Portable Ultrasound Research Articles

A Prospective Cohort Study to Evaluate Needle Passes Using a Portable Ultrasound Device versus Traditional Landmark Approach for Epidural Anesthesia in a Busy Obstetric Tertiary Care Center

Despite its many cited benefits, ultrasound guidance for neuraxial procedures is not widespread in anesthesiology. Some cited limitations include device cost and accessibility. We test the hypothesis that a handheld and relatively inexpensive ultrasound can improve neuraxial proficiency (e.g., decreased needle manipulations and block time). This prospective study compared the number of needle passes, redirections, and procedural time between epidural placed with a handheld ultrasound versus landmarks. Needle passes and attempts were defined as the number of times the Tuhoy needle was redirected, and the times skin was punctured (re-insertion). Procedural time was defined as the time from local anesthetic infiltration until loss of resistance was obtained. The impact of level of training and accuracy of the device were also analyzed. 302 patients receiving labor epidural were included in the study. No difference in body mass index (BMI) nor distribution of level of training was noted between the groups. Regression analysis adjusted for BMI demonstrated a decrease in needle passes (-1.75 (95% CI -2.62, -0.89), p < 0.001), needle attempts (-0.51 (95% CI -0.97, -0.04), p = 0.032) and procedural time (-154.67s 95% CI -303.49s, -5.85s), p = 0.042) when a handheld ultrasound was utilized. The mean (95% Confidence interval) difference between needle depth and ultrasound depth was 0.39 cm (0.32, 0.46), p < 0.001. The use of a handheld device resulted in statistically significant decrease of needle manipulations and block time. More research is needed to evaluate the impact of and increase in accessibility of ultrasound technology.

Rib detection using pitch-catch ultrasound and classification algorithms for a novel ultrasound therapy device

BackgroundNoninvasive ultrasound (US) has been used therapeutically for decades, with applications in tissue ablation, lithotripsy, and physical therapy. There is increasing evidence that low intensity US stimulation of organs can alter physiological and clinical outcomes for treatment of health disorders including rheumatoid arthritis and diabetes. One major translational challenge is designing portable and reliable US devices that can be used by patients in their homes, with automated features to detect rib location and aid in efficient transmission of energy to organs of interest. This feasibility study aimed to assess efficacy in rib bone detection without conventional imaging, using a single channel US pitch-catch technique integrated into an US therapy device to detect pulsed US reflections from ribs.MethodsIn 20 healthy volunteers, the location of the ribs and spleen were identified using a diagnostic US imaging system. Reflected ultrasound signals were recorded at five positions over the spleen and adjacent ribs using the therapy device. Signals were classified as between ribs (intercostal), partially over a rib, or fully over a rib using four models: threshold-based time domain classification, threshold-based frequency domain classification, logistic regression, and support vector machine (SVM).ResultsSVM performed best overall on the All Participants cohort with accuracy up to 96.25%. All models’ accuracies were improved by separating participants into two cohorts based on Body Mass Index (BMI) and re-fitting each model. After separation into Low BMI and High BMI cohorts, a simple time-thresholding approach achieved accuracies up to 100% and 93.75%, respectively.ConclusionThese results demonstrate that US reflection signal classification can accurately provide low complexity, real-time automated onboard rib detection and user feedback to advance at-home therapeutic US delivery.

Ultrasound in sports traumatology.

Ultrasound (US) has numerous applications in sports traumatology. The technical progress of mobile US devices has led to increasing use of ultrasound as a primary diagnostic tool. New applications such as elastography and 3 D vascularization are used for special indications. The purpose of this review is to present the current status of ultrasound in the diagnosis of sports injuries and sport traumatology including established applications and new technical advances. US is presented both in its comparison to other imaging modalities and as a sole diagnostic tool. US can be used for initial diagnosis to improve the clinical examination and for intensive short-term follow-up imaging. The main areas of application are currently the diagnosis of acute muscle and tendon injuries as well as overuse injuries. In particular, the exclusion of structural muscle injuries can be adequately ensured with US in the majority of anatomical regions. The recently published guideline on fracture ultrasound has strengthened the clinical evidence in this area, especially in comparison to conventional radiography and in the development of algorithms and standards. The increasing use of mobile ultrasound equipment with adequate image quality makes US a location-independent modality that can also be used at training sites or during road games. · Typically used for quick, focused initial diagnostic assessment and short-term follow-up after injury. · Mobile US devices allow increased use in training centers and training camps. · New US applications (SWE, 3 D) increase standardization in follow-up of tendon injuries. · Targeted use of US for musculoskeletal diagnostic assessment saves money and frees up capacity. · Lerchbaumer MH, Perschk M, Gwinner C. Ultrasound in sports traumatology. Fortschr Röntgenstr 2024; 196: 440 - 449.

