Ultrasound Guidelines Research Articles

Emergency ward ultrasound: clinical audit on disinfection practices during routine and sterile examinations

ContextIn the emergency ward, where the use of ultrasound is common (including for sterile procedures), ward equipment is constantly exposed to high risks of microbiological contamination. There are no clear guidelines for disinfection control practices in emergency departments, and it is not known how emergency ward doctors follow good hygiene practices.MethodA multi-centre audit was conducted in 16 emergency services from Northern France regional hospitals, in form of a questionnaire. It was proposed to all emergency ward physicians. We excluded questionnaires when physicians mentioned that they did not use ultrasound on a daily basis. The questionnaire was designed using existing hygiene and ultrasound disinfection practices guidelines from varying French medical societies. It included three different clinical scenarios: (a) ultrasound on healthy skin, (b) on injured skin, and (c) ultrasound-guided punctures. All questions were closed-ended, with only one answer corresponding to the guidelines. We then calculated compliance rates for each question, each clinical situation, and an overall compliance rate for all the questions.Results104 questionnaires were collected, and 19 were excluded. For the 85 analysed questionnaires, the compliance rates were 60.4% 95% CI [56.4–64.7] for ultrasound on healthy skin, 70.9% 95% CI [66.3–76.1] on injured skin and 69.4% 95% CI [65.1–73.6] for ultrasound-guided punctures. The overall compliance rate for the compliance questions was 66.1% 95% CI [62.8–69.1]. Analysis of the questionnaires revealed severe asepsis errors, misuse of gel, ignorance of infection control practices to be applied in the context of ultrasound-guided puncture and exposure of the probe to body fluids.ConclusionThis study details areas for quality improvement in the disinfection of emergency ultrasound scanner use. Consequently, we propose a standardized protocol based upon the recommendations used for the questionnaire drafting, with a visual focus on the low compliance points that have been revealed in this audit. This protocol has been distributed to all the medical emergency services audited and included in the emergency resident’s ultrasound learning program.

PSIX-27 Evaluation of real-time ultrasound to predict pre-harvest market endpoints in serial slaughtered British x Continental steers administered an E2+TBA implant treatment vs non-implanted controls

Abstract Steers (n = 80; initial BW 271 ± 99) were serially scanned at 42-d intervals during a 378-d feeding period using an Aloka 500 device by a certified Ultrasound Guidelines Council (UGC) technician using real-time ultrasound. This included 10 separate ultrasound scanning sessions following the initial weight and ultrasound data taken on day minus 7 (one week prior to initial start date). Steers were randomly assigned to implant treatment (either implanted with Revalor XS or not) at day -7. Cattle were weighed and scanned for 12th-rib fat thickness (FTU), 12th-rib longissimus muscle area (LMAU), percentage intramuscular fat (%FATU), and rump fat thickness (RFU) to determine the ability of ultrasound to predict carcass grading outcomes at harvest. Scans were processed by CUP Lab technicians. Eight steers were harvested each 42 days. Carcasses were assessed 48h after harvest to determine 12th-rib fat thickness (FTC), 12th-rib longissimus muscle area (LMAC), and marbling score (MARB). Data were analyzed via Pearson correlation and linear regression to determine the relationship of ultrasound measures to carcass outcomes. Positive correlations (P < 0.01) between ultrasound measures taken the day before harvest and carcass measurements indicated strong relationships between FTU and FTC (r = 0.91), LMAU and LMAC (r = 0.93), and moderately strong relationships between %FATU and MARB (r = 0.76). Prediction equations were generated to estimate FTC = .0088 + (1.02585 x FTU), LMAC = 16.29720 + (0.77197 x LMAU) and MARB = 19.87510 + (5.19832 x %FATU). Results suggest real-time ultrasound data provides an effective tool to estimate carcass outcomes pre-harvest.

