NAFLD Reduces Risk of DM Type 2

DENGUE FEVER and GB MOTOR FUNCTION TEST in US

LUS, HOW to AVOID MISTAKES.

How to avoid mistakes 
in Lung Ultrasound

This commentary provides an excellent review of the misconceptions and problems concerning the application of lung ultrasonography in critically ill patients. Lung ultrasound can have a significant clinical impact in acute care, if used in the appropriate way. (Chest)

ABVS distinguishes malignant from benign breast lesions.

By Kate Madden Yee, AuntMinnie.com staff writer

July 15, 2019 -- The automated breast volume scanner (ABVS) performs just as well as handheld ultrasound for distinguishing between malignant and benign breast lesions, according to a literature review published in the August issue of Ultrasound in Medicine and Biology.

The findings suggest that clinicians can trust ABVS as an alternative to handheld ultrasound -- which can be affected by user skill variability -- and that it shows promise as a breast imaging technique for both screening and diagnosis, wrote co-authors Dr. Liang Wang and Zhen-Hong Qi of Peking Union Medical College Hospital in Beijing.

"Conventional handheld ultrasound has several inherent limitations, including the operator dependence and the time required for whole-breast examination," they wrote (Ultrasound Med Biol, August 2019, Vol. 45:8, pp. 1874-1881). "In contrast, the automated breast volume scanner has several advantages over handheld ultrasound, such as higher reproducibility, less operator dependence, and less time required for image acquisition."

Most radiologists continue to use handheld ultrasound to characterize breast lesions identified on mammography or other screening modalities, and the diagnostic performance of ABVS is controversial, Wang and Qi noted. To better assess this, the two conducted a literature review of PubMed, Embase, and Cochrane Library databases.

Their research included nine studies with 1,985 lesions from 1,774 patients; of the lesions, 628 were malignant and 1,357 were benign. Wang and Qi evaluated the following performance measures for the two techniques: sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios.

Across all measures, ABVS performed comparably to handheld ultrasound for distinguishing benign from malignant breast lesions, the researchers found.

Comparison of handheld ultrasound and ABVS for distinguishing benign from malignant breast lesions
Performance measure	Handheld ultrasound	ABVS
Sensitivity	90.6%	90.8%
Specificity	81%	82.2%
Positive likelihood ratio	5.22	5.39
Negative likelihood ratio	0.11	0.10
Diagnostic odds ratio	52.60	61.68
Area under the receiver operating characteristic curve	0.94	0.93

"On the basis of our data, the ABVS and handheld ultrasound exhibited similar sensitivity and specificity in the differentiation of malignant and benign breast lesions," Wang and Qi wrote.

They cautioned that these results were based on grayscale ultrasound interpretation, meaning that only morphological features were displayed, rather than functional information that elastography and Doppler ultrasound offer.

"Both elastography and Doppler ultrasound can provide independent diagnostic information in addition to the grayscale imaging, which could significantly improve the diagnostic accuracy for breast ultrasound," they wrote.

But ABVS does have an advantage over handheld ultrasound that could make it a valuable tool in clinical practice: its ability to gather additional morphological information on the reconstructed coronal plane.

"The retraction phenomenon on the coronal plane of the ABVS is regarded as a highly diagnostic feature in the differentiation of benign and malignant breast lesions," the researchers wrote. "Therefore, it seems reasonable that the ABVS may be superior to handheld ultrasound in differential diagnosis with the help of coronal reconstruction."

TRUS and MRI in PROSTATE CANCER

US and Astronaut Spinal Anatomy and Disorders.

Abstract

Objectives

Back pain is one of the most common conditions of astronauts during spaceflight and is hypothesized to be attributed to pathologic anatomic changes. Ultrasound (US) represents the only available imaging modality on the International Space Station, but a formal US protocol for imaging the structures of the spinal column does not exist. This investigation developed a method of acquiring diagnostic‐quality images of the anterior lumbar and cervical regions of the spine during long‐duration spaceflight.

Methods

Comprehensive spinal US examinations were conducted on 7 long‐duration spaceflight astronauts before flight, in flight, and after flight and compared to preflight and postflight magnetic resonance imaging data. In‐flight scans were conducted after just‐in‐time training assisted by remote expert tele‐US guidance.

Results

Novice users were able to obtain diagnostic‐quality spinal images with a 92.5% success rate. Thirty‐three anomalous or pathologic findings were identified during the preflight US analysis, and at least 14 new findings or progressions were identified during the postflight US analysis. Common findings included disk desiccation, osteophytes, and qualitative changes in the intervertebral disk height and angle.

