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Background: Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine)., Objective: The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses., Materials and Methods: In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination., Results: The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism., Conclusion: A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital., (© 2024. The Author(s).)

The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties, as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Not only since the Corona pandemic has bedside ultrasound examination of the lung become an indispensable part of acute medicine. In addition to a presentation of the technical basics, this article provides an overview of how lung sonography can also be used in surgical acute medicine., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja, von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: ja, von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Bettina Siepe: Mitglied in der Deutschen Gesellschaft für Thoraxchirurgie Armin Seibel: Leiter des Arbeitskreises Notfallsonographie der Deutschen Gesellschaft für Ultraschall in der Medizin (DEGUM), Mitglied des Arbeitskreises Ultraschall der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), (Thieme. All rights reserved.)

Dermatologic ultrasound is a recent application of ultrasound for the evaluation of healthy skin and appendages and their diseases. Although the scientific literature regarding this application is still not sufficient for evidence-based guidelines, general recommendations issued by scientific societies are necessary. The EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) steering committee for dermatologic ultrasound has developed a series of consensus position statements regarding the main fields of dermatologic ultrasound (technical requirement, normal skin and appendages, inflammatory skin diseases, tumoral skin diseases, aesthetic dermatology and practice-training requirements). This document is the foundation for future evidence-based recommendations and guidelines for dermatologic ultrasound practice., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The Society for Acute Medicine launched their ultrasound accreditation in September 2016, involving a practical course alongside completion of scanning competencies. Candidates require a registered supervisor to oversee their training. We present here the results of a survey of attendees of practical courses approximately 2 years after launch. The majority of respondents were Consultants or trainees within AIM. Fourteen of 76 (18.4%) respondents had completed the whole accreditation process, whilst 51 (67.1%) had not completed any of the three individual modules. The biggest barriers to accreditation were seen to be lack of supervisors, and lack of dedicated training time. There was good uptake of available online learning resources with good feedback. These results will be used to help develop the training pathway further and widen access to ultrasound training within the specialty and beyond.

Nerve ultrasound is a fairly new non-invasive method to visualise peripheral nerves and to detect peripheral nerve lesions. This technique can depict nerve compression syndromes and their aetiologies as well as fascicular torsions. It is also suitable for sonographically guided nerve interventions and for intraoperative navigation. The main advantage of nerve ultrasound is its capability for early diagnosis of severe traumatic nerve lesions that require immediate surgery. Neurologists further use this method to aid the diagnosis of different kinds of polyneuropathies. Within this review we introduce nerve ultrasound to surgeons from a neurological perspective. We focus on different peripheral nerve disorders that might need surgical interventions. Nerve ultrasound will lay the grounds to bring together different expertise in medicine and thus to establish interdisciplinary excellence centres for the understanding, diagnosis and treatment of diseases of the peripheral nervous system., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Study Objective: To compare the detection rate of adenomyosis when ultrasound is performed by a radiologist compared with a gynecologic expert sonologist., Design: A retrospective, single-center study., Setting: A university teaching hospital., Patients: All women above 18 years of age with a positive histopathology diagnosis of adenomyosis obtained in a hysterectomy specimen from October 1, 2011, to October 1, 2017, were screened for inclusion. Cases without a preoperative pelvic ultrasound report, those with coexisting premalignant/malignant conditions, and patients presenting to the clinic with symptoms other than abnormal uterine bleeding, dysmenorrhea, or abdominal pain were excluded. A total of 412 cases were included in the final analysis., Measurements and Main Results: The preoperative ultrasound was performed by a radiologist in 241 patients (59%) and by an expert gynecologic sonologist in 171 patients (42%). Patients' age, body mass index, race, ethnicity, parity, and history of prior cesarean section were comparable between the 2 groups. The adenomyosis detection rate was significantly higher in the expert gynecologic sonologist group compared with radiologists (95 [56%] vs 29 [12%], p <.01). After controlling for patients' race, body mass index, prior cesarean sections, and presence of myomas using multivariable logistic regression, gynecologic expert sonologists were 7.8 times more likely to detect adenomyosis than radiologists (odds ratio = 7.84; 95% confidence interval, 4.58-13.44). Regardless of medical specialty, the presence of myomas significantly decreased the detection of adenomyosis compared with the absence of myomas (odds ratio = 0.23; 95% confidence interval, 0.13-0.39)., Conclusion: The detection rate of adenomyosis was significantly higher when ultrasound was performed by expert gynecologic sonologists compared with radiologists. The presence of myomas significantly decreased detection rates regardless of specialty. Ultrasound evaluation for detecting adenomyosis should be preferentially performed by gynecologic expert sonologists., (Copyright © 2019. Published by Elsevier Inc.)

