Use Of Ultrasound Imaging Research Articles

Point-of-care ultrasound in resource-limited environments: a review

Ultrasound is a standard assessment modality in hospital and prehospital settings. It is becoming more accessible in remote, austere and resource-limited environments. Aim: This article aims to review the literature on the use of point-of-care ultrasound (POCUS) imaging in low- to medium-income countries (LMICs) and by practitioners working in remote and austere out-of-hospital environments. Methods: Fifteen articles published between 2019 and 2023 found via PubMed were identified and analysed. Results: The 15 papers present the use of ultrasound imaging by practitioners in LMICs: six were systemic reviews; five were narrative reviews; two were randomised clinical trials; and two were case studies. Conclusions: Few articles focusing on POCUS use in LMICs were published over the five-year period. However, the number of publications increased over the years. Of the 15 studies in this review, six (40%) were systematic reviews, five (33%) were narrative reviews, two (13%) were random clinical trials and two (13%) were case studies. All studies were conducted in district hospitals or other resource-limited environments. The studies have revealed a significant increase in POCUS use over the past few years, with the majority of the devices now being smartphone-based. This is a promising development in POCUS use in austere environments.

The annual ovarian cycle in Northern pit vipers (Bothrops atrox) using serum steroids and ultrasound of the female reproductive tract

Knowledge on hormonal regulation of reproductive cycles in viperid snakes is still incipient, especially when it comes to females and tropical species. There is an urgent need to understand the reproduction of venomous snakes to improve assisted reproduction techniques and optimize the maintenance of these animals in captivity. With this in mind, we monitored Northern pit viper females year-round throughout different seasons via serum levels of progesterone (P4) and estradiol (E2) in conjunction with ultrasound examinations. Ovarian follicles were classified according to their size and stage of vitellogenesis in F-I and F-II (non-vitellogenic phase) or in F-III and F-IV (vitellogenic phase). During autumn and winter, five adult males were rotated among these females for reproductive pairing, which resulted in 17 copulations and 2 pregnancies in the first year and 12 copulations and 5 pregnancies in the second year. Then, we assessed changes in P4 and E2 levels according to seasons, predominant ovarian structures and the presence of embryos or eggs in the oviduct. Our findings showed high levels of E2 when a greater number of vitellogenic follicles were detected, indicating a possible influence of E2 on vitellogenesis and higher levels of P4 whenever eggs and embryos were visualized in the oviduct, implying its role in maintaining pregnancy. Descriptive analysis of the vipers’ ovarian cycles revealed a greater number of vitellogenic follicles during winter, probably as a result of increases in E2; whereas pregnancies occurred predominantly in spring, under the influence of P4. The use of ultrasound images, as a minimally invasive methodology, associated with serum steroid levels has proven to be an efficient approach in the reproductive monitoring of Northern pit vipers in vivo. In addition, these data suggest that female pit vipers under human care display a seasonal reproductive cycle, despite earlier studies involving captive males of the species indicating a lack of seasonality in sperm production and quality.

798 Improving the Use of Ultrasound Imaging in the Diagnosis and Assessment of Paediatric Patients Admitted with Suspected Appendicitis

Abstract Aim To investigate the barriers to and rate of ultrasonography use to facilitate the diagnosis of suspected appendicitis and assess its effect on negative appendicectomy rates in concordance with GIRFT guidelines for children with abdominal pain. Method Retrospective single-site data on paediatric patients presenting with suspected appendicitis was collected over 6 months, using operative and admission records, imaging requests and histology results. An anonymous survey was distributed amongst Surgical clinicians to determine the perceived impact of access to and influencers of ultrasonography use for children. Results Of 91 patients, 35 underwent a diagnostic laparoscopy. The operation findings were: 23% (8) not acute appendicitis, 23% (8) perforated or complex appendicitis and 54% (19) “other” acute appendicitis. 85% (30) of patients who were surgically managed did not have an ultrasound before theatre. 23% (21) of the total cohort underwent an ultrasound and none of the scans suggested acute appendicitis. Of these, 76% (16) of patients were managed non-operatively. Of the 5 patients who underwent an ultrasound and proceeded to laparoscopy; none had intraoperative findings of appendicitis. Further analysis aims to investigate why ultrasound was utilised for only 23% of patients and to clarify the decision-making processes behind a “straight to theatre” versus an “imaging-first” approach. Conclusions The negative paediatric appendicectomy rate in this District General Hospital was 23%. According to this data, ultrasonography is a reliable rule-out tool for suspected appendicitis and more frequent use could reduce unnecessary operations.

