US Screening Research Articles

Brachial Plexus Birth Injury: US Screening for Glenohumeral Joint Instability

Brachial Plexus Birth Injury: US Screening for Glenohumeral Joint Instability

What Is the Optimal Strategy To Screen for Hip Dysplasia?

Orthopaedics| October 01 2009 What Is the Optimal Strategy To Screen for Hip Dysplasia? AAP Grand Rounds (2009) 22 (4): 37. https://doi.org/10.1542/gr.22-4-37 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation What Is the Optimal Strategy To Screen for Hip Dysplasia?. AAP Grand Rounds October 2009; 22 (4): 37. https://doi.org/10.1542/gr.22-4-37 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental hip dysplasia, hip region, decision analysis Source: Mahan ST, Katz JN, Kim Y-J. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91(7):1705–1719; doi:10.2106/JBJS.H.00122 Investigators from Children’s Hospital, Boston, used decision analysis to evaluate three different screening decision strategies to detect newborn developmental dysplasia of the hip (DDH): no screening (NS); universal physical examination and ultrasound screening (universal PE/US); and universal physical examination and selective ultrasound screening (universal PE/selective US). With decision analysis, outcomes in a hypothetical group of patients who undergo various diagnostic assessments and treatments are compared based on probabilities derived from literature review and clinical practice guidelines. Where uncertainty exists, analyses using a range of probabilities are conducted. For this study, DDH in the immature hip was defined as a continuum from mild acetabular dysplasia, dislocatable hip, subluxated hip, to a frankly dislocated hip. Each of the three screening strategies has known risk and benefits, including missed diagnosis in the unscreened to overtreatment and risk of avascular necrosis (AVN) or other surgical complications in those screened. The outcome used to assess the effects of different screening strategies (and different treatments based on the results of screening) was development of osteoarthritis of the hip by age 60 years, either from incomplete treatment or from a complication of treatment. In a normal population without DDH, 96% of adults will not have arthritis by age 60 years, so the maximum possible expected value in the analysis was set at 96%. The best screening strategy was determined to be universal PE/selective US screening. The expected value for avoiding severe arthritis before age 60 years for universal PE/US screening was 95.86%, 95.90% for universal PE/selective US screening, and 95.78% for NS. Varying assumed rates of disease prevalence, US sensitivity, rate of late diagnosis, and rate of AVN did not change the hierarchy of the best screening strategy, with either of the screening options still preferred over no screening. The authors estimated that in 2005 universal PE/selective US screening would have meant 1,566 fewer infants born in the US would have arthritis by age 60 years compared to universal PE/US screening. Universal PE/ selective US screening compared to NS gave an even larger difference of 4,969 cases. The authors recommend screening of all neonates by physical examination with selective US screening for high-risk neonates such as those with an abnormal physical examination, breech delivery, or positive family history. Dr Schwend has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The investigators determined that the expected probability of having a non-arthritic hip by age 60 years would be improved with the strategy of universal PE/selective US for high-risk patients. Under no condition were either NS, which is essentially the natural history of DDH, or universal PE/US the best option. Early US screening has resulted in exaggerated DDH prevalence rates as high... You do not currently have access to this content.

US findings of melamine-related renal disorders in Hong Kong children

The melamine-tainted milk incident has caused renal disorders in more than 290,000 children from mainland China since the start of the outbreak in 2008. Since then, more than 27,000 children in Hong Kong have undergone renal US screening. To present and discuss the US features of melamine-related renal abnormalities in Hong Kong children. Between September 2008 and February 2009, 3,835 children attended the Department of Radiology of Princess Margaret Hospital for renal US examination. CT or plain abdominal radiography was performed in those with inconclusive findings. The US findings of detected melamine-related renal disorders were analysed. Echogenic foci in the kidneys were found in 22 children (0.6%). These were located in the renal pelvicalyceal system (in 12 children) and in the renal medulla (in 10 children). The echogenic foci measured 0.1-0.7 cm, with 6 children showing posterior acoustic shadowing, 14 showing comet-tail artefacts, and 2 showing echogenic dots. The incidence of renal disorders amongst Hong Kong children exposed to melamine was lower than in their mainland China counterparts. The renal stones detected were also relatively small, with most demonstrating comet-tail artefacts instead of posterior acoustic shadowing.

