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Annunziata G, Verde L, Grillo ARA, Stallone T, Colao A, Muscogiuri G, Barrea L. Association among measurements obtained using portable ultrasonography with sex, body mass index, and age in a large sample of adult population. J Transl Med 2025; 23:236. [PMID: 40016819 PMCID: PMC11869708 DOI: 10.1186/s12967-025-06159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 01/21/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND The assessment of the site-specific distribution of subcutaneous tissues (ST) represents an important addition to the body composition (BC) estimation. In this context, ultrasound stands out as a valuable method. However, the absence of reference values complicates both the interpretation of the obtained parameters and the monitoring of their changes during nutritional interventions or training programs. METHODS A total of 6,270 ultrasound images obtained with a technique using a non-diagnostic B-mode 2.5 MHz ultrasound probe (BodyMetrixTM, IntelaMetrix, Inc., Livermore, CA, USA) were obtained from adult men and women and analysed by grouping them according to sex, body mass index (BMI), and age. The thicknesses of total (tSAT), superficial (sSAT), and deep (dSAT) subcutaneous adipose tissue and muscle (MT), their ratios (sSAT/dSAT and MT/SAT), and muscle echogenicity (EG) were measured at the abdomen, thigh, chest, triceps, and hip sites. RESULTS Women exhibited greater tSAT, sSAT, dSAT, and EG (p < 0.001) and lower MT (p < 0.001), sSAT/dSAT (p = 0.008 for the abdomen and p < 0.001 for the thigh), and MT/SAT (p < 0.001) compared to men at both the abdomen and thigh sites. SAT-related parameters showed significant correlations with BMI, with thicknesses correlating positively and ratios negatively (p < 0.001). Muscle-related parameters correlated significantly with age, with MT and EG showing positive correlations and MT/SAT showing negative correlations (p < 0.001) in both sexes. Among SAT parameters, dSAT showed the strongest association with BMI in both men and women. CONCLUSIONS This study is the first to report the mean values of SAT-related quantitative and qualitative measurements (thickness and EG) in various body sites assessed through ultrasound and their associations with sex, BMI, and age in a large cohort. These findings could prove valuable in clinical practice for precise monitoring of nutritional and/or training interventions, as well as for a more comprehensive evaluation of nutritional status.
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Affiliation(s)
- Giuseppe Annunziata
- Facoltà di Scienze Umane, della Formazione e dello Sport, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, Naples, 80143, Italy
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | | | - Tiziana Stallone
- Departmental Faculty of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, Via Di Sant'Alessandro 8, Rome, 00131, Italy
| | - Annamaria Colao
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Endocrinologia, Diabetologia, Andrologia e Nutrizione, Unità di Endocrinologia, Diabetologia e Andrologia, Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, 80131, Italy
| | - Giovanna Muscogiuri
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Endocrinologia, Diabetologia, Andrologia e Nutrizione, Unità di Endocrinologia, Diabetologia e Andrologia, Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, 80131, Italy
| | - Luigi Barrea
- Dipartimento di Psicologia e Scienze della Salute, Università Telematica Pegaso, Centro Direzionale Isola F2, Via Porzio, Naples, 80143, Italy.
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Maruszczak K, Kochman M, Madej T, Gawda P. Ultrasound Imaging in Diagnosis and Management of Lower Limb Injuries: A Comprehensive Review. Med Sci Monit 2024; 30:e945413. [PMID: 39223775 PMCID: PMC11378687 DOI: 10.12659/msm.945413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Medical imaging tests are widely used to diagnose a broad spectrum of lower-limb injuries. Among these modalities, ultrasound (US) imaging has gained significant traction as a valuable diagnostic instrument for assessing conditions primarily affecting muscles, tendons, ligaments, and other soft tissues. However, there are important dilemmas related to the indications and possibilities of US in lower-limb injuries. Conflicting findings and approaches raise questions regarding the validity, accuracy, and usefulness of the US in that area. This narrative review attempts to summarize the current state of knowledge regarding US imaging of lower-limb injuries. The study provides a detailed discussion of the existing literature and contemporary insights on the diagnosis of lower-limb injuries using US examination, and draws attention to the role of the US in interventional procedures and monitoring of the healing process. The characteristics of normal muscles, tendons, and ligaments in US imaging are presented, along with the most commonly documented conditions affecting these tissues. Furthermore, the benefits and justifications for employing US in interventional procedures are discussed, ranging from platelet-rich plasma injections to physiotherapeutic treatments like percutaneous electrolysis. The study was further augmented with US pictures depicting various lower-limb injuries, mainly affecting young athletes. This article aims to review the role of US imaging in the diagnosis and management of common lower-limb injuries.
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Affiliation(s)
- Krystian Maruszczak
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Maciej Kochman
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Tomasz Madej
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, Lublin, Poland
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Boneš E, Gergolet M, Bohak C, Lesar Ž, Marolt M. Automatic Segmentation and Alignment of Uterine Shapes from 3D Ultrasound Data. Comput Biol Med 2024; 178:108794. [PMID: 38941903 DOI: 10.1016/j.compbiomed.2024.108794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The uterus is the most important organ in the female reproductive system. Its shape plays a critical role in fertility and pregnancy outcomes. Advances in medical imaging, such as 3D ultrasound, have significantly improved the exploration of the female genital tract, thereby enhancing gynecological healthcare. Despite well-documented data for organs like the liver and heart, large-scale studies on the uterus are lacking. Existing classifications, such as VCUAM and ESHRE/ESGE, provide different definitions for normal uterine shapes but are not based on real-world measurements. Moreover, the lack of comprehensive datasets significantly hinders research in this area. Our research, part of the larger NURSE study, aims to fill this gap by establishing the shape of a normal uterus using real-world 3D vaginal ultrasound scans. This will facilitate research into uterine shape abnormalities associated with infertility and recurrent miscarriages. METHODS We developed an automated system for the segmentation and alignment of uterine shapes from 3D ultrasound data, which consists of two steps: automatic segmentation of the uteri in 3D ultrasound scans using deep learning techniques, and alignment of the resulting shapes with standard geometrical approaches, enabling the extraction of the normal shape for future analysis. The system was trained and validated on a comprehensive dataset of 3D ultrasound images from multiple medical centers. Its performance was evaluated by comparing the automated results with manual annotations provided by expert clinicians. RESULTS The presented approach demonstrated high accuracy in segmenting and aligning uterine shapes from 3D ultrasound data. The segmentation achieved an average Dice similarity coefficient (DSC) of 0.90. Our method for aligning uterine shapes showed minimal translation and rotation errors compared to traditional methods, with the preliminary average shape exhibiting characteristics consistent with expert findings of a normal uterus. CONCLUSION We have presented an approach to automatically segment and align uterine shapes from 3D ultrasound data. We trained a deep learning nnU-Net model that achieved high accuracy and proposed an alignment method using a combination of standard geometrical techniques. Additionally, we have created a publicly available dataset of 3D transvaginal ultrasound volumes with manual annotations of uterine cavities to support further research and development in this field. The dataset and the trained models are available at https://github.com/UL-FRI-LGM/UterUS.
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Affiliation(s)
- Eva Boneš
- University of Ljubljana, Faculty of Computer and Information Science, Večna pot 113, Ljubljana, 1000, Slovenia.
| | - Marco Gergolet
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, Ljubljana, 1000, Slovenia.
| | - Ciril Bohak
- University of Ljubljana, Faculty of Computer and Information Science, Večna pot 113, Ljubljana, 1000, Slovenia; King Abdullah University of Science and Technology, Visual Computing Center, Thuwal, 23955-6900, Saudi Arabia.
| | - Žiga Lesar
- University of Ljubljana, Faculty of Computer and Information Science, Večna pot 113, Ljubljana, 1000, Slovenia.
| | - Matija Marolt
- University of Ljubljana, Faculty of Computer and Information Science, Večna pot 113, Ljubljana, 1000, Slovenia.
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Wu D, Smith D, VanBerlo B, Roshankar A, Lee H, Li B, Ali F, Rahman M, Basmaji J, Tschirhart J, Ford A, VanBerlo B, Durvasula A, Vannelli C, Dave C, Deglint J, Ho J, Chaudhary R, Clausdorff H, Prager R, Millington S, Shah S, Buchanan B, Arntfield R. Improving the Generalizability and Performance of an Ultrasound Deep Learning Model Using Limited Multicenter Data for Lung Sliding Artifact Identification. Diagnostics (Basel) 2024; 14:1081. [PMID: 38893608 PMCID: PMC11172006 DOI: 10.3390/diagnostics14111081] [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: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Deep learning (DL) models for medical image classification frequently struggle to generalize to data from outside institutions. Additional clinical data are also rarely collected to comprehensively assess and understand model performance amongst subgroups. Following the development of a single-center model to identify the lung sliding artifact on lung ultrasound (LUS), we pursued a validation strategy using external LUS data. As annotated LUS data are relatively scarce-compared to other medical imaging data-we adopted a novel technique to optimize the use of limited external data to improve model generalizability. Externally acquired LUS data from three tertiary care centers, totaling 641 clips from 238 patients, were used to assess the baseline generalizability of our lung sliding model. We then employed our novel Threshold-Aware Accumulative Fine-Tuning (TAAFT) method to fine-tune the baseline model and determine the minimum amount of data required to achieve predefined performance goals. A subgroup analysis was also performed and Grad-CAM++ explanations were examined. The final model was fine-tuned on one-third of the external dataset to achieve 0.917 sensitivity, 0.817 specificity, and 0.920 area under the receiver operator characteristic curve (AUC) on the external validation dataset, exceeding our predefined performance goals. Subgroup analyses identified LUS characteristics that most greatly challenged the model's performance. Grad-CAM++ saliency maps highlighted clinically relevant regions on M-mode images. We report a multicenter study that exploits limited available external data to improve the generalizability and performance of our lung sliding model while identifying poorly performing subgroups to inform future iterative improvements. This approach may contribute to efficiencies for DL researchers working with smaller quantities of external validation data.
