Real-time US Research Articles

Central Line Insertion Review for Anesthesiologists: Review Article

Central venous catheter (CVC) is an essential tool for monitoring hemodynamics and intravenous access in many healthcare settings and, by far, most in a dynamic environment such as the operating room. It's one of the most frequent invasive procedures performed by clinicians in their practice. The literature describes many different approaches that use anatomical landmarks. However, Practice guidelines published in 2020 by the American Society of Anesthesiologists recommend the confirmation of a guide wire and central line insertion in the vein by real-time ultrasound US. This recommendation has significant practical implications, as it can lead to a reduction in adverse events following the CVS insertion. A large multicentre cohort study done in 2022, after implying the use of ultrasound-guided, reviewed the rate of adverse events following the CVS insertion and identified a variety of reasons linked with higher complication rates. A recent randomized trial compared techniques used in central line was conducted on neonates coming to the operating room who had CVS catheter placement done by pediatric anesthesiologists concluded that the modified technique was superior in regards to time efficiency and safety. This article aims to review basic knowledge and recent relevant literature about the topic in order to provide anesthesiologists with a deeper understanding of it while performing the procedure.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided.

The objective of our study is to compare the success rate, duration, and incidence of complications of a right internal jugular vein (IJV) cannulation by using three different techniques. A randomised controlled trial was conducted at atertiary care teaching hospital. A total of201 patients were randomly allocated to one of the following three groups (67 in each group). Techniques were categorised as anatomical landmark technique group (Group ALT), ultrasound guided pre-location group (Group USG-Pre), and real-time ultrasound-guided technique group (Group USG-RT). Central venous catheter insertion via three techniques. In 138 (73.01%) patients' IJV canulated in the first attempt, USG-RT, USG-Pre, and ALT were 51 (83.6%), 44 (72.1%), and 43 (64.2%), respectively. On the other hand, 37 (19.57%) patients were required in the second attempt, while only 14 (7.40%) patients were required in the third attempt for successful IJV cannulation. The success rates, as defined in our study, were only 138 (73%) as, in 51 (27%), we cannulated in more than a single attempt or switched to another technique. We found a significant difference in preparation time in all techniques as P-value <0.05, but no significant difference was found in venous access time, cannulation time, and duration of the procedure. Any technique can be used for IJV cannulation, but the most acceptable is the real-time US technique. However, no difference in the overall procedure time among all three techniques was noted, and no major incidence of complication was found.

Innovative AI techniques to aid clinical diagnosis of complex lung pathologies in ultrasound images

Lung ultrasound (LUS) has recently gained increasing interest as a reliable method for point of care (POC) diagnostics and management of lung diseases. LUS is easily accessible, has no radiation-related risks and is portable, so it does not require relocating the patient, minimising the risk of further infection. This research aims to develop efficient and automated methods for lung pathology diagnosis using AI to support clinicians. We have introduced a binary classifier based on a state-of-the-art Swin Transformer to discriminate between LUS clips of healthy patients and patients with interstitial lung disease (ILD). Differently from previous approaches, this is better aligned with the current clinical assessments of ILD since it evaluates LUS clips instead of single frames; and does not require any additional annotations from clinicians, since its training is based only on the already available medical report. Furthermore, we propose an unsupervised deep learning approach (based on a generative adversarial network) to convert in real-time US volumes to MRI-like volumes of the thoracic region. This approach can be used to spatially localise the US probe with respect to the MRI in real-time and gather anatomical contextual information of the imaged region, providing thus guidance to clinicians.

