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Utilization of musculoskeletal ultrasound, in particular for sports medicine, has dramatically increased in recent years. Ultrasound is an important adjunct tool to physical examination and other imaging methods in the evaluation and management of the injured athlete. It offers unique advantages in specific clinical scenarios. Dedicated training and a standardized scanning technique are important to overcome the inherent operator dependence and avoid diagnostic pitfalls. Ultrasound guidance can also improve accuracy in targeted percutaneous injection therapies. This article reviews the general ultrasound appearance of muscle, tendon, ligament, and nerve abnormalities in the athlete with a focus on sport-specific injuries.

Critical care ultrasonography allows rapid bedside assessment and monitoring of severely ill patients. It provides important information on a real-time basis for patients' management and clinical decision-making, leading to improvements in delivered quality of care. Provision of this service is not possible without appropriate equipment. This document recommends minimum standards for ultrasound equipment required for use in intensive care units in Australia and New Zealand.

To be a successful ultrasound practitioner, it is imperative to have a sound knowledge of the principles of ultrasound and the equipment (machine and probes) being used. The patient being examined and most importantly their body habitus needs to be considered. In addition, an awareness of general ultrasound scanning principles is necessary. In this chapter, we will go through this briefly. This book’s purpose is to provide a very practical and hands on guide to the use of musculo-skeletal ultrasound in rheumatology, so the descriptions of the physics are not completely exhaustive.

In general ultrasound (USG) serves as the first-line imaging modality for diseases of the thyroid and parathyroid gland. Currently, in the hands of a surgeon, USG not only provides invaluable data about nodular thyroid disease and parathyroid adenomas but plays a crucial role in the preoperative and intraoperative setting to design minimal-sized incisions for the best cosmetic effect and to guide invasive procedures with higher diagnostic accuracy. Moreover, routine use of USG after positioning results in designing the most appropriate incision for focused parathyroidectomy. The confirmatory USG scanning of the neck region by the surgeon after removal of the predicted lesion is of paramount importance acting as an insurance policy for the surgeon. Beyond the initial diagnosis, in recurrent malignant cases, the surgeon-performed intraoperative USG is a safe way to detect and visualize nonpalpable, subcentimeter lymph nodes in an adequate fashion which is otherwise a great dilemma for the surgeon. As for the issue of recurrence in a previously dissected compartment, surgeon-performed intraoperative USG directed focused dissection is one of the best approaches warranted. The most critical point to be emphasized is that surgeon-performed thyroid, and parathyroid USG requires training, validation, experience, and establishment of competency.

The Fabry-Perot (FP) polymer film sensor can detect ultrasound over a broadband frequency range (tens of MHz), with small element sizes (tens of microns), and high sensitivity. It has been used extensively in photoacoustic imaging as well as general ultrasound field characterisation. Although it will clearly affect the ultrasound field measurements, the directional response of the sensor has not been widely studied. The objective of this work was to develop an analytical model to study how the various wave types propagating in the multilayer FP sensor affect the directionality. This is critical to optimise the design of the FP sensor, and to reduce sensor-related image artefacts.

Introduction Being an affordable and effective diagnostic tool1, ultrasound can be carried out at different clinical settings, ranging from small clinics to large hospitals with elaborate emergency rooms. It is crucial for health practitioners and sonographers to recognize and convey critical abnormal findings, as delay in diagnosis may result in prolonged hospitalization and complications of patient's condition2. This poster aims to illustrate sonographic features of critical illnesses to help sonographers and medical trainees in their recognition of urgent sonographic findings. The importance of providing immediate attention to the cases will also be elaborated. Learning Objectives This didactic exhibit aims to • Illustrate and discuss sonographic features which require immediate medical attention and; • Highlight the importance of such findings and alert the medical team to expedite management Materials General ultrasound cases performed by the radiology department in Sengkang General Hospital from 2016 to 2019 were retrospectively reviewed and correlated with available interventions and/or imaging to confirm critical sonographic findings. Conclusion Sonographers are encouraged to recognise sonographic findings which can help expedite appropriate patient care resulting in better patient outcome and reduced morbidity.

ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group).DesignA discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks.SettingWest Midlands, England.Participants524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire.Outcome measuresCoefficients for attributes in relation to their reference levels.ResultsThe AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by specialists, devices with a lower risk of underdiagnosis and receiving their results at the appointment where the scan takes place. The general group had a strong preference for the person performing the scan to know their medical history.ConclusionsPatients being scanned for general abdominal conditions prefer to be scanned in a general practice by practitioners who know their medical history. Patients undergoing surveillance of AAA size prefer to be scanned in a hospital setting. Both groups would prefer to be informed of the scan results as soon as possible. Further research is required to explore the clinical scenarios in which targeted scanning by community practitioners would be of benefit to patients.

