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Prentice CLS, Flavell CA, Massy-Westropp N, Milanese S. Understanding responsiveness to an exercise intervention for people with persistent low back pain and lateral abdominal muscle impairments. A mixed methods study. Physiother Theory Pract 2025:1-21. [PMID: 40160008 DOI: 10.1080/09593985.2025.2484593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 03/09/2025] [Accepted: 03/21/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND Exercise consistently demonstrates a small effect size for patients with persistent low back pain (PLBP). Determining patient characteristics that influence intervention responsiveness may improve treatment allocation and effect sizes. An exercise intervention for patients with PLBP and maladaptive changes in lateral abdominal muscle (LAM) contraction was recently trialed. OBJECTIVE To identify factors predicting responsiveness to an exercise intervention for patients with PLBP and why. METHODS This was a secondary mixed methods analysis of results from a feasibility randomized controlled trial with 50 participants. The 12-week program included individualized motor control and graded activity exercise. Regressions were performed to understand potential associations between characteristics (demographic, condition-specific signs and symptoms, compliance with exercise, and beliefs about exercise) and outcomes (pain, function, disability, and LAM contraction). Interview transcripts were analyzed for characteristics unique to participants that responded most and least to the intervention. Data was integrated for complementarity. RESULTS At baseline, females, participants with lower BMIs, decreased chronicity, fewer areas of pain, who had less previous interactions with healthcare professionals, and who were more positive about the potential for exercise to improve their pain had greater responsiveness (Adjusted R2 ranged from 0.17 to 0.66). During and after the program, increased physical activity levels was a positive predictor. CONCLUSION Responsiveness to the intervention may have been mediated by several baseline factors which may have affected participants' engagement with the intervention and continuation with exercise post intervention. Such characteristics may assist clinicians identifying whether this may be an appropriate intervention for patients with PLBP.
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Affiliation(s)
| | - Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Nicola Massy-Westropp
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Steve Milanese
- Department of Allied Health, Swinburne University of Technology, Hawthorn, Australia
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2
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Bellomo TR, Goudot G, Lella SK, Landau E, Sumetsky N, Zacharias N, Fischetti C, Dua A. Feasibility of Encord Artificial Intelligence Annotation of Arterial Duplex Ultrasound Images. Diagnostics (Basel) 2023; 14:46. [PMID: 38201355 PMCID: PMC10795888 DOI: 10.3390/diagnostics14010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
DUS measurements for popliteal artery aneurysms (PAAs) specifically can be time-consuming, error-prone, and operator-dependent. To eliminate this subjectivity and provide efficient segmentation, we applied artificial intelligence (AI) to accurately delineate inner and outer lumen on DUS. DUS images were selected from a cohort of patients with PAAs from a multi-institutional platform. Encord is an easy-to-use, readily available online AI platform that was used to segment both the inner lumen and outer lumen of the PAA on DUS images. A model trained on 20 images and tested on 80 images had a mean Average Precision of 0.85 for the outer polygon and 0.23 for the inner polygon. The outer polygon had a higher recall score than precision score at 0.90 and 0.85, respectively. The inner polygon had a score of 0.25 for both precision and recall. The outer polygon false-negative rate was the lowest in images with the least amount of blur. This study demonstrates the feasibility of using the widely available Encord AI platform to identify standard features of PAAs that are critical for operative decision making.
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Affiliation(s)
- Tiffany R. Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Guillaume Goudot
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
| | - Srihari K. Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Eric Landau
- Encord, Cord Technologies Inc., New York City, NY 10013, USA;
| | - Natalie Sumetsky
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Chanel Fischetti
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (G.G.); (S.K.L.); (N.S.); (N.Z.); (A.D.)
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA;
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3
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De Rosa L, Salvati A, Bonino F, Brunetto MR, Faita F. Effects of Different Scan Projections on the Quantitative Ultrasound-Based Evaluation of Hepatic Steatosis. Healthcare (Basel) 2022; 10:374. [PMID: 35206988 PMCID: PMC8872438 DOI: 10.3390/healthcare10020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is becoming a global public health issue and the identification of the steatosis severity is very important for the patients' health. Ultrasound (US) images of 214 patients were acquired in two different scan views (subcostal and intercostal). A classification of the level of steatosis was made by a qualitative evaluation of the liver ultrasound images. Furthermore, an US image processing algorithm provided quantitative parameters (hepatic-renal ratio (HR) and Steato-score) designed to quantifying the fatty liver content. The aim of the study is to evaluate the differences in the assessment of hepatic steatosis acquiring and processing different US scan views. No significant differences were obtained calculating the HR and the Steato-score parameters, not even with the classification of patients on the basis of body mass index (BMI) and of different classes of steatosis severity. Significant differences between the two parameters were found only for patients with absence or mild level of steatosis. These results show that the two different scan projections do not greatly affect HR and the Steato-score assessment. Accordingly, the US-based steatosis assessment is independent from the view of the acquisitions, thus making the subcostal and intercostal scans interchangeable, especially for patients with moderate and severe steatosis.
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Affiliation(s)
- Laura De Rosa
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
- Department of Information Engineering and Computer Science, University of Trento, 38122 Trento, Italy
| | - Antonio Salvati
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy; (A.S.); (M.R.B.)
| | - Ferruccio Bonino
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Naples, Italy;
| | - Maurizia Rossana Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Centre of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, 56124 Pisa, Italy; (A.S.); (M.R.B.)