What caused the decline in US breast cancer incidence?

The incidence of breast cancer in the US dropped sharply between 2002 and 2003. In this Viewpoint, the author discusses two theories to account for this observation: the decrease in use of hormone-replacement therapy and a decline in the US screening mammography rates.

New Screening Methods Offer Hope for More Accurate Breast Cancer Detection

CHICAGO—Screening for breast cancer with mammography saves lives, but researchers say new approaches offer the potential of more accuracy in identifying abnormalities. While mammography as it is performed now reduces mortality, it does not detect all cancers. It also identifies some benign abnormalities as possibly cancerous, causing unnecessary stress for women needing further assessment and increasing costs for retesting and interpretation. At the Scientific Sessions of the Radiological Society of North America (RSNA) held here in November, investigators presented findings on improvements to current mammography techniques and data on new mammography modalities that may improve sensitivity and specificity. According to the American Cancer Society, in the United States at least 211 240 women were diagnosed with invasive breast cancer and 40 410 died from the disease in 2005 (http: //www.cancer.org/downloads/STT /CAFF2005BrFacspdf2005.pdf). Screening mammography is estimated to result in a relative reduction in mortality of 20% to 35% for women aged 50 to 69 years and about 20% for women aged 40 to 49 years. Film mammography remains the most common screening tool for breast cancer. Gradually being adopted is digital mammography, which produces an electronic image that can be stored and transmitted by computer. Digital mammography is now offered in about 20% of US screening clinics, but so far it has been shown to be only slightly more sensitive than film mammography in detecting breast cancer but only in women younger than 50 years, women with radiographically dense breasts, and premenopausal women (Pisano ED et al. N Engl J Med. 2005;353[17]:17731783). Another new digital tool is computeraided detection, which serves as a second read for radiologists. But its efficacy was questioned in a recent study that found this method reduces the accuracy of interpreting results and increases the rate of biopsy (Fenton JJ et al. N Engl J Med. 2007;356[14]:13991409). However, other researchers believe that this study was flawed and are thus not dismissing computer-aided detection. Overall, researchers think they can do better. “In general, there’s been increasing awareness in the medical community that mammography misses a substantial number of cancers, especially in women with dense breasts,” said Wendie Berg, MD, PhD, a radiologist with American Radiology Services in Lutherville, Md, who presented findings on a study evaluating the addition of ultrasound to standard mammography at the RSNA meeting. “So there’s been interest in screening with a variety of techniques.”

Telemedicine network for ultrasound screening of HCC

Neoplasic diseases are widely recognized as extremely disabling, requiring in advanced stages a large amount of medical, technical, and financial support and, eventually, leading to death. This is why it is recommended to early diagnose them, gaining time for proper care and/or cure. Hepatocellular carcinoma (HCC) is one of these neoplasic diseases, meeting the requirements to become the target of a close surveillance: it is a frequent condition; it has a high rate of mortality; it affects a very well defined at risk population (chronic liver diseases patients). This population can be closely followed-up using a sensitive and easily accepted method (ultrasonography - US). Under these circumstances, the improvement of the screening and surveillance system for the patients at risk for HCC is needed, so the early diagnosis is increased, as well as the chance for an efficient and curative therapeutic intervention. A possible choice would be a telemedicine network for the US screening of a large number of chronic liver disease patients (especially liver cirrhosis) for the early detection of HCC.

Assessing the Safety of Anthrax Immunization in US Army Aircrew Members via Physical Examination

Anthrax in weaponized form is the bioterrorism agent of most concern. Questions raised about the safety of the anthrax vaccine can be addressed by comparing immunized and unimmunized people in population-based studies. A retrospective evaluation of data from periodic physical examinations collected on anthrax-immunized and -unimmunized US Army aircrew members between 1998 and 2005 was performed to evaluate the safety of anthrax immunization. Mean changes in variables found on physical examination and laboratory analysis were compared by use of t tests. Multiple linear regression predicted change in outcome from baseline characteristics. We compared 6,820 immunized subjects and 4,145 unimmunized controls based on US Army aircrew physical examination and screening laboratory tests. No association between anthrax immunization and a clinically relevant change in a tested physiologic parameter was detected. No attributable risk of anthrax immunization was observed in this group of Army aircrew members.