To assess the effectiveness of general ultrasound screening to prevent first operative procedures of the hip.We conducted a case-control study in a population in which general ultrasound screening supplementing clinical screening is recommended and offered free of charge for all children. Participation in ultrasound screening before week 7 as recommended in Germany was the exposure of interest. Case ascertainment was based on active surveillance in orthopedic hospitals. The case definition was: first operative procedure for developmental dysplasia of the hip (closed reduction, open reduction, or osteotomy) in children9 weeks old and5 years old and born between 1996 and 2001. Control subjects from the same birth cohorts were recruited in telephone surveys.Cases of first operative procedures for developmental dysplasia of the hip (n = 446) were compared with 1173 control subjects for ultrasound screening. Effectiveness of ultrasound screening to prevent first operative procedures for developmental dysplasia of the hip was estimated as 52% (95% CI, 32-67). Effectiveness did not vary substantially for closed and open reductions and osteotomy.General ultrasound screening reduces the rate of operative procedures for developmental dysplasia of the hip; the impact on developmental dysplasia of the hip. Treatment rates and avascular necrosis need further assessment to balance the benefit against potential overtreatment and adverse effects.

To determine the changes in corneal properties induced by riboflavin-ultraviolet A (UVA) irradiation using a noninvasive ultrasound (US) method in a porcine eye model.Department of Biomedical Engineering, Ohio State University, Columbus, Ohio, USA.Fresh porcine globes acquired within 24 hours postmortem were divided into equal groups. In the collagen crosslinking (CXL) group, the globes were irradiated with UVA in combination with riboflavin application following the standard protocol. The control group had the same procedures as the CXL group but with no UVA irradiation. Corneal properties were measured before and after treatments in both groups using a quantitative US method. Changes in corneal thickness, density, and stiffness were examined and the difference between the changes in the CXL group and the control group was analyzed.Each group comprised 14 porcine globes. After riboflavin-UVA treatment, there was a significant increase in corneal stiffness (mean 2.59 +/- 0.08 GPa before and 2.70 +/- 0.08 GPa after CXL) (P.001) and in the speed of sound in corneal tissue (1557 +/- 23 m/s versus 1588 +/- 22 m/s) (P.001). There was no significant change in corneal stiffness or in the speed of sound in the control group. Corneal thickness increased significantly after the treatment in both groups. No significant change in corneal density was observed in either group.Corneal stiffness increased after riboflavin-UVA CXL, a finding detected using a noninvasive US technique.Dr. Liu has filed a patent application for the general ultrasound technique used in the study. No other author has a financial or proprietary interest in any material or method mentioned.

The features and issues regarding clinical waiting lists in general and general ultrasound waiting lists in particular are reviewed, and operational aspects of providing a general ultrasound service are also discussed. A case study is presented describing a service improvement intervention in a UK NHS hospital’s ultrasound department, from which arises requirements for a predictive planning model for an ultrasound waiting list. In the course of this, it becomes apparent that a booking system is a more appropriate way of describing the waiting list than a conventional queue. Distinctive features are identified from the literature and the case study as the basis for a predictive model, and a discrete event simulation model is presented which incorporates the distinctive features.

By means of a retrospective analysis of the hospital reports of 107 children with 131 dislocated hips we investigated the influence of ultrasound examination on the diagnosis and therapy of congenital dislocation of the hip. We could show, that although the ultrasound examination had increased since 1985 the number of dislocated hips receded only little. However the diagnosis was made earlier in children who had been examined by ultrasound. In these children operative reposition of the dislocated hip had to be performed less frequently compared to the unexamined children. Several case reports are given to demonstrate typical faults in ultrasound diagnostics and treatment of congenital hip dislocation. Our results support the call for a general ultrasound screening of the newborn hip.

