Journal of Ultrasound in Medicine最新文献

Author: Karen Nussbaumer, BS, RDMS, RVT, Academy of Diagnostic and Osteopathic Medicine (ADOM)

Objectives: This study explores the relationship between healthcare access, cancer incidence, and life expectancy across 60 countries. It aims to investigate whether greater access to healthcare—including radiative diagnostic tests (such as x-rays, CT scans) and treatments like chemotherapy—leads to lower cancer rates, or if healthcare access increases cancer risk and contributes to longer survival in high-access countries.

Methods: Cancer incidence and life expectancy data were collected from high-access countries such as Australia, the United States, and New Zealand and compared to low-access countries like Niger, Gambia, and Bhutan. The study analyzes cancer rates and the average age of death in relation to healthcare access, examining whether early detection and treatments lead to longer survival or if cancer rates are higher due to healthcare-related factors.

Results: In high-access countries such as Australia (life expectancy: 84.6 years), cancer rates are significantly higher, with 452.4 cases per 100,000 people. However, patients diagnosed with cancer often live longer, reaching their 60s to 70s, or in cases of less aggressive cancers, living into their 70s and 80s. Despite the availability of early detection and advanced treatments, healthcare access in these countries does not correlate with lower cancer rates; in fact, cancer incidence is higher in countries with more frequent use of diagnostics and treatments. In low-access countries like Niger (life expectancy: 61.5 years) and Gambia, cancer rates are lower, ranging around 78-82 cases per 100,000 people, yet other factors, such as poor living conditions and water quality, contribute to earlier mortality. Cancer patients in these regions tend to die in their 40s or 50s, but the lower cancer rates may also reflect limited diagnostic infrastructure.

Conclusions: This study suggests that access to healthcare does not decrease cancer rates and may even contribute to higher incidence in high-access countries. While patients in these countries often live longer, potentially without the benefit of early access, the frequent use of diagnostics and treatments may play a role in increased cancer rates. Meanwhile, in low-access countries, patients may die earlier from other health challenges unrelated to cancer. These findings call for a reassessment of the role healthcare access plays in cancer prevention and management, particularly in balancing the benefits of detection and treatment with potential risks.

Author: Jean-Eric Morice, PhD, Department gyneco obstetrique CHU Nord Marseille

Author: Nathalie Frandji, Maternité CHU Nord Marseille France

Author: Georges Haddad, Maternite CHU Tours

Author: Florence Bretelle, Maternité CHU La Timone Marseille France

Objectives: First trimester screening is quite often suspect of retrognatism, generating unnecessary fear. Mandibular articulation's distance is fixed by the skill, so chin position determines the angle between its branches. We wanted to know if an axial mandibular scan could help to discriminate severe ones, the more so only these are interesting to consider at this stage.

Methods: We determined systematically 100 mandibular branches angles for each first trimester screening and compared them with 5 severe retrognatism on profile scan.

Results: As we could expect sharp angle is found as if we had a “retrognatism impression”, between 60 and 70 degrees. In all cases when a severe retrognatism was suspected, thanks to this scan, we could confirm it: the angle couldn’t be measured but there was a mandibular staple form.

Conclusions: As expected and unusual form in staple form of the mandibula confirm a severe retrognatism, the only ones interesting to consider at the first trimester. Much more often when there is a doubt on the profile, a sharp mandibular angle is very helpful to infirm severe retrognatism and avoid fear. We think a regular practice of this mandibular measurement interesting to detect more easily severe forms of retrognatism.

Author: Nin-Chieh Hsu, National Taiwan University Hospital

Author: Hung-Bin Tsai

Objectives: The primary focus of point-of-care ultrasound (POCUS) examinations is on addressing specific clinical problems and scenarios. However, the potential role of routine screening using POCUS in selected populations remains underexplored.

Methods: This prospective observational study seeks to evaluate the effectiveness of point-of-care ultrasound (POCUS) in acute inpatient settings through the implementation of a predefined Admission POCUS Examination (APEX) protocol. The APEX protocol encompasses a systematic assessment of the inferior vena cava (IVC), pericardial effusion, ascites, hydronephrosis, pleural effusion, and bladder volume, with the objective of identifying previously undiagnosed pathologies and facilitating early medical interventions. The examinations were performed within 24 hours of admission by four trained and certified nurse practitioners, under the supervision of a gastroenterologist and three hospitalists.

