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Get connected with NewsWire! This bi-weekly e-newsletter from the American Registry for Diagnostic Medical Sonography® (ARDMS®), offers its Registrants and members of the sonography community current and innovative news and technology related to the field of sonography.

April 24, 2009

Headlines in the News:    

Ultrasound Imaging Now Possible with Smartphone

Washington University Computer engineers are developing USB-based ultrasound probe technology with a smartphone, which enables a compact, mobile computational platform and a medical imaging device that fits in the palm of a hand. William D. Richard and David Zar have made commercial USB ultrasound probes compatible with Microsoft Windows Mobile-based smartphones.

Richard and Zar demonstrated a fully functional smartphone-compatible USB ultrasound probe at Microsoft Research Techfest 2009 in February, and Zar presented the technology at the 2009 World Health Care Congress held in Washington, D.C., from April 14-16.

Now it is possible to build smartphone-compatible USB ultrasound probes for imaging the kidney, liver, bladder, and eyes, endocavity probes for prostate and uterine screenings and biopsies, and vascular probes for imaging veins and arteries for starting IVs and central lines.

Another promising application is for caregivers of patients with Duchene's Muscular Dystrophy, an incurable degenerative disease that often strikes young boys. The caregiver would only have to do a one-minute scan, transfer the data captured to the clinic, and the results would come back to the caregiver, Zar said.

Zar said the new system will be used to train people in remote areas of the developing world on the basics of gathering data with the phones and sending it to a centralized unit many miles away where specialists can analyze the image and make a diagnosis.

View the article online.

Article written by staff at technology.am and adapted for the purposes of this newsletter.

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The Ultrasound Probe Used During Biopsy May Affect Diagnosis

There are two basic types of transrectal ultrasound probe most commonly used to monitor positioning of biopsy needles during the biopsy procedure - the so-called "side fire" and "end fire" types. A recent analysis of data from the Cleveland Clinic suggests that the type of ultrasound probe used may significantly affect the likelihood of diagnosis.

Data was evaluated from 2,674 patients who underwent initial prostate biopsy between 2000 and 2008 with respect to PSA level, biopsy technique, and pathological findings. Patients included 1,124 in whom biopsies were performed with an "end fire" probe and 1,550 in whom biopsies were performed with a "side fire" probe.

The results of the evaluation are as follows:

  • There was a significant difference in the overall cancer detection rate between patients in the "end fire" vs the "side fire" groups (45.8 vs 38.5 percent).
  • This significant difference was also evident in two subsets of patients
    • Those with PSA levels between greater than 4 and less than or equal to 10 ng/ml (46.4 vs 38.9 percent)
    • Those with PSA levels greater than 10 ng/ml (61.7 vs 49.1 percent)
  • There was a significant difference in detection rates between probes in those patients who had between 8 and 19 biopsy cores taken.
  • If greater than or equal to 20 cores were taken, there was no statistically significance difference in the results between the two types of probe.
  • Prostate volume, patient age, PSA level, and hypo echoic findings were all independent variables for predicting cancer detection on multivariate analysis.

The authors concluded that the type of probe significantly affects the overall prostate cancer detection rate, particularly in patients who have PSA levels greater than 4 ng/ml and/or nonsaturation prostate biopsies (with 8 to 19 cores).

The authors suggest that this result may occur because the "end fire" probe allows better mechanical sampling of the lateral and apical regions of the peripheral zone, where cancer is most likely to reside. They suggest that these data "set the stage" for a randomized clinical trial of the two types of biopsy, but The "New" Prostate Cancer InfoLink wonders whether such a trial is ethical, given the large degree of statistical significance between the biopsy results using these two different types of probe.

View the article online.

Article written by staff at prostatecancerinfolink.net and adapted for the purposes of this newsletter.

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New Ultrasound to Help Diagnose Lung Cancer

New technology is changing the way doctors diagnose lung cancer.

