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June 24, 2011



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ARDMS: Important Testing Center Update

Ultrasound Scanner Could Spell the End of Arm Squeezing Cuff To Take Your Blood Pressure

Doppler Ultrasound May Help Identify Infant Allergies to Cow's Milk

3D Transvaginal Ultrasound Bests Hysterosalpingography (HSG) For Uterine Abnormalities

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ARDMS: Important Testing Center Update

Important Testing Center Update: Due to heightened security measures for admission to the test centers, previously accepted forms of ID will not be accepted if the name on the ID does not exactly match the name on your ARDMS examination-confirmation letter.  If the names are different in any way (including a middle initial that appears on the ID but no in your record or vice versa) on either form of identification, you must update your name of record with ARDMS immediately. Failure to present two forms of identification that exactly match the name reflected on your Examination Confirmation Letter will result in you being turned away from the test center and being marked absent for the appointment. Should this occur, you will be required to submit a new online application form and testing fee in order to obtain a new eligibility period within which to examine.

Ultrasound Scanner Could Spell the End of Arm Squeezing Cuff To Take Your Blood Pressure

The days of having your blood pressure taken with an uncomfortable arm-squeezing cuff may be numbered, after scientists developed a far more pleasant technique.

Researchers used an ultrasound scanner, more commonly used on pregnant women, to measure a person's blood pressure pulse at various points around the body.

The team, from the Eindhoven University of Technology in The Netherlands, said the procedure would help prevent heart attacks and strokes by giving a far clearer picture of the condition of the heart and blood vessels.

Dr. Nathalie Binjnens, said scientists had been searching for such a non-invasive method for years.

She said: "The usual method is to insert a catheter with a pressure sensor. But that's an invasive procedure, and not suitable for preventive diagnostics."

"There's also the traditional method using an inflatable arm cuff. But that doesn't allow any conclusions to be drawn about – for example – the blood pressure in the carotid artery." The cartoid arteries are found on each side of the neck and provide the main blood supply to the brain.

"You won't find anyone willing to have the blood pressure in their neck measured using an inflatable cuff," Dr. Binjnens said.

In the new technique doctors apply a small amount of gel to various points around the body so that the scanner makes good contact with the skin.

The researchers then use a mathematical model to achieve a good visualization of the blood flow and the blood vessel wall motion, from which the blood pressure can be derived.

They can also see the variations in blood pressure and flow in time as a result of the beating of the heart.

The simultaneous knowledge of pressure and flow also provides information about 'downstream' parts of the vascular system.

Doctors will be able to use the technique to give an early warning to patients in danger of developing cardiovascular problems.

Dr Binjens said: "By performing a simple scan, the physician can detect vascular disease in an early stage and decide for a preventive treatment."

She said it could be used to monitor diseases such as thrombosos or aneurysms (dangerous dilations of a blood vessel that can lead to strokes).

The researchers published their results last month in the scientific Journal Ultrasound in Medicine and Biology.

The method was first tested on elastic plastic tubes, and after that on pigs' carotid arteries from an abattoir, with good results.
It is currently being tested on volunteers in advance of clinical tests with patients. The results have been promising but researchers say it will take a few years to develop before it is ready for general practices.

View the article online.

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

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Doppler Ultrasound May Help Identify Infant Allergies To Cow's Milk


Doppler ultrasound may be a viable screening tool to help diagnose infants with allergies to cow's milk, suggests an article published online in the June issue of the American Journal of Roentgenology (AJR).

Approximately 2.5% to 7.5% of infants develop this allergy, but it can be difficult to diagnose due to a variety of symptoms. Infants suspected of having cow's milk allergies are placed on an exclusion diet for several weeks, which is followed by a challenge test.

Physicians at the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul in Porto Alegre, Brazil, conducted a study to evaluate the effectiveness of grayscale and color Doppler ultrasound for identifying intestinal inflammation caused by the allergy (AJR, June 2011, Vol. 196:6, pp. W817-W822).

Seventeen symptomatic and 17 asymptomatic infants 6 months of age and younger were recruited for the study. The diet of all 34 infants included cow's milk. Irritability (100%) and vomiting (70%) were the most frequently reported symptoms.

An ultrasound exam was performed when an infant came to the Serviço de Gastroenterologia Pediátrica between May 2006 and July 2009 for treatment (study group) or for a routine checkup (control group). The grayscale ultrasound exam measured the thickness of the wall of bowel loops in the jejunum, terminal ileum, and all colon segments.

The color Doppler test evaluated the quantity of peripheral mesenteric vessels in a 4-cm2 area. Five areas were examined in right side and five in the left side of the abdomen to examine the ileal and jejunal regions, according to lead author Dr. Matias Epifanio and colleagues.

All colored areas were classified as vessels, and vessel density in the surface was evaluated using public domain image analysis software (ImageJ, U.S. National Institutes of Health). A value of 0% to 100%, the percentage of vessel density, was obtained from the vascularized area.

Symptomatic infants were then placed on a diet of amino acid-based formula, after which 15 of the 17 infants had an evaluation in the pediatric gastroenterology department and a second set of ultrasound examinations. After being fed cow's milk in a challenge test lasting up to a week, the infants underwent a third ultrasound exam.

