SoS for Breast Cancer

Speed of sound ultrasound (SoS)

Abstract

Objectives

To measure speed of sound (SoS) with a novel hand-held ultrasound technique as a quantitative indicator for muscle loss and fatty muscular degeneration.

Methods

Both calf muscles of 11 healthy, young females (mean age 29 years), and 10 elderly females (mean age 82 years) were prospectively examined with a standard ultrasound machine. A flat Plexiglas® reflector, on the opposite side of the probe with the calf in between, was used as timing reference for SoS (m/s) and ΔSoS (variation of SoS, m/s). Handgrip strength (kPA), Tegner activity scores, and 5-point comfort score (1 = comfortable to 5 = never again) were also assessed. Ultrasound parameters (muscle/adipose thickness, echo intensity) were measured for comparison.

Results

Both calves were assessed in less than two minutes. All measurements were successful. The elderly females showed significantly lower SoS (1516 m/s, SD17) compared to the young adults (1545 m/s, SD10; p < 0.01). The ΔSoS of elderly females was significantly higher (12.2 m/s, SD3.6) than for young females (6.4 m/s, SD1.5; p < 0.01). Significant correlations of SoS with hand grip strength (r = 0.644) and Tegner activity score (rs = 0.709) were found, of similar magnitude as the correlation of hand grip strength with Tegner activity score (rs = 0.794). The average comfort score of the elderly was 1.1 and for the young adults 1.4. SoS senior/young classification (AUC = 0.936) was superior to conventional US parameters.

Conclusions

There were significant differences of SoS and ΔSoS between young and elderly females. Measurements were fast and well tolerated. The novel technique shows potential for sarcopenia quantification using a standard ultrasound machine.

Key Points

• Speed of sound ultrasound: a novel technique to identify sarcopenia in seniors.

• Measurements were fast and well tolerated using a standard ultrasound machine.

• The novel technique shows potential for sarcopenia quantification.

Anatomy Lab Trends for 2019

And Now, a Word from Our Instructors: Anatomy Lab Trends for 2019

POSTED ON WED, MAR 13, 2019 @ 02:40 PM BY THE TEAM AT VISIBLE BODY

The results are in! We reached out to anatomy lab instructors across the U.S. and inquired about the tools they use and the challenges they face. We asked about current and future lab setups, trends in educational technology, and how (or if!) the money available and student enrollments were growing or shrinking.

Want to hear what more than 100 instructors of undergraduate and graduate anatomy labs have to say? Keep reading for a summary. You can also download the data to share with colleagues!

1. The State of Anatomy Lab Courses

Student engagement and procuring resources were the two biggest challenges faced by instructors.

“Students are not as prepared; lack of critical thinking skills and integrating what they are learning in lab to lecture; distracted by cell phones; would rather take pictures of slides and models and then leave.” — 2-year college anatomy professor

• 77% of instructors noted student engagement was a problem, with issues ranging from poor study skills to a lack of preparedness for class. 
  
• 71% cited the cost of lab materials as a challenge. Respondents reported that over the last three years, they’ve seen a decrease in the availability and quality of biological specimens. Fewer labs are using human cadavers because they are expensive and difficult to maintain, and animal specimens are becoming harder to acquire as well. 
  
• Some said that increasing enrollment means they need to find resources that can serve a larger number of students in an affordable way. 
  
• 16% of instructors reportedbudget decreases, most of which were due to funding cuts at the university or state level.

The dissection of biological specimens remains a central component of anatomy lab courses.

• 50% reported that students worked with prosections of human or animal organs.
• 37% conducted complete animal dissections.
• 28% of labs dissected human cadavers.

A 2-year college anatomy instructor reports "increased safety concerns when using cadavers for students and faculty. Movement away from dissections due to cost, upkeep and time needed for dissection.”

Synthetic models are also a staple in anatomy labs.

• Plastic and synthetic models are found in 56% of labs.

Tablets (such as iPads) are the most popular anatomy lab technology.