95 Evaluation of variation attributable to lab and technician for measurements of beef carcass traits made using ultrasound

Abstract Carcass data that is collected using ultrasound contributes to national genetic evaluation of beef cattle. Cattle are scanned by many technicians and the resulting images are processed by three laboratories providing data to breed associations. The Ultrasound Guidelines Council certifies technicians and laboratories as being proficient. However, there has been no comprehensive evaluation of non-genetic sources of variation that affect the data. The objective of this study was to partition the variance of ultrasound carcass measurements to animal genetic effects, ultrasound scanning technician and image interpretation laboratory. Ultrasound carcass data for longissimus muscle area, percent intramuscular fat, and subcutaneous fat depth were provided by the American Angus Association (n=65,971), American Hereford Association (n=43,380), and American Simmental Association (n=48,298). For each breed variance components were estimated for additive genetic effects of each animal, technician, contemporary group nested within technician and residual. Genetic correlations were estimated treating measurements from the different interpretation laboratories as separate traits. Across all three breeds, additive genetic effects explained between 15 and 30%, 11 and 25%, and 6 and 13% of the phenotypic variance for IMF, SQF, and LMA, respectively. Similarly, technician explained 12-27%, 4-28%, and 4-26% of the phenotypic variance; contemporary groups within technician accounted for 25-45%, 20-54%, and 43-73% of phenotypic variance. Among the image interpretation laboratories, the ratio of greatest to least residual variance was 3.96, 1.62, and 1.50 for IMF, SQF, and LMA, respectively. Genetic correlations between labs ranged from 0.79 to 0.95 for IMF, 0.64 to 0.94 for SQF and 0.78 to 0.98 for LMA. These results suggest the potential for the residual variances to be heterogeneous, particularly for IMF, depending on the image interpretation laboratory.

PSIX-24 Comparison of serial real-time A-mode vs. B-mode ultrasound fat depth measures on prediction of final carcass value endpoints

Abstract Charolais x Angus steers (n = 80) were evaluated across a 378-day feeding period in response to administration of a growth promoting implant containing trenbolone acetate (TBA) and estradiol (E2) using A-mode and B-mode ultrasound. Steers were scanned at 42-d intervals (0, 42, 84, 126, 168, 210, 252, 294, 336) during 10 separate ultrasound scanning sessions 24-h prior to harvest. Ultrasound B-mode rump fat images (BRFU) were obtained by a certified Ultrasound Guidelines Council (UGC) technician using an ALOKA 500V console equipped with a 17.2 cm carcass probe. Ultrasound A-mode images (ARFU) were obtained by a non-UGC certified technician using a RENCO Lean Meater. Images of BRFU were analyzed by the CUP lab whereas ARFU image results were determined chute side by the scanning technician. Carcasses were dissected into total lean, fat and bone post-harvest. Rump fat thickness ultrasound measurements were compared to carcass traits used to determine carcass value. Carcass endpoints included 12th–rib fat thickness (FTC), 12th rib-eye area (REAC), marbling score (MARB), and total percentage of carcass fat (PCF). The correlation between BRFU and ARFU was 0.70 (P < 0.01). Positive correlations (P < 0.01) between ultrasound rump fat measures taken the day before harvest and carcass measurements indicated moderate relationships between BRFU and FTC (r=0.80); BRFU and REAC (r=0.66); BRFU and MARB (r=0.68); BRFU and PCF (r=0.75); ARFU and FTC (r=0.69); ARFU and REAC (r=0.76); ARFU and MARB (r=0.79); and ARFU and PCF (r=0.80). These results indicate A- and B-mode ultrasound measures of rump fat may be adequate measures for estimation of total percent carcass fat.

PSVII-19 Serial ultrasound measures of implanted and non-implanted feedlot steers to determine carcass endpoints

Abstract An Aloka SSD-500V real-time ultrasound unit, equipped with a 17.2cm carcass probe, was used to serially scan feedlot steers (n = 80; initial BW 271 ± 99) at 42-d intervals during a 378-d feeding period by a certified Ultrasound Guidelines Council (UGC) technician. This included 10 separate ultrasound scanning sessions following the initial weight and ultrasound data taken on day minus 7 (one week prior to initial start date). Steers were randomly assigned to implant treatment (REV) or not (CON) at day -7 with the implanted group being re-implanted on day 190. Cattle were weighed and scanned for 12th-rib fat thickness (FTU), 12th-rib longissimus muscle area (LMAU), percentage intramuscular fat (%FATU), and rump fat thickness (RFU) to determine the ability of ultrasound to predict carcass grading outcomes at harvest in implanted vs non-implanted steers. Eight steers were harvested each 42 days and evaluated 48h after harvest to determine final body weight (FBW), 12th-rib fat thickness (FTC), 12th-rib longissimus muscle area (LMAC), and marbling score (MARB). Data were analyzed to determine treatment (TRT) and days on feed (DOF) interactions using the GLIMMIX procedure. Least square (LS) means illustrated differences (P < 0.05) between TRT for FBW, FTU, REAU, and %FATU. No differences (P = 0.088) between TRT for RFU were observed. Differences (P < 0.05) between DOF were observed for FBW through all 10 weigh days. A difference (P < 0.05) across DOF for days 42, 84, 126, 168, 210, 252, and 294 was noted for FTU. These data suggest growth promoting implants cause differences (increases) in weight and traditional ultrasound measures of carcass endpoints.