Conclusions

Ultrasound has proven efficacy as a portable and versatile diagnostic imaging modality under austere conditions. We demonstrated a potential role for US to evaluate spinal integrity and alterations in the extreme environment of space on the International Space Station. Further investigations should be performed to corroborate this imaging technique and to create a larger database related to in‐flight spinal conditions during long‐duration spaceflight.

Using LUNG US to diagnose Pediatric Pneumonia.

By Kate Madden Yee, AuntMinnie.com staff writer

June 28, 2019 -- Lung ultrasound is a viable alternative to chest x-ray and CT for diagnosing pneumonia in children -- with a sensitivity of 94% and a specificity of 92% -- but it is dependent on operator experience, according to a study published online June 18 in Academic Emergency Medicine.

Although using ultrasound to diagnose pneumonia in children appears to be effective, sonographer experience must be taken into account, wrote a team led by Dr. Po-Yang Tsou of Driscoll Children's Hospital in Corpus Christi, TX.

"To our knowledge, this is the first article demonstrating significant differences in lung ultrasound's diagnostic accuracy for pneumonia between novice and advanced sonographers," Tsou and colleagues wrote. "[Our] findings suggest that the sonographer's experience level should be considered when using lung ultrasound to diagnose pneumonia in children."

Difficult diagnosis

Pneumonia is a leading cause of death in children around the world, the authors noted. In developed countries, the annual incidence rate is 33 per 10,000 children 0 to 5 years of age, with a mortality rate of less than one per 1,000 children. But in developing countries, the condition is more serious with an annual incidence rate of 2,900 per 10,000 children age 0 to 5 and a mortality rate of 26 per 1,000 children.

To make matters worse, diagnosis of pediatric pneumonia can be challenging, in part due to the variation in signs and symptoms. The illness has typically been identified with chest x-ray and clinical presentation. Chest CT is also used and has excellent diagnostic accuracy, but its drawbacks include radiation exposure, high cost, and the possible need for sedation of pediatric patients.

Past studies have suggested that lung ultrasound may be a viable alternative to these modalities for pediatric pneumonia, but it has been unclear whether operator dependence affects its accuracy.

"Studies measuring the diagnostic accuracy of lung ultrasound for childhood pneumonia generally report excellent sensitivity and specificity," the group wrote. "However, ultrasound's accuracy varies by user skill and training."

The researchers conducted a review study to assess the diagnostic accuracy of the modality and compared performance between novice and experienced sonographers. The team searched PubMed and EMBASE from their inception to February 2018 for studies that evaluated the utility of lung ultrasound in children with suspected pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. The group also assessed diagnostic accuracy between novice (seven days or fewer of training) and advanced sonographers.

The analysis included 25 studies with a total of 3,389 patients presenting with pneumonia symptoms. Of these 25, 18 were prospective cohort studies, five were retrospective cohort studies, one was a randomized controlled trial, and one case was a control study. Subjects were mostly infants, children, and adolescents. Of the studies included in the research, 16 used advanced sonographers, seven used novice sonographers, and two used sonographers of unknown training level in lung ultrasound.

Lung ultrasound showed an overall sensitivity of 94%, specificity of 92%, and an area under the curve (AUC) of 0.97. However, the group did find a significant difference in diagnostic accuracy for pneumonia between less experienced and more experienced sonographers, with novice sonographers showing less sensitivity than their advanced counterparts.

Tsou and colleagues also found that point-of-care lung ultrasound performed better than exams conducted in the radiology department.

Comparison of sonographer experience and location for lung ultrasound
Performance measure	Novice sonographers	Advanced sonographers	All sonographers	Point-of-care lung ultrasound	Radiology department lung ultrasound
Sensitivity	80%	96%	94%	94%	91%
Specificity	96%	90%	92%	94%	86%
AUC	0.97	0.97	0.97	0.98	0.93

Not only does lung ultrasound show promise as a diagnostic tool for pediatric pneumonia, it also can be used to monitor disease progression without exposing children to radiation, costs less than more invasive tests, and may even decrease the length of stay in the emergency department.

Standardized curriculum

Novice sonographers included in this study had experience ranging from one hour to seven days of training. So what can be done to improve novice sonographers' ability to use lung ultrasound to diagnose pneumonia effectively? It comes down to instituting a standardized curriculum in the department, according to the research team.

"This study also importantly reveals the training of lung ultrasound impacts its diagnostic accuracy for pneumonia," the authors concluded. "[These] results indicate the need for a standardized curriculum, ideally consisting of a certain number of supervised scans and a post-test administered by ultrasound experts. ... Future studies are needed to standardize the curriculum for lung ultrasound training and determine the [number] of scans and duration of training required for a novice to achieve adequate proficiency in lung ultrasound."

ACUTE APPENDICITIS: CT and US