• Almost all instructors mentioned traditional classroom technology like monitors, screens, and projectors.
• By far the most popular newer technological tool in the lab was a tablet, like the iPad. 42% of anatomy instructors mentioned these are used in their labs.

2. The Future of Anatomy Lab Courses

62% of instructors surveyed were at a school with an online anatomy course or a school that will soon offer such a course.

Anatomy lab courses remain in high demand!

• 56% of instructors reported thatenrollments are steady and 38% reported that they are trending up.
• 55% noted that limits on lab space posed a challenge.
• 42% of instructors are already at a school that offers online anatomy courses, and another 20% see such courses on the horizon.

The use of virtual models in anatomy labs is growing.

A medical school lab instructor predicts they will see “more students in the lab and their increased reliance on anatomy sources from the internet as compared to text usage.”

•  39% of instructors reported that they used digital/virtual models.
• Many such models are available on tablets. In addition to the 42% who already used tablets, 17% of instructors said they would be adding them to their labs within the next three years.
• 11% currently utilize technologies like Anatomage tables, Sectra, or Virtual Reality headsets. 7% said they would soon be getting access to Sectra/Anatomage technologies, and 9% would be getting VR headsets

Video from ECR 2019: Erik Ranschaert on AI training

 Artificial IntelligenceSponsored by Philips

Video from ECR 2019: Erik Ranschaert on AI training

March 5, 2019 -- VIENNA - There's an urgent need for radiologists to become better informed about artificial intelligence (AI), according to Dr. Erik Ranschaert, PhD. He talks about his new book on AI and medical imaging and why it represents excellent value for the money, and he also outlines some future initiatives being organized by the European Society of Medical Imaging Informatics (EuSoMII), of which he is president.

Illumeo with adaptive intelligence, is reshaping imaging
This intelligent solution acts as an assistant, providing technologies and tools to enhance the radiologist’s expertise. Improving a radiologist’s interaction with images and enabling a rich and dynamic output for referring physicians can increase the value of the radiologist to the clinical care team.

Dr. Erik Ranschaert, PhD, from Tilburg, the Netherlands

The Earliest Timing Ultrasound can be Performed in the Screening for Developmental Dysplasia of the Hips (DDH)

Si Heng Sharon Tan, Keng Lin Wong, Andrew Kean Seng Lim and James HoiPo Hui Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore (Full postal address: 1E Kent Ridge Road, NUHS Tower Block, Level 11, Department of Orthopaedic Surgery, Singapore 119074)

 Abstract

  Purpose

 The current study aims to evaluate the results of ultrasound screening done at various weeks of life, to determine the earliest timing ultrasound screening can be performed reliably.

 Methods

 In the 17-year cohort study, all neonates who underwent ultrasound screening prior to the twelfth week of life  with subsequent follow-up radiograph done at one year of life were included. The ultrasound images were  evaluated according to Graf classification, Harcke's dynamic ultrasound screening and Terjesen's femoral head  coverage. The radiographic images were evaluated according to acetabular index and femoral head position. The  accuracy and correlation between the ultrasound findings performed at the various weeks of life with the  radiographic findings performed at one year of life were evaluated.

Results

 A total of 348 neonates were included. When the ultrasound findings were correlated with the radiographic  findings at one year of life, significant differences were identified for ultrasound screening performed prior to the fourth week of life (day 21 and before) (p < 0.05). In contrast, there were no significant differences  identified when the ultrasound was performed between the fourth and twelfth week of life (day 22 and beyond)  (p > 0.05). The accuracy of ultrasound screening was 79.2% and above when performed during or after the  fourth week of life (day 22 and beyond).

Conclusion

The earliest timing that ultrasound screening for DDH can be performed reliably is during the fourth week of life (day 22 and beyond).

