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Introduction: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported.Methods: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance. We performed systematic searches in MEDLINE and Embase for original, primary data articles from January 2012–June 2021 comparing the efficacy of POCUS performed by EPs to the local standard. Quality Assessment of Diagnostic Accuracy Studies-2 for individual articles are reported. We obtained summary measures of sensitivity, specificity, and their corresponding 95% confidence intervals (CI) using bivariate mixed-effects regression models. We performed meta-regression, subgroup, and sensitivity analyses as planned in the protocol CRD42021268799 submitted to PROSPERO.Results: Fifteen publications fit the inclusion criteria, totaling 2,511 examinations. Pooled sensitivity and specificity were 90% (95% CI 82%–95%) and 95% (CI 91%–97%), respectively. Subgroup analyses by EP experience found significantly better accuracy for exams performed by EP specialists (93%, CI 88%–97%) vs trainees (77%, CI 60%–94%). Specificity for EP specialists (97%, CI 94%–99%) was higher than for trainees (87%, CI 76%–99%, P = 0.01). Three-point compression ultrasound (CUS) was more sensitive than two-point CUS but was only statistically significant when limited to EP specialists (92% vs 88%, P = 0.07, and 95% vs 88%, P = 0.02, respectively).Conclusion: Point-of-care ultrasound performed by emergency physicians is sensitive and specific for the diagnosis of suspected DVT when performed by trained attending EPs. Three-point compression ultrasound examination may be more sensitive than two-point CUS.

Introduction: Imaging fibroid vascularity may predict fibroid growth and aid to determine most appropriate therapy. Microvascular (MV) flow imaging is relatively new and is able to detect slow flow in small vessels. Data on feasibility, reproducibility, and reliability of MV‐flow imaging in fibroids is lacking. The purpose of our study was to determine the reproducibility of MV‐flow imaging and to explore this technique for clinical practice for assessing blood flow in fibroids. Material and Methods: Thirty patients with one or multiple fibroids (diameter 1.5–12.0 cm) were prospectively included. Transvaginal ultrasound scanning was performed in B‐mode, 2D MV‐Flow™, 2D and 3D power Doppler mode (HERA W10, Samsung) by two experienced gynecologists at a tertiary care clinic from February to December 2021. The primary outcome was intra‐ and interobserver agreement of the vascular index (VI) and color score (CS). The following parameters: '2D MV‐flow VI', '3DPD VI', '2D MV‐flow CS' and '2DPD CS' were measured offline in the center, pseudocapsule, and entire fibroid. Secondary offline outcomes for exploring 2D MV‐flow for clinical practice, included (1) ability to discern vascular structures, (2) assessing the degree of vascularity via CS and calculating a VI, and (3) determining penetration depth of the ultrasound signal in both power Doppler and MV‐flow imaging. Results: All scans of the 30 included patients were of sufficient quality to analyze. Inter‐ and intra‐observer correlations of all studied parameters were good to excellent, both for 2D MV‐flow and 2D power Doppler (intercorrelation coefficient 0.992–0.996). Using 2D MV‐flow different vascular structures were visible in detail, in contrary to using 2D and 3D power Doppler. In significantly more fibroids central flow could be visualized using 2D MV‐flow (63%) than with 2D power Doppler (13%, p = 0.001). Finally, penetration of the ultrasound signal was deeper using 2D MV‐flow (3.92 cm) than with 2D power Doppler (2.95 cm, p = 0.001). Conclusions: Using 2D MV‐flow imaging for determining vascularity is highly reproducible. It has potential added value for clinical practice as it depicts detailed vascular structures and the degree of vascularity, especially in the center of the fibroid. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of preoperative sonographic staging in patients with primary invasive breast cancer. Methods: We retrospectively analyzed a prospectively kept service database of patients with newly diagnosed, unifocal, cT1-3, invasive breast cancer. All patients were diagnosed at a single center institution between January 2013 and December 2021. Clinical T stage was assessed preoperatively by ultrasound and correlated with the definite postoperative pathologic T stage. Demographics, clinical and pathological characteristics were collected. Factors influencing accuracy, over- and underdiagnosis of sonographic staging were analyzed with multivariable regression analysis. Results: A total of 2478 patients were included in the analysis. Median patients' age was 65 years. 1577 patients (63.6%) had clinical T1 stage, 864 (34.9%) T2 and 37 (1.5%) T3 stage. The overall accuracy of sonography and histology was 76.5% (n = 1896), overestimation was observed in 9.1% (n = 225) of all cases, while underestimation occurred in 14.4% (n = 357) of all cases. Accuracy increased when clinical tumor stage cT was higher (OR 1.23; 95% CI 1.10–1.38, p ≤ 0.001). The highest accuracy was seen for patients with T2 stage (82.8%). The accuracy was lower in Luminal B tumors compared to Luminal A tumors (OR 0.71; 95% CI 0.59–0.87, p ≤ 0.001). We could not find any association between sonographic accuracy in HER2 positive patients, and demographic characteristics, or tumor-related factors. Conclusion: Our unicentric study showed a high accuracy of sonography in predicting T stage, especially for tumors with clinical T2 stage. Tumor stage and biological tumor factors do affect the accuracy of sonographic staging. [ABSTRACT FROM AUTHOR]

