Ultrasound Unit Research Articles

Association Between a Body Shape Index and Subclinical Carotid Atherosclerosis in Population Free of Cardiovascular and Cerebrovascular Diseases.

Aim: We used a dataset from a cross-sectional survey conducted in China to determine which of the anthropometric indices of obesity are important in terms of carotid atherosclerosis free of cardiovascular and cerebrovascular diseases. Methods: A total of 5,245 participants who were volunteering for carotid ultrasound unit in this cross-sectional survey were included in the present analysis. All subjects were free of angina, myocardial infarction, heart failure and stroke, and cancer. A low-risk subgroup was defined as people free of hypertension, diabetes, and hyperlipidemia. All analyses based on logistic regression were gender-specific. Results: The present study consisted of 2,501 males and 2,744 females, with 776 (31.03%) diagnosed as carotid artery plaque in males and 550 (20.04%) in females. Univariable analyses in unadjusted logistic model showed significant associations between disease presence and all central obesity indices. After adjusting for more variables, only a body shape index (ABSI) was associated with the presence of disease in both males and females. Moreover, stepwise regression approaches revealed that ABSI was always an independent determinant of the presence of subclinical carotid plaque. Multiple regression shows a linear and significant increase in the prevalence of atherosclerosis in males and females as ABSI decile levels increased. Similar results were obtained when the association between ABSI and carotid plaque was studied in this low-risk subgroup. Conclusions: ABSI, as a novel anthropometric indicator compared with traditional indices, was found to have a closer relationship with subclinical carotid atherosclerosis, even in populations free of hypertension, diabetes, and hyperlipidemia.

Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease

To evaluate the ultrasound features, types, and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptoms DESIGN: A retrospective observational study. Gynecological ultrasound units from January 2014 to June 2020. A total of 43 adolescents (aged 12-20 years) who were diagnosed as having adenomyosis at a pelvic ultrasound examination. Ultrasound features and location and type of adenomyosis within the uterus were evaluated on stored 2-dimensional images and videos and 3-dimensional volumes. Adenomyosis was classified as mild, moderate, and severe according to the extension of the disease in the uterus as described in our previous published classification. Adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas, and some types of junctional zone alterations. The posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% of adolescents (19/43) with adenomyosis, at least 1 location of pelvic endometriosis was documented. Dysmenorrhea was the most commonly reported symptoms (88%), and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry, and intramyometrial cystic areas. Adolescents with dyspareunia showed diffuse adenomyosis (9/9 patients) including both the inner and outer myometrium (7/9 patients) and in the posterior wall (7/9 patients). Heavy menstrual bleeding was associated with diffuse adenomyosis (18/23 patients) mostly of the outer myometrium (22/23 patients). Scoring system showed predominantly mild disease and no severe adenomyosis was found. Adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding compared with those with the focal disease of the inner myometrium. This study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild-to-moderate form and is associated with typical painful symptoms. In adolescents, the diagnosis of adenomyosis is feasible through a noninvasive way with ultrasound and a proper management can be set.

Cost evaluation of PAGE-B risk score guided HCC surveillance in patients with treated chronic hepatitis B

BackgroundThe PAGE-B score (Platelet Age GEnder–HBV) selects chronic hepatitis B (cHB) patients showing no relevant 5-year risk for hepatocellular carcinoma (HCC). We, therefore, explored potential cost reduction following the introduction of a PAGE-B tailored ultrasound screening in a single center cohort of cHB patients receiving stable antiviral therapy.MethodscHB patients attending throughout the year 2018 were documented. Patients eligible for PAGE-B score were classified into high (≥18 points), intermediate (10–17 points) and low (≤9 points) HCC risk groups. Patients of the low HCC risk group could postpone HCC screening to reduce HCC screening expenses. Full costs for hepatic ultrasound were assessed.ResultsThroughout the year cHB patients (n = 607) attended our clinic, which included PAGE-B eligible patients (n = 227, 37.4%) of whom n = 94 (15.8%) were allocated to the low HCC risk group. Sonographic HCC screening during a median exam time of 12.4 min (IQR 9.2–17.2) resulted in total costs of 22.82 Euro/exam. Additional opportunistic expenses caused by patient’s lost earnings or productivity were 15.6–17.5 €/exam and 26.7 €/exam, respectively. Following a PAGE-B tailored HCC screening at our institution annual full costs for cHB patients could be reduced by 15.51%, which equals a cost reduction by 1.91% for our total sonography unit. In comparison, 1.35% up to 7.65% of HBV-infected patients of Caucasian descent could postpone HCC screening according to population-based estimates from Germany.ConclusionsPAGE-B risk score adapted screening for HCC is an efficient and cost neutral tool to reduce costs for sonography in Caucasian patients with chronic hepatitis B receiving antiviral treatment.