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
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4
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Kim J, Albakheet SS, Han K, Yoon H, Lee MJ, Koh H, Kim S, Suh J, Han SJ, Ihn K, Shin HJ. Quantitative MRI Assessment of Pancreatic Steatosis Using Proton Density Fat Fraction in Pediatric Obesity. Korean J Radiol 2021; 22:1886-1893. [PMID: 34269534 PMCID: PMC8546128 DOI: 10.3348/kjr.2020.1343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/14/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the feasibility of quantitatively assessing pancreatic steatosis using magnetic resonance imaging (MRI) and its correlation with obesity and metabolic risk factors in pediatric patients. Materials and Methods Pediatric patients (≤ 18 years) who underwent liver fat quantification MRI between January 2016 and June 2019 were retrospectively included and divided into the obesity and control groups. Pancreatic proton density fat fraction (P-PDFF) was measured as the average value for three circular regions of interest (ROIs) drawn in the pancreatic head, body, and tail. Age, weight, laboratory results, and mean liver MRI values including liver PDFF (L-PDFF), stiffness on MR elastography, and T2* values were assessed for their correlation with P-PDFF using linear regression analysis. The associations between P-PDFF and metabolic risk factors, including obesity, hypertension, diabetes mellitus (DM), and dyslipidemia, were assessed using logistic regression analysis. Results A total of 172 patients (male:female = 125:47; mean ± standard deviation [SD], 13.2 ± 3.1 years) were included. The mean P-PDFF was significantly higher in the obesity group than in the control group (mean ± SD, 4.2 ± 2.5% vs. 3.4 ± 2.4%; p = 0.037). L-PDFF and liver stiffness values showed no significant correlation with P-PDFF (p = 0.235 and p = 0.567, respectively). P-PDFF was significantly associated with obesity (odds ratio 1.146, 95% confidence interval 1.006–1.307, p = 0.041), but there was no significant association with hypertension, DM, and dyslipidemia. Conclusion MRI can be used to quantitatively measure pancreatic steatosis in children. P-PDFF is significantly associated with obesity in pediatric patients.
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Affiliation(s)
- Jisoo Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Salman S Albakheet
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology, King Faisal General Hospital, Al-Hofuf, Saudi Arabia
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kim
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junghwan Suh
- Department of Pediatric Endocrinology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Joo Han
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Ihn
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
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Brickson LL, Hyun D, Jakovljevic M, Dahl JJ. Reverberation Noise Suppression in Ultrasound Channel Signals Using a 3D Fully Convolutional Neural Network. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1184-1195. [PMID: 33400649 PMCID: PMC8500501 DOI: 10.1109/tmi.2021.3049307] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Diffuse reverberation is ultrasound image noise caused by multiple reflections of the transmitted pulse before returning to the transducer, which degrades image quality and impedes the estimation of displacement or flow in techniques such as elastography and Doppler imaging. Diffuse reverberation appears as spatially incoherent noise in the channel signals, where it also degrades the performance of adaptive beamforming methods, sound speed estimation, and methods that require measurements from channel signals. In this paper, we propose a custom 3D fully convolutional neural network (3DCNN) to reduce diffuse reverberation noise in the channel signals. The 3DCNN was trained with channel signals from simulations of random targets that include models of reverberation and thermal noise. It was then evaluated both on phantom and in-vivo experimental data. The 3DCNN showed improvements in image quality metrics such as generalized contrast to noise ratio (GCNR), lag one coherence (LOC) contrast-to-noise ratio (CNR) and contrast for anechoic regions in both phantom and in-vivo experiments. Visually, the contrast of anechoic regions was greatly improved. The CNR was improved in some cases, however the 3DCNN appears to strongly remove uncorrelated and low amplitude signal. In images of in-vivo carotid artery and thyroid, the 3DCNN was compared to short-lag spatial coherence (SLSC) imaging and spatial prediction filtering (FXPF) and demonstrated improved contrast, GCNR, and LOC, while FXPF only improved contrast and SLSC only improved CNR.
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6
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Ifelayo OI, Oyemade KA, Tawfic SS, Jeeji AK, Ekstein SF, Smoot WA, Voelkel JE, Laughlin MJ, Lohse CM, Kummer T, Bellamkonda VR. Increased body mass index does not impact the imaging quality of focused assessment with sonography in trauma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:452-456. [PMID: 32557626 DOI: 10.1002/jcu.22884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many clinicians believe that a patient's body mass index (BMI) affects the likelihood of obtaining high quality ultrasound images. OBJECTIVES To assess the hypothesis that increased BMI is associated with worsening focused assessment with sonography in trauma (FAST) image quality. METHODS We conducted a retrospective single-center study of FAST examinations performed in a large academic emergency department (ED) with fellowship-trained emergency ultrasonography faculty performing quality assurance review. RESULTS Mean (SD) BMI was 28.0 (6.6) among the 302 included studies. The overall quality rating tended to decrease as BMI increased but did not achieve statistical significance in a univariable setting (P = .06) or after adjustment for age and sex (P = .06). Operators perception of image adequacy was largely unaffected by BMI, with the exception of the pericardial view. CONCLUSION This study did not identify a statistically significant difference in FAST quality with increased BMI. This result may help assuage clinician concerns about ultrasonography for patients in the ED.
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Affiliation(s)
- Oluwatomilona I Ifelayo
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kafayat A Oyemade
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Sarah S Tawfic
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Archana K Jeeji
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - William A Smoot
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jacob E Voelkel
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Michael J Laughlin
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Kummer
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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7
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Aamir MA, Sahebally SM, Heneghan H. Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery-a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2020; 31:133-142. [PMID: 32779074 DOI: 10.1007/s11695-020-04898-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Effective postoperative analgesia is paramount in patients undergoing bariatric surgery, given their increased predisposition to narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery. MATERIALS AND METHODS PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until June 2020. All randomized trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included postoperative pain scores at 24 h, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. RESULTS Seven randomized controlled trials were included, capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (MD -12.63 mg, 95% CI = -31.67 to 6.41, p = 0.19), pain scores (MD -0.71, 95% CI = -1.93 to 0.50, p = 0.25) or complications (RD = -0.00, 95% CI = -0.03 to 0.03, p = 0.87) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (MD -2.22 h, 95% CI = -3.89 to -0.56, p = 0.009) and PONV (OR = 0.13, 95% CI = 0.05 to 0.35, p < 0.0001). CONCLUSIONS TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation, but similar complication rates, narcotic usage and postoperative pain at 24 h compared to no TAP.
