Ultrasound最新文献

Aim: Pelvic floor defaecatory dysfunction is traditionally investigated with defaecatory proctography, which examines rectocele, enterocele, intussusception and functional aspects including dyssynergy and completeness of evacuation. Integrated total pelvic floor ultrasound offers a means to investigate these anatomical features as well as muscle co-ordination and propulsion, without the requirement of rectal contrast expulsion on a commode. We explore patient preference for each procedure.

Method: A prospective study was taken of women who had undergone both defaecatory proctography and total pelvic floor ultrasound for defaecatory dysfunction (incomplete evacuation with or without concomitant faecal incontinence). Patients were given a preference questionnaire after each test, which was subsequently qualitatively analysed.

Results: A total of 247 patients underwent defaecatory proctography and total pelvic floor ultrasound with completed data sets for 224. Total pelvic floor ultrasound was preferred by 123 patients, 86 preferred defaecatory proctography and 15 had no preference. Scores for embarrassment, discomfort and anxiety were less for total pelvic floor ultrasound. There was no significant difference in mean pain scores for either test or in their ability to improve patient understanding of the underlying symptom aetiology. There was no significant difference in embarrassment scores between those with or without seepage of barium paste during defaecatory proctography, nor in cases of poor co-ordination or propulsion in either total pelvic floor ultrasound or defaecatory proctography.

Conclusion: More patients preferred total pelvic floor ultrasound due to less embarrassment, discomfort and the absence of oral contrast or rectal paste. This study offers insights into patient perspectives on pelvic floor investigations, serving as an important starting point for patient-centred clinical decision-making.

Introduction: Entrapment of the radial nerve proper can cause sensory and motor symptoms which can be challenging to clinically interpret and identify.

Method: A review of literature relating to radial nerve proper entrapment and the sonographic technique to image and assess the radial nerve proper was performed, and results were analysed and synthesised.

Findings: There are five main sites of potential radial nerve proper entrapment which sonographers can readily assess to exclude or identify the cause, site and degree of any neural involvement.

Discussion: Ultrasound of the radial nerve proper when used appropriately provides a fast, cost-effective method to image and assess the radial nerve proper and its surrounding structures and identify entrapment.

Conclusion: Real-time correlation of sonographic findings regarding the radial nerve proper and sensory symptoms with the sonographic Tinel test can help guide patient management and interventions such as local anaesthesia for pain relief or hydrodissection to free entrapped nerves from surrounding tissues.

Introduction: Distal biceps brachii tendon disorders predominantly result from repetitive use and eccentric loading. High-resolution ultrasound has emerged as a preferred diagnostic tool due to its dynamic imaging capabilities, accessibility, and cost-effectiveness.

Topic description: This paper introduces the Radial arc technique, a didactic and systematic ultrasound scanning method from a medial approach designed to facilitate the identification of the distal biceps brachii tendon insertion in the long-axis view. The technique is a five-step sonographic approach navigating sonographers and clinicians through a series of landmarks to address the often-complex sonographic examination of the distal biceps brachii tendon insertion. The paper also provides detailed anatomical insights into the biceps brachii muscle and the distal tendinous complex, highlighting key morphological features critical for accurate ultrasound interpretation.

Discussion: The proposed approach is tailored to support the educational development of undergraduate and postgraduate students specialising in musculoskeletal sonography and enhance the practical skills of early-career and experienced sonographers and clinicians utilising point-of-care ultrasound. The anatomical framework provided offers a deeper understanding of the distal biceps brachii tendinous complex, supporting diagnostic accuracy for distal biceps brachii tendon-related conditions that are critical for guiding patient management.

Conclusion: The systematic nature of the Radial arc technique aims to standardise practices not only in clinical settings but also in the design and execution of research studies involving the assessment of the distal biceps brachii tendon integrity with ultrasound. Future research should focus on assessing the reproducibility of the Radial arc technique in diverse clinical settings and among different practitioners and operators, crucial for its adoption in sonographic diagnostics.

Background: A departmental audit identified a case of adenomyosis which had not been reported, highlighting the need to assess whether the current service provision is adequate in identifying patients with (possible) adenomyosis and how improvements in this part of the service could be made.

