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Welcome to 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.
We want to hear from you! NewsWire was designed to serve as an informational forum. As such, we welcome your article suggestions, questions, comments and feedback on ways to make this resource a more valuable tool in your day-to-day professional life. Please write to us at: communications@ardms.org |
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Ultrasound Proves Just as Useful as CT for Detecting Free Air
Ultrasound is just as useful as CT in diagnosing intraperitoneal free air.
Japanese researchers have established by studying nearly 500 patients that ultrasound is just as useful as CT in diagnosing intraperitoneal free air in patients suffering from abdominal pain or acute injury.
After blunt trauma, it is important to diagnose gastrointestinal perforation, especially in the peritoneal cavity. In the U.S., CT is used almost exclusively for the workup of acute abdominal pain, but Dr. Yoshihiro Moriwaki, from the Critical Care and Emergency Center at Yokohama City University, and colleagues argue for ultrasound.
Ultrasound is simple, rapid, inexpensive, and dynamic, and it can be used as often as necessary without harm to the patient, Moriwaki said. Ultrasound can also be used in remote locations such as emergency scenes and ambulances and with unstable patients unable to travel to a radiographic examination area.
In their study, Moriwaki and colleagues examined 484 patients using ultrasound, abdominal radiography, and abdominal CT (Arch Surg 2009;144[2]:137-141). Ultrasound detected intraperitoneal free air (IPFA) in 85.2% (46) of the blunt trauma patients (54). In the remaining eight patients, three did not show IPFA even on CT, and two did not show IPFA in front of the liver surface but rather in the intermesenteric space. In the other three patients, IPFA could not be visualized by ultrasound despite the presence of sufficient amounts for its detection.
Ultrasound demonstrated 85.7% sensitivity and 99.6% specificity in patients with blunt abdominal trauma. In patients with severe acute abdominal pain, sensitivity was 85% and specificity was 100%, according to the researchers.
When it comes to ultrasound, however, the most important issue is interpretation. At the Critical Care and Emergency Center in Japan, ultrasound is used often so the physicians have honed their technique and increased their familiarity with the device. As such, they are skilled at detecting IPFA.
Ultrasound diagnosis of IPFA is operator-dependent because many of the techniques for detection are dynamic and require patience, according to Dr. Christine S. Cocanour from the department of surgery at the University of California, Davis Medical Center in Sacramento.
"In busy hospitals in the U.S., where technicians perform nearly all ultrasounds, ultrasound will probably not replace CT or plain radiographs for the diagnosis of free air unless we truly decide that we need to decrease medical costs," she said in an accompanying editorial.
Moriwaki does not, however, advocate ultrasound replacing CT.
"I believe that, essentially and practically, we should not compare the usefulness of CT alone with ultrasound alone for diagnosing gastrointestinal perforation, but should compare CT alone with CT + ultrasound," Moriwaki told Diagnostic Imaging.
View the article online.
Article written by staff at diagnosticimaging.com and adapted for the purposes of this newsletter.
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ASA: Ultrasound-Activated Microbubbles Boost Clot-Busting Action of tPA
Ultrasound-stimulated microspheres with tissue plasminogen activator (tPA) could speed up recanalization in acute ischemic stroke.
Using ultrasound-stimulated microspheres with tissue plasminogen activator (tPA) could speed up recanalization in acute ischemic stroke and enhance recovery, researchers found.
The lower 1.4-ml dose of perflutren microspheres used in the dose-ranging study appeared safe -- there were no intracerebral hemorrhages -- while more than doubling the rate of good functional outcome (P=0.0424).
Used alone, the micron-sized spheres of gas covered in a lipid shell -- used for decades as contrast agents for diagnostic ultrasound -- haven't been seen to have any effect on tPA therapy, Dr. Alexandrov said.
But when hit with a pressure wave from ultrasound, the microspheres oscillate, stirring the tPA in the target vessel and adding a mechanical grinding or sanding action to break down the fibrin clot causing the stoke, he said.
Following on earlier success in the CLOTBUST trial, Dr. Alexandrov's group conducted the multicenter phase I-II Transcranial Ultrasound in Clinical Sonothrombolysis (TUCSON) trial.
The trial randomized acute ischemic stroke patients to open-label treatment with the standard 0.9 mg/kg dose of intravenous tPA with saline placebo and intermittent transcranial Doppler monitoring or the tPA with microspheres plus 90 minutes of continuous 2-MHz transcranial Doppler ultrasound.
