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Headlines in the News:
Fetal Musculoskeletal (MSK) Anomalies Need Orthopedic Surgeon Involvement
Fetal musculoskeletal anomalies have become easier to detect, thanks to technological advancements in 3D and 4D ultrasound equipment...
Carotid Ultrasound May Help Predict Cardiac Events
Performing ultrasound studies of carotid intima-media thickness (CIMT) provides long-term prognostic value for adverse cardiac events...
Study Ranks Needle Visibility Under Ultrasound
Of the most common needles used in ultrasound-guided regional anesthesia, three models rank among the best for use in interventional pain procedures...
Making Waves: Biomedical Researcher Uses Ultrasound to Measure Early Response to Cancer Treatment
By comparing high-frequency ultrasound patterns before and after treatment, doctors can potentially know within days if a tumor is responding to a prescribed therapy...
Innovative Sound Device Could Bust Cancer Cells, Sharpen Ultrasound Clarity
A pair of researchers have developed a new tool that could be used to destroy cancer cell...
Fetal Musculoskeletal Anomalies Need Orthopedic Surgeon Involvement
Fetal musculoskeletal anomalies have become easier to detect, thanks to technological advancements in 3D and 4D ultrasound equipment...
Fetal musculoskeletal anomalies have become easier to detect, thanks to technological advancements in 3D and 4D ultrasound equipment and its capability to characterize fetal deformities, according to a recent article in the Journal of Pediatric Orthopedics.
Because the majority of isolated musculoskeletal anomalies can be treated successfully, parents need to be offered immediate counseling by a pediatric orthopedic surgeon to learn what surgical options will be possible, said authors from Children's Hospital Boston (J Pediatr Orthop,).
The rate of reported musculoskeletal fetal anomalies is approximately 0.6%, compared to 2% for congenital anomalies. The reported incidence of upper extremity anomalies is one in 1,000 fetuses and may include cleft hands; clasped thumb; bent, overlapping, and/or webbed fingers; extra or missing fingers; and radial dysplasia.
The most common lower extremity anomaly that can be identified in a prenatal ultrasound is clubfoot. An isolated clubfoot may suggest the presence of other fetal abnormalities, according to lead author Dr. Susan Mahan, a pediatric orthopedic surgeon at Children's Hospital, and Dr. James Kasser. Other lower extremity musculoskeletal anomalies include dislocated knees or hips, curly toes, cleft foot, congenital short femur, proximal femoral focal dysplasia, and fibular hemimelia.
Once a musculoskeletal anomaly is identified, the authors recommend that a pediatric orthopedic surgeon be consulted to provide information about the probability of the correct in utero diagnosis, the severity of the expected deformity, treatment options, and the likelihood of a happy and productive life of the unborn child.
They warn that parents-to-be who do not receive an immediate explanation and counseling about the diagnosis may become excessively fearful and form inappropriate opinions about the child's condition, especially with easy access through the Internet to both accurate and inaccurate clinical information.
With timely counseling, parents will be better informed of treatment expectations and will be able to make more knowledgeable decisions with their obstetricians with respect to managing the pregnancy once a musculoskeletal deformity is identified, the authors suggested.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
Carotid Ultrasound May Help Predict Cardiac Events
Performing ultrasound studies of carotid intima-media thickness (CIMT) provides long-term prognostic value for adverse cardiac events...
Performing ultrasound studies of carotid intima-media thickness (CIMT) provides long-term prognostic value for adverse cardiac events, giving doctors important clues about who is at risk for a heart attack, according to a study published April 6 in the Journal of the American College of Cardiology (JACC).
Researchers from Baylor College of Medicine in Houston found that about 23% of patients would be reclassified into a different risk group by adding information obtained from ultrasound assessment of CIMT to traditional risk factors used for predicting future cardiac events. Risk prediction using this approach was more accurate, and it could help better define which patients should be screened with CIMT ultrasound.
"More people were reclassified down rather than up" in risk, said lead author and cardiologist Dr. Vijay Nambi in a JACC video interview accompanying the study's release.
"Noninvasive ultrasound can give us a more complete snapshot of our patients' risk, so we can do a better job determining if they'll have a heart attack," added study co-author Dr. Christie Ballantyne, also from Baylor, in a statement accompanying the release.
