Use Of Ultrasound Scanning Research Articles

The impact of temporal artery biopsy on surgical practice.

BackgroundGiant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.Materials and MethodsA retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.ResultsA total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.ConclusionsTAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

Bedside ultrasound in the emergency department and abdominal pain

Purpose: Abdominal pain is a common symptom in emergency room (ER), covering 10% of the assists. The delay in diagnosis and treatment adversely affects the patient's prognosis. Transabdominal ultrasonography is most commonly used to obtain images of hepatobiliary, urogenital, and pelvic structures. However, improvements in ultrasound technology and increasing familiarity with ultrasonographic findings in a variety of gastrointestinal disorders, as Crohn's disease (CD), are broadening its applications, and it is an aspect to be considered by emergency physicians (EP) in patients with recurrent abdominal pain. We present a case of CD, diagnosed at ER, through the use of ultrasound scanning by EP.

The influence of gender and age on the thickness and echo-density of skin.

The more recent use of ultrasound scanning allows a direct measurement on unmodified skin, and is considered to be a reliable method for in vivo measurement of epidermal and dermal thickness. The objective of this study was to assess the influence of gender and age on the thickness and echo-density of skin measured by high frequency ultrasonography (HFUS). This study was carried out on 30 healthy volunteers (17 female, 13 male) with age range of 24-61 years old. The thickness and echo-density of dermis as well as epidermal entrance echo thickness in five anatomic sites (cheek, neck, palm, dorsal foot, and sole) were measured using two different types of B mode HFUS, 22 and 50 MHz frequencies. The epidermal entrance echo thickness and thickness of dermis in males were higher than females, which was statistically significant on neck and dorsum of foot. The echo-density of dermis was higher in females on all sites, but was only statistically significant on neck. The epidermal entrance echo thickness and thickness of dermis in young age group was statistically higher than old group on sole and dorsal of the foot respectively. Overall, the skin thickness decreased with age. High frequency ultrasonography method provides a simple non-invasive method for evaluating the skin thickness and echo-density. Gender and age have significant effect on these parameters. Differences in study method, population, and body site likely account for different results previously reported.

The use of ultrasound scanning at different times of the finishing period in lean cattle

This study aimed to evaluate the predictive ability of ultrasound at different ages based on the 10–12th rib-cut composition. Ultrasound measurements at different times of the finishing period and 10–12th rib-cut composition were measured on 163 bulls of three European beef breeds (Charolais, n=55; Limousine, n=55; Retinta, n=53). Ultrasound measurements (area and intramuscular fat percentage of the longissimus thoracis muscle, 12th-rib fat thickness, rump fat thickness, and gluteus medius depth) were taken every 30±5 days until slaughter (approximately at 180, 150, 120, 90, 60, 30, and 1–7 days before slaughter). Correlation and determination coefficients between ultrasound measurements and rib-cut composition were low-medium. The regression equations, developed from the live ultrasound measurements explained 45%, 43%, 35%, 35%, 35% and 36% of the variation in total lean, longissimus thoracis muscle, fat (total, subcutaneous and intermuscular) and bone percentages obtained by dissection of 10–12th rib-cut, respectively, and 34% in intramuscular fat determined by ether extract analysis of 12th rib. The predictive precision of ultrasonic measurements increased as animals approached slaughter, reaching maximum values at the last scan. When data from two or more scans were included, the last scan could be advanced in at least 30 days under the conditions of this experiment.

P72 In the Post Ultrasound Era, are Core Medical Trainees Struggling to get Experience in Chest Drain Insertion?

IntroductionIn the UK, upon completion of Core Medical Training (CMT), procedural independence is expected for pneumothorax drains and is desirable for pleural effusions. In 2009, prompted by a National Patient...

