Ultrasound Practice Research Articles

AIUM Practice Parameter for the Performance of Selected Ultrasound‐Guided Procedures

AIUM Practice Parameter for the Performance of Selected Ultrasound‐Guided Procedures

AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

AIUM Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination.

AIUM Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination.

AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures

AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures

Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

BackgroundA growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach.AimTo implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures.SettingThe study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns.Program descriptionThis was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention.ResultsThirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099.ConclusionsA single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

Sex chromosome aneuploidy screening in a general population.

Cell-free fetal DNA testing is being used in parallel or in contingency screening as part of the first trimester screen. The test has high sensitivity and specificity for the trisomies 21, 18 and 13. The test also offers the option of assessing sex chromosome aneuploidies (SCA) which are recognised to be the next most common group of aneuploidies in the live birth population. Companies that offer the sex chromosome assessment report an accuracy rate of above 99% and a significant number of high-risk results have been detected in a multi-site Australian ultrasound practice. A high proportion of these women underwent prenatal testing to further assess the sex chromosomes. This study reports the results of these invasive investigations and results show that many of the high-risk SCA results appear to be false positives. This study reports the clinical experience of cell-free fetal DNA (cfDNA) testing with regard to sex chromosome aneuploidies in singleton pregnancies for a multi-site Sydney specialist O&G Ultrasound practice.

Ultrasound Imaging of the Hand and Wrist: Fundamentals and New Perspectives

Technological advances in musculoskeletal ultrasound, specifically the introduction of high-resolution probes, have helped produce exquisite imaging of the small structures in the hand and wrist allowing ultrasound to rival or surpass MRI for many imaging indications. The superficial nature of the structures in the hand and wrist makes scanning easy once the relevant anatomy is understood, potentially providing a starting point for a growing musculoskeletal ultrasound practice. Recent advances in hand and ultrasound technology such as sonoelastography and improvements in probe technology have allowed for increased utilization of ultrasound in hand and wrist imaging. Particular advancements have been made in the evaluation of tendons and nerves, particularly the median nerve in the setting of carpal tunnel syndrome. There has also been intensive research in the area of ultrasound utilization for evaluation of rheumatologic conditions. Ultrasound can now be used as the primary imaging modality used for many conditions in the hand and wrist. The dynamic imaging abilities of ultrasound can provide insights into pathology that are not possible with static imaging modalities such as MRI and CT.

Ultrasound Simulation—How to Adapt It for Donald School Needs?

ABSTRACT “Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand.” —Confucius, 450 BC Use of simulation technology allows learners to perform repetitive ultrasound examinations and practice at their own pace without compromising patient comfort and/or safety. Structured training and incremental exposure to different pathologies enables gradual knowledge and scanning skill acquisition. Ultrasound simulation helps shorten novices’ learning curve in image orientation, hand-eye coordination, interpretation skills and clinical reasoning. Learning new scanning protocols in a scaled, self-directed manner is very useful, especially when considering the patient discomfort, intimate nature of OB GYN sonography and limited faculty spare time. New generation of ultrasound simulators provides an opportunity for longitudinal monitoring of the learners’ scanning skills based on the outcomes obtained by validated tools for assessment. More complex modules can be used for advanced Donald School courses under the guidance of experts to assess skill levels and suggest interventions to improve the quality and timeliness of performing comprehensive examination. How to cite this article Plavsic SK. Ultrasound Simulation— How to Adapt It for Donald School Needs? Donald School J Ultrasound Obstet Gynecol 2017;11(3):179-183.

ACR BI-RADS Use in Low-Income Countries: An Analysis of Diagnostic Breast Ultrasound Practice in Uganda

ACR BI-RADS Use in Low-Income Countries: An Analysis of Diagnostic Breast Ultrasound Practice in Uganda

Evidence‐based practice in sonography – making sense of diagnostic accuracy studies

AbstractBackgroundThe first paper in this series explored the general philosophy of evidence‐based practice for sonographers.AimsThis paper focuses on a specific type of research question that is of most relevance to the practice of sonography, the diagnostic accuracy study.ConclusionAs users of the medical literature, it is important that sonographers are able to accurately read and critically review diagnostic accuracy studies.

OP08.07: Non‐medical fetal sex determination in Denmark: a study on ultrasound practice and quality

OP08.07: Non‐medical fetal sex determination in Denmark: a study on ultrasound practice and quality

The Paul Allan prize for the best paper in Ultrasound.