COMBINATION of ADVANCED ULTRASOUND TECHNIQUES, DIAGNOSING for THYROID NODULES BETTER

By Kate Madden Yee, AuntMinnie.com staff writer

March 5, 2019 -- Using a combination of advanced ultrasound techniques improves the accuracy of the modality for diagnosing suspicious thyroid nodules compared with conventional ultrasound alone, according to a study published online March 1 in the International Journal of Clinical Oncology

Chinese researchers used a combination of superb microvascular imaging (SMI), real-time elastography (RTE), and conventional ultrasound to analyze the characteristics of thyroid nodules that could indicate malignancy, wrote a team led by Dr. Shufang Pei of Southern Medical University, Guangzhou, Guangdong.

"The ultrasonographic features of these thyroid nodules are complex, and the characteristics of conventional ultrasound images often overlap," the group wrote. "The conventional ultrasound features of some nodules were shown to be benign, and the pathology of the surgery was confirmed to be malignant; while the conventional ultrasound features of some nodules showed malignancy, and the pathology confirmed by surgery was benign. ... Therefore, it is particularly important to accurately diagnose benign and malignant nodules.

Pei and colleagues conducted a study that included 196 thyroid nodules classified as category 4 using the Thyroid Imaging Reporting and Data System (TI-RADS 4) -- first imaged on ultrasound alone, then with a combination of ultrasound, SMI, and RTE. The group compared the sensitivity, specificity, accuracy, false-negative rate, and false-positive rate of each ultrasound method; the gold standard was surgical pathology results.

Of the nodules imaged, 78 were benign and 118 were malignant. The researchers found that their combination technique improved the diagnostic accuracy of TI-RADS 4 nodules and also helped differentiate malignant from benign nodules.

Advanced ultrasound techniques vs. conventional ultrasound for thyroid nodules
Performance measure	Ultrasound alone	Superb microvascular imaging (SMI)	Real-time elastography (RTE)	Ultrasound + SMI and RTE
Sensitivity	65.3%	78%	80.5%	94%
Specificity	69.2%	93.6%	84.6%	87.2%
Accuracy	66.8%	84.2%	82.1%	91.3%
False-negative rate	34.8%	22%	19.5%	6.9%
False-positive rate	30.8%	6.4%	15.4%	12.8%

All results were statistically significant.

The sensitivity, specificity, and accuracy rates of SMI and RTE were higher than those for ultrasound alone. Additionally, the group found that RTE had a higher sensitivity than SMI but also a higher false-positive rate.

It was the combination of the three that was the winning ticket.

"The results of this study suggest that the application of RTE and SMI may help compensate in areas in which conventional ultrasound may be deficient in assessing the TI-RADS category 4 nodules," the group concluded. "Thus, multimodal ultrasound imaging -- using the three methods -- may provide more comprehensive information regarding the nodules, facilitating more accurate diagnoses."

BMD MEASUREMENT by ULTRASOUND

Transcranial sonography identifies Parkinson's earlier

By Kate Madden Yee, AuntMinnie.com staff writer

February 11, 2019 -- Transcranial sonography offers clinicians a viable way to diagnose Parkinson's disease, even before it manifests in clinical symptoms, according to a review published in the March issue of Ultrasound in Medicine and Biology.

...

Traditionally, CT and PET have been used to diagnose and monitor Parkinson's disease, but these exams can be invasive and expensive and may not always be available. But in 1995, researchers using transcranial sonography discovered that hyperechogenicity of the substantia nigra -- a midbrain basal ganglia structure -- appeared in 90% of Parkinson's patients compared with 10% of healthy patients. This finding suggested a new way to identify Parkinson's even before clinical symptoms manifest, wrote the team led by Dr. Anyu Tao of Huazhong University of Science and Technology in Wuhan, China (Ultrasound Med Biol, March 2019, Vol. 45:3, pp 628-641).

"Since the first description of substantia nigra hyperechogenicity in Parkinson's disease patients ... transcranial sonography has now been widely accepted for the assessment of Parkinson's disease," the group wrote.

Transcranial sonography's benefits include its low cost, wide availability, noninvasiveness, and repeatability, the researchers noted. But the technique does have limitations, such as operator dependence and insufficient temporal bone window, which can occur in 5% to 20% of patients.