Ex vivo method for rapid quantification of post traumatic brain injury lesion volumes using ultrasound

BackgroundStudies of traumatic brain injury often involve the quantification of the lesion volume as a major outcome measure. The determination of lesion volume typically employs the cutting and mounting of brain tissue, and the calculation of the cross-sectional area of the lesion within each section of brain after histological staining. This is a time consuming and laborious task often requiring many weeks to determine the lesion volume for an individual brain. MethodsIn this report we present a method for determining the lesion volume within the brain following traumatic brain injury that involves the use of ultrasound imaging. With this process the lesion volume can be determined within a time period of 90 min per brain rather than weeks and months. Moreover, we have developed a pipeline that will combine the cross-sectional ultrasound images of the brain with the Allen Mouse Brain Atlas to provide the precise anatomical structures that are affected by traumatic injury to the brain. The anatomical detail was lastly paired with behavioral data showing neurological deficits correlated with specific areas of brain injury. ResultsThe accuracy and precision of this method was shown to be highly consistent with the traditional histological approach. Additionally, the mapping process and behavioral data show that neurological recovery from 1 to 3 weeks post injury is not correlated with gross anatomical recovery of the TBI lesion in our TBI model. ConclusionTogether these approaches will enhance the pipeline for processing brain tissue in experimental conditions where the lesion volume is an important outcome parameter and provide more high resolution information about the identity of the damaged regions of the brain.

Precision Medicine in Rheumatology: The Promise of Ultrasound-Guided Synovial Biopsy, Barriers to Its Implementation in the United States, and Proposed Solutions.

In the clinical evaluation of inflammatory arthritis and the research into its pathogenesis, there is a growing role for the direct analysis of synovial tissue. Over the years, various biopsy techniques have been used to obtain human synovial tissue samples, and there have been progressive improvements in the safety, tolerability, and utility of the procedure. The latest advancement in synovial tissue biopsy techniques is the use of ultrasound imaging to guide the biopsy device, along with evolution in the characteristics of the device itself. While ultrasound guided synovial biopsy (UGSB) has taken a strong foothold in Europe, the procedure is still relatively new to the United States of America (USA). In this paper, we describe the expansion of UGSB in the USA, elucidate the challenges faced by rheumatologists developing UGSB programs in the USA, and describe several strategies for overcoming these challenges.

An extended focused assessment with sonography in trauma ultrasound tissue-mimicking phantom for developing automated diagnostic technologies.

Introduction: Medical imaging-based triage is critical for ensuring medical treatment is timely and prioritized. However, without proper image collection and interpretation, triage decisions can be hard to make. While automation approaches can enhance these triage applications, tissue phantoms must be developed to train and mature these novel technologies. Here, we have developed a tissue phantom modeling the ultrasound views imaged during the enhanced focused assessment with sonography in trauma exam (eFAST). Methods: The tissue phantom utilized synthetic clear ballistic gel with carveouts in the abdomen and rib cage corresponding to the various eFAST scan points. Various approaches were taken to simulate proper physiology without injuries present or to mimic pneumothorax, hemothorax, or abdominal hemorrhage at multiple locations in the torso. Multiple ultrasound imaging systems were used to acquire ultrasound scans with or without injury present and were used to train deep learning image classification predictive models. Results: Performance of the artificial intelligent (AI) models trained in this study achieved over 97% accuracy for each eFAST scan site. We used a previously trained AI model for pneumothorax which achieved 74% accuracy in blind predictions for images collected with the novel eFAST tissue phantom. Grad-CAM heat map overlays for the predictions identified that the AI models were tracking the area of interest for each scan point in the tissue phantom. Discussion: Overall, the eFAST tissue phantom ultrasound scans resembled human images and were successful in training AI models. Tissue phantoms are critical first steps in troubleshooting and developing medical imaging automation technologies for this application that can accelerate the widespread use of ultrasound imaging for emergency triage.

Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework

ObjectiveTo establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity DesignDelphi study SettingInternational, web-based survey ParticipantsA purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15). InterventionsIn round 1, open-ended questions were posed relating to potential scope of practice for ‘ultrasound imaging in spasticity management’; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated. Outcome measures5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above. ResultsThree different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated. ConclusionRelating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.