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Affiliation(s)
- Derek Wu
- Department of Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Delaney Smith
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Blake VanBerlo
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Amir Roshankar
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Hoseok Lee
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Brian Li
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Faraz Ali
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Marwan Rahman
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - John Basmaji
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Jared Tschirhart
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Alex Ford
- Independent Researcher, London, ON N6A 1L8, Canada;
| | - Bennett VanBerlo
- Faculty of Engineering, Western University, London, ON N6A 5C1, Canada;
| | - Ashritha Durvasula
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Claire Vannelli
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Chintan Dave
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Jason Deglint
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Jordan Ho
- Department of Family Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Rushil Chaudhary
- Department of Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Hans Clausdorff
- Departamento de Medicina de Urgencia, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Scott Millington
- Department of Critical Care Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Samveg Shah
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Brian Buchanan
- Department of Critical Care, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Robert Arntfield
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
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Wang R, Liu X, Tan G. Coupling speckle noise suppression with image classification for deep-learning-aided ultrasound diagnosis. Phys Med Biol 2024; 69:065001. [PMID: 38359452 DOI: 10.1088/1361-6560/ad29bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024]
Abstract
Objective. During deep-learning-aided (DL-aided) ultrasound (US) diagnosis, US image classification is a foundational task. Due to the existence of serious speckle noise in US images, the performance of DL models may be degraded. Pre-denoising US images before their use in DL models is usually a logical choice. However, our investigation suggests that pre-speckle-denoising is not consistently advantageous. Furthermore, due to the decoupling of speckle denoising from the subsequent DL classification, investing intensive time in parameter tuning is inevitable to attain the optimal denoising parameters for various datasets and DL models. Pre-denoising will also add extra complexity to the classification task and make it no longer end-to-end.Approach. In this work, we propose a multi-scale high-frequency-based feature augmentation (MSHFFA) module that couples feature augmentation and speckle noise suppression with specific DL models, preserving an end-to-end fashion. In MSHFFA, the input US image is first decomposed to multi-scale low-frequency and high-frequency components (LFC and HFC) with discrete wavelet transform. Then, multi-scale augmentation maps are obtained by computing the correlation between LFC and HFC. Last, the original DL model features are augmented with multi-scale augmentation maps.Main results. On two public US datasets, all six renowned DL models exhibited enhanced F1-scores compared with their original versions (by 1.31%-8.17% on the POCUS dataset and 0.46%-3.89% on the BLU dataset) after using the MSHFFA module, with only approximately 1% increase in model parameter count.Significance. The proposed MSHFFA has broad applicability and commendable efficiency and thus can be used to enhance the performance of DL-aided US diagnosis. The codes are available athttps://github.com/ResonWang/MSHFFA.
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Affiliation(s)
- Ruixin Wang
- College of Computer Science and Software Engineering, Hohai University, Nanjing 210098, People's Republic of China
| | - Xiaohui Liu
- The First People's Hospital of Kunshan, Affiliated Kunshan Hospital of Jiangsu University, Kunshan 215300, People's Republic of China
| | - Guoping Tan
- College of Computer Science and Software Engineering, Hohai University, Nanjing 210098, People's Republic of China
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Bergmann A, Feng C, Chochlidakis K, Russo LL, Ercoli C. A comparison of alveolar ridge mucosa thickness in completely edentulous patients. J Prosthodont 2024; 33:132-140. [PMID: 37470112 DOI: 10.1111/jopr.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/13/2023] [Accepted: 06/25/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The purpose of this cross-sectional clinical study was to determine and compare alveolar ridge mucosa thickness at crestal, buccal, and lingual locations of the maxillary and mandibular arches in completely edentulous patients using a dedicated, ultrasonic gingival scanner. MATERIALS AND METHODS Thirty-eight completely edentulous subjects were included in the study. In each subject, soft tissue thickness was measured at 28 sites of the edentulous ridge by a single calibrated examiner. Intra-observer reliability was calculated with Intraclass Correlation Coefficients by measuring 10 subjects twice, after 1 week. Measurements (mm) were taken at the buccal, lingual, and crestal aspects of the ridge with a dedicated ultrasonic scanner. Repeated measures ANOVA and paired t-tests were used to compare the mean buccal, lingual, and crestal soft tissue thicknesses at each site. The Generalized Estimating Equations model was used to study the effects of age, sex, and race. Confidence level was set to 95%. RESULTS Mean tissue thickness ranged from 0.96 to 1.98 mm with a mean of 1.63 ± 0.25 mm. Intraclass Correlation Coefficients were > 0.97. No significant differences between buccal, crestal, and lingual sites were noted for the mandibular arch as well as at 4 sites on the maxillary arch (maxillary right second molar, maxillary right canine, maxillary left first premolar, maxillary left second molar). However, significant differences in soft tissue thickness were noted for all remaining maxillary sites. Race was found to be positively correlated with tissue thickness, with Black individuals showing a significantly greater thickness than White individuals at 4 sites (maxillary right first molar, maxillary left canine, mandibular right second premolar, mandibular right first molar). Age was found to be positively correlated with tissue thickness at 4 sites (maxillary left central incisor, maxillary left first molar, maxillary left second molar, mandibular left second premolar) and negatively correlated at 2 sites (mandibular right canine, mandibular right second molar). Female sex was positively (maxillary left second premolar, maxillary left second molar) and negatively (mandibular right canine) correlated, respectively, with tissue thickness at 3 sites. When data for anterior and posterior sites were respectively pooled, tissue thickness was significantly less at anterior sextant lingual and crestal sites, while no difference was seen for buccal sites. CONCLUSION Statistically significant differences for alveolar ridge mucosa thickness were found at several sites in the maxilla and between anterior and posterior sextants for lingual and crestal sites in the maxillary and mandibular arches. Tissue thickness differences were also noted for race with Black individuals showing greater tissue thickness at some sites. Age and sex did not show a clear effect on tissue thickness. Recorded differences in tissue thickness were however small and appear of uncertain clinical significance.
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Affiliation(s)
- Andrew Bergmann
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Konstantinos Chochlidakis
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Lucio Lo Russo
- Department of Prosthodontics, School of Dentistry, University of Foggia, Foggia, Italy
| | - Carlo Ercoli
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
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Harutyunyan R, Jeffries SD, Morse J, Hemmerling TM. Beyond the Echo: The Evolution and Revolution of Ultrasound in Anesthesia. Anesth Analg 2024; 138:369-375. [PMID: 38215715 DOI: 10.1213/ane.0000000000006834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
This article explores the evolving role of ultrasound technology in anesthesia. Ultrasound emerged decades ago, offering clinicians noninvasive, economical, radiation-free, and real-time imaging capabilities. It might seem that such an old technology with apparent limitations might have had its day, but this review discusses both the current applications of ultrasound (in nerve blocks, vascular access, and airway management) and then, more speculatively, shows how integration of advanced ultrasound modalities such as contrast-enhanced imaging with virtual reality (VR), or nanotechnology can alter perioperative patient care. This article will also explore the potential of robotics and artificial intelligence (AI) in augmenting ultrasound-guided anesthetic procedures and their implications for medical practice and education.
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Affiliation(s)
- Robert Harutyunyan
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sean D Jeffries
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Joshua Morse
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Thomas M Hemmerling
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Hänni O, Ruby L, Paverd C, Frauenfelder T, Rominger MB, Martin A. Confounders of Ultrasound Attenuation Imaging in a Linear Probe Using the Canon Aplio i800 System: A Phantom Study. Diagnostics (Basel) 2024; 14:271. [PMID: 38337786 PMCID: PMC10855333 DOI: 10.3390/diagnostics14030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
There have been studies showing attenuation imaging (ATI) with ultrasound as an approach to diagnose liver diseases such as steatosis or cirrhosis. So far, this technique has only been used on a convex probe. The goal of the study was to investigate the feasibility of ATI measurements using the linear array on a canon Aplio i800 scanner on certified phantoms. Three certified liver tissue attenuation phantoms were measured in five different positions using a linear probe. The effects of positioning and depth were explored and compared. The values were compared to the certified expected value for each phantom as well as the different measurement values for each measurement position. The ATI measurements on phantoms showed significant effect for the different probe positions and region of interest (ROI) depths. Values taken in the center with the probe perpendicular to the phantom were closest to certified values. Median values at 2.5-4.5 cm depth for phantoms 1 and 2 and 0.5-2.5 cm for phantom 3 were comparable with certified values. Measurements taken at a depth greater than 6 cm in any position were the least representative of the certified values (p-value < 0.01) and had the widest range throughout the different sessions. ATI measurements can be performed with the linear probe in phantoms; however, careful consideration should be given to depth dependency, as it can significantly affect measurement values. Remaining measurements at various depths within the 0.5-6.0 cm range showed deviation from the certified values of approximately 25%.
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Affiliation(s)
- Olivia Hänni
- Faculty of Medicine, University of Zurich, Dekanat Pestalozzistrasse 3, 8032 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Catherine Paverd
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Marga B. Rominger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Alexander Martin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
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Rusetsky YY, Miroshnichenko AP, Elovikov VA, Kogan MA, Haddadin DT. [The normal sonographic picture of the paratonsillar region and the prerequisites for ultrasound diagnosis of purulent pathology of the pharynx]. Vestn Otorinolaringol 2024; 89:4-9. [PMID: 38506018 DOI: 10.17116/otorino2024890114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Paratonsillar abscess (PTA) stands out among all otorhinolaryngological diseases, since it can cause life-threatening complications that develop in the shortest possible time due to the close connection of the cellular spaces of the head, neck and mediastinum. In addition to physical examination, computed tomography and magnetic resonance imaging are routinely used to diagnose PTA, sonography is less often used. With the help of the latter, it is possible to reliably distinguish PTA from both paratonsillitis and a number of other diseases, including an aneurysm of the internal carotid artery, using the Doppler mode. However, there are significant gaps in the ultrasound diagnosis of PTA and paratonsillitis: the use of a percutaneous convex sensor is not described, there is no description of clear anatomical landmarks for reliable and rapid recognition of PTA, and diagnostically complete algorithms for verification and visualization of paratonsillitis and PTA using sonographic examination have not been developed. Our work is aimed at filling these gaps.