Aim: To assess whether sonographers are effectively identifying and reporting adenomyosis on transvaginal ultrasound.

Methodology: A scoping review and retrospective service evaluation was undertaken which included (n = 79) adult female premenopausal patients with symptoms of adenomyosis who had undergone a transvaginal ultrasound scan during the first quarter of 2023. Patients were identified using the CRIS statistic module according to pre-defined inclusion and exclusion criteria. All data were anonymised and collated to include the patient age, referral information (symptoms), scan report and sonographer. The scan report and archived images were evaluated using the sonographic signs identified by the Morphological Uterus Sonographic Assessment group (Harmsen et al., 2022) and then compared to the original report.

Results: In total, 21.5% (n = 17) of patients had signs of adenomyosis on image review, but only 23.5% (n = 4) of these were reported as such. The majority (n = 8) of unidentified cases were reported as having a 'heterogeneous myometrium'. Inter-rater agreement ranged from 50% to 100%.

Conclusion: Most ultrasonic diagnoses of adenomyosis were not identified in our service which is likely due to a lack of internationally agreed criteria for ultrasound diagnosis of adenomyosis preventing adequate reporting.

Objectives: To implement a transvaginal ultrasound (TVUS) simulation to improve comfort with obstetric and gynaecologic ultrasound and increase knowledge in diagnosis and management of early pregnancy-related complications.

Methods: Third-year medical students enrolled in the Obstetrics and Gynaecology (OBGYN) clerkship between 2023 and 2024 participated in a didactic session and ultrasound simulation about aetiologies for vaginal bleeding in early pregnancy. They were guided through four different clinical scenarios of pelvic pathology including a non-pregnant uterine model representing a pregnancy of unknown location (PUL), ectopic pregnancy and normal first-trimester intrauterine pregnancy. Pre- and post-assessments were completed focused on knowledge and self-perceived confidence in evaluation and management of early pregnancy bleeding using TVUS.

Results: A total of 109 students completed the pre-assessment, and 104 completed the post-assessment. The mean pre-simulation knowledge score was 58%, and mean post-test knowledge score was 69%. We compared pre- and post-simulation percent correct which showed approximately a 11% increase in percent correct in the assessment after the didactic and ultrasound simulation (p-value < 0.05). Overall comfort in diagnosis of early pregnancy complications and TVUS skills significantly increased from an average Likert-type scale of 2 to 5 (p < 0.05).

Conclusion: TVUS simulation can be a helpful adjunct to learning important women's health topics and should be considered an important skill in training future physicians.

Purpose: The aim of this preclinical study was to test if the organic coating of two breast tissue clip markers (HydroMARK and UltraClip) can be sampled selectively by an ultrasound-guided core cut biopsy.

Methods: Ten clip markers of each type were inserted in four turkey breasts. Sonographic visibility was graded by the performing physicians. Core cut biopsy was performed, aiming to sample only the organic coating while leaving the clip marker in situ. Mammography, specimen radiography and gross inspection of the biopsy samples were conducted to evaluate dislocation or removal of the clips. The specimens were examined histopathologically to detect fragments of the coating material.

Results: HydroMARK was superior regarding biopsy feasibility and detectability of the coating. The organic coating of HydroMARK could be sampled selectively without dislocating the clip marker. Fragments of the coating material were visible macroscopically in 7 out of 10 biopsy specimens and could be detected in the histopathologic workup in 5 out of 10 specimens. The coating material of the UltraClip was not visible in any sample.

Conclusion: This study showed that the organic coating could be identified in core cut biopsy samples, both on a macroscopic and microscopic level. This could potentially be used to verify representativity of minimal invasive biopsies.

Background: Renal transplantation stands as the gold standard treatment for end-stage renal disease, offering improved quality of life and increased survival compared to dialysis. However, despite its advantages, renal allograft failure can occur, necessitating careful management to mitigate associated complications. Instances of liquefaction of the transplanted kidney are exceedingly rare, posing unique challenges to clinicians in the management of allograft failure. Existing literature highlights the complexities surrounding decisions regarding dialysis reinitiation, immunosuppression management, and the potential need for transplant nephrectomy in patients with failed renal allografts.