Postnatal clinical and imaging follow-up of infants with prenatal isolated mild ventriculomegaly: a series of 101 cases

Postnatal imaging and clinical outcome of fetuses with isolated mild ventriculomegaly (IMV) have never been systematically analysed. To evaluate the postnatal clinical outcomes of a large cohort of fetuses with IMV and to correlate them with pre- and postnatal imaging. We report a prospective study of 101 fetuses with IMV (10-15 mm ventriculomegaly with otherwise normal US, MRI, karyotype and TORCH screening). IMV was divided into minor (10-11.9 mm) and moderate (12-15 mm) ventriculomegaly. Ventriculomegaly was considered uni- or bilateral, stable, progressive, regressive or resolved according to the prenatal US follow-up. Clinical follow-up was performed by a neuropaediatrician. Postnatal imaging included cranial US (n = 71) and MRI (n = 76). The outcome of minor and moderate IMV was excellent in 94% and 85% of infants, respectively. It was not different between uni- and bilateral IMV, and between stable, regressive and resolved IMV, and was independent of gestational age at diagnosis and gender. Fixed neurological abnormalities were observed in nine infants. Postnatal MRI showed white-matter abnormalities in 14 infants, including 6 of the 9 infants with a poor outcome. The prognosis was slightly better in minor IMV than in moderate IMV. Postnatal MRI showed white-matter abnormalities in two-thirds of the infants with a poor outcome.

A role for US screening in juvenile idiopathic arthritis

More than 50 years ago, the introduction of corticosteroid treatment dramatically changed signs and symptoms of a crippling disease now called rheumatoid arthritis. The effects of corticosteroid treatment on synovium have been shown to be measurable, but initial interest in the subject of arthritis documentation seemed lukewarm at best [1]. In recent changes of management of inflammatory arthritis, physicians have modulated their role in therapy of rheumatoid (RA) and juvenile idiopathic arthritis (JIA) from an indiscriminate suppression of inflammation to a targeted immune treatment including tumor necrosis factor inhibition and B-cell depletion [2]. In this setting of immune system therapy, which can lead to life-threatening infections, appropriate imaging proof of inflammatory arthritis becomes paramount. Correct and well-timed diagnosis will help us avoid treating patients who do not have the disease and, on the other hand, let the ones with the disease be treated early enough so that normal tissues are preserved [3]. Treatment can now for the first time stop the devastation that starts with destruction of bone and cartilage in chronic arthritis. Imaging follow-up of the effects of treatment also increases in importance when disease-modifying agents are considered, because the pictorial review can often prove whether a treatment is working. Up until a decade ago, RA and JIA left imprints on radiographs only by erosion and demineralization of bone—late but characteristic findings of joint inflammation. By having to rely on radiology, rheumatologists always seemed one step behind in the battle against the aggression caused by arthritis. The pathologic diagnosis is based on biopsy findings of pannus, a tissue that deforms joints before it attacks the bone. As a diagnostic tool, invasive synovial biopsy is rarely used. Newer methods of imaging have demonstrated pannus and are able to show the healing and reconstruction of erosions under influence of immune regulating agents. Both MRI and sonography have contributed in documentation of disease status and in recording of follow-up therapy. In the paper by Karmazyn et al. [4], the authors show a practical way of evaluating the pannus of JIA. The authors show that one can screen hands of patients using ultrasound, a noninvasive technique that does not use ionizing radiation, does not require sedation and can be repeated cost-effectively. JIA has proved to be a disease difficult to diagnose, likely an amalgam of chronic arthritides with vastly different prognoses [5]. With continued research in the application of ultrasound in JIA, different and potentially more effective treatment regimens will be devised and tested by regular sonographic measurements of synovial thickness. As imagers, we have an opportunity to expand our role in the diagnosis of juvenile idiopathic arthritis from the making of an accurate but delayed diagnosis with radiographs to early diagnosis of pannus and the monitoring of disease activity through sonography or MRI [6]. With a renewed interest in imaging by non-imagers we can also watch more passively and see it all unfold as onlookers at the sidelines. Pediatr Radiol (2007) 37:623–624 DOI 10.1007/s00247-007-0523-0

