European Federation Of Societies For Ultrasound In Medicine And Biology Research Articles

Foreword to Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) deserves our thanks for recognizing the need for ultrasound contrast agent (UCA) guidelines and for writing and publishing them in 2004 (Albrecht et al. 2004) and 2008 (Claudon et al. 2008). The third iteration of UCA guidelines in the liver, Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012, contains major changes from the two previous versions.

EFSUMB Guidelines 2011: Comments and Illustrations

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced the first guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB document focused mainly on liver applications. However, new applications extending beyond the liver were subsequently developed. Therefore, in the update of the clinical recommendations on the use of CEUS by the EFSUMB, applications in other organs were also described and published in 2008. Increased interest in recent years in the CEUS technique and in the application of CEUS in novel fields has resulted in CEUS indications and applications for nearly all organ systems. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the indications are established, whereas others are preliminary. The latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on comments, illustrations and examples of the application of CEUS in the pancreas, spleen, gastrointestinal tract, kidney, adrenals, lymph nodes, perineum, and hepatobiliary system. The potential for endoscopic ultrasound to highlight the importance of CEUS in the daily routine is also addressed.

EFSUMB Guidelines 2011: Comment on Emergent Indications and Visions

The focus of this article is the emergent and potential indications of contrast-enhanced ultrasound (CEUS). Emergent applications of CEUS techniques include extravascular and intracavitary contrast-enhanced ultrasound, quantitative assessment of microvascular circulation for tumor response assessment, and tumor characterization using dynamic contrast-enhanced ultrasound (DCE-US). Potential indications for microbubble agents include novel molecular imaging and drug and gene delivery techniques, which have been successfully tested in animal models. "Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Non-Liver Guidelines 2011" which focus more on established applications are published in the same supplement to Ultraschall in der Medizin (European Journal of Ultrasound).

Contrast-Enhanced Ultrasound (CEUS) in the Diagnostic Algorithm of Hepatocellular and Cholangiocellular Carcinoma, Comments on the AASLD Guidelines

Contrast-enhanced ultrasound (CEUS) has long been present in important guidelines and recommendations for the diagnostic work-up of focal liver lesions in patients with cirrhosis. These guidelines have included the guidelines of the American Association for the Study of Liver Diseases (AASLD) 2005, the Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma, the recommendations of the Japanese Society of Hepatology, and the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 (in preparation). Recently, the AASLD removed CEUS from their guidelines in part because of the perceived possibility of false-positive hepatocellular carcinoma (HCC) diagnosis in patients with intrahepatic cholangiocarcinoma (ICC), and in part because CEUS is not available in the USA. This latter factor means that published results are not entirely applicable to a North American population. The present manuscript discusses the diagnostic algorithm of hepatocellular carcinoma and provides information on the differential diagnosis between HCC and ICC.

Contrast-enhanced endoscopic ultrasound.

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, new applications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in the application of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhanced EUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CE-EUS in various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS. This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced high mechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (known as contrast-enhanced low mechanical index endosonography or CELMI EUS).

Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies

To document the practice and training opportunities of US-guided arthrocentesis and joint injection (UGAJ) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). An English-language questionnaire, containing questions on demographics, clinical and practical aspects of UGAJ, training options in UGAJ for rheumatologists, UGAJ education in the rheumatology training curriculum and other structured education programmes in UGAJ was sent to three different groups: (i) all national rheumatology societies of EULAR; (ii) all national societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB); and (iii) 22 senior rheumatologists involved in EULAR musculoskeletal US training from 14 European countries, who were also asked to circulate the questionnaire among relevant colleagues. Thirty-three (75%) of 44 countries responded to the questionnaire (61.3% of national rheumatology societies, 25% of the national US societies and 100% of expert ultrasonographers). In the majority of countries (85%) <10% of rheumatologists routinely perform UGAJ in clinical practice, while the remaining countries (15%) reported a rate of 10-50%. The percentage of rheumatologists receiving training in UGAJ was <10% in the majority (72.7%) of countries. The study highlights the relatively low prevalence of UGAJ as compared with the high (>80%) rate of rheumatologists performing conventional joint injection in most of the surveyed countries. The reported variations in practice and the lack of available structured training programmes for trainees in most countries indicates the need for standardization in areas including training guidelines.

