Australasian Journal of Ultrasound in Medicine最新文献

The recent proliferation of point-of-care ultrasonography (POCUS) in the clinical practice of many medical specialties has exposed persistent barriers to education, training and standardisation. Specialist training curriculums are already overwhelming, having grossly insufficient time available for the specialist trainees and for the small number of available trainers alike to incorporate POCUS into postgraduate education. The logical solution to overcome these barriers could be to incorporate basic POCUS education and training into the undergraduate university curriculums, introducing longitudinal integration with other relevant medical sciences. The Australasian Society of Ultrasound in Medicine already has well-established educational programmes in POCUS with standardised assessment of competency, which could potentially offer the basis for symbiosis with the Australian and New Zealand medical schools.

Intussusception is typically considered an acute emergency; however, the increased utilisation of medical imaging has revealed that intussusceptions can also be transient, asymptomatic and possibly physiologic. Sonographers should be aware of three categories of intussusceptions: (i) persistent intussusceptions resulting in acute abdomen and requiring urgent intervention, (ii) transient symptomatic intussusceptions which may be amenable to a ‘wait-and-see’ strategy and (iii) transient asymptomatic intussusceptions which almost always involve the small bowel. In particular, the incidental discovery of enteroenteric intussusceptions in children should not be confused with acute pathology. In adults, sonographers should be mindful of the frequent presence of pathological lead points and further investigations may be warranted. In this literature review, we provide an overview of transient intussusceptions, highlight important differences between children and adults and describe sonographic appearances of various intussusceptions and their mimics.

POCUS, or point-of-care ultrasound, is everywhere and is not going away. Enthusiasts are plentiful as are detractors. Enthusiasts claim that POCUS augments clinical examination to expedite diagnosis, thus improving management. Detractors claim that POCUS is an inadequate substitute for comprehensive diagnostic ultrasound that leads to misdiagnosis. Both are true. This issue of AJUM is all about POCUS.

Wong et al.¹ present data on the role of focussed cardiac and lung ultrasound performed by a junior doctor as part of the pre-operative assessment in patients undergoing non-cardiac surgery. They found that the rate of pathology picked up rose from 28% based on clinical examination to 72% after the POCUS examination. Point-of-care ultrasound led to changes in patient management, predominantly in fluid administration. Interestingly, on retrospective review, there was poor agreement between the junior doctor and POCUS expert reviewer on the interpretation of haemodynamic status, which had guided these management changes. Point-of-care ultrasound will change management regardless of its accuracy, highlighting the importance of adequate training and quality assurance structures for novice users, particularly for identifying when image quality is too poor to allow meaningful interpretation.

Using ultrasound to augment clinical examination is an important part of POCUS, and Pettit et al.² present a study showing that, after brief training, medical students and junior doctors improved their diagnosis of elevated jugular venous pressure (JVP) using ultrasound and that ultrasound resulted in similar clinical estimations as experienced cardiologists using physical examination. This is an important clinical adjunct as novices often find the measurement of JVP difficult to do.

Expanding training opportunities to meet the demand from a growing pool of interested novice POCUS users is an ongoing challenge. Zhao et al.³ present a study where they employed both telemedicine and peer-assisted learning. After didactic lessons, a cohort of second-year medical students were randomised to 1:1 instruction from a peer (second-year medical students with an interest in POCUS) in person or through telemedicine. There was no difference in their ability, or improvement in ultrasound skills, whether the training was in person or not. They concluded that, to be effective, POCUS training may not need to be in person, nor delivered by experts.

In some areas, such as lung ultrasound, POCUS users have created a new application for diagnostic ultrasound and are leading the way into areas unexplored by traditional ultrasound. In this issue of AJUM, Zadeh et al.⁴ present a review and pictorial essay on the assessment of pneumonia using contrast-enhanced ultrasound and B-mode imaging, correlating lung ultrasound with CT. The portability a

Occasionally, patients ask me, ‘Why am I having this ultrasound examination done?’ Sometimes, I hear colleagues ask, ‘Does anyone really pay attention to my reports?’ And often, I am asked, ‘Can you scan this patient urgently, so we can discharge the patient today?’ The answer to all these questions is inevitably, ‘It depends’. A more nuanced reply to the question as to why the examination is being done might be, ‘To assist your doctor make decisions about your management’. As to whether the report is useful, ‘If you answered the clinical question and provided measurements and information that will help guide management it was useful’. And to the third question, the ubiquitous pre-discharge examination, my typical reply is almost always, ‘Do it as an outpatient, or if it's critical to your management decisions, keep them in and we will do it next week’. This always seems to happen on a Friday afternoon.

It should be obvious how every ultrasound examination we perform fits into clinical care, but this is not always explicitly stated either amongst ourselves, from our referring colleagues, or to our patients. And whilst some examples, such as using ultrasound to guide IV access, are clearly understandable to patients and clinicians alike, some are less obvious.

In this issue of AJUM, we present new research showing the added clinical benefit of ultrasound in different clinical specialities and scenarios. Clinical research undertaken in groups of patients, including audits, outcome studies, comparison of techniques, and measurement reliability provides the evidence base that informs both the practice of ultrasound and the implementation of ultrasound imaging into clinical management of individual patients. This issue of AJUM has several excellent examples of clinical research showing that measurements, and how they are obtained, play an important role in clinical management.

Using a retrospective clinical audit approach, Hill et al.¹ undertook an examination of their patient cohort referred for the investigation of abdominal aortic aneurysm. They compared their ultrasound measurements with those obtained on CT scanning, with particular focus on ultrasound measurement taken in three planes—transverse, sagittal and coronal diameters. Their main finding was that coronal diameter of the abdominal aorta measured in the decubitus window was best correlated with CT measurements.

Applying a comparison of techniques, Alfuraih et al.² compared the measurements of vastus lateralis, rectus femoris and vastus intermedius muscles by novice operators using a handheld ultrasound device (HUD) with the measurements made with a standard machine (also by the same novice) and found good agreement. As we transition to smaller devices, we expect a degradation in image quality based on transducer resolution and less processing capability, so it is reassuring that HUD measurements are c

Renal point-of-care ultrasound (POCUS) is an increasingly common initial imaging modality in the diagnostic workup of renal colic. The primary use of renal POCUS is to assess for hydronephrosis; however, other significant findings suggestive of malignancy can also be identified. We present three cases of unexpected findings identified initially on POCUS in the emergency department, which subsequently led to new diagnoses of malignancy. As renal POCUS becomes more frequently used in clinical practice, physicians must be able to recognise abnormal images that indicate possible malignancy and the need for further workup.