Objectives: To achieve international consensus across multiple specialties on a generic ultrasound rating scale using a Delphi technique., Methods: Ultrasound experts from Obstetrics-Gynaecology, Surgery, Urology, Radiology, Rheumatology, Emergency Medicine, and Gastro-Enterology representing North America, Australia, and Europe were identified. A multi-round survey was conducted to obtain consensus between these experts. Of 60 invited experts, 44 experts agreed to participate in the first Delphi round, 41 remained in the second round, and 37 completed the third Delphi round. Seven key elements of the ultrasound examination were identified from existing literature and recommendations from international ultrasound societies. All experts rated the importance of these seven elements on a five-point Likert scale in the first round and suggested potential new elements for the assessment of ultrasound skills. In the second round, the experts re-rated all elements and a third round was conducted to allow final comments. Agreement on which elements to include in the final rating scale was pre-defined as more than 80% of the experts rating an element four or five, on importance to the ultrasound examination., Results: Two additional elements were suggested by more than 10% of the experts in the first Delphi round. Consensus was obtained to include these two new elements along with five of the original elements in the final assessment instrument: 1) Indication for the examination 2) Applied knowledge of ultrasound equipment 3) Image optimization 4) Systematic examination 5) Interpretation of images 6) Documentation of examination and 7) Medical decision making., Conclusion: International multispecialty consensus was achieved on the content of a generic ultrasound rating scale. This is the first step to ensure valid assessment of clinicians in different medical specialties using ultrasound.

Ultrasonic research in biology and medicine, both fundamental and applied, has become so vast in scope, that a mere listing of specific subject-areas would take up too much space. This article is intended to give an overview of Soviet scientists' contribution to the field, with the emphasis on the most important and promising subject-areas which are now given priority in the U.S.S.R. Among specific subject-areas in ultrasonics are the studies of the biological action of ultrasound and ultrasonic safety in medicine, the effect of focused ultrasound, acoustic spectroscopy of solutions of biological media and acoustic specification of biological objects, acoustic visualization and microscopy and clinical ultrasonics.

Abstract Introduction Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university. Methods A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students’ medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a “Direct Observation of Practical Skills” practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2. Results The study group rated their skills significantly higher after the course (p

Abstract This research aimed to assess the validity of ultrasound scans with new features in detecting fetal anal atresia and verify the effectiveness of these new features. Additionally, we aimed at investigating the perinatal incidence of anal atresia. This multicenter prospective study recruited 94,617 normal gravidas and 84 gravidas with anal atresia fetuses. The gold standard for diagnosing perinatal anal atresia is routine neonatal anus examinations. The incidence calculation was based on the results of the gold standard. The validity of our new approach was evaluated via a diagnostic test involving all 94,701 subjects. The effectiveness of our new features was assessed through an ablation study in a randomly established new dataset, with the ratio of anal atresia to non-anal atresia cases of 1:4. The annual perinatal incidence of anal atresia between 2019 and 2023 ranges from 0.57‰ to 1.29‰. Our new method performed great regarding the Youden index, diagnostic odds ratio (DOR), area under the curve (AUC) of the receiver operating characteristic curve (ROCC), AUC of the precision-recall curve (PRC), F1-score, and Cramer’s V. In the ablation study, our new approach surpassed its competitors concerning Youden index, DOR, AUC of the ROCC, and AUC of the PRC. Ultrasound scans show high validity and clinical value in detecting fetal anal atresia. Our new ultrasound features significantly promote the detection of fetal anal atresia.

A heterozygous microdeletion of chromosome 7q11.23 causes the rare neuropsychiatric developmental disorder Williams-Beuren Syndrome. The syndrome is more difficult to diagnose before birth than after, even though the syndrome often manifests prenatally as intrauterine growth restriction and cardiovascular defects on prenatal ultrasonography. The potentially poor prognosis of affected individuals highlights the need to improve prenatal diagnosis of the syndrome. This review summarizes recent advances in our understanding of the genetics of Williams-Beuren Syndrome and its manifestations on prenatal ultrasonography, which may facilitate its early detection and inform prenatal genetic counseling.

