Pub Date : 2024-02-01DOI: 10.1177/1742271X231223558
Colin P Griffin
{"title":"Editorial.","authors":"Colin P Griffin","doi":"10.1177/1742271X231223558","DOIUrl":"https://doi.org/10.1177/1742271X231223558","url":null,"abstract":"","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"32 1","pages":"3"},"PeriodicalIF":0.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.1177/1742271x231215501
Samantha Thomas, Anna Erenbourg, Melissa Chang, A. G. D. M. T. Ferreira, Gordon Stevenson, Alec Welsh
Novel ultrasound technology and software processing allow offline evaluation of tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements. We wished to compare both novel 4D matrix (eM6C) and conventional (RAB6-D) transducers with variable settings (electronic spatiotemporal image correlation, spatiotemporal image correlation and four-dimensional real time) to determine if there was a significant difference in absolute value, quality and repeatability of the resultant reconstructed image and M-mode trace. A blinded prospective cross-sectional study of normal fetuses from 23 to 38 weeks’ gestation were recruited. After routine sonography, four-dimensional volumes were stored and analysed using GE 4DView™ software. Statistical analysis explored variability, correlations and repeatability of the measurements with chi-square analysis, intraclass correlations and the Bland–Altman comparison plots. A scoring system was devised for image quality. Eighteen participants generated 282 data volumes. Absolute values demonstrated some inconsistencies for both tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements with variations between transducers: the highest for the RAB6-D/spatiotemporal image correlation setting and the lowest for the four-dimensional real-time settings. The RAB6-D/spatiotemporal image correlation setting was the most repeatable combination (intraclass correlation coefficient = 0.85). Poorest image quality (M-mode trace, four-chamber view, annuli) came from the RAB6-D/four-dimensional real-time combination with the eM6C/electronic spatiotemporal image correlation and RAB6-D/spatiotemporal image correlation settings being nearly identical. We show that transducer and setting combinations influence absolute tricuspid annular plane systolic excursion/mitral annular plane systolic excursion measurements, so need to be articulated in future research. The transducer setting (electronic spatiotemporal image correlation/spatiotemporal image correlation/four-dimensional real time) was a more significant factor than the type of transducer (conventional vs matrix). Subjective image evaluation does not correlate well with repeatability of image acquisition. Further studies are needed to compare measurements using four-dimensional post-processing tools against conventional real-time measurements.
通过新型超声技术和软件处理，可以离线评估三尖瓣瓣环平面收缩期偏移和二尖瓣瓣环平面收缩期偏移测量值。我们希望比较新型四维矩阵（eM6C）和传统（RAB6-D）换能器的不同设置（电子时空图像相关性、时空图像相关性和四维实时性），以确定重建图像和 M 型轨迹的绝对值、质量和可重复性是否存在显著差异。一项盲法前瞻性横断面研究招募了妊娠 23 至 38 周的正常胎儿。常规超声造影后，使用 GE 4DView™ 软件储存和分析四维容积。统计分析通过秩方分析、类内相关性和布兰-阿尔特曼对比图探讨了测量的变异性、相关性和重复性。还设计了一套图像质量评分系统。18 名参与者生成了 282 个数据量。三尖瓣瓣环面收缩期偏移和二尖瓣瓣环面收缩期偏移测量的绝对值显示出一些不一致性，不同传感器之间存在差异：RAB6-D/时相图像相关设置的绝对值最高，四维实时设置的绝对值最低。RAB6-D/spatiotemporal 图像相关设置是重复性最高的组合（类内相关系数 = 0.85）。RAB6-D/四维实时组合的图像质量最差（M 型轨迹、四腔切面、环形），而 eM6C/电子时空图像相关和 RAB6-D/ 时空图像相关设置几乎相同。我们发现，换能器和设置组合会影响三尖瓣环面收缩期绝对偏移/半月环面收缩期绝对偏移的测量，因此需要在今后的研究中加以阐明。换能器设置（电子时空图像相关/时空图像相关/四维实时）是比换能器类型（传统与矩阵）更重要的因素。主观图像评价与图像采集的可重复性没有很好的相关性。还需要进一步研究，将使用四维后处理工具进行的测量与传统的实时测量进行比较。
{"title":"Does matrix transducer technology improve quality and repeatability of four-dimensional tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements?","authors":"Samantha Thomas, Anna Erenbourg, Melissa Chang, A. G. D. M. T. Ferreira, Gordon Stevenson, Alec Welsh","doi":"10.1177/1742271x231215501","DOIUrl":"https://doi.org/10.1177/1742271x231215501","url":null,"abstract":"Novel ultrasound technology and software processing allow offline evaluation of tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements. We wished to compare both novel 4D matrix (eM6C) and conventional (RAB6-D) transducers with variable settings (electronic spatiotemporal image correlation, spatiotemporal image correlation and four-dimensional real time) to determine if there was a significant difference in absolute value, quality and repeatability of the resultant reconstructed image and M-mode trace. A blinded prospective cross-sectional study of normal fetuses from 23 to 38 weeks’ gestation were recruited. After routine