O-025 Value of hysteroscopy

Abstract text The 3 main characters in any ART are the uterus, the endometrium, and the embryo. With the rutinary use of 2D US and especially 3D US in infertile patients we are able to assess most of the uterine anomalies and intrauterine pathologies. Until recently, the assessment of the endometrial cavity with hysteroscopy was reserved only for cases of IVF failure, as a complementary evaluation to ensure that nothing was missed during the ultrasound scan. We also need to remember how hysteroscopy was performed in the past and, unfortunately, in some cases even today. In the old days, to assess the endometrial cavity, it was required to take the patient to the operating room and under general anesthesia, dilate the cervix to then introduce a large diameter hysteroscope only for diagnostic purposes. The prevalent working model in ART today is in close collaboration between Fertility specialists, Ultrasound and Hysteroscopy units in order to improve patient’s outcome. In our center, a diagnostic hysteroscopy is performed as part of the diagnostic workup of the infertility patient. It is performed in office setting and without anesthesia, by the staff of the reproduction and infertility unit. When we look at hysteroscopy as an in-office procedure and no longer as a procedure performed in operating room, we appreciate that it is something that all infertility patients can benefit from. The right question to ask now would be “Is there a benefit in performing a hysteroscopy to all our patients?”. Ultrasound is not perfect, especially when evaluating the endometrium. The gold standard and the only modality that we have to assess the endometrium with direct visualization is hysteroscopy. Chronic endometritis, adhesions and adenomyosis are only a few examples of what can be assessed by direct vision of the endometrial cavity. The advantages of a simple, inexpensive, office procedure such as hysteroscopy outweigh any other consideration against it. During my talk all these points will be presented helping to understand why hysteroscopy is becoming an indispensable tool in every assisted fertility unit.

Changes In Sonographic Characteristics Of The UCL Following A 30-minute Swing Session In Female Collegiate Division I Golfers

PURPOSE: Medial elbow complex injuries have been reported in competitive and recreational golfers. Ultrasound imaging (USI) is a common method for assessing characteristics of the UCL. Prior research has found that sonographic characteristics of the UCL and MJS may be altered due to loads applied to these structures. Loads resulting from repeated golf swings can potentially alter these sonographic characteristics. The purpose of this pilot study was to examine the difference of sonographic characteristics of the UCL and MJS before and after a 30-minute golf swing session by asymptomatic female collegiate golfers. METHODS: Seven asymptomatic NCAA Division I collegiate female golfers (age 19.6 ± 1.5 yrs) participated. Ultrasound images of the UCL and medial joint space of both elbows were obtained using a GE LOGIQ E ultrasound unit. Participants were placed supine with elbow position at 30 degrees, with a wedge placed underneath the humerus creating a gravity induced valgus force on the MJS. Measurements of the thickness of the UCL at mid substance and trochlea apex and MJS were performed, and the difference of pre and post session sonographic measurements were assessed by paired t-tests. RESULTS: There were no statistically significant differences in sonographic UCL and MJS measurements pre and post golf swing session (t = .55-2.3, p > .05). CONCLUSIONS: This pilot investigation found no differences in sonographic UCL and MJS measurements following a single 30-minute swing session. Further research is needed to examine potential differences using larger sample sizes, longer sessions, sessions over time, and more heterogeneous study populations.

