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Introduction Musculoskeletal diagnostic ultrasound is an expanding clinical tool and increasingly used at point of care in clinical practice. Criticism around the accuracy of this modality is often attributed to operator dependence. This study evaluated the accuracy of a sonographer’s reporting against shoulder surgery. Methods A musculoskeletal sonographer performed same-day ultrasound scans prior to elective shoulder surgery procedures. The sonographer was blinded to clinical history and previous investigations. A brief physical examination of resisted external rotation and resisted abduction strength was performed prior to scanning. Scan results were reported using British Elbow and Shoulder Society (BESS) reporting criteria. The sonographer attended surgery to gain immediate visual feedback. Sonographic reports and magnetic resonance imaging (MRI) reports were graded (1= complete agreement; 2 = minor discrepancy unlikely to alter patient care; 3 = potentially significant discrepancy; 4 = definite, significant discrepancy) against surgical findings. The accuracy of sonographic reporting was correlated with patients’ body mass index (BMI). Results Fifty-four cases were compared and correlations evaluated. Grade 1 (complete agreement) was reported 87.0% ( n = 47), Grade 2 (minor discrepancy) 9.3% (n = 5) and Grade 3 (potentially significant discrepancy) 3.7% (n = 2). Sonographic reports closely correlated (Grade 1 or 2 scores) with surgical findings in 96% of cases. Conclusions The musculoskeletal sonographic reporting had a high correlation with surgery findings. Ultrasound was more accurate than MRI in reporting full thickness rotator cuff tears. Clinical weakness in resisted external rotation or abduction did not correlate with imaging. Ultrasound was found to be unreliable in detecting rotator cuff tears in participants with a BMI ≥ 35.

Background The use of multiparametric magnetic resonance imaging (mpMRI) within active surveillance of prostate cancer programmes is identified by the UK National Institute for Health and Care Excellence (NICE guideline NG 131 2019) as having a role for monitoring disease. The widespread demands on mpMRI capacity may limit its use in surveillance. It is therefore timely to review the options that modern ultrasound imaging present to this cohort of patients in the monitoring of prostate cancer. Methods Between April and September 2020, 10 databases were searched to recruit studies for the review. Three reviewers evaluated the publications for inclusion. Characteristics including the inclusion criteria for the study cohort, how disease was determined, identification of disease progression, and the modality and mode of imaging used were reviewed. Given the paucity of full text articles, a meta-analysis was not possible. A narrative review was undertaken. Results In total, 12 studies, utilising the range of ultrasound parameters of B-mode, micro-ultrasound, colour Doppler, contrast ultrasound and elastography were included. The review demonstrated that micro-ultrasound offers promise as an imaging tool comparable with mpMRI. However, this is an emerging technology with limited availability. Analysis of the data further demonstrated that by combining the diagnostic features provided by multiple modes reviewed, ultrasound has a role in the diagnostic imaging of patients on active surveillance. Conclusion Providing a multiparametric approach is utilised, stable ultrasound findings may allow for increased intervals between biopsy for men on surveillance. The advent of micro-US offers promise as an imaging modality within an active surveillance pathway but requires further verification.

Introduction Duplex ultrasound is often the sole imaging modality used in diagnosing carotid artery disease. However, the reproducibility and repeatability of scientists in determining the peak systolic velocity and end diastolic velocity of the internal carotid artery and common carotid artery (CCA) is widely debated. Study aim To investigate intra- and inter-operator variability in diagnostic ultrasound of the carotid arteries across a centralised vascular network using a healthy test subject. To identify potential causes of variability and highlight areas for improvement. Methods Fifteen vascular scientists across four hospital Trusts in the Bristol, Bath and Weston vascular network measured the peak systolic velocity and end diastolic velocity of the internal carotid artery and common carotid artery in a subject using a single portable ultrasound machine. A double blind assessment of spectral Doppler images was performed by two vascular clinical scientists for optimal caliper placement, spectral gain and angle correction. Results were compared for intra- and inter-operator variability. Results Initial quality assessment of the Doppler images revealed that three out of 15 scientists produced suboptimal results. Box plot analysis of the common carotid artery and internal carotid artery for each scientist revealed significant variance (ANOVA p Conclusion This study highlights the difficulty in obtaining consistent velocity measurements from a subject. Despite the variability in absolute peak systolic velocity and end diastolic velocity, scientists were generally consistent in obtaining an optimal spectral Doppler trace. Some issues with consistency were, however, identified which were subsequently addressed.

Diagnostic ultrasound is considered to be the gold standard imaging modality for testicular assessment. As a result, it is frequently encountered by general radiologists and sonographers on daily ultrasound lists as well as by radiology residents out of hours. The main strength of diagnostic ultrasound in testicular assessment is that the high-frequency linear transducers utilized reproduce high-resolution images allowing accurate assessment of the testicular parenchyma. The fact that no ionizing radiation is utilized is particularly important as many patients on whom a testicular scan is requested are young or middle aged and the testis as an organ is very radiosensitive. This pictorial review comprises a range of illustrated images of congenital, benign, malignant, infection, polyorchidism and prosthesis-related pathologies collated over a two-year period at our institution.