Using ultrasound, researchers examined the carotid arteries of 13,145 patients, analyzing the thickness of the artery wall and the presence or absence of plaque inside the artery to determine if these characteristics influenced the traditional risk factors for heart attack and coronary heart disease (JACC).
"We have known that people with heart disease tend to have thicker carotid arteries on ultrasound, but we now know how to use the artery thickness and presence or absence of plaque to better predict who is at risk for heart disease," Nambi said.
The retrospective analysis was performed using data from the Atherosclerosis Risk in Communities (ARIC) study, Nambi said. The risk-prediction models (overall, and separately for men and women) analyzed in the study included traditional risk factors only, traditional risk factors with the addition of CIMT or plaque, and, finally, traditional risk factors plus CIMT and plaque. Traditional risk factors, such as smoking, age, high cholesterol, and comorbidities, were the same as those used in the Framingham study, Nambi explained.
The predictive value of the various combinations for cardiac events was determined by calculating the area under the receiver operator characteristics curve (AUC) adjusted for the phenomenon of "overoptimism" that can occur when the fit of the model is tested using the same data in which it was described.
The researchers used Cox proportional hazards models to estimate 10-year risk of coronary heart disease for each model and determine the number of subjects reclassified. Observed events were compared to expected events.
"Now follow-up has been almost 15 to 17 years, so we used data to evaluate if the addition of [CIMT plus plaque] data was useful to risk stratification," Nambi said. There were 1,822 events over the follow-up period, including 650 coronary revascularization procedures and about 1,200 "hard" events such as myocardial infarction or cardiac heart disease and death, he said.
Of 13,145 eligible subjects (5,682 men, 7,463 women) who were scanned with baseline ultrasound, 23% were reclassified by adding CIMT plus plaque information. Overall, the best improvement of risk (improvement in AUC) was obtained using CIMT plus traditional risk factors plus plaque, the authors reported. Similarly, the CIMT plus traditional risk factors plus plaque improved net classification by 9.9% in the overall population.
The AUC improved from 0.742 (traditional risk factors only) to 0.755 (95% confidence interval for the difference in adjusted AUC: 0.008 to 0.017) in the overall cohort.
As for which component of the ultrasound exam had a greater effect on risk, intima-media thickness "had a lot more additive effect in men and plaque had more additive effect in women," for reasons that are not entirely clear, Nambi said.
One possible explanation is that "since middle-aged women have a relatively low prevalence of atherosclerosis, plaque presence, which reflects a definite area of atherosclerosis, was more powerful than using a sex-specific percentile 'thickness' (CIMT)," the study team wrote. "Similarly, given the overall lower prevalence of atherosclerosis in women, it is possible that a CIMT > 75th percentile misclassifies subjects without atherosclerosis as higher risk, and a specific CIMT cutpoint may be better in women."
The data showed clearly that CIMT plus plaque best improved risk prediction in men and women. And, importantly, the information from CIMT plus plaque reclassified more people to lower risk than to higher risk.
"Almost 61.9% of those reclassified from the intermediate-risk group (5% to 20% estimated 10-year coronary heart disease risk) were reclassified to lower risk," the authors wrote. "Furthermore, nobody from the low-risk group was reclassified to a high-risk group, and nobody from the high-risk group was reclassified to the low-risk group."
"All the action was in intermediate risk," Nambi said in his video interview. The authors concluded that adding plaque and CIMT to traditional risk factors improved coronary heart disease risk prediction in their study.
"We now have really good evidence that measuring the intimal-medial thickness and plaque of the carotid artery can be significant in the risk stratification of patients with coronary artery disease," Nambi said.
Because changes in risk assessment weighed most heavily on those of intermediate risk for coronary heart disease (i.e., those with a 5% to 20% risk of coronary heart disease over 10 years), CIMT screening should be considered in the intermediate-risk group and not in the population at large.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
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Study Ranks Needle Visibility Under Ultrasound
Of the most common needles used in ultrasound-guided regional anesthesia, three models rank among the best for use in interventional pain procedures...
Of the most common needles used in ultrasound-guided regional anesthesia, three models rank among the best for use in interventional pain procedures, according to new research results.
Although ultrasound promises direct visualization of needles as they advance toward nerves and through adjacent structures, in practice the picture often is much hazier. Many interventional pain physicians have had the following experience: The footprint of the transducer beam shifts, the needle fades and, as the angle of incidence increases, the needle is simply “lost.”
“Lost needle” phenomenon can be based on a number of factors, including the quality of a given ultrasound machine and the skill of the operator. But the echogenicity of the needle—the needle’s inherent ability to reflect high-frequency ultrasound waves—is among the most important.
“There’s solid evidence that ultrasound-guided blocks are safer and often more successful. They allow for decreased use of local anesthetic and decrease the incidence of vascular and visceral puncture,” said Benjamin Wallisch, DO, assistant professor of anesthesiology at the University of Texas Health Science Center in San Antonio. “Well, that’s all certainly true if you can actually see the needle. If you can’t see the needle and you have someone blindly advancing a needle, I would say that ultrasound-guided blocks might be more dangerous [than nerve stimulation technique].”
At the moment, some companies produce highly echogenic needles that will help fulfill the promise of ultrasound-guided regional anesthesia—increased success and fewer complications. But, according to Dr. Wallisch, given cost constraints, most physicians performing interventional techniques will likely continue to be trained on—and use—needles designed for nerve stimulation techniques.
Although needle echogenicity is a critical factor in producing a clear ultrasound image, no study has categorically ranked the echogenic properties of the most commonly available needles.
“Each time I come across 60 or 70 people trying to learn ultrasound technique, this is the most common question I receive: ‘What needle should I use?’” said Krishna Boddu, MD, associate professor of anesthesiology and director of acute pain medicine at the University of Texas Medical School in Houston.
The Meat of the Study
After eight years of fielding the same question, Dr. Boddu, who conducts an annual pain symposium at the University of Texas Medical School and lectures internationally on ultrasound-guided techniques, set out to find an answer. In doing so, he conducted what experts describe as an elegantly simple and much-needed analysis of how well needles perform under ultrasound.
Dr. Boddu collected samples of some of the commonly used needles on the market from company representatives in his area and then proceeded to the local supermarket and purchased what he described as a “huge chunk” of round roast beef. He placed the animal tissue on his desk and standardized all variables of the ultrasound procedure, including needle depth and angle of incidence, and the resolution settings on the machine and the transducer. Dr. Boddu then took images of each of at least eight brands of needles in varying sizes under these standardized conditions.
Using a Web-based survey tool, Dr. Boddu sent blinded images to all of the physicians who had previously attended his workshops and were using ultrasound-guided techniques, asking them to rank the clarity of each image on a five-point scale. At the time the data were presented, Dr. Boddu had received 22 responses.
In general, responses indicated that the smaller the needle, the less favorable it is for ultrasound. Among specific models and brands, 21- to 25-gauge Stimuplex (B. Braun) and ProBloc II (Life-Tech) needles ranked the highest in image clarity; among larger needles, Polymedic (Temena) and B. Braun needles had the most favorable clinical responses.
“The beauty of the study is that it’s the first study ever comparing the needles,” said Dr. Boddu. “And there is a huge range—some of the needles you can’t see anything and some of the needles you can see nice, bright structure.”
“The pictures are beautiful and the thing I really liked about this study was that it kind of opened my eyes to which are the best of the needles that we already have,” said Dr. Wallisch. He added that the study could also serve as a worthwhile reference to consult before approaching potentially difficult patients—such as those with altered anatomy or excessive adipose tissue—who may need to be stimulated as well.
For the moment, ultrasound-guided techniques for regional anesthesia are in transition, Dr. Boddu said. Many physicians new to ultrasound guidance prefer to have nerve stimulation technique as a backup, but the insulation that allows the needle to be stimulated is precisely what decreases a given needle’s echogenic properties.
Results of the study were presented at the annual meeting of the American Society of Regional Anesthesia and Pain Medicine.
Article written by staff at painmedicinenews.com and adapted for the purposes of this newsletter.
Making Waves: Biomedical Researcher Uses Ultrasound to Measure Early Response to Cancer Treatment
By comparing high-frequency ultrasound patterns before and after treatment, doctors can potentially know within days if a tumor is responding to a prescribed therapy...