sonography, four-dimensional volumes were stored and analysed using GE 4DView™ software. Statistical analysis explored variability, correlations and repeatability of the measurements with chi-square analysis, intraclass correlations and the Bland–Altman comparison plots. A scoring system was devised for image quality. Eighteen participants generated 282 data volumes. Absolute values demonstrated some inconsistencies for both tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements with variations between transducers: the highest for the RAB6-D/spatiotemporal image correlation setting and the lowest for the four-dimensional real-time settings. The RAB6-D/spatiotemporal image correlation setting was the most repeatable combination (intraclass correlation coefficient = 0.85). Poorest image quality (M-mode trace, four-chamber view, annuli) came from the RAB6-D/four-dimensional real-time combination with the eM6C/electronic spatiotemporal image correlation and RAB6-D/spatiotemporal image correlation settings being nearly identical. We show that transducer and setting combinations influence absolute tricuspid annular plane systolic excursion/mitral annular plane systolic excursion measurements, so need to be articulated in future research. The transducer setting (electronic spatiotemporal image correlation/spatiotemporal image correlation/four-dimensional real time) was a more significant factor than the type of transducer (conventional vs matrix). Subjective image evaluation does not correlate well with repeatability of image acquisition. Further studies are needed to compare measurements using four-dimensional post-processing tools against conventional real-time measurements.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"51 37","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28DOI: 10.1177/1742271x231215716
Michelle Fenech
The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton’s neuroma and intermetatarsal bursitis can be challenging. A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton’s neuroma and/or intermetatarsal bursitis when present to guide patient management.
{"title":"Sonographic anatomy and technique to image the plantar digital nerves and aid identification of a Morton’s neuroma","authors":"Michelle Fenech","doi":"10.1177/1742271x231215716","DOIUrl":"https://doi.org/10.1177/1742271x231215716","url":null,"abstract":"The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton’s neuroma and intermetatarsal bursitis can be challenging. A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton’s neuroma and/or intermetatarsal bursitis when present to guide patient management.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"66 3","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28DOI: 10.1177/1742271x231215500
Nabil Rtam
The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2–5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author’s department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss’ kappa and Gwet-AC1. The operators’ accuracy was measured against the most experienced operator in the department using Cohen’s kappa and percentage agreement. Fair agreement (Fleiss’ K = 0.21) was obtained between the participants when U-scoring (U2–5). Fair-to-moderate agreement was noted between sonographers ( K = 0.40). Significant variability was demonstrated between radiologists ( p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists’ AC1 = 0.34, sonographers’ AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity ( K = 0.29), composition ( K = 0.33), shape ( K = 0.58), margin ( K = 0.45), halo ( K = 0.34) and vascularity ( K = 0.44). Accuracy reached fair agreement (mean Cohen’s K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study.
英国甲状腺协会超声分级是一种风险分层模型，根据甲状腺结节的声像图外观将其分为U2-5级。有文献报道，超声操作人员在进行 U 级评分时存在差异，作者所在科室也发现了一些证据。本研究的目的是调查该科室是否存在明显的分歧，并找出产生差异的潜在原因。研究人员招募了八名操作员，包括放射科医生和超声技师，对 33 例 TN 进行评分，并使用英国甲状腺协会词典回答打勾问卷。使用 Fleiss' kappa 和 Gwet-AC1 评估了操作员之间在 U 分类、细针穿刺活检指征和超声特征方面的差异性。使用 Cohen's kappa 和一致性百分比来衡量操作员与科室内最有经验的操作员之间的准确性。在进行 U 评分（U2-5）时，参与者之间的一致性尚可（Fleiss' K = 0.21）。超声技师之间的一致性为中等偏上（K = 0.40）。放射医师之间存在显著差异（P > 0.05）。细针穿刺活检的适应症达到相当到基本一致（放射医师的 AC1 = 0.34，超声技师的 AC1 = 0.58，总体 AC1 = 0.41）。在回声(K = 0.29)、成分(K = 0.33)、形状(K = 0.58)、边缘(K = 0.45)、光晕(K = 0.34)和血管(K = 0.44)方面均无明显差异。U类和细针穿刺活检的准确性分别达到了相当一致（平均Cohen's K = 0.29）和中等一致（平均AC1 = 0.53）。放射医师的准确性较低。该科室所有操作人员之间在 U 评分或建议进行细针穿刺活检方面没有明显的评分者间差异。放射科医生在 U 值评分方面存在明显差异，准确性较低。通过解决本研究发现的问题类别和特征，可以提高可靠性和准确性。