VP45.25: Management of COVID‐19 associated with ultrasound use in obstetrics and gynecology/maternal‐fetal medicine

As a cornerstone of obstetrics and gynecological care, ultrasound equipment needs to be properly cleaned and disinfected for safe patient use. We sought to determine the impacts of SARS-CoV2 on ultrasound infection prevention practices in maternal and fetal care. The objectives were to review the reported risks of SARS-CoV2 infection for pregnant women and in addition to the ISUOG guidelines, identify and analyse ultrasound infection prevention recommendations from global professional societies. A systematic review of studies assessing pregnancy outcomes in SARS-CoV2 infected patients was conducted. Global ultrasound infection prevention guidelines from professional societies involved with maternal and fetal care were identified and analysed for notable COVID-19 risks and infection prevention recommendations. The literature reported negative outcomes for COVID-19 during pregnancy demonstrating that pregnant women may be a high risk population during the pandemic. Disinfection of all medical equipment as well as their surrounding environment is an important consideration in minimising transmission-based precautions as recommended by guidelines identified. The same ultrasound guidelines also provide guidance around medical equipment use and reprocessing including ultrasound. The application of the Spaulding classification to determine appropriate disinfection level based on risk associated with intended use remains the recommended approach. There is a need for stringent infection prevention measures in settings providing care for pregnant patients. As the full impacts of COVID-19 on pregnancy emerge, these settings should review and upscale their infection prevention practices to protect maternal and fetal health and the health of healthcare workers. Disinfection of the ultrasound environment and equipment is an important part of infection prevention and facilities should consider stringent reprocessing policies as part of the fight against SARS-CoV2.

Deep vein thrombosis protocol optimization to minimize healthcare worker exposure in coronavirus disease-2019

ObjectiveThere are no societal ultrasound (US) guidelines detailing appropriate patient selection for deep vein thrombosis (DVT) imaging in patients with COVID-19, nor are there protocol recommendations aimed at decreasing exposure time for US technologists. We aimed to provide COVID-19-specific protocol optimization recommendations limiting US technologist exposure while optimizing patient selection. MethodsA novel two-pronged algorithm was implemented to limit the DVT US studies on patients with COVID-19 prospectively, which included direct physician communication with the care team and a COVID-19-specific imaging protocol was instated to reduce US technologist exposure. To assess the pretest risk of DVT, the sensitivity and specificity of serum d-dimer in 500-unit increments from 500 to 8000 ng/mL and a receiver operating characteristic curve to assess performance of serum d-dimer in predicting DVT was generated. Rates of DVT, pulmonary embolism, and scan times were compared using t-test and Fisher's exact test (before and after implementation of the protocol). ResultsDirect physician communication resulted in cancellation or deferral of 72% of requested examinations in COVID-19-positive patients. A serum d-dimer of >4000 ng/mL yielded a sensitivity of 80% and a specificity of 70% (95% confidence interval, 0.54-0.86) for venous thromboembolism. Using the COVID-19-specific protocol, there was a significant (50%) decrease in the scan time (P < .0001) in comparison with the conventional protocol. ConclusionsA direct physician communication policy between imaging physician and referring physician resulted in deferral or cancellation of a majority of requested DVT US examinations. An abbreviated COVID-19-specific imaging protocol significantly decreased exposure time to the US technologist.

Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe.

