Search

Introduction Nosocomial transmission of Coronavirus Disease 2019 (COVID-19) is a preventable risk to the patient population and radiographer workforce. This article aims to describe the prevention of COVID-19 nosocomial transmission during radiographic procedures by the utilization of stringent infection prevention measures at a leading tertiary hospital in Singapore. Methods The implemented measures are the appropriate use of personal protective equipment, staff education, infection controls measures such as equipment disinfection, physical distancing and segregation of staff and patients. Results Despite the handling of 1637 COVID-19 cases as of July 25, 2020, there has not been a single case of known nosocomial transmission of the disease in the institution. Discussion The absence of nosocomial transmission suggests that the implemented measures are adequate. These measures will need to be sustainable for the long term in order to ensure continued success. Conclusion Radiographers are a crucial part of the team in the fight against COVID-19 and are at risk of contracting COVID-19. Strict adherence to appropriate infection control measures is essential for the safety of Radiology staff and their patients, and the successful control of this pandemic.

Industrial printed circuit boards (PCBs) are nonhomogeneous and anisotropic composites consisting of copper traces, glass-reinforced epoxy laminate (FR-4), solder mask, vias, and other features. Past efforts to model the elastic behavior of PCBs involve either simplistic assumptions or complicated and detailed modeling. In this paper, a practical method that gives reasonably accurate predictions of PCB’s elastic deformation is proposed. Three micromechanics models for fibrous composite, namely, the Cox–Krenchel, modified Cox lamina, and Pan, were employed in computing the mechanical properties of an industrial PCB. Copper trace orientations were accounted for in the modified Cox lamina model. A homogenization scheme based on the micromechanics models was implemented via the finite-element method to predict the board elastic bending and shear responses. Four-point bend and shear tests were conducted to verify all the three models. It was found that the models predict the bending stiffness well but overestimate its shear stiffness. In-plane strains, however, are in good agreement with the experiments.

The coronavirus 2019 (COVID-19) outbreak poses a serious public health risk. To date, the disease has affected almost all countries in the world. The enormous scale of the outbreak and the relative lack of knowledge and information regarding a new virus, as well as the unpredictability of events, make it challenging for leadership teams to respond. This paper shares how we have reconfigured our radiology leadership team into a smaller disease outbreak task force (DOTF) to respond and coordinate all related efforts during this ongoing COVID-19 pandemic. The DOTF format is modelled after the military with domain groups looking at manpower, intelligence, operations, and logistics matters on a daily basis so that timely decisions can be made and action plans executed promptly. In managing the DOTF, discipline, flexibility, and teamwork are key principles, and these are built upon a strong foundation of focus on infection prevention and control, and patient and staff safety as well as staff well-being. The DOTF has positioned us well to confront the many challenges to date. We believe it will also help us navigate the complex issues that will arise with future surges in cases and in formulating strategies to manage exit from the present and future lockdowns. Key Points • In a pandemic, regular and directed meetings by a smaller leadership core group are required, for prompt decision making and execution of action plans. • The military format, with domain groups to look at manpower, intelligence, operations, and logistics matters, is useful in managing a pandemic. • Discipline, flexibility, and teamwork with strong focus on infection prevention and control, and patient and staff safety as well as staff well-being are key principles for leadership teams managing a pandemic.

Objectives This paper aims to share our experience in reorganising our general radiography service during the coronavirus disease (COVID-19) pandemic from the viewpoint of a large tertiary referral medical centre. Key findings Re-organization of the radiography workforce, patient segregation, and modification of routine radiographic practices are key measures to help radiographic services deal with the COVID-19 pandemic. Specific emphasis on deploying more mobile radiographic units, segregating equipment, developing consistent image acquisition workflows, and strict adherence to infection control protocols are paramount to minimize the possibility of in-hospital transmission and ensure a safe environment for both patients and staff. Streamlining communication channels between leadership and ground staff allows quick dissemination of information to ultimately facilitate safe provision of services. Conclusion COVID-19 has drastically altered the way general radiography teams provide services. The institution of several key measures will allow hospitals to safely and sustainably provide radiographic services. To date, there have been zero incidences of radiographer healthcare worker transmission within our institution during the course of work. Implication for practice Radiographers are facing the challenge of providing high-quality services while simultaneously minimizing pathogen exposure to staff and patients. Our experience may lend support to other radiographic services responding to the COVID-19 outbreak and serve as a blueprint for future infectious disease outbreak contingency plans.