Many of you will have heard the sad news that Dr Paul Allan died suddenly in January this year, shortly before he was due to retire as Clinical Director of Radiology in Edinburgh. Paul was well known to us through his many publications in ultrasound. He authored many peer-reviewed papers and book chapters and was an editor of several well-known books, including the third edition of Clinical Ultrasound, published in 2011. Paul also made many contributions to the British Medical Ultrasound Society (BMUS), including serving as Honorary Treasurer and then President from 1998 to 2000. He was made an honorary member of BMUS in 2010. For many years, Paul was also an active member of the Shadows Radiological Travelling Club, a club founded in 1946, which meets twice a year at different locations around the UK. In recognition of Paul’s many contributions to the Shadows, the club has offered to sponsor a prize each year for the best paper published in Ultrasound. The prize of £100 will be awarded to the lead author of the best paper published in Ultrasound in each calendar year as judged by BMUS. All authors and categories of paper will be considered and the prize winner will be announced at the BMUS Annual Scientific Meeting. There is no need to apply, but you will need to submit an article via http://mc.manuscriptcentral.com/ult! We begin this August issue of Ultrasound with a research article by Martin et al. on the results of an online survey of transvaginal ultrasound (TVUS) practice in the UK. The survey was publicised through several organisations, including BMUS, and is part of a programme commissioned by the Department of Health aimed at assessing safety and clinical practice in TVUS. The safety of TVUS in early pregnancy scanning is of particular concern as the transducer can be placed close to the fetus, which may then be exposed to heat generated both by ultrasound absorption and by the transducer itself. The survey showed that although most users had a general understanding of thermal and mechanical indices, some were not aware of their meaning or purpose and 40% of respondents rarely or never monitored them during scanning. This article highlights the importance of continued ultrasound safety training and promotion of safety guidelines to users. Purohit and King give a comprehensive review of the use of ultrasound in lower limb sports injuries. This article describes the mechanisms of sports injuries in muscles, tendons and ligaments, followed by well-illustrated descriptions of their ultrasound appearances. This article will be a very useful learning resource for musculoskeletal (MSK) sonographers and is available as a BMUS CPD article via the BMUS website members’ area. Hoskins and Kenwright then review the principles and development of four commercially available ultrasound technologies for vascular applications. Three-dimensional (3D) ultrasound, vector Doppler, wall motion estimation and shear wave elastography have all contributed to the understanding of vascular disease, but it seems they have not been adopted widely into clinical practice. A third review, by Abe et al. studies the literature on morphological and functional relationships of ultrasound measured muscle thickness in the leg. It seems that muscle thickness measurements can be used to predict muscle cross-sectional area and volume in several thigh and lower leg muscles. However, there is little evidence relating muscle function with muscle thickness. A further article in the long running PoCUS series, by Lewis et al. reviews the accuracy of ultrasound in detecting foreign bodies and describes ultrasound techniques for identifying and guiding the removal of various types of foreign body materials. Ultrasound is a cost effective tool for dealing with foreign bodies in the emergency department and can be accurate in the hands of trained emergency physicians. This issue concludes with two case studies. Drought et al. describe the finding of bilateral congenital cataracts in a fetus during a second trimester anomaly scan. They propose that examination of the face and orbits should become a routine part of the fetal anomaly survey, especially where there is a risk of genetic syndromes. Brownfoot et al. describe a rare case of persistent reversed end diastolic flow in the fetal middle cerebral artery. Few such cases have ever been reported and the outcome is normally poor, but this case demonstrates that treatment may be possible if an urgent follow up is made.

WE-A-210-00: Educational: Diagnostic Ultrasound QA

This presentation will focus on the present role of ultrasound medical physics in clinical practices. The first part of the presentation will provide an overview of ultrasound QC methodologies and testing procedures. A brief review of ultrasound phantoms utilized in these testing procedures will be presented. The second part of the presentation will summarize ultrasound imaging technical standards and professional guidelines by American College of Radiology (ACR), American Institute of Ultrasound in Medicine (AIUM), American Association of Physicists in Medicine (AAPM) and International Electrotechnical Commission (IEC). The current accreditation requirements by ACR and AIUM for ultrasound practices will be described and the practical aspects of implementing QC programs to be compliant with these requirements will be discussed. Learning Objectives: 1. Achieve familiarity with common ultrasound QC test methods and ultrasound phantoms. 2. Understand the coverage of the existing testing standards and professional guidelines on diagnostic ultrasound imaging. 3. Learn what a medical physicist needs to know about ultrasound program accreditation and be able to implement ultrasound QC programs accordingly.

WE-A-210-01: Overview of Methods and Accreditation Updates

This presentation will focus on the present role of ultrasound medical physics in clinical practices. The first part of the presentation will provide an overview of ultrasound QC methodologies and testing procedures. A brief review of ultrasound phantoms utilized in these testing procedures will be presented. The second part of the presentation will summarize ultrasound imaging technical standards and professional guidelines by American College of Radiology (ACR), American Institute of Ultrasound in Medicine (AIUM), American Association of Physicists in Medicine (AAPM) and International Electrotechnical Commission (IEC). The current accreditation requirements by ACR and AIUM for ultrasound practices will be described and the practical aspects of implementing QC programs to be compliant with these requirements will be discussed. Learning Objectives: 1. Achieve familiarity with common ultrasound QC test methods and ultrasound phantoms. 2. Understand the coverage of the existing testing standards and professional guidelines on diagnostic ultrasound imaging. 3. Learn what a medical physicist needs to know about ultrasound program accreditation and be able to implement ultrasound QC programs accordingly.