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Affiliation(s)
- Yu Yu Rusetsky
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | | | - V A Elovikov
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Inozemtsev City Clinical Hospital, Moscow, Russia
| | - M A Kogan
- Inozemtsev City Clinical Hospital, Moscow, Russia
| | - D T Haddadin
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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Chen F, Chen L, Kong W, Zhang W, Zheng P, Sun L, Zhang D, Liao H. Deep Semi-Supervised Ultrasound Image Segmentation by Using a Shadow Aware Network With Boundary Refinement. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:3779-3793. [PMID: 37695964 DOI: 10.1109/tmi.2023.3309249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Accurate ultrasound (US) image segmentation is crucial for the screening and diagnosis of diseases. However, it faces two significant challenges: 1) pixel-level annotation is a time-consuming and laborious process; 2) the presence of shadow artifacts leads to missing anatomy and ambiguous boundaries, which negatively impact reliable segmentation results. To address these challenges, we propose a novel semi-supervised shadow aware network with boundary refinement (SABR-Net). Specifically, we add shadow imitation regions to the original US, and design shadow-masked transformer blocks to perceive missing anatomy of shadow regions. Shadow-masked transformer block contains an adaptive shadow attention mechanism that introduces an adaptive mask, which is updated automatically to promote the network training. Additionally, we utilize unlabeled US images to train a missing structure inpainting path with shadow-masked transformer, which further facilitates semi-supervised segmentation. Experiments on two public US datasets demonstrate the superior performance of the SABR-Net over other state-of-the-art semi-supervised segmentation methods. In addition, experiments on a private breast US dataset prove that our method has a good generalization to clinical small-scale US datasets.
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11
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Gottlieb M, Patel D, Kayarian F, Peksa GD, Bailitz J. Effect of pleural depth and width on the accuracy of lung ultrasound for detecting pulmonary edema. Am J Emerg Med 2023; 72:210-212. [PMID: 37558511 DOI: 10.1016/j.ajem.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Fae Kayarian
- Rush Medical College of Rush University Medical Center, Chicago, IL, United States of America.
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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12
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Duncan B, Al-Kassas R, Zhang G, Hughes D, Qiu Y. Ultrasound-Mediated Ocular Drug Delivery: From Physics and Instrumentation to Future Directions. MICROMACHINES 2023; 14:1575. [PMID: 37630111 PMCID: PMC10456754 DOI: 10.3390/mi14081575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Drug delivery to the anterior and posterior segments of the eye is impeded by anatomical and physiological barriers. Increasingly, the bioeffects produced by ultrasound are being proven effective for mitigating the impact of these barriers on ocular drug delivery, though there does not appear to be a consensus on the most appropriate system configuration and operating parameters for this application. In this review, the fundamental aspects of ultrasound physics most pertinent to drug delivery are presented; the primary phenomena responsible for increased drug delivery efficacy under ultrasound sonication are discussed; an overview of common ocular drug administration routes and the associated ocular barriers is also given before reviewing the current state of the art of ultrasound-mediated ocular drug delivery and its potential future directions.
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Affiliation(s)
- Blair Duncan
- School of Engineering, Faculty of Engineering & Technology, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
| | - Raida Al-Kassas
- School of Pharmacy & Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
| | - Guangming Zhang
- School of Engineering, Faculty of Engineering & Technology, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
| | - Dave Hughes
- Novosound Ltd., Biocity, BoNess Road, Newhouse, Glasgow ML1 5UH, UK
| | - Yongqiang Qiu
- School of Engineering, Faculty of Engineering & Technology, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
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13
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Gottlieb M, Patel D, Viars M, Tsintolas J, Peksa GD, Bailitz J. Comparison of artificial intelligence versus real-time physician assessment of pulmonary edema with lung ultrasound. Am J Emerg Med 2023; 70:109-112. [PMID: 37269797 DOI: 10.1016/j.ajem.2023.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Lung ultrasound can evaluate for pulmonary edema, but data suggest moderate inter-rater reliability among users. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of B line interpretation. Early data suggest a benefit among more novice users, but data are limited among average residency-trained physicians. The objective of this study was to compare the accuracy of AI versus real-time physician assessment for B lines. METHODS This was a prospective, observational study of adult Emergency Department patients presenting with suspected pulmonary edema. We excluded patients with active COVID-19 or interstitial lung disease. A physician performed thoracic ultrasound using the 12-zone technique. The physician recorded a video clip in each zone and provided an interpretation of positive (≥3 B lines or a wide, dense B line) or negative (<3 B lines and the absence of a wide, dense B line) for pulmonary edema based upon the real-time assessment. A research assistant then utilized the AI program to analyze the same saved clip to determine if it was positive versus negative for pulmonary edema. The physician sonographer was blinded to this assessment. The video clips were then reviewed independently by two expert physician sonographers (ultrasound leaders with >10,000 prior ultrasound image reviews) who were blinded to the AI and initial determinations. The experts reviewed all discordant values and reached consensus on whether the field (i.e., the area of lung between two adjacent ribs) was positive or negative using the same criteria as defined above, which served as the gold standard. RESULTS 71 patients were included in the study (56.3% female; mean BMI: 33.4 [95% CI 30.6-36.2]), with 88.3% (752/852) of lung fields being of adequate quality for assessment. Overall, 36.1% of lung fields were positive for pulmonary edema. The physician was 96.7% (95% CI 93.8%-98.5%) sensitive and 79.1% (95% CI 75.1%-82.6%) specific. The AI software was 95.6% (95% CI 92.4%-97.7%) sensitive and 64.1% (95% CI 59.8%-68.5%) specific. CONCLUSION Both the physician and AI software were highly sensitive, though the physician was more specific. Future research should identify which factors are associated with increased diagnostic accuracy.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Miranda Viars
- Rush Medical College, Chicago, IL, United States of America.
| | - Jack Tsintolas
- Rush Medical College, Chicago, IL, United States of America.
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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14
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Malomo T, Allard Brown A, Bale K, Yung A, Kozlowski P, Heran M, Streijger F, Kwon BK. Quantifying Intraparenchymal Hemorrhage after Traumatic Spinal Cord Injury: A Review of Methodology. J Neurotrauma 2022; 39:1603-1635. [PMID: 35538847 DOI: 10.1089/neu.2021.0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Intraparenchymal hemorrhage (IPH) after a traumatic injury has been associated with poor neurological outcomes. Although IPH may result from the initial mechanical trauma, the blood and its breakdown products have potentially deleterious effects. Further, the degree of IPH has been correlated with injury severity and the extent of subsequent recovery. Therefore, accurate evaluation and quantification of IPH following traumatic spinal cord injury (SCI) is important to define treatments' effects on IPH progression and secondary neuronal injury. Imaging modalities, such as magnetic resonance imaging (MRI) and ultrasound (US), have been explored by researchers for the detection and quantification of IPH following SCI. Both quantitative and semiquantitative MRI and US measurements have been applied to objectively assess IPH following SCI, but the optimal methods for doing so are not well established. Studies in animal SCI models (rodent and porcine) have explored US and histological techniques in evaluating SCI and have demonstrated the potential to detect and quantify IPH. Newer techniques using machine learning algorithms (such as convolutional neural networks [CNN]) have also been studied to calculate IPH volume and have yielded promising results. Despite long-standing recognition of the potential pathological significance of IPH within the spinal cord, quantifying IPH with MRI or US is a relatively new area of research. Further studies are warranted to investigate their potential use. Here, we review the different and emerging quantitative MRI, US, and histological approaches used to detect and quantify IPH following SCI.
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Affiliation(s)
- Toluyemi Malomo
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aysha Allard Brown
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Bale
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Yung
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piotr Kozlowski
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj Heran
- Department of Radiology, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, and Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Quantitative Ultrasound Analysis of Oral Mucosa: An Observational Cross-Sectional Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: Ultrasonography is gaining popularity as a diagnostic tool in the study of the oral mucosa. The precision of ultrasound has made it possible to identify the various layers, based on their echogenicity. The aim of this study was to perform a quantitative analysis of healthy oral mucosa based on the analysis of greyscale, echo levels (dB), and attenuation values (dB/cm). (2) Methods: Thirty-three patients (17 females and 16 males; 58.42 ± 13.29 y.o) were recruited for this study. The images were acquired with the GE Logiq-e R7 with a linear probe at 18 MHz frequency (harmonic). For each tissue (epithelium, rete ridges, connective tissue, muscle, and bone), regions of interest were traced for the analysis of echo levels, grey levels, and attenuation values. One-way ANOVA and pairwise comparison were performed. (3) Results: Three-hundred and thirty images were analyzed. Analysis of echo levels and grey levels showed a significant difference between epithelium and rete ridges (p = 0.001), and between rete ridges and connective tissue (p = 0.001), but not between epithelium and connective tissue (p = 0.831) or connective and muscle layers (p = 0.383). The attenuation values appeared to be specific for each tissue layer (p = 0.001). (4) Conclusions: Quantitative analysis applied to ultrasound imaging of the oral mucosa allows the definition of specific tissue areas.
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16
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Alsaedi HI, Krsoom AM, Alshoabi SA, Alsharif WM. Investigation Study of Ultrasound Practitioners' Awareness about Artefacts of Hepatobiliary Imaging in Almadinah Almunawwarah. Pak J Med Sci 2022; 38:1526-1533. [PMID: 35991221 PMCID: PMC9378392 DOI: 10.12669/pjms.38.6.5084] [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: 07/27/2021] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the knowledge and awareness of ultrasound practitioners' concerning ultrasound artefacts in evaluating the hepatobiliary system. METHODS This electronic questionnaire-based comparative study involved the ultrasound practitioners' who work in the radiology departments in Almadinah Almunawwarah governmental hospitals during the period from 1 November 2020 to 30 April 2021. Spearman's rho correlation test was used to correlate between knowledge and job, academic qualification, and years of experience. A T-test and cross tabulation test were done to compare the knowledge about artefacts among radiologists and radiologic technologists. RESULTS This study involved 94 participants distributed as 22 (23.4%) radiologists and 72 (76.6%) radiologic technologists. The results shows that 85%, 71%, 73%, 69%, 54% and 53% of the participants assigned the acoustic shadowing, acoustic enhancement, ring down, side lobe, reverberation and mirror artefacts, as artefacts respectively. However, 68%, 53%, 19%, 19%, 18%, and 40% of the participants gave correct final diagnosis of acoustic shadowing, acoustic enhancement, ring down, side lobes, reverberation, and mirror artifacts, respectively. Spearman's rho correlation test shows significant correlation between participants with more than three years experience and knowledge related mirror artefacts (r=0.328, p=0.001). It shows significant correlation between radiologists with knowledge related mirror artefacts (r=0.367, p<0.001). A significant correlation was found between highly qualified participants and knowledge related mirror artefacts (r=0.336, p=0.001) and side lobe artefacts (r=0.237, p=0.008). CONCLUSION The questionnaire-based comparative study of knowledge about artefacts of hepatobiliary ultrasound imaging reveals a high level of Ultrasound practitioners' knowledge in differentiating artefacts from pathology with a high level of knowledge in identifying hepatobiliary acoustic shadowing and acoustic enhancement artefacts. However, insufficient knowledge was noted in identifying mirror, side lobe, reverberation and ring down artefacts. A direct link was found between academic qualification, years of experience and practioners' knowledge among.