ObjectiveTo research on area ossification ratio (AOR), a novel parameter for quantitatively assessing adolescent bone age by conventional ultrasonography, and evaluate the correlation between AOR and radiographic bone age.MethodsThe study selected healthy adolescents from a middle school in Shandong Province in June 2023. Ultrasonic images were collected from five anatomical sites (the styloid process of the ulna, the styloid process of the radius, the lateral epicondyle of the femur, the medial condyle of the tibia, and the posterior median sagittal plane of the tibia). The second ossification center and epiphyseal area on these 2D ultrasound images were delineated to calculate AOR. This ratio was then compared with radiographic bone age measured by Greulich-Pyle (GP) atlas. Inter- and intra-observer consistency was evaluated using intraclass correlation coefficient (ICC) and the Bland-Altman method.ResultsA total of 179 healthy adolescents (109 males and 70 females) were included. For both genders, AOR of each site exhibited a significant to high correlation with radiological bone age (r=0.60~0.91). The sum of the AORs of the five sites showed a high correlation with radiological bone age (males: r=0.95, females: r=0.87). Measurements of AOR by different doctors and the same doctor at different times demonstrated high repeatability (inter-observer: ICC=0.926, P < 0.001, intra-observer: ICC=0.954, P < 0.001).ConclusionsThe sum of AORs in adolescents is highly correlated with radiographic bone age, and the measurement method shows high repeatability. The AOR is a reliable parameter for the ultrasonic quantitative assessment of bone age in adolescents.

Abstract Despite the increasing use of lung ultrasound (LUS) in the evaluation of respiratory disease, operators’ competence constrains its effectiveness. We developed a deep-learning (DL) model for multi-label classification using LUS and validated its performance and efficacy on inter-reader variability. We retrospectively collected LUS and labeled as normal, B-line, consolidation, and effusion from patients undergoing thoracentesis at a tertiary institution between January 2018 and January 2022. The development and internal testing involved 7580 images from January 2018 and December 2020, and the model’s performance was validated on a temporally separated test set (n = 985 images collected after January 2021) and two external test sets (n = 319 and 54 images). Two radiologists interpreted LUS with and without DL assistance and compared diagnostic performance and agreement. The model demonstrated robust performance with AUCs: 0.93 (95% CI 0.92–0.94) for normal, 0.87 (95% CI 0.84–0.89) for B-line, 0.82 (95% CI 0.78–0.86) for consolidation, and 0.94 (95% CI 0.93–0.95) for effusion. The model improved reader accuracy for binary discrimination (normal vs. abnormal; reader 1: 87.5–95.6%, p = 0.004; reader 2: 95.0–97.5%, p = 0.19), and agreement (k = 0.73–0.83, p = 0.01). In conclusion, the DL-based model may assist interpretation, improving accuracy and overcoming operator competence limitations in LUS.

Abstract Background We aimed to study, for the first time in the Egyptian population, the relationship between the serum adiponectin level in knee osteoarthritis (KOA) patients and its correlation with clinical, radiological, and ultrasonographic characteristics. Additionally, investigate the relationship between the adiponectin (ADIPOQ) gene rs1501299 (+ 276G/T) polymorphism and KOA susceptibility and severity. Methods This case-control study enrolled 40 patients with primary KOA and 40 matched controls. All patients underwent physical examination of the knee, pain assessment using the visual analogue scale (VAS), and functional evaluation by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Severity of KOA was assessed by Kellgren Lawrence (KL) grading scale and ultrasonography grading systems. Serum adiponectin levels and adiponectin (ADIPOQ) gene single nucleotide polymorphism (SNP) (rs1501299) genotyping were done for all patients and controls. Results The study included 40 patients with primary symptomatic KOA and 40 controls with comparable age, sex, and body mass index. The genotype of the rs1501299 (+ 276G/T) polymorphism of the ADIPOQ gene was determined using TaqMan allelic discrimination. An enzyme-linked immunosorbent test was used to measure the level of serum adiponectin. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score was used to assess functional capability, while the visual analogue scale was utilised to assess knee pain. Using the Kellgren-Lawrence (KL) grading method and global femoral cartilage (GFC) ultrasound grading, the severity of KOA was assessed. No significant differences between patients and controls as regards the genotype distributions and allele frequencies (p = 0.400, p = 0.507, respectively) of ADIPOQ gene rs1501299 (+ 276G/T) polymorphism. Furthermore, serum adiponectin level was significantly higher in the patients compared to healthy subjects (p

Abstract This study aimed to investigate whether metabolic dysfunction-associated fatty liver disease (MAFLD) defined by the fatty liver index (FLI) affects the decline in kidney function and whether this relationship is still observed in MAFLD defined by ultrasonography (USG). A retrospective cohort study was conducted using de-identified data from participants who received health checkups at Samsung Changwon Hospital between 2002 and 2018. The primary and secondary exposures were the presence of FLI- and USG-defined MAFLD, respectively. The primary outcome was 5-years slope of eGFR. The secondary outcome was a rapid decline in kidney function, defined as a 5-years slope of estimated glomerular filtration rate (eGFR) of less than − 3 mL/min/1.73 m2 per year. A total of 37,500 participants were included in the analysis. Participants with FLI-defined MAFLD had a larger decline in 5-year eGFR slope than those without FLI-defined MAFLD (beta coefficients − 0.11; 95% CI − 0.14 to − 0.08). Participants with FLI-defined MAFLD had a higher risk of rapid kidney function decline than those without FLI-defined MAFLD (odds ratio 1.33; 95% confidence intervals (CIs) 1.05–1.69). However, USG-defined MAFLD was less related to kidney function decline. In conclusion, the presence of FLI-defined MAFLD was associated with larger and faster kidney function decline.