Real-Time Precision Needle Tracking for Gynecological Interstitial Brachytherapy: A Phantom Feasibility Study

To determine if an advanced needle navigation and real-time precision tracking system developed for prostate biopsies can be used for the purpose of real-time guidance of interstitial needles in modern image-guided gynecologic brachytherapy. An agarose gel pelvic phantom was previously designed using 3D Slicer and Autodesk Fusion360 to model an average uterus from a 50-patient dataset, a vaginal canal from KleenSpec (TM, Welch Allyn) speculum dimensions, and a rectum to accommodate a BK 8848 endocavity biplane ultrasound [US] probe. After manufacturing the phantom with a 7.2cm x 3.7cm x 4.4cm (LxWxH) uterus and an attached 2.7cm x 1.4cmx 1.7cm (LxWxH) focal HR-CTV target, the model was imaged using MRI. The uterus and HR-CTV were contoured on MRI to aid in registration with US and provide a target for needle placement. The tracking system with endorectal probe was then used to image the phantom. Ultrasound images from a 180-degree sweep were acquired and a 3D Ultrasound-based volume was generated. Using the commercially available system, the MRI was imported and an MRI-Ultrasound fusion performed based on the uterus contours and then refined using contour-based deformable registration. Three desired locations for needle placement were defined to test the ability of the system to guide needles at these locations: one in the most lateral aspect of the HRCTV, one at the HRCTV-uterus interface, and one inside the uterus. The needle tracking sleeve that was indexed to the probe was used in conjunction with the software interface to guide the 17-gauge titanium needle placement in real time. The distance between actual needle and the intended needle location was measured for each successful needle placement. When possible, needles were removed and reinserted at the same desired location to test the reproducibility of insertion under US guidance. Two of the three intended needles were successfully placed using real-time US guidance. The most lateral needle in the HRCTV was not inserted due to limitations of the phantom design, specifically inaccessibility to the agarose phantom through the phantom wall supports. The inserted needles were visible and tracked to the desired location within 0.6 mm (needle located at HRCTV-uterus interface), and 2.2 mm (needles inserted centrally in the uterus). For the target within the uterus, needles were reinserted at the same target of interest with a ∆ 0.15mm in greatest range between attempts. We have demonstrated a proof of concept in which existing technology for prostate biopsies can be utilized for the application of interstitial gynecologic brachytherapy with a high degree of fidelity. Ongoing modifications to our validation phantom and the tracking system are needed to allow for variations in uterine anatomy, more rigorous evaluation of reproducibility, and multi-catheter placement.

COMPARISON OF PRE PROCEDURAL AND REAL TIME ULTRASOUND GUIDED SPINAL ANESTHESIA FOR TRAUMATIC LOWER LIMB INJURY

Objectives:The study aimed to compare real time ultrasound-guided approach with pre procedural ultrasound-guided approach for spinal anaesthesia in trauma patients. Methods: 200 patients in two groups: group pre-procedure (PP) and group real time (RT) of 100 patients in each group using inclusion and exclusion criteria. Standard monitoring done and Spinal anesthesia was administered by a trained anesthetist. The outcome measures included the number of attempts took to access the subarachnoid space, number of skin punctures, time from first needle insertion to completion of the intrathecal injection, total procedure time, success rate of cerebrospinal fluid acquisition, failure and complications were recorded and statistical analysis was performed. A two-tailed p-value &lt;0.05 was considered as statistically significant. Results: Mean number of needle passes, median number of skin puncture, total time for successful lumbar puncture, the block failure rate and procedural complications were significantly less in the RT group as compared to PP group. There are widely varying reports of the failure rate of spinal anesthesia in the literature. The individual studies have reported higher success rates (97% and 100%) using real-time US guidance than with pre-procedure ultrasound (80%). Conclusion: Real-time ultrasound-guided technique is a clinically feasible, higher success rate, less time consuming and less complication rate as compared to preprocedural ultrasound guidance technique.