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Affiliation(s)
- Hassan Ibrahim Alsaedi
- Hassan Ibrahim Alsaedi, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Anas Malik Krsoom
- Anas Malik Krsoom, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Sultan Abdulwadoud Alshoabi
- Sultan Abdulwadoud Alshoabi, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Walaa M. Alsharif
- Walaa M. Alsharif, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
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17
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Wohlgemuth KJ, Blue MN, Mota JA. Reliability and accuracy of ultrasound image analyses completed manually versus an automated tool. PeerJ 2022; 10:e13609. [PMID: 35729910 PMCID: PMC9206842 DOI: 10.7717/peerj.13609] [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: 02/01/2022] [Accepted: 05/28/2022] [Indexed: 01/17/2023] Open
Abstract
Analysis of Brightness-mode ultrasound-captured fascicle angle (FA) and fascicle length (FL) can be completed manually with computer-based programs or by automated programs. Insufficient data exists regarding reliability and accuracy of automated tools. Therefore, the purpose of this study was to determine the test-retest reliability of automatic and manual ultrasound analyses, while determining accuracy of the automatic tool against the manual equivalent. Twenty-three participants (mean ± SD; age = 24 ± 4 years; height = 172.2 ± 10.5 cm; body mass = 73.1 ± 16.1 kg) completed one laboratory visit consisting of two trials where vastus lateralis muscle architecture was assessed with ultrasound. Images were taken at both lower (10 MHz) and higher frequency (12 MHz). Images were analyzed manually in an open-source imaging program and automatically using a separate open-source macro function. Test-retest reliability statistics were calculated for automatic and manual analyses. Accuracy was determined with validity statistics and were calculated for automatic analyses. The results show that manual ultrasound analyses for FA and FL for both lower and higher frequency displayed good reliability (ICC2,1 = 0.75-0.86). However, automatic ultrasound analyses for FA and FL revealed moderate reliability (ICC2,1 = 0.61-0.72) for the lower frequency images and poor reliability (ICC2,1 = 0.16-0.27) for higher frequency images. When assessed against manual techniques, automatic analyses presented greater total error (TE) and standard error of the estimate (SEE) for FA at lower frequency (constant error (CE) = -3.91°, TE = 5.57°, SEE = 3.45°) than higher (CE = -2.78°, TE = -4.54°, SEE = 2.45°). For FL, the higher frequency error (CE = 0.92 cm, TE = 2.12 cm, SEE = 1.15 cm) was similar to lower frequency error (CE = 1.98 cm, TE = 3.66 cm, SEE = 1.57 cm). The findings overall show that manual analyses had good reliability and low absolute error, while demonstrating the automated counterpart had poor to moderate reliability and large errors in analyses. These findings may be impactful as they highlight the good reliability and low error associated with manually analyzed ultrasound images and validate a novel automatic tool for analyzing ultrasound images. Future work should focus on improving reliability and decreasing error in automated image analysis tools. Automated tools are promising for the field as they eliminate biases between analysts and may be more time efficient than manual techniques.
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Affiliation(s)
- Kealey J. Wohlgemuth
- Department of Kinesiology, University of Alabama - Tuscaloosa, Tuscaloosa, AL, United States
| | - Malia N.M Blue
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jacob A. Mota
- Department of Kinesiology, University of Alabama - Tuscaloosa, Tuscaloosa, AL, United States
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18
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Kwizera EA, Stewart S, Mahmud MM, He X. Magnetic Nanoparticle-Mediated Heating for Biomedical Applications. JOURNAL OF HEAT TRANSFER 2022; 144:030801. [PMID: 35125512 PMCID: PMC8813031 DOI: 10.1115/1.4053007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Indexed: 05/17/2023]
Abstract
Magnetic nanoparticles, especially superparamagnetic nanoparticles (SPIONs), have attracted tremendous attention for various biomedical applications. Facile synthesis and functionalization together with easy control of the size and shape of SPIONS to customize their unique properties, have made it possible to develop different types of SPIONs tailored for diverse functions/applications. More recently, considerable attention has been paid to the thermal effect of SPIONs for the treatment of diseases like cancer and for nanowarming of cryopreserved/banked cells, tissues, and organs. In this mini-review, recent advances on the magnetic heating effect of SPIONs for magnetothermal therapy and enhancement of cryopreservation of cells, tissues, and organs, are discussed, together with the non-magnetic heating effect (i.e., high Intensity focused ultrasound or HIFU-activated heating) of SPIONs for cancer therapy. Furthermore, challenges facing the use of magnetic nanoparticles in these biomedical applications are presented.
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Affiliation(s)
- Elyahb Allie Kwizera
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD 20742
| | - Samantha Stewart
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD 20742
| | - Md Musavvir Mahmud
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD 20742
| | - Xiaoming He
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD 20742; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD 21201
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19
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Contreras J, Stimpson A, Ahmed I, Irvine DJ, Whittington AR. Developing Echogenic Materials as Catheters for Use with Ultrasound. ACS Biomater Sci Eng 2022; 8:1312-1319. [PMID: 35171551 DOI: 10.1021/acsbiomaterials.1c01323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with peripherally inserted central catheters (PICCs) are routinely discharged with the catheters in place. These patients experience complications due to undetected thrombosis or accidental dislodgement, with tracking through limited X-ray imaging. Developing catheters with the capability to be tracked without the need for X-ray imaging would greatly benefit these patients by decreasing patient stress, reducing time to diagnosis, and increasing nursing home capabilities. This study reports on the incorporation of echogenic microspheres into catheters to produce bulk echogenic effects for developments in the field of real-time ultrasound tracking of polymeric medical devices. The impact on elastic modulus, ultrasound contrast, and cytocompatibility of the polymer was analyzed when incorporating up to 10 wt % glass microspheres. Up to this loading level, the elastic modulus was found to remain constant. However, at 10 wt %, extrusion defects due to agglomeration, air bubbles, and shearing were numerous and deemed detrimental to ultrasound imaging. Successful, defect-free samples were produced with 5 wt % microsphere loading and when embedded in a soft tissue phantom revealed a significant increase in the signal-to-noise ratio as compared to the polymer alone. Preliminary results have shown a successful increase in polymer's echogenic properties, without undermining its mechanical and cytocompatibility properties.
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Affiliation(s)
- Jerry Contreras
- Materials Science and Engineering, Virginia Tech, 400 Stanger Street, 109A Surge Bldg, MC0237, Blacksburg, Virginia 24061, United States
| | - Amy Stimpson
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Ifty Ahmed
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Derek J Irvine
- Faculty of Engineering, University of Nottingham, Coates Building, University Park Campus, Nottingham NG7 2RD, U.K
| | - Abby R Whittington
- Materials Science and Engineering, Virginia Tech, 400 Stanger Street, 109A Surge Bldg, MC0237, Blacksburg, Virginia 24061, United States.,Chemical Engineering, Virginia Tech, 635 Prices Fork Road, 255 Goodwin Hall MC0211, Blacksburg, Virginia 24061, United States
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20
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Cao J, Xie P, Feng F, Li K, Tan L, Chen Z, Ren J, Zheng R, Rong L. Potential Application of MR-MR-US Fusion Imaging Navigation with Needle Tail Intelligent Positioning in Guiding Puncture in Percutaneous Transforaminal Endoscopic Discectomy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3458-3469. [PMID: 34593278 DOI: 10.1016/j.ultrasmedbio.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
This study sought to investigate the feasibility of using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) fusion imaging navigation (FIN) with needle tail intelligent positioning (NTIP) to guide puncture in percutaneous transforaminal endoscopic discectomy (PTED). First, in a pig experiment, we found that puncture errors in lumbar intervertebral foramen (LIF) puncture using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) FIN with NTIP for experienced and novice operators were 2.00 ± 1.00 and 2.57 ± 0.98 mm, respectively (p = 0.231), suggesting this technique was minimally dependent on experience. Then, two experienced surgeons agreed (inter-observer agreement к=0.801) that the quality of MR-MR fusion images was good or sufficient. Finally, we performed PTED in eight patients using MR-MR-US FIN with NTIP, and no significant complications were reported during LIF puncture. Overall, MR-MR-US FIN with NTIP may be a potential application for guiding puncture in PTED, but more clinical studies with a larger sample size are required to further evaluate the advantages of MR-MR-US FIN with NTIP.
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Affiliation(s)
- Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Zihao Chen
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China.
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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21
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Hilbert-Carius P, Struck MF, Rudolph M, Knapp J, Rognås L, Adler J, Slagt C, Jacobsen L, Pich H, Christian MD, Dandrifosse D, Abu-Zidan FM. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med 2021; 29:124. [PMID: 34446076 PMCID: PMC8390051 DOI: 10.1186/s13049-021-00933-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. Method A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes. Results During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations. Conclusions The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00933-y.
