Portable Ultrasound Research Articles

Portable ultrasound-guided Trans-sylvian minimally invasive intracerebral hemorrhage surgery: how I do it.

Intracerebral hemorrhage (ICH) is a common neurosurgical emergency with high morbidity and mortality. The trans-sylvian microsurgical evacuation of ICH in the basal ganglia is a classic but technically challenging approach. We describe a novel technique using handheld portable ultrasound to guide trans-sylvian, trans-insular evacuation of basal ganglia hematomas, allowing for rapid identification, precise evacuation, and post-evacuation assessment from a small Sylvian fissure opening. Intraoperative portable ultrasonography is a rapid, simple, and inexpensive technique that provides real-time visualization of ICH and key cortical structures, minimizing potential damage during exposure and exploration.

Evaluation of Bedside Lung Ultrasonography in Diagnosis of Acute Pulmonary Oedema

Background: Pulmonary oedema is one of the major causes of mortality and morbidity. Acute heart failure is the major cause of pulmonary oedema. NT-pro B-type natriuretic peptide has been found to be effective in distinguishing acute pulmonary oedema from other causes of dyspnea in the emergency care setting. But it is costly and time consuming. Bedside lung ultrasonography (LUS) is being considered as noninvasive, radiation-free and easy to perform tool to diagnosis pulmonary oedema. Objective: To determine the role of bedside LUS in diagnosis of patients with acute pulmonary oedema. Methods: This observational cross-sectional study was carried out in ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from August 2018 to October 2019. Ethical approval was sought before conduction of the study. One hundred critically-ill patients with pulmonary oedema, detected by clinical examination & chest X-ray, due to heart failure were included in the study. Routine labs including NT-pro B-type natriuretic peptide level were sent. Bedside LUS was done with a portable ultrasound machine. Data was collected by using a semi-structured data sheet. Observation and Results: The median age was 42 years (IQR 18-66). Among them, 67.71% were male. 90.0% of patients diagnosed as acute pulmonary oedema by NT-pro B-type natriuretic peptide levels findings and 88.5% of patients were diagnosed as acute pulmonary oedema by bedside lung ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasonography findings alone statistically significant as 94.2%, 66.7%, 96.4% & 54.5% and 91.66% respectively in detection of pulmonary oedema. Conclusions: Bed side lung ultrasonography can be an effective adjunct tool for rapid and high diagnostic accuracy for diagnosis of acute pulmonary oedema along with NT pro BNP level in ICU. Bangladesh Crit Care J September 2024; 12 (2): 113-117

Hypopressive abdominal gymnastics protocol in postpartum women after cesarean section in the remote period: Preliminary case series

Background: The postpartum period is pronounced by important changes to return to the pre-pregnancy situation. During pregnancy, the recumbent muscles of the abdomen suffer withdrawal, characterizing diastasis of the rectus abdominis muscles (DRAM), and this condition may remain pathological postpartum. Hypopressive abdominal gymnastics (HAG) has a beneficial role in activating the abdominal muscles, presenting positive results in reducing DRAM. Objective: To describe the effect of a HAG protocol in postpartum women undergoing cesarean section in the remote period, comparing the inter-rectum distance (IRD) and abdominal circumference before and after applying the protocol. Methods: Case series quasi-experimental character involving participants had their IRD assessed using a portable ultrasound machine with a linear transducer and abdominal circumference measured using a flexible measuring tape. They received a HAG protocol, with nine postures, for three weeks, twice a week, totaling six sessions lasting 45 to 60 minutes each. After intervention, all participants were reevaluated using the same methods. Results: Four postpartum women participated. The largest point before intervention was the umbilical at rest. Both supraumbilical points analyzed obtained greater results in reducing IRD. Participant 001 achieved the greatest reduction in IRD after the protocol, as she had higher IRD values ​​during evaluation, in addition to a high body mass index (BMI) and a largest measurement of abdominal circumference. The measurement of abdominal circumference showed a change after HAG, reaching a reduction of 10 cm in one of the participants. Conclusion: This case series demonstrated positive results from the practice of HAG in reducing RAD, mainly supra-umbilical, and also in reducing abdominal circumference. Participants with higher BMI and waist circumference showed greater reductions in IRD.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