Use of ultrasound scanning to estimate teat wall thickness in Murciano-Granadina goats

To evaluate the ultrasound technique as a method for estimating the effect of mechanical milking on teat thickness in Murciano-Granadina goats, the following work was carried out with a twofold objective: (1) to study the most suitable ultrasound exploration frequency for this breed and the effect of the operator in applying the technique and (2) to validate the approach, comparing it with measurements taken by another estimation method (cutimeter) and performing ultrasound examinations in cows using the same methodology. To this end, three studies were designed. In the first study, 2 experiments were carried out: (a) the first (E1) tested the frequencies 5, 7.5 and 10MHz; (b) the second (E2) tested the frequencies 3.5 and 5MHz. In the second study, 2 different independent operators (OP) performed sonography on the same animals (E3), chose the best image of ultrasound examinations recorded as a video sequence (E4) and carried out measurements on ultrasound images (E5). In the third study, the technique tested in goats was applied in 10 Holstein cows (E6) and, finally, ultrasound scans were performed at 5MHz frequency and cutimeter measurements taken in 63 goats (E7).The following variables were measured in the ultrasound scans: teat wall thickness (TWT), teat wall area (TWA) and teat end area (TEWA). The cutimeter was also used to measure teat wall thickness (TT).From the results obtained, we observed that frequencies of 5 and 7.5MHz were the most suitable to estimate the teat wall changes brought about by mechanical milking. Moreover, applying the same methodology and frequencies in Holstein cows, the results achieved were similar to those published in the bibliography and the variables measured (TWT, TWA and TEWA) presented a high and significant correlation (R=0.62) with the variable (TT) measured by cutimeter. OP experience had an effect on TEWA before milking in all three experiments (E3–E5) and in TWT, TWA and TEWA after milking in E4 and E5. Despite the effects observed for some variables before and after milking, a significant effect was only found for the difference (after–before milking) in TEWA in E3 and TWT in E4.The ultrasound technique used can serve as a useful tool to evaluate teat wall thickness changes caused by mechanical milking in goats. Nevertheless, it would be appropriate to carry out another study to develop IT tools to minimise the operator effect in the measurement of ultrasound variables.

Ultrasound scanning for percutaneous dilatational tracheostomy: a systematic review

Percutaneous dilatational tracheostomy (PDT) remains a frequently performed procedure in the ICU. However, there is great variability in the course of blood vessels in the pre-tracheal area. A 5% risk of clinically relevant bleeding was recently reported for patients undergoing PDT [1]. We conducted a systematic review of reports evaluating clinical outcomes following use of ultrasound scanning (US) for PDT.

Gender determinations by ultrasound in a Nigerian health facility: How accurate are sonologists?

Background: With the widespread use of ultrasound scan in pregnancy, there is a growing concern about the ability and accuracy of sonographic determination of the fetal gender. Aim: This study aims to find out how accurate this is in a health facility in Port Harcourt, South Nigeria. Materials and Methods: A retrospective cohort study was carried out over a 2-year period. The birth gender of 750 women who were scanned during the index pregnancy and the fetal sex noted on routine ultrasound were compared to find out how accurate the gender was determined by ultrasound. The data obtained were subjected to statistical analysis. Results: During the study period out of the 945 women who attended the antenatal clinic of the health facility during the study period, 750 (79%) had relevant scan reports from various imaging centers in Port Harcourt. The study showed that all sonographic sex determinations were made later than 19 weeks gestation and overall accuracy throughout pregnancy was 98.4%. Conclusions: Gender determination by ultrasound which has a high accuracy in this environment also has a degree of failure. Thus the expectant mother and referring physician should be aware of its limitations and accuracy in our environment.

Ultrasound scanning for recalcitrant plantar fasciopathy. Basis of a new classification

The treatment of recalcitrant plantar fasciopathy is often empirical. Imaging is usually in the form of radiographs, if undertaken at all. The aim of this study is to characterise the disease pattern in recalcitrant cases of plantar fasciopathy. This allows classification of the pathology, which in turn allows meaningful evaluation of current and future treatments. One hundred and twenty-five consecutive feet with symptoms of 'plantar fasciitis' lasting longer than 6 months (all of which had failed to improve with a stepwise conservative management protocol) had confirmed plantar fasciopathy on ultrasound scanning. The disease characteristics were evaluated based on the scan findings. Of the patients evaluated, 66 % had typical insertional disease. The remaining 34 % had atypical distal fascia disease; 22 % had mixed insertional and distal disease, and 12 % had pure distal disease. Patients with pure distal disease were found to have either distal thickening or discrete fibromata. In this cohort of recalcitrant cases, ultrasound scans detected a high proportion of atypical non-insertional plantar fascia disease. This would not be detected without imaging studies, and therefore we recommend the use of ultrasound scanning in cases of recalcitrant plantar heel pain that have failed proper first-line management, in order to confirm the clinical diagnosis and to classify the disease as either insertional or non-insertional plantar fasciopathy (or mixed disease). Only in this way can treatments for this group of patients be systematically evaluated against different disease patterns to determine their effectiveness.

Utilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China

BackgroundAntenatal ultrasound scan is a widely accepted component of antenatal care. Studies have looked at the relationship between ultrasound scanning and caesarean section (CS) in certain groups of women in China. However, there are limited data on the utilization of antenatal ultrasound scanning in the general population, including its association with CS. The purpose of this study is to describe the utilization of antenatal ultrasound screening in rural Eastern China and to explore the association between antenatal ultrasound scan and uptake of CS.MethodsBased on a cluster randomized sample, a total of 2326 women with childbirth participated in the study. A household survey was conducted to collect socio-economic information, obstetric history and utilization of maternal health services.ResultsCoverage of antenatal care was 96.8% (2251/2326). During antenatal care, 96.1% (2164/2251) women received ultrasound screening and the reported average number was 2.55. 46.8% women received at least 3 ultrasound scans and the maximum number reached 11. The CS rate was found to be 54.8% (1275/2326). After adjusting for socio-demographic and clinical variables, it showed a statistically significant association between antenatal ultrasound scans and uptake of CS by multivariate logistic regression model. High husband education level, high maternal age, having previous adverse pregnant outcome and pregnancy complications during the index pregnancy were also found to be risk factors of choosing a CS.ConclusionsA high use of antenatal ultrasound scan in rural Eastern China is found and is influenced by socio-demographic and clinical factors. Evidence-based guidelines for antenatal ultrasound scans need to be developed and disseminated to clinicians including physicians, nurses and sonographers. Guidance about the appropriate use of ultrasound scans should also be shared with women in order to discourage unreasonable expectations and demands. It is important to monitor the use of antenatal ultrasound scan as well as the indications for caesarean section in rural China.

Ultrasound surveillance in the high risk patient -does it deliver?

BackgroundUltrasound surveillance remains one of the main stay in the management of the high risk antenatal patient. However, it contributes significantly to the burden of most Scan departments. The National...

Diagnostic Ultrasound of the Rotator Cuff: Sensitivity and Specificity in a District General Hospital

Background Rotator cuff tears are associated with significant morbidity. Ultrasound scanning in the diagnosis and evaluation of cuff tears has been shown to be highly sensitive and specific. However, it is hypothesized that ultrasound may not be such a precise modality in the setting of a district general hospital. Materials and Methods The present study identified all patients in a 1-year period who underwent shoulder arthroscopy and who had also undergone a preceding ultrasound scan. Tables (2 × 2) were drawn up to compare findings and calculate sensitivity, specificity and predictive values. Results Eighty-five patients were identified with a total of 59 (69%) cuff tears detected at surgery. Overall, the sensitivity and specificity of ultrasound was 66% and 54%, respectively. This equated to an overall accuracy of 62%. The positive predictive value was 76% and the negative predictive value was 41%. Discussion The results obtained in the present study demonstrate disappointingly low sensitivity, specificity, positive and negative predictive values, as well as accuracy, for the use of ultrasound scanning in the assessment of the rotator cuff. This has implications not only for the diagnostic process, but also in terms of theatre time logistics. It is suggested that a regular multidisciplinary team meeting is held to discuss imaging and consideration of magnetic resonance imaging as an alternative modality in this setting.

Fetal therapy: progress made and lessons learnt

Fetal therapy began more than half a century ago when Liley reported the first intraperitoneal transfusion for the treatment of fetal anaemia in Rhesus disease (Liley, 1963). This was to be replaced with intravascular transfusion, initially by fetoscopy and subsequently by ultrasound-guided cordocentesis. This is now a wellestablished therapy and one which was never subjected to rigorous evaluation. In this issue of Prenatal Diagnosis, we focus on fetal therapy, exploring how far it has developed since these early reports and discuss how new approaches might further change management, highlighting the need for rigorous evaluation of any new technology prior to clinical implementation. The widespread use of ultrasound scanning in the 1980s and the prenatal detection of fetal defects stimulated the development of a wide range of techniques for intrauterine interventions. The aim was to improve the outcome for conditions that were traditionally treated by postnatal surgery because it was thought that prenatal surgery could reduce irreversible damage to the developing organs. However, for the large part the absolute benefit in terms of improved longer term outcome for affected fetuses remains unknown. It is only in the last few decades or so that we have realised that the only way to properly assess many of these therapies is with randomised trials, which must include structured long-term follow-up to determine the true benefits and costs. A good example is the management of lower urinary tract obstruction where shunting initially seemed to improve outcome as more babies survived the neonatal period. However, most studies were small and had no control group, thus making it impossible to define any benefit resulting from the intervention and longer term follow-up was patchy and inconsistently collected (Ruano, 2011). Furthermore, because of the rarity of many of these conditions, much of this research must be multicentre and multinational, raising an issue in itself as these techniques will be concentrated in centres of excellence, thereby limiting equity of access and focussing expertise in a few centres (Ville, 2011).