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

CLINICAL AND HEALTHCARE IMPACTS OF PORTABLE ULTRASONOGRAPHY IN AMBULATORY CARE MUSCULOSKELETAL REHABILITATION CONSULTATIONS.

We evaluated the impact of Point-of-care ultrasound (POCUS) in musculoskeletal consultations out of hospital using a Philips Lumify portable ultrasound device. We aimed to determine the impact of POCUS on the number of hospital referrals for injections as well as on the number of injections performed in consultation. Retrospective case study comparing 2 periods: June to September 2021 (pre-POCUS) and November 2021 to February 2022 (POCUS). Statistical comparisons were performed using the χ2. In both periods, 21 medical consultations were performed. In the pre-POCUS period, 470 patients were assessed, with an average of 1.29 hospital referrals made per day of consultation for hospital injections and an average of 2.05 injections performed per day of medical consultation. In the POCUS period, 589 patients were assessed, with an average of 0.1 hospital referrals per day (-92.6%; p < 0.00001) and an average of 2.76 injections performed per day (+34.9%; p < 0.00001). The introduction of POCUS at our practice reduced the number of hospital referrals made for injections and increased the number of injections performed every day of consultation. This suggests that POCUS is of great clinical value in out-of-hospital musculoskeletal rehabilitation consultations.

A system-on-chip solution for deep learning-based automatic fetal biometric measurement

Ultrasound assessment of fetal biometry is widely used for gestational age prediction and abnormal fetal growth diagnosis. However, manual biometric measurements require time-consuming procedures and current automated measurement approaches remain challenging in terms of accuracy and computational complexity. This paper proposes deep learning-based efficient automatic fetal biometry measurement method for system-on-chip (SoC) solution. For end-to-end automated measurements, a hardware-friendly bilateral segmentation network (H-BiSeNet) was designed and optimized for multiple fetal objects (i.e., head, abdomen and femur), and fetal biometric parameters were then calculated with a robust multiple keypoint detection algorithm. For hardware implementation with a SoC, a deep learning processing unit (DPU) was employed to accelerate the proposed segmentation network, and biometric measurements with image pre- and postprocessing were conducted on an application processing unit (APU). A total of 6000 fetal ultrasound images in the three regions were collected from 2568 subjects, and the dataset was utilized to train the proposed network. In the performance evaluation, the proposed segmentation network with optimal quantization (H-BiSeNet-Q) outperformed other segmentation networks (i.e., U-Net, U-Net++, Attention U-Net, U-Net3+, DeepLabv3 + and BiSeNetv2) in terms of the average Dice coefficient, and automated measurements with H-BiSeNet-Q were highly correlated with manual measurements (r ≥ 0.983, p < 0.01 for all parameters, i.e., biparietal diameter, head circumference, abdominal circumference and femur length). In the execution time analysis, H-BiSeNet-Q ran at 4.25 frames per second (FPS) with parallelism corresponding to 80% resource utilization in the SoC. These results showed feasibility in low-resource hardware settings such as portable ultrasound systems.

Knowledge distillation for efficient standard scanplane detection of fetal ultrasound

In clinical practice, ultrasound standard planes (SPs) selection is experience-dependent and it suffers from inter-observer and intra-observer variability. Automatic recognition of SPs can help improve the quality of examinations and make the evaluations more objective. In this paper, we propose a method for the automatic identification of SPs, to be installed onboard a portable ultrasound system with limited computational power. The deep Learning methodology we design is based on the concept of Knowledge Distillation, transferring knowledge from a large and well-performing teacher to a smaller student architecture. To this purpose, we evaluate a set of different potential teachers and students, as well as alternative knowledge distillation techniques, to balance a trade-off between performances and architectural complexity. We report a thorough analysis of fetal ultrasound data, focusing on a benchmark dataset, to the best of our knowledge the only one available to date.Graphical abstract

An optimized optical-flow-based method for quantitative tracking of ultrasound-guided right diaphragm deformation