Automatic bony structure segmentation and curvature estimation on ultrasound cervical spine images - a feasibility study

Abstract The loss of cervical lordosis is a common degenerative disorder known to be associated with abnormal spinal alignment. In recent years, ultrasound (US) imaging has been widely applied in the assessment of spine deformity and has shown promising results. The objectives of this study are to automatically segment bony structures from the 3D US cervical spine image volume and to assess the cervical lordosis on the key sagittal frames. In this study, a portable ultrasound imaging system was applied to acquire cervical spine image volume. The nnU-Net was trained on to segment bony structures on the transverse images and validated by 5-fold-cross-validation. The volume data were reconstructed from the segmented image series. An energy function indicating intensity levels and integrity of bony structures was designed to extract the proxy key sagittal frames on both left and right sides for the cervical curve measurement. The mean absolute difference (MAD), standard deviation (SD) and correlation between the spine curvatures of the left and right sides were calculated for quantitative evaluation of the proposed method. The DSC value of the nnU-Net model in segmenting ROI was 0.973. For the measurement of 22 lamina curve angles, the MAD±SD and correlation between the left and right sides of the cervical spine were 3.591±3.432° and 0.926, respectively. The results indicate that our method has a high accuracy and reliability in the automatic segmentation of the cervical spine and shows the potential of diagnosing the loss of cervical lordosis using the 3D ultrasound imaging technique.

A Product Evaluation of Augmented Reality Equipment Coupled to Diagnostic Medical Sonography: A Potential Equipment and Ergonomic Innovation

Objective: The aim of this product evaluation was to investigate the workflow and occupational health benefits of implementing augmented reality (AR) technology (MediView XR Inc, Cleveland, OH) paired with a portable ultrasound equipment system. Materials and Method: A diverse sample of sonography users was consented and ranged in experience levels. They were asked to complete a video training session, a hands-on demonstration, and remote instruction while using the augmented reality ultrasound (AR US) system. The duration of participants’ tasks was assessed during the use of both AR US and the 2-dimensional ultrasound (2D US) system. Participants’ postures and positions were evaluated using the Rapid Upper Limb Assessment (RULA), which assessed ergonomic risk factors, linked to body position and muscle usage. Participants also completed the System Usability Scale (SUS). Finally, participants were invited to complete a qualitative interview session, regarding the use of the AR US system. Results: A total of 20 participants provided data after using both the AR US and 2D US systems. The assessment data revealed positive SUS scores, which reflected favorably on both the product, education, and the training provided. The time spent on simulated work (20 minutes), with both imaging systems, remained consistent. The Rapid Upper Limb Assessment tool (RULA) scores for the cohort indicated a lower (better) median upper body score when using the AR US system. The cohort also had a statistically significant lower median subscore for the neck, trunk, and legs, compared with 2D US ( p &lt; 0.00). Conclusion: Although larger studies are necessary to validate these findings, this cohort identified several opportunities for integrating the AR US system. Preliminary evidence suggests that an AR US system may offer occupational health benefits, as part of the imaging workflow.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

The feasibility of ultrasound-guided latex labeling of the anterolateral ligament in anatomical dissection – A cadaveric study

BackgroundThe present study aims to investigate the feasibility of labeling ligaments using ultrasound-guided injections. On formalin-fixed cadavers, the anterolateral ligament was selected and targeted for demonstration. The development of portable ultrasound machines and the ability to connect them to tablets via Bluetooth or WLAN makes it an accessible tool to implement into the anatomical dissection courses in order to associate medical imaging (MRI and ultrasound), anatomical structures and their subsequent dissection. Methods8 formalin fixed human cadavers were used for the ultrasound-guided injections of 1 mL of blue latex into the anterolateral ligament. 8 cadavers were not injected with latex for comparative purposes. The injections were performed by an experienced ultra-sonographer. After approximately 10 months, five dissections were carried out by students during the dissection course and three specimens were dissected by anatomists. ResultsThe anterolateral ligament was successfully marked and demonstrated in 7 out of 8 cases. In 4 out of 5 cases, the dissection was primarily conducted by students, while in 3 out of 3 cases, it was performed by anatomists. The accuracy was 80 % and 100 %, respectively. ConclusionThe present study demonstrated that labeling obscure ligaments, such as the anterolateral ligament, using ultrasound guidance is feasible on formalin-fixed cadavers. It also showed that students can successfully perform the dissections as the structure is highlighted and that the time between injection and dissection (approximately 10 months) has little impact on the outcome. The use of ultrasound in dissection courses should be further encouraged.

