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The comprehensive description of the zonal anatomy of the prostate as developed by McNeal has identified the likely sites of cancer within the gland and provided further understanding of the way in which prostate tumors spread. Two areas where the capsule is deficient have been described: the invaginated extraprostatic space and the apex of the prostate, both of which are easy avenues along which tumor may escape the confines of the prostate. Cancer of the prostate is hypoechoic in comparison with the normal peripheral zone tissue in all cases and can be diagnosed with great accuracy by the use of ultrasound-guided biopsies. The sensitivity of transrectal ultrasound in the diagnosis of prostate cancer is twice that of digital rectal examination. In our clinical study, the overall positive predictive value of a hypoechoic lesion was 41 per cent, and it increased to 61 per cent when combined with the finding of a positive digital rectal examination and to 52 per cent if the prostate-specific antigen level was elevated. Thirty-two per cent of the cancers diagnosed with transrectal ultrasound were not detectable by digital rectal examinations.

A case of massive fetal intracerebral hemorrhage diagnosed by sonography in the 32nd week of pregnancy is reported. The stillborn male fetus, electively delivered two days later, underwent postmortem examination, which confirmed the sonographic findings. The lesion appeared to arise from both the internal carotid and basivertebral arterial systems.

Transrectal ultrasonography is a technique that is gaining popularity in the assessment of rectal and extrarectal disease. From April 1987 to May 1989, 53 transrectal sonograms were done to evaluate rectal disease. Twenty-seven of 30 adenocarcinomas have been correctly staged. The operative procedure and the decision to use preoperative radiotherapy have been influenced by the results of these studies. Recurrent tumors and less common anorectal disease have also been evaluated with this technique. When feasible to perform, ultrasonographically guided biopsies yield specimens that can provide added information on which to base a therapeutic approach.

A practical program to train family physicians in obstetric ultrasound was tested with 13 family physicians. Each physician completed 6.5 days of course work and ultrasound laboratory apprenticeship prior to beginning a clinical preceptorship of approximately 14 months' duration. During the clinical preceptorship the physicians performed ultrasound studies in their own offices. All studies were reviewed by a local consultant radiologist utilizing examination data sheets and videotapes. At the conclusion of the training program, the physicians took a combined practical and written proficiency examination administered by an independent sonographer. Eight physicians completed the training, performing during the preceptorship an average of 78 examinations. The rated performance of the physicians improved markedly over the course of the preceptorship. During the last segment of the preceptorship the radiologist preceptors rated 94 percent of the ultrasound studies as acceptable, compared with 79 percent rated acceptable at the beginning of the preceptorship. Seven of the eight physicians completing the protocol took the proficiency examination: all passed. This study can provide a blueprint for an individual family physician to design his own training, or it can guide an academic department of family medicine in developing and evaluating ultrasound training programs for residents and practicing physicians.