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Affiliation(s)
| | - Shaheel Mohammad Sahebally
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Helen Heneghan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland.,Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
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Factors associated with temporal window failure in transcranial Doppler sonography. Neurol Sci 2020; 41:3293-3299. [PMID: 32405883 DOI: 10.1007/s10072-020-04459-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Temporal window failure (TWF) is found in 8-20% of subjects. There are still insufficient studies about the factors affecting TWF. We aimed to elucidate the underlying causes of TWF. METHODS We analyzed 376 patients who underwent both transcranial Doppler sonography and cerebral angiographic imaging. They were divided into two groups: with and without TWF. Demographics, cardiovascular factors, degree of stenosis from the proximal intracranial artery to the middle cerebral artery (MCA), MCA diameter, and skull features were examined. RESULTS The subjects were 314 TWF-negative patients and 62 TWF-positive patients. The TWF-negative group was younger than that of the TWF-positive group (67.0 ± 12.1 vs. 75.2 ± 9.4, p < 0.001). The proportion of men in the TWF-negative group was higher than in the TWF-positive group (71% vs. 29%; p < 0.001). The TWF-negative group had a higher smoking rate than the TWF-positive group (34.4% vs. 12.9%; p = 0.001). In multivariate logistic regression analysis, age (odds ratio (OR), 1.05; p = 0.019), sex (OR, 4.64; p = 0.002), temporal bone thickness (OR, 6.03; p < 0.001), temporal bone density (OR, 0.996; p = 0.002), and soft tissue thickness (OR, 1.31; p = 0.004) significantly affected TWF. CONCLUSIONS In addition to age, sex, temporal bone thickness, and temporal bone density which were previously reported as variables associated with TWF, we confirmed that soft tissue thickness of the temporal area is a new associated factor of TWF. Measuring soft tissue thickness of the temporal area for patients with suspected TWF could be useful in identifying measurement error due to technical problems.
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9
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Wardhan R, Kantamneni S. The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients. Cureus 2020; 12:e7626. [PMID: 32292684 PMCID: PMC7153808 DOI: 10.7759/cureus.7626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Thoracic paravertebral blocks (TPVBs) provide an effective pain relief modality in conditions where thoracic epidurals are contraindicated. Historically, TPVBs were placed relying solely on the landmark-based technique, but the availability of ultrasound imaging makes it a valuable and practical tool during the placement of these blocks. TPVBs also provide numerous advantages over thoracic epidurals, namely, minimal hypotension, absence of urinary retention, lack of motor weakness, and remote risk of an epidural hematoma. Utilization of both landmark-based and ultrasound-guided techniques may increase the successful placement of a TPVB. This article reviews relevant sonoanatomy as it pertains to TPVBs. However, certain patient-related issues, including pneumothoraces, surgical emphysema, body habitus, and transverse process fractures, all may make imaging with ultrasound challenging. The changes noted on ultrasound imaging as a result of these issues will be further described in this review.
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Affiliation(s)
- Richa Wardhan
- Anesthesiology, University of Florida, Gainesville, USA
| | - Sowmya Kantamneni
- Anesthesiology, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, USA
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10
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Bottenus N, Pinton GF, Trahey G. The Impact of Acoustic Clutter on Large Array Abdominal Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:703-714. [PMID: 31715564 PMCID: PMC7103500 DOI: 10.1109/tuffc.2019.2952797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Abdominal imaging suffers from a particularly difficult acoustic environment-targets are located deep and overlying tissue layers with varying properties generate acoustic clutter. Increasing array size can overcome the penetration and lateral resolution problems in ideal conditions, but how the impact of clutter scales with increasing array extent is unknown and may limit the benefits in vivo. Previous ex vivo experimental work showed the promise of large arrays but was technically limited to a length of 6.4 cm and to only partial sampling of the array elements. We present an extension of those studies using the Fullwave simulation tool to create a 10 cm ×2 cm matrix array with full lateral element sampling. We used a numerical model of the abdomen based on the maps of tissue acoustical properties and found that propagation through the modeled abdominal layers generated on average 25.4 ns of aberration and 0.74 cm of reverberation clutter across the array extent. Growing the full aperture from 2 to 10 cm improved contrast by 8.6 dB and contrast-to-noise ratio by 22.9% in addition to significantly improving target resolution. Alternative array strategies that may be useful for implementation-mismatched aperture sizes or a swept synthetic aperture-also produced improved quality with growing aperture size. These results motivate the development of larger diagnostic imaging arrays for the purpose of high-resolution imaging in challenging environments.
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11
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Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block as Part of Multimodal Analgesia in Laparoscopic Roux-en-Y Gastric Bypass Within an Enhanced Recovery After Surgery (ERAS) Program: a Prospective Randomized Clinical Trial. Obes Surg 2019; 28:3374-3379. [PMID: 29980989 DOI: 10.1007/s11695-018-3376-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite the ultrasound guidance of transversus abdominis plane (TAP) blocks has allowed greater precision of needle placement in the desired tissue plane, visualization of the abdominal wall muscles can be hindered by morbid obesity and could lead to failed regional anesthesia. The aim of this study was to assess the feasibility and effect of laparoscopic-guided TAP block in patients undergoing Roux-en-Y gastric bypass and to compare it with port-site infiltration. PATIENTS AND METHODS A prospective randomized clinical trial was performed. Patients were randomized into two groups: patients undergoing laparoscopic-guided TAP (TAP-lap) and patients undergoing port-site infiltration (PSI). Pain quantification as measured by visual analogic scale (VAS) and morphine needs during the first 24 h were evaluated. RESULTS One hundred and forty patients were included, 70 in each group. The mean operation time was 83.3 + 15.6 min in TAP-lap and 80.5 + 14.4 min in PSI (NS). The mean postoperative pain, as measured by VAS, 24 h after surgery was 16.8 + 11.2 mm in PSI and 10 + 8.1 mm in TAP-lap (p = 0.001). Morphine rescues were necessary in 13.2% in PSI and 2.9% in TAP-lap (p = 0.026). The mean hospital stay was 2.1 + 1.2 days in TAP-lap and 2.9 + 1.3 days in PSI (p = 0.019). Hospital discharge during the first 48 h after surgery was possible in 52.9% of the patients in PSI and 71% in TAP-lap (OR 4.75; 95% CI 2.1-10.8; p = 0.029). CONCLUSION Laparoscopic-guided TAP block can reduce postoperative pain, opioid needs, and hospital stay, when compared with port-site infiltration with the same anesthetic drug, without increasing operation time. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03203070.