Substitutes versus complements among credit risk management tools

Practitioners, regulators and researchers have long recognized important conceptual distinctions among screening, monitoring and collection of loans. However, virtually no empirical studies have explored whether these tools of risk management are employed as net substitutes or as net complements. This paper finds evidence that, across the US banking industry, screening and monitoring behave as net substitutes but collection is complementary to screening and monitoring. A subset of low-risk banks suggests that best practices may involve net substitutability between each pair of these tools and, further, that any weakness in screening is fully offset by strength in monitoring and vice versa.

P01.15: Ultrasound screening of fetal chromosomal diseases in the first trimester of pregnancy in St. Petersburg (Russia)

To assess the effectiveness of US screening at 11–13 weeks of pregnancy using such markers as fetal nuchal translucency (NT) thickness and fetal nasal bones (NB) absence. It is very important to make such analysis due to lack of such investigations in Russia. We investigate 1026 women at 10–13 weeks of pregnancy, mean age 32 (16–47). We use US scanner Aloka SSD-2000, both transabdominal and transvaginal probes. We measure NT thickness and visualize NB in saggital section of fetus. For those fetuses with visible NB we measure it using maximal magnification of ultrasonic picture of fetal face. CVS was done if NT was more than 2.5 mm or fetal NB was not visualised, in case of balanced paternal chromosomal aberrations or previous birth of baby with chromosomal disease. Outcomes of pregnancy were collected using database of local genetic centre. In 40 of 1026 fetuses there was NT 2.5 mm or more. Detection rate of chromosomal diseases using NT thickness was 74% (17/23), sensitivity 74%, specificity 97.7%, PPV-42.5%, NPV-99.4%, FPR-2.2%. In 4 of 1026 fetuses there was absence of fetal NB, and only 3 of them have chromosomal diseases. Detection rate of screening with visualisation of NB was 13% (3/23), sensitivity 13%, specificity 99.9%, PPV-75%, NPV-98%, FPR-0.09% (1/1026). Only in one fetus with trisomy 21 NB length was less than 5th percentile, in other chromosomally abnormal fetuses it was in normal ranges. US screening in the first trimester of pregnancy increases the detection of fetal chromosomal diseases. It is worthwhile to use NT as a marker of fetal chromosomal diseases in US screening. At first glance absence of fetal NB is not so sensitive marker in our population because in almost all fetuses with chromosomal aberrations NB are already ossified in 11–13 weeks of pregnancy. Large studies are needed to confirm whether the measurement of NB length provides any benefits as a marker of fetal chromosomal diseases.

Screening of Immigrants and Refugees for Pulmonary Tuberculosis in San Diego County, California

To evaluate the outcomes of a tuberculosis (TB) screening program for recent immigrants to San Diego County, CA, and to compare the demographic and clinical characteristics of pulmonary TB cases occurring in recently arrived foreign-born persons detected through this screening with those of similar cases found through routine surveillance. Retrospective review of computer databases and medical records. Local public health department. Recent immigrants and refugees classified as TB suspects in their country of departure and foreign-born patients with active TB detected through routine surveillance. Five hundred seventy-one of 658 immigrants and refugees (87%) of completed screening. Thirty-nine subjects (7%) were found to have active TB, and 433 subjects (76%) were found to have latent TB. A diagnosis of active TB was associated with age of 25 to 44 years (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6) and A (odds ratio, 25.7; 95% confidence interval, 1.3 to 512.2) or B1 classifications (odds ratio, 4.3; 95% confidence interval, 1.5 to 12.5). Cases detected through screening comprised 12% of all reported foreign-born persons with active TB. Compared to other recently arrived foreign-born persons with active TB, those detected through immigrant screening were more likely to be Asian and born in the Philippines and less likely to have advanced disease. Most immigrants and refugees classified as TB suspects by foreign screening completed the US screening process, which had a high yield for detecting active and latent TB. Only a minority of foreign-born persons (12%) with active TB were discovered through this program, however, and additional measures are needed to facilitate early case finding in other foreign-born populations.

