Real-time Ultrasound Scanning Research Articles

Direct – Maternal Genetic Parameters Estimated for Real-Time Ultrasound Scan Measures of Eye Muscle Area, Rib Fat Depth, and their Correlation with Body Weight in Male Philippine Riverine Buffaloes

Background: Ultrasound scanning is a non-invasive technique for evaluating animals based on carcass yield and meat quality traits. It has been incorporated into the beef cattle breeding program. However, little has been done in buffaloes. Thus, this study was conducted to estimate the genetic parameters for growth traits- body weights (BW) and a real-time ultrasound scan of eye muscle area (EMA) and rib fat (RF) to determine their suitability as a tool for selection.
 Methods: Four hundred thirty-eight (438) male Philippine riverine buffaloes with 1,535 BW records and 417 real-time ultrasound scans of EMA and RF scans at the 12th rib were available for the study. BW was taken and adjusted at birth, 6, 12, 18, 24, 30, and 36 months while RF and EMA scans were taken at 12 & 18 mos. Genetic parameters were estimated with a pedigree-based multi-trait animal model using ASREML software.
 Results: The average BW of buffaloes adjusted to 6, 12, 18, 24, 30, and 36 months of age were 135kg, 230.8kg, 323.0kg, 382.7, 453.6, and 502.4kg, respectively. The mean EMA and RF at 12 months were 29.7 cm2 and 3.2mm, respectively. Direct genetic heritabilities were 0.26±0.16, 0.29±0.12, 0.35±0.19 and 0.67±0.32 for birth, BW12mos, EMA12mos and RF12mos, respectively. Maternal genetic heritability for birth weight. was 0.12±0.09. Genetic correlations among traits were positive except between birth and RF.
 Conclusions: Results indicate that ultrasound scanning can be used for selection together with BW at 12mos. and suggest that early performance is an excellent predictor of performance at a later age.

A Study of Maternal Outcomes in Post Dated Pregnancy

Background: Post-dated pregnancy may be associated with perinatal complications like fetal distress, meconiumaspiration syndrome and fetal asphyxia. This study was designed to study maternal outcomes in post datedpregnancy (or beyond 40 weeks gestation).Materials & Methods: Real time ultrasound scanning was performed using (Philips EPIQ 5G, Philips EPIQ 7G andPhilips affinity 50 G model) 1-5 MHz biconvex probe and general survey of foetus was done. Total 114 pregnantwomen beyond 40 weeks of gestation were studied. A detailed clinical history like menstrual history, marital,family history of the pregnant women included in the study was taken. For induction, cervical ripening agents likedinoprostone gel or misoprostol tablets were used. Then the patients were observed for uterine contractions andstrict foetal heart rate monitoring was done.Results: In this study total 114 cases beyond 40 weeks of gestation were analyzed to know the maternal and foetaloutcome in post-dated pregnancies. Majority of the postdated pregnancies 102 (89.5%) were in between 40 weeks-40 weeks 6 days. Primigravida were 55.3% while only 44.7% were multigravida. Out of total 114 patients havingpregnancies beyond 40 weeks of gestation, 67.6% were delivered vaginally while 32.4% underwent lower segmentcaesarean section. Majority (65.8%) of patients had Bishops score <=4, Bishops score > 6 (20.2%), Bisops score inbetween 5-6 (14%). Incidence of meconium stained liquor was 6.1%.Conclusion: Post-dated pregnancy is a high risk pregnancy, so correct dating is done by early first trimester USGor by second trimester USG so that induction can be done at 40 weeks and timely detection of foetal distress andmanagement can be safely introduced.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for (Adult) Hip.

In this dynamic scanning protocol, ultrasound assessment of the adult hip is described using different maneuvers for various conditions. Real-time patient examination and ultrasound scanning videos are coupled for convenience as well as for better insight. The text covers the common conditions around the hip where especially dynamic ultrasound scanning provides valuable information in addition to static imaging. The protocol is prepared by an international consensus of several experts in the field of musculoskeletal ultrasound.