Mass synchronization of gonadal maturation in banded knifefish broodstock (Gymnotus cf. carapo)

The banded knifefish Gymnotus cf. carapo (Pisces, Gymnotidae), also known locally as tuvira, is a natural resource of great importance to the Pantanal biome that has been used as live bait in sport fishing. This study investigated the mass synchronization of gonadal development of banded knifefish in captivity by subjecting them to different water electrical conductivity at different time intervals (pre and post conductivity change) and also evaluated the use of ultrasound imaging to identify the sex and phases of ovarian recrudescence of the captive broodstock. Fish were exposed to three different combinations of time intervals (Group 1: 40 + 30 days; Group 2: 45 + 25 days; Group 3: 50 + 20 days) and water conductivity (high: 180 μS/cm, followed by low: 15 μS/cm conductivity, respectively). The control group was kept in low water conductivity throughout the 70-day trial. Based on the results, 93%, 94%, and 86% of mass gonadal maturation of Gymnotus cf. carapo could be achieved by keeping the fish in high water conductivity (180 μS/cm) for 40, 45, or 50 days, and subsequently in low conductivity (15 μS/cm). The sexing and maturation assessment of the fish using ultrasound imaging was fundamental for effectively evaluating the mass gonadal maturation protocol. The combined use of these techniques proved safe in reproductive studies with banded knifefish.

Deep clustering for abdominal organ classification in ultrasound imaging.

The purpose of this study is to examine the utilization of unlabeled data for abdominal organ classification in multi-label (non-mutually exclusive classes) ultrasound images, as an alternative to the conventional transfer learning approach. We present a new method for classifying abdominal organs in ultrasound images. Unlike previous approaches that only relied on labeled data, we consider the use of both labeled and unlabeled data. To explore this approach, we first examine the application of deep clustering for pretraining a classification model. We then compare two training methods, fine-tuning with labeled data through supervised learning and fine-tuning with both labeled and unlabeled data using semisupervised learning. All experiments were conducted on a large dataset of unlabeled images () and a small set of labeled images () comprising progressively 10%, 20%, 50%, and 100% of the images. We show that for supervised fine-tuning, deep clustering is an effective pre-training method, with performance matching that of ImageNet pre-training using five times less labeled data. For semi-supervised learning, deep clustering pre-training also yields higher performance when the amount of labeled data is limited. Best performance is obtained with deep clustering pre-training combined with semi-supervised learning and 2742 labeled example images with an -score weighted average of 84.1%. This method can be used as a tool to preprocess large unprocessed databases, thus reducing the need for prior annotations of abdominal ultrasound studies for the training of image classification algorithms, which in turn could improve the clinical use of ultrasound images.

Utilization of Truncal Fascial Plane Nerve Blocks for Chronic Pain Management: A Narrative Review

Nerve blocks constitute an integral portion in the management of chronic pain. The widespread use of ultrasound imaging opened the door to a flood of newer blocks especially truncal plane nerve blocks. We reviewed the current medical literature for studies and case reports utilizing the two most common truncal plane nerve blocks, transversus abdominis plane and erector spinae plane blocks, to manage chronic pain. We found some evidence, mostly in case reports and retrospective observational studies, that supports the use of transversus abdominis plane and erector spinae plane nerve blocks, usually with steroids, as a safe and valuable part of interdisciplinary management of chronic abdominal and chest walls pain. Ultrasound-guided truncal fascial plane nerve blocks are safe, easy to learn, and proven to help with post-operative acute pain management. Although limited, our current review provides evidence from the current medical literature regarding the utility of these blocks to manage some of the challenging chronic and cancer-related pain conditions of the trunk region.

The ultrasound assessment of osteoarthritis: the current status.

Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.

A Hybrid Approach to 3D Shape Estimation of Catheters Using Ultrasound Images

Catheter-based cardiac interventions have substantially improved the efficacy of the treatment. However, catheter navigation still poses several challenges including its poor visualization and localisation. Therefore, various imaging methods have been used to localize the catheter and estimate its shape. The use of ultrasound imaging is superior to other modalities in many aspects, but suffers from poor spatial resolution. Hence, we present a hybrid approach involving deep learning and classical approach to 3D shape estimation of catheters. Our novel approach uses two stages. First, a UNet-3D model is proposed to estimate the catheter centroid in the ultrasound image. Then, an adaptive Kalman Filter (AKF) is used to fuse the points into the 3D world coordinate frame. Simulation studies, phantom and ex-vivo experimentation results demonstrate the robustness of the method to ultrasound noise and extreme configurations (sharp curves).

Evaluation of the Cell Concentration in Suspensions of Human Leukocytes by Ultrasound Imaging: The Influence of Size Dispersion and Cell Type.