Serological Evidence of HIV/HBV Co-infection among HIV-infected patients in Onitsha, Anambra State, Nigeria

Research suggests that HIV-infected individuals who have also been co-infected with HBV face a greater risk of HIV progression. Hepatitis B and HIV infections pose serious public health challenges in sub-Saharan Africa. This study examined the possible HBV co-infection with the socio-demographic traits of HIV-infected individuals attending the HIV clinic at a referral specialist mission hospital in Onitsha, Anambra State, Nigeria. Two hundred and twenty (220) HIV-infected individuals gave consent to participate in the study. Between March 2022 and October 2022, blood samples (about 5ml) were aseptically collected during routine investigations into sterile EDTA bottles, and plasma samples were obtained by centrifugation. These samples were tested for HBsAg using a Monolisa HBsAg ULTRA kit (Bio-Rad, USA). CD4 counts were measured using the Partec CyFlow. Plasma viral loads (PVL) were also determined using the Abbott Real-Time HIV-1 Assay US protocol. HIV/HBV co-infection was 40.9%. The results showed that most (39.7%) study participants co-infected with HBV had a CD4 cell count of 350 cells/µl. The virological assay revealed that the highest HBsAg seroprevalence was detected in the study participants whose viral loads were between 40 and 1000µl (61.9%). The majority of the study participants were female HIV patients (74.5%), while those co-infected with HBV were mainly male patients (48.2%). HIV-positive individuals aged 18-30 (53.3%) were mostly affected. None of the socio-demographic variables tested was significantly associated with HBV in HIV-infected patients in Onitsha, Anambra State, Nigeria. This study showed a high HIV/HBV co-infection in Onitsha, Anambra State, Nigeria.

Co-infection of Hepatitis C among HIV-infected patients: A cross-sectional study from A University Teaching hospital in Anambra State, Nigeria

Hepatitis C virus co-infection (HCV) with HIV is regarded as a significant public health risk despite being less frequent than hepatitis B co-infection with HIV. This observation results from HIV's impact on the HCV life cycle and, ultimately, the hepatic system. In this study, potential HCV co-infection was examined in connection to the socio-demographic characteristics of HIV-positive patients attending an HIV clinic at a University Teaching Hospital in Awka, Anambra State, Nigeria. Between September 2021 and June 2022, 255 HIV patients who consented to participate in the study had their HCV levels checked using the anti-HCV antibody ELISA kit (DIA.PRO, Italy). Using the Partec CyFlow, CD4 counts were calculated. During routine investigations, blood samples (approximately 5ml) were aseptically collected into sterile EDTA vials, and plasma samples were obtained by centrifugation. With the aid of Abbott Real-Time HIV-1 Assay US methodology, plasma viral loads (PVL) were also calculated. A total of 11 (4.3%) HIV-positive people were also confirmed to have HCV infection, with women making up the majority (4.8%). Most of those affected were between the ages of 31 and 40 (6.8%). With marital status, HCV co-infection was found more amongst married patients, with a rate of 4.8%. The prevalence of HIV/HCV co-infection was higher (4.8%) in those with CD4 cell counts under &gt;350 cells per ml than others. Most patients (3.1%) did not have their viral RNA detected (TND). Self-employed infected persons and those with secondary school educational backgrounds had the highest HIV/HCV prevalence rate of 6.6% and 7.6%, respectively. The study's findings show no statistically significant relationships between the patients' socio-demographic traits and HCV. Also, HCV co-infection prevalence was significantly low in the study participants.

Robust tip localization under continuous spatial and temporal constraints during 2D ultrasound-guided needle puncture.

During ultrasound-guided (US-guided) needle puncture for minimally invasive procedures, automated needle tip localization can help clinicians capture small tips in US images easily and precisely, providing them with obvious tip indicators on the screen and bringing them more confidence during the procedures. However, automated needle tip localization in US images is challenging due to serious interferences arising from all kinds of echoes. We propose a method that localizes needle tips under continuous spatial and temporal constraints in the real-time US frame stream. A temporal constraint is firstly acquired by detecting translational tip motion in motion-enhanced US images with a deep learning-based (DL-based) detector. A spatial constraint and candidate tip locations are obtained by detecting needle shafts and tips in the raw grayscale B-mode images with another DL-based detector. To provide continuous constraints, estimated tip velocity from acquired temporal constraint is used to predict tip locations in frames where no temporal or spatial constraint is detected. Finally, tip coordinates are precisely localized among candidate tips under the spatial and temporal constraints. Experimental results evaluated on 1121 US images from porcine organ punctures, and 895 images from human thyroid punctures demonstrate that the proposed method is effective and efficient, surpassing existing methods. On porcine organ data, a 97.2% recall rate and a 91.9% precision rate on tip detection and 0.88 ± 0.70mm root-mean-square error (RMSE) on tip localization were achieved. On the human thyroid data, which was not involved in the training, 86.5% recall, 84.3% precision and 0.92 ± 0.78mm RMSE were achieved separately. The running speed of 14.5 frames per second was achieved only using a CPU. The proposed method provides a more reliable solution for automated needle tip localization during US-guided needle puncture, being more robust to interferences. Fast running speed leads to its practicability in the real-time US stream.