Abstract Background Clinicians from multiple professional backgrounds are increasingly using point-of-care ultrasound in clinical practice. Performing ultrasound is a complex skill, and training is required to ensure competency and patient safety. There is a lack of skilled trainers within health professions to meet this increasing educational demand. The role of sonographers in educating other health professionals in point-of-care ultrasound has not yet been well defined. Sonographers can provide ultrasound education interprofessionally, if equipped with appropriate clinical knowledge and educational skills. Methods A Delphi consensus study was conducted to define the knowledge, skills and attributes required of sonographers teaching point-of-care ultrasound to other health professionals in Australia and New Zealand. Health professionals with subject matter expertise in the leadership, facilitation, and delivery of ultrasound education by sonographers were invited to participate. Results There were 72 expert participants in survey round one, and 49 in round two. Participants included physicians, sonographers, and other health professionals. Consensus was reached on 31 competency items for sonographers teaching ultrasound interprofessionally, with agreement of greater than 94% reached by participants. Conclusions This consensus study has defined the knowledge, skills and attitudes required for sonographer competence in point-of-care ultrasound education. This is an important step to developing a training pathway for sonographers engaging in this emerging area.

Extramedullary Haematopoiesis (EMH) is a compensatory response occurring secondary to inadequate bone marrow function and is observed in many haematological conditions. EMH can occur in many haemoglobinopathies. Extramedullary haemopoiesis favours certain sites such as the liver, the spleen, and the paraspinal regions of the thorax. However, in addition to these common sites of extramedullary haemopoiesis, the process can involve virtually any organ or tissue and can often manifest as a mass mimicking a neoplasm. Although EMH is usually asymptomatic, clinical symptoms can appear due to mass effect. Radiological evaluation can be done using Ultrasonography (USG), Computed Tomography (CT) scan, and T2, T1 weighted Magnetic Resonance Imaging (MRI). Both conservative and surgical treatments are practiced depending on the organ involvement. Here, is a rare case of a young female in her mid-20s, who was a known case of beta thalassaemia major. She presented with a mass insidiously growing in left flank region, which on radiological imaging was found to be focal mass in the spleen. The pathological diagnosis after elective splenectomy was EMH of spleen. Due to chronic transfusions in patients of beta thalassaemia major, EMH is rarely seen. In-fact, the incidence of EMH in beta-thalassaemia major is thought to be less than 1%, which makes the present case a rare entity.

Background and objective: Thoracic injuries are a common presentation in emergency hospitals in the Kurdistan region, mainly caused by road traffic accidents. Early and accurate diagnosis of rib fractures is essential in saving lives and preventing complications. The objective was to assess the validity of ultrasound in the diagnosis of rib fractures in comparison to plain x-ray. Methods: Present study was a cross-sectional study carried out in the Emergency department of Rozhalat Hospital in Erbil city-Kurdistan region/Iraq over ten months, from August 2021 to May 2022, on a sample of fifty-five (55) patients with suspected rib fractures. Rib fractures were diagnosed by the researcher based on clinical, ultrasound, and x-ray findings, and the findings of rib fracture were confirmed by CT-scan. All imaging methods were done at the Radiology department of Rozhalat hospital. Results: The validity findings of ultrasound examination taking CT scan as the gold standard was as follow: (97.7% sensitivity, 63.6% specificity, and 90.0% accuracy), while the validity findings of x-ray examination taking CT scan as the gold standard were (56.8% sensitivity, 54.5% specificity and 56.3% accuracy). The validity of ultrasound in detecting cortical disruption or hematoma was (93.8% sensitivity, 43.6% specificity, and 58.1% accuracy), while the validity of CXR in the detection of displacement was (31.3% sensitivity, 84.6% specificity, and 48.7% accuracy). Conclusion: Sonograph is an accurate diagnostic tool for detecting rib fracture with superior validity compared to a chest x-ray.