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Affiliation(s)
- Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, BG Klinikum Bergmannstrost Halle gGmbH, and HEMS, Christoph 84" and "Christoph 85", DRF-Luftrettung, Halle (Saale), Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, and HEMS "Christoph 33"and "Christoph 71, Senftenberg, Germany
| | - Marcus Rudolph
- DRF Stiftung Luftrettung Gemeinnützige AG, Filderstadt, Germany
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jörn Adler
- Luxembourg Air Rescue A.S.B.L, Sandweiler, Luxembourg
| | - Cor Slagt
- Department of Anesthesiology, Pain and Palliative Medicine and Helicopter Emergency Medical Service, Lifeliner 3" and "Lifeliner 5", Radboudumc, Nijmegen, The Netherlands
| | - Lars Jacobsen
- Sørlandet Hospital, Air Ambulance dpt, Arendal, Norway.,The Norwegian Air Ambulance Foundation, Arendal, Norway
| | - Henryk Pich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany.,HEMS "Christoph 33"and "Christoph 71", Senftenberg, Germany
| | | | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
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22
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Cai L, Gao N, Sun T, Bi K, Chen X, Zhao X. Application of an ultrasound semi-quantitative assessment in the degradation of silk fibroin scaffolds in vivo. Biomed Eng Online 2021; 20:48. [PMID: 34006299 PMCID: PMC8130099 DOI: 10.1186/s12938-021-00887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Research on the degradation of silk fibroin (SF) scaffolds in vivo lacks uniform and effective standards and experimental evaluation methods. This study aims to evaluate the application of ultrasound in assessing the degradation of SF scaffolds. METHODS Two groups of three-dimensional regenerated SF scaffolds (3D RSFs) were implanted subcutaneously into the backs of Sprague-Dawley rats. B-mode ultrasound and hematoxylin and eosin (HE) staining were performed on days 3, 7, 14, 28, 56, 84, 112, 140, and 196. The cross-sectional areas for two groups of 3D RSFs that were obtained using these methods were semi-quantitatively analyzed and compared to evaluate the biodegradation of the implanted RSFs. RESULTS The 3D RSFs in the SF-A group were wholly degraded at the 28th week after implantation. In contrast, the 3D RSFs in the SF-B group were completely degraded at the 16th week. Ultrasonic examination showed that the echoes of 3D RSFs in both groups gradually decreased with the increase of the implantation time. In the early stages of degradation, the echoes of the samples were higher than the echo of the muscle. In the middle of degeneration, the echoes were equal to the echo of the muscle. In the later stage, the echoes of the samples were lower than that of the muscle. The above changes in the SF-B group were earlier than those in the SF-A group. Semi-quantitative analysis of the cross-sectional areas detected using B-mode ultrasound revealed that the degradations of the two 3D RSF groups were significantly different. The degradation rate of the SF-B group was found to be higher than that of the SF-A group. This was consistent with the semi-quantitative detection results for HE staining. Regression analysis showed that the results of the B-mode ultrasound and HE staining were correlated in both groups, indicating that B-mode ultrasound is a reliable method to evaluate the SF scaffold degradation in vivo. CONCLUSIONS This study suggests that B-mode ultrasound can clearly display the implanted SF scaffolds non-invasively and monitor the degradation of the different SF scaffolds after implantation in living organisms in real-time.
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Affiliation(s)
- Lihui Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Nan Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - TingYu Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Ke Bi
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Xin Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Laboratory of Advanced Materials, Fudan University, 220 Handan Road, Shanghai, 200433, People's Republic of China
| | - Xia Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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23
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Higano NS, Ruoss JL, Woods JC. Modern pulmonary imaging of bronchopulmonary dysplasia. J Perinatol 2021; 41:707-717. [PMID: 33547408 PMCID: PMC8561744 DOI: 10.1038/s41372-021-00929-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/05/2020] [Accepted: 01/15/2021] [Indexed: 01/30/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a complex and serious cardiopulmonary morbidity in infants who are born preterm. Despite advances in clinical care, BPD remains a significant source of morbidity and mortality, due in large part to the increased survival of extremely preterm infants. There are few strong early prognostic indicators of BPD or its later outcomes, and evidence for the usage and timing of various interventions is minimal. As a result, clinical management is often imprecise. In this review, we highlight cutting-edge methods and findings from recent pulmonary imaging research that have high translational value. Further, we discuss the potential role that various radiological modalities may play in early risk stratification for development of BPD and in guiding treatment strategies of BPD when employed in varying severities and time-points throughout the neonatal disease course.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Lauren Ruoss
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
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24
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Zaltieri M, Massaroni C, Cauti FM, Schena E. Techniques for Temperature Monitoring of Myocardial Tissue Undergoing Radiofrequency Ablation Treatments: An Overview. SENSORS (BASEL, SWITZERLAND) 2021; 21:1453. [PMID: 33669692 PMCID: PMC7922285 DOI: 10.3390/s21041453] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.
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Affiliation(s)
- Martina Zaltieri
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Carlo Massaroni
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Cardiology Division, S. Giovanni Calibita Hospital, Isola Tiberina, 00186 Rome, Italy;
| | - Emiliano Schena
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
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25
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Montrief T, Alerhand S, Denault A, Scott J. Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review. Can J Anaesth 2020; 67:1824-1838. [PMID: 32944839 DOI: 10.1007/s12630-020-01813-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022] Open
Abstract
Right-to-left pulmonary and cardiac shunts (RLS) are important causes of refractory hypoxia in the critically-ill perioperative patient. Using a point-of-care ultrasound (POCUS) agitated saline bubble study for an early diagnosis allows patients with clinically significant RLSs to receive expedited therapy. This narrative review discusses the principles of agitated saline ultrasonography as well as the role of POCUS in detecting the most common RLS types seen in the intensive care unit, including patent foramen ovale, atrial septal defects, and pulmonary arterio-venous malformations. An illustrated discussion of the procedure, as well as shunt-enhancing maneuvers (Valsalva or lung recruitment maneuver with subsequent rapid release) is provided. With the wide dissemination of bedside ultrasound within the perioperative and critical care arena, POCUS practitioners should be knowledgeable of the potential pitfalls leading to both false-positive and false-negative studies. False-positive studies may be due to congenital abnormalities, mischaracterization of intrapulmonary shunts as intracardiac shunts (and vice versa), or evidence of the Valsalva effect. False negatives are typically due to respiratory-phasic variation, performing an inadequate shunt-enhancing maneuver, inadequate injection of agitated saline, or pathophysiologic states of elevated left atrial pressure. Finally, alternative POCUS methods for determining presence of an RLS in patients with poor echocardiographic windows are discussed, with a focus on pulsed-wave Doppler interrogation of arterial signals.
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Affiliation(s)
- Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - André Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
| | - Jeffrey Scott
- Division of Cardiothoracic and Transplant Critical Care, Jackson Health System, Miami Transplant Institute, Miami, FL, USA
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26
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Zhao Y, Wang S, Merrill JA, Arellano JD, Trevisi LM, Li Y, Xiang L, Qu J, Liu L. Triplex radiometric, photoacoustic, and ultrasonic imaging based on single-pulse excitation. OPTICS LETTERS 2020; 45:1703-1706. [PMID: 32235978 PMCID: PMC7995640 DOI: 10.1364/ol.387501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/11/2020] [Indexed: 06/01/2023]
Abstract
In this Letter, we propose a novel triplex-parameter detection method to realize simultaneous radiometric, photoacoustic, and ultrasonic imaging based on single-pulse excitation. The optical attenuation, optical absorption, and acoustic impedance properties can be obtained simultaneously by analyzing the photoacoustic signals and the ultrasonic echo signals. To test the feasibility and accuracy of this method, agar phantoms with different absorption coefficients and elastic coefficients were measured. Then, this method was experimentally verified by imaging a leaf skeleton piece embedded in an agar cylinder. Furthermore, pilot experiments were performed by triplex imaging of pig ear tissue ex vivo to characterize the cartilage and surrounding tissue. Experimental results demonstrated that this technique has future potentials for visualizing and providing the functional and structural information of biological tissues.
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Affiliation(s)
- Yue Zhao
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Siqi Wang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019, USA
| | - John A. Merrill
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Jesus D. Arellano
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Luis M. Trevisi
- Chemical, Biological, and Materials Engineering, University of Oklahoma, Norman, Oklahoma 73071, USA
| | - Yizhou Li
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Liangzhong Xiang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Junle Qu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Liwei Liu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
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27
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Grune J, Beyhoff N, Hegemann N, Lauryn JH, Kuebler WM. From bedside to bench: lung ultrasound for the assessment of pulmonary edema in animal models. Cell Tissue Res 2020; 380:379-392. [PMID: 32009189 PMCID: PMC7210222 DOI: 10.1007/s00441-020-03172-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Traditionally, the lung has been excluded from the ultrasound organ repertoire and, hence, the application of lung ultrasound (LUS) was largely limited to a few enthusiastic clinicians. Yet, in the last decades, the recognition of the previously untapped diagnostic potential of LUS in intensive care medicine has fueled its widespread use as a rapid, non-invasive and radiation-free bedside approach with excellent diagnostic accuracy for many of the most common causes of acute respiratory failure, e.g., cardiogenic pulmonary edema, pneumonia, pleural effusion and pneumothorax. Its increased clinical use has also incited attention for the potential usefulness of LUS in preclinical studies with small animal models mimicking lung congestion and pulmonary edema formation. Application of LUS to small animal models of pulmonary edema may save time, is cost-effective, and may reduce the number of experimental animals due to the possibility of serial evaluations in the same animal as compared with traditional end-point measurements. This review provides an overview of the emerging field of LUS with a specific focus on its application in animal models and highlights future perspectives for LUS in preclinical research.
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Affiliation(s)
- Jana Grune
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Niklas Beyhoff
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Institute of Pharmacology, Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Hessische St 3-4, 10115, Berlin, Germany
| | - Niklas Hegemann
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353, Berlin, Germany
| | - Jonathan H Lauryn
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany. .,The Keenan Research Centre for Biomedical Science at St. Michael's, Toronto, Canada. .,Departments of Surgery and Physiology, University of Toronto, Toronto, Canada.