Doctors at OSF St. Francis Medical Center used the new technology on a patient in a live procedure that was shown simultaneously to conference attendees in Springfield. The technology is this small piece of equipment called an Endobronchial Ultrasound. It's a more high-tech ultrasound that allows doctors to insert this small scope orally, which helps them see what they're doing. This is something that isn't possible with current procedures.

Dr. Patrick Whitten was one of the pulmonologist during the live procedure and said, "What the difference is, is what we can see. We can see outside the lung, we know where the lymph nodes and blood vessels are, we can get better tissue, easier diagnosis. Quicker diagnosis leads to better treatment".

Since the scope gives doctors a better view, no cutting is necessary. The procedure takes only a few hours and the patient goes home the same day. Lung cancer is the leading cause of cancer deaths in America.

View the article online.

Article written by staff at centralillinoisproud.com and adapted for the purposes of this newsletter.

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New Ultrasound-guided Biopsy Method Allows Improved Diagnosis Of Endometrial Disease

A procedure used in conjunction with a vaginal ultrasound might make it easier to visualize and diagnose diseases in the lining of the uterus, researchers at UT Southwestern Medical Center have found.

Physicians evaluated the endometrium, a cavity that lines the inside of the uterus, in women who were in the midst of or had gone through menopause and who complained of abnormal bleeding. Abnormal bleeding can indicate certain diseases of the endometrium that may or may not be malignant.

The current standard of care is to blindly biopsy the endometrium; however, the biopsy might not always sample the part of the cavity that is diseased.

A study available online and in the April issue of Obstetrics and Gynecology shows that using saline-infusion sonography (SIS), or ultrasound, a minimally invasive procedure, allows doctors to actually see where in the endometrium a polyp or growth exists and to biopsy it accordingly.

"Saline infusion sonography augments the usual transvaginal sonogram and lets us see what is inside the endometrium," said Dr. Elysia Moschos, associate professor of obstetrics and gynecology at UT Southwestern and the lead author of the study. "Normally, the endometrial cavity is collapsed, but when we infuse it with saline, we can visualize inside the cavity and see if it contains any abnormalities."

On a sonogram, water appears dark and tissue is light, so polyps or tumors look bright in comparison with the surrounding saline solution. Using the SIS procedure, physicians inject saline through a catheter threaded into the uterus through the cervix to fill up and expand the endometrial cavity.

Doctors can then easily visualize and biopsy an existing growth under sonography guidance and send it to a pathologist for analysis.

A total of 88 saline-infusion sonography endometrial samples were obtained. In the final outcome of 80 of those samples, saline-infusion endometrial sampling provided a diagnosis 89 percent of the time, compared with 52 percent for endometrial biopsy.

The study showed there were no women for whom blind biopsy of the endometrium would still be an appropriate first step, Dr. Moschos said. The blind biopsies missed 15 of 16 benign polyps and one-third of cancers.

By comparison, two-thirds of benign polyps were correctly diagnosed by saline-infusion sonography endometrial sampling and no premalignant or malignant growths were missed.

Abnormal bleeding is a common complaint among patients, particularly during and after menopause. Women experiencing this symptom need to be evaluated for any kind of gynecologic cancers, Dr. Moschos said. The first step should be imaging of the endometrium by ultrasound.

According to the American College of Obstetrics and Gynecology (ACOG), postmenopausal women who have an endometrial lining thicker than 4 millimeters need further follow-up.

"In women with abnormal endometrial appearances, SIS should then be performed. If the endometrium is uniformly thickened on the SIS exam, only then is a blind biopsy appropriate," Dr. Moschos said. "However, most endometrial pathology is focal, and therefore directed sampling, such as with saline infusion sonography guidance, is necessary."

The patients were all evaluated at Parkland Health and Hospital System in Dallas, the primary teaching hospital for UT Southwestern faculty physicians.

Other UT Southwestern authors included Dr. Raheela Ashfaq, professor of pathology and obstetrics and gynecology; Dr. Donald McIntire, professor of obstetrics and gynecology; and Dr. Diane Twickler, professor of radiology and obstetrics and gynecology.

View the article online.

Article written by staff at sciencedaily.com and adapted for the purposes of this newsletter.

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