Remote Monitoring, AI, Machine Learning and Mobile Ultrasound Integration upon 5G Internet in the Prehospital Care to Support the Golden Hour Principle and Optimize Outcomes in Severe Trauma and Emergency Surgery.

Feasibility and reliability evaluation of 5G internet networks (5G IN) upon Artificial Intelligence (AI)/Machine Learning (ML), of telemonitoring and mobile ultrasound (m u/s) in an ambulance car (AC)- integrated in the pre-hospital setting (PS)- to support the Golden Hour Principle (GHP) and optimize outcomes in severe trauma (TRS). (PS) organization and care upon (5G IN) high bandwidths (10 GB/s) mobile tele-communication (mTC) experimentation by using the experimental Cobot PROMETHEUS III, pn:100016 by simulation upon six severe trauma clinical cases by ten (N1=10) experts: Four professional rescuers (n1=4), three trauma surgeons (n2=3), a radiologist (n3=1) and two information technology specialists (n4=2) to evaluate feasibility, reliability and clinical usability for instant risk, prognosis and triage computation, decision support and treatment planning by (AI)/(ML) computations in (PS) of (TRS) as well as by performing (PS) (m u/s). A. Trauma severity scales instant computations by the Cobot PROMETHEUS III, pn 100016) ) based on AI and ML complex algorithms and Cloud Computing, telemonitoring and r showed very high feasibility and reliability upon (5GIN) under specific, technological, training and ergonomic prerequisites B. Measured be-directional (m u/s) images data sharing between (AC) and (ED/TC) showed very high feasibility and reliability upon (5G IN) under specific, technological and ergonomic conditions in (TRS). Integration of (PS) tele-monitoring with (AI)/(ML) and (PS) (m u/s) upon (5GIN) via the Cobot PROMETHEUS III, (pn 100016) in severe (TRS/ES), seems feasible and under specific prerequisites reliable to support the (GHP) and optimize outcomes in adult and pediatric (TRS/ES).

A portable photoacoustic microscopy and ultrasound system for rectal cancer imaging

Photoacoustic microscopy offers functional information regarding tissue vasculature while ultrasound characterizes tissue structure. Combining these two modalities provides novel clinical applications including response assessment among rectal cancer patients undergoing therapy. We have previously demonstrated the capabilities of a co-registered photoacoustic and ultrasound device in vivo, but multiple challenges limited broad adoption. In this paper, we report significant improvements in an acoustic resolution photoacoustic microscopy and ultrasound (ARPAM/US) system characterized by simulation and phantom study, focusing on resolution, optical coupling, and signal characteristics. In turn, higher in-probe optical coupling efficiency, higher signal-to-noise ratio, higher data throughput, and better stability with minimal maintenance requirements were all accomplished. We applied the system to 19 ex vivo resected colorectal cancer samples and found significantly different signals between normal, cancer, and post-treatment tumor tissues. Finally, we report initial results of the first in vivo imaging study.

Bedside assessment of sarcopenia in hospitalized patients with liver cirrhosis: Magnitude and clinical implications.