Industrial printed circuit boards (PCB)s are composites with complex geometrical features. In this study, a homogenization scheme was proposed to model bending, i.e., the primary deformation mode of industrial PCBs. Four-point bend tests were conducted on two types of industrial PCBs to measure their bending stiffness in the longitudinal and the lateral directions, respectively. The experimental results showed significant anisotropy and non-uniformity in the mechanical properties of the PCBs. PCB modelling was performed using the finite element method and a zoning approach. Three micromechanics models, namely Cox-Krenchel model, modified Cox Lamina model and Pan model, were adopted. These models were compared to the classical rule of mixtures (ROM). Results showed that ROM and the micromechanics models gave the upper and the lower bounds, respectively, of the stiffness and overall response of the PCB in bending. Among the micromechanics model, Pan model gave the best prediction of elastic stiffness, at accuracy of more than 80%.

This study aims to explore the potential use of ultrasound in locating the second posterior sacral foramen acupuncture point, quantifying depth of insertion and describing surrounding anatomical structures. We performed acupuncture needle insertion on a study team member. There were four steps in our experiment. First, the acupuncturist located the acupuncture point by palpation. Second, we used an ultrasound machine to visualize the structures surrounding the location of the acupuncture point and measure the depth required for needle insertion. Third, the acupuncturist inserted the acupuncture needle into the acupuncture point at an angle of 30°. Fourth, we performed another ultrasound scan to ensure that the needle was in the desired location. Results suggested that ultrasound could be used to locate the acupuncture point and estimate the depth of needle insertion. The needle was inserted to a depth of 4.0 cm to reach the surface of the sacral foramen. Based on Pythagoras theorem, taking a needle insertion angle of 30° and a needle insertion depth of 4.0 cm, the estimated perpendicular depth is 1.8 cm. An ultrasound scan corroborated the depth of 1.85 cm. The use of an ultrasound-guided technique for needle insertion in acupuncture practice could help standardize the treatment. Clinicians and students would be able to visualize and measure the depth of the sacral foramen acupuncture point, to guide the depth of needle insertion. This methodological guide could also be used to create a standard treatment protocol for research. A similar mathematical guide could also be created for other acupuncture points in future.

Color Doppler imaging (CDI) can be used to noninvasively create images of human blood vessels and quantitatively evaluate blood flow in real-time. The purpose of this study was to assess the effects of acupuncture on the blood flow of the peripheral, mesenteric, and retrobulbar arteries by CDI. Statistical significance was defined as P values less than 0.05. Blood flow in the radial and brachial arteries was significantly lower during needle stimulation on LR3 than before in healthy volunteers, but was significantly higher after needle stimulation than before. LR3 stimulation also resulted in a significant decrease in the vascular resistance of the short posterior ciliary artery and no significant change of blood flow through the superior mesenteric artery (SMA) during acupuncture. In contrast, ST36 stimulation resulted in a significant increase in blood flow through the SMA and no significant change in the vascular resistance of the retrobulbar arteries. Additionally, acupuncture at previously determined acupoints in patients with open-angle glaucoma led to a significant reduction in the vascular resistance of the central retinal artery and short posterior ciliary artery. Our results suggest that acupuncture can affect blood flow of the peripheral, mesenteric, and retrobulbar arteries, and CDI can be useful to evaluate hemodynamic changes by acupuncture.