Tao and colleagues sought to explore the diagnostic accuracy of transcranial ultrasound in the detection of Parkinson's disease by conducting a systematic review and meta-analysis of literature published in the past 10 years. The researchers searched PubMed, Embase, and Cochrane Library databases from their inception to 2018, using appropriate keywords; 39 studies that included 6,641 patients met their inclusion criteria.

From their analysis, the researchers found that transcranial sonography had a sensitivity of 84% and a specificity of 85% for detecting Parkinson's when substantia nigra hyperechogenicity was used as the reference standard for the disease. In addition, in a subgroup analysis, the modality had a sensitivity of 85% and a specificity of 89% in differentiating Parkinson's disease patients from normal controls. Finally, transcranial sonography had a sensitivity of 82% and a specificity of 74% when it came to distinguishing Parkinson's from other syndromes.

Because substantia nigra hyperechogenicity is detectable in the early stages of Parkinson's, identifying it using transcranial sonography could give clinicians and their patients more options for dealing with the disease, according to Tao's group.

"We believe that transcranial sonography imaging should be the initial noninvasive assessment method for the diagnosis of Parkinson's disease," the researchers concluded.

DCNN and Sonographic Images of THYROID CANCER

Summary

Background

The incidence of thyroid cancer is rising steadily because of overdiagnosis and overtreatment conferred by widespread use of sensitive imaging techniques for screening. This overall incidence growth is especially driven by increased diagnosis of indolent and well-differentiated papillary subtype and early-stage thyroid cancer, whereas the incidence of advanced-stage thyroid cancer has increased marginally. Thyroid ultrasound is frequently used to diagnose thyroid cancer. The aim of this study was to use deep convolutional neural network (DCNN) models to improve the diagnostic accuracy of thyroid cancer by analysing sonographic imaging data from clinical ultrasounds.

Methods

We did a retrospective, multicohort, diagnostic study using ultrasound images sets from three hospitals in China. We developed and trained the DCNN model on the training set, 131 731 ultrasound images from 17 627 patients with thyroid cancer and 180 668 images from 25 325 controls from the thyroid imaging database at Tianjin Cancer Hospital. Clinical diagnosis of the training set was made by 16 radiologists from Tianjin Cancer Hospital. Images from anatomical sites that were judged as not having cancer were excluded from the training set and only individuals with suspected thyroid cancer underwent pathological examination to confirm diagnosis. The model's diagnostic performance was validated in an internal validation set from Tianjin Cancer Hospital (8606 images from 1118 patients) and two external datasets in China (the Integrated Traditional Chinese and Western Medicine Hospital, Jilin, 741 images from 154 patients; and the Weihai Municipal Hospital, Shandong, 11 039 images from 1420 patients). All individuals with suspected thyroid cancer after clinical examination in the validation sets had pathological examination. We also compared the specificity and sensitivity of the DCNN model with the performance of six skilled thyroid ultrasound radiologists on the three validation sets.

Interpretation

The DCNN model showed similar sensitivity and improved specificity in identifying patients with thyroid cancer compared with a group of skilled radiologists. The improved technical performance of the DCNN model warrants further investigation as part of randomised clinical trials.

ASE offers TEE guidelines for congenital heart disease

By AuntMinnie.com staff writers

February 5, 2019 -- The American Society of Echocardiography (ASE) has published new guidelines for performing comprehensive transesophageal echocardiographic (TTE) exams in children and all patients with congenital heart disease (CHD).

Endorsed by over a dozen cardiology societies worldwide, the new document updates the ASE's previous recommendations published in 2005. It details TEE's technical considerations and imaging techniques, as well as the value the procedure can add to the management of specific congenital heart defects, according to the ASE. It also covers the use of TEE for guiding catheter-based interventions and discusses the need for specific training and educational pathways for performing TEE in children and CHD patients.

The guidelines were published in the February issue of the Journal of the American Society of Echocardiography, and they are also available on the ASE's website.

Proposed Uterus Imaging Reporting and Data System (UI-RADS).