Image Fusion Involving Real-Time Transabdominal or Endoscopic Ultrasound for Gastrointestinal Malignancies: Review of Current and Future Applications.

Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a more precise lesion characterization with higher accuracy in tumor detection, staging, and interventional/image guidance. We conducted a literature review to identify the current possibilities of real-time image fusion involving US with a focus on clinical applications in the management of GI malignancies. Liver applications have been the most extensively investigated, either in experimental or commercially available systems. Real-time US fusion imaging of the liver is gaining more acceptance as it enables further diagnosis and interventional therapy of focal liver lesions that are difficult to visualize using conventional B-mode ultrasound. Clinical studies on EUS guided image fusion, to date, are limited. EUS-CT image fusion allowed for easier navigation and profiling of the target tumor and/or surrounding anatomical structure. Image fusion techniques encompassing multiple imaging modalities appear to be feasible and have been observed to increase visualization accuracy during interventional and diagnostic applications.

Normal placental structural anatomy: ultrasound and doppler features elucidated with US-MR image fusion and ferumoxytol-enhanced MRI.

To elucidate ultrasound features of normal placental anatomy through correlation of gray-scale and ultrasound Doppler with ferumoxytol-enhanced MRI features using US-MR image fusion. All patients referred to MR for ultrasound findings worrisome for PAS (placenta accreta spectrum) were included in this retrospective study. MR studies included a ferumoxytol-enhanced T1-weighted MRI. Ultrasound imaging included gray-scale, color Doppler, power Doppler, and spectral Doppler techniques. After the MR, US-MRI fusion was performed by co-registering a MR acquisition to real-time US, which allowed precise, point-to-point correlation of placental features. Fourteen patients at risk for PAS were studied using the US-MR image fusion. At delivery, there were six cases without PAS (gestational age range: 24weeks 3days to 34weeks 0days), and these composed the study cohort. Placental features that were on high signal intensity on post-ferumoxytol acquisitions represent spaces with maternal blood flow and corresponded to hypoechoic areas on ultrasound created by a paucity of reflective interfaces (villi). Color and spectral Doppler allowed the separation of maternal and fetal circulations in individual perfusional domains and demonstrated spiral artery inflow, circulation around the villous tree, and return of blood flow to the basal plate. Recognizable histopathologic features by ultrasound included the central cavity, villous tree, and venous return channels. Internal placental architecture can be discerned on ultrasound. This anatomy can be correlated and confirmed with ferumoxytol-MR through US-MR fusion. Understanding this structural anatomy on ultrasound could serve as a basis to identify normal and abnormal placental features.

LBODP095 Radiofrequency Ablation Performed By Endocrinologists Is A Viable Treatment Option For Recurrent Thyroid Cancer In The Outpatient Community Setting In The United States