Results: A total of 134 admitted patients were included from two hospital medicine wards, with an average age of 73 ± 14 years, a mean hospital stay of 22 ± 18 days, and an average APACHE II score of 14 ± 6. Abnormal findings were remarkable for 69 patients (51.4%) in IVC, 20 (14.9%) with hydronephrosis, 14 (10.4%) with pericardial effusion, 12 (8.9%) with ascites, 9 (6.7%) with pleural effusion. The APEX protocol led to unanticipated medical decisions in 94 patients (70.1%), including fluid status management in 54 (57.4%), hydronephrosis management in 14 (14.9%), and pericardial effusion assessment and management in 11 (11.7%).

Conclusions: The APEX protocol, particularly the assessment of the IVC, provides a personalized approach for acutely ill patients, potentially enhancing patient safety and outcomes. This study highlights the potential role of POCUS examinations in unselected patients within relevant inpatient settings.

Author: Tiffany Yang, MD

Author: Hannah Agoglia, BS

Author: Megan Reinhard, MD

Author: David Garry, DO

Author: Cassandra Heiselman, DO, MPH

Objectives: This study aims to show whether nuchal translucency (NT) thickness measured by ultrasound between 11 and 14 weeks gestation is an effective screening marker of abnormal cell free DNA on non-invasive prenatal testing.

Methods: This was a retrospective review of adult pregnant patients who received ultrasound screening between 11 and 14 weeks gestation between January 2015 and July 2023 who had a NT measurement ≥ 2.5 mm. An ROC curve was created to select the ideal cut-off value in prediction of abnormal cell free DNA results. Using coordinates and Youden's Index, 3.55 mm was identified as the cut off for abnormal cell free DNA screening with a sensitivity 73.6%, specificity 53.6%, and an AUC 0.652 [0.570-0.735] (p < 0.001). Patients were then stratified with 140 (60%) patients with NT ≥ 3.55 mm and 93 (40%) with NT < 3.55 mm. Patient information and outcomes were extracted and Chi-squared, and Mann-Whitney U test analysis were performed.

Results: Groups were similar in age, insurance status, race, parity, maternal co-morbidities, and pregnancy-induced hypertension. Patients with an NT ≥ 3.55 mm were more likely to use tobacco products (7% v 0%, p = 0.01) and have a lower BMI (26 v 28, p = 0.02). Patients with an NT ≥ 3.55 mm were more likely to have abnormal cell free DNA screening compared to an NT < 3.55 mm (47% v 23%, p < 0.001). Patients with an NT ≥ 3.55 mm were more likely have structural anomalies (59% v 32%, p < 0.01); however, incidence of cardiac malformations was similar. Those with an NT ≥ 3.55 mm was more likely to have invasive testing performed (54% v 31%, p < 0.01). Results with abnormal karyotypes similar across groups (56 v 54%, p = 1.00); however, the NT < 3.55 mm group was more likely to have abnormal microarray (58% v 32%, p = 0.05). Birth outcomes including gestational age at delivery, birth weight, Apgar scores, NICU admission, and postpartum hemorrhage were similar across groups.

Conclusions: Patients with NT measurement greater than or equal to 3.5 mm on ultrasound between 11-14 weeks gestation were more likely to have positive screening cell-free DNA results, as well as structural anomalies.

Author: Karen Nussbaumer, BS, RDMS, RVT, Academy of Diagnostic and Osteopathic Medicine (ADOM)

Author: Brittany Harrison, BS, RDMS, RVT, RDCS

Objectives: This study introduces a new, simplified method for performing an ultrasound of the pancreas. The goal is to provide a more accessible and efficient approach to pancreatic imaging, improving routine assessments while minimizing complexity and enhancing patient comfort.

Methods: The new technique modifies patient positioning and probe angles to optimize visualization of the pancreas, particularly in challenging cases. It focuses on practical adjustments during standard ultrasound procedures, ensuring clearer images of the pancreatic head, body, and tail. This method will be compared to existing ultrasound techniques to assess improvements in image quality and diagnostic efficiency.

Results: Preliminary results suggest that this new approach enhances visualization of the pancreas without requiring additional equipment or advanced techniques. It provides clearer images of the organ and surrounding structures, allowing for better routine assessment of pancreatic health.

Conclusions: This simplified method for performing pancreatic ultrasounds offers a more effective and patient-friendly alternative to traditional approaches. The technique has the potential to become a standard practice in routine pancreatic evaluations, providing clearer imaging results without added complexity.