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12
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Ruiz-Tovar J, Albrecht E, Macfarlane A, Coluzzi F. The TAP block in obese patients: pros and cons. Minerva Anestesiol 2019; 85. [PMID: 30945517 DOI: 10.23736/s0375-9393.19.13545-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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13
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He Y, Wu H, Xiong R, Liu H, Shi J, Xu J, Zhang N, Liu Y. Intravasation Affects the Diagnostic Image Quality of Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography With SonoVue. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2169-2180. [PMID: 30597629 DOI: 10.1002/jum.14914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors. METHODS A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. RESULTS Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. CONCLUSIONS In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.
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Affiliation(s)
- Yanni He
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ran Xiong
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Hongmei Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jiayao Shi
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ning Zhang
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Yu Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
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Hoscheit LP, Heng HG, Lim CK, Weng HY. Survey of the prevalence and methodology of quality assurance for B-mode ultrasound image quality among veterinary sonographers. Vet Radiol Ultrasound 2018. [PMID: 29528172 DOI: 10.1111/vru.12603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Image quality in B-mode ultrasound is important as it reflects the diagnostic accuracy and diagnostic information provided during clinical scanning. Quality assurance programs for B-mode ultrasound systems/components are comprised of initial quality acceptance testing and subsequent regularly scheduled quality control testing. The importance of quality assurance programs for B-mode ultrasound image quality using ultrasound phantoms is well documented in the human medical and medical physics literature. The purpose of this prospective, cross-sectional, survey study was to determine the prevalence and methodology of quality acceptance testing and quality control testing of image quality for ultrasound system/components among veterinary sonographers. An online electronic survey was sent to 1497 members of veterinary imaging organizations: the American College of Veterinary Radiology, the Veterinary Ultrasound Society, and the European Association of Veterinary Diagnostic Imaging, and a total of 167 responses were received. The results showed that the percentages of veterinary sonographers performing quality acceptance testing and quality control testing are 42% (64/151; 95% confidence interval 34-52%) and 26% (40/156: 95% confidence interval 19-33%) respectively. Of the respondents who claimed to have quality acceptance testing or quality control testing of image quality in place for their ultrasound system/components, 0% have performed quality acceptance testing or quality control testing correctly (quality acceptance testing 95% confidence interval: 0-6%, quality control testing 95% confidence interval: 0-11%). Further education and guidelines are recommended for veterinary sonographers in the area of quality acceptance testing and quality control testing for B-mode ultrasound equipment/components.
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Affiliation(s)
- Larry P Hoscheit
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
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15
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Freehand three-dimensional ultrasound system for assessment of scoliosis. J Orthop Translat 2015; 3:123-133. [PMID: 30035049 PMCID: PMC5982385 DOI: 10.1016/j.jot.2015.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/23/2022] Open
Abstract
Background/Objective Standing radiograph with Cobb's method is routinely used to diagnose scoliosis, a medical condition defined as a lateral spine curvature > 10° with concordant vertebral rotation. However, radiation hazard and two-dimensional (2-D) viewing of 3-D anatomy restrict the application of radiograph in scoliosis examination. Methods In this study, a freehand 3-D ultrasound system was developed for the radiation-free assessment of scoliosis. Bony landmarks of the spine were manually extracted from a series of ultrasound images with their spatial information recorded to form a 3-D spine model for measuring its curvature. To validate its feasibility, in vivo measurements were conducted in 28 volunteers (age: 28.0 ± 13.0 years, 9 males and 19 females). A significant linear correlation (R2 = 0.86; p < 0.001) was found between the spine curvatures as measured by Cobb's method and the 3-D ultrasound imaging with transverse process and superior articular process as landmarks. The intra- and interobserver tests indicated that the proposed method is repeatable. Results The 3-D ultrasound method using bony landmarks tended to underestimate the deformity, and a proper scaling is required. Nevertheless, this study demonstrated the feasibility of the freehand 3-D ultrasound system to assess scoliosis in the standing posture with the proposed methods and 3-D spine profile. Conclusion Further studies are required to understand the variations that exist between the ultrasound and radiograph results with a larger number of volunteers, and to demonstrate its potential clinical applications for monitoring of scoliosis patients. Through further clinical trials and development, the reported 3-D ultrasound imaging system can potentially be used for scoliosis mass screening and frequent monitoring of progress and treatment outcome because of its radiation-free and easy accessibility feature.
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Adler D, Schmidt CM, Al-Haddad M, Barthel JS, Ljung BM, Merchant NB, Romagnuolo J, Shaaban AM, Simeone D, Pitman MB, Layfield LJ. Clinical evaluation, imaging studies, indications for cytologic study and preprocedural requirements for duct brushing studies and pancreatic fine-needle aspiration: The Papanicolaou Society of Cytopathology Guidelines. Cytojournal 2014; 11:1. [PMID: 25191515 PMCID: PMC4153337 DOI: 10.4103/1742-6413.133326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 12/19/2022] Open
Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing and postbiopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.