Objective To investigate the value of ultrasound micro-flow imaging (MFI) combined with serum inflammatory factors in the early diagnosis of diabetic kidney disease (DKD). Methods A total of 92 patients with DKD who were admitted to The Affiliated Hospital of Qingdao University from June 1, 2022 to June 30, 2023 were enrolled as DKD group, and 64 patients with type 2 diabetes mellitus (T2DM) who were admitted to our hospital during the same period of time were enrolled as T2DM group. Related data were collected for the two groups, including clinical indicators, ultrasound blood flow parameters, and serum inflammatory factors. Ultrasound blood flow parameters included MFI-value, left renal interlobar artery resistance index (RI1), right renal interlobar artery resistance index (RI2), left renal interlobar arterial peak velocity (PSV1), and right renal interlobar arterial peak velocity (PSV2). The Spearman method was used to investigate the correlation of MFI-value with clinical indicators and serum inflammatory factors; the forward conditional approach in binary logistic regression was used to analyze the impact of DKD; the receiver operating characteristic (ROC) curve was used to analyze the value of MFI-value and serum inflammatory factors in predicting DKD. Results Compared with the DKD group, the T2DM group had significantly lower RI1 and serum levels of C-reactive protein, interleukin-6 (IL-6), and interleukin-18 (Z=-6.73--3.20,P

Studies have shown that there are differences in clinical evaluation parameters and difficult intubation rates among different ethnic populations. In our study, we aimed to evaluate the efficacy of upper airway clinical and ultrasonographic measurement methods in Turkish population.

Abstract A whiplash injury can alter neck muscle function, which remains years after the injury and may explain why symptoms such as persistent pain and disability occur. There is currently limited knowledge about dynamic neck muscle function in chronic whiplash-associated disorders (WAD), and about the extent to which altered muscle function can improve after rehabilitation. Ultrasound can detect mechanical neck muscle function by measuring real-time deformation and deformation rate in the muscles. This method was used for five dorsal neck muscles in participants with chronic WAD versus matched controls in resistant neck rotation. We obtained real-time, non-invasive ultrasound measurements using speckle tracking, multivariate analyses, and mixed-design ANOVA analyses. The results showed altered deformation in the three deepest neck muscle layers, with less deformation area in the WAD group compared to controls in rotation to the most painful side at baseline. Participants in the WAD group performed three months of neck-specific exercises, resulting in improved deformation in the deep neck muscles in WAD and with a similar deformation pattern to controls, and the significant group differences ceased. We reveal new and important insights into the capability of ultrasound to diagnose altered neck muscle function and evaluate an exercise intervention.

Background: Transurethral resection of bladder tumor (TURBT) is usually done spinal anesthesia but it does not prevent the obturator reflex leading to bladder perforation, bleeding, or incompletely resection of resection of the tumor which could be prevented by obturator nerve block (ONB) in TURBT. Aims and Objectives: The aim of our study is to compare the effectiveness of ONB by peripheral nerve stimulator (PNS) and ultrasonography (USG) in TURBT and also compare morbidity between USG- and PNS-guided ONB in TURBT under spinal anesthesia. Materials and Methods: Sixty patients were randomly divided into two groups. Group (1) patients had a PNS-guided ONB and Group (2) patients had ONB-guided ONB. The presence or absence of adductor muscles reflexes was recorded. Bladder perforation and bleeding during surgery were also recorded. Results: A success rate of 90% was achieved in the Group (2) compared to 66% in Group (1) which was clinically significant with P=0.049. Complete bladder perforation was detected in four patients in Group (1) whereas no perforation was observed in Group (2). Bleeding was observed in both groups but severe bleeding was present in five patients in Group (1) and required a blood transfusion. Conclusion: We concluded that USG-guided ONB is more efficient and safer as compared to PNS-guided ONB.

Introduction: Neonatal Respiratory Distress Syndrome (RDS) is a major cause of foetal mortality and morbidity, especially in preterm labour because of concerns about foetal lung maturity. One of the method to assess foetal lung maturity is the Doppler assessment of the foetal Pulmonary Artery. Aim: To assess the accuracy of Doppler findings of the foetal Main Pulmonary Artery (MPA) in foetal lung maturity assessment and prediction of the development of neonatal RDS in preterm deliveries. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, along with the Departments of Obstetrics and the Department of Paediatrics of Rama Medical College, Hospital, and Research Institute in Kanpur, India from May 2022 to December 2022. A total of 76 pregnant women with singleton pregnancies and gestational age