Comparative assessment of two imaging modalities and their application in the evaluation of pancreatic/peripancreatic changes due to acute pancreatitis

Aim: Comparison of two imaging modalities and their application in the evaluation of pancreatic/peripancreatic changes due to acute pancreatitis.Materials and Methods: The present comparative study was performed on 100 patients suspected of acute pancreatitis confirmed by elevated serum amylase and serum lipase levels, between November 2015 to May 2017 in the Department of Radiodiagnosis in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute, Bengaluru. All patients underwent a real-time ultrasound scan of the abdomen using a curvilinear transducer of 2 to 6 MHz of Philips IU22 and triple-phase contrast-enhanced computed tomography of the abdomen by Philips INGENUITY 128 slice CT in Victoria hospital or Siemens SOMATOM 6 slice CT present in Bowring hospital.Results: Most patients with acute pancreatitis (~30%) belonged to the age group 41-50 years while 28% each belonged to the age group 31-41 and 41-50 years respectively. Amongst males (n=88), 72% (n=64) were cases of acute pancreatitis and 28% (n=24) were the cases of acute on pancreatitis. On the other hand, of 12 females, 58% (n=07) were the cases of acute pancreatitis and 42% (n=05) were the cases of acute on chronic pancreatitis. Both ultrasonography (US) and MDCT were able to delineate normal-sized pancreas, increased size of head and body of pancreas and atrophic pancreas. While the US was able to identify only 17 cases, CT was able to detect 55 with a sensitivity of ~31%, which was statistically significant (p

Filariasis diagnosed by real-time ultrasound scanning as filarial dance sign - A case report.

IntroductionLymphatic filariasis (LF) is a vector-borne illness caused due to Wuchereria bancrofti. Genital abnormalities may result from chronic inflammation of the lymphatic vessels and obstruction of the afferent vessels in Bancroftian filariasis. Doxycycline, albendazole, diethylcarbamazine, and ivermectin are among the treatments available.CaseA 16-year male presented to our OPD with a complaint of left inguinal swelling for the past 6 Months. Examination of the swelling revealed a left-sided inguinal swelling of 5 × 4 cm with intact overlying skin. A provisional diagnosis of inguinal lymph varix was made, and real-time ultrasound scanning along with FNAC was performed. Swelling resolved after conservative management.DiscussionUltrasonography can easily observe adult worms due to their size and fast movements. Using pulsed-wave doppler mode, the characteristic movement profile of adult worms in pulsed-wave doppler mode can be distinguished from other movements (e.g., blood in venous vessels).ConclusionUltrasound is the imaging modality of choice to detect filarial worms/microfilaria in the lymphatic system, which produces the classic twirling of microfilaria in the lymphatic system, known as the "filarial dance sign".

Isolated partial tear of extensor digitorum longus tendon with overlying muscle herniation in acute ankle sports injury: role of high resolution musculoskeletal ultrasound

Lateral Ankle sprain is a common sports-related trauma with the mechanism of injury ranging from inversion to plantar flexion. These injuries commonly affect the ligaments but can also affect the associated soft tissue structures like the eversion muscles and tendons. Prompt and accurate diagnosis of such injuries is warranted so as to ensure early return to play and prevent long-term complications. Lateral ankle sprain injuries in sports may not always be associated with ligament injuries. We report a never before reported case of lateral ankle sprain injury in a soccer player with the unusual finding of isolated partial tear of Extensor digitorum longus muscle and its fascia leading to myo-fascial herniation. The lateral ankle ligaments were intact. The diagnosis was clinched on a high-frequency ultrasound scan supported by dynamic maneuvers which in fact proved to be superior to MRI as the latter failed to demonstrate the myo-fascial herniation in our case. We therefore propose that real-time ultrasound scanning with dynamic maneuvers should be the first line of investigation to assess sports injuries in anatomically complex joints like the ankle.