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Affiliation(s)
- Douglas Adler
- Address: Division of Gastroenterology, Department of Internal Medicine at the University of Utah School of Medicine, Indianapolis, Indiana
| | - C Max Schmidt
- Department of Surgery and Biochemistry/Molecular Biology, Indiana University, School of Medicine, Indianapolis, Indiana
| | - Mohammad Al-Haddad
- Department of Medicine, Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | | | - Britt-Marie Ljung
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, California
| | - Nipun B Merchant
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joseph Romagnuolo
- Department of Medicine, Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina
| | - Akram M Shaaban
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, Utah
| | - Diane Simeone
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
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Adler D, Max Schmidt C, Al-Haddad M, Barthel JS, Ljung BM, Merchant NB, Romagnuolo J, Shaaban AM, Simeone D, Bishop Pitman M, Field A, Layfield LJ. Clinical evaluation, imaging studies, indications for cytologic study, and preprocedural requirements for duct brushing studies and pancreatic FNA: the Papanicolaou Society of Cytopathology recommendations for pancreatic and biliary cytology. Diagn Cytopathol 2014; 42:325-32. [PMID: 24554480 DOI: 10.1002/dc.23095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/08/2014] [Indexed: 12/21/2022]
Abstract
The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreaticobiliary cytology including indications for endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) biopsy, techniques for EUS-FNA, terminology and nomenclature to be used for pancreaticobiliary disease, ancillary testing, and post-biopsy management. All documents are based on expertise of the authors, literature review, discussions of the draft document at national and international meetings, and synthesis of online comments of the draft document. This document selectively presents the results of these discussions. This document summarizes recommendations for the clinical and imaging work-up of pancreatic and biliary tract lesions along with indications for cytologic study of these lesions. Prebrushing and FNA requirements are also discussed.
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Affiliation(s)
- Douglas Adler
- Department of Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah
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Dimcevski G, Erchinger FG, Havre R, Gilja OH. Ultrasonography in diagnosing chronic pancreatitis: New aspects. World J Gastroenterol 2013; 19:7247-7257. [PMID: 24259955 PMCID: PMC3831206 DOI: 10.3748/wjg.v19.i42.7247] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/27/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
The course and outcome is poor for most patients with pancreatic diseases. Advances in pancreatic imaging are important in the detection of pancreatic diseases at early stages. Ultrasonography as a diagnostic tool has made, virtually speaking a technical revolution in medical imaging in the new millennium. It has not only become the preferred method for first line imaging, but also, increasingly to clarify the interpretation of other imaging modalities to obtain efficient clinical decision. We review ultrasonography modalities, focusing on advanced pancreatic imaging and its potential to substantially improve diagnosis of pancreatic diseases at earlier stages. In the first section, we describe scanning techniques and examination protocols. Their consequences for image quality and the ability to obtain complete and detailed visualization of the pancreas are discussed. In the second section we outline ultrasonographic characteristics of pancreatic diseases with emphasis on chronic pancreatitis. Finally, new developments in ultrasonography of the pancreas such as contrast enhanced ultrasound and elastography are enlightened.
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Sinha A, Jayaraman L, Punhani D. Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obes Surg 2013; 23:548-53. [PMID: 23361468 DOI: 10.1007/s11695-012-0819-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block as a part of multimodal analgesia was evaluated in morbidly obese patients undergoing laparoscopic bariatric surgery. METHODS We studied 100 patients with body mass index > 35 kg/m2. They were randomly allocated to study (USG-TAP) and control groups. Pain scores at rest and on movement at various time points up to 24 postoperative hours were compared. Other parameters evaluated were patients requiring Tramazac hydrochloride (TMZ) as rescue analgesic, sedation score, time to ambulate, any adverse events, and patient satisfaction. RESULTS The median visual analogue scale pain score of the study (USG-TAP) group was consistently lower at 1, 3, 6, 12, and 24 h at rest and on movement, in the postoperative period. Number of patients requiring TMZ required in the first, third, and sixth hour was significantly lower in the USG-TAP group. The prolonged sedative effect of the TMZ affected the time to ambulate. Patients in the control group remained more sedated. Four patients in the control group required BIPAP support postoperatively; no adverse event was observed. Time to ambulate was 6.3 ± 1.8 h in USG-TAP and 8 ± 1.8 h in control groups; P < 0.001. Patient satisfaction scores were significantly higher in the USG-TAP group; P < 0.001. CONCLUSIONS Our study demonstrates that the USG-TAP as part of multimodal analgesic technique in morbidly obese patients undergoing laparoscopic gastric bypass reduces opioid requirement, improves pain score, decreases sedation, promotes early ambulation, and has greater patient satisfaction.
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Affiliation(s)
- Aparna Sinha
- Institute of Minimal access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India.
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Yoshida T, Masani K, Sayenko DG, Miyatani M, Fisher JA, Popovic MR. Cardiovascular Response of Individuals With Spinal Cord Injury to Dynamic Functional Electrical Stimulation Under Orthostatic Stress. IEEE Trans Neural Syst Rehabil Eng 2013; 21:37-46. [DOI: 10.1109/tnsre.2012.2211894] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dahl J, Jakovljevic M, Pinton GF, Trahey GE. Harmonic spatial coherence imaging: an ultrasonic imaging method based on backscatter coherence. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2012; 59:648-59. [PMID: 22547276 PMCID: PMC3342045 DOI: 10.1109/tuffc.2012.2243] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We introduce a harmonic version of the short-lag spatial coherence (SLSC) imaging technique, called harmonic spatial coherence imaging (HSCI). The method is based on the coherence of the second-harmonic backscatter. Because the same signals that are used to construct harmonic B-mode images are also used to construct HSCI images, the benefits obtained with harmonic imaging are also obtained with HSCI. Harmonic imaging has been the primary tool for suppressing clutter in diagnostic ultrasound imaging, however secondharmonic echoes are not necessarily immune to the effects of clutter. HSCI and SLSC imaging are less sensitive to clutter because clutter has low spatial coherence. HSCI shows favorable imaging characteristics such as improved contrast-to-noise ratio (CNR), improved speckle SNR, and better delineation of borders and other structures compared with fundamental and harmonic B-mode imaging. CNRs of up to 1.9 were obtained from in vivo imaging of human cardiac tissue with HSCI, compared with 0.6, 0.9, and 1.5 in fundamental B-mode, harmonic B-mode, and SLSC imaging, respectively. In vivo experiments in human liver tissue demonstrated SNRs of up to 3.4 for HSCI compared with 1.9 for harmonic B-mode. Nonlinear simulations of a heart chamber model were consistent with the in vivo experiments.