Vienna, Austria, 26-29 August 2011 – WFUMB 2011

It is our great pleasure to invite you to the WFUMB 2011 Congress in Vienna, Austria. WFUMB 2011 is the unique joint meeting of the 13th World Congress of the World Federation for Ultrasound in Medicine and Biology (WFUMB), the 23rd Congress of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the 35th Joint Meeting of the Austrian (ÖGUM), German (DEGUM) and Swiss (SGUM) Societies for Ultrasound in Medicine. Thus, whether you are a dedicated specialist in ultrasound or a novice with an interest in learning more on all subjects of ultrasound, you should visit Vienna and attend this important event – “connecting the world of ultrasound”.

0507: EFSUMB Guidelines for Contrast Enhanced Ultrasound

In 2004 the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) issued the first set of recommendations for Contrast Enhanced UltraSonography (CEUS). At that time the only established indications for CEUS were detection and characterisation of focal liver lesions, and thus the document dealt solely with these applications. Since then the ultrasound community has witnessed a constantly increasing number of new indications for CEUS with a range of different organs and new applications being implemented, and thus EFSUMB has found it necessary to revise the recommendations.

Actualización del uso de contrastes en ecografía. Revisión de las guías clínicas de la Federación Europea de Ecografía (EFSUMB)

The aim of this article is to review the current indications for the use of contrast agents in ultrasonography in imaging departments with reference to the guidelines and recommendations recently published by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The article begins with a brief description of currently available contrast agents, of their adverse effects and contraindications, and of the specific techniques that enable the signal emitted from the microbubbles in the contrast to be detected. Next, we review the indications for ultrasound contrast agents both in the liver (detecting and characterizing focal lesions as well as guiding and monitoring percutaneous treatments) and outside the liver (in the kidney, vesicoureteral reflux, pancreas, traumatisms, and cerebral circulation). For each of the indications, first we describe the interpretation of the findings, then the recommended uses, and finally the limitations of the technique. Finally, we review all the other applications that have yet to be included in the EFSUMB guidelines.

Clinical management of focal liver lesions: the key role of real-time contrast-enhanced US

Ultrasonography (US) is the most commonly used liver imaging modality worldwide. Unfortunately, it has limited sensitivity in the detection of small tumor nodules. Moreover, US findings are often nonspecific, as appearances of benign and malignant liver lesions overlap. The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver US. The advent of second-generation agents that enable continuous real-time contrast-enhanced imaging has been instrumental in improving the acceptance and reproducibility of the examination. With the publication of guidelines for the use of contrast agents in liver US by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast-enhanced US has entered clinical practice. The guidelines define the indications and recommendations for the use of contrast agents in focal liver lesion detection, characterization, and posttreatment follow-up. Recently, the clinical value of contrast US as a reliable alternative to CT or MR imaging in characterizing hepatocellular carcinoma in cirrhosis has been endorsed by the practice guideline document issued by the American Association for the Study of Liver Diseases and the 2005 Monothematic Conference on Hepatocellular Carcinoma of the European Association for the Study of the Liver. In this article, the current role of contrast US in the diagnostic management of focal liver lesions is discussed with regard to the following clinical scenarios: (1) characterization of incidental findings; (2) diagnosis of hepatocellular carcinoma in patients with cirrhosis; and (3) identification of hepatic metastases in oncology patients; (4) guidance and monitoring of tumor ablation procedures.