Summary: Point‐of‐care ultrasonography is a powerful tool for the practitioner in determining diagnosis and prognosis in unwell horses. Proper case selection and patient preparation are keys to successful ultrasonographic examinations of the equine thorax and abdomen. Practitioners can expand the use of their equipment to augment evaluations for multiple clinical complaints. The most common application for body cavity ultrasonography in the adult horse is acute abdominal pain. [ABSTRACT FROM AUTHOR]

Introduction: The job of sonographers exposes them to numerous ergonomic risk factors, making the sonography profession one of the high-risk job groups vulnerable to musculoskeletal disorders (MSDs). The present systematic review and meta-analysis specifically examined the prevalence of MSDs among sonographers. Materials and methods: The present review study was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The protocol of the study was registered in the international prospective register of systematic review (PROSPERO) with the code CRD42024507972. Searches were conducted in databases including PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar, without imposing a time limit until February 7th, 2024. The random-effects model was employed for meta-analysis, and the I2 index was used to assess heterogeneity among studies. Finally, data analysis was performed using STATA (version 14). Results: Based on the search in different databases, a total of 4367 articles were identified. Finally, after screening, selecting, and quality evaluation of the studies, 30 studies were considered for meta-analysis in which 13,916 sonographers were examined. According to the results of the meta-analysis, the overall prevalence of MSDs among sonographers was reported as 75.80% (95% CI: 65.37–86.23, I2 = 99.7%, P < 0.001). Additionally, the prevalence rates of these disorders in the neck (63.73%), shoulder (60.13%), upper back (53.69%), lower back (49.84%), wrist (44.41%), elbow (27.46), hip (24.93%), knee (19.59), and ankle (16.92%) were determined. Conclusion: Given the relatively high prevalence of MSDs among sonographers and the importance of reducing specific risk factors associated with their duties, it is recommended to consider solutions such as carrying out ergonomic assessments and interventions, as well as providing training programs and appropriate corrective exercises to mitigate MSDs among sonographers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the rate of disease progression and the factors associated with such progression in patients with an ultrasound diagnosis of adenomyosis. Methods: This was a single center, prospective, observational, cohort study performed at a tertiary referral center. Patients who obtained an ultrasound diagnosis of adenomyosis from May 2022 to August 2022 were recruited. Demographic, clinical and ultrasound data were recorded at the first visit (T0) and after 12 months (T1) for enrolled patients and compared between T0 and T1. The study population was divided in two groups according to progression (increase in uterine volume >20%) or stability/regression (decrease or increase in uterine volume ≤20%) of adenomyosis at T1. Primary study outcome was the rate of adenomyosis progression, while secondary study outcome was the association of adenomyosis progression with demographic and clinical factors. Post hoc subgroups analyses for primary and secondary study outcomes were performed based on hormonal therapy (untreated and treated). Results: A total of 221 patients were enrolled in the study, with no significant difference in terms of baseline data among the two study groups and no patients were lost to follow‐up. The overall rate of adenomyosis progression was 21.3% (47/221 patients). The rate was 30.77% in hormonally untreated women, and 18.34% in hormonally treated women. Progression was associated with the presence of focal adenomyosis of the outer myometrium (P = 0.037), moderate to severe dysmenorrhea (P = 0.001), chronic pelvic pain (P = 0.05), dyschezia (P = 0.05), and worsening of chronic pelvic pain (P = 0.04) at T1. Conclusion: Adenomyosis showed a rate of disease progression of 21.3% at the 12‐month follow‐up (30.77% in hormonally untreated women, and 18.34% in hormonally treated women). The presence and/or worsening of painful symptoms, such as severe dysmenorrhea, dyschezia and chronic pelvic pain, as well as the presence focal adenomyosis of the outer myometrium, might help identify patients at higher risk of disease progression and tailor their follow‐up. Synopsis: Adenomyosis ultrasonographic progression rate was found to be 21.3% and was associated with moderate/severe dysmenorrhea, chronic pelvic pain, dyschezia, and worsening chronic pelvic pain. [ABSTRACT FROM AUTHOR]