Dynamic esophageal patency assessment: an effective method for prenatally diagnosing esophageal atresia

Esophageal atresia is a major anomaly with a low prenatal detection rate. We propose a sonographic method termed dynamic esophageal patency assessment. This study aimed to assess the feasibility and performance of the dynamic esophageal patency assessment in a high-risk population. A prospective study was conducted in a single tertiary fetal ultrasound unit for 12 months. The study group included pregnant women referred for a targeted scan because of one or more of the following: (1) polyhydramnios; (2) small or absent stomach; (3) vertebral, anal atresia, cardiac, tracheoesophageal fistula, renal, and limb abnormalities; (4) first-degree relative with esophageal atresia; and (5) genetic mutation associated with esophageal atresia. In addition to dynamic esophageal patency assessment, a comprehensive anomaly scan was carried out. The fetal esophagus was observed during swallowing. Cases that demonstrated uninterrupted fluid propagation through the esophagus were classified as normal. Cases that demonstrated interrupted fluid propagation, with the formation of a pouch, were classified as abnormal. Cases with unclear visualization of the esophagus or cases that failed to demonstrate either fluid propagation or a pouch were classified as undetermined. Dynamic esophageal patency assessment results were compared with postnatal findings, considered "gold standard." Test performance indices and intra- and interobserver agreements were calculated. For 12 months, 130 patients were recruited, and 132 fetuses were scanned. The median gestational age (interquartile range) at the time of scan was 31.4 weeks (29.0-35.3). Of 132 fetuses enrolled, 123 (93.2%) were normal, 8 (6%) were abnormal, and 1 (0.8%) was undetermined. Excluded from test performance analysis were 3 cases that were terminated without postmortem autopsy (1 was abnormal and 2 were normal), and a fourth case was excluded as it was classified as undetermined. The detection rate of esophageal atresia was 100%, with no false-positive or false-negative case. Sensitivity, specificity, and positive and negative predictive values of the dynamic esophageal patency assessment were 100%. The Kappa coefficient was 1 for both inter- and intraobserver agreements (P<.0001). The median time (interquartile range) required to complete the dynamic esophageal patency assessment was 6.00 minutes (3.00-13.25). The dynamic esophageal patency assessment is a feasible and highly effective method of ascertaining an intact esophagus and detecting esophageal atresia in suspected cases.

Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes

BackgroundRegarding the staging of mediastinal lymph nodes before lung cancer surgery, Endobronchial Ultrasound Transbronchial Needle Aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Endoscopic Ultrasound Fine Needle Aspirations (EUS-FNA) plays an important role in the diagnosis and staging of thoracic diseases, including lung cancer. In this study we analysed all patients underwent endoscopic procedures in our endoscopic mediastinal ultrasound unit.MethodsBetween January 2013 and February 2018, we performed a total of 929 endoscopic procedures, 432 EBUS-TBNA and 497 EUS-FNA. Biopsy was performed at the following mediastinal sites: station 7 in 642 cases, at stations 8 and 9 in 211 cases; at station 3P and 4L in 27 and 114 cases respectively; with EUS we were able to perform biopsy at station 5 in 52 cases.ResultsA total of 841 patients showed a diagnosis of cancer: non-small cell lung cancer (NSCLC) in 645 patients, SCLC in 190 patients, neuroendocrine tumour in 5 patients and one patient with mesothelioma. 88 patients were negative for cancer. In terms of sensitivity, specificity and accuracy, the association between EUS-FNAb and EBUS-TBNAb showed a better quality on diagnosis compared to single procedures. EUS-FNA and EBUS-TBNA are safe, feasible, and highly sensitive techniques.ConclusionsAn endoscopic mediastinal ultrasound unit allows to perform a higher number of endoscopic procedures and improved the sensitivity and the accuracy of the minimally invasive hilar-mediastinal staging.

Transvaginal Ultrasound-Guided Core Biopsy-Experiences in a Comprehensive Cancer Centre.