Abstract Objective To determine if radiofrequency ablation (RFA) performed by endocrinologists for recurrent thyroid cancer in the neck is a treatment option in the outpatient community setting in the USA. Methods A review of 9 patients with 12 recurrent thyroid cancer lesions in the neck who were treated with RFA was conducted (July 2020 to November 2021). Recurrence was defined as biochemical and structural identification of disease. Recurrence was confirmed with ultrasound guided fine needle aspiration (US-FNA) cytology and measurement of thyroglobulin (Tg) washout concentration in cases of papillary thyroid cancer (PTC) and calcitonin washout concentration in medullary thyroid cancer (MTC). Informed consent was obtained. RFA was done in the outpatient setting with standard aseptic techniques, conscious sedation, and local anesthesia. Real time US imaging was used to perform hydro-dissection and a limited "moving shot" technique with a medial to lateral approach. Node volume in mL (length x depth x width×0.525) and tumor markers were recorded before at 6 to 12 weeks and at 6 months (m) after RFA. The volume reduction percentage (VRP) for each nodule was calculated using the following equation: VRP = {[baseline volume in mL - final volume in mL]/baseline volume in mL}×100 A VRP of more than 50% was considered a significant response, and VRP of 100% was considered complete response. Results A total of 9 patients with 12 nodes were included in the study. 7 patients had nodal recurrence of PTC in the neck. RFA was recommended for 1 patient as palliative treatment while on treatment with chemotherapy. 1 patient had recurrent MTC. There were no serious complications. 6 m data was unavailable for 2 patients. 9 of 10 (90%) nodes for which data is available had a volume decrease of at least 50% at 6 m. The only patient without at least a partial response to therapy was on chemotherapy. 4 of the 10 (40%) metastatic nodes of papillary thyroid cancer had a complete response. Mean volume reduction for all lesions at 6 mos was 0.339 mL, P = 0. 012. Median change in Tg level at 6 months was 0.4 IU/ml with a downward trend in 4/5 (80%) of patients with recurrent papillary thyroid cancer who were not receiving chemotherapy. Discussion Complete response may be expected in about 40% of patients after RFA at 6 m, however, this may potentially be improved with extended follow up time or multiple RFA sessions. Patients who are not surgical candidates, refuse surgery, or require palliative treatment may be potential candidates for this procedure. Therefore, RFA appears to be a viable treatment option in selected patients with recurrent thyroid carcinoma. Presentation: No date and time listed

Real-time ultrasound elastographic features and color doppler imaging of mitral valve prolapse

Background: The aim of this study was to investigate the elasticity of ocular structures in patients with mitral valve prolapse (MVP).&#x0D; Material and Methods: This prospective study included a total of 35 patients with MVP (study group) and 35 healthy volunteers (control group). The elastography value of the ratio of orbital fat- sclera (ROF/S) was measured with real-time US elastography. For each eye, central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA) were evaluated, respectively. &#x0D; Results: The mean ages of the patients in the study and the control groups were 31.77 ± 11.40 years, and 30.65 ± 7.45 years, respectively (P =0.511). Mean ROF/S were 1.95 ± 0.81 and 1.37 ± 1.06 (P=0.001) in the study groups and control, respectively. The mean RI of the OA was 0.67 ± 0.05 in the control group, 0.67 ±0.05 (0.55; 0.87) in study group. The mean RI of the PCA was 0.66 ± 0.05 in the control group, 0.68 ±0.06 in study group. . The mean RI of the CRA was 0.66 ± 0.05 in the control group, 0.66 ±0.06 in study group. The RI value was not a significant difference between control and study group (p &gt; 0.05).&#x0D; Conclusion: Scleral elasticity was significantly increased in MVP patients. These could be related to ocular pathologies such as glacouma, kerataconus in MVP.

Informativeness of trades around macroeconomic announcements in the foreign exchange market

• We study the extent of private information revealed through trades in the foreign exchange market. • We find the intraday variation in the proportion of permanent price variations driven by trade-related information has a repetitive periodic pattern, • We show the information share of private information in trades evolves across trading periods in the FX markets. • We find that, among market participants, heterogeneous interpretation of announcements and opinion disagreement after the announcement are revealed from order flow, and the efficient price is still driven by information implicit in trading activities after the announcement. We study the extent to which private information is revealed through trades in the foreign exchange market. The trade informativeness measured from the VAR framework of trades and quotes allows us to quantify the impact of asymmetric information on return variation. We find the intraday variation in the proportion of permanent price variation driven by trade-related information has a repetitive periodic pattern, and trades in the overlapping trading hours of London and New York carry most information than the other time segments. The results show the fraction of trade-related component to exchange rate variation positively relates to trading volume and reversely relates to effective spread. With a comprehensive set of 48 real-time US, European, and Japanese macroeconomic news surprises variables, and controlling for the effect of trading volume, spread, and volatility, we find news of production-related economic indicator, e.g., GDP and industrial production, has a positive relationship with the trade informativeness in a trading period, suggesting the increased private information share may be attributed to heterogeneous interpretations of the announcement among market participants. Announcement-related information is gradually resolved into the price, and the information is transited via the channel of trading activities.