Ultrasound competency and practice: what's in a number?

Ultrasound competency and practice: what's in a number?

Scan When You Can: Using Open Ultrasound Practice Sessions as a Venue to Encourage Interprofessional Education

Recently many medical schools have introduced ultrasound education, with several institutions adopting formal teaching of ultrasound into their anatomy curricula. Additionally, medical schools nationwide have begun to incorporate various forms of interprofessional education (IPE) into their programs to prepare medical students for the teamwork necessary to serve as physicians. The Anatomy course at Mayo Medical School incorporated several IPE sessions with physical therapy students. Since the course is integrated with radiology, ultrasound imaging was recently added to complement static images and visualize living anatomy. Due to the success of prior IPE endeavors in anatomy, a new elective experience for hands‐on ultrasound practice sessions was offered to both medical and physical therapy students. The aim of this study was to assess student perception of elective ultrasound practice sessions as an opportunity for interprofessional peer‐learning. Practice sessions were scheduled once a week for 4 hours and a trained teaching assistant was available during the sessions. Students were encouraged to discuss different techniques and anatomical knowledge based on their respective experiences. A sign‐in sheet was kept to monitor how many students from both groups attended. Students were asked to fill out a survey at the end of 4 weeks to assess perceptions of the interprofessional experience. Preliminary results indicate that students appreciated the diversity of an interprofessional approach to learning ultrasound skills and enjoyed teaching each other anatomy through ultrasound.

A critical evaluation in the delivery of the ultrasound practice: the point of view of the Internal Medicine hospitalist

A critical evaluation in the delivery of the ultrasound practice: the point of view of the Internal Medicine hospitalist

A critical evaluation in the delivery of the ultrasound practice: the point of view of the radiologist

The authors describe the benefits and risks of massive and widespread diffusion of ultrasound diagnostics for public and affiliated centers. The main considerations regarding organizational aspects, cultural and qualitative assistance of various medical professionals belonging to the Public Service, unfortunately point out that not all lesions found are able to use the same standardized diagnostic criteria. The risks of errors in diagnostic consumerism, with consequent multiplication of exams, often redundant, are on the rise. The authors urge greater control and the adoption of stricter criteria for the selection of clinical skills of operators who are responsible for this delicate, difficult and at the same time valuable diagnostic task, moreover, of great social value.

Using Standardized Patients to Teach Point-of-Care Ultrasound-Guided Physical Examination Skills to Internal Medicine Residents.

Point-of-care (POC) ultrasound has been shown to improve procedural outcomes and physical examination accuracy in multiple settings. There are limited data regarding the optimal way to train nonradiologists in POC ultrasound. This is a primary barrier to more widespread use of ultrasound in the physical examination. We created a workshop to instruct postgraduate year (PGY)-2 and PGY-3 internal medicine residents in POC ultrasound imaging of the abdominal aorta and kidneys. A half-day simulation center workshop was created to review ultrasound operations and teach residents to independently obtain ultrasound images of the abdominal aorta and kidneys on standardized patients with normal anatomy. The workshop incorporated didactic instruction and hands-on ultrasound practice in small groups. Each resident's ability to independently obtain ultrasound images was assessed using a preworkshop and postworkshop skills examination with a standardized patient. Resident knowledge and attitudes toward POC ultrasound were also assessed using a preworkshop and postworkshop test and survey. A total of 58 residents completed the workshop, and 84% were able to independently obtain high-quality images of the abdominal aorta and kidney after workshop completion, compared with 16% on the preworkshop test. Residents demonstrated a statistically significant increase in their self-reported confidence with ultrasound operation and image acquisition. Training using standardized patients can prepare residents to independently obtain POC ultrasound images of the aorta and kidneys. Training resulted in increased resident confidence with POC ultrasound and self-reported likelihood of future use.

Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice.

The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved from a mean of 67.9 (SD, 12.8) before implementation to a mean of 87.8 (SD, 14.1) after implementation (t = -7.6; p < 0.001). Safety climate scores improved from a mean of 76.5 (SD, 12.8) before implementation to a mean of 88.3 (SD, 13.4) after implementation (t = -4.6; p < 0.001). In particular, teamwork items about "input being well received" and "speaking up" were the most responsive to the intervention. The implementation of TeamSTEPPS tools was associated with statistically significant improvements in safety and teamwork metrics in an academic interventional ultrasound practice. The most notable improvements were seen in communication among team members and role clarification. We think that this model, which has been successfully implemented in many nonradiologic areas in medical care, is also applicable in imaging practice.