Sarcopenia is associated with many adverse outcomes in patients with cirrhosis. The tools currently in use for assessing sarcopenia have numerous flaws. We evaluated the utility of portable ultrasonography and a dynamometer for the bedside assessment of sarcopenia and its implications in hospitalized cirrhosis patients. A dynamometer was used to test the hand-grip strength (HGS) and ultrasound was used to measure the thickness of the forearm and quadriceps muscles. HGS value < 27kg for men and < 16kg for women was taken as significant according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. The lower normal limit of muscle mass (5th percentile) was determined on 100 matched healthy controls. According to the EWGSOP2 criteria and HGS values, the prevalence of sarcopenia and probable sarcopenia among 300 cirrhosis patients were 56% and 62.3%, respectively. HGS alone identified sarcopenia in 88.9% of patients, while overestimated it in 6.3% of cases. The prevalence rate of sarcopenic obesity was 11%. Compared to patients without sarcopenia, sarcopenic patients had more complications of cirrhosis such as ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, sepsis, hepatorenal syndrome and refractory ascites. In-hospital (p = 0.037), three-month (p < 0.001), and six-month (p < 0.001) mortality rates were all higher among sarcopenic patients. On cox regression survival analysis, overall six-month mortality was significantly higher in sarcopenic patients compared to patients without sarcopenia (hazard ratio, 6.37; 95% confidence interval, 3.15-12.8, p < 0.001). Bedside assessment of sarcopenia using a portable ultrasound machine and a dynamometer detects liver cirrhosis patients with high risk of complications and mortality.

Concerning on different types of transthoracic echocardiography

The article discusses the evolution of transthoracic echocardiography due to the introduction into clinical practice of new technologies and methods of cardiac ultrasound and the development of pocket ultrasound devices. Often, new technologies did not replace the old ones but were used as an addition to them, which led to an increase in the duration and complexity of the examination. On the other hand, the use of portable ultrasound machines has made it possible to perform point-of-care transthoracic echocardiography, but it has been limited by solving a specific clinical problem. It became clear that different clinical situations require examinations that differ in complexity, labor intensity, levels of experience, and training of the doctors. Various types, features, and place in the clinical practice of transthoracic echocardiography are presented. The necessity of changing approaches to both accounting for effort estimates depending on the protocols and volumes of examinations and to planning the work of ultrasound and functional diagnostics departments is substantiated. Ways to solve problems that hinder the introduction of targeted, including focused, examinations into routine clinical practice are proposed.

Self-conducted sonographic monitoring of the knee in patients with haemophilia-A feasibility study.

To evaluate whether patients with haemophilia (PwH) can be enabled to perform ultrasonography (US) of their knees without supervision according to the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) protocol and whether they would be able to recognize pathologies. Five PwH (mean age 29.6 years, range 20-48 years) were taught the use of a portable US device and the HEAD-US protocol. Subsequently, the patients performed US unsupervised at home three times a week for a total of 6 weeks with a reteaching after 2 weeks. All images were checked for mapping of the landmarks defined in the HEAD-US protocol by a radiologist. In a final test after the completion of the self-sonography period, participants were asked to identify scanning plane and potential pathology from US images of other PwH. On the images of the self-performed scans, 82.7% of the possible anatomic landmarks could be identified and 67.5% of the requested images were unobjectionable, depicting 100% of the required landmarks. There was a highly significant improvement in image quality following reteaching after 2 weeks (74.80±36.88% vs. 88.31±19.87%, p<.001). In the final test, the participants identified the right scanning plane in 85.0% and they correctly identified pathology in 90.0% of images. Appropriately trained PwH can perform the HEAD-US protocol of their knee with high quality and are capable to identify pathologic findings on these standardized images. Asynchronous tele-sonography could enable early therapy adjustment and thereby possibly reduce costs.

Accuracy of portable ultrasound machines for obstetric biometry.

To evaluate the accuracy of two portable ultrasound machines (PUM) in assessing fetal biometry and estimated gestational age (EGA). This was a secondary analysis of data from the Fetal Age Machine Learning Initiative, an observational study of pregnant women in the USA and Zambia. Each participant underwent ultrasound assessment by an experienced sonographer using both a high-specification ultrasound machine (HSUM) and a PUM (Butterfly iQ or Clarius C3) to measure fetal biometry and calculate EGA at each visit. By comparing paired PUM and HSUM scans, we estimated agreement between individual biometry measurements and aggregate gestational age estimates by reporting mean difference, intraclass correlation coefficient (ICC) and Bland-Altman plots, adjusting for trend. Between April and December 2021, 818 participants contributed 1386 paired PUM-HSUM ultrasound investigations, of which 991 PUM scans were obtained using the Butterfly iQ device and 395 using the Clarius C3 device. Gestational age at scan ranged from 7 to 38 weeks. Compared with HSUM, the Butterfly iQ PUM had a mean difference of -0.20 (95% CI, -0.60 to 0.20) days in the first trimester and -0.68 (95% CI, -0.93 to -0.44) days in the second/third trimesters. Compared with HSUM, the Clarius C3 PUM had a mean difference of -0.47 (95% CI, -1.11 to 0.18) days in the first trimester and -1.67 (95% CI, -2.10 to -1.25) days in the second/third trimesters. ICCs were 0.989 or greater throughout. Increasing gestational age was associated with increasing error and absolute error in EGA and fetal biometry. Both PUM devices demonstrated a modest trend toward underestimation of EGA with advancing gestational age in second/third-trimester scans, compared with HSUM. The Butterfly iQ and Clarius C3 PUM devices were highly accurate in performing fetal biometry in a diverse population from the USA and Zambia. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