Hepatocellular Carcinoma in Evolution: Correlation with CEUS LI-RADS

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver with a high incidence worldwide and a high associated mortality. Well-recognized risk factors that cause a predisposition to the development of HCC include chronic infection with the hepatitis B or C virus, alcohol-related and non-alcohol-related fatty liver disease, and cirrhosis. In these chronically diseased livers, benign regenerative nodules can increase in size and develop cellular atypia that progress into dysplastic nodules and ultimately HCC. This sequence of hepatocarcinogenesis is coupled with changes in nodule vascularity, including progressive decreased density of portal triads and induced neoangiogenesis, resulting in increased hepatic arterial recruitment. Changes in vascularity result in an array of patterns of nodule enhancement and washout, which can be sensitively depicted with dynamic real-time contrast-enhanced US. Regenerative nodules are isoenhancing relative to the liver with all phases, while HCC classically shows avid arterial phase hyperenhancement with late mild washout. In between, there is great variation as nodules evolve through progressive grades of dysplasia toward HCC. Observed patterns of enhancement and washout can be used to diagnose or stratify the risk of malignancy in liver nodules by using the diagnostic algorithm described by the American College of Radiology Liver Imaging Reporting and Data System (LI-RADS). This facilitates the detection and close monitoring of potential early-stage disease. LI-RADS categorizes nodules according to a probabilistic likelihood for HCC with criteria for LR-5 nodules that are highly specific for the diagnosis of HCC, allowing treatment without exposing the patient to invasive biopsy. An invited commentary by Fetzer is available online. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2022.

Point-of-care ultrasound for neonatal central catheter positioning: impact on X-rays and line tip position accuracy

Real-time US use for line tip positioning in the NICU significantly decreased the number of X-rays performed and was associated with better-positioned lines, decreased irradiation and cost. • The use of point-of-care ultrasound (PoCUS) by critical care providers in neonatology has increased in recent years. International guidelines advocate for the use of PoCUS as valid guidance to practical procedures in neonatology. • Central catheters (umbilical catheters and neonatal peripherally inserted central catheters) are among the most commonly used devices to support NICU patients. Proper positioning is crucial to avoid complications and PoCUS has high sensitivity and specificity in accurately determining line tip position. The current standard practice for line tip position confirmation in neonatology is still conventional radiography despite multiple evidence suggest significant inaccuracy of X-ray compared to ultrasound. • PoCUS implementation for line tip positioning leads to a significant decrease in the number of X-rays performed, in radiation effective dose and costs. PoCUS evaluation of central catheters significantly increases the accuracy of the final line tip position with more lines at the cavoatrial junction. • Training is fundamental for univocal interpretation of ultrasound images and an effective learning strategy is being proposed.

Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

Background: Malignant cervical lymphadenopathy in the setting of lung cancer represents N3 disease, and neck ultrasound (NUS) with sampling is described in the Royal College of Radiologists ultrasound training curriculum for the non-radiologists. This study reviews the incorporation of NUS +/− biopsy in the routine practice of a lung cancer fast-track clinic in the UK. Methods: We retrospectively assessed 29 months of activity of a lung cancer fast-track clinic. Systematic focused NUS was conducted in suspected thoracic malignancy, sampling nodes with a ≥5-mm short axis, under real-time US using a linear probe (5–12 Mhz). Fine-needle aspirations (FNAs) with or without 18 Ga core biopsies were taken. Results: Between August 2017 and December 2019, of 152 peripheral lymph nodes (LNs)/deposits sampled, 98 (64.5%) were supraclavicular fossa LNs with median [IQR] size 12 [8–18] mm. Core biopsies were performed in 54/98 (55%) patients, while all patients had FNAs. No complications occurred. The representative yield was 90/95 (94.7%) in cases with suspected cancer. No difference was seen between FNA versus core biopsy (p = 0.44). Of the 5 non-diagnostic samples, one was FNA only. The commonest diagnosis was lung cancer in 66/98 (67.3%). PDL-1 was sufficient in 35/36 tested (97.2%). ALK-FISH was successful in 24/25 (96%) cases. EGFR mutation analysis was successful in 28/31 (90.3%) cases. Median time from clinic to initial diagnosis was 7 [5–10] days. Computed tomography (CT) scans reported no significant lymphadenopathy in 18/96 (18.7%) cases, yet 10/18 (55.5%) cases were positive for malignancy. Conclusion: Neck nodal sampling by respiratory physicians was safe, timely, with a high diagnostic yield and suitability for molecular testing. Neck US can provide a timely diagnosis in cases that may be missed by CT alone.

The Role of MRI-US Fusion Techniques in Detection of Clinically Significant Prostate Cancer

Prostate cancer is the commonest male cancer and the second leading cause of cancer-related death in men. Over many decades, prostate cancer detection represented a continuous challenge to urologists. Although all urologists and pathologists agree that tissue diagnosis is essential especially before commencing active surgical or radiation treatment, the best way to obtain the biopsy was always the big hurdle. The heterogenicity of the tumor pathology is very well seen in its radiological appearance. Ultrasound has been proven to be of limited sensitivity and specificity in detecting prostate cancer. However, it was the only available targeting technique for years and was used to guide biopsy needle passed transrectally or transperineally. Magnetic Resonance Imaging (MRI) has revolutionized the process with the advent of its multiparametric imaging (mp MRI) where the prostate is evaluated by different MRI techniques and the likelihood of the detected lesion is scored using the new prostate imaging-reporting and data system (PIRADS) scoring. Despite the improved detection of clinically significant prostate cancer by mpMRI, the ideal way to target the area of suspicion detected by mpMRI is the next level of challenge. In this review article, we will discuss the recent methods of targeting and focus on the different platforms used to integrate the mpMRI static images with the real-time US scanning in what is called (US-MRI fusion techniques).

Comparison of three different techniques for internal jugular vein cannulation under real time ultrasound guidance

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ultrasound (USG) guided Internal jugular venous (IJV) cannulation is preferred than traditional approach due to increase in success rate, reduction in time taken and attempts of successful cannulation and less complications. The purpose of our study was to observe and compare three different real time 2-dimensional US-guided approaches and to determine which approach improves rate of successful cannulation, decreases complications along with shorter average time taken for the procedure. Primary outcomes of the study were venous access time, catheterization time and success rate. Secondary outcomes were number of patients requiring second attempt and complications observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;120 adult patients were randomly divided into three groups according to real time US guided cannulation done with SAX-OP approach, LAX-IP approach and OAX-IP approach. Parameters like venous access time, catheterization time, number of patients requiring second attempt and complications were noted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Venous access time was shortest in LAX group 21.84±3.67 seconds which was just significant statistically. Catheterization time was shortest in LAX group 241±123 seconds. Cannulation success rate was highest in LAX group 98% and was statistically significant. Patients requiring second attempt was least in LAX group 2.5%. Posterior IJV wall puncture was observed in 10% patients in SAX group and none in LAX and OAX group which was statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; LAX-IP showed better performance in terms of higher cannulation success, lesser average venous access time and catheterization time and lesser complications. On toggling USG probe, both IJV and carotid artery can be differentiated and carotid puncture could be avoided. Hence LAX approach is safer and effective approach.&lt;/p&gt;

Comparison of standard versus ultrasound guidance in radial and femoral access: a subanalysis of the randomised SURF trial