The objective of this study was to investigate the feasibility of using sonoelastography to depict Achilles tendon stiffness after platelet-rich plasma injection and eccentric exercise for chronic Achilles tendinopathy, and to correlate sonoelastography findings with clinical outcome up to 12 months after treatment. Forty-five Achilles tendons from 45 patients (33 males, 12 females; mean age 51 years) were examined using sonoelastography and ultrasound at baseline, 4–6 weeks, 6 months and 12 months post-treatment. The strain ratio (between Achilles tendon and Kager's fat) during sonoelastography was obtained. The proportion of tendons with hypoechogenicity and neovascularity were documented. Clinical outcomes were assessed by the Victorian Institute of Sport Assessment-Achilles questionnaire and correlated with sonographic findings. The Victorian Institute of Sport Assessment-Achilles improved significantly from 38.4 (±14.1) at baseline, 77.2 (±12.5) at 6 months ( p

It has been well established that lead-free solder underperforms conventional leaded solder in reliability under dynamic impact. Common failures observed on ball-grid-array (BGA) solder balls on chip under board level impact include bulk solder ductile failure, intermetallic (IMC) layer crack and pad-lift. In this work, a finite element modeling approach was proposed to model bulk solder ductile failure and intermetallic layer crack. The use of beam elements and connector elements to represent the bulk solders and board/component side intermetallic layers, respectively, offers the advantage of simplicity over the use of continuum elements and cohesive elements for solder joints. This approach enables the modeling of assembly level impact with significantly less computational resources. The model was verified by comparing its prediction of BGA solder reliability against actual test results in a dynamic four-point bend test. The physical tests consist of ball impact at varying heights on a board with a mounted chip, and the subsequent analysis of the failure modes of the BGA solder joints. Simulation results were in good agreement with test results. The study shows that it is feasible to model BGA solder joint ductile failure and intermetallic layer crack under impact with simple elements with reasonable accuracy.

Respiration-induced movement of abdominal organs hampers the targeting accuracy of non-invasive surgical techniques such as focused ultrasound surgery and radiosurgery. Unaccounted organ movement can result in either under dosage or damage to intervening healthy tissues. The respiration-induced movement is known to be significantly large in kidneys; however, the impact of abnormalities such as tumors and cysts on kidney movement is poorly understood. In this study, we quantified the movement patterns of kidneys in 48 normal and 62 affected kidneys (43 calcified cysts, 11 angiomyolipomas, 4 renal cell carcinomas and 4 polycystic kidneys) using ultrasound and simultaneously tracked the respiratory movement patterns using a stereo camera system. The kidneys were localized from 2-D ultrasound sequences using a template matching technique. The average movements of the right and left kidneys were, respectively, 24.54 ± 6.4 and 17.06 ± 3.66 mm in the superior-inferior and 13.62 ± 3.71 and 9.80 ± 3.32 mm in the transverse directions. Average movement in the superior-inferior direction of normal kidneys was greater than that of affected kidneys for both right (26.9 ± 5.1 vs. 22.6 ± 3.3, p 0.001) and left (17.8 ± 2.5 vs. 16.1 ± 4.2, p = 0.01) kidneys. On the basis of spatial extent of abnormality, affected kidneys were categorized as category A (10 mm in 26 patients), category B (10-20 mm in 22 patients) and category C (20 mm in 14 patients). Compared with normal patients, the extent of movement was significantly reduced in abnormal categories B (p 0.001) and C (p 0.001), but the change was not significant in category A (p = 0.04). Hysteresis plots of the kidneys revealed a maximum change of 12.3 mm. The movement patterns of the kidneys also closely correlated with the respiratory movement pattern (Pearson correlation = 0.89 [right] and 0.87 [left]). We expect that the movement pattern analyses and quantification carried out in this study would aid in developing movement adaptive surgical protocols for non-invasive treatment of kidney tumors/cancers.