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Affiliation(s)
- Jeremy Dahl
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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Erchinger FG, Dimcevski G, Engjom T, Gilja OH. Transabdominal ultrasonography of the pancreas: basic and new aspects. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Erchinger F, Dimcevski G, Gilja OH, Hausken T. Abdominal ultrasound after colonoscopy with insufflation of carbon dioxide versus air. Scand J Gastroenterol 2010; 44:1055-9. [PMID: 19670077 DOI: 10.1080/00365520903121693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate whether the use of carbon dioxide (CO(2)) compared with air insufflation during colonoscopy improves ultrasonography after the procedure. MATERIAL AND METHODS In a double-blind trial, 30 patients were randomized to insufflation with CO(2) or air. Thirty minutes after colonoscopy abdominal ultrasound was performed. Immediately after ultrasonography, the ultrasound quality of the liver, gallbladder, biliary ducts, pancreas, spleen, kidneys, abdominal vessels, antrum, bowel, urinary bladder and prostate/uterus was evaluated for optimal ultrasound scanning quality, minor reduction of scanning conditions, major reduction of scanning conditions and unacceptable scanning conditions. RESULTS Ultrasound quality 30 min after colonoscopy was significantly better when using CO(2) insufflation instead of air (p<0.003). Significant improvement in imaging quality was observed for the liver, portal vein, splenic vein, all three divisions of the pancreas, aorta, coeliac trunk, superior mesenteric artery, iliac vessels, left kidney and uterus. CONCLUSIONS Ultrasound investigation can be done after a colonoscopy with CO(2) insufflation, whereas it is not recommended after a colonoscopy with air insufflation. In selected cases, this approach may enable and improve post-colonoscopy ultrasound scanning.
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25
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Saranteas T. Limitations in Ultrasound Imaging Techniques in Anesthesia: Obesity and Muscle Atrophy? Anesth Analg 2009; 109:993-4. [DOI: 10.1213/ane.0b013e3181ae09a4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Martinez-Ares D, Aguirre PAA, López JY, Barrenechea IMG, Cadilla JM, Martinez DR, Peral AP. Sensitivity of ultrasonography for gastric cancer diagnosis in symptomatic patients. Dig Dis Sci 2009; 54:1257-64. [PMID: 18758959 DOI: 10.1007/s10620-008-0474-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 07/24/2008] [Indexed: 12/20/2022]
Abstract
Endoscopy with biopsy sampling is the gold standard used in gastric cancer diagnosis. However, the positive predictive value of signs and symptoms for the diagnosis of carcinomas is quite limited, and, therefore, many patients are subjected to non-diagnostic endoscopies, especially when symptoms are not so specific. This study shows that ultrasonography is sensitive enough for the diagnosis of gastric cancer, and, therefore, use of this technique would further ensure a better selection of patients for endoscopy. The study included 143 patients (86 men and 57 women, with an average age of 68.6 years) who were suspected of having gastric cancer. The diagnostic accuracy of ultrasonography was evaluated in a blind study. The conventional technique was used in all cases. Demographic parameters and a series of other clinical-analytical variables were studied to look for possible gastric cancer predictive factors, which when present would make ultrasonographic results irrelevant. Statistical analysis was done using SPSS 12.0, wherein a value of P < 0.05 was considered to be statistically significant. Of the 143 patients studied, 40 were diagnosed to have gastric cancer. Sonography was able to diagnose 37 cases correctly, while there were three false negative findings and eight false positive findings. This results in 92.5% sensitivity, 92.2% specificity, 82.2% positive predictive value, 96.9% negative predictive value, and a global accuracy of 92.3%. Univariate analysis showed that persistent vomiting (P = 0.021), hemoglobin level of less than 8 g/dl (P = 0.045) and a positive ultrasonography result (P < 0.0001) were associated with a higher frequency of gastric cancer. Multivariate analysis showed that persistent vomiting, with an odds ratio for gastric cancer of 3.68 (95% confidence interval 1.15-11.79; P = 0.039), and a positive ultrasonography result, with an odds ratio for gastric cancer of 117.78 (95% confidence interval 32.45-427.49; P < 0.0001), could be considered as independent predictive factors for gastric cancer. It was concluded that ultrasonography is a very sensitive and specific technique for diagnosing gastric cancer. Gastric cancer was found to be present in just 28% of the patients studied, and their condition was suspect because of the clinical manifestations. Only vomiting and a positive ultrasonography result can be considered as independent predictive factors of gastric cancer.
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Affiliation(s)
- David Martinez-Ares
- Servicio Digestivo, Complejo Hospitalario Xeral-Cies, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain.
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Imaging of the Small Bowel: Challenges and Advances in Imaging Techniques. J Med Imaging Radiat Sci 2008; 39:55-63. [DOI: 10.1016/j.jmir.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Almeida ADM, Cotrim HP, Barbosa DBV, Athayde LGMD, Santos AS, Bitencourt AGV, Freitas LARD, Rios A, Alves E. Fatty liver disease in severe obese patients: Diagnostic value of abdominal ultrasound. World J Gastroenterol 2008; 14:1415-8. [PMID: 18322958 PMCID: PMC2693692 DOI: 10.3748/wjg.14.1415] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis.
METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard.
RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis on US was associated to advanced grades of steatosis on histology (P = 0.016).
CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.
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Li Y, Robinson B. The cross algorithm for phase-aberration correction in medical ultrasound images formed with two-dimensional arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2008; 55:588-601. [PMID: 18407849 DOI: 10.1109/tuffc.2008.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Common-midpoint signals in the near-field signal-redundancy (NFSR) algorithm for one-dimensional arrays are acquired using three consecutive transducer elements. An all-row-plus-two-column algorithm has been proposed to implement the one-dimensional NFSR algorithm on two dimensional arrays. The disadvantage of this method is that its ambiguity profile is not linear and a timeconsuming iterative method has to be used to linearize the ambiguity profile. An all-row-plus-two-column-and-a-diagonal algorithm has also been proposed. Its ambiguity profile is linear, but it is very sensitive to noise and cannot be used. In this paper, a novel cross algorithm is proposed to implement the NFSR algorithm on two-dimensional arrays. In this algorithm, common-midpoint signals are acquired using four adjacent transducer elements, which is not available in one-dimensional arrays. Its advantage includes a linear ambiguity profile and a higher measurement signal-to-noise ratio. The performance of the cross algorithm is evaluated theoretically. The region of redundancy is analyzed. The procedure for deriving the phaseaberration profile from peak positions of cross-correlation functions between common-midpoint signals is discussed. This algorithm is tested with a simulated data set acquired with a two-dimensional array, and the result shows that the cross algorithm performs better than the all-row plus-twocolumn NFSR algorithm.