Purpose To ascertain changes in the utilization rates of diagnostic ultrasound among radiologists, cardiologists, and other physicians in recent years. Methods and materials The nationwide Medicare Part B databases for 1993 and 2001 were searched in all ultrasound Current Procedural Terminology 4 codes, except for ophthalmic ultrasound and supervision and interpretation codes. Ultrasound examinations were categorized as general, vascular, breast, obstetric (very low in the Medicare population), and echocardiography. Using the Medicare physician specialty codes, utilization rates per thousand Medicare beneficiaries per year were calculated for radiologists, cardiologists, and other physicians for all codes in the five aforementioned categories. Results Radiologists performed 24% of all ultrasound examinations in 2001. The overall utilization rate of ultrasound examinations among radiologists increased from 132.9 per thousand Medicare beneficiaries in 1993 to 166.3 in 2001, a 25% increase. Among cardiologists, the rate increased from 190.3 in 1993 to 356.1 in 2001, an 87% increase. The vast bulk of these examinations were echocardiograms, but cardiologists also had some involvement in vascular ultrasound. Among other physicians, the rate increased from 116.9 in 1993 to 167.0 in 2001, a 43% increase. The areas of greatest involvement by these other physicians were echocardiography, vascular ultrasound, and general ultrasound. Of the five ultrasound categories, echocardiography had by far the highest volume. Conclusion Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography. Between 1993 and 2001, the ultrasound utilization rate grew over 3 times as rapidly among cardiologists as among radiologists; the rate among other physicians grew almost twice as rapidly as it did among radiologists. This raises the concern that self-referral may be leading to higher utilization and costs.

The use of ultrasonography in medical practice has evolved dramatically over the last few decades and will continue to improve as technological advances are incorporated into daily medical practice. Although ultrasound machine size and equipment have evolved, the basic principles and fundamental functions have remained essentially the same. This article reviews the general ultrasound apparatus design, the most common probe types available, and the system controls used to manipulate the images obtained. Becoming familiar with the machine and the controls used for image generation optimizes the scans being performed and enhances the use of ultrasound in patient care.

1656 newborns were examined by ultrasound for early diagnosis of CDH in a screening program. In 2.5% of the cases, dysplasia or dislocation of the hip was diagnosed and required treatment. In all cases the final outcome after adequate treatment showed a hip joint without any abnormalities. 11.3% of type IIa-hips (using Graf's classification) did not reach an alpha-angle of 60 degrees until the 12th week. They were then therefore classified as type IIb. 97% of all hip joints were judged as normal in the course of the 4th month. This study emphasizes the necessity of a general ultrasound screening program. It also demonstrated that early and adequate treatment leads to a normal development of the joint.

Prevention of disease transmission by cross infection is very important in the hospital environment to protect both staff and patients.At the present time most hospitals have stringent infection control policies which are largely geared toward the wards, critical care units and the operating theatres but there does not appear to be specific guidelines for ultrasound departments. Considering the contact nature of the ultrasound examination and the large number of tests that are performed in most hospitals annually it was felt that this was an area that needed to be addressed. One must be aware not only of protection of patients and staff but also of care in the cleaning of expensive equipment.We undertook a national survey of the larger general ultrasound departments, vascular and cardiac laboratories to establish current practices and to assess whether these are adequate. We also contacted a number of ultrasound companies and requested cleaning specifications for their equipment.The full results of the survey, the biological effectiveness of different cleaning techniques and their compatibility with ultrasound transducers will be discussed. Finally, recommendations regarding safe effective cleaning procedures and sensible infection control precautions in ultrasound departments will be made.

“General ultrasound” has become assimilated into abdominal ultrasound over the years. Although this is a modest part of critical ultrasound, we will begin with this classical field and provide the young physician with a better understanding of the abdominal examination. This chapter includes only notions useful for managing critical situations.

Background: A research study in the Netherlands showed that general ultrasound (US) screening was cost-effective in the detection of developmental dysplasia of the hip (DDH). This study was followed by a pilot implementation study. Part of this pilot implementation study is to investigate whether professionals of the infant health care (IHC) system, with no previous US experience, would be able to perform US of the hip. Objective: This study looks at health care worker ability to classify US images into a modified Graf system. Materials and methods: After theoretical and practical training, seven nurses and physicians of the participating IHC centers reported their findings on sonographic images of 80 children. This was repeated five months later. From the two evaluation moments the intraobserver agreement and the interobserver agreement was determined. Results: The average estimated interobserver Cohen’s kappa for both sessions was for nurses 0.6 and for physicians 0.5. The second evaluation showed a decrease from an average of 4.3% missed cases per screener to 2.3% and an increase of an average of 5% false positives per screener to 9.1%. Conclusion: The inter- and intra-observer agreement is comparable to similar studies in which the participants had a professional background in US examination. The level of agreement of the trainees in the perspective of the screening process was considered sufficient for the pilot implementation project.