Current ultrasound education for sonographers is at post-graduate level and it is a service expectation that sonographers are equipped with advanced skills on qualification. The aim of the working party review was to assess the current roles and responsibilities of the sonographers, with a view to determining whether there was an opportunity to introduce a lower band practitioner role within the local hospital ultrasound department as well as the wider ultrasound community. Qualitative data, for the review, were obtained from two sources: (i) a local working party consisting of two ultrasound managers, two sonographers, one consultant radiologist, one line manager and one lecturer in diagnostic imaging and (ii) radiologists of the local department, ultrasound colleagues within the Yorkshire and Humber Strategic Health Authority (SHA), local and national Higher Education Institute and Consortium for the Accreditation of Sonographic Education colleagues. The career structure of sonographers was reviewed with options to introduce a band 6 ultrasound practitioner post in the local radiology department. The level of work expected of sonographers within the local Trust demands advanced skills, currently recognized as Agenda for Change band 7, are utilized on a daily basis. Little opportunity for practitioners to work at a lower grade which would require only technical reports, with no diagnostic opinion, was identified. In conclusion, there is currently no scope for a band 6 ultrasound practitioner within the local radiology department. The review suggests there is a need for an ultrasound practitioner career structure, which is comparable with other professional groups. Such developments will require input and support from clinicians, radiologists, the professional body and the higher education institutions. The review recognizes the need for an ultrasound governance team within individual Trusts to oversee ultrasound provision, reporting and clinical developments.

This is an account of a two week introductory programme in abdominal ultrasound run at and by the University of Salford (UoS) in the UK, jointly planned and delivered by four European institutions, and funded as an ‘intensive programme’ by the EU Lifelong Learning Programme, in order to promote development of education and practice in diagnostic ultrasound throughout the EU member countries. The course syllabus was embedded within existing modules at UoS. Each partner institution was asked to supply a cohort of students and a teacher to assist with delivery of the programme: 30 students from the four institutions attended the course. The course did not in any way confer or imply any measure of clinical competency and this was clear to all participants. The success of the course proves the value of international healthcare education and brings us a step closer to harmonisation of ultrasound education and practice across Europe.

Ultrasound is widely used in small animal veterinary medicine for the investigation of cardiac disease and abdominal disorders. However, non-abdominal non-thoracic ultrasound in dogs and cats currently has a much more minor role in routine diagnostic work-ups. This article, based on a presentation given to the annual BMUS meeting in 2007, aims to provide some insight into the use of diagnostic ultrasound in evaluating the small parts of small patients.

Aim: The on-screen Mechanical Index (MI), was recorded from eight diagnostic ultrasound machines used for cardiac scanning of neonates. The objective of the study was to compare values of MI used in neonatal cardiac scanning with those recommended by the British Medical Ultrasound Society safety guidelines. Methods: The eight scanners were based at Sheffield Teaching Hospitals NHS Trust (STH), Sheffield Children's Hospitals NHS Trust (SCH) and Leeds Teaching Hospitals NHS Trust (LTH). Two methods of recording the MI value were used. At the Sheffield sites the on-screen safety index was obtained from archived patient studies saved on the Trust PACS. At the Leeds site the on-screen safety index was recorded from the scanner when it was switched on to its default neonatal or paediatric pre-sets with the appropriate transducer connected. Results: Data from clinical examinations at the Sheffield sites show that on average the MI values, for cardiac scanning, in B-mode and colour/pulsed wave Doppler mode were 1·1±0·3 and 1·3±0·3 respectively. The maximum values of MI recorded during clinical cardiac examinations were 1·6 for B-mode and 1·7 for colour/pulsed wave Doppler mode. Data from the Leeds site recorded default MI values, using appropriate transducers with neonatal and paediatric presets. One scanner from the Leeds site defaulted to an MI value of 1·9 in colour/pulsed Doppler mode with a neonatal preset. All the MI values are well above BMUS guideline recommendations for neonates when lung tissue is present within the ultrasound beam. Conclusions: The implication of these results is that neonates undergoing cardiac ultrasound examinations, were regularly exposed to MI values at least four to six times that recommended by BMUS guidelines (MI

Diagnostic ultrasound is generally considered to provide images without causing any significant biological effects in the tissues being visualized. If, however, the energy used is increased sufficiently, ultrasound can kill cells instantaneously, and causes thermal necrosis. High intensity focused ultrasound beams are being used to destroy masses in deep-seated tissues without damage to the intervening, overlying structures. This new technique is being investigated for use in the treatment of cancer of the prostate, liver, kidney, breast and bone.