A biomedical scientist at Ryerson University in Toronto, Canada is exploring how ultrasound and light can be used to measure the effectiveness of cancer treatment in the early stages of therapy. By comparing high-frequency ultrasound patterns before and after treatment, doctors can potentially know within days if a tumor is responding to a prescribed therapy.
“Currently, patients have to complete an entire course of radiation and/or chemotherapy treatments – possibly enduring the negative side effects – before they know if the treatment has been effective,” said Michael Kolios, a professor in the Ryerson Department of Physics. “With the use of high-frequency ultrasound doctors could determine a tumor’s response to therapy very early on in treatment. As a result, better-informed decisions can be made about the efficacy of treatment and whether to continue with the prescribed plan or develop a different one.”
Kolios, who recently received renewed funding for his Tier 2 Canada Research Chair in Biomedical Applications of Ultrasound, is focused on two areas of research: how ultrasound patterns can quickly determine if a treatment is effective; and researching how ultrasound can be applied as a therapy itself. This research, in collaboration with Gregory Czarnota, a Physics Professor at Ryerson and a researcher at Sunnybrook Health Sciences Centre, and Ryerson Physics Professor Carl Kumaradas, has several potential benefits: improving the quality of life for people suffering from a variety of diseases; supporting other research by offering fast feedback on the effectiveness of trial therapies; and possibly reducing the need for invasive procedures and surgeries.
“One of our goals is to explore how ultrasound technologies can be used in the fight against cancer,” said Kolios. “I’m hopeful that we can expand the practice and application of ultrasound to develop new, more accurate and lower-cost disease diagnosis and treatment monitoring techniques.”
Ryerson has the only physics department in Canada fully dedicated to medical physics, a specialized branch of applied physics that is at the forefront of advancements in the prevention, diagnosis and treatment of diseases such as cancer and heart disease through the use of physics and technology.
Article written by staff at newswise.com and adapted for the purposes of this newsletter.
Innovative Sound Device Could Bust Cancer Cells, Sharpen Ultrasound Clarity
A pair of researchers have developed a new tool that could be used to destroy cancer cell...
There are a number of interesting devices usually developed for the sole reason of fighting diseases like cancer. Many of them use nanoscale particles created from simple and metamaterials alike. Some worm their way directly into a cell to cause its destruction via outside influences, while others simply hook themselves to tumorous growths and bathe them with pharmaceuticals designed to destroy the diseased cells.
A pair of researchers -- one from the California Institute of Technology at Pasadena, the other from Graduate Aerospace Laboratories -- have developed a new tool that could be used to destroy cancer cells. Though the device uses metamaterial science, it involves no injections, drugs or otherwise invasive techniques.
The technology Alessandro Spadoni (GAL) and Chiara Daraio (CITP) have harnessed is a mixture of metamaterial science and sonic wave generation. Known as an acoustic lens, the device can be thought of as similar to an ultrasound scanning machine, but many times more focused and, if need be, many times more powerful.
What separates the machine from a standard sonic scope is the design of the lens itself. Spadoni and Daraio's lens is a metamaterial composed of an array of steel spheres, 21 tall and 21 deep. The array is what the device uses to focus normal sound waves into a solitary wave, which can be delivered with pinpoint accuracy up to a few centimeters deep into tissues. By changing the spacing between the steel spheres, they can control the pulse of the emitted waves, creating sound bullets or successive "pings" for sound/ultrasound scanners.
To imagine how the device works, picture 21 Newton's Cradles all stacked on top of each other. To produce the solitary wave, the top and bottom rows are compacted closely together while in the inner rows, the spheres hang slightly separated. To produce the wave, a high energy pulse is first sent through the upper and lower rows, followed by a delayed pulse going from the outer to inner rows. The high energy pulse of the outer rows hits the medium first, followed in succession by the lower energy pulse of the inner rows in something of a C shape. This staggered pulse from outside to inside focuses all the energy towards the center of the solitary wave now traveling through the medium.
The technology could be harnessed for sonically destroying diseased or dead tissues without harming the surrounding cells, breaking up the various stones that can form in organs in the body, or at much lower powers, as an easily focusable and highly mobile sounding wand for sonic scopes.
The duo's release, titled "Generation and control of sound bullets with a nonlinear acoustic lens," can be found at the Proceedings of the National Academy of Sciences website.
Article written by staff at dailytech.com and adapted for the purposes of this newsletter.
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