Abstract Background Ultrasound (US) guidance in facilitating arterial access may reduce vascular complications and possible bleeding. There are still limited trials assessing real-time US guidance for coronary angiography. The SURF (Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention) trial showed no difference in primary outcome when the combined radial and femoral ultrasound analysis compared with standard (SD) technique, but significantly improved access efficiency and success rate. Purpose This subanalysis compared clinical and procedural outcomes of the individual radial and femoral access with US guidance versus standard technique. Methods Patients (n=1388) undergoing coronary angiography and percutaneous coronary intervention were randomised (1:1) into radial or femoral access, and (1:1) to SD or US guidance. The primary outcome was a composite of ACUITY (Acute Catheterisation and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Secondary outcomes were access time, number of attempts, venepuncture, difficult accesses and first-pass success. Results Compared to standard, US guidance produced no difference in composite endpoint for both radial (1.4% vs 1.2%, p=0.78) and femoral (3.1% vs 3.8%, p=0.65) accesses. ACUITY major bleeding (radial: 0.9% US vs 0.6% SD, p=0.69; femoral: 1.9% US vs 2.3% SD, p=0.69), vascular complications (radial: 0.3% US vs 0.3% SD, p=0.98; femoral: 1.3% US vs 0.9% SD, p=0.63) and MACE (radial: 0.6% US vs 0.3% SD, p=0.59; femoral: 0.9% US vs 1.2% SD, p=0.78) were similar in the US and SD approaches, respectively. However, US guidance resulted in improved procedural outcomes for both accesses. Femoral access derived the most benefit from US, with reduced mean access time (73 sec vs 97 sec, p=0.006), attempts (1.35 vs 1.84, p≤0.0001), difficult accesses (1.8% vs 6.2%, p=0.004), venepuncture (5.8% vs 12.6%, p=0.002) and improved first-pass success (77.2% vs 58.8%, p≤0.0001). For radial, US reduced attempts (1.59 vs 1.97, p=0.0007), difficult accesses (6.9% vs 12.3%, p=0.02), venepuncture (2.5% vs 5.6%, p=0.04) and improved first-pass success (69.2% vs 60.7%, p=0.02). There was no difference in radial mean access time (111 sec vs 126 sec, p=0.18). Conclusions US guidance in radial and femoral access did not reduce primary outcome compared to standard technique. The use of US significantly improved the efficiency and success rate of arterial cannulation, with femoral access derived the most benefit. Funding Acknowledgement Type of funding source: None

A deep learning method for real-time intraoperative US image segmentation in prostate brachytherapy.

This paper addresses the detection of the clinical target volume (CTV) in transrectal ultrasound (TRUS) image-guided intraoperative for permanent prostate brachytherapy. Developing a robust and automatic method to detect the CTV on intraoperative TRUS images is clinically important to have faster and reproducible interventions that can benefit both the clinical workflow and patient health. We present a multi-task deep learning method for an automatic prostate CTV boundary detection in intraoperative TRUS images by leveraging both the low-level and high-level (prior shape) information. Our method includes a channel-wise feature calibration strategy for low-level feature extraction and learning-based prior knowledge modeling for prostate CTV shape reconstruction. It employs CTV shape reconstruction from automatically sampled boundary surface coordinates (pseudo-landmarks) to detect the low-contrast and noisy regions across the prostate boundary, while being less biased from shadowing, inherent speckles, and artifact signals from the needle and implanted radioactive seeds. The proposed method was evaluated on a clinical database of 145 patients who underwent permanent prostate brachytherapy under TRUS guidance. Our method achieved a mean accuracy of [Formula: see text] and a mean surface distance error of [Formula: see text]. Extensive ablation and comparison studies show that our method outperformed previous deep learning-based methods by more than 7% for the Dice similarity coefficient and 6.9 mm reduced 3D Hausdorff distance error. Our study demonstrates the potential of shape model-based deep learning methods for an efficient and accurate CTV segmentation in an ultrasound-guided intervention. Moreover, learning both low-level features and prior shape knowledge with channel-wise feature calibration can significantly improve the performance of deep learning methods in medical image segmentation.