1) To investigate the current practice in point-of-care ultrasound use in PICUs across Europe; 2) to understand the barriers for point-of-care ultrasound implementation in the clinical practice; 3) to identify existing point-of-care ultrasound training programs; and 4) to assess training needs. Cross-sectional electronic survey. Medical directors of European PICUs. The response rate was 42.3%; 142 of the 336 invited PICU medical directors from 26 European countries completed the survey. The clinicians in almost all the PICUs across Europe were reported to use point-of-care ultrasound in some form. A significant variation in the clinical practice according to the patient characteristics and presence of a fellowship training program was observed. PICUs with cardiosurgical patients reported using point-of-care ultrasound significantly more often than others. Ultrasound-guided vascular access was the most common point-of-care ultrasound indication, except in PICUs providing joint care for neonates and children. Units with a fellowship training program reported an increased use of point-of-care ultrasound for hemodynamic evaluation, during resuscitation and a positive impact on collaboration with imaging specialties. Although no barrier was deemed substantial to impede point-of-care ultrasound implementation, a number of potential hindrances to its implementation were reported-such as lack of formal training curriculum, collaborative learning opportunities, and quality assurance processes. Bedside informal teaching in point-of-care ultrasound was reported the most common method to acquire point-of-care ultrasound skills. Point-of-care ultrasound is being used extensively across heterogeneously organized PICU settings in Europe. However, there remains a significant variation in the clinical practice across the units. Clear needs for improved point-of-care ultrasound training programs and clinical governance structure were identified. Evidence-based point-of-care ultrasound guidelines, structured training programs dedicated to neonatal and pediatric intensive care settings, and educational research in point-of-care ultrasound use may help in strengthening clinical governance, making clinical practice uniform and enhancing quality assurance.

Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible ­abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = –0.66, p < 0.001). Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings.

Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

Objectives: To determine the frequency of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax. Study Design: Descriptive cross sectional study. Setting: Conducted in gastroenterology unit at Isra University Hospital, Hyderabad. Periods: One year from April 2016 to March 2017. Material &amp; Methods: Sample of 174 patients of Hepatic Hydrothorax was taken. Patients were of both gender and age ≥ 18 years, having diagnosed cirrhosis since last 5 years and currently having child class B &amp; C severity were included. Hepatic hydrothorax was confirmed on ultrasound chest. After aseptic measures 50ml of pleural fluid was aspirated and sent to Isra University Hospital laboratory following the ultrasound guidelines. Spontaneous bacterial empyema was assessed as “polymorph nuclear cell count” more than 500 cells/mm3 or +ve culture with PMN cell count more than 250 cells/mm3 without parapneumonic effusion. All the data was recorded in the proforma. Results: The mean ± SD age of patients was 53.52 ± 5.52 years. Males were 60.92% while 39.08% were females. The frequency of spontaneous bacterial empyema was about 14.9%. Frequency of spontaneous bacterial empyema was little more in male gender than females (p value = 0.391), while it was significantly increased with increasing age as most common in age group of 61-65 years (p-value = 0.017). Conclusion: It was concluded that spontaneous bacterial empyema in cirrhosis patients was 14.9%.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid.

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts

OBJECTIVE. The purpose of this study was to evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. MATERIALS AND METHODS. A retrospective multicenter study of ultrasound-detected adnexal cystic lesions with appropriate follow-up was conducted. Lesions were classified into benign, indeterminate, or malignant categories according to criteria based on the IOTA simple rules and the SRU guidelines. The prevalence of nonneoplastic cysts, neoplasms, and malignant tumors was calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and ROC analysis for the diagnosis of malignancy was performed. RESULTS. A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). CONCLUSION. Both imaging characterization methods were sensitive for identifying ovarian malignancies, but the PPV was low among women presenting to radiology departments, and the indeterminate classification harbored one-third of the total malignancies. Exploration of varied clinical settings and inclusion of secondary tests may help to refine these systems.

Emergency Ultrasound Literature and Adherence to Standards for Reporting of Diagnostic Accuracy Criteria.