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Affiliation(s)
- Yue Li
- Commonwealth Scientific and Industrial Research Organisation, Information and Communication Technologies Center, Sydney, Australia.
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Li Y, Robinson B. Implementation of the near-field signal redundancy phase-aberration correction algorithm on two-dimensional arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2007; 54:42-51. [PMID: 17225799 DOI: 10.1109/tuffc.2007.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Near-field signal-redundancy (NFSR) algorithms for phase-aberration correction have been proposed and experimentally tested for linear and phased one-dimensional arrays. In this paper the performance of an all-row-plus-two-column, two-dimensional algorithm has been analyzed and tested with simulated data sets. This algorithm applies the NFSR algorithm for one-dimensional arrays to all the rows as well as the first and last columns of the array. The results from the two column measurements are used to derive a linear term for each row measurement result. These linear terms then are incorporated into the row results to obtain a two-dimensional phase aberration profile. The ambiguity phase aberration profile, which is the difference between the true and the derived phase aberration profiles, of this algorithm is not linear. Two methods, a trial-and-error method and a diagonal-measurement method, are proposed to linearize the ambiguity profile. The performance of these algorithms is analyzed and tested with simulated data sets.
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Affiliation(s)
- Yue Li
- Commonwealth Scientific and Industrial Research Organisation, Information and Communication Technologies Center, Sydney, Australia.
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Bohris C, Jensen H, Bayer T, Liong ML. A New Integrated Ultrasound System for Shockwave Lithotripsy. J Endourol 2006; 20:863-9. [PMID: 17144852 DOI: 10.1089/end.2006.20.863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Inline ultrasound monitoring requires good image quality for accurate stone localization, as well as low shockwave shadowing and a robust transducer. In general, conventional transducers designed for another purpose, such as abdominal scanning, are employed. The distance between the transducer and the SWL focus can be varied by a mechanical drive. The drawback is reduced fragmentation at short distances and poor imaging at long distances. This paper introduces a new approach using a specially designed transducer without a mechanical drive. MATERIALS AND METHODS A transducer prototype with optimized beam focusing (B-K Medical, Herlev, Denmark) was integrated into a modified Compact Delta II therapy head (Dornier MedTech, Wessling, Germany). Image quality was tested at two clinical sites, where 40 kidney and 14 ureteral stones were treated. The shockwave was characterized by model stone tests and fiberoptic hydrophone measurements. RESULTS Both kidney and ureteral stone treatments could be monitored reliably. Despite the long distance to the SWL focus, the transducer could be operated with relatively high frequencies (3.5-6 MHz), so that high image resolution was obtained. Model stone tests yielded the same fragmentation as the standard Compact Delta II without a transducer. CONCLUSIONS This study shows that the concept of an integrated transducer distant from the shockwave focus is feasible. Transducer elevation, which is accompanied by shockwave shadowing and early transducer failure, is avoided by employing a dedicated transducer design.
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Soffer D, Schulman CI, McKenney MG, Cohn S, Renaud NA, Namias N, Lynn M. What Does Ultrasonography Miss in Blunt Trauma Patients With A Low Glasgow Coma Score (GCS)? ACTA ACUST UNITED AC 2006; 60:1184-8. [PMID: 16766959 DOI: 10.1097/01.ta.0000196751.46589.0d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of ultrasound (US) as a screening tool for the evaluation of blunt abdominal trauma is still controversial. Determining the types of missed injuries and the accuracy of US in patients with a low GCS will improve the evaluation of these blunt trauma patients. METHODS Prospectively collected data from the trauma registry of a Level I trauma center was reviewed. RESULTS 7,952 patients were included in the study. US examination had an accuracy of 89%, sensitivity of 77%, specificity of 97%, positive predictive value (PPV) of 78%, and negative predictive value (NPV) of 98%. GCS correlated with ISS and base deficit levels. US examination had a significantly lower accuracy in patients with a low GCS and in women. CONCLUSION The sensitivity and specificity of US examination is similar in those with normal and low GCS. Therefore ultrasonographic examination may be considered a good screening tool for the evaluation of patients with blunt abdominal trauma, but its accuracy is diminished in patients with a low GCS. Further imaging may be warranted in these patients.
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Affiliation(s)
- Dror Soffer
- Dewitt Daughtry Family Department of Surgery, Division of Trauma, University of Miami School of Medicine, Miami, Florida 33101, USA
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Malinger G, Levine A, Rotmensch S. The fetal esophagus: anatomical and physiological ultrasonographic characterization using a high-resolution linear transducer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:500-505. [PMID: 15459941 DOI: 10.1002/uog.1091] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To study the sonographic anatomy and physiology of the human fetal esophagus during the mid-trimester of pregnancy using a high-resolution linear transducer. METHODS This was a prospective observational study of the fetal esophagus between 19 and 25 weeks' gestation. The study was performed in 60 consecutive fetuses, after a normal anatomy scan, using a 5-13-MHz matrix array wide-band transducer. During the examination the collapsed esophagus was first visualized, and followed by a 5-min video recording in order to demonstrate luminal patency and peristaltic waves. RESULTS Complete anatomical visualization of the esophagus was possible in 52 (86.7%) patients and at least partial visualization in 58 (96.7%) patients. Three different patterns of esophageal motility were observed: a simultaneous and short opening of the whole esophagus was found in 35 (58.3%) fetuses; a segmental, peristalsis-like movement from the pharynx, through the mediastinum, and into the stomach was found in 18 (30%) fetuses; and in one fetus reflux-like passage of solid contents from the stomach was observed. The mean time required for demonstration of esophageal patency was 96.1 (range, 10-300) s. CONCLUSIONS Demonstration of normal anatomy and physiological activity of the fetal esophagus is feasible using appropriate transducers. The most commonly observed pattern of esophageal motility in the mid-trimester of pregnancy is the simultaneous relaxation of the upper and lower esophageal sphincters with concurrent opening of the esophageal lumen from the upper thorax to the stomach. Demonstration of a patent esophagus may be helpful in fetuses with suspected esophageal atresia.