Ultrasound screening for developmental dysplasia of the hip.

Clinical examination of newborns has been shown to be inadequate for the early detection of developmental dysplasia of the hip (DDH). It is debatable whether US examination is a valid alternative. To contribute further knowledge to the natural history of DDH; to examine the distribution of hip morphology as classified by Graf according to sex and risk factors in an unselected Italian population; to propose a temporal pattern of US screening of all newborns to detect DDH. All newborns (n=8,896) sequentially delivered in the Maternal and Child Health Hospital of Milan underwent US examination in the first week of life and, when findings were within normal limits, in the third month of life. Subjects categorised at birth as Graf type 2a with alpha angle between 50 degrees and 52 degrees, underwent a further US examination at the end of the first month of life. Subjects with ambiguous findings at the 3-month examination were re-examined at the end of the fourth month of life. All infants with abnormal hips abandoned the screening process and underwent treatment. RESULTS. Overall, 56 cases of DDH were identified: 34 in the first week of life examination, 10 at 1 month; 10 at 3 months and 2 at 4 months. CONCLUSIONS. A two-step US screening of newborns is recommended: at the end of the first month and within the fourth month of life.

Towards a more sophisticated use of breast ultrasound.

The diagnostic role of breast ultrasound has been expanded along with the improvement of high-frequency transducers and digital technology. Vascular assessment has progressed enough to depict normal vascular anatomy of the breast and the lymph nodes. Pathologic vessels are seen in almost all the tumors, thus improving US sensitivity for nonpalpable carcinomas. New contrast agents will recirculate enough to search for vascular foci during a thorough investigation of both breasts and nodal stations. The US role in screening might be now revised. Many factors are now in favor of targeted US screening in dense and complex breasts and in high-risk patients. Screening sensitivity is significantly increased. Most of these US-detected tumors are small enough to be curable. Mammography and sonography together are a unique problem-solving and cost-effective tool. They can easily guide fine aspirations or larger biopsies reducing the cost of unnecessary surgical procedures. Accurate US investigations facilitate the surgical approach to a very conservative and cosmetic operation. High-resolution sonography can demonstrate the intraductal spread of tumors and their multiple foci more easily than mammography, but US diagnosis is less sensitive than magnetic resonance mammography in the evaluation of the real tumoral extent. Ductal branching has a complex pattern; therefore, intraductal spread and multifocal nodes are better demonstrated by multiplanar analysis of 3D ultrasound data volumes. Sonography can easily explore the different nodal chains. Metastatic disease is indicated by an enlarged and round shape and the absence of the echogenic hilum. Irregularities in the cortex are a very useful sign in metastatic nodes without total replacement of lymphoid tissue by neoplastic cells. These signs are very specific. A time-consuming, radiation-emitting and costly sentinel biopsy may be avoided in one of every five clinically node-negative patients. But preoperative US assessment is also important as sonography is very sensitive in patients with extensive nodal involvement that might result negative at the sentinel node procedure. New technologies and contrast agents allow perfusional studies that enhance the contrast resolution and will increase the sensitivity of US for small nodal metastases.

Antenatal hydronephrosis: changing concepts in diagnosis and subsequent management.

The overall incidence of genitourinary abnormalities during routine prenatal US screening is 2±9 per 1000 births [1±5], with a male to female ratio of 2 : 1 [3]. The spectrum of genitourinary abnormalities detected in utero is extremely varied; most affected fetuses (50±87%) have hydronephrosis [6±8]. The remaining anomalies include multicystic dysplastic kidney, autosomal recessive polycystic kidney disease, renal agenesis and dysplasia. Other abnormalities that have been described include bladder exstrophy, adrenal hyperplasia, imperforate anus, cloacal abnormalities, neuroblastoma, mesoblastic nephroma and genital abnormalities [6]. The accuracy of the prenatal diagnosis of hydronephrosis has been compared with postnatal evaluations and a false-positive diagnostic error rate of 9±22% is reported [9,10]. This overestimation may be because there are no accepted criteria for the diagnosis of hydronephrosis, and in utero resolution during fetal development [11].

