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With, Sonography, celebrating its 10th birthday, it is timely to reflect on the changes in ultrasound and the role of the sonographer, across the same period. This paper will present the significant changes that have occurred across the last 10 years in a large public hospital network in Australia across a diversity of themes. In the areas where challenges have emerged, the way these were navigated will be described. Documenting this change in ultrasound provision may be valuable to future planning for all key stakeholders. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the incidence of lateral incisor root resorption associated with impacted maxillary canines and determine predisposing factors that may be used to predict its occurrence.

Context: Extracorporeal shock wave therapy (ESWT) is increasingly used for plantar fasciitis, but limited evidence supports its use.Objective: To determine whether ultrasound-guided ESWT reduces pain and improves function in patients with plantar fasciitis.Design: Double-blind, randomized, placebo-controlled trial conducted between April 1999 and June 2001.Setting: Participants were recruited from the community-based referring physicians (primary care physicians, rheumatologists, orthopedic surgeons, and sports physicians) of a radiology group in Melbourne, Australia.Participants: We screened 178 patients and enrolled 166; 160 completed the 15-week protocol. Entry criteria included age at least 18 years with plantar fasciitis, defined as heel pain maximal over the plantar aspect of the foot of at least 6 weeks' duration, and an ultrasound-confirmed lesion, defined as thickening of the origin of the plantar fascia of at least 4 mm, hypoechogenicity, and alterations in the normal fibrillary pattern.Interventions: Patients were randomly assigned to receive either ultrasound-guided ESWT given weekly for 3 weeks to a total dose of at least 1000 mJ/mm(2) (n = 81), or identical placebo to a total dose of 6.0 mJ/mm(2) (n = 85).Main Outcome Measures: Overall, morning, and activity pain, measured on a visual analog scale; Maryland Foot Score; walking ability; Short-Form-36 Health Survey (SF-36) score; and Problem Elicitation Technique score, measured at 6 and 12 weeks after treatment completion.Results: At 6 and 12 weeks, there were significant improvements in overall pain in both the active group and placebo group (mean [SD] improvement, 18.1 [30.6] and 19.8 [33.7] at 6 weeks [P =.74 for between-group difference], and 26.3 [34.8] and 25.7 [34.9] at 12 weeks [P =.99], respectively). Similar improvements in both groups were also observed for morning and activity pain, walking ability, Maryland Foot Score, Problem Elicitation Technique, and SF-36. There were no statistically significant differences in the degree of improvement between treatment groups for any measured outcomes.Conclusion: We found no evidence to support a beneficial effect on pain, function, and quality of life of ultrasound-guided ESWT over placebo in patients with ultrasound-proven plantar fasciitis 6 and 12 weeks following treatment. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT) coronary angiogram (CTCA) is commonly used for diagnostic evaluation of low-moderate risk patients due to its excellent performance and cost-effectiveness. However, previous cost analyses have not factored in the burden of management of pulmonary nodules, which are a common occurrence. We sought to describe the frequency and characteristics of lung nodules on CTCA in an Australian tertiary hospital, and to assess cost impacts., Methods: Consecutive CTCAs performed in the calendar year 2012 were retrospectively identified from the imaging department database. Subjects were excluded if they were under the age of 35, had known malignancy or findings identified prior to CTCA. Patients were stratified on smoking history and nodule size., Results: Of the 2479 CTCAs included, full-field imaging revealed nodules in 358 patients (13.9%). The nodules were generally small (73% <6mm), multiple (63%) and in the lower lobe (83.4%). There was no significant difference when stratified for smoking, with 60% of nodules detected in never-smokers. A minimum of 445 subsequent scans was required for nodule surveillance, resulting in an additional overall cost of $63.62 per CTCA. Limited-Field-of-View (L-FOV) would have identified only 22 nodules, with a cost of $6.14 for every CTCA performed, a cost saving of $57 per patient., Conclusions: Indeterminate pulmonary nodules are a common incidental finding on CTCA and prevalence appears to be independent of smoking status. There is a consequent significant cost burden that has not previously been recognised. Use of L-FOV reduces the number of nodules identified, with a significant cost benefit, but this has to be balanced against the ethical and medico-legal issues inherent in not reconstructing the irradiated lung., (Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Introduction: Point-of-care ultrasound (PoCUS) is a rapidly growing area, providing physicians with a valuable diagnostic tool for patient assessment. This paper describes a collaborative model, utilising radiology department ultrasound expertise, to train and credential physicians in PoCUS. A 6-year experience of the implementation and outcomes of the programme established within the emergency departments of a large, multi-campus hospital network are presented., Methods: A collaborative model was initially developed and implemented between radiology and emergency departments. Key elements of the programme included hospital executive support, close collaboration with stakeholders, resource allocation, appointment of a sonographer educator, clear scope of practise and robust quality processes., Results: Participation grew from 36 emergency physicians in 2011 to 96 physicians in 2016. A total 11064 scans were logged with the programme in the 6-year period. Routine quality audit of 61.8% (6836/11064) of all scans included 2836 Focussed Assessment by Sonography in Trauma (FAST) and 1422 Abdominal Aortic Aneurysm (AAA) examinations. False-positive or false-negative diagnoses occurred in 3.6% (102/2836) FAST and 1.3% (19/1422) AAA cases. No adverse clinical outcomes were reported to involve programme-compliant scans., Conclusion: A collaborative model to train and credential physicians in PoCUS has been successfully implemented. The programme grew significantly, produced excellent quality outcomes and resolved many issues of potential conflict related to PoCUS., (© 2017 The Royal Australian and New Zealand College of Radiologists.)