Given the wide usage of emergency point-of-care ultrasound (EUS) among emergency physicians (EPs), rigorous study surrounding its accuracy is essential. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were established to ensure robust reporting methodology for diagnostic studies. Adherence to the STARD criteria among EUS diagnostic studies has yet to be reported. Our objective was to evaluate a body of EUS literature shortly after STARD publication for its baseline adherence to the STARD criteria. EUS studies in 5 emergency medicine journals from 2005-2010 were evaluated for their adherence to the STARD criteria. Manuscripts were selected for inclusion if they reported original research and described the use of 1 of 10 diagnostic ultrasound modalities designated as "core emergency ultrasound applications" in the 2008 American College of Emergency Physicians Ultrasound Guidelines. Literature search identified 307 studies; of these, 45 met inclusion criteria for review. The median STARD score was 15 (interquartile range [IQR] 12-17), representing 60% of the 25 total STARD criteria. The median STARD score among articles that reported diagnostic accuracy was significantly higher than those that did not report accuracy (17 [IQR 15-19] vs. 11 [IQR 9-13], respectively; p<0.0001). Seventy-one percent of articles met ≥50% of the STARD criteria (56-84%) and 4% met >80% of the STARD criteria. Significant opportunities exist to improve methodological reporting of EUS research. Increased adherence to the STARD criteria among diagnostic EUS studies will improve reporting and improve our ability to compare outcomes.

P108: Characterizing use of next-day ultrasound from the emergency department

Introduction: Formal ultrasound imaging, with use of ultrasound technicians and radiologists, provides a valuable diagnostic component to patient care in the Emergency Department (ED). Outside of regular weekday hours, ordering formal ultrasounds can produce logistical difficulties. EDs have developed protocols for next-day ultrasounds, where the patient returns the following day for imaging and reassessment by an ED physician. This creates additional stress on ED resources – personnel, bed space, finances – that are already strained. There is a dearth of literature regarding the use of next-day ultrasounds or guidelines to direct efficient use. This study sought to accumulate data on the use of ED next-day ultrasounds and patient oriented clinical outcomes. Methods: This study was a retrospective chart review of 150 patients, 75 from each of two different tertiary care hospitals in Saskatoon, Saskatchewan. After a predetermined start date, convenience samples were collected of all patients who had undergone a next-day ultrasound ordered from the ED until the quota was satisfied. Patients were identified by an electronic medical record search for specific triage note phrases indicating use of next-day ultrasounds. Different demographic, clinical, and administrative parameters were collected and analyzed. Results: Of the 150 patients, the mean age was 35.9 years and 75.3% were female. Median length of stay for the first visit was 4.1 hours, and 2.2 hours for the return visit. Most common ultrasound scans performed were abdomen and pelvis/gyne (34.7%), complete abdomen (30.0%), duplex extremity venous (10.0%). Most common indications on the ultrasound requisition were nonspecific abdominal pain (18.7%), vaginal bleeding with or without pregnancy (17.3%), and hepatobiliary pathology (15.3%). Ultrasounds results reported a relevant finding 56% of the time, and 34% were completely normal. After the next-day ultrasound 5.3% of patients had a CT scan, 10.7% had specialist consultation, 8.2% were admitted, and 7.3% underwent surgery. Conclusion: Information was gathered to close gaps in knowledge about the use of next-day ultrasounds from the ED. A large proportion of patients are discharged home without further interventions. Additional research and the development of next-day ultrasound guidelines or outpatient pathways may improve patient care and ED resource utilization.

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.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents

BackgroundPoint-of-care ultrasound (POCUS) is an important clinical tool for a growing number of medical specialties. The current American College of Emergency Physicians (ACEP) Ultrasound Guidelines recommend that trainees perform 150–300 ultrasound scans as part of POCUS training. We sought to assess the relationship between ultrasound scan numbers and performance on an ultrasound-focused observed structured clinical examination (OSCE).MethodsThis was a cross-sectional cohort study in which the number of ultrasound scans residents had previously performed were obtained from a prospective database and compared with their total score on an ultrasound OSCE. Ultrasound fellowship trained emergency physicians administered a previously published OSCE that consisted of standardized questions testing image acquisition and interpretation, ultrasound machine mechanics, patient positioning, and troubleshooting. Residents were observed while performing core applications including aorta, biliary, cardiac, deep vein thrombosis, Focused Assessment with Sonography in Trauma (FAST), pelvic, and thoracic ultrasound imaging.ResultsTwenty-nine postgraduate year (PGY)-3 and PGY-4 emergency medicine (EM) residents participated in the OSCE. The median OSCE score was 354 [interquartile range (IQR) 343–361] out of a total possible score of 370. Trainees had previously performed a median of 341 [IQR 289–409] total scans. Residents with more than 300 ultrasound scans had a median OSCE score of 355 [IQR 351–360], which was slightly higher than the median OSCE score of 342 [IQR 326–361] in the group with less than 300 total scans (p = 0.04). Overall, a LOWESS curve demonstrated a positive association between scan numbers and OSCE scores with graphical review of the data suggesting a plateau effect.ConclusionThe results of this small single residency program study suggest a pattern of improvement in OSCE performance as scan numbers increased, with the appearance of a plateau effect around 300 scans. Further investigation of this correlation in diverse practice environments and within individual ultrasound modalities will be necessary to create generalizable recommendations for scan requirements as part of overall POCUS proficiency assessment.