Real Time Sonography as an anatomy teaching aid in undergraduate radiography institutions in Northern Nigeria.

Real-time ultrasound scanning is increasing in popularity as a teaching tool for human anatomy because it is non-invasive, offers real-time 3-D anatomy and is cheaper than dissections. To assess real-time ultrasound scanning as a teaching method of human anatomy, and to determine what teaching methods radiography students consider effective for understanding human anatomy. One hundred and ten self-administered, structured and pre-tested questionnaires were distributed to Clinical Radiography students (Third, fourth and fifth year)in Northern Nigeria featuring University of Maiduguri and Bayero University Kano. The questionnaire consists of two sections;Demographics and preferred methods of delivery of anatomical information. Participation was voluntary. Comparisons among teaching methods were made using repeated measures ANOVA. A significant difference among the eight delivery methods with 3-D Radiology imaging being as the most preferred method overall (48.17, p<0.0001) and ultrasound the least (32.48, p<0.0001). With Duncan's multiple Range test, it is clearly shown that 3-D Radiology imaging differ with mean value(5.2522) followed by Computer programs(5.1292), Anatomic models( 4.7593), Laboratory videos(4.5815), textbooks(4.5358), animal dissection(4.2568), lectures(3.2568) and finally ultrasound scan (3.6087), (P<0.0001). 3-D Radiology imaging is the most preferred method of delivering anatomical information and ultrasound scanning is the least preferred method.

The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects: Scientific Impact Paper No. 60.

Heart problems are common in newborn babies, affecting approximately 5-10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year. In the UK, pregnant women are offered a scan at around 20weeks to try and spot any heart problems. In most cases there is not a clear reason for the problem, but sometimes other issues, such as genetic conditions, are discovered. In recent years the care given to these babies after they are born has improved their chances of surviving. However, it is recognised that babies born with heart problems have a risk of delays in their learning and development. This may be due to their medical condition, or as a result of surgery and complications after birth. In babies with heart problems, there is a need for more research on ultrasound and magnetic resonance imaging (MRI) to understand how the brain develops and why these babies are more likely to have delays in learning and development. This paper discusses the way ultrasound and MRI are used in assessing the baby's brain. Ultrasound is often used to spot any problems, looking at how the baby's brain develops in pregnancy. Advances in ultrasound technologies have made this easier. MRI is well-established and safe in pregnancy, and if problems in the brain have been seen on ultrasound, MRI may be used to look at these problems in more detail. While it is not always clear what unusual MRI findings can mean for the baby in the long term, increased understanding may mean parents can be given more information about possible outcomes for the baby and may help to improve the counselling they are offered before their baby's birth.

Real-Time Elastography in the Diagnosis of Prostate Cancer: Personal Experience:

Prostate cancer is the most common cancer in men. In the future, a significant further increase in the incidence of prostate cancer is expected. The indication to perform a prostate biopsy is digital rectal examination suspicious for prostate cancer, total prostate specific antigen (PSA) value, free PSA/total PSA ratio, PSA density and PSA velocity, and an evidence of hypoechoic area at transrectal ultrasound scan. Unfortunately the specificity and sensibility are still poor. The aim of this retrospective study is to evaluate the specificity and sensibility of real time elastography versus ultrasound transrectal B-mode scan. We retrospectively evaluated 108 pts. having undergone TRUS-guided transrectal prostate biopsy (10 samples). The indication for biopsy is: digital rectal examination, total prostate specific antigen (PSA) value, PSA ratio, PSA density and PSA velocity suspicious for prostate cancer, and/or an evidence of hypoechoic area at transrectal ultrasound scan, and/or hard area at real-time elastography. The mean age of patients is 66.8 years, mean PSA 6.5 ng/mL, and mean ratio 16.5%. We compared the histopathological findings of needle prostate biopsies with the results of transrectal ultrasound and transrectal real-time elastography. 32/108 (29.6%) pts. were positive for prostate cancer (mean Gleason score 7.08), mean PSA 14 ng/mL and mean ratio 9.5%. Transrectal ultrasound scan shows a sensibility of 69% and specificity of 68%. Transrectal ultrasound scan shows a VPP of 51.4%. Transrectal ultrasound scan shows a VPN of 80.9%. Real-time elastography shows a sensibility of 56% and specificity of 85.7%. Real-time elastography shows a VPP of 60.1%. Real-time elastography shows a VPN of 83%. Elastography has a significantly higher specificity for the detection of prostate cancer than the conventionally used examinations including DRE and TRUS. It is a useful real-time diagnostic method because it is not invasive, and simultaneous evaluation is possible while performing TRUS.