Simple SummaryAdequate histological diagnosis defines the treatment in gynaecologic oncology. Although transvaginal ultrasound (TVUS) has widespread use in the diagnosis of pelvic tumours, TVUS-guided core biopsy is not a common procedure. In this study we summarize our experience in TVUS-guided biopsies performed in a comprehensive cancer centre, discussing the results of 303 patients who underwent this procedure. In addition, we compare the histological results of the biopsies with subsequent surgical histological results in 94 cases. Our study demonstrates that TVUS-guided core biopsy is a safe and effective histological sampling procedure providing adequate tissue for pathological evaluation in 99% of cases. Compared to surgically obtained histology, this procedure can reliably guide therapy, as its performance is satisfactory. In our opinion, TVUS-guided core biopsy is an effective diagnostic method providing possible benefits to patients referred for suspicion of gynaecological malignancy.In this paper, we report our experience of transvaginal ultrasound (TVUS)-guided core biopsies involving 303 patients referred to the gynaecological ultrasound unit of our national comprehensive cancer centre. Adequate histologic specimens were obtained in 299 patients (98.7%). The most common sites of biopsy sampling were the adnexa (29.7%), the vaginal stump or wall (13.5%), the uterus (11.6%) and the peritoneum (10.2%). Malignancy was confirmed in two-thirds of patients (201/303) and a primary malignancy was diagnosed in 111 of the 201 histologically verified malignant cases (55.2%). Interestingly, 23.9% (48/201) of malignant tumours were proven to have a non-gynaecological origin. Among them, gastrointestinal tumours occurred the most frequently (31/48 patients). Three abscesses were discovered following the biopsy procedure, resulting in a complication rate of 1%. In 94 (31%) patients, subsequent surgery allowed the comparison of the ultrasound-guided and surgically obtained histologic results. We found inaccuracy in 12 cases (12.8%), which is discussed in this paper in detail. Sensitivity, specificity, PPV and NPV to diagnose malignancy was 94.8%, 94.1%, 98.7% and 80.0%, respectively. This is the largest study reported to date about the efficacy and safety of TVUS-guided core biopsy in evaluating pelvic lesions giving rise to a suspicion of gynaecological cancer.

Complete chiral resolution in a continuous flow crystallizer with recycle stream

Repeated temperature cycling of crystals from a conglomerate forming chiral substance suspended in their saturated solution has shown to be effective in converting a mixture of both enantiomers into an enantiomerically pure state. While by now a large number of different setups has been demonstrated, here we show for the first time how a continuous flow temperature cycler with recycle stream is capable of establishing enantiopurity while converting a racemic starting suspension. By capturing the most significant parameters influencing the process kinetics a competitive productivity could be achieved. We show, that fast crystal dissolution at high undersaturations and fast crystal growth at high supersaturations are speeding up the process as long as nucleation can be kept to a minimum or avoided at all. Temperature cycling has shown to result in a shift towards larger sizes for the particle size distribution of the crystals suspended, which is detrimental to the present process governed by size-dependent solubility. By implementing an ultrasound unit recycled material was comminuted, resulting in nearly stable deracemization rates.Graphical abstract

Placental thickness and Transcerebellar diameter for accurate estimation of gestational age in the second trimester (A cross sectional study)

Objective: To assess the accuracy of combined measurementof placental thickness and transcerebellar diameter in estimation of fetal gestational age in second trimester.Patients and Methods: A cross sectional study was conducted at ultrasound unit, department of obstetrics and gynecology,Ain shams University Maternity Hospital in the period betweenJanuary 2020 and March 2020.The population studied included161 pregnant ladies at 14 to 26 weeks.Trans-abdominal ultrasound (Samsung H60, Convex Pro = CV1 = 8MHz - probe 4.9MHz) was used to asses placental thickness and transcerebellardiameter.Results: Our results showed that there is positive correlationbetween Placental thickness and gestational age r= 0.44 whichis highly significant (P value < 0.001). Also highly statisticallysignificant positive correlation between TCD and G.A (P value < 0.001) r= 0.92. Statistical analysis of our results showedthat trans-cerebellar diameter was more accurate than placentalthickness for accurate estimation of gestational age with almostperfect agreement (0.91) between gestational age by last menstrual period and gestational age by trans-cerebellar diameter.Conclusion: Client’s aged 32.8 ±3.4. More than half had primary infertility with mean duration of 4.6 ± 2.4. Female factorinfertility was the commonest cause of infertility. The pregnancy rate per embryo transfer was 36.4%, miscarriage rate was9.1%, while the live rate was 27.3%. The mean VAS scores at1hour, 6 hours, 24 hours and at embryo transfer were 7.1 ± 2.8,4.6 ±1.4, 2.8 ±1.2 and 1.0 ± 0.9 respectively. The mean Likertscore was 2.4 ± 0.9.Conclusion: Both placental thickness and TCD are useful fetalbiometric parameters that can be used for assessment of gestational age. Although placental thickness is positively correlatedto G.A, it is not as accurate as TCD. Unfortunately, combineduse of placental thickness and TCD is not superior to TCDalone in accurate estimation of gestational age.

Paramedic-performed Prehospital Point-of-care Ultrasound for Patients with Undifferentiated Dyspnea: A Pilot Study.

