the world of inspection for infrastructure safety, inspector well-being, and even product design improvements. While the community tends to agree on the value proposition of digital transformation of NDE, it also recognizes the challenges associated with such a major shift in a well-established and regulated sector. The work presented in this paper shows a part of the project that aims to develop a modular ultrasound diagnostic NDE system (consisting of exchangeable transducers, electronics, and acquisition/analysis software algorithms), for applications in hazardous environments within nuclear power plants. The paper will show how the software part of this system can reach near-total automation by implementing various deep learning algorithms as its features and, then, testing those algorithms on laboratory samples, showing encouraging results and promises of online monitoring applications. Furthermore, future general prospects of this technology are discussed, and how this technology can affect the well-being of nuclear power plant inspectors and contribute to overall plant safety.

Artificial intelligence breast ultrasound and handheld ultrasound in the BI-RADS categorization of breast lesions: A pilot head to head comparison study in screening program.

Artificial intelligence breast ultrasound diagnostic system (AIBUS) has been introduced as an alternative approach for handheld ultrasound (HHUS), while their results in BI-RADS categorization has not been compared. This pilot study was based on a screening program conducted from May 2020 to October 2020 in southeast China. All the participants who received both HHUS and AIBUS were included in the study (N = 344). The ultrasound videos after AIBUS scanning were independently watched by a senior radiologist and a junior radiologist. Agreement rate and weighted Kappa value were used to compare their results in BI-RADS categorization with HHUS. The detection rate of breast nodules by HHUS was 14.83%, while the detection rates were 34.01% for AIBUS videos watched by a senior radiologist and 35.76% when watched by a junior radiologist. After AIBUS scanning, the weighted Kappa value for BI-RADS categorization between videos watched by senior radiologists and HHUS was 0.497 (p < 0.001) with an agreement rate of 78.8%, indicating its potential use in breast cancer screening. However, the Kappa value of AIBUS videos watched by junior radiologist was 0.39, when comparing to HHUS. AIBUS breast scan can obtain relatively clear images and detect more breast nodules. The results of AIBUS scanning watched by senior radiologists are moderately consistent with HHUS and might be used in screening practice, especially in primary health care with limited numbers of radiologists.

A Comparative Study on Depth of Penetration Measurements in Diagnostic Ultrasounds Through the Adaptive SNR Threshold Method

Depth Of Penetration (DOP) has been investigated in the scientific literature as an informative parameter able to monitor over time both the sensitivity and the general performance of ultrasound (US) diagnostic systems. In common practice, this parameter may suffer from operator-related errors due to its visual assessment. Different image analysis algorithms have been proposed in the literature to address this issue. In this regard, the present work evaluates the Adaptive SNR Threshold Method (AdSTM) on six US diagnostic systems equipped with three US probe models, operating at four frequencies. Data were collected from a US phantom with two distinct zones with different attenuation coefficients. The AdSTM results were compared to the outcomes provided by the Naked Eye Method (NEM), which was performed by 5 non-medical observers. Despite the small population sample of observers, the obtained results were generally consistent across methods, and suggest the implementation of a calibration procedure for AdSTM, and a more extensive testing.

Two-dimensional shear wave elastography utilized in patients with ascites: a more reliable method than transient elastography for noninvasively detecting the liver stiffness-an original study with 170 patients.

Two dimensional shear wave elastography (2D-SWE) is an ultrasound elastography technique based on shear waves implemented on a diagnostic ultrasound system. Transient elastography (TE) uses an ultrasound displacement M-mode and A-mode image produced by the system. So, TE mechanically induced impulse at tissue surface and difficultly across water. This paper compared the reliability and reproducibility of 2D-SWE with that of TE in patients with chronic hepatic disease. Comparisons were made in terms of the success rate, reliability, reproducibility, operation time, and influence of operator experience. A total of 170 patients were included in this study. Participants underwent 2D-SWE and TE performed by 2 different operators (a novice and veteran) on the same day. Nonparametric statistical tests were used to compare the technical success rate and reliable measurement rate, and inter-operator reproducibility was evaluated using intra-class correlation coefficients (ICCs). The 2D-SWE technique showed a higher technical success rate than TE. Either 2D-SWE or TE can be utilized in patients with ascites lamella of less than 10 mm or ascites lamella plus skin-capsular distance of less than 25 mm. However, although the reliability rate of liver stiffness measurement with 2D-SWE did not significantly differ between the novice and veteran operators, for TE, there was a significant difference when body mass index (BMI) ≤25 kg/m2. When performed by the novice and veteran operators, 2D-SWE and TE both showed excellent inter-operator agreement, with ICCs of 0.968 and 0.973, respectively. Both 2D-SWE and TE displayed reliable measurement and excellent reproducibility in patients with chronic liver disease, were minimally influenced by operator experience. 2D-SWE may be a more reliable method for clinical application in noninvasive detecting the liver stiffness.

A Comparative Study on a Novel Quality Assessment Protocol Based on Image Analysis Methods for Color Doppler Ultrasound Diagnostic Systems.

Color Doppler (CD) imaging is widely used in diagnostics since it allows real-time detection and display of blood flow superimposed on the B-mode image. Nevertheless, to date, a shared worldwide standard on Doppler equipment testing is still lacking. In this context, the study herein proposed would give a contribution focusing on the combination of five test parameters to be included in a novel Quality Assessment (QA) protocol for CD systems testing. A first approach involving the use of the Kiviat diagram was investigated, assuming the diagram area, normalized with respect to one of the gold standards, as an index of the overall Doppler system performance. The QA parameters were obtained from the post-processing of CD data through the implementation of custom-written image analysis methods and procedures, here applied to three brand-new high-technology-level ultrasound systems. Experimental data were collected through phased and convex array probes, in two configuration settings, by means of a Doppler flow phantom set at different flow rate regimes. The outcomes confirmed that the Kiviat diagram might be a promising tool applied to quality controls of Doppler equipment, although further investigations should be performed to assess the sensitivity and specificity of the proposed approach.