Monitoring gonadotropin therapy of anovulatory infertility by ultrasound alone

In our study we monitor the gonadotopin therapy by ultrasound because serum oestradiol is not available in Basrah, and we investigate whether pelvic ultrasound alone suffices to control ovarian response to gonadotropin to induce ovulation. Real time ultrasound scanning of follicular development was performed for 35 patients receiving metrodin during 113 cycle. Twenty pregnancies were obtained resulting in a pregnancy rate of (57.1%); with (16) patients singletons, set of twins 4 (20%), with abortions 6(30%) and about patients 2 (5%) develops mild ovarian hyperstimulation syndrome (OHSS). So ultrasound alone can be used effectively to control gonadotropin therapy in the majority of cases.

Does ultrasound guidance add accuracy to continuous caudal‐epidural catheter placements in neonates and infants?

Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement. We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block. External measurement defined as the distance from the caudal space and the surgically congruent vertebral level was measured in centimeters with the back gently flexed. Subsequently, a caudo-epidural block was performed in the same position. The epidural catheter insertion was followed under real-time ultrasound guidance till the predetermined vertebral level was reached. The actual length placed under real-time ultrasound scan was defined as the actual length. The high-frequency probe was placed longitudinal and paramedian to the spine. The vertebral level was determined by identifying the lumbosacral junction in longitudinal saggital view and counting the vertebrae up from L5. The catheter length at the skin was compared with the length recorded by external measurement. The actual length placed under real-time ultrasound scan were consistently longer than the external distance between the caudal space and selected vertebral level. The mean values of ultrasound were higher than the mean values of external measurement with a difference of 4.28 cm. Accuracy was not affected by age or affected by the selected vertebral level in the age group we studied. We conclude that catheters placed under ultrasound guidance are more accurate than the traditional method developed before the advent of ultrasound in young infants.

Relationships between live weight, body condition, dimensional and ultrasound scanning measurements and carcass attributes in adult Angora goats

Real-time ultrasound scanning is an accurate non-invasive technique used to improve quality in sheep, cattle and pig meat production but has been overlooked in meat production from heavy goat carcasses. The aims of this study were to: determine subjective and objective carcass attributes of 6year old Angora castrate goats prior to and following slaughter; and determine the relationships between carcass attributes, bodyweight, body condition score (BCS), body dimension measurements and ultrasound measurements using multiple regression modelling. Key attributes were: on-farm bodyweight (range 35–77kg), BCS (1, very thin to 4.3, fat), dimensional frame measures (wither height, heart girth, anterior-posterior circumference, body volume (circumference×girth)), carcass weight (range 11.6–33.2kg), GR tissue depth of carcasses (1–27mm) and the ultrasound measurements of eye muscle depth (EMD, 17–35mm) and subcutaneous fat depth (SFD, 1–6mm). Goats from three genetic backgrounds were grazed on pasture together for 6 years. In the three months preceding slaughter the goats grew from an average live weight of 50.7kg gaining live weight at an average of 117g/d to reach an average live weight of 62kg. There were moderate correlations between all measurements. BCS accounted for 55.1% of the variance in carcass weight, 51.3% of the variance in EMD, (3.2% more than did GR tissue depth) and 59.9% of the variance in SFD. Live weight accounted for 83.8% of the variance in carcass weight. The best prediction equation for carcass weight included terms for live weight, SFD, EMD and sire, accounting for 91.5% of variance. Body dimensional measurements were not as useful as BCS in predicting carcass weight, with the best, body volume, accounting for 5% less of the variance than live weight. The best prediction for the EMD included terms for BCS and carcass weight, accounting for 61% of variance. GR tissue depth was primarily associated with SFD, and in combination with carcass weight and BCS explained 71.9% of the variance. In relation to predicting carcass traits, girth accounted for more of the variance in EMD, SFD and GR tissue depth than wither height or body circumference. If breeders aim to alter the EMD and SFD of Angora goats then ultrasound scanning provided better estimates compared with relying on live weight with or without body condition scoring. Both EMD and SFD were also in the best model for predicting carcass weight. BCS was a useful on-farm measurement for estimating carcass attributes but girth was not as useful as body volume in explaining the variance in live weight.