Neonatal cranial ultrasound is routinely performed to screen preterm infants for complications of prematurity. A key component of this examination is the measurement of the lateral ventricles to identify and monitor ventriculomegaly. This study assesses the two-dimensional (2-D) interobserver error of neonatal cranial lateral ventricle measurements on 40 neonates who were undergoing cranial ultrasound in the neonatal intensive care unit. Three-dimensional (3-D) volumes were obtained using a matrix transducer. Lateral ventricle (LV) measurements were subsequently measured on a departmental 3-D workstation by two workstation sonographers. The interobserver error of this technique was calculated and compared with the conventional 2-D technique. Both techniques demonstrated acceptable interobserver variability although the established 2-D technique had less variation. This identifies a potential role for 3-D analysis in the neonatal cranial ultrasound examination. It also affirms the potential of 3-D ultrasound in performing similar small measurements in other clinical settings., (Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role., Method: The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence., Results: A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT., Conclusion: The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.

Objective: The objective of our study was to investigate the effect of activity on tendon vascularity in 17 abnormal patellar tendons., Conclusion: Tendon vascularity is significantly increased by activity (p < 0.001). From this finding, we infer that imaging abnormal tendons with color Doppler sonography to detect neovascularization may be most useful after the patient exercises. Investigations to determine how much activity is necessary to ensure maximal vascularity is detected by Doppler sonography are required.

This article presents a clinical approach to the role of ultrasound in the assessment of intra-articular and extra-articular knee pathology, including a comprehensive review of both acute and chronic conditions that may affect the tendons, ligaments, and bursae related to the knee joint. A brief review of the ultrasound findings in degenerative and inflammatory arthropathies and some of the more common tumors and masses that may be encountered around the symptomatic knee also has been included. Finally, the limited role of ultrasound in the assessment of the knee menisci and the symptomatic postarthroscopic patient is discussed.

Dialysis related amyloidosis (DRA) is a common complication of chronic dialysis, but diagnosis can be difficult. Hand involvement, as carpal tunnel syndrome (CTS) or particularly amyloid hand, can affect dexterity. To investigate the prevalence and extent of hand involvement, ultrasound evaluation of the carpal tunnel and tendons of the hand was performed in 25 chronic hemodialysis patients. Clinical symptoms of CTS were present in 18/50 wrists (36%); symptomatic patients had undergone hemodialysis for a significantly longer period than those without symptoms (16 +/- 2.9 years vs 5.3 +/- 3.0 years). The ultrasound indicators suggestive of DRA in the wrist which correlated with CTS were 1) increased carpal tunnel depth (15 +/- 2.3 mm vs 11 +/- 1.5 mm), 2) increased displacement of flexor tendons from the radius (3.4 +/- 2.4 mm vs 11 +/- 0.6 mm), and 3) presence of hypoechoic masses, erosions and fluid collections (16% of wrists). There was no relationship between symptoms and either flexor retinaculum thickness or median nerve surface area index. Five patients (20%) had severe stiffness of their fingers; ultrasound revealed thickening of the tendons of the hand in all these cases. Ultrasound technology allows the non-invasive examination of the wrist and hand for DRA and may be valuable in diagnosis and planning surgery.

Objective: The purpose of this study was to test the efficacy of sonography in the diagnosis of rupture of the anterior cruciate ligament in the setting of a recent traumatic hemarthrosis., Subjects and Methods: Sonography was prospectively performed in 37 patients with a recent traumatic hemarthrosis of the knee, no bone abnormality seen on plain radiographs, and no history of a previous knee injury. The presence of a hypoechoic collection along the lateral wall of the femoral intercondylar notch was interpreted as a hematoma at the femoral attachment of the anterior cruciate ligament. Arthroscopy was subsequently performed in 30 patients. The findings of three diagnostic techniques (sonography, MR imaging, and arthroscopy) were compared., Results: The sonographic findings were confirmed by MR imaging and arthroscopy in 34 of the 37 patients. For the three false-negative results, sonographic findings were abnormal but equivocal in two cases and were reported as negative. The technique was therefore 91% sensitive and 100% specific. The positive predictive value was 100%. The negative predictive value was 63%., Conclusion: Sonography is a useful and inexpensive method of detecting the presence of rupture of the anterior cruciate ligament in the clinical setting of a traumatic hemarthrosis.

The purpose of this essay is to illustrate sonographic findings for patients with abnormalities of the tendon of the long head of the biceps muscle of the arm. The tendon is vulnerable to a variety of injuries caused by abnormalities of its osseous and soft-tissue supports, including impingement of the tendon against the acromion and arthritis of the glenohumeral joint. These abnormalities include acute and chronic tenosynovitis, rupture, subluxation, and dislocation.