This work focuses on the use of ultrasound imaging to evaluate the cell concentration of dilute leukocyte suspensions in the range of 10-3000 cells/µL. First, numerical simulations were used to study the influence of the size dispersion and the leukocyte type on the performance of the concentration estimation algorithms, which were developed in previous works assuming single-sized scatterers. From this analysis, corrections to the mentioned algorithms were proposed and then the performance of these corrections was evaluated from experiments. For this, ultrasound images were captured from suspensions of lymphocytes, granulocytes, and their mixtures. These images were obtained using a 20 MHz single-channel scanning system. Results confirmed that concentration estimates provided by conventional algorithms were affected by the size dispersion of cells, leading to a remarkable underestimation of results. The proposed correction to compensate for cell size dispersion obtained from simulations improved the concentration estimation of these algorithms, for the cell suspensions tested, approaching the results to the reference optical characterization. Moreover, it was shown that these models provided a total leukocyte concentration from the ultrasound images which was independent of the relative populations of different white blood cell types.

Ultrasound Imaging-Based Methods for Assessing Biological Maturity during Adolescence and Possible Application in Youth Sport: A Scoping Review.

Bone maturity is an indicator for estimating the biological maturity of an individual. During adolescence, individuals show heterogeneous growth rates, and thus, differences in biological maturity should be considered in talent identification and development. Radiography of the left hand and wrist is considered the gold standard of biological maturity estimation. The use of ultrasound imaging (US) may be advantageous; however, its validity and reliability are under discussion. The aims of this scoping review are (1) to summarize the different methods for estimating biological maturity by US imaging in adolescents, (2) to obtain an overview of the level of validity and reliability of the methods, and (3) to point out the practicability and usefulness of ultrasound imaging in the field of youth sports. The search included articles published up to November 2022. The inclusion criteria stipulated that participants had to fall within the age range of 8 to 23 years and be free of bone disease and fractures in the region of interest. Nine body regions were investigated, while the hand and wrist were most commonly analyzed. US assessment methods were usually based on the estimation of a bone maturity stage, rather than a decimal bone age. Furthermore, 70% of the assessments were evaluated as applicable, 10% expressed restraint about implementation, and 20% were evaluated as not applicable. When tested, inter- and intra-rater reliability was high to excellent. Despite the absence of ionization, low costs, fast assessment, and accessibility, none of the US assessments could be referred to as a gold standard. If further development succeeds, its application has the potential to incorporate biological age into selection processes. This would allow for more equal opportunities in talent selection and thus make talent development fairer and more efficient.

Routine use of ultrasound imaging to diagnose skier’s thumb. Results from a first-aid orthopedic department in an Italian ski resort

Damage to the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal joint (TMPJ) can result in severe functional impairment: correct diagnosis is critical to ensure the appropriate treatment to restore full TMPJ function. In an acute phase, clinical findings and X-rays alone are not reliable enough for a precise diagnosis: ultrasound scan (USS) may represent a fast, inexpensive and sensitive technique to improve the diagnosis of thumb trauma in emergency department. The purpose of this study is to assess if the introduction of the routine use of USS in clinical practice to evaluate thumb trauma could aid in diagnosis and treatment of this common injury. During eight winter seasons (2012-19), we dealt with 2553 injuries of the TMCJ at our emergency department. During the first period (2012-2015), the diagnosis of TMCJ injuries relied on clinical examination and X-rays; in the second study period (2016-2019) the diagnosis of all thumb traumas were based on clinical examination, radiographs, and ultrasound. Patients affected by type I and II lesions were conservatively treated by the application of a thumb spica plaster for three weeks, while in type III injuries for a period of one month. Type IV UCL lesions underwent surgery through a phalanx tunneling and anchor fixation technique followed by 5-weeks of immobilization in a thumb spica plaster cast. Both groups were followed up either clinically or as phone consultations for foreign patients. In the period 2012-2015, we classified 27% of TMPJ lesions as type I, 19% as type II, 15% as type III, and 27% as type IV lesions. The remaining 12% represented a fracture variant (type V). USS identified 30% type I, 21% type II, 18% type III, and 19% type IV lesions, the latter with a positive so called tadpole sign (14) (247 pts.); the remaining 12% of patients presented a fracture variant. During the first study period, the diagnosis of TMPJ injuries made exclusively by clinical examination and X-ray studies, lead to a high number of false positive type IV diagnoses that were not confirmed during surgery (13%). The introduction of USS imaging during the second period led to a detection of almost all (> 98%) type IV lesions intra-operatively, thereby avoiding unnecessary surgery, possible complications, rehabilitation, and recovery. Our work demonstrates that the routine use of USS imaging in the study of thumb UCL injuries improves the diagnostic sensitivity of clinical findings in a low cost, quick and feasible manner. USS can lead to a significant decrease in the number of misdiagnoses as previously demonstrated by other studies. USS is likely to improve patient collaboration and could potentially supplant stress-test radiography which can be painful and potentially risky in some patients.

Rehabilitative Ultrasound Imaging in Multifidus – A Review

The main objective of this paper was to estimate the use of Rehabilitative Ultrasound Imaging (RUSI) in multifidus, obtaining the all-cross-sectional view of muscle, and to measure muscle morphology. Learning the different categories of US, techniques, modes while application. Effectiveness of the RUSI over other imaging technologies. Several articles were used as reference for the study. Research done by various authors are been compared to know the benefits and extent of USI. Also, use of Ultrasound imaging on cervical multifidus has been studied under this article. Muscle thickness of multifidus has been measured at different cervical level. It is found out that patients with LBP and neck pain have smaller cross- sectional area compare to normal subjects. The study concludes that use of RUSI in LBP, chronic neck pain patients and even on healthy subjects for comparative study. Use along with EMG and some types of manipulation for better outcome.

Nonoperative Treatment of Dupuytren’s Contracture: The Use of Ultrasound Imaging to Assess Efficacy

ObjectiveWe have used ultrasound imaging technology to objectively demonstrate changes in the degree and quality of diseased fascia in patients with Dupuytren’s disease treated nonoperatively with therapeutic splinting and tissue mobilization. Materials and MethodsMeasurement of active proximal interphalangeal and metacarpophalangeal joint extension along with ultrasound elastography imaging of the fascia was performed prior to, and 6 months after, the initiation of therapy. ResultsImprovement in active joint extension over the course of therapy was associated with a consistent decrease in the radiologic dimensions of the diseased fascia in combination with qualitative changes in its composition. ConclusionThe use of a simple orthosis and soft tissue mobilization techniques have a quantifiable effect on the degree of deformity and the quantity and quality of contracted fascia in Dupuytren’s disease, and would appear to have a role in the management of mild to moderate presentations of the disease when enzymatic or surgical interventions may not be practical.

69P Novel urinary methylated DNA biomarkers for kidney cancer detection and prognosis

69P Novel urinary methylated DNA biomarkers for kidney cancer detection and prognosis

Ultrasound-assisted subarachnoid block in a patient with severe kyphosis

Here, we report a case of ultrasound-assisted subarachnoid block in a patient with severe kyphosis. A 69-year-old man was scheduled for metal removal from hip screws. He had a previous experience with subarachnoid block using the landmark-guided technique, but it was very difficult due to severe kyphosis. However, we could easily determine the correct needle insertion point using ultrasound imaging and performed a successful dural puncture on the first attempt. This case demonstrates the clinical usefulness of ultrasound imaging for subarachnoid blocks in patients with severe kyphosis.

Ultrasound imaging in diagnostics of Monteggia lesion in children.

Purpose:The aim of the study is to evaluate the use of ultrasound imaging in diagnostics of Monteggia lesion in children where conventional radiographs and the use of the radiocapitellar line fail to provide an accurate diagnosis.Methods:Prospective diagnostic study of 70 patients treated between May 2018 and July 2021 in a pediatric level 1 trauma center. In 20 patients with the confirmed radiographic diagnosis of Monteggia lesion, an ultrasound of the humeroradial joint was performed to determine signs of both normal and dislocated elbow joint. In 36 patients with suspected humeroradial dislocation on plain radiographs, ultrasound imaging was performed to determine the definitive diagnosis. Overall, 14 patients with elbow joint injury other than humeroradial dislocation were excluded from the study.Results:The “double-hump sign” and the “congruency sign” were determined as normal findings on ultrasound of the humeroradial joint. These signs were applied to patients with unclear findings on radiographs. In three patients, the dislocation of the humeroradial joint was confirmed by ultrasound. In two patients, “defect in congruency sign” was seen during reduction despite normal radiographs, which required re-reduction. In 31 patients, dislocation of the humeroradial joint was refuted. In 34 out of the 36 patients, the diagnosis determined by ultrasound was confirmed in follow-up. Two patients did not attend the follow-up examination.Conclusion:Ultrasound imaging is an accessible, non-invasive, and dynamic point-of-care method that can be applied in children suffering from suspected humeroradial dislocation and/or subluxation.Level of evidence:Level III—diagnostic study.