Postpartum uterus involution observed by real-time ultrasound scanning and vaginal cytology in Van cats.

The objective was to investigate postpartum uterus involution by real-time ultrasonography and vaginal cytology in Van cats. This study included 15 healthy Van cats belonging to the Van Cat Research Centre (Yuzuncu Yil University, Van, Turkey). Starting 24 h postpartum, ultrasonographic measurements were performed on the placental and interplacental uterine horn regions every day. Decreases in the diameters and uterine content were considered as criteria for uterine involution. Vaginal discharge samples were collected every day for 4 weeks postpartum. The smears were stained with Papanicolaou stain. The average diameters of placental and interplacental regions (IPRs) in the uterine horns were 3.12 ± 0.29 cm and 2.36 ± 0.43 cm, respectively, at 24 h postpartum. Placental regions (PRs) shrank faster than IPRs. At 48 h postpartum, it became difficult to distinguish PRs from IPRs in the uterine horns. The uterine horns could be seen in the abdominal cavity up to 5.60 ± 0.99 days postpartum. The mean of the last assessable diameter of the uterine horns from days 4 to 7 in all cats was 0.49 ± 0.07 cm. The vaginal epithelial cells appeared to be under the effect of oestrogen for 4 weeks postpartum. The morphological involution of the uterus completes, to a large extent, within the first 48 h postpartum in Van cats. A more detailed hormonal analysis would contribute greatly to the understanding of the physiological processes involved in this period. Although postpartum involution appeared complete by 5.60 ± 0.99 days after parturition in Van cats, histological verification of this finding is needed.

Exploratory Study of the Relationship Between Maternal Body Mass Index and Spontaneous Fetal Movements

Maternal body mass index (BMI) has been reported to be associated with the number of fetal body movements and the duration of fetal breathing movements in hypertensive pregnant women (Brown et al., 2008). However, whether a relationship exists in pregnancies classified as overweight or normal weight but not complicated by hypertension is unknown and the focus of this study. Forty-five maternal-fetal pairs (normotensive, normal weight=15; normotensive, overweight=15; hypertensive=15) who had participated in a study of fetal behavior which included a 20 min real-time ultrasound scan observation of fetal movements were randomly selected from the laboratory archival database. Gestational age at testing ranged from 33-39 weeks [M(SD)= 36.2 (1.4) weeks]. All infants were delivered healthy at term. Video-recordings of the ultrasound scans were scored for the number of fetal body movements (interrater reliability r=.97) and the cumulative duration of breathing (interrater reliability r=.94) movements. The number of fetal body movements differed between groups, F(2,38)=3.19, p=0.05, with fetuses of overweight mothers moving less frequently than those of normal weight mothers (M=9.7 vs 15.5, respectively). Maternal BMI prior to pregnancy, r=-0.43, p&lt;0.01, and at time of observation, r=-0.44, p&lt;0.01, was associated with the number of fetal body movements, but not with duration of breathing movements. As BMI increased, the number of fetal body movements decreased. It was concluded that maternal BMI may affect the number of spontaneous fetal movements. A prospective study is necessary to determine whether BMI should be considered when using body movement counts to assess well-being and/or neurodevelopment.