{"title":"Evaluation of the departmental inter-rater reliability when scoring thyroid nodules according to the British Thyroid Association Ultrasound-classification model: Is there significant disagreement?","authors":"Nabil Rtam","doi":"10.1177/1742271x231215500","DOIUrl":"https://doi.org/10.1177/1742271x231215500","url":null,"abstract":"The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2–5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author’s department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss’ kappa and Gwet-AC1. The operators’ accuracy was measured against the most experienced operator in the department using Cohen’s kappa and percentage agreement. Fair agreement (Fleiss’ K = 0.21) was obtained between the participants when U-scoring (U2–5). Fair-to-moderate agreement was noted between sonographers ( K = 0.40). Significant variability was demonstrated between radiologists ( p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists’ AC1 = 0.34, sonographers’ AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity ( K = 0.29), composition ( K = 0.33), shape ( K = 0.58), margin ( K = 0.45), halo ( K = 0.34) and vascularity ( K = 0.44). Accuracy reached fair agreement (mean Cohen’s K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"12 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-01-28DOI: 10.1177/1742271X221147860
Essie Kaur, Jane Arezina, Louise Bryant, Kathryn I Pollak, Gill Harrison, Ruth Bender Atik, Jen Coates, Natasha K Hardicre, Roxanne Sicklen, Karen Horwood, Teresa Lardner, Jon Arnold, Rebecca Wallace, Judith Johnson
Introduction: Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers.
Methods: Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years).
Results: Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques.
Conclusions: Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary.
{"title":"Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study.","authors":"Essie Kaur, Jane Arezina, Louise Bryant, Kathryn I Pollak, Gill Harrison, Ruth Bender Atik, Jen Coates, Natasha K Hardicre, Roxanne Sicklen, Karen Horwood, Teresa Lardner, Jon Arnold, Rebecca Wallace, Judith Johnson","doi":"10.1177/1742271X221147860","DOIUrl":"https://doi.org/10.1177/1742271X221147860","url":null,"abstract":"<p><strong>Introduction: </strong>Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years).</p><p><strong>Results: </strong>Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques.</p><p><strong>Conclusions: </strong>Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary.</p>","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"31 4","pages":"273-283"},"PeriodicalIF":0.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1177/1742271X231203825
Colin P Griffin
{"title":"Editorial.","authors":"Colin P Griffin","doi":"10.1177/1742271X231203825","DOIUrl":"10.1177/1742271X231203825","url":null,"abstract":"","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"31 4","pages":"243"},"PeriodicalIF":0.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.1177/1742271x231195741
Richard Cahanin, Andre Fallavollita, Troy Burley, Samuel McQuiston
Purpose: To determine and compare the reliability and efficiency of various methods of leg-length measurement. Methods: A total of 88 leg-lengths were measured among 50 subjects (79%–84% female, mean age = 30–33 years). Leg-lengths were measured in both supine and standing positions using multiple devices, including a tape measure, a LASER distance meter, and diagnostic ultrasound. Results: All methods of leg-length measurement using the middle of the femoral head as a reference point, identified via ultrasound, demonstrated excellent reliability (intraclass correlation coefficient = 0.95–1.00). Measurements performed in supine, using the anterior superior iliac spine as a reference point, with a tape measure, demonstrated good-to-excellent reliability (intraclass correlation coefficient = 0.86–0.95, standard error of the measurement = 16.1–19.9 cm). Standing measurements using the anterior superior iliac spine as a reference point, using a tape measure, demonstrated fair-to-excellent reliability (intraclass correlation coefficient = 0.71–0.95). Conclusion: Ultrasound-guided landmark identification appear to be a more reliable method compared to palpation of the anterior superior iliac spine for measurement of leg-length using clinical tools. When coupled with ultrasound guidance, a hand-held LASER distance meter/pitch locator apparatus or a retractable tape measure appears to be acceptable alternatives to a fixed LASER distance meter on a linear actuator for leg-length measurement.