ObjectivesTo develop a quantitative analysis method for right diaphragm deformation. This method is based on optical flow and applied to diaphragm ultrasound imaging.MethodsThis study enrolls six healthy subjects and eight patients under mechanical ventilation. Dynamic images with 3–5 breathing cycles were acquired from three directions of right diaphragm by a portable ultrasound system. Filtering and density clustering algorithms are used for denoising Digital Imaging and Communications in Medicine (DICOM) data. An optical flow based method is applied to track movements of the right diaphragm. An improved drift correction algorithm is used to optimize the results. The method can automatically analyze the respiratory cycle, inter-frame/cumulative vertical and horizontal displacements, and strain of the input right diaphragm ultrasound image.ResultsThe optical-flow-based diaphragm ultrasound image motion tracking algorithm can accurately track the right diaphragm during respiratory motion. There are significant differences in horizontal and vertical displacements in each section (p-values < 0.05 for all). Significant differences are found between healthy subjects and mechanical ventilation patients for both horizontal and vertical displacements in Section III (p-values < 0.05 for both). There is no significant difference in global strain in each section between healthy subjects and mechanical ventilation patients (p-values > 0.05 for all).ConclusionsThe developed method can quantitatively evaluate the inter-frame/cumulative displacement of the diaphragm in both horizontal and vertical directions, as well as the global strain in three different imaging planes. The above indicators can be used to evaluate diaphragmatic dynamics.

Single Image based Super Resolution Ultrasound Imaging Using Residual Learning of Wavelet Features.

The generation of super resolution ultrasound images from the low-resolution (LR) brightness mode (B-mode) images acquired by the portable point of care ultrasound systems has been of sufficient interest in the recent past. With the advancements in deep learning, there have been numerous attempts in this direction. However, all the approaches have been concentrated on employing the direct image as the input to the neural network. In this work, a stationary wavelet (SWT) decomposition is employed to extract the features from the input LR image which is passed through a modified residual network and the learned features are combined using the inverse SWT to reconstruct the high resolution (HR) image at a 4× scale factor. The proposed approach when compared to the state-of-the art approaches, results in an improved high resolution reconstruction.Clinical relevance- The proposed approach will enable the generation of high-resolution images from portable ultrasound systems, allowing for easier interpretation and faster diagnostics in primary care settings.

Relationship between shoulder abduction strength and rotator cuff tear in elderly women: a general population study

ObjectivesTo investigate the effect of age-related rotator cuff tears on shoulder strength in a general population cohort.DesignCross sectional observational study.SettingThis study was set in an outpatient clinic setting in Chingford,...

Poster 274: Preseason patellar tendon thickness as a predictor of symptomatic patellar tendinopathy in NCAA Division I Basketball players