The proposed Uterus Imaging Reporting and Data System (UI-RADS) could read something like the following:

·     UI-RADS 0: Need further imaging because of poor-quality study

·     UI-RADS 1: Normal uterus, no masses

·     UI-RADS 2: Uterine tumor present, benign (single tumor, < 5 cm, no necrosis, echogenicity consistent with benign fibroid)

·     UI-RADS 3: Uterine tumor(s) present, cannot be classified as most likely benign (multiple tumors, size 5-10 cm, no central necrosis, indeterminate echogenicity)

·     UI-RADS 4: Uterine tumors(s) present, concerning findings for malignancy (multiple tumors, size > 10 cm, < 10% central necrosis present, indeterminate echogenicity)

·     UI-RADS 5: Uterine tumor(s) present, most likely malignant (multiple tumors, size > 10 cm, > 10% central necrosis, echogenicity consistent with malignancy)

·     UI-RADS 6: Uterine tumor(s) present, previously established malignancy present

A woman's UI-RADS grade can then be assessed for its "concordance" with clinical and, potentially, pathological findings to determine the necessary clinical action.

Each of these classifications would lead to the following clinical actions by the gynecologist:

·     UI-RADS 0: Repeat imaging

·     UI-RADS 1: Routine screening

·     UI-RADS 2: Follow-up imaging at one year; if unchanged, proceed with routine imaging follow-up. If growing > 50% in one year, upgrade to UI-RADS 3. If clinical symptoms require myomectomy, perform with intraoperative biopsy to establish a reasonable assurance of benignity before surgically violating the uterine capsule. If clinical symptoms require total uterine resection, perform without tumor disruption.

·     UI-RADS 3: Follow-up imaging at six months and one year; if unchanged, proceed with routine imaging follow-up. A stable UI-RADS 3 downgrades to UI-RADS 2. If growing > 50% in one year, upgrade to UI-RADS 4. If clinical symptoms require myomectomy, perform with intraoperative biopsy to establish a reasonable assurance of benignity before surgically violating the uterine capsule. If clinical symptoms require total uterine resection, perform without tumor disruption.

·     UI-RADS 4: Establish clinical concordance (i.e., severe bleeding, anemia, pelvic pressure, dyspareunia, urinary frequency), measure LDH level, and perform abdominal CT or MRI. Perform screening chest CT. In "concordant" cases, proceed with an oncologically safe uterine resection as soon as possible, given the high likelihood of malignancy. If the woman is interested in maintaining her fertility, myomectomy can be considered only after tissue biopsy provides a reasonable assurance of benignity. In "discordant" cases, offer UI-RADS 4 patients an oncologically safe uterine resection or, if the patient prefers to maintain her uterus for family planning reasons, perform a biopsy to establish a reasonable assurance of benignity.

·     UI-RADS 5: Establish clinical concordance. Perform alternative imaging to better characterize the tumor(s). Perform a staging chest CT. Proceed to an oncologically safe uterine resection. Do not offer myomectomy.

·     UI-RADS 6: Patient under direct care of a gynecologic oncologist and medical oncologist.

UI-RADS ought to be a standardized risk assessment tool to help ob/gyn physicians generate a stringent screening scheme for uterine tumors, and to prevent the gynecological assumption of benignity about uterine tumors. It would rely on the establishment of routine uterine ultrasound screening in women, similar to the mammography paradigm. Of course, in clinically symptomatic women, the UI-RADS score would allow risk stratification and a more stringent and aggressive approach to diagnosing and resecting malignant tumors.

Given the incidence of malignancy in tumors of the uterine corpus, as delineated by the CDC, it is unacceptable for ob/gyn physicians to act only when the patient becomes symptomatic. Nor is it acceptable for physicians to simply assume that uterine tumors are benign -- especially when patients are symptomatic.

.....

Dr. Hooman Noorchashm, PhD, is a physician-scientist. He is an advocate for ethics, patient safety, and women's health. He and his six children live in Pennsylvania. This article was adapted from one published by the author on Medium.com.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.

...

Copyright © 2019 AuntMinnie.com
Last Updated np 2/1/2019 10:37:10 AM