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 shortterm 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.

Automated Foreign Object Detection for Carbon Fiber Laminates Using High-Resolution Ultrasound Testing.

Carbon fiber laminates have become popular in the manufacturing industry for their many desirable properties, like good vibration damping, high strength-to-weight ratio, toughness, high dimensional stability, and low coefficient of thermal expansion. During the manufacturing process, undesirable foreign objects, such as peel-ply strips, gloving material, and Kapton film, can be introduced into the part which can lead to a localized weakness. These manufacturing defects can function as stress concentration points and oftentimes cause a premature catastrophic failure. In this study, a method using high-resolution pulse-echo ultrasound testing is employed for the detection and quantification of the dimensions of foreign object debris (FOD) embedded within carbon fiber laminates. This research presents a method to create high-resolution C-scans using an out of immersion tank portable housing ultrasound scanning system, with similar capabilities to that of a full immersion system. From the full-waveform dataset, we extract the FOD depth and planar dimensions with an automatic edge detection technique. Results from several carbon fiber laminates are investigated with embedded foreign objects that are often considered undetectable. Results are presented for FOD identification for two different shapes: circles with diameters ranging from 7.62 mm to 12.7 mm, and 3-4-5 triangles with hypotenuses ranging from 7.6 mm to 12.7 mm. CT imaging is used to confirm proper FOD placement and that the FOD was not damaged or altered during manufacturing. Of importance for the ultrasound inspection results, in every single case studied, the FOD is detected, the layer depth is properly identified, and the typical error is less than 1.5 mm for the primary dimension.

Imaging performance of portable and conventional ultrasound imaging technologies for ophthalmic applications.

The aim of this study was to evaluate the imaging capabilities of Butterfly iQ with conventional ophthalmic (piezoelectric) ultrasound (COU) for ophthalmic imaging. Custom phantom molds were designed and imaged with Butterfly iQ and COU to compare spatial resolution capabilities. To evaluate the clinical imaging performance of Butterfly iQ and COU, a survey containing pathological conditions from human subjects, imaged with both Butterfly iQ and COU probes, was given to three retina specialists and graded on image detail, resolution, quality, and diagnostic confidence on a ten-point Likert scale. Kruskal-Wallis analysis was performed for survey responses. Butterfly iQ and COU had comparable capabilities for imaging small axial and lateral phantom features (down to 0.1 mm) of high and low acoustic reflectivity. One of three retina specialists demonstrated a statistically significant preference for COU related to resolution, detail, and diagnostic confidence, but the remaining graders showed no significant preference for Butterfly iQ or COU across all sample images presented. The emergence of portable ultrasound probes offers an affordable alternative to COU technologies with comparable qualitative imaging resolution down to 0.1 mm. These findings suggest the value to further study the use of portable ultrasound systems and their utility in routine eye care.

Multiwavelength laser diode based portable photoacoustic and ultrasound imaging system for point of care applications.