IntroductionThoracic ultrasound is frequently used in the emergency department (ED) to determine the etiology of dyspnea, yet its use is not widespread in the prehospital setting. We sought to investigate the feasibility and diagnostic performance of paramedic acquisition and assessment of thoracic ultrasound images in the prehospital environment, specifically for the detection of B-lines in congestive heart failure (CHF).MethodsThis was a prospective observational study of a convenience sample of adult patients with a chief complaint of dyspnea. Paramedics participated in a didactic and hands-on session instructing them how to use a portable ultrasound device. Paramedics assessed patients for the presence of B-lines. Sensitivity and specificity for the presence of bilateral B-lines and any B-lines were calculated based on discharge diagnosis. Clips archived to the ultrasound units were reviewed and paramedic interpretations were compared to expert sonologist interpretations.ResultsA total of 63 paramedics completed both didactic and hands-on training, and 22 performed ultrasounds in the field. There were 65 patients with B-line findings recorded and a discharge diagnosis for analysis. The presence of bilateral B-lines for diagnosis of CHF yielded a sensitivity of 80.0% (95% confidence interval [CI], 51.4–94.7%) and specificity of 72.0% (95% CI, 57.3–83.3), while presence of any B-lines was 93.3% sensitive (95% CI, 66.0–99.7%), and 50% specific (95% CI, 35.7–64.2%) for CHF. Paramedics archived 117 ultrasound clips of which 63% were determined to be adequate for interpretation. Comparison of paramedic and expert sonologist interpretation of images showed good inter-rater agreement for detection of any B-lines (k = 0.60; 95% CI, 0.36–0.84).ConclusionThis observational pilot study suggests that prehospital lung ultrasound for B-lines may aid in identifying or excluding CHF as a cause of dyspnea. The presence of bilateral B-lines as determined by paramedics is reasonably sensitive and specific for the diagnosis of CHF and pulmonary edema, while the absence of B lines is likely to exclude significant decompensated heart failure. The study was limited by being a convenience sample and highlighted some of the difficulties related to prehospital research. Larger funded trials will be needed to provide more definitive data.

Prevalence of Vitreous &amp; Retinal Disorders among Sudanese Diabetic Patients: A B-Scan Ultrasonography Study

Retina and vitreous abnormalities represent the most common eye disorders in diabetic patients; they may be associated with severe complications. Therefore, this study aimed to study the prevalence of vitreous and retinal pathologies in diabetic patients using B-Scan ultrasound (U/S). A total of two hundred and three Sudanese diabetic patients with long diabetic disease duration (mean 16.28 ± 4.830) years were enrolled in a descriptive-analytical study. 55% (n = 112) were males and 45% (n = 91) were females. The mean age of the participants was 62.28 ± 8.041(range between 30-79 years -old). The study was conducted in a Sudanese ophthalmologic hospital in Khartoum, during the period from 2016–2019. A Nidek (Echoscan US–4000) - B-scan ultrasound unit with 10 MHZ transducer was used. A high-frequency direct contact technique was applied. The inclusion criteria included adult diabetic patients. The vitreous and retina disorders were more prevalent in diabetic hypertensive participants 55 % (n = 112). The high frequency of the disorders was observed in age groups: 60–69 and 50–59 years-old. The most common disorder was retinal detachment which was detected in30.5% (n = 62) followed by vitreous changes in16.3% (n = 33). Posterior vitreous was observed in 15.8% (n = 32), vitreous hemorrhage seen in 15.3% (n = 31), both retinal detachment with vitreous hemorrhage were detected in 11.3%) (n = 23), retinal detachment with cataract were reported in 3.4% (n = 7), retinal detachment with Vitreous changes were seen in 3% (n = 6), and other changes were noted in 4.4% (n = 9) of the participants. There is no significant a statistical association between gender/diabetic duration and age with the disorders (P = 0.2, 0.43, and 0.5) respectively. Vitreous &amp; Retinal disorders were more prevalent in diabetic hypertensive patients. The high frequency of the disorders was observed in the age group (50–70). The ultrasound is a useful method in diagnosing Vitreous &amp; Retinal disorders among the diabetics.