Objectives: Patellar tendinopathy is prevalent in elite jumping athletes, with a particularly high risk in basketball players. Previous prospective research has demonstrated that ultrasound (US) findings, primarily the presence of hypoechoic regions within the tendon, are prevalent in both symptomatic and asymptomatic elite jumping athletes and thus do not necessarily indicate patellar tendon pathology. Other studies have suggested that hypoechoic regions within asymptomatic tendons are predictive of new onset symptomatic patellar tendinopathy. None of these previous studies evaluated the utility of patellar tendon thickness as a predictive measure. The purpose of this study is to build on the previous literature to identify whether preseason US is a clinically relevant preseason screening tool in elite basketball players. We hypothesized that increased preseason anteroposterior (AP) thickness of the proximal patellar tendon, as well as hypoechoic regions, are predictive of symptomatic patellar tendinopathy and associated sequelae. Methods: Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this prospective cohort study. Both patellar tendons of each athlete were evaluated at preseason, midseason, and postseason time points, resulting in a total of 52 patellar tendons from 27 athletes included in this analysis after exclusion of 4 tendons that were previously operated on and 6 tendons from 3 athletes who transferred to a new team during the season. Basic demographic data were collected for each athlete. At each time point, Victorian Institute of Sports Assessment – Patellar Tendon (VISA-P) scores, patellar tendon AP thickness, and presence of proximal patellar tendon hypoechoic regions were evaluated. Outcome measures included 1) proximal patellar tendon hypoechoic region, 2) trip to the training room (TTR), 3) time-loss symptomatic patellar tendinopathy (TLPT), and 4) patellar tendon rupture. TTR was defined as symptomatic patellar tendinopathy causing the athlete to seek evaluation by team medical staff. TLPT was a binary outcome that involved 1 or more missed game due to patellar tendinopathy symptoms. Measurement of patellar tendon AP thickness was performed using the Butterfly iQ portable US probe (Butterfly Network, Inc., Burlington, MA) and accompanying iPhone mobile application (Apple, Cupertino, CA) (Figure 1). Two distinct images were saved for each patellar tendon at each time point. Each of these images were independently evaluated by two reviewers, one of which was a fellowship- trained musculoskeletal radiologist. Intra- and interrater reliability was calculated. Covariates evaluated in multivariate regression model included age and body mass index (BMI). Significance was set to p&lt;.05. Results: Of the total of 52 tendons (mean age 20.67 ± 1.22 years, mean BMI 24.1 ± 1.57), the mean preseason AP thickness was 4.78 ± 1.22 mm. Intra- and interrater reliability for AP thickness were both excellent (ICC=0.99, p&lt;.01 and ICC=0.98, p&lt;.01, respectively). Compared to preseason values, there was a significant increase in mean AP thickness at both midseason (p&lt;.01) and postseason (p&lt;.01) evaluation (Table 1, Figure 2). VISA-P scores decreased from preseason to midseason (p=.04), but increased from midseason to postseason (p=.03) (Table 1). A total of 9 patellar tendons resulted in a TTR (17.31%) (Table 2). Preseason AP thickness was associated with an increased odds of TTR (aOR=7.58 [2.09, 29.66], p&lt;.01). Assuming mean age and BMI, an 8mm tendon at baseline predicted a 97.19% probability of a TTR during the season, while a 4mm tendon predicted a 0.90% probability. Of the 9 tendons that demonstrated preseason hypoechoic regions, 5 (55.56%) resulted in a TTR (aOR=12.60, p&lt;.01). Preseason VISA-P scores (p=.36) were not predictive of TTR. There were 4 cases of TLPT (7.69%) (Table 2). There was a significant association between preseason AP thickness and increased odds of TLPT (aOR=1.61 [1.02, 2.54], p=.04). Assuming mean age and BMI, an 8mm tendon at baseline demonstrated a 24.83% probability of resulting in TLPT, while a 4mm tendon demonstrated a 4.26% probability. Preseason VISA-P scores (p=.39) were not predictive of TLPT. Conclusions: This is the first analysis evaluating patellar tendon thickness and patellar tendon sequelae in elite basketball players at more than two time points. This study demonstrated the ability for preseason US screening to identify symptomatic patellar tendinopathy and associated sequelae during the season. Additionally, there was a significant increase in mean AP thickness from preseason to midseason as well as from midseason to postseason. This is in contrast to VISA-P scores, which initially increased, but then decreased to preseason levels at postseason evaluation. Patellar tendon AP thickness may thus serve as a more stable and precise measure of patellar tendinopathy severity when compared to VISA-P scores. Further research with increased sample size may establish US as a clinically relevant screening tool in elite jumping athletes. [Table: see text][Table: see text]

Feasibility and Acceptance of Self-Guided Mobile Ultrasound among Pregnant Women in Routine Prenatal Care

Background and objectives: Mobile and remote ultrasound devices are becoming increasingly available. The benefits and possible risks of self-guided ultrasound examinations conducted by pregnant women at home have not yet been well explored. This study investigated aspects of feasibility and acceptance, as well as the success rates of such examinations. Methods: In this prospective, single-center, interventional study, forty-six women with singleton pregnancies between 17 + 0 and 29 + 6 weeks of gestation were included in two cohorts, using two different mobile ultrasound systems. The participants examined the fetal heartbeat, fetal profile and amniotic fluid. Aspects of feasibility and acceptance were evaluated using a questionnaire. Success rates in relation to image and video quality were evaluated by healthcare professionals. Results: Two thirds of the women were able to imagine performing the self-guided examination at home, but 87.0% would prefer live support by a professional. Concerns about their own safety and that of the child were expressed by 23.9% of the women. Success rates for locating the target structure were 52.2% for videos of the fetal heartbeat, 52.2% for videos of the amniotic fluid in all four quadrants and 17.9% for videos of the fetal profile. Conclusion: These results show wide acceptance of self-examination using mobile systems for fetal ultrasonography during pregnancy. Image quality was adequate for assessing the amniotic fluid and fetal heartbeat in most participants. Further studies are needed to determine whether ultrasound self-examinations can be implemented in prenatal care and how this would affect the fetomaternal outcome

A Bipolar 3-Level High-Voltage Pulser for Highly Integrated Ultrasound Imaging Systems

This paper presents a design solution for a bipolar return to zero (RZ) 3-level high-voltage TX pulser for high performance portable ultrasound medical imaging systems. Designed to be integrated in the front end of a PMUT probe composed by a 64-channel array working in the 1-10 MHz frequency range, the pulser is compact and power efficient as it employs minimum number of power transistors while ensuring high transmitting linearity because of the implementation of the RZ state. The circuit presents programmable features such as variable delays and rise/fall times to be controlled independently through a digital interface and it dissipates only 4.5 mW to bias the PMUT in RX state while achieving a small Req (2.24 Y). Transistor level and post-layout simulations performed in a BCD-SOI 0.16-lm technology are reported to demonstrate the effectiveness of the approach.