The percentage of mesenteric vessel density according to color Doppler scans in patients suspected of having cow's milk allergies (mean, 28.1%) was significantly greater than in the control infants (mean, 7.8%), the authors reported.

Epifanio and colleagues recommended a cutoff point of 18.7% for vessel density. At this cutoff point, patients with cow's milk allergies could be differentiated from those without allergies with 81.8% sensitivity and 94.1% specificity.

"Ultrasound findings, particularly vessel density, seem to be associated with inflammatory changes in the intestinal wall," the authors wrote. "The physiopathologic mechanism of cow's milk allergy in infants is usually associated with intestinal inflammation, and ultrasound may detect these changes."

When associated with clinical parameters, Doppler ultrasound examinations may be useful as a screening tool, they concluded.

View the article online.

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

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3D Transvaginal Ultrasound Bests Hysterosalpinography (HSG) For Uterine Abnormalities

3D transvaginal ultrasound performs better and is more cost-effective than hysterosalpingography (HSG) in women with uterine abnormalities, according to a study from Eastern Virginia Medical School.

From the prospective study involving 103 women, researchers determined that 3D transvaginal ultrasound visualized and evaluated the uterine cavity with similar or better accuracy than standard HSG in the office setting. It also yielded lower cost and morbidity.

"These results show 3D ultrasound as a very promising tool which may eliminate the need for diagnostic surgery in the diagnosis of uterine anomalies," said Dr. Silvina Bocca, PhD. She presented the findings at the American Institute of Ultrasound in Medicine (AIUM) annual meeting in April.

Uterine abnormalities are associated with an increased risk of sterility, miscarriage, and obstetrical complications. While some of these abnormalities can often be detected by 2D transvaginal ultrasound, final diagnosis is traditionally obtained by HSG, MRI, or a combination of hysteroscopy and laparoscopy, Bocca said.

The Eastern Virginia team sought to prospectively compare the costs, accuracy, risk, and benefits of 3D transvaginal ultrasound with HSG in women with uterine abnormalities. The group enrolled 101 women (age, 26-44) with evidence of uterine pathology who were attending an infertility clinic.

All participants had a routine HSG as part of their infertility evaluation as well as a 3D transvaginal ultrasound exam as part of the study. The ultrasound exam was performed by one of the investigators on a Voluson Expert scanner (GE Healthcare) using the Z technique for the multiplanar display of the midcoronal plane of the uterus. The scanning investigator was blinded to the HSG findings.

If the patients had received a hysteroscopy with or without laparoscopy, surgical findings were used as the gold standard for their diagnosis. A total of 119 uterine abnormalities were identified; 30 were congenital and 89 were acquired. There were also six normal uteri.

The 30 congenital uterine abnormalities were classified as arcuate (three), unicornuate (one), bicornuate (four), didelphys (two), and septate uteri (20). The 89 acquired abnormalities were classified as polyps (38), fibroids (30), synechiae (17), and adenomyosis (four).

In congenital abnormalities, 3D transvaginal ultrasound detected 100% of fibroids, 100% of synechiae, and 50% of adenomyosis, compared with HSG detection rates of 83%, 80%, and 62%, respectively.

No adverse effects were reported after 3D ultrasound, while six minor/moderate adverse events were reported after HSG.

Cost analysis

Using the Medicare rates from the state of Virginia (not including radiologist or hospital fees), 3D ultrasound has a cost of $138.49 per patient, contrast-enhanced MRI has a cost of $1,539, and HSG has a cost of $408.87. Hysteroscopy has a cost range of $228.24 to $541.96.

3D ultrasound was 100% accurate in the six normal uteri, generating a total cost of $834 ($139 x 6) for all normal patients. No further evaluation or treatment was necessary.

HSG, however, failed to correctly classify these patients, costing a total of $2,454 for all six individuals, Bocca said. In addition, these patients required further evaluation, which would have cost $9,234 ($1,539 x 6) if an MRI was ordered and $1,374 if hysteroscopy ($229 x 6) was needed. The aggregate cost would range from $3,828 to $11,779 for the entire patient group, compared with $834 from the use of 3D ultrasound.

3D ultrasound also correctly diagnosed all 20 septate uteri. This generated a cost of $2,780 ($139 x 20) for diagnosis and $10,840 for hysteroscopic septoplasty ($542 x 20) for evaluation. The aggregate cost for this patient group was $13,620.

"Fifteen of these 20 patients conceived spontaneously," she said.

HSG only correctly diagnosed seven of the 20 patients at an aggregate cost of $6,657, including $2,983 ($409 x 7) for the HSG and $3,794 for septoplasty ($542 x 7). The 13 uncertain diagnoses required further testing, adding an aggregate cost of approximately $19,000 for MRI and $10,000 when hysteroscopy and laparoscopy were ordered.

View the article online.

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

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NewsWire. Copyright 2011.  American Registry for Diagnostic Medical Sonography. The ideas and opinions expressed herein do not necessarily reflect those of ARDMS.


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