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound.

This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.

Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports

BackgroundMicrophthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic and/or environmental causes. Prenatal diagnosis is neither frequent nor easy and relies on precise, high-quality ultrasonography. Current antenatal ultrasound protocols for imaging of the fetal eye are inconsistent and inadequate to screen for the spectrum of ocular malformations, and there are no clear guidelines on detection of these rare abnormalities. Our study of two cases highlights the importance of early detection, and we review current practice and suggest a definitive fetal imaging protocol.Case presentationWe present two antenatal cases, one each of microphthalmia and anophthalmia, both diagnosed at the morphology scan at our tertiary fetal medicine unit. In both cases, the parents (a 36-year-old woman of Mauritanian ethnicity and a non-consanguineous partner of Nepalese descent, and a 31-year-old Caucasian woman and non-consanguineous Caucasian partner) elected to terminate their pregnancies and made unremarkable recoveries. Subsequent fetal autopsy confirmed the ultrasound scan findings.ConclusionsWe recommend that antenatal ultrasound guidelines are updated to specify use of a curvilinear transducer (2–9 MHz) to image both orbits in the axial and coronal planes, aided by use of a transvaginal probe when the transabdominal approach is inadequate to generate these images. When applicable, three-dimensional reverse-face imaging should be obtained to aid the diagnosis. The presence, absence, or non-visualization of lenses and hyaloid arteries should be documented in reports and these cases referred for a tertiary-level ultrasound scan and fetal medicine review. Imaging of the orbits should occur from 12 weeks’ gestation. Magnetic resonance imaging and amniocentesis with chromosome microarray testing may provide additional genetic and structural information that may affect the overall morbidity associated with a diagnosis of microphthalmia or anophthalmia.

Establishing a Carotid Artery Stenosis Disease Cohort for Comparative Effectiveness Research Using Natural Language Processing

Investigation of asymptomatic carotid stenosis treatment is hindered by the lack of a contemporary population-based disease cohort. We describe the use of natural language processing (NLP) to identify stenosis in patients undergoing carotid imaging. Adult patients undergoing carotid imaging between 2008 and 2012 in a large integrated health care system were identified. An NLP process was developed to characterize carotid stenosis according to the Society of Radiologists in Ultrasound guidelines. The resulting algorithm assessed text descriptors to categorize normal, moderate, and severe stenosis as well as occlusion in both carotid ultrasound (US) and axial imaging (computed tomography and magnetic resonance angiography [CTA/MRA]). For US reports, internal carotid artery systolic and diastolic velocities and velocity ratios were assessed and matched for laterality to supplement accuracy. All studies with abnormal findings and a random sample of studies with normal findings were manually reviewed for confirmation. Sensitivity, positive predictive value (PPV), and prevalence were calculated. A total of 95,880 qualifying index studies (76,249 US and 19,631 CTA/MRA) were identified among 94,804 patients, including 1061 patients who underwent multiple studies on the same day. During follow-up through 2017, 30% of these patients underwent 60,672 additional studies. Overall, 16,830 diseased carotid artery imaging studies were identified, with 5349 (31.8%) exhibiting bilateral disease. This resulted in a laterality-specific cohort with 13,381 moderate, 5177 severe, and 3619 occluded arteries. For studies of normal arteries, the NLP algorithm showed excellent performance with a PPV of 99% for both US and CTA/MRA. After review of 1.6% of random samples, we excluded 72,563 studies without further review. PPV and sensitivity to identify an abnormal artery with correct laterality in the CTA/MRA and US samples were 61% and 96% and 79% and 95%, respectively. Use of NLP to detect carotid disease can result in accurate lesion identification with substantially reduced need for manual review. The resulting cohort allows efficient research and holds promise for similar reporting in other vascular diseases.