Abstract No. 135 Point-of-care ultrasound (POCUS) versus conventional ultrasound imaging quality

To compare the quality of point-of-care-ultrasound (POCUS) imaging guidance for interventional procedures compared to that of conventional ultrasound (US) imaging Intra-procedural US images from the first 119 procedures in 108 patients using POCUS following its integration into our practice were uploaded to a HIPAA compliant cloud. When conventional US imaging from these cases was also captured and stored on our picture archival system (PACS) for quality assurance and documentation, these images were also evaluated. 119 comparable procedures in patients with similar body mass indices and matched procedural type where conventional US was utilized were identified. Studies were reviewed by the P.I. and the intra-procedural images stripped of PHI and proprietary ultrasound unit graphics or annotations. Representative images from each case were imported into a PowerPoint (Microsoft Corp. Redmond, WA) presentation, 1-2 images per slide, for a total of 331 case slides (123 POCUS-guided procedures with 101 correlative images taken with conventional US imaging, and 107 matched procedures performed with conventional US imaging). Slides were assorted using a random sequence generator. The PowerPoint presentation was then stored in an electronic folder on the Departmental share-drive for review by three blinded co-investigators for image quality on a 10-point Likert scale (inadequate ≤ 4.9; adequate 5.0-6.9; good 7.0-8.9; excellent 8.0-10). Scores were compared between procedures completed with the two different US technologies (POCUS versus conventional) and across procedural categories. 331 total observations were made. Overall quality of the POCUS images was rated as 5.7, compared with 7.0 for conventional US images of the same cases and 6.8 for the other conventional US-guided cases. For POCUS cases, all procedural categories had images rated as adequate (5.0-5.8) except vascular access which was rated as good (6.8) and conversely nephrostomy access which was rated as 4.7. This compares to conventional US images, which were rated as good for all categories (6.4-7.9), except nephrostomy access which was rated as 5.7. In 10 cases, two of three of the reviewers deemed the image quality ≥ adequate for procedural guidance compared to the third reviewer; 9 of these cases were in the POCUS group. Point-of-care ultrasound pocket-sized imaging was rated as “adequate“ for guidance of most vascular access and non-vascular procedures compared to “good“ for conventional ultrasound imaging.

Point-of-care hand-held ultrasound for peripheral intravenous cannulation: a scoping review protocol

Background Billions of peripheral intravenous catheters (PIVCs) are used globally each year, with 44-58% of first attempts failing. Ultrasound use for PIVC insertion has demonstrated improved first pass success, reduced attempts, and improved satisfaction. With the expansion of point-of-care and hand-held ultrasound units, there is a need to identify and explore options for clinical use. Aim We aim to conduct a scoping review of peer-reviewed and non-peer-reviewed literature to identify articles that explore the nature and distribution of research activity and current state of evidence in the adoption and use of point-of-care and hand-held ultrasound for PIVC insertion. Methods A search using keywords and Medical Subject Headings for published and unpublished literature in English between the years 2000 to 2021 will be undertaken in electronic databases and clinical trial registry sites. Two independent reviewers will screen all titles and abstracts for eligibility and extract data from relevant articles into a standardised electronic data collection form. Quantitative studies will be classified into groups investigating similar interventions, strategies and outcomes, and data presented as descriptive statistics, as appropriate. A thematic analysis will be conducted on the information extracted from qualitative studies and findings presented using narrative synthesis. Ethics and dissemination Ethics approval is not required for this review. The findings will be published and presented to audiences invested in peripheral intravenous cannulation success.

A Practical, Clinical User-Friendly Format for Breast Ultrasound Report.

Breast ultrasound (BUS) is often performed as an adjunct to mammography in breast cancer screening or for evaluating breast lesions. Our aim was to design a practical and user-friendly format for BUS that could include the details of the Breast Imaging Reporting and Data System. As a team of radiologists and surgeons trained in the management of breast diseases, we gathered and carried out the project in four phases-literature search and collection of present report formats, summarizing key points and preparing the first draft, seeking expert opinion and preparing the final format, and pilot testing-followed by a survey was answered by the research team's radiologists and surgeons. It produced a list of items to be stated in the BUS report, the final BUS report format, and the pilot format guide. Then, the radiologists used the format in three active ultrasound units in university-affiliated centers, and reports were referred to the surgeons. At the end of the project, the survey showed a high degree of ease of use, clarity, conciseness, comprehensiveness, and well-classified structure of the report format; but radiologists believed that the new organization took more time. We propose our design as a user-friendly and practical format for BUS reports. It should be used for a longer time and by various ultrasound centers in order to ascertain its benefits.