Correlates of physicians' prevention-related practices. Findings from the Women Physicians' Health Study.

Determinants of physicians' prevention-related counseling and screening practices are not well understood. Such determinants are worth knowing because we can then intervene on malleable variables and produce physicians with stronger prevention-related skills. Of the few such variables that have been examined, they have typically only been studied in univariate analyses or in small or otherwise limited populations and have been especially sparsely studied in women physicians. To explore the effect of potential counseling- and screening-related variables in 4501 respondents to the Women Physicians' Health Study, a questionnaire-based study of a representative sample of US women MDs. Being a primary care practitioner and practicing a related health habit oneself were significantly correlated with reporting counseling and screening for all prevention-related variables examined. Current attempts to improve a related habit oneself, ethnicity, region, practice site, and amount of continuing medical education were sometimes significantly correlated with counseling and screening; most other variables studied (i.e., personal health status, a personal or family history of disease, control of work environment, and career satisfaction) were rarely significantly correlated. Being a primary care practitioner and having related healthy habits oneself were the most significant correlates of US women physicians' self-reported prevention-related counseling and screening practices. These findings suggest potential new directions for physician training.

Prevention of colorectal cancer by once-only sigmoidoscopy

There is no national screening programme for colorectal cancer in the UK despite the fact that the annual death toll from this disease exceeds that of breast and cervical cancer. Faecal occult blood testing (FOBT) is under evaluation for screening, but screening by sigmoidoscopy is not considered viable. This situation contrasts with the USA where both annual FOBT and screening by flexible sigmoidoscopy every 3 to 5 years are recommended from 50 years old. We seek to demonstrate that most of the benefit from the US screening policy would accrue from a single flexible sigmoidoscopy examination at age 55 to 60 years with appropriate colonoscopic surveillance for the 3% to 5% found to have high-risk adenomas (≥1 cm or villous histology). If applied nationally, this screening regimen could prevent about 5500 colorectal cancer cases and 3500 deaths in the UK each year, thus saving 40 000 years of life. We estimate that there would be little net cost to the National Health Service because savings obtained from treating fewer patients would largely offset the cost of screening. We recommend that a randomised trial to evaluate screening by single flexible sigmoidoscopy should start without delay. Such a trial would involve about 120 000 participants, and 15 years of follow-up would be required to obtain a clear answer on mortality, although information on incidence reduction would be available sooner.

Thyroid gland: US screening in a random adult population.

High-frequency ultrasound examination of the thyroid was performed in 253 subjects (130 women and 123 men; age range, 19-50 years) that were randomly selected from the population in an area of Finland where goiter is not endemic. Thyroid echo abnormalities were detected in 69 subjects (27.3%). Prevalence of abnormalities increased with age, and women showed more lesions than did men in each of the 3 decades. The abnormality was solitary in 39 subjects (57%), multiple in 15 (22%), and diffuse in 15 (22%). Of the 68 individual nodules, 48 (70%) were smaller than 1 cm in diameter. Anechoic rounded nodules 1-5 mm in diameter were found in 28 subjects. Fine-needle aspiration biopsy was performed in 30 subjects. Cytologic examination revealed no unequivocal malignancies. In eight subjects (3.2%) with a diffuse echo abnormality, cytologic evaluation indicated lymphocytic thyroiditis. It is concluded that the prevalence of small thyroid echo abnormalities in a randomly selected adult population is rather high, a fact that supports use of a conservative approach to these types of findings.

Abdominal US Screening in an Occupational Group Screener's Experience and Accuracy of US Examination

Abdominal US Screening in an Occupational Group Screener's Experience and Accuracy of US Examination

Abdominal US screening employed in an occupational ingroup and the regional people

Abdominal US screening employed in an occupational ingroup and the regional people