1145: Education, guidelines and accreditation

The need for education, guidelines and accreditation is fundamental in providing high quality ultrasonic imaging at both national and international levels. The increasing clinical reliance on breast ultrasound has resulted in societies and organizations providing educational programs, developing guidelines for examinations and interventional procedures and establishing accreditation programs. The International Breast Ultrasound School (IBUS) provides educational programs to improve the standards of practice of breast ultrasound. Programs consisting of lectures and interactive workshops are held in conjunction with scientific meetings or as a stand-alone curriculum over a one to three d period. In response to the increased need for education and accreditation in breast ultrasound, IBUS is providing a new series of five d residential courses in Ferrara, Italy, in association with the University of Ferrara. These international courses satisfy continuing medical education requirements, and participants will be assessed on their competency. The published IBUS guidelines form the basis of recommendations required to become proficient in ultrasonic breast imaging. The experience necessary to achieve accuracy and confidence is based on the examination and reporting of a minimum of 500 breast cases in a multidisciplinary environment, and in order to become proficient with interventional techniques at least 50 procedures must be undertaken. The German Society for Ultrasound in Medicine (DEGUM) has established guidelines for training courses based on a three level structure consisting of basic, advanced and final components. Each component is a two day course supervised by an accredited course director with five years experience in breast ultrasound and has performed at least 5000 breast ultrasound examinations. Course participants receive a certificate on completing theoretical and practical training extending over a period of not less than 9 months. The American Institute of Ultrasound in Medicine (AIUM) has produced breast ultrasound accreditation guidelines to encourage practices to meet or exceed recognized standards in a number of practice-related areas. Individuals must participate in continuing medical education programs, and practices must demonstrate that examination findings and final reports are monitored. The brochure “AIUM Standard for the Performance of Breast Ultrasound Examinations” documents the minimum criteria for high quality breast ultrasound examinations. The American College of Radiology (ACR) has developed a number of accreditation programs. The “Breast Ultrasound Accreditation Program” evaluates the qualification of personnel, equipment performance, effectiveness of quality control measures, and quality of clinical images. Accreditation can be obtained for ultrasonic imaging alone or in combination with ultrasound-guided biopsy procedures when these are included in the facility. Individuals are required to fulfil qualification criteria, and undertake continuing medical education. The Japanese Society of Ultrasonics in Medicine (JSUM) and the Japan Association of Breast and Thyroid Sonology (JABTS) have published guidelines describing the diagnostic criteria for diffuse and discrete breast lesions based on their long term experience. Recently, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published the “Guidelines for Ultrasound Guided Breast Biopsy”, and this document outlines the clinical role of the available percutaneous needle biopsy methods.

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

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

European federation of societies for ultrasound in medicine and biology (EFSUMB) guidelines for the use of contrast agents in liver ultrasound: what is the impact in clinical practice?

Ultrasound is the most commonly used liver imaging modality worldwide. Unfortunately, ultrasound has limited sensitivity in the detection of small tumour nodules. Moreover, ultrasound findings are often non-specific, as there is enough variability and overlap in the appearance of benign and malignant liver lesions to make a definite distinction problematic. Recently, the introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. The advent of second-generation agents that have higher harmonic emission capabilities has been instrumental in improving the easiness and the reproducibility of the examination. Over the past few years, several reports have shown that real-time contrast-enhanced ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast-enhanced ultrasound has entered clinical practice. The guidelines define the indications and recommendations for the use of contrast agents in focal liver lesion detection, characterization and posttreatment follow-up. In this paper, we discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging with regard to four clinical scenarios: (1) characterization of focal liver lesions of incidental detection; (2) diagnosis of HCC in patients with cirrhosis; (3) detection of hepatic metastases in oncology patients; (4) guidance and assessment of the outcome of percutaneous tumour ablation procedures.

Ultrasound Training for Medical and Surgical Specialties

An increasing number of medical and surgical specialties are undertaking their own ultrasound scans. This brings challenges to those wishing to perform ultrasound to ensure that they are competent and for those who provide training to be adequately resourced to do this. In the United Kingdom it is proposed that ultrasound training becomes an integral part of the Urology Specialist Registrar (SpR) training programme. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) have defined three levels of minimum training standards and this concept has been embraced by the Royal College of Radiologists in a publication which outlines recommended syllabuses for 10 difference specialties.

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Clinical Safety Statement for Diagnostic Ultrasound (October 1996)

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Clinical Safety Statement for Diagnostic Ultrasound (October 1996)