Investigating the value of fine needle aspiration cytology in thyroid cancer

Background:Current guidance recommends the use of fine needle aspiration cytology (FNAC) as an essential investigation in patients presenting with a thyroid lump. Current literature suggests that the sensitivity of FNAC in thyroid nodules ranges between 80-90%. However, only very few studies have looked specifically at the sensitivity of FNAC in solely thyroid cancer patients.Aims:The aim of our study was to investigate the value of FNAC as a first-line investigation in patients with thyroid cancer. We aimed specifically to assess the sensitivity of FNAC within this group.Materials and Methods:Patients diagnosed with thyroid cancer between 2000-08 were identified from a local histopathology database. Sixty-seven case notes were retrieved, retrospectively reviewed and analyzed. Analysis included results of FNAC, ultrasound scanning and final histopathological diagnosis.Results:Analysis of the 56 patients who underwent FNAC revealed that a cytological grading of thy3 or greater was only given to 31 cases (55.3%).Conclusion:In this study, FNAC findings of thy3 or greater were reported only in 55.3% of proven thyroid cancer cases. This study highlights the greater diagnostic difficulties of thyroid cancer compared to other thyroid nodules. Our findings suggest that clinicians must interpret the results of this initial investigation with caution and consider the routine use of ultrasound scanning to help guide FNAC.

PWE-090 Use of ultrasound scan for diagnosis and monitoring of small bowel Crohn's disease

<h3>Introduction</h3> Diagnoses and monitoring of small bowel Crohn9s disease can often present a challenge. Tests for aiding decision making are often not available readily and involve radiation. This can potentially results in uncertainty in diagnosis and reluctance and delay in treatment. We studied the role of ultrasound scan (USS) in diagnosis of small bowel Crohn9s disease. We compared the results of USS with Magnetic Resonant Imaging (MRI). <h3>Methods</h3> This was a prospective study of use of USS followed by a MRI small bowel. Patients who were clinically suspected to have a first diagnosis of small bowel Crohn9s/recurrence after surgery/exacerbation of known Crohn9s disease were referred from Gastroenterology clinics and inpatients. USS were performed by experienced Radiology consultant. All the patients first had an USS performed and reported, followed by MRI scan. <h3>Results</h3> A total of 30 patients were identified for this study. Age range was from 17 to 78 years and median age of 30 years. 50% of patients were males and 50% females. 20% of the patients were known to have Crohn9s disease, 10% had known post surgical recurrence, 17% suspected post surgical recurrence and 53% were clinically suspected to have small bowel Crohn9s. USS was reported as normal or no active disease in 70% of all scans. Out of the remaining 30%, 10% of post resection, 7% of clinically suspected and 13% of the known Crohns disease patients were found to have active disease and stricturing in small bowel on USS. Subsequent MR scans showed very good sensitivity of USS in diagnosis. In 96.2% patients MRI scan showed same or very similar findings as on USS. All Abnormal USS were confirmed with same abnormality on MRI scans (positive predictive value 100%). Of the Normal USS only one MRI scan (3%) showed a stricture in proximal small bowel (Negative predictive value 95.2%). Of the remaining, two MRI scans (7%) could not be performed, as patients were unable to tolerate procedure. One (3%) MRI scan was cancelled after USS, as no longer indicated. One further MRI scan showed a primary small bowel volvulus, but no Crohns disease, where USS was normal. <h3>Conclusion</h3> With emergence of new modalities the role of ultrasound in small bowel disease has diminished. This study shows that ultrasound scan can still play a very important role in monitoring and diagnosis of Crohn9s disease. USS can aid in planning management of patients in acute settings, where other investigations may cause delay. It has the advantages of ready availability, less time to perform, well tolerated and no radiation exposure. In our study it proved to be very sensitive and accurate in comparison to MRI scan and may be usefully employed in assisting clinical decision making before other investigations are performed.