Vascular diseases are a leading cause of death and disability worldwide. Despite having precursor conditions like peripheral arterial disease (PAD), they are often only diagnosed after the onset of stroke or heart attack. Low-cost, portable, noninvasive, point-of-care (POC), label-free assessment of deep vascular function benefits PAD diagnosis, especially in resource poor settings of the world. Doppler ultrasound-based blood flow measurements can diagnose PAD, albeit with limited sensitivity and specificity. To overcome this, here, we propose the first-of-its-kind dual-modality photoacoustic-and-ultrasound (PAUS) imaging system that integrates a multiwavelength pulsed laser diode (PLD) with a compact ultrasound data acquisition unit. The mesoscopic imaging depth of the portable PLD-PAUS system was validated using tissue phantoms, and its multispectral photoacoustic imaging capabilities were validated using an atherosclerosis-mimicking phantom. Furthermore, we demonstrated high-contrast volumetric in vivo photoacoustic imaging of rodent abdominal vasculature and quantified vessel reactivity due to hypercapnia stimulation. The multiparametric functional and molecular imaging capabilities of the PLD-PAUS system holds promise for POC applications.

Teledidactic Versus Hands-on Teaching of Abdominal, Thoracic, and Thyroid Ultrasound—The TELUS II Study

BackgroundThe worldwide COVID-19 pandemic has initiated a change in medical education and the development of new teaching concepts has become inevitable to maintain adequate training.ObjectiveThis pilot study aims to compare teledidactic teaching with traditional face-to-face teaching for abdominal, thoracic, and thyroid ultrasound.DesignConcurrently, a teledidactic and a face-to-face ultrasound course were held. The students completed seven 90-min modules using mobile ultrasound probes (Butterfly IQ). Each module consisted of a lecture, a demonstration of probe guidance, and independent training.ParticipantsA total of thirty medical students took part in the study and were randomly assigned to a teledidactic and a face-to-face group.Main MeasuresAn objective structured assessment of ultrasound skills (OSAUS) was performed as a pre-test and as the final exam and ultrasound images obtained during the exam were evaluated using the brightness mode quality ultrasound imaging examination (B-QUIET) scale.Key ResultsNo significant difference between the two cohorts on the OSAUS final exam was shown (p > 0.05 in all modules). There was a significant difference in the assessment of the images in the focused assessment with sonography for trauma (FAST) (p 0.015) and aorta (p 0.017) modules. Students in the teledidactic group performed better in both modules, scoring 33.59 (± 2.61) out of 44 in the module FAST (face-to-face group 30.95 (± 1.76)) and aortic images averaged 35.41 (± 2.61) points (face-to-face group 32.35 (± 3.08)).ConclusionsA teledidactic course for abdominal and thoracic ultrasound examinations is equally effective to traditional face-to-face teaching in this pilot study. Digital implementation with a portable ultrasound machine could be a great opportunity to promote ultrasound education worldwide and over great distances.

Correlation of cerebral blood flow velocity with haematocrit in neonates at risk of polycythaemia: a COHORT study

Background: The incidence of polycythemia is 1.5-4% of all live births. To diagnose polycythemia, a venous hematocrit is necessary, and polycythaemia is linked to changes in cerebral blood flow. The primary objective is to compare cerebral blood flow velocity (CBFV) and resistance index (RI) between polycythemia and normocythemia groups. The secondary objective is to correlate the peak systolic velocity (PSV) of anterior and middle cerebral arteries (ACA and MCA) with hematocrit in neonates at risk for polycythemia. Methods: In a prospective observational study, babies with a gestational age of &gt;35 weeks and a risk factor for polycythaemia were enrolled in the study. Free-flowing venous blood was sent for haematocrit measurement between 2 and 6 hours of life. Repeat PCV is sent to babies with a prior value of PCV &gt;65% at 36 hours of life or before discharge. PSV, end diastolic velocity (EDV), RI of ACA and MCA were measured using Mindray portable ultrasound machine with a mini- curved ultrasound transducer (8-13 mhz). Data is entered in excel and analysed. Results: Out of 75 enrolled babies, 19 had polycythaemia. The mean PSV±SD of MCA was 27.84±6.04 cm/s and 27.27±5.74 cm/s in the normocythemia and polycythemia groups, respectively, at 6 hours of life, which is statistically insignificant. The mean PSV±SD of MCA was 31.41±6.92 cm/s and 29.61±6.57 cm/s in normocythemia and polycythaemia groups, respectively, at 36 hours of life, which is statistically insignificant too. Conclusions: Cerebral Doppler values did not correlate with haematocrit between the normocythemia and polycythemia groups in the neonates at risk of polycythemia.