• Increased intraneural microvascular could be detected in patients with peripheral neuropathies using sonography. • Intraneural hypervascularization was frequently observed in patients with inflammatory neuropathies. • Superb microvascular imaging is the most sensitive technique for evaluating microvessel flow within peripheral nerves. We assessed microvessel flow within peripheral nerves using nerve sonography in patients with peripheral neuropathy. This study included consecutive patients with peripheral neuropathy who were admitted to our hospital. The patients were divided into two groups: inflammatory neuropathies for immune-mediated neuropathies, such as Guillain − Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and the rest were defined as non-inflammatory neuropathies. We assessed nerve size and intraneural blood flow at four sites on each median and ulnar nerve. Blood flow was evaluated using color Doppler imaging, advanced dynamic flow (ADF), and superb microvascular imaging (SMI) techniques. Thirty-nine patients (median age, 60.0 years; 20 male) were enrolled in this study. An increase in intraneural blood flow was observed in five patients when evaluated by color Doppler, five patients by ADF, and 13 patients by SMI. An overall analysis of the three methods showed that intraneural blood flow was significantly higher in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy (54.2% vs. 0%, p = 0.0005). Intraneural hypervascularization is more frequent in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy. Evaluation of microvessel flow within peripheral nerves may contribute to the diagnosis of peripheral neuropathy. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions Vocal fold immobility (VFI) is a cause of significant morbidity and mortality in the paediatric population. Laryngoscopy is the current first‐line investigation for patients with suspected VFI. Laryngeal ultrasound (LUS) has recently emerged as an alternative method of identifying VFI. Compared to laryngoscopy, LUS is less invasive, does not require anaesthesia, and can be performed by non‐otolaryngologists. The objectives of this study are to evaluate LUS as a diagnostic method for the identification of VFI in a cohort of paediatric patients in Aotearoa New Zealand (NZ) and to estimate the frequency of use of LUS in the paediatric population by clinicians around the world.A retrospective, single‐centre cohort study was performed on all paediatric patients who had undergone laryngoscopy and LUS at Starship Children's Health in Auckland, NZ, between 2020 and 2023. An eight‐question survey was also developed and distributed to better understand clinicians' use of LUS in their clinical practice to diagnose paediatric VFI globally.Twenty‐nine paediatric patients met the inclusion criteria. LUS demonstrated good sensitivity (80.95%) for detecting VFI and increased to 93.33% for the detection of unilateral VFI. Of the 87 respondents to the survey, 41.38% utilise LUS in their clinical practice in the paediatric population. The main barriers to implementation of LUS as identified by non‐users were lack of equipment, expertise, and training.These findings support the use of LUS as an accurate diagnostic tool for the detection of unilateral VFI. Further studies in non‐surgical populations and in patients with bilateral VFI, as well as standardised guidelines for LUS technique and reporting, are required. [ABSTRACT FROM AUTHOR]

Introduction: The research field of artificial intelligence (AI) in medicine and especially in gastroenterology is rapidly progressing with the first AI tools entering routine clinical practice, for example, in colorectal cancer screening. Contrast-enhanced ultrasound (CEUS) is a highly reliable, low-risk, and low-cost diagnostic modality for the examination of the liver. However, doctors need many years of training and experience to master this technique and, despite all efforts to standardize CEUS, it is often believed to contain significant interrater variability. As has been shown for endoscopy, AI holds promise to support examiners at all training levels in their decision-making and efficiency. Methods: In this systematic review, we analyzed and compared original research studies applying AI methods to CEUS examinations of the liver published between January 2010 and February 2024. We performed a structured literature search on PubMed, Web of Science, and IEEE. Two independent reviewers screened the articles and subsequently extracted relevant methodological features, e.g., cohort size, validation process, machine learning algorithm used, and indicative performance measures from the included articles. Results: We included 41 studies with most applying AI methods for classification tasks related to focal liver lesions. These included distinguishing benign versus malignant or classifying the entity itself, while a few studies tried to classify tumor grading, microvascular invasion status, or response to transcatheter arterial chemoembolization directly from CEUS. Some articles tried to segment or detect focal liver lesions, while others aimed to predict survival and recurrence after ablation. The majority (25/41) of studies used hand-picked and/or annotated images as data input to their models. We observed mostly good to high reported model performances with accuracies ranging between 58.6% and 98.9%, while noticing a general lack of external validation. Conclusion: Even though multiple proof-of-concept studies for the application of AI methods to CEUS examinations of the liver exist and report high performance, more prospective, externally validated, and multicenter research is needed to bring such algorithms from desk to bedside. [ABSTRACT FROM AUTHOR]