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28
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Khan MAB, Abu-Zidan FM. Point-of-care ultrasound for the acute abdomen in the primary health care. Turk J Emerg Med 2020; 20:1-11. [PMID: 32355895 PMCID: PMC7189821 DOI: 10.4103/2452-2473.276384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a focused examination, which is performed and interpreted at the bedside by the treating physician answering a specific clinical question. It is currently utilized as an essential adjunct to physical examination in many medical specialties. Recent advances in technology have made POCUS machines portable, affordable, and could be used with minimal training even by nonradiologists. This review aims to cover the fundamental physics of POCUS and its applications for diagnosing the acute abdomen in the primary health care including the most common causes encountered by family physicians. These are acute appendicitis, acute cholecystitis, renal colic, ectopic pregnancy, acute diverticulitis, bowel obstruction, and abdominal aortic aneurysm. We hope to encourage primary care physicians to incorporate POCUS in their routine clinical practice. We also highlight challenges encountered when using POCUS in the primary health care including limited availability and the need for proper training. Furthermore, we review the POCUS results when performed by primary health-care physicians. Integrating POCUS in primary health care empowers primary health-care physicians to provide high-quality, safe, and cost-effective care to the patients.
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Affiliation(s)
- Moien A B Khan
- Department of Family Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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29
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Domingues C, Alvarez-Lorenzo C, Concheiro A, Veiga F, Figueiras A. Nanotheranostic Pluronic-Like Polymeric Micelles: Shedding Light into the Dark Shadows of Tumors. Mol Pharm 2019; 16:4757-4774. [DOI: 10.1021/acs.molpharmaceut.9b00945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Cátia Domingues
- Faculty of Pharmacy, University of Coimbra, Coimbra 3000-295, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Coimbra 3004-504, Portugal
- CIMAGO, Center of Investigation on Environment Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Coimbra 3004-531, Portugal
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - Francisco Veiga
- Faculty of Pharmacy, University of Coimbra, Coimbra 3000-295, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Coimbra 3004-504, Portugal
| | - Ana Figueiras
- Faculty of Pharmacy, University of Coimbra, Coimbra 3000-295, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Coimbra 3004-504, Portugal
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Hefny AF, Kunhivalappil FT, Paul M, Almansoori TM, Zoubeidi T, Abu-Zidan FM. Anatomical locations of air for rapid diagnosis of pneumothorax in blunt trauma patients. World J Emerg Surg 2019; 14:44. [PMID: 31497066 PMCID: PMC6720854 DOI: 10.1186/s13017-019-0263-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. However, the thoracic anatomical locations to be examined are debateable. We aimed to study the anatomical locations of blunt traumatic pneumothoraces as defined by chest CT scan to identify the areas that should be scanned while performing bedside diagnostic ultrasound. METHODS This is a retrospective analysis of a data collected for a previous study in blunt trauma patients at our hospital during a 4-year-period with CT confirmed pneumothoraces. The anatomical distribution of the pneumothoraces and their volume were analyzed. Advanced statistical analysis was performed using repeated measures logistic regression models. RESULTS Seven hundred three patients had a CT scan of the chest. Seventy-four patients (10.5%) were confirmed to have a pneumothorax. Only 64 were included in the study as they did not have a chest tube inserted before the CT scan. Twelve (18.8%) patients had bilateral pneumothorax. Seventy-six pneumothoraces were identified for which 41 patients had a right-sided pneumothorax and 35 patients had a left-sided pneumothorax. 95.1 % of the pneumothoraces detected on the right side were in the whole parasternal area with 75.6% seen in the lower parasternal region only. Similarly, 97.1 % of the pneumothoraces on the left side were seen in the whole parasternal area with 80% seen in the lower parasternal region only. CONCLUSIONS The current study showed that air pockets of blunt traumatic pneumothoraces are mainly located at the parasternal regions especially in pneumothorax with small volume. We recommend a quick ultrasound scanning of the parasternal regions on both sides of the chest from proximal to distal as the appropriate technique for the detection of pneumothoraces in blunt trauma setting.
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Affiliation(s)
- Ashraf F. Hefny
- Trauma group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P O Box 18532, Al-Ain, United Arab Emirates
| | | | - Manoj Paul
- Department of Radiology, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Taoufik Zoubeidi
- Department of Statistics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Trauma group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P O Box 18532, Al-Ain, United Arab Emirates
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Sönmez G, Kamburoğlu K, Yılmaz F, Koç C, Barış E, Tüzüner A. Versatility of high resolution ultrasonography in the assessment of granulomas and radicular cysts: a comparative in vivo study. Dentomaxillofac Radiol 2019; 48:20190082. [PMID: 31188679 PMCID: PMC6747443 DOI: 10.1259/dmfr.20190082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/07/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To evaluate and compare the diagnostic potential of high resolution ultrasound with periapical radiographs (PR) and CBCT in assessing granulomas and radicular cysts. METHODS This study included a total of 33 teeth from 33 patients with periapical lesions. Subjects were distributed among three groups. A consisted of teeth that were extracted. B consisted of teeth treated with root-canal treatment followed by apical surgery. C consisted of teeth treated with root-canal treatment only. Pre-treatment PR, ultrasound and CBCT images were obtained for Groups A, B and C and 6 month post-treatment PR and ultrasound images were obtained for Groups B and C. In addition, histopathological analysis was performed on lesions in Groups A and B. Lesions were classified as either cystic lesions or granulomas. Width, height, depth, surface area and volume of lesions were measured using the built-in softwares of the appropriate imaging modalities. Measurements were compared by Wilcoxon and paired sample t tests. Ultrasound and histopathological findings were compared with κ and Mc Nemar. Statistical significance was set at p < 0.05. RESULTS κ coefficient (0.667; p = 0.002) suggested good agreement between ultrasound and histopathology. No statistically significant differences were found among periapical radiography, CBCT and ultrasound in the pre-treatment measurements of lesion width ( p = 0.308) or between CBCT and periapical radiography in the pre-treatment measurements of lesion height ( p = 0.863). In all cases, mean measurement values for all variables were lower for ultrasound than for CBCT. CONCLUSION Ultrasound provided useful information for the diagnosis and assessment of granulomas and radicular cysts.
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Affiliation(s)
- Gül Sönmez
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Funda Yılmaz
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Cemre Koç
- Department of Endodontics, Faculty of Dentistry, Başkent University, Ankara, Turkey
| | - Emre Barış
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Ayşegül Tüzüner
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Koratala A, Bhattacharya D, Kazory A. Point of care renal ultrasonography for the busy nephrologist: A pictorial review. World J Nephrol 2019; 8:44-58. [PMID: 31363461 PMCID: PMC6656660 DOI: 10.5527/wjn.v8.i3.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
| | - Deepti Bhattacharya
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
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Koratala A, Bhattacharya D, Kazory A. Point of care renal ultrasonography for the busy nephrologist: A pictorial review. World J Nephrol 2019. [DOI: 10.5527/wjcc.v8.i3.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Despite our understanding that the microvasculature plays a multifaceted role in the development and progression of various conditions, we know little about the extent of this involvement. A need exists for non-invasive, clinically meaningful imaging modalities capable of elucidating microvascular information to aid in our understanding of disease, and to aid in the diagnosis/monitoring of disease for more patient-specific care. In this review article, a number of imaging techniques are summarized that have been utilized to investigate the microvasculature of skin, along with their advantages, disadvantages and future perspectives in preclinical and clinical settings. These techniques include dermoscopy, capillaroscopy, Doppler sonography, laser Doppler flowmetry (LDF) and perfusion imaging, laser speckle contrast imaging (LSCI), optical coherence tomography (OCT), including its Doppler and dynamic variant and the more recently developed OCT angiography (OCTA), photoacoustic imaging, and spatial frequency domain imaging (SFDI). Attention is largely, but not exclusively, placed on optical imaging modalities that use intrinsic optical signals to contrast the microvasculature. We conclude that whilst each imaging modality has been successful in filling a particular niche, there is no one, all-encompassing modality without inherent flaws. Therefore, the future of cutaneous microvascular imaging may lie in utilizing a multi-modal approach that will counter the disadvantages of individual systems to synergistically augment our imaging capabilities.
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Affiliation(s)
- Anthony J Deegan
- Department of Bioengineering, University of Washington, 3720 15th Ave. NE., Seattle, WA 98195, United States of America
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Abu-Zidan FM, Cevik AA. Kunafa knife and play dough is an efficient and cheap simulator to teach diagnostic Point-of-Care Ultrasound (POCUS). World J Emerg Surg 2019; 14:1. [PMID: 30636969 PMCID: PMC6325793 DOI: 10.1186/s13017-018-0220-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Point-of-Care Ultrasound (POCUS) is a useful diagnostic tool. Nevertheless, it needs proper training to reach its required level of competency. Educators who work in low-income countries find it difficult to purchase expensive training computer-based simulators. We aim in this communication to describe the methods to build up and use an efficient, simple, and cheap simulator which can be used for teaching POCUS globally. Methods It took our group 2 years to develop the simulator to its current form. The required material for the simulator includes a Kunafa knife, a carton gift box and its cover and colored play dough. The Kunafa knife with its blade is an excellent simulator for the small print convex array probe (3–5 MHz) and its ultrasound sections. It is useful to teach two important principles. First, the three basic hand movements used to control the ultrasound probe (fanning, tilting, and shifting). Second, the thin blade of the knife (1 mm thick) simulates the shape of the two-dimensional ultrasound images. The play dough is used to simulate different organs to be cut in different directions like the aorta and inferior vena cava. Results The simulator was used to teach 88 fifth year medical students during the period of November 2017 to November 2018 at the College of Medicine and Health Sciences, UAE University. The simulator was valid, simple, portable, and sustainable. The students greatly enjoyed its use. The cost of the simulator is less than 10 US dollars. Conclusions Surgical educators who work in low-income countries are encouraged to develop their educational tools that are tailored to their own needs. Our simulator can help our colleagues who want to teach POCUS and cannot purchase expensive mannequins and computer-based simulators.
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Affiliation(s)
- Fikri M Abu-Zidan
- 1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
| | - Arif Alper Cevik
- 2Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
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Chang KV, Yang KC, Wu WT, Huang KC, Han DS. Association between metabolic syndrome and limb muscle quantity and quality in older adults: a pilot ultrasound study. Diabetes Metab Syndr Obes 2019; 12:1821-1830. [PMID: 31571957 PMCID: PMC6750006 DOI: 10.2147/dmso.s219649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Limited imaging studies have investigated whether limb muscle quantity and quality change after metabolic syndrome (MetS) development. This pilot study examined MetS influence on limb muscle characteristics in older adults. METHODS Participants were recruited from annual health examinations; their right biceps brachii, triceps brachii, rectus femoris, and gastrocnemius muscles were measured by ultrasound. Anthropometric parameters, blood biochemistry, and physical performance (handgrip strength and gait speed) were also examined. RESULTS Overall, 129 participants were enrolled, including 26 with MetS. Although handgrip strength was lower in MetS patients, there were no significant between-group differences considering thickness and mean echogenicity of the four muscles. Handgrip strength was positively correlated with the thickness of biceps brachii, triceps brachii, and rectus femoris but was negatively associated with their echogenicity. On multivariate analysis, triceps muscle echogenicity was trivially associated (odds ratio, 0.93; 95% confidence interval, 0.86-0.99) with MetS, possibly due to multicollinearity with grip strength. CONCLUSION No significant difference was recognized in limb muscle thickness and echogenicity in the geriatric population with MetS compared with healthy controls by ultrasound imaging. However, the finding might be caused by the small sample size of our participants. Future large-scale studies should explore the influence of separated risk factors of MetS on limb muscle echotexture and examine whether manifestation differs in different age populations.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
- Correspondence: Der-Sheng HanDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, No. 87, Nei-Jiang Road, Wan-Hwa District, Taipei108, TaiwanTel +886 223 717 101 5001Email
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Abstract
The transdermal transport of pharmaceuticals possesses various advantageous properties over conventional drug administration techniques such as oral delivery and hypodermic injections. However, the stratum corneum persists as the main barrier, which impedes percutaneous transport. The ultrasound-based transdermal delivery of therapeutics is one of the techniques that are being investigated to overcome this obstacle. This review outlines the background information pertaining to sonophoresis and then discusses the individual sections of sonophoretic research. These areas include the sonophoretic application of various drugs, dual-frequency sonophoresis, synergistic combinations of transdermal drug delivery techniques, and the use of nanosized carriers in ultrasound-based transdermal delivery. The various challenges associated with sonophoretic drug delivery and trends of future research are also highlighted.
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Affiliation(s)
| | - Boon Mian Teo
- School of Chemistry, Monash University, Clayton, VIC 3800, Australia,
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Abu-Zidan FM, Cevik AA. Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced. World J Emerg Surg 2018; 13:47. [PMID: 30356808 PMCID: PMC6190544 DOI: 10.1186/s13017-018-0209-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn’s disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.
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Affiliation(s)
- Fikri M Abu-Zidan
- 1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
| | - Arif Alper Cevik
- 2Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
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Matusin DP, Fontes-Pereira AJ, Rosa PTCR, Barboza T, de Souza SAL, von Krüger MA, Pereira WCDA. EXPLORING CORTICAL BONE DENSITY THROUGH THE ULTRASOUND INTEGRATED REFLECTION COEFFICIENT. ACTA ORTOPEDICA BRASILEIRA 2018; 26:255-259. [PMID: 30210256 PMCID: PMC6131282 DOI: 10.1590/1413-785220182604177202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: This work evaluates the relationship between ultrasonic reflection and bone density from fourteen cylindrical bovine cortical bone samples (3.0-cm thick). Methods: Twenty US reflection signals per sample were acquired along the bone surface (2.0-mm step). The Integrated Reflection Coefficient (IRC) from each signal was compared to Quantitative Computed Tomography (QCT). Results: Seven IRC and QCT curves presented Pearson's Correlation R-values above 0.5. For weak correlation curves, QCT and IRC showed similar trends in several segments. Conclusion: IRC was sensitive to bone density variation. Level of Evidence: Experimental Study, Investigating a Diagnostic Test.
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Affiliation(s)
- Daniel Patterson Matusin
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Aldo José Fontes-Pereira
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Paulo Tadeu Cardozo Ribeiro Rosa
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thiago Barboza
- Laboratório de Marcação de Células e Moléculas (LMCM), Department of Radiology, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Laboratório microPET/SPECT/CT, Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Sergio Augusto Lopes de Souza
- Laboratório de Marcação de Células e Moléculas (LMCM), Department of Radiology, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Laboratório microPET/SPECT/CT, Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marco Antônio von Krüger
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Wagner Coelho de Albuquerque Pereira
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Cevik AA, Noureldin A, El Zubeir M, Abu-Zidan FM. Assessment of EFAST training for final year medical students in emergency medicine clerkship. Turk J Emerg Med 2018; 18:100-104. [PMID: 30191188 PMCID: PMC6107923 DOI: 10.1016/j.tjem.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 10/25/2022] Open
Abstract
Background Extended Focused Assessment Sonography for Trauma (EFAST) is an important bedside tool for the management of multiple trauma patients. We aimed to evaluate the assessment of our EFAST education in the Emergency Medicine Clerkship (EMC) for final year medical students and the correlations of EFAST marks with other practical skill stations and the final multiple choice question (MCQ) exam marks. Methods Fifty-four final year medical students were trained on performing EFAST on human models during their 4-week clerkship. Students received an hour of didactic lecture, 4-hours practical sessions on human models, and completed a minimum of three EFAST examinations on trauma patients. Finally, the EFAST performance was evaluated on human models using a standard evaluation form during an Objective Structured Clinical Examination (OSCE). The marks of 51 students who completed the final exam were analyzed. Results The overall passing rate of the EFAST station was 88% (n: 45). EFAST station mark had significant weak correlations with other OSCE stations marks (p = 0.027, rho = 0.31), and with the final EMC mark (p = 0.032, rho = 0.3), but not with the final MCQ exam. Conclusions Final year medical students demonstrated effective EFAST learning as measured by their examination performance. One hour EFAST training and 4 -hours practice provide an acceptable level of skill for medical students. The EFAST final marks showed significant weak correlation with other OSCE station marks and final clerkship marks, but not with the final MCQ exam mark which assesses a different cognitive learning domain.
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Affiliation(s)
- Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Abdel Noureldin
- Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Margret El Zubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Giraldo A, Talavera López J, Fernandez-Del-Palacio MJ, García-Nicolás O, Seva J, Brooks G, Moraleda JM. Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model. J Vis Exp 2018:56699. [PMID: 29443073 PMCID: PMC5908667 DOI: 10.3791/56699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Cell and gene therapy are exciting and promising strategies for the purpose of cardiac regeneration in the setting of heart failure with reduced ejection fraction (HFrEF). Before they can be considered for use, and implemented in humans, extensive preclinical studies are required in large animal models to evaluate the safety, efficacy, and fate of the injectate (e.g., stem cells) once delivered into the myocardium. Small rodent models offer advantages (e.g., cost effectiveness, amenability for genetic manipulation); however, given inherent limitations of these models, the findings in these rarely translate into the clinic. Conversely, large animal models such as rabbits, have advantages (e.g., similar cardiac electrophysiology compared to humans and other large animals), whilst retaining a good cost-effective balance. Here, we demonstrate how to perform a percutaneous contrast echocardiography-guided intramyocardial injection (IMI) technique, which is minimally invasive, safe, well tolerated, and very effective in the targeted delivery of injectates, including cells, into several locations within the myocardium of a rabbit model. For the implementation of this technique, we also have taken advantage of a widely available clinical echocardiography system. After putting in practice the protocol described here, a researcher with basic ultrasound knowledge will become competent in the performance of this versatile and minimally invasive technique for routine use in experiments, aimed at hypothesis testing of the capabilities of cardiac regenerative therapeutics in the rabbit model. Once competency is achieved, the whole procedure can be performed within 25 min after anaesthetizing the rabbit.
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Affiliation(s)
- Alejandro Giraldo
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading;
| | - Jesús Talavera López
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia;
| | | | - Obdulio García-Nicolás
- Institute of Virology and Immunology (IVI); Departamento de Anatomía y Anatomía Comparada, Facultad de Veterinaria, Universidad de Murcia
| | - Juan Seva
- Departamento de Anatomía y Anatomía Comparada, Facultad de Veterinaria, Universidad de Murcia
| | - Gavin Brooks
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading
| | - José María Moraleda
- Unidad de Trasplante Hematopoyético y Terapia Celular, Departamento de Hematología, Hospital Universitario Virgen de la Arrixaca, IMIB, Universidad de Murcia
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Abu-Zidan FM. Ultrasound diagnosis of fractures in mass casualty incidents. World J Orthop 2017; 8:606-611. [PMID: 28875125 PMCID: PMC5565491 DOI: 10.5312/wjo.v8.i8.606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
The role of point-of-care ultrasound in mass casualty incidents (MCIs) is still evolving. Occasionally, hospitals can be destroyed by disasters resulting in large number of trauma patients. CAVEAT and FASTER ultrasound protocols, which are used in MCIs, included extremity ultrasound examination as part of them. The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs. The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively. Nevertheless, majority of these studies were in children and they had very high heterogeneity. The portability, safety, repeatability, and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs. Its potential in managing fractures in MCIs needs to be further defined. The operator should master the technique, understand its limitations, and most importantly correlate the sonographic findings with the clinical ones to be useful. This editorial critically reviews the literature on this topic, describes its principles and techniques, and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.
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Ahmed R, Samardzic D, Santos MA, Mesina A, Maines J. Just a mirage: heterotopic intrauterine and twin ectopic pregnancy mimicked by mirror imaging on ultrasound. Radiol Case Rep 2017; 12:422-426. [PMID: 28491202 PMCID: PMC5417754 DOI: 10.1016/j.radcr.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/25/2017] [Accepted: 03/06/2017] [Indexed: 10/28/2022] Open
Abstract
Heterotopic pregnancies are rare and are usually diagnosed by transvaginal ultrasound. Despite the routine use of sonography in early pregnancy, artifact created by mirror imaging can drastically and erroneously alter medical decision making by interfering with image interpretation. A heterotopic pregnancy with a single intrauterine gestation and twin left adnexal ectopic gestational sacs was observed on ultrasound in a woman presenting with abdominal pain. During laparoscopy, an ectopic pregnancy was not identified, and subsequent intraoperative ultrasound reproduced the heterotopic pregnancy through manipulation of bowel, confirming mirror image artifact. This phenomenon is rarely seen in obstetric imaging; therefore, lack of awareness can lead to false diagnosis of heterotopic pregnancy. Techniques to verify correct diagnosis should be used to resolve potential mirror artifact before proceeding with surgical management.
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Affiliation(s)
- Rimsha Ahmed
- Department of Obstetrics and Gynecology, Penn State Milton S Hershey Medical Center, 500 University Drive, Room H3510, MC H103, Hershey, PA 17033, USA
| | - Dejan Samardzic
- Department of Radiology, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Michael A Santos
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Anna Mesina
- Department of Obstetrics and Gynecology, Penn State Milton S Hershey Medical Center, 500 University Drive, Room H3510, MC H103, Hershey, PA 17033, USA
| | - Jaimie Maines
- Department of Obstetrics and Gynecology, Penn State Milton S Hershey Medical Center, 500 University Drive, Room H3510, MC H103, Hershey, PA 17033, USA
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Abu-Zidan FM, Balac K, Bhatia CA. Surgeon-performed point-of-care ultrasound in severe eye trauma: Report of two cases. World J Clin Cases 2016; 4:344-350. [PMID: 27803918 PMCID: PMC5067499 DOI: 10.12998/wjcc.v4.i10.344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/09/2016] [Accepted: 08/01/2016] [Indexed: 02/05/2023] Open
Abstract
The indications of point-of-care ultrasound (POCUS) in the management of multiple trauma patients have been expanding. Although computed tomography (CT) scan of the orbit remains the gold standard for imaging orbital trauma, ultrasound is a quick, safe, and portable tool that can be performed bedside. Here we report two patients who had severe eye injuries with major visual impairment where surgeon-performed POCUS was very useful. One had a foreign body injury while the other had blunt trauma. POCUS was done using a linear probe under sterile conditions with minimum pressure on the eyes. Ultrasound showed a foreign body at the back of the left eye globe touching the eye globe in the first patient, and was normal in the second patient. Workup using CT scan, fundsocopy, optical coherence tomography, and magnetic resonance imaging of the orbits confirmed these findings. The first patient had vitreous and sub retinal haemorrhage and a full thickness macular hole of the left eye, while the second had traumatic optic neuropathy. POCUS gave accurate information concerning severe eye injuries. Trauma surgeons and emergency physicians should be trained in performing ocular ultrasound for eye injuries.
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Abu-Zidan FM. On table POCUS assessment for the IVC following abdominal packing: how I do it. World J Emerg Surg 2016; 11:38. [PMID: 27499803 PMCID: PMC4974670 DOI: 10.1186/s13017-016-0092-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/12/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Some surgeons may lack proper experience in abdominal packing. Overpacking may directly compress the inferior vena cava (IVC). This reduces the venous return and possibly causes hypotension. Here, a new on table Point-of-Care Ultrasound application that has been recently used to assess the effect of abdominal packing on the IVC diameter is described. Following abdominal packing, a small print convex array probe with low frequency (2-5 MHz) is used to visualize the IVC. Using the B mode, the IVC can be directly evaluated through a hepatic window between the ribs. The ultrasound beam should be vertical to the IVC longitudinal section at its midpoint. The abdominal towels will be in front of the IVC. This will enable us to judge whether there was overpacking on the IVC. RESULTS Our method demonstrates that overpacking does not compress the IVC in a patient whose blood pressure has improved. The IVC diameter progressively increases on table and in the ICU with active resuscitation implying that bleeding stopped and the resuscitation was successful. Furthermore, presence of intra-peritoneal fluid can be excluded. CONCLUSIONS This new application of ultrasound evaluation of IVC patency after abdominal packing is simple, practical, easily reproducible, and can guide a less experienced surgeon in determining if overpacking of the abdomen is the cause of hypotension. Ultrasound findings should be correlated with the clinical picture to be useful.
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Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Chichra A, Makaryus M, Chaudhri P, Narasimhan M. Ultrasound for the Pulmonary Consultant. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 10:1-9. [PMID: 27398039 PMCID: PMC4928647 DOI: 10.4137/ccrpm.s33382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/07/2016] [Accepted: 04/19/2016] [Indexed: 01/06/2023]
Abstract
Bedside ultrasonographic assessment of the lung and pleura provides rapid, noninvasive, and essential information in diagnosis and management of various pulmonary conditions. Ultrasonography helps in diagnosing common conditions, including consolidation, interstitial syndrome, pleural effusions and masses, pneumothorax, and diaphragmatic dysfunction. It provides procedural guidance for various pulmonary procedures, including thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. This article describes major applications of ultrasonography for the pulmonary consultant along with illustrative figures and videos.
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Affiliation(s)
- Astha Chichra
- Division of Pulmonary and Critical Care Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Mina Makaryus
- Division of Pulmonary and Critical Care Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Parag Chaudhri
- Division of Pulmonary and Critical Care Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Mangala Narasimhan
- Division of Pulmonary and Critical Care Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
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Abu-Zidan FM, Idris K, Khalifa M. Strangulated epigastric hernia in a 90-year-old man: Point-of-Care Ultrasound (POCUS) as a saving kit: Case report. Int J Surg Case Rep 2016; 22:19-22. [PMID: 27017275 PMCID: PMC4844665 DOI: 10.1016/j.ijscr.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/13/2016] [Accepted: 03/13/2016] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The physiological reserve of extreme elderly patients is very limited and has major impact on clinical decisions on their management. Hereby we report a 90-year-old man who presented with a strangulated epigastric hernia and who developed postoperative intra-abdominal bleeding, and highlight the value of Point-of-Care Ultrasound (POCUS) in critical decisions made during the management of this patient. PRESENTATION OF CASE A 90-year-old man presented with a tender irreducible epigastric mass. Surgeon-performed POCUS using colour Doppler showed small bowel in the hernia with no flow in the mesentery. Resection anastomosis of an ischaemic small bowel and suture repair of the hernia was performed. Twenty four hours after surgery, in a routine follow up using POCUS, significant intra-peritoneal fluid was detected although the patient was haemodynamically stable. The fluid was tapped under bedside ultrasound guidance and it was frank blood. During induction of anaesthesia for a laparotomy, the patient became hypotensive. Resuscitation under inferior vena cava sonographic measurement, followed by successful damage control surgery with packing, was performed. 36h later, the packs were removed, no active bleeding could be seen and the abdomen was closed without tension. The patient was discharged home 50 days after surgery with good general condition. CONCLUSION POCUS has a central role in the management of critically-ill elderly patients for making quick critical decisions.
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Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
| | - Kamal Idris
- Intensive Care Unit, Al-Ain Hospital, Al-Ain, United Arab Emirates.
| | - Mohammed Khalifa
- Surgical Institute, Al-Ain Hospital, Al-Ain, United Arab Emirates.
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Evirgen Ş, Kamburoğlu K. Review on the applications of ultrasonography in dentomaxillofacial region. World J Radiol 2016; 8:50-58. [PMID: 26834943 PMCID: PMC4731348 DOI: 10.4329/wjr.v8.i1.50] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/31/2015] [Accepted: 12/03/2015] [Indexed: 02/06/2023] Open
Abstract
Use of ultrasonography (US) in dentomaxillofacial region became popular in recent years owing to increasing radiation dose concerns and economic limitations. It helps to visualize fine detail of the surface structure of the oral and maxillofacial tissues without ionizing radiation. In diagnostic ultrasound, high frequency sound waves are transmitted into the body by a transducer and echoes from tissue interface are detected and displayed on a screen. Sound waves are emitted via piezoelectric crystals from the ultrasound transducer. US technique can be used in dentomaxillofacial region for the examination of bone and superficial soft tissue, detection of major salivary gland lesions, temporomandibular joint imaging, assessment of fractures and vascular lesions, lymph node examination, measurement of the thickness of muscles and visualization of vessels of the neck. It has the potential to be used in the evaluation of periapical lesions and follow up of periapical bone healing. Also, it may be used for the evaluation of periodontal pocket depth and for the determination of gingival thickness before dental implantology.
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Effect of Cortical Bone Thickness on Detection of Intraosseous Lesions by Ultrasonography. Radiol Res Pract 2015; 2015:797593. [PMID: 26366296 PMCID: PMC4561116 DOI: 10.1155/2015/797593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Usefulness of ultrasound (US) in detection of intrabony lesions has been showed. A cortical bone perforation or a very thin and intact cortical bone is prerequisite for this purpose. Objective. The current in vitro study was aimed at measuring the cut-off thickness of the overlying cortical bone which allows ultrasonic assessment of bony defects. Materials and Methods. 20 bovine scapula blocks were obtained. Samples were numbered from 1 to 20. In each sample, 5 artificial lesions were made. The lesions were made in order to increase the overlying bone thickness, from 0.1 mm in the first sample to 2 mm in the last one (with 0.1 mm interval). After that, the samples underwent ultrasound examinations by two practicing radiologists. Results. All five lesions in samples numbered 1 to 11 were detected as hypoechoic area. Cortical bone thickness more than 1.1 mm resulted in a failure in the detection of central lesions. Conclusion. We can conclude that neither bony perforation nor very thin cortical bones are needed to consider US to be an effective imaging technique in the evaluation of bony lesion.
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Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH, Shahmorady Z, Niknejad MT. Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol 2014; 44:20140229. [PMID: 25426703 DOI: 10.1259/dmfr.20140229] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To compare the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes. METHODS Foreign bodies of four sizes (0.5, 1, 2 and 3 mm) including metal, tooth, wood, plastic, stone, glass and graphite were embedded in six fresh sheep heads on bone surface between the corpus mandible and muscle, and inside the tongue muscle. A human dry skull served as an air-filled space. Plain radiography, CT, MRI and ultrasonography were used, and four skilled radiologists rated the findings individually. RESULTS All embedded foreign bodies except wood were best visualized using CT. Wood could only be detected using ultrasonography, and then only when fragments were >0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal and graphite. MRI was the least useful imaging technique. CONCLUSIONS In cases with suspected foreign bodies in the maxillofacial region, CT seems to be the optimal initial imaging study. Wood, however, could only be detected using ultrasonography.
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Affiliation(s)
- R Javadrashid
- 1 Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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