Background & Aims: Ovarian cancers are increasing in incidence, and an accurate ultrasonographic diagnosis, along with a complete physical examination and history taking, is essential for prompt diagnosis and early reporting. In this study, we aimed to evaluate the efficacy of ultrasonography (USG) in identifying ovarian lesions using histopathology as the gold standard. Materials & Methods: This was a retrospective study conducted by evaluating the reports of patients in the menopausal age group who had undergone total hysterectomy or oophorectomy. Histopathological diagnoses were retrieved from the Department of Pathology, and ultrasonographic (USG) reports were obtained from the patients' medical records. Results: This study included the histopathological and ultrasonographic reports of 239 women, of which 95.4% of cases were benign, while borderline lesions and malignant lesions constituted 3.3% and 1.3%, respectively. USG showed sensitivities of 93.55%, 66.7%, and 33% in identifying benign, borderline, and malignant lesions, respectively. Specificities of 91.67%, 91.84%, and 99.46% were noted in classifying ovarian lesions as benign, borderline, and malignant, respectively. Conclusion: Ultrasonography (USG) remains an important imaging tool for the early diagnosis of ovarian lesions, and a standardized reporting protocol should be implemented in every institution to increase the accuracy of USG and to reduce the inter-observer variability commonly encountered in ultrasound.

INTRODUCTION: Accurate prediction of birth weight is crucial for both fetuses and mothers. Low birth weight (birth weight < 2500g) and high birth weight (birth weight > 4000g) can lead to high perinatal mortality rates, various complications, and both short-term and long-term health outcomes such as chronic diseases. This article aims to propose a machine-learning solution to enhance the accuracy of birth weight prediction and assist clinicians in identifying potential risks before birth. METHODS: Seven hundred thirty different fetuses between weeks 15-40 were analyzed using clinical data. Nine different regression models from supervised machine learning methods, including logistic regression, support vector machine, decision tree, elastic net regressor, lasso regressor, ridge regressor, artificial neural network, random forest, and k-nearest neighbors algorithms, were employed to predict fetal birth weights based on gestational week, maternal age, gender, and ultrasound measurements, including biparietal diameter, abdominal circumference, and femur length. RESULTS: Our study revealed that abdominal circumference was the most influential parameter, while gender had the least impact. The performance of the nine different algorithms in birth weight prediction was compared, and the elastic net regressor algorithm exhibited the best predictive performance. The proposed model yielded a prediction result with an average absolute error percentage of 8.87% and an average error of +-284g. A new formula for the newborn weight prediction model was developed using the elastic net regressor machine learning method. DISCUSSION AND CONCLUSION: Our study demonstrates that the model created with the elastic net regressor algorithm can predict birth weight at any gestational age between weeks 15-40.

Background: The hallmark of Nephrotic syndrome is massive proteinuria, with associated enlarged kidneys. However the association between remission status and size of the kidneys in patients with nephrotic syndrome is not known. This study is aimed at determining the dimensions of the kidneys of children with nephrotic syndrome and to compare kidney dimensions in patients with nephrotic syndrome who were in remission compared with the dimensions in patients who were not in remission. Subjects and Methods: This is a case-control study, where fiftythree children with diagnosis of Nephrotic syndrome and fifty- seven age matched healthy controls were analysed. The kidneys of both cases and controls were scanned using the B- mode ultrasound and the kidneys Bipolar, anteroposterior and transverse dimensions and volume were determined. Results: The mean renal longitudinal, anteroposterior, transverse dimensions and volume were higher in cases compared to the controls, bilaterally (p

Background/Aims Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. Methods We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Results Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Conclusions Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.

Abstract We evaluate the value of oral contrast-enhanced gastric ultrasonography (OCUS) by comparing it with conventional gastroscopy in diagnosing and staging benign peptic ulcer. From July 2018 to December 2020, 44 patients with gastroscopy-confirmed benign peptic ulcers (a total of 45 ulcers were detected), who also received OCUS, were retrospectively reviewed. Each patient’s ultrasound images were compared with gastroscopy and pathology findings. The characteristics of ultrasonic images of different stages of ulcer were analysed. A total of 43 ulcers were detected by OCUS in 44 patients with benign peptic ulcers. There were no false positive results among the OCUS exams, but two ulcers were misdiagnosed. OCUS for benign peptic ulcer staging also shows acceptable clinical practice results. OCUS is useful for detecting and staging benign peptic ulcer, and may be considered an alternative method for conventional gastroscopy. OCUS is especially useful in the follow-up of BPU treatment, but futher study is needed to improve the diagnostic accuracy of benign and malignant ulcers.