Ewe whole body composition predicted in vivo by real-time ultrasonography and image analysis

The relationship between ultrasound measurements and the empty body chemical composition of mature ewes was studied in two breeds. The breeds were a milk-producing breed Churra da Terra Quente—CTQ (n=33; live weight 42.0±7.3kg, mean±SD), and a meat breed Ile de France—IF (n=23; live weight 60.7±9.1kg, mean±SD). Fat and muscle depths were measured in the live animals by real-time ultrasound scanning (RTU; 7.5MHz probe) over the 13th thoracic, and between the 3rd and 4th lumbar vertebrae, and total tissue depth over the 11th rib. Following slaughter, the carcass and non-carcass components of the empty body were combined and subjected to chemical analysis and assessment of energy value. Data obtained by RTU after image analysis was used to develop simple and multiple regression models for each breed. The traits most accurately estimated from single RTU measurements were the absolute values for fat content and energy value of the empty body. The respective coefficients of determination (R2) for IF and CTQ ewes using subcutaneous fat depth over the 13th thoracic vertebra were 0.768 and 0.908 for fat, 0.821 and 0.900 for energy; and for measurements between the 3rd and 4th lumbar vertebrae were 0.845 and 0.911 for fat, 0.852 and 0.906 for energy. All these coefficients were significant (P<0.01). The best prediction models included one to three RTU measurements and were better for CTQ ewes, where adjusted R2 values ranged from 0.923 (P<0.001) for water to 0.969 (P<0.001) for protein, than for IF ewes, where the range was 0.394 (P<0.01) for protein to 0.940 (P<0.001) for fat. The results revealed good estimates of the fat and energy content of the empty body of both breeds and also good estimates of protein content for CTQ ewes, but poor estimates of protein content for IF ewes, with the best prediction models for each body component being different from each breed. Consequently, it is concluded that predictive models that are specific to the breed and circumstances of the study in which they are to be used will have to be established to have a practical application.

Fetal Ultrasound Image Classification Using a Bag-of-words Model Trained on Sonographers’ Eye Movements

The acquisition of fetal biometric measurements via 2-D B-Mode ultrasound (US) scans is crucial for fetal monitoring. However, acquiring standardised head, abdominal and femoral image planes is challenging due to variable image quality. There remains a significant discrepancy between the way automated computer vision algorithms and human sonographers perform this task; this paper contributes to the attempt to bridge this gap by building knowledge of US image perception into a pipeline for classifying images obtained during 2-D fetal US scans. We record the eye movements of 10 participants performing 4 2-D US scans each, on a phantom fetal model at varying orientations. We analyse their eye movements to establish which high-level constraints and visual cues are used to localise the standardised abdominal plane. We then build a vocabulary of visual words trained on SURF descriptors extracted around eye fixations, and use the resulting bag of words model to classify head, abdominal and femoral image frames acquired during 10 clinical US scans and 10 further phantom US scans. On phantom data, we achieve classification accuracies of 89%, 87% and 85% for the head, abdominal and femoral images respectively. On clinical data, we achieve classification accuracies of 76%, 68% and 64% for the head, abdominal and femoral images respectively. This constitutes the first insight into image perception during real time US scanning, and a proof of concept for training bag of words models for US image analysis on human eye movements.

The effect of a functional exercise programme following total hip replacement on the relaxed posterior gluteus medius thickness as measured by real-time ultrasound: A pilot randomised controlled trial