For the primary endpoint of sustained complete recanalization at 120 minutes, there was a signal for benefit with the lowest microbubble dose but no significant trend (P=0.221).
The rates of recanalization were:
· 67% among the 12 patients treated with the 1.4-ml microsphere dose
· 46% among the 11 patients treated with the 2.8-ml dose
· 33% among the 12 controls
Other recanalization outcomes likewise tended to be best with the lowest microsphere dose, including complete recanalization (67% versus 46% with 2.8-ml dose and 33% with placebo, P=0.177).
Median time to any recanalization, though, was equally fast with the two doses (30 minutes for both versus 60 with placebo, P=0.054).
Clinical outcomes at three months uniformly favored the 1.4-ml microsphere group, including a significantly higher rate of favorable outcome defined by a modified Rankin Scale 0 of 1 (75% versus 50% with the 2.8 ml dose and 36% in controls, P=0.0424 for 1.4 ml versus placebo).
Other findings included a tendency toward more patients with "dramatic early clinical recovery" (42%, 27%, 17%, respectively, P=0.396) and with a modified Rankin score of 2 or less (83%, 60%, and 55%, P=0.297).
Mortality was seen only in the 2.8-ml dose group (30% versus 0% in the other two groups, P=0.022).
They noted also an excess of symptomatic intracerebral hemorrhage events in the higher microsphere dose group (27% versus 0% in the other two groups, P=0.028).
Post-hoc analysis revealed significantly higher stroke severity in this group (P=0.047 versus the lower dose group) and uncontrolled hypertension in all three symptomatic hemorrhage cases.
"The rate of symptomatic intracerebral hemorrhage observed in the second dose tier may have been related to excessive blood pressures while lower recanalization and recovery rates could be due to greater stroke severity at baseline," they said.
But, "alternatively, bleeding with the higher microsphere dose could be related to greater mechanical stress to the endothelium and tissues," Dr. Alexandrov's group said.
They cautioned, however, that the study included a relatively small sample size in every group without the ability to extend enrollment.
View the article online.
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
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SCAN: Delivering Bone Disorder Diagnosis, Fracture Healing
Ultrasound device being developed by space biomedical researchers.
The fight against bone disorders that affect millions of Americans will soon receive a boost from an ultrasound device being developed by space biomedical researchers. The technology under development will allow early prediction of bone disorders such as osteoporosis and guided acceleration of fracture healing.
National Space Biomedical Research Institute (NSBRI) scientists are developing the technology to assist astronauts during long-duration spaceflights. Like the elderly on Earth, astronauts in space lose bone structure and quality.
Dr. Yi-Xian Qin, associate team leader for NSBRI's Smart Medical Systems and Technology Team, calls the new technology Scanning Confocal Acoustic Navigation (SCAN). He said the objective is to develop a small, mobile device that is easy to use and patient friendly.
"SCAN uses non-invasive and non-destructive ultrasound to image bone. It will allow us to identify weak regions, to make a diagnosis and to assist in healing fractures," said Qin, who is also the director of the Orthopedic Bioengineering Research Laboratory at Stony Brook University - State University of New York.
Stress-related fractures are a big concern for astronauts during long missions to the moon or in space. Qin said the fracture rate could be high on the moon due to workload force, heavy spacesuits and gravity that is one-sixth of Earth's.
The researchers are developing the new technology using scanning confocal acoustic diagnostic imaging for diagnosis and low-intensity pulsed ultrasound technology for treatment. Compared to current diagnostic ultrasound scanners, Qin's new technology is more advanced because of its ability to assess a higher number of parameters and is designed for imaging of hard tissue such as bone.
"Our new ultrasound technology can detect bone mineral density. In addition, we can assess bone quality, such as stiffness, and then predict the risk of fracture," Qin said. "Overall bone quality assessment, including strength and structure, is essential because the risk of fracture is probably more related to the quality of a bone rather than the density of a bone alone."
On Earth, X-ray machines are the standard tools of choice for monitoring bone health, but they are only used to detect bone mineral density. X-ray machines are not ideal for use in space due to the health risk radiation poses to astronauts, who are exposed to higher levels of radiation outside of Earth's protective atmosphere and magnetic field.