Context: Pregnant women in India are often unable to recall the last menstruation period (LMP) and also present in the late trimester. In India, to determine the fetal age by ultrasonography (USG), Western nomogram is being used, but the racial and ethnic variation might lead to variation in estimation of fetal parameter. Aim: The aim of this study was to estimate the value of different fetal biometric parameters by USG and to compare it with Western nomogram like Hadlock’s. Settings and Design: This was a descriptive cross-sectional study. Subjects and Methods: The study was performed among 150 pregnant women in their second or third trimester following the inclusion and exclusion criteria. Statistical Analysis Used: The data were analyzed with Microsoft Excel and SPSS (Statistical Package for the Social Sciences) version 22.0. Results: 51.33% of participants were in 29–37 weeks of pregnancy. A statistically significant high positive linear correlation within the estimates of different sonological parameters was found. The observed coefficient of correlation for different parameters was as follows: biparietal diameter (r = 0.968), head circumference (r = 0.963), abdominal circumference (r = 0.964), and femur length (r = 0.963). In the same gestational age (GA), Hadlock’s chart reported higher diameter(s)/length, and differences were noted to be statistically significant. GA estimated by Hadlock’s chart was found to be significantly lower than that of the GA determined from LMP. Conclusion: The biometric sonological fetal parameters in the present study were significantly different from the Hadlock’s chart which notes a considerably higher reading for the same GA, indicating that the probability of race, ethnicity, and sample size played a role.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Abstract The meniscal position within the knee is critical to maintain normal knee function. The joint capsule might dynamically coordinate the medial meniscus (MM) by transmitting a semimembranosus action. However, their interrelationships in vivo are unclear. We aimed to determine relationships among the MM, joint capsule, and semimembranosus during passive tibial external-internal and isometric tibial internal rotation at the medial and posteromedial knees of 10 healthy individuals in vivo using ultrasound. We analyzed images of the MM and joint capsule locations at the medial and posteromedial knee and the velocity waveform similarity of each structure during rotational tasks. Both isometric internal rotation with semimembranosus action and passive tibial external rotation displaced the MM inward at the medial knee. The MM and joint capsule during these MM displacements coordinately moved with more than moderate cross-correlation coefficients (passive external and isometric internal rotations, ≥ 0.54 and ≥ 0.90, respectively). The movements of the MM and joint capsule to the semimembranosus during isometric internal rotation also coordinated with moderate cross-correlation coefficients (≥ 0.62). Therefore, the joint capsule might dynamically coordinate the MM by transmitting semimembranosus action. Whether increased tibial internal rotation or semimembranosus shortening causes MM extrusion awaits further investigation.

Abstract Background Lumbar puncture is challenging for patients with scoliosis. Previous ultrasound-assisted techniques for lumbar puncture used the angle of the probe as the needle trajectory; however, reproducing the angle is difficult and increases the number of needle manipulations. In response, we developed a technique that eliminated both the craniocaudal and lateromedial angulation of the needle trajectory to overall improve this technique. We assessed the feasibility and safety of this method in patients with scoliosis and identify factors related to difficult lumbar puncture. Methods Patients with spinal muscular atrophy and scoliosis who were referred to the anesthesia department for intrathecal nusinersen administrations were included. With a novel approach that utilized patient position and geometry, lumbar puncture was performed under ultrasound guidance. Success rates, performance times and adverse events were recorded. Clinical-demographic and spinal radiographic data pertaining to difficult procedures were analyzed. Results Success was achieved in all 260 (100%) lumbar punctures for 44 patients, with first pass and first attempt success rates of 70% (183/260) and 87% (226/260), respectively. Adverse events were infrequent and benign. Higher BMI, greater skin dural sac depth and smaller interlaminar size might be associated with greater difficulty in lumbar puncture. Conclusions The novel ultrasound-assisted horizontal and perpendicular interlaminar needle trajectory approach is an effective and safe method for lumbar puncture in patients with spinal deformities. This method can be reliably performed at the bedside and avoids other more typical and complex imaging such as computed tomography guided procedure.

Background: Confirmation of the position of the endotracheal tube (ETT) is an essential step for verification of intubation. Failure to diagnose esophageal intubation may lead to fatal consequences. Capnography is the gold standard for confirmation of ETT position, but it is practically impossible to be performed in all situations. Ultrasonography (USG) or “visual stethoscope” can be used as an effective alternative for all intubators in all situations. Aims and Objectives: The study was conducted to evaluate the ultrasonography (USG) technique with respect to its efficacy to detect the proper endotracheal position of ETT compared to end-tidal capnography among patients undergoing general anesthesia; to compare the time taken by the USG technique with that of capnography for detection of proper placement of ETT; to assess the feasibility of USG to detect accidental esophageal intubation. Materials and Methods: This prospective comparative cross-sectional observational study was conducted on 68 patients. Both capnography and upper airway USG were performed immediately after intubation to confirm the ETT placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. The time required to determine ETT placement by the two methods was found out and compared. Agreement between the methods was assessed with kappa statistics. Results: USG detected all three cases of esophageal intubation but could not detect two patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.92% (95% confidence interval [CI]: 93.54–100%), specificity of 100%, positive predictive value of 100%, and negative predictive value of 60% (95% CI: 50.4–69.6%). The Kappa value was found to be 0.735, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 21.68±2.63 s versus 11.44±1.38 s for upper airway USG (P