Objective: To investigate the prevalence of sonographic abnormalities at the mid-Achilles tendon among a cohort of asymptomatic professional football players and to determine whether these sonographic abnormalities predict midportion Achilles tendon symptoms.Design: Longitudinal study. Setting: A single competitive season in the Australian Rules Football League. Participants: Forty-two elite Australian Rules football players. Main Outcome Measures: Using ultrasound and sonoelastography, 42 players were examined at baseline and again 9 months later (postseason) for the existence of intratendinous hypoechogenicity, delamination, softening, and neovascularization. The anterio-posterior (AP) thickness and cross-sectional area (CSA) were measured. Players reporting Achilles tendon pain or with Victorian Institute of Sports Assessment-Achilles scores below 80 at the end of the season were classified as symptomatic. Results: At preseason, ultrasound and/or sonoelastographic abnormalities were found in 22 (22/42, 52.4%) asymptomatic players. Baseline AP thickness and CSA were significantly greater in symptomatic players at the end season than those in asymptomatic players (0.57 ± 0.05 cm vs 0.50 ± 0.03 cm; P < 0.001 and 0.67 ± 0.07 cm2 vs 0.57 ± 0.06 cm2; P < 0.001, respectively). The presence of intratendinous softening and delaminations at baseline was associated with pain onset during the season (P = 0.046; P = 0.048, respectively). Conclusions: Ultrasound and sonoelastography–detected abnormalities were relatively common among the asymptomatic footballers. Greater AP thickness and CSA and also the presence of intratendinous softening and delaminations were associated with the increased risk of developing symptoms. Clinical Relevance: Conventional ultrasound supplement with sonoelastography may be able to identify elite athletes at risk of Achilles tendon injury, which may, in turn, impact therapeutic decisions. Refereed/Peer-reviewed

Objectives To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy. Design Cross-sectional study. Methods Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires. Results Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness ( p p =0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores ( p =0.098). Conclusions Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice.

Acupuncture has been found to relieve muscle stiffness effectively, especially after physical exercise.1 2 Previous studies have measured muscle stiffness pre- and post-acupuncture using a pressure scale1 or ‘muscle hardness meter’.2 Both of these methods estimate muscle stiffness based on the pressure required to compress muscle. Limitations of these devices include potential inaccuracy of measurement, as the distribution of muscle stiffness may be heterogeneous, as well as inability to visualise the muscle. Furthermore, changes in muscle stiffness during acupuncture needling cannot be evaluated. An ultrasound-based shear wave imaging technique has recently been developed to measure muscle stiffness.3 Benefits of using ultrasound include the ability to visualise the muscle under investigation and to quantify changes in muscle stiffness over time. Ultrasound as an imaging modality has many potential uses in acupuncture research and education,4 and can be successfully used to explore its physiological and physical effects.5 The aim of this study was to measure the effects of acupuncture needling on muscle stiffness using shear wave elastography. ### Acupuncture needle insertion We performed acupuncture needle insertion on two healthy volunteers (one male, one female) who were part of the study team. The acupuncture point used …

To determine the prevalence of morphological and mechanical stiffness alterations at the mid Achilles tendon in asymptomatic marathon runners before and after a competition. To assess the relationship between pre-existing Achilles tendon alterations and pain after running. All marathon runners from a local running club who were participating in the Melbourne Marathon 2013 (full marathon category) were invited for conventional ultrasound and sonoelastography 1 week leading up to the marathon and again within 3 days post-marathon. Another group of active, healthy individuals not involved in running activities were recruited as controls. Intratendinous morphological (tendon thickness, hypoechogenicities), Doppler as well as stiffness properties of the Achilles were recorded. Achilles tendon pain was evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A). Twenty-one asymptomatic runners (42 Achilles tendons) and 20 healthy controls (40 Achilles tendons) were examined. On the pre-marathon evaluation, runners showed significantly more morphological changes on B-mode ultrasound compared to the controls (p

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

We report a case of rare Castleman's disease of the kidney that mimicked a renal neoplasm with emphasis on the imaging and histologic findings. A 47-year-old man presented with dyspeptic symptoms. Ultrasound revealed a vascular, heterogeneous mass in the left kidney. Multiphasic CT scan confirmed an enhancing lesion with enlarged left para-aortic lymph nodes suspicious for nodal metastases. The provisional diagnosis was renal cell carcinoma. Percutaneous biopsy yielded a diagnosis of Castleman's disease of the hyaline-vascular type. Despite advancement in imaging modalities, differentiation of hyaline-vascular variant of Castleman's disease from hypervascular renal neoplasm remains difficult and the final diagnosis requires histopathological confirmation. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:438–442, 2015

The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79 %; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm2). There was a good correlation between the severity of NCS and CSA (r = 0.78, p

OBJECTIVE Plantar fasciosis is a common complaint of athletes, particularly for runners. The medial calcaneal nerve (MCN) may play a role in the pain syndrome, and radiofrequency (RF) denervation has been previously reported. The hypothesis is that ultrasound-guided denervation of the MCN results in symptomatic improvement. DESIGN Retrospective cohort. SETTING Private practice. PATIENTS Twenty-nine patients previously receiving ultrasound-guided RF denervation of the MCN, having failed conservative therapy, were assessed in 2 groups, those more than (group 1, n = 16) or less than (group 2, n = 13) 6 months since the procedure. INTERVENTIONS Ultrasound-guided RF denervation of the MCN. MAIN OUTCOME MEASURES Pain scores before denervation, as well as at maximal pain relief and the time of the interview. Levels of satisfaction and attitudes toward surgery were also assessed. RESULTS Pain scores decreased significantly in both groups, for both best and residual pain scores. Group 1 mean pain scores were 8.56 before procedure, 2.81 (P < 0.001 compared to baseline) at best pain score, and 3.75 (P < 0.01) residual pain score. Group 2 mean pain scores were 7.23 before procedure, 3.77 (P < 0.01) at best pain score and 4.92 (P < 0.01) residual pain score. Levels of satisfaction were predominantly positive (69% of group 1% and 54% of group 2 were either somewhat or very satisfied), with attitudes toward surgery unchanged. CONCLUSIONS For patients with refractory plantar heel pain, ultrasound-guided denervation of the MCN can potentially improve symptoms, although efficacy needs assessing in comparative studies. CLINICAL RELEVANCE Ultrasound-guided denervation of the MCN provides a further management option for patients with refractory plantar fasciosis.

Aim: Research is a key component of evidence-based medical imaging. Good knowledge and attitude towards research is important in implementing the paradigm shift from the traditional model of practice to evidence-based practice. The aim of this study was to ascertain the attitude, level of awareness and knowledge of radiographers about research. Potential barriers might also be identified so that programmes and schemes could be developed to raise the profile of research in clinical practice. Methods: A 20-item scale self-completion questionnaire was designed and distributed to radiographers in the Department of Diagnostic Radiology, SGH. The questionnaire consisted of questions pertaining to years of working experience, specialization of practice, role/involvement in any research, training needs and identification of potential barriers to research. Results: The final response rate was 67% (N ¼ 114). Although the involvement in research is 39% (N ¼ 44), the radiographers strongly believed that it is essential for them to participate in research to develop themselves and the profession, as well as to improve the quality of care delivered to patients. The main identified perceived barriers to research included lack of time, resources and heavy clinical workload. Sixty-four percent (N ¼ 73) of participants indicated that provision of courses would improve their research skills, such as research methodology, biostatistics, literature critique, and a lack of these could be some of the reasons for low research involvement among radiographers. Conclusions: The data suggest that positive attitudes, institutional support and provision of research related courses are needed to increase radiographers’ involvement in research.

Purpose: The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference. Materials and Methods: Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference. Results: Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P

Objectives Forearm injuries are common and debilitating to elite rowers. Chronic exertional compartment syndrome, intersection syndrome and proximal radial bone stress injuries have been documented in this population. This paper explores the imaging findings related to these conditions in asymptomatic elite rowers. Design Observational study. Methods 19 asymptomatic senior elite and under-23 rowers currently competing at National level or above underwent ultrasound (US), Magnetic Resonance Imaging (MRI) and muscle functional MRI evaluation of their forearms. A comprehensive evaluation sheet identifying characteristics of bone stress, intersection syndrome and chronic exertional compartment syndrome was utilised based on a literature search and review by senior clinicians working with this population. Results Peritendinous fluid of Extensor Carpi Radialis Longus ( n =10, 53%) or Extensor Carpi Radialis Brevis ( n =6, 32%) was a common finding on US. MRI had a higher rate of identification than US. Extensor Digitorum (Coeff=−1.76, 95%CI −3.04 to −0.49), Flexor Carpi Radialis (Coeff=−2.86, 95%CI −5.35 to −0.38) and Flexor Carpi Ulnaris (Coeff=−3.31, 95%CI −5.30 to −1.32), Pronator Teres (Coeff=−3.94, 95%CI −6.89 to −0.99), and Supinator (Coeff=−168, 95%CI −3.28 to −0.02) showed statistically significant changes immediately post-exercise. Mild proximal radial marrow hyperintensity was present ( n =15, 78.9%) with three participants (15.8%) also having mild periosteal oedema of the radius. Conclusions Imaging findings commonly seen in symptomatic populations are observed in elite, asymptomatic rowers. Care should be taken when diagnosing bone stress injuries, intersection syndrome and compartment syndrome on imaging findings alone. Data presented can be utilised as a normative dataset for future case studies.