Qin is currently conducting clinical evaluations of the diagnostic part of the technology. The mobile device runs off of a laptop computer, and an image of the heel or wrist can be completed in about five minutes. Also under development is the capability to scan the knee and hip.
Meanwhile, the group is continuing development of the therapeutic portion of the technology. On Earth, it takes six weeks to heal a fracture in normal conditions. The healing process may take longer in space. He said the device will help accelerate fracture healing by stimulating bone regeneration.
Ultrasound has been used to heal fractures, but it has not been effective due to its lack of accuracy at the fracture site. This is where Qin's guided approach will be beneficial. "We are trying to use ultrasound technology as a way to get an image of the fracture site," Qin said. "An integrated probe will directly shoot ultrasound into the region of the fracture. We hope this will result in effective acceleration of fracture healing."
SCAN technology will be an ideal tool for health care providers on Earth who are dealing with an increasing elderly population and for those in rural areas where access to medical facilities is limited. In addition to being small and easier to use than X-ray based bone density measurement machines, the ultrasound device could be as much as 10-times cheaper to purchase and operate. "If we can provide a cost-effective, easy to operate machine at the doctor's office, then they can monitor patients at minimal cost," Qin said. "Also, it is non-invasive and non-destructive. People are not hesitant to get additional tests."
Qin's project is one of nine currently in the NSBRI Smart Medical Systems and Technology Team's portfolio devoted to developing new integrated medical systems to assist in delivering quality health care in space. Other areas being researched include space surgery and supporting techniques, routine risk and health-monitoring systems, and automated systems and devices to aid in decision-making, training and diagnosis. The new systems will have immediate benefits for health care on Earth.
View the article online.
Article written by staff at nsbri.org and adapted for the purposes of this newsletter.
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The Future of Sports Injuries Will Be in 3D
Increasingly reliable diagnosis and more effective treatment of musculoskeletal system injuries.
A study shows that new three-dimensional technologies applied to the traditional ultrasound scan significantly improve the quality of imaging. The applications, already used in the gynecological field, are particularly useful for carrying out an increasingly reliable diagnosis and more effective treatment of musculoskeletal system injuries.
For several years now doctors have been using ultrasound scanning as a tool for diagnosing sports injuries. Medicine is now in the hands of technology to achieve a clear improvement in imaging quality, which will not only result in a better diagnosis, but also a more effective treatment and subsequent recovery.
This research, led by José Fernando Jiménez Díaz, a specialist in sports medicine from the University of Castilla la Mancha, analyzed the usefulness of these new applications in injuries, particularly those produced in work or sports contexts. It has already been used for several years in specialist areas such as gynecology for the diagnosis and monitoring of pregnancies.
To carry out the assessment, the study published in the journal Advances in Therapy, compared two high definition ultrasound portable devices. One of the devices had the traditional applications and the other had in its system: harmonic imaging, real time ultrasound, panoramic view, 3D imaging and virtual convex.
Five types of injuries were compared: muscle contusion, intrinsic muscle lesion, patellar tendonitis, calcified patellar tendonitis and partial rupture of the medial ligament of the knee. The results showed that the new systems incorporated improve the scanning of injured tissues in all types of injury analyzed.
"Applications of this technology focus on both the diagnosis and treatment of injuries," Jiménez Díaz explained to SINC. "The new branch of ultrasound scanning, known as intra-operative ultrasound, makes it possible to avoid some of the surgeries that were previously unavoidable when applying ultrasound-guided treatment to the musculoskeletal system."
The promising future of 3-D technology
While new technological applications have been adopted in major hospitals over the last three to four years, three-dimensional applications in portable or compact devices have only been applied since the beginning of 2007 in the diagnosis of soft tissue injuries (those on the skin, the subcutaneous tissue, the aponeuroses and muscles).
As the researcher indicated to SINC, "the idea behind an improvement in imaging quality is not to give the patient a prettier photo, but rather to improve the scanning of structures, particularly small injuries which are difficult to interpret. This is where the 3-D experience can help achieve optimum injury recovery".
Experts are optimistic about the future of these types of technologies. "The blooming of the ultrasound in diagnosing injuries is yet to come. I hope that applications for scanning structures which we still consider partially blind improve even more. The improvement will enable a safer diagnosis and the application of a more reliable treatment", concluded Jiménez Díaz.
View the article online.
Article written by staff at alphagalileo.org and adapted for the purposes of this newsletter.
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