BACKGROUND: Prolonged physical impairments are often reported post total hip replacement (THR). It is unclear which exercises should be performed to maximise rehabilitation following surgery. PURPOSE: The aim of this pilot study was to describe a method of imaging the relaxed posterior gluteus medius muscle in patients following surgery, and to measure the secondary outcome of relaxed muscle thickness of the posterior gluteus medius on the side of their THR following a rehabilitation intervention in this patient group. METHOD: This was a randomised controlled pilot study investigating the effect of functional exercise on the relaxed muscle thickness of the posterior gluteus medius as measured by real-time ultrasound. 57 patients were randomised to either a functional exercise class or usual care group. Real time ultrasound scanning of the posterior gluteus medius muscle were undertaken in both groups at baseline (week 12) and post intervention (week 18). RESULTS: There was no significant difference found in the size of the posterior gluteus medius between the intervention and control groups over the six week period of intervention. There was a statistically significant increase in the size of the posterior gluteus medius muscle at three points with a mean difference of 0.78 (95% CI 0.53–1.03), 1.05 (95% CI 0.67–1.43), 1.01 (95% CI 0.56–1.5) on the operated side in both groups over the six week period (p < 0.000). CONCLUSION: The thickness of the posterior gluteus medius on the operated side increased over a six week period from week 12 to week 18 post THR. There was no difference found in the thickness of the posterior gluteus medius in those attending a functional exercise class twice weekly and those receiving usual care.

Teaching percutaneous renal biopsy using unfixed human cadavers.

BackgroundPercutaneous renal biopsy (PRB) is an important diagnostic procedure. Despite advances in its safety profile there remains a small but significant risk of bleeding complications. Traditionally, operators train to perform PRB through tutor instruction and directly supervised PRB attempts on real patients. We describe an approach to teaching operators to perform PRB using cadaveric simulation.MethodsWe devised a full day course hosted in the Clinical Anatomy Skills Centre, with places for nine candidates. Course faculty consisted of two Consultant Nephrologists, two Nephrology trainees experienced in PRB, and one Radiologist.Classroom instruction included discussion of PRB indications, risk minimisation, and management of complications. Two faculty members acted as models for the demonstration of kidney localisation using real-time ultrasound scanning. PRB was demonstrated using a cadaveric model, and candidates then practised PRB using each cadaver model.ResultsWritten candidate feedback was universally positive. Faculty considered the cadaveric model a realistic representation of live patients, while the use of multiple cadavers introduced anatomical variation.ConclusionsOur model facilitates safe simulation of a high risk procedure. This might reduce serious harm associated with PRB and improve patient safety, benefiting trainee operators and patients alike.

The use of real time ultrasound scanning as a teaching method of anatomy in an undergraduate sonography and medical imaging degree in an Australian university

BackgroundReal-time ultrasound scanning is increasing in popularity as a teaching tool for human anatomy because it is non-invasive, offers real-time 3-D anatomy and is cheaper than dissections. AimTo assess real-time ultrasound scanning as a teaching method of human anatomy, and to determine what teaching methods medical imaging and sonography students consider effective for understanding human anatomy. MethodSurveys were distributed to two consecutive cohorts of first year medical imaging and medical sonography students at CQUniversity. Participation was voluntary. Comparisons among teaching methods were made using repeated measures ANOVA. ResultsReal-time ultrasound scanning was the most preferred method of delivery for anatomy classes overall especially compared to computer programs, videos, 3-D radiological images and dissection. Specifically, students indicated that ultrasound scanning was the preferred method to encourage learning from experience (F7,231 = 2.942, p = 0.006), to develop team skills (F7,231 = 4.550, p < 0.006), to follow complex instructions (F7,231 = 4.656 p < 0.001) and to appreciate anatomical variation (F7,231 = 2.067, p = 0.048). Dissection was the least favoured teaching method. ConclusionReal-time ultrasound scanning is a useful tool for teaching anatomy, and animal dissections are a poor substitute for the use of human cadavers.

Immediate Effects of Core-Stability Exercises and Clinical Massage on Dynamic-Balance Performance of Patients With Chronic Specific Low Back Pain

Context:Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear.Objective:To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome.Design:Randomized, assessor-blind, test–retest.Setting:University research laboratory.Patients:10 physically active adults (5 men, 5 women).Main Outcome Measures:Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively.Interventions:The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP).Results:Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side.Conclusion:CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.