Assessing student perception of the integration of portable wireless ultrasound imaging in undergraduate anatomy education.

Anatomy is the foundation of many physiology and healthcare-related degrees. With limited access to cadavers in many universities, it is essential to investigate techniques that could be utilized to support and enhance the teaching of anatomy. Ultrasound is used clinically to aid the diagnosis of a wide range of conditions by visualizing the anatomy of the patient. While research has investigated the advantages of ultrasound in medical education, the potential benefits of ultrasound in undergraduate bioscience degrees remain to be investigated. The aim of this study was to identify if a portable ultrasound probe that wirelessly attaches to a smartphone or tablet was perceived by students as beneficial for their understanding and learning of anatomy, and to identify if there were any barriers for students partaking in ultrasound sessions. Following five ultrasound-teaching sessions, 107 undergraduate students completed a 5-point likert questionnaire on their perception of the integration of portable ultrasound machines in anatomy education. The data indicated that 93% of students perceived that the ultrasound teaching sessions improved their anatomical understanding, 94% perceived that ultrasound increased their ability to understand the clinical relevance of learning anatomy, 97% enjoyed the sessions, and 95% of students believed that ultrasound should be integrated into anatomy teaching. In this study, we also found several barriers for students taking part in ultrasound sessions, including religious beliefs, and lacking adequate background knowledge. In conclusion, these findings demonstrate, for the first time, that students perceive portable ultrasound to enhance their anatomy studies, demonstrating the potential benefit the integration of ultrasound into the anatomy curriculum may serve within undergraduate bioscience courses.

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.

Point-of-care ultrasound training in low-income countries: a need of time.

Point of care ultrasound (POCUS) is "an ultrasonography performed at the bedside in real-time by the treating physician." It is a powerful imaging modality used as an adjunct to physical examination and has gained momentum to become the future stethoscope. By using POCUS, the treating physician performs all image acquisition and interpretation and uses the information immediately to address specific hypotheses and guide the ongoing therapy. There is a shred of solid evidence that POCUS improves the diagnosis and management of acutely unwell patients is expanding rapidly. Due to the rise in the practice of POCUS in clinical medicine, the use of consultative ultrasonographic services has been reduced. The widespread availability of portable ultrasound machines and training an adequate number of clinicians to become competent in performing POCUS is a great challenge. The development of effective competency levels, curriculum, and assessment methods is imperative for the training of POCUS.

Point-of-care ultrasound in general practice: an exploratory study in rural South Australia.

Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to address this gap. We aimed to examine how POCUS is utilised by doctors in contemporary Australian rural general practice. A portable ultrasound machine and access to a training course were provided to four general practices in rural South Australia, and the type and frequency of POCUS scans were recorded, along with user information, between July 2020 and June 2021. Participating general practitioners (GPs) completed a survey at the commencement of the study regarding their previous experience and confidence in using POCUS for specific assessments and procedures. Of the 472 scans recorded, most (95%) were for clinical indications, 3% for teaching activities and 2% for self-learning. Overall, 69% were obstetric scans, followed by abdominal (12%), gynaecological procedures (10%), other procedural (7%) and thoracic exams (1.5%). Users reported higher confidence for lower complexity POCUS. Although POCUS has diverse potential applications in rural practice, GPs reported limited confidence for certain scans and used POCUS predominantly for obstetric indications. Further studies should examine the barriers to POCUS utilisation, with particular attention to training requirements, reimbursement for use and access to machines.