Case presentation: A 52-year-old Caucasian female with a complex medical history including stage 5 chronic kidney disease, non-ST-segment elevation myocardial infarction, hypertrophic cardiomyopathy with mild left ventricular systolic dysfunction, atrial fibrillation, and a history of cardiac arrest resulting in hypoxic brain injury, presented with a unique complication following renal transplantation. Imaging studies revealed complete breakdown and liquefaction of the transplanted kidney in the right iliac fossa. Despite interventions such as ultrasound-guided aspiration and drainage, the patient's condition continued to deteriorate.

Conclusion: This case highlights a rare occurrence of allograft liquefaction following renal transplantation, emphasising the need for vigilance in monitoring transplant recipients for uncommon complications. The management of such cases requires a multidisciplinary approach, considering factors such as dialysis reinitiation timing, immunosuppression management, and the potential need for transplant nephrectomy. Further research is warranted to elucidate the pathophysiology and optimal management strategies for unique complications such as allograft liquefaction, underscoring the importance of individualised treatment approaches in complex clinical scenarios.

Introduction: Sonographers are required to deliver unexpected news to expectant parents in real time during obstetric ultrasound scans. The complexity of these interactions requires sonographers to conduct the clinical task while communicating their findings and managing the expectant parent's response within the designated appointment time. Communication coaching for sonographers (CCS) is a tailored intervention that has previously been associated with improvements in confidence and news delivery practice. The current study explored the views and experiences of sonographers who completed CCS to evaluate and inform future delivery of this intervention.

Methods: Nine sonographers participated in semi-structured qualitative interviews after completing CCS. We analysed data using a Reflexive Thematic Analysis (RTA) approach.

Results: Participants reported CCS to be valuable and informative. The key themes identified included (1) innovating the path: tailored and novel training for sonographers, (2) humanising care: honouring the self, service-users and relevant others in the delivery of compassion-focused care and (3) making space: considerations for successfully delivering coaching. Participants said the coaching provided practical suggestions and was experienced as a 'safe space' for reflective practice that helped to enhance their capacity to identify and respond to emotion in others. There were practical challenges to taking part in CCS and organisational factors could act as a barrier; managerial championing of the intervention was crucial to uptake and completion.

Conclusions: Participants viewed CCS positively. To implement CCS, there needs to be organisational coordination. Further controlled studies will be needed to establish the effectiveness of CCS.

Aim: Growth Assessment Protocol is a fetal growth initiative designed to improve antenatal detection of babies who are small-for-gestational-age and reduce stillbirths. However, its direct impact on pregnancy outcome and stillbirth rates is questioned. This service evaluation aimed to assess Growth Assessment Protocol's influence on pregnancy outcomes at a National Health Service hospital.

Method: Anonymous, maternity and ultrasound data, routinely acquired between 2014 and 2022 were extracted from clinical databases (Viewpoint, Euroking). Trends in maternity data and ultrasound scan volume were explored with descriptive statistics. Variables of stillbirth, antenatal small-for-gestational-age detection and scan volume were compared before and after Growth Assessment Protocol implementation. Associations between these variables were evaluated using Spearman's rho.

Results: The percentage of babies born small-for-gestational-age reduced by 0.3% across the evaluation period. Antenatal small-for-gestational-age diagnosis rose from 4.1% to 14.3%. However, the number of false-positive cases of antenatally diagnosed small-for-gestational-age increased fivefold from 2.2% to 11.5%. Although stillbirth rates remained consistent post-Growth Assessment Protocol, complex scan volume (e.g. number of growth scans using Doppler) increased annually. The peak incline coincided with the Growth Assessment Protocol implementation period (2016-2018). Complex scan volume was significantly associated with overall small-for-gestational-age detection (rho = 0.8, p =< 0.001), but not with stillbirth frequency (rho = -0.1, p = 0.4).

Conclusion: Small-for-gestational-age detection increased following Growth Assessment Protocol implementation, although this was associated with a high false-positive rate and no reduction in stillbirths. The potential implications associated with clinical management, parent experiences and departmental workflow, alongside the benefits for stillbirth reduction, should be fully considered prior to the introduction of a new fetal growth initiative to the antenatal care pathway.