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Affiliation(s)
- G Malinger
- Prenatal Diagnosis Unit, The Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Obesidade é uma doença complexa, de mútiplas etiologias e suficientemente comum para constituir um problema de saúde pública, assim como um dilema clínico importante. Especialistas da área clínica e cirúrgica são freqüentemente desafiados pelas alterações fisiopatológicas associadas com a obesidade. Essas alterações comprometem virtualmente todos os sistemas do organismo, podendo apresentar-se como barreiras no diagnóstico e na terapêutica. Há evidências marcantes de que obesidade acarreta risco excessivo para a saúde; de fato, a mortalidade aumenta de forma aguda quando o índice de massa corporal ultrapassa 30 kg/m2, principalmente quando há distribuição central de tecido adiposo concomitante. O autor discute os efeitos da obesidade nos sistemas respitatório, cardiovascular, digestório e geniturinário. Os obstáculos enfrentados em procedimentos diagnósticos ordinários, prescrição de medicamentos, traumas, assim como descrições patológicas raras de lipomas, são apresentados.
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Hinkelman LM, Mast TD, Metlay LA, Waag RC. The effect of abdominal wall morphology on ultrasonic pulse distortion. Part I. Measurements. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 1998; 104:3635-49. [PMID: 9857521 DOI: 10.1121/1.423946] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The relative importance of the fat and muscle layers of the human abdominal wall in producing ultrasonic wavefront distortion was assessed by means of direct measurements. Specimens employed included six whole abdominal wall specimens and twelve partial specimens obtained by dividing each whole specimen into a fat and a muscle layer. In the measurement technique employed, a hemispheric transducer transmitted a 3.75-MHz ultrasonic pulse through a tissue section. The received wavefront was measured by a linear array translated in the elevation direction to synthesize a two-dimensional aperture. Insertion loss was also measured at various locations on each specimen. Differences in arrival time and energy level between the measured waveforms and computed references that account for geometric delay and spreading were calculated. After correction for the effects of geometry, the received waveforms were synthetically focused. The characteristics of the distortion produced by each specimen and the quality of the resulting focus were analyzed and compared. The measurements show that muscle produces greater arrival time distortion than fat while fat produces greater energy level distortion than muscle, but that the distortion produced by the entire abdominal wall is not equivalent to a simple combination of distortion effects produced by the layers. The results also indicate that both fat and muscle layers contribute significantly to the distortion of ultrasonic beams by the abdominal wall. However, the spatial characteristics of the distortion produced by fat and muscle layers differ substantially. Distortion produced by muscle layers, as well as focal images aberrated by muscle layers, show considerable anisotropy associated with muscle fiber orientation. Distortion produced by fat layers shows smaller-scale, granular structure associated with scattering from the septa surrounding individual fat lobules. Thick layers of fat may be expected to cause poor image quality due to both scattering and bulk absorption effects, while thick muscle layers may be expected to cause focus aberration due to large arrival time fluctuations. Correction of aberrated focuses using time-shift compensation shows more complete correction for muscle sections than for fat sections, so that correction methods based on phase screen models may be more appropriate for muscle layers than for fat layers.
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Affiliation(s)
- L M Hinkelman
- Department of Electrical Engineering, University of Rochester, New York 14627, USA
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Li Y. Phase aberration correction using near-field signal redundancy. I. Principles [Ultrasound medical imaging]. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 1997; 44:355-371. [PMID: 18244133 DOI: 10.1109/58.585120] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The signal redundancy principle in the near field is analyzed quantitatively. It is found that common midpoint signals are not identical (or redundant) for echoes coming from arbitrary target distributions in the near field. A dynamic near-field correction is proposed to reduce the difference between common midpoint signals for echoes coming from the region of interest. When phase aberrations are present, it is shown that the dynamic correction can generally be done assuming no phase aberration, and the relative time-shift between common midpoint signals can be used to measure phase-aberration profiles. A phase-aberration correction algorithm based on that principle is proposed. In this algorithm, after common midpoint signals are collected they are dynamically corrected for near-field effects and cross-correlated with one another. In a related way, the phase errors are measured from peak positions of these cross-correlation functions. The phase-aberration profile across the array is derived from these measurements. The relationship between the errors in the derived phase aberration profile and the errors in the measured relative time-shift between common midpoint signals is derived. A method for treating the situation of different transmission and reception phase-aberration profiles is also proposed. This algorithm works for general target distributions, iteration is not required, and it can be used in other near-field, pulse-echo, imaging systems.
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Affiliation(s)
- Y Li
- Div. of Radiophys., CSIRO, Epping, NSW
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John TG, Greig JD, Carter DC, Garden OJ. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 1995; 221:156-64. [PMID: 7857143 PMCID: PMC1234948 DOI: 10.1097/00000658-199502000-00005] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with carcinomas of the pancreatic head and periampullary region. SUMMARY BACKGROUND DATA Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy. METHODS A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region). RESULTS "Occult" metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively). CONCLUSIONS Staging laparoscopy is indispensable in the detection of "occult" intra-abdominal metastases. Laparoscopic ultrasonography improves the accuracy of laparoscopic staging in patients with potentially resectable pancreatic and periampullary carcinomas.
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Affiliation(s)
- T G John
- Department of Surgery, Royal Infirmary, Edinburgh, Scotland, United Kingdom
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