This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p0.05), compared with B-mode US (κ = 0.74, p0.05) and color Doppler imaging (κ = 0.49, p0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties.

We report a case of rare Castleman's disease of the kidney that mimicked a renal neoplasm with emphasis on the imaging and histologic findings. A 47-year-old man presented with dyspeptic symptoms. Ultrasound revealed a vascular, heterogeneous mass in the left kidney. Multiphasic CT scan confirmed an enhancing lesion with enlarged left para-aortic lymph nodes suspicious for nodal metastases. The provisional diagnosis was renal cell carcinoma. Percutaneous biopsy yielded a diagnosis of Castleman's disease of the hyaline-vascular type. Despite advancement in imaging modalities, differentiation of hyaline-vascular variant of Castleman's disease from hypervascular renal neoplasm remains difficult and the final diagnosis requires histopathological confirmation.

Injury to a tendon leads to alterations in the mechanical properties of the tendon. Axial-strain sonoelastography and shear-wave elastography are relatively new, real-time imaging techniques that evaluate the mechanical properties of tendons in addition to the existing morphological and vascular information that is obtained with traditional imaging tools. Axial-strain sonoelastography displays the subjective distribution of strain data on an elastogram caused by tissue compression, whereas shear-wave elastography provides a more objective, quantitative measure of the intrinsic tissue elasticity using the acoustic push-pulse. Recent studies suggest that axial-strain sonoelastography is able to distinguish between asymptomatic and diseased tendons, and is potentially more sensitive than conventional ultrasound in detecting early tendinopathy. Shear-wave elastography seems to be a feasible tool for depicting elasticity and functional recovery of tendons after surgical management. While initial results have been promising, axial-strain sonoelastography and shear-wave elastography have not yet found routine use in wider clinical practice. Possible barriers to the dissemination of axial-strain sonoelastography technique include operator dependency, technical limitations such as artefacts and lack of reproducibility and quantification of sonoelastography data. Shear-wave elastography may improve the reproducibility of elastography data, although there is only one published study on the topic to date. Large-scale longitudinal studies are needed to further elucidate the clinical relevance and potential applications of axial-strain sonoelastography and shear-wave elastography in diagnosing, predicting, and monitoring the progress of tendon healing before they can be widely adopted into routine clinical practice.

Around 50% of the population harbour thyroid nodules on ultrasonography, up to 7% of which may be malignant irrespective of size. While fine-needle aspiration biopsy is reliable, subjecting every thyroid nodule to this procedure is not cost-effective. Hence, ultrasonography is used primarily to characterise thyroid nodules, whereas nodules that have suspicious features are subject to a fine-needle aspiration biopsy. The presence of microcalcifications, macrocalcifications, irregular margins, 'taller-than-wide' shape, marked hypoechogenicity and intrinsic vascularity are features that render a thyroid nodule suspicious for malignancy. Spongiform appearance and the presence of colloid plugs or purely cystic nodules are considered features of benignity. In this article, these aforementioned sonographic features of malignancy and benignity are pictorially illustrated and a basic approach to dealing with solitary and multiple thyroid nodules is highlighted.

The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference.Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference.Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P0.05).Our early experience has shown that CEUS can be accurate in differentiating malignant from benign FLLs and may become a useful first-line imaging tool where CT or MRI are not available or contra-indicated.