Evaluation of Therapeutic Efficacy and Imaging Capabilities of 153Sm2O3-Loaded Polystyrene Microspheres for Intra-Tumoural Radionuclide Therapy of Liver Cancer Using Sprague-Dawley Rat Model

Introduction: Neutron-activated samarium-153-oxide-loaded polystyrene ([153Sm]Sm2O3-PS) microspheres has been developed in previous study as a potential theranostic agent for hepatic radioembolization. In this study, the therapeutic efficacy and diagnostic imaging capabilities of the formulation was assessed using liver cancer Sprague-Dawley (SD) rat model. Methods: Twelve male SD rats (150-200 g) that implanted with N1-S1 hepatoma cell line orthotopically were divided into two groups (study versus control) to monitor the tumour growth along 60 days of treatment. The study group received an intra-tumoural injection of approximately 37 MBq of [153Sm]Sm2O3-PS microspheres, while control group received an intra-tumoural injection of 0.1 mL of saline solution. A clinical single photon emission computed tomography/computed tomography (SPECT/CT) system was used to scan the rats at Day 5 post-injection to investigate the diagnostic imaging capabilities of the microspheres. All rats were monitored for change in tumour volume using a portable ultrasound system throughout the study period. Histopathological examination (HPE) was performed after the rats were euthanized at Day 60. Results: At Day 60, no tumour was observed on the ultrasound images of all rats in the study group. In contrast, the tumour volumes in the control group were 24-fold larger compared to baseline. Statistically significant difference was observed in tumour volumes between the study and control groups (p < 0.05). The SPECT/CT images clearly displayed the location of [153Sm]Sm2O3-PS in the liver tumour of all rats at Day 5 post-injection. Additionally, the [153Sm]Sm2O3-PS microspheres was visible on the CT images and this has added to the benefits of 153Sm as a CT contrast agent. The HPE results showed that the [153Sm]Sm2O3-PS microspheres remained concentrated at the injection site with no tumour cells observed in the study group. Conclusions: Neutron-activated [153Sm]Sm2O3-PS microspheres demonstrated excellent therapeutic and diagnostic imaging capabilities for theranostic treatment of liver cancer in a SD rat model. Further studies with different animal and tumour models are planned to validate this finding.

The International Olympic Committee Venue Ultrasound Program: A Pilot Study From Tokyo 2020 Olympic Games.

The objective of this pilot investigation was to describe the novel use of venue ultrasound at the 2020 Tokyo Olympic Games. Portable laptop ultrasound machines were made available to cover seven Olympic sports at seven venues. The responses by both the National Olympic Committee personnel accompanying the medical room visits and by the examining physicians were recorded. Athletes were followed up until the end of the Olympic Games and the ultrasound diagnostic accuracy was evaluated. Fourteen athletes were evaluated using venue ultrasound and the recorded injuries included seven soft tissue, five osseous, and two nonmusculoskeletal injuries. From these, eight athletes were evaluated further by other imaging modalities, which indicated that the ultrasound provided an accurate diagnosis in all cases. All National Olympics Committee personnel reported increased diagnostic confidence and felt that venue ultrasound should be considered for future sports events. Furthermore, all evaluating physicians felt ultrasound was helpful in refining the diagnosis. The average years of sports ultrasound experience was 8.4 yrs and the average years of clinical sports medicine experience was 9.3 yrs among the physicians. In conclusion, the International Olympic Committee Venue Ultrasound Pilot Program showed promise in improving venue triaging, suggesting its role at future sports events.

Ultrasonographic sex determination of the flathead grey mullet (Mugil cephalus).

Determination of sex in fish without external sexual dimorphism is important. Sex determination of the flathead grey mullet (Mugil cephalus) in the culture system and spawn-producing and fish reproduction system is very important. Currently, there are several methods to determine the sex of fish; however, they are time-consuming, expensive and sometimes dangerous for the fish. The purpose of this study was the sex determination of flathead grey mullet by ultrasonography as a safe and accurate method. In this regard, 30 flathead grey mullets (early in their maturation) from a farm in Gomishan-Golestan province, Iran were examined using a portable ultrasound machine with a 6-12MHz waterproof linear transducer. Scanning was performed on the ventral body surface in the sagittal and transverse planes, between ventral and anal fins. Differences in shape, qualitative size, echogenicity and the wall layers of the ovary and testis were evaluated for sex determination. Results of ultrasonography were confirmed immediately at necropsy. Ultrasonographic accuracy for sex determination was 100%. The speed of the procedure was around 30s per fish. Overall, the sex determination of flathead grey mullet by ultrasonography was high in accuracy and speed, non-invasive and safe for fish and consumers, and may be considered a priority. Place of the organs in the M. cephalus coelomic cavity and the obtained experience showed that for rapid and easy sex identification, the best place to put the transducer is on the ventral surface of the fish in the caudal part of the coelomic cavity for taking transverse and sagittal ultrasonograms.