Comparison of Body Mass Index, Smoking, Vitamin E and Type of Oil Consumed Between Patients Suffering from Non-alcoholic Fatty Liver Disease Versus Non-affected Patients: A Case-Control Study

Background: Non-alcoholic fatty liver disease (NAFLD) has an increasing trend in the world and can lead to liver failure and death if left untreated. Lifestyle modification is very important in the treatment of this disease. Objectives: This study aimed to determine the comparison of body mass index (BMI), smoking, vitamin E consumption, and type of oil consumed by patients with NAFLD with non-alcoholic patients. Methods: The present study was a retrospective case-control study that was performed on 120 patients referred to the ultrasound unit of Shohaday Ashayer Hospital in Khorramabad. The participants were divided into two groups, including case (61 people) and control (59 people). The questionnaire consisted of three parts: (1) the first part was related to demographic information; (2) the second part was related to liver ultrasound results; (3) and the third part was related to height, weight, BMI, weekly vitamin E intake, daily smoking status, and type of oil consumed. Data were analyzed using SPSS-23 software and descriptive and inferential statistical methods. Results: Most of the participants in the study were 69 (55.8%) and 92 (76.66%) were married. The mean BMI of patients with NAFLD was significantly higher than non-alcoholic patients (P = 0.003). There was no statistically significant difference in daily smoking and weekly intake of vitamin E in patients with and without non-alcoholic fatty liver disease (P &lt; 0.05). According to Fisher's exact test, it was found that there was a statistically significant difference in the frequency by patients with NAFLD and non-alcoholic (P = 0.014). Also, a statistically significant difference was observed in the frequency of the type of oil consumed by patients with NAFLD (P = 0.014). Conclusions: Consumption of olive and sesame oil along with weight loss is recommended. Smoking as a risk factor, as well as the use of vitamin E to prevent and treat NAFLD, require further studies with a larger sample size.

Strain Elastography of Injured Equine Superficial Digital Flexor Tendons: A Reliability Study of Manual Measurements.

Simple SummaryStrain elastography is an ultrasound-based technique that assesses the mechanical properties of tissues and gives a relative representation of elasticity. Early diagnosis of tendon injuries and long-term monitoring of the healing process are key to equine practice; thus, an accurate method is needed for analyzing and interpreting the images obtained with strain elastography. The first aim of the study was to demonstrate the intraoperator repeatability and interoperator reproducibility of manual measurements of elastograms obtained from injured superficial digital flexor tendons of horses; the second aim was to perform a standardization of the manual measurement method by comparing it with external software. Despite their subjectivity, manual measurements proved to be repeatable and reproducible. In addition, the results obtained with the manual method matched those obtained with the external software.Early diagnosis of tendon injuries and accurate long-term monitoring of the healing process are key for equine veterinarians that use conventional ultrasonography. The development of strain elastography could improve the management of clinical cases. The aim of the study was to assess the intraobserver repeatability and interobserver reproducibility of manual measurements of the colored areas of the tendons within elastograms and to standardize this manual modality by comparing the analysis of the images with ImageJ. Twenty elastograms of the injured superficial digital flexor tendons (SDFTs) of horses were analyzed by two different operators after an acute injury was diagnosed with ultrasonography. Statistical analysis demonstrated excellent intraobserver repeatability (intraclass correlation coefficient, ICC = 0.949) and good interobserver reproducibility (ICC = 0.855) for manual measurements performed with tools available on the ultrasound unit. A good agreement between manual measurements and measurements performed with ImageJ (ICC = 0.849) was then demonstrated. Despite its subjectivity, the manual modality proved to be a valid method for analyzing images obtained with strain elastography.