The replacement of common organic solvents by room-temperature ionic liquids (RTILs) is a topical subject in both academia and industry. In the last decades, the number of applications for RTILs has followed an exponential curve and spilled over the boundaries of chemistry. Still, one of the main drawbacks of these compounds is their difficult access. The present ultrasound-assisted method affords a general and easy access to a large variety of room-temperature ionic liquids.

A general ultrasound service has evolved over several years. Radiographers undertake the general ultrasound lists, and show the request card and the hard copy films to a radiologist prior to the patient leaving the department. Whilst it is generally accepted for radiographers to carry the burden of obstetric scanning, this is less so for general work. This audit is of a sample of 100 patients out of the general ultrasound lists. These patients underwent the standard service examination by a radiographer and subsequent report by the radiologist. They also had a separate examination and report by an independent radiologist. 42 patients were agreed to have normal findings. 75 diagnoses or observations were made in the remaining 58 patients. Discrepancies arose between the two limbs of the audit in 20 of the observations. Review of the hard copy films and repeat scanning of patients where necessary identified one relevant error by the auditing radiologist and three relevant errors by the standard service. Whilst errors are made both by radiologists and radiographers, it is concluded that the existing radiographer based ultrasound service provides a satisfactory level of accuracy.

This atlas was designed to give an overview of the appearance on ultrasound of pathological entities in the upper and lower extremities. The book begins with a section on the general ultrasound appearance of various structures in the body. The normal as well as the pathological appearance of muscles, bones, bursae, capsules, cartilage, neurovascular structures, and skin is discussed. The images are well presented. However, as stated in the …

Through-the-lid eye scanning with general ultrasound equipment was initiated in a District General Hospital, to determine whether the technique is accurate in diagnosing ocular pathology. Two hundred consecutive scans were carried out on 184 patients. The examination was simple to perform with production of good images. One hundred and thirty-eight abnormalities were demonstrated, 80 of which were not previously known, with one false positive. The latter was an incorrect interpretation of an abnormal scan, which was diagnosed as a tumour but proved to be a haemorrhage. Ninety-four scans were negative, four of which were false negatives. Three of these were small, almost resolved vitreous haemorrhages, and one was a small melanoma. The method proved sensitive (92%) and specific (99%) in the detection and exclusion of intra-ocular disease. The investigation is, therefore, within the scope of the radiologist who does not have access to dedicated equipment.

A prospective study was made to evaluate whether bedrest in hospital is beneficial in pregnancies where intra-uterine growth retardation (IUGR) was suspected. Diagnosis was based on routine fetometry at 32 weeks of gestation, in conjunction with general ultrasound screening. 107 patients with suspected IUGR-pregnancies were divided into two groups, 49 in a hospital bedrest group and 58 in an 'out-patient' group. Fifteen women in the bedrest group refused hospitalization, and 8 women in the out-patient group had to be hospitalized for medical reasons other than suspected growth retardation, leaving 79% of the women in their allocated group. The women in the bedrest group were hospitalized for a mean duration of 29.2 days (range 5-54). The results suggest that bedrest in hospital is not beneficial, either to fetal growth or to pregnancy outcome.

For most ultrasound sections and especially for those who are just beginning intraoperative ultrasound, it will be necessary to perform these studies with scanners brought from the general ultrasound section. The purpose of this article is to familiarize sonographers with the preparation of equipment for intraoperative ultrasound: choosing and sterilizing the most appropriate transducer, and ensuring that the scanner is clean and electrically safe for operating room use.

Background Diagnosis and early treatment of developmental dysplasia of the hip (DDH) continue to be issues of discussion. In 1992, a nationwide general ultrasound screening program using Graf technique was introduced to detect DDH in Austria. We investigated the effects of this program on the rates of operative and conservative interventions and the influence of the program on the number of hospital admissions for the treatment of DDH. Methods All cases of DDH documented in Austrian hospitals from 1992 to 2008 were included in this retrospective study. The database of the Austrian Ministry of Health was used to extract documented diagnoses and treatments. Results Since the introduction of the screening program, the number of patients who require pelvic surgery to treat DDH has decreased by 46 % and the number of open reductions is as low as 0.16 per 1,000 live births. Hospital admissions for the treatment of DDH decreased from 9.5 to 3.6 per 1,000 live births. All noted results gained statistical significance. Conclusion Compared with routine clinically based screening programs, our results confirm low numbers of open reductions and pelvic surgeries. We, therefore, advocate a standardized nationwide general ultrasound screening program to reduce the rates of operative interventions and hospital admissions associated with the treatment of DDH. Level of evidence Level III, diagnostic