Rethinking breast cancer screening strategies in resource-limited settings.

The incidence of breast cancer in sub-Saharan nations is increasing. There is a worsening scarcity of Human Resource for Health in Uganda in particular and Sub Saharan Africa in general. Resources available for health care are predominantly spent on infectious disease care such as (HIV/AIDS, Tuberculosis and Malaria). These factors and more make the future of breast cancer care including screening in Sub Saharan African grim.Although mass breast cancer screening by mammography has been proved to be efficacious in the developed nations of the world, this has not been replicated in the developing nations because mass screening is not yet possible for the reasons stated. This paper proposes an alternative to mammography mass screening.Breast health programs for the most part are adhoc or non-existent in Uganda. The challenge of mass screening is not only limited to less readily available mammogram machines and trained human resources but also to the fact that the targeted population is of relatively young women in their 30s, implying that screening should commence earlier than it is practiced in nations where breast cancer peaks among women in their 50s. Mammography is not efficacious in young women with dense breast tissue. Ultra sound scans are not only up to 10 fold more available than mammography machines but are half the cost per examination.Although using ultra sound Scan for screening for non-palpable lumps is not up to par with standard breast cancer care mammography. It may be better than nothing, may be beneficial in aiding early cancer diagnosis. This concept is akin to the 'task shifting' advocated by WHO. It is worth investigating use of ultra sound scan for mass screening for breast cancer in resource-limited environments. This is not in any way lowering standards of oncologic diagnosis but filling the otherwise unattended to gap, the unmet need.

Intussusception in a 20 weeks pregnant woman: a case report

Intussusception in pregnancy is rare and poses unique diagnostic and therapeutic challenges. We present the case of a 22 year old, 20 weeks pregnant woman who presented with acute abdominal pain. Following abdominal ultrasound scanning she was diagnosed with intussusception. The patient underwent laparotomy and a small bowel resection was performed without any post operative complications. We review the literature to give a concise and up to date summary on the diagnosis and treatment of the condition with particular emphasis on the recently recognised usefulness of ultrasound scanning.

The Role of Ultrasound in the Management of Flexor Tendon Injuries

The use of ultrasound scanning to establish tendon pathologies was assessed retrospectively in 17 patients in 18 digits. The ultrasound scan demonstrated four patterns: (1) normal intact tendons in four, (2) ruptured tendons in three, (3) tendons in continuity but attenuated in five and (4) tendons in continuity but thickened with fibrosis and decreased movement representing adhesions in five patients. Surgery was undertaken in only three cases, confirming the ultrasound diagnosis in two. Surgery was offered to all three patients with ruptures but was declined by two. Ultrasound imaging helped to avoid surgery in 14 cases by excluding flexor tendon re-ruptures. This allowed on-going mobilisation, leading to recovery of function.

Actual False-Negative Rate Prompts the Routine Use of Ultrasound Scan Before and After Sentinel Node Biopsy in Melanoma

Actual False-Negative Rate Prompts the Routine Use of Ultrasound Scan Before and After Sentinel Node Biopsy in Melanoma

An ultrasound-based silent speech interface

The paper proposes the use of ultrasound scans of tongue movement and video sequences of the lips to synthesize speech. A speech synthesizer driven only by video acquisitions may be qualified as a “silent speech interface,” which could be used by laryngectomyzed patient as an alternative to tracheo-esophageal speech, for voice communication where silence must be maintained, or in very noisy environments. Our system is based on the building of a one-hour audiovisual corpus of phonetic units, which associates visual features extracted from video with acoustic observations. The ultrasound and optical images are interpreted as a linear combination of standard configurations obtained by principal components analysis (PCA) from a phonetically balanced subset of typical frames. HMM-based stochastic models trained on these visual features sequences are subsequently used to predict phonetic targets from video-only data. Finally, a Viterbi unit selection algorithm is used to find the optimal sequence of acoustic units given both this phonetic prediction and the sequence of visual features. The system is able to perform phonetic transcription from video-only speech data with over 55% correct recognition, on continuous speech, using neither phonotactic nor linguistic constraints.