GALLBLADDER STONES SPECTRUM IN SAUDI POPULATION BY USING ULTRASONOGRAPHY

Objective:This study was designed with an aim to determine the incidence of gallbladder stonesandto evaluate the accuracy of ultrasonography in the diagnosis of calculus, occur in Saudi patients whom presents at the Radiology and Ultrasound Department. Materials and method: Retrospective study in the period 22 August 2020 to 22 December 2020, a total of 108 patientsunderwentultrasound. When the gallbladder is investigated using ultrasound imaging (US) modality. Ultrasound instrument used was spatial digital U22 Philips Convex probe 3.5 Data analysis performed using the tables and computerized systems,ultrasound using different types of ultrasound units with 3.5 MHz and 5 MHz curve linear probes.Statistical analysis was performed using Microsoft Excel Software and the Standard Statistical Package for the Social Sciences version 15 for windows. Result: Out of 108 examined samples [mean age of 29 years male to female ratio of .9:1].Gallstones in this study were more common in the age range from 2 to 39, (58.3%).The most common causes of gallbladder stones are, 0ral contraceptives44(40.7%),Cholesterol28 (25.9%),Biliary dyskinesia 17 (15.7%),Diabetes 12 (11.1%),and Spinal cord injury7 (6.5%)one of the commonest complaints is upper abdominal pain,52(48.1%) and in majority of the cases the etiology is treatable,Nausea30 (27.8%) andVomiting 26(24.1%).Confirmation is done by CT scan 20 (18.5%) for the cases of small gall stones (&lt;2mm) and impacted stones in cystic duct and operations, Cholecystectomy 14(13%) were done for stones large than (&gt;2 cm), who have a nonfunctional or calcified (porcelain) gallbladder and patients for spinal cord injured. Conclusion: Ultrasound (US) is the preferred method for evaluating gallstones with 96% accuracy. The number, size and calcification can be evaluated by virtue of US inversion and attenuation. If there are more than five stones, the accuracy decreases.

Sonographic Cardiovascular Assessment of the Aorta: Pilot of a Modified Image Grading System

Objective: Atherosclerosis is a chronic inflammatory disease that can be undetected in middle-aged patients. Abdominal aortic calcifications (AACs) are one form of cardiovascular disease (CVD), and these can go undetected during a routine physician visit. Sonography has the potential to assess CVD progression, quantify plaque in the aorta, and help to quantify risk in asymptomatic patients. Methodology: This pilot study modified a current AAC grading system to create a scoring method for sonographic images among a small cohort of asymptomatic participants. A traditional portable ultrasound unit was used to image participants, and a subset underwent the same imaging with a handheld transducer and tablet. Results: In this cohort, six males and five females, it was possible to adequately visualize and assess plaque, utilizing both types of ultrasound equipment. The abdominal aorta was divided into segments on the sonogram for quality of grading. Ten participants were categorized with a grade II and one participant was given a grade IIIA. Conclusion: Replication of this modified grading system is needed to better understand the clinical utilization of sonography as a risk assessment tool. The risk assessment scoring was not dependent on the type of device used.

281 Aspirin acceptance rate and perceived preeclampsia risk after the implementation of universal screening for preeclampsia

To determine the acceptance rate of low-dose aspirin (81 mg) after the implementation of universal screening for preeclampsia in the ultrasound unit using a questionnaire and assess the accuracy of the patient’s perception of risk. This is a retrospective cohort study of all women presenting for their first-trimester ultrasound at Saint Francis Hospital and Medical Center between December 1, 2017 and December 31, 2019. The women were screened for clinical risks of preeclampsia using a self-administered questionnaire developed from the United States Preventative Task Force (USPTF) risk-assessment recommendations. Those found to be at moderate or high risk for preeclampsia were recommended to take a low-dose aspirin (LDA). During their anatomy ultrasound, patients completed a follow-up questionnaire assessing aspirin compliance and perceived risk for developing preeclampsia. Descriptive statistics were used to calculate frequencies. Of 3,872 patients, 767 (19.8%) screened moderate or high risk for developing preeclampsia, 142 patients who had already been recommended by their obstetrician to take an LDA were excluded. The remaining 625 patients were recommended to take an LDA. 59.8% (374/625) subsequently completed the follow-up questionnaire. Of these, 93.8% (351/374) reported their perceived risk: 18.5% (65/351) reported no risk, 36.7% (129/351) low risk, 32.8% (115/351) moderate risk, and 12.0% (42/351) high risk. The acceptance rate of LDA was 77.3% (289/374). Only 25.6% (74/289) of those taking the aspirin accurately perceived their risk. When asked about the reason for taking the LDA, 70.1% (197/281) reported that LDA lowered their risk of preeclampsia or hypertension and 21.4% (60/281) reported it was recommended by their physician. A simple and quick intervention using a questionnaire in the ultrasound unit led to good acceptance of the LDA recommendation by patients found to be at moderate or high risk for developing preeclampsia even though only 1/4 of patients accurately perceived their risk for preeclampsia.