Diagnostic Ultrasound has a well recognized role in the evaluation of patients across the spectrum of clinical practice. Technological advances have improved image quality, while making the functionality and ease of use better. This has resulted in more compact systems becoming available at more affordable prices. Over the past 10 years there has been an increase in the development of the point of care application of this skill, in particular at the bedside by clinicians looking to complement their traditional forms of patient assessment. This has been most evident in some of the acute specialist practices, such as Emergency Medicine, and other critical care practices, as well as some out-patient and primary care environments. In this article we describe some of the training and educational challenges inherent in the development of imaging skills by non-traditional practitioners. We describe an innovative post-graduate award (Postgraduate Certificate) that has been specifically designed to provide a suitable educational structure for clinicians wishing to develop focused ultrasound skills. In particular we concentrate on the experience of the first cohort of students from Emergency Medicine who have completed the course successfully. We describe the experience related to the development of the course and the lessons learned from its provision. We argue that there is an increasing need for such courses across the spectrum of clinician ultrasound at the bedside and we look forward to further evaluation in the years ahead.

The temperature rises at the surface of diagnostic ultrasound transducers in air and in contact with a tissue-equivalent phantom have been compared. Twenty-five transducers from seven different manufacturers were studied in imaging and pulsed Doppler modes. Comparisons were made between the temperature rise at 200 s 'in air' and 'on phantom' using two standard tissue mimicking materials (TMMs). Temperature rises in contact with the phantom (ΔTp) were always lower than those in air (ΔTa). Using a phantom that included a 1·5-mm silicone rubber layer to mimic the skin, the relative temperature rises ΔTp/ΔTa varied from 43 to 87 % with an average of 60%. The two TMMs gave comparable temperature rises despite their different compositions. Relative temperature rise depended slightly on frequency (2·5% MHz−1) and was higher on average in imaging mode than in pulsed Doppler mode. Linear relationships were observed between temperature rise and acoustic power, and relative temperature rise and silicone rubber thickness (∼11.5% mm−1). The phantoms gave rise to broadly similar temperature rises to those on skin, although the 1·5-mm silicone rubber skin-mimic layer may give a slight over-estimate of temperature rise for some transducers.

The safety committee of the British Medical Ultrasound Society has drawn up guidance that is intended to encourage best practice in determining and reporting the exposure conditions used in ultrasound bio-effect studies among researchers. The guidance addresses diagnostic and therapeutic applications of ultrasound, and is intended for bio-effects researchers, review boards of ethical and funding committees, and the editors and reviewers of scientific journals.

Diagnostic ultrasound has an excellent safety record, with no evidence to date for harm arising from human exposure. It is, however, still the responsibility of the person carrying out the ultrasound examination to conduct it in a safe manner. This entails drawing on a good knowledge of the machine settings and their effect on potential bio-effects to control the output of the scanner. Most international professional ultrasound societies regard the giving of guidance for the continued safe use of diagnostic ultrasound to be of sufficiently great importance to have established their own safety committees, giving them the remit of providing advice to the society’s membership on this topic. While most of these committees have drawn up their own separate clinical safety statements, the content of these is, unsurprisingly, generally similar. Few societies, however, have issued application specific guidelines for the conduct of ultrasound examinations, and it is only the British Medical Ultrasound Society (BMUS) that have made detailed recommendations about exposure times. The new BMUS Guidelines for the safe use of diagnostic ultrasound equipment were developed by BMUS’s Safety Committee. Their basis lies in their original guidelines (written in 2000), which introduced recommended maximum times for exposure during obstetric examinations. When first published, this was an innovative move that has since gained widespread acceptance. Two types of safety index can be displayed on the scanner screen, one concerned with potential heating (the thermal index, TI) and the other with mechanical (mainly cavitational) events (the mechanical index, MI). MI is of most concern when microbubble contrast agents are being used. For the majority of ultrasound examinations, especially in obstetrics, it is the potential for inducing a temperature rise that is of most concern on safety grounds. The recommended exposure times are therefore linked with upper limits of TI. The BMUS Committee was concerned that many practitioners had not read, or, if they had, did not remember, the guidelines in their previous incarnation. This new version represents an attempt to render them more ‘user friendly’. The new guidelines have been formulated in three sections

Diagnostic ultrasound of the shoulder is recognised as being one of the most technically challenging aspects of musculoskeletal ultrasound to master. It has a steep learning curve and makes gaining competency a time-intensive training process for both the trainee and their trainer. This article describes a training, assessment and feedback package developed within the framework of a Consortium for the Accreditation of Sonographic Education approved post-graduate ultrasound course. The package comprises: (i) a shoulder diagnostic ultrasound scan protocol with definition of findings, differential diagnosis and pro forma for recording scan findings, (ii) an assessment form for performance of shoulder diagnostic ultrasound scans with assessment criteria and (iii) a combined performance assessment and scan findings form, for each tissue being imaged. The package has been developed using medical education principles and provides a mechanism for trainees to follow an internationally recognised protocol. Supplementary information includes the differential diagnostic process used by an expert practitioner, which can otherwise be difficult to elicit. The package supports the trainee with recording their findings quickly and consistently and helps the trainee and trainer to explicitly recognise the challenges of scanning different patients or pathologies. It provides a mechanism for trainers to quantify and trainees to evidence their emerging competency. The package detailed in this article is therefore proposed for use in shoulder ultrasound training and its principles could be adapted for other musculoskeletal regions or other ultrasound disciplines.