{"title":"The reliability of clinical tools with and without ultrasound guidance to measure leg-length inequality","authors":"Richard Cahanin, Andre Fallavollita, Troy Burley, Samuel McQuiston","doi":"10.1177/1742271x231195741","DOIUrl":"https://doi.org/10.1177/1742271x231195741","url":null,"abstract":"Purpose: To determine and compare the reliability and efficiency of various methods of leg-length measurement. Methods: A total of 88 leg-lengths were measured among 50 subjects (79%–84% female, mean age = 30–33 years). Leg-lengths were measured in both supine and standing positions using multiple devices, including a tape measure, a LASER distance meter, and diagnostic ultrasound. Results: All methods of leg-length measurement using the middle of the femoral head as a reference point, identified via ultrasound, demonstrated excellent reliability (intraclass correlation coefficient = 0.95–1.00). Measurements performed in supine, using the anterior superior iliac spine as a reference point, with a tape measure, demonstrated good-to-excellent reliability (intraclass correlation coefficient = 0.86–0.95, standard error of the measurement = 16.1–19.9 cm). Standing measurements using the anterior superior iliac spine as a reference point, using a tape measure, demonstrated fair-to-excellent reliability (intraclass correlation coefficient = 0.71–0.95). Conclusion: Ultrasound-guided landmark identification appear to be a more reliable method compared to palpation of the anterior superior iliac spine for measurement of leg-length using clinical tools. When coupled with ultrasound guidance, a hand-held LASER distance meter/pitch locator apparatus or a retractable tape measure appears to be acceptable alternatives to a fixed LASER distance meter on a linear actuator for leg-length measurement.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report: A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion: The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion: Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients.
{"title":"Ultrasound and computed tomography findings of hepatic portal venous gas associated with acute appendicitis in a paediatric patient: A case report","authors":"Takashi Furuta, Mayu Fujiwara, Takahiro Motonaga, Hironori Matsufuji, Hiroshi Tateishi, Soichi Nakada, Tsutomu Kanagawa, Masashi Uchida","doi":"10.1177/1742271x231195752","DOIUrl":"https://doi.org/10.1177/1742271x231195752","url":null,"abstract":"Introduction: Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report: A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion: The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion: Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134957673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: This study investigated the depth-related bias and the influence of scan plane angle on performance of point-shear-wave elastometry in a chronic hepatitis C patient cohort. Materials and Methods: We included 104 patients affected by chronic liver disease related to the hepatitis C virus. Liver surface nodularity was the reference to diagnose cirrhosis. The ultrasound platform was the Siemens S2000, equipped with point-shear-wave elastometry software. Measurements were obtained in left lateral decubitus from the liver surface to the maximum depth of 8 cm in two orthogonal scan planes according to a standard sampling plane. Scatterplot and box plots explored the depth-related bias graphically. The area under the receiver operating characteristic was used to determine the point-shear-wave elastometry diagnostic performance at progressive depths according to liver surface nodularity. Results: Of the 104 patients, 68 were cirrhotics. Depth-related bias equally modified point-shear-wave elastometry in the two orthogonal scan planes. A better point-shear-wave elastometry diagnostic performance was observed between depths of 4 and 5 cm. The frontal scan plane assured better discrimination between cirrhotic patients and non-cirrhotic patients. Conclusion: Depth is crucial for point-shear-wave elastometry performance. Excellent diagnostic performance at a depth between 4 and 5 cm can also be obtained with a smaller number of measurements than previously recommended.
{"title":"Depth effect on point shear wave velocity elastography: Evidence in a chronic hepatitis C patient cohort","authors":"Leonardo Rizzo, Luca L’Abbate, Massimo Attanasio, Arturo Montineri, Salvatore Magliocco, Vincenza Calvaruso","doi":"10.1177/1742271x231183370","DOIUrl":"https://doi.org/10.1177/1742271x231183370","url":null,"abstract":"Background and Aims: This study investigated the depth-related bias and the influence of scan plane angle on performance of point-shear-wave elastometry in a chronic hepatitis C patient cohort. Materials and Methods: We included 104 patients affected by chronic liver disease related to the hepatitis C virus. Liver surface nodularity was the reference to diagnose cirrhosis. The ultrasound platform was the Siemens S2000, equipped with point-shear-wave elastometry software. Measurements were obtained in left lateral decubitus from the liver surface to the maximum depth of 8 cm in two orthogonal scan planes according to a standard sampling plane. Scatterplot and box plots explored the depth-related bias graphically. The area under the receiver operating characteristic was used to determine the point-shear-wave elastometry diagnostic performance at progressive depths according to liver surface nodularity. Results: Of the 104 patients, 68 were cirrhotics. Depth-related bias equally modified point-shear-wave elastometry in the two orthogonal scan planes. A better point-shear-wave elastometry diagnostic performance was observed between depths of 4 and 5 cm. The frontal scan plane assured better discrimination between cirrhotic patients and non-cirrhotic patients. Conclusion: Depth is crucial for point-shear-wave elastometry performance. Excellent diagnostic performance at a depth between 4 and 5 cm can also be obtained with a smaller number of measurements than previously recommended.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135397063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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