Background: Breast pain is the second most common breast symptom (after breast lump) for which women seeks medical attention. Breast pain can affect daily life, including sleeping, or physical, social, and work-school life. Mastalgia is one of the common causes for women in tier 2 city visiting health care facility but there are only few studies which focus on demographic findings and ultrasonographic findings in mastalgia. Aims and Objectives: The objective of this study was to study demographics of breast pain in a tier 2 city and ultrasound evaluation of mastalgia. Materials and Methods: In this prospective study, 143 patients presenting with mastalgia irrespective of focality, duration, or cyclical nature were included. In these patients, we studied demographic profile and ultrasonographic findings in mastalgia. Results: About 37% women were in 20–29 years of age group and least number was in 70–79 years of age group. About 86% of women in our study were in reproductive age group. Most patient with mastalgia have associated palpable lump (58%) followed by 43% patients with mastalgia and nipple discharge, only 27% of patients have mastalgia alone whereas 4% women have pain with skin changes. The majority (49%) of mastalgia cases fall under the breast imaging-reporting data system (BI-RADS)-I category while cases in BI-RADS-IV and V category were 2 and 1, respectively. Conclusion: Women in their reproductive age group and in their 3rd decade of life are more prone for mastalgia. Ultrasonography is also helpful in detecting cancers in setups where routine mammography is not possible.

Background: Ultrasonography (USG) is used extensively across countries to diagnose and manage diseases. However, the existing USG services must be utilised rationally and effectively. Aim: Understanding the pattern of USG prescriptions and findings is important for improving the quality of healthcare services delivered by any healthcare system. Patients and Methods: A mixed methods study was conducted at a rural sub-district hospital in northern India to assess the pattern and completeness of prescriptions and USG findings and explore the patient and doctor-related factors influencing the USG prescription practices. Results: Of the 505 patients studied, 324 (64.2%) were females. The median age was 32 years (interquartile range: 24–45 years). The availability of complete medical history and clinical examination recording was 471 (85.7%) and 145 (28.7%), respectively. The indication for USG was mentioned in 436 (86.3%) prescriptions. Of the total, 251 (49.7%) had abnormal ultrasound findings. The abnormal finding was significantly high amongst patients (a) aged 45–59 years (P = 0.015) and (b) referred from surgery, paediatrics and other outpatient departments (P = 0.001) after adjustment to other factors. Patient-related factors such as non-harmfulness, free availability, reassurance of normality and health system/provider-level factors such as absence or low awareness of guidelines and changed clinical practice were the reasons for the current pattern of USG prescriptions. Conclusion: Although the medical history is better recorded, the incomplete recording of clinical examination needs improvement. Placing a guideline for prescribing USG, imposing nominal user fees and patient education and counselling can be tested for effectively utilising the USG services. Further, tracking the change in clinical management following the USG in Indian setting is the need of the hour.

Background: The aim of this study was to evaluate the feasibility of ultrasound-guided pectoral nerve block combined with interpleural block for surgical anesthesia during the modified radical mastectomy (MRM). Methods: Thirty-six female patients scheduled to undergo MRM were included in this study. After taking all aseptic precautions, an ultrasound-guided pectoral nerve block and interpleural block were performed with 20 ml of 0.25% bupivacaine for each block. We started all patients on dexmedetomidine infusion to achieve conscious sedation and used injection ketamine as rescue analgesia. We recorded hemodynamic parameters throughout the surgery and visual analog scale scores of pain at baseline and after providing rescue analgesia. Postoperatively, we assessed surgeon and patient satisfaction scores. Results: MRM was completed in 31 (86%) out of the 36 recruited patients. Among these 31 patients, 5 (16%) did not require a rescue dose of ketamine, 14 (45%) required one rescue dose, and 12 (39%) patients required two rescue doses of ketamine. Postoperatively, the median patient and surgeon satisfaction scores were 85 (75–90) and 85 (80–90), respectively. The mean dose of dexmedetomidine was 175 (±27) μg, and the mean dose of ketamine was 32.8 (±6) mg. No serious adverse events were reported. Conclusion: MRM can be feasibly performed under ultrasound-guided pectoral nerve block and interpleural block, along with conscious sedation, without any significant adverse events.

Pure embryonal carcinoma (EC) is a rare malignant tumor that primarily occurs in infants with a sex development disorder and adults aged in their thirties to forties. This tumor behaves more aggressively than other germ cell tumors in the testis, and most of them should undergo surgery or chemotherapy. However, only a few case reports have involved imaging, and most of them are limited. Here, we present a case of pure EC in the testis of a 27-year-old male with multimodal ultrasonography, computed tomography, and magnetic resonance imaging.