The objective of this pilot study was to assess the reliability of superb microvascular ultrasound (SMI) for the measurement of the cerebrospinal fluid (CSF) flow within VPS systems as an indirect sign for shunt dysfunction. Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (N = 19) patients in the proximal and in 89.5% (N = 17) in the distal catheter. The distal catheter tip was detectable in 27.7% (N = 5) patients. Free intraabdominal fluid was initially detected in 21.4% (N = 4) patients and in 57.9% (N = 11) at the end of the examination (P = 0.049). ONSD was significantly lower after pump activation (4.4 ± 0.9 mm versus 4.1 ± 0.8 mm, P = 0.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2 ± 45.2 versus 5.6 ± 3.7 cm/sec, P = 0.015; 16.6 ± 9.5 ml/sec versus 5.1 ± 4.0 ml/sec, P = 0.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (P = 0.975) or PD (P = 0.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system. [ABSTRACT FROM AUTHOR]

Highlights Doppler ultrasound may be used to assess leg blood flow (Q̇leg${{\dot{Q}}_{{\mathrm{leg}}}}$), but the reliability of this method remains unexplored in patients with chronic obstructive pulmonary disease (COPD), where between‐subject variability may be larger than healthy due to peripheral vascular changes. This study aimed to investigate the reliability of Doppler ultrasound in quantifying Q̇leg${{\dot{Q}}_{{\mathrm{leg}}}}$ during single‐leg knee‐extensor exercise (KEE) in COPD patients compared with those obtained from healthy matched controls. In this case–control study, 16 participants with COPD were matched based on sex and age with 16 healthy controls. All participants underwent measurement of Q̇leg${{\dot{Q}}_{{\mathrm{leg}}}}$ using Doppler ultrasound in a KEE set‐up at various intensities on two separate visits. Confounding factors on Q̇leg${{\dot{Q}}_{{\mathrm{leg}}}}$ were controlled for, and the ultrasound scans were consistently performed by the same sonographer. During exercise, smallest real difference (SRD) ranged from 367 mL to 583 mL in COPD and 438 mL to 667 mL in the control group. The coefficient of variation (CV) ranged from 7.9% to 14.3% in COPD and 9.4% to 10.4% in the control group. The intraclass correlation coefficient ranged from 0.75 to 0.92 in COPD and 0.67 to 0.84 in the control group. CV was lower in the control group during exercise at 0 W, but apart from that, reliability was not different between groups during exercise. Doppler ultrasound showed nearly equal reliability when evaluating Q̇leg${{\dot{Q}}_{{\mathrm{leg}}}}$ in COPD patients and healthy individuals with a CV below 15% during exercise for both groups. What is the central question of this study? What is the between‐day reliability of Doppler ultrasound when quantifying leg blood flow during single‐leg knee‐extensor exercise in COPD patients compared to healthy matched controls? What is the main finding and its importance? This study demonstrates a coefficient of variation ranging from 7.9 to 14.3% during single‐leg knee‐extensor exercise for between‐day reliability when applying Doppler ultrasound to assess leg blood flow in patients with COPD. Furthermore, it offers insights into the peripheral circulatory constraints in COPD, as evidenced by diminished leg blood flow. This study is the first of its kind to evaluate the reliability of Doppler ultrasound in the assessment of the peripheral circulation during exercise in COPD. What is the central question of this study?What is the between‐day reliability of Doppler ultrasound when quantifying leg blood flow during single‐leg knee‐extensor exercise in COPD patients compared to healthy matched controls?What is the main finding and its importance?This study demonstrates a coefficient of variation ranging from 7.9 to 14.3% during single‐leg knee‐extensor exercise for between‐day reliability when applying Doppler ultrasound to assess leg blood flow in patients with COPD. Furthermore, it offers insights into the peripheral circulatory constraints in COPD, as evidenced by diminished leg blood flow. This study is the first of its kind to evaluate the reliability of Doppler ultrasound in the assessment of the peripheral circulation during exercise in COPD. [ABSTRACT FROM AUTHOR]

Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study on native human cadavers was to compare clinical, sonographic, and radiological measurements of fenestrations, dehiscences, and 3‐wall bone defects on implants. Materials and Methods: The examination was carried out on five human mandibles. After the insertion of 27 implants, dehiscences (n = 14), fenestrations (n = 7) and 3‐wall bone defects (n = 6) were prepared in a standardized manner. The direct measurement of the bone defects was carried out with a periodontal probe and the radiological examination was carried out using digital volume tomography (DVT). The ultrasound examination (US) was performed using a clinical 24‐MHz US imaging probe. Means and standard deviations of the direct, US, and DVT measurements were calculated. Measurements were statistically compared using the Pearson correlation coefficient and Bland–Altman analysis. Results: Bone defects were on average 3.22 ± 1.58 mm per direct measurement, 2.90 ± 1.47 mm using US, and 2.99 ± 1.52 mm per DVT assessment. Pairwise correlations of these measurements were R =.94 (p <.0001) between direct and US, R =.95 (p <.0001) between DVT and US, and R =.96 (p <.0001) between direct and DVT. The mean differences of the measurements (and 95% CI) between direct and US was 0.41 (−0.47 to 1.29), US and DVT 0.33 (−0.30 to 0.97), and direct and DVT 0.28 (−0.50 to 1.07). Conclusion: All peri‐implant bone defects could be identified and sonographically measured. US measurements showed a strong correlation with direct and DVT measurements. The sonographic measurement accuracy was highest for dehiscences, followed by fenestrations and 3‐wall bone defects. [ABSTRACT FROM AUTHOR]

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS). Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; longaxis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared. Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt stepoff defect at L5PI. Conclusion: We report the first technique description and verification of the L5PI using DUS. [ABSTRACT FROM AUTHOR]

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications, such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step‐by‐step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step‐by‐step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low‐lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life‐threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e‐learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Recent studies have highlighted the recognition of diaphragmatic dysfunction as a significant factor contributing to respiratory disturbances in severely ill COVID-19 patients. In the field of noninvasive respiratory support, high-flow nasal cannula (HFNC) has shown effectiveness in relieving diaphragm dysfunction. This study aims to investigate the diaphragmatic response to HFNC in patients with COVID-19 pneumonia by utilizing ultrasound. Methods: This retrospective study was conducted in a medical-surgical intensive care unit (ICU) at a tertiary care center in Buenos Aires, Argentina (Sanatorio de Los Arcos) over a 16-month period (January 2021–June 2022). The study included patients admitted to the ICU with a diagnosis of COVID-19 pneumonia who were deemed suitable candidates for HFNC therapy by the attending physician. Diaphragm ultrasound was conducted, measuring diaphragmatic excursion (DE) both before and during the utilization of HFNC for these patients. Results: A total of 10 patients were included in the study. A statistically significant decrease in respiratory rate was observed with the use of HFNC (p = 0.02), accompanied by a significant increase in DE (p = 0.04). Conclusion: HFNC leads to a reduction in respiratory rate and an increase in DE as observed by ultrasound in patients with COVID-19 pneumonia, indicating promising enhancements in respiratory mechanics. However, further research is required to validate these findings. [ABSTRACT FROM AUTHOR]

The proposed system aims at reproducibility in ultrasound follow-up examinations by storing the position of the ultrasound transducer in relation to acquired images. The system utilizes an electromagnetic tracking system. It includes a guidance feature to assist in placing the transducer correctly on the patient. Evaluation of the system involved technical accuracy tests on a phantom and accuracy tests on human subjects. The results showed that the technical accuracy of the system met the required criteria, but the transducer positioning error in realistic scenarios was above the threshold. Usability testing indicated potential benefits for medical training and provided suggestions for improving the user interface. Overall, the system shows promise for further development and can already be used for training ultrasound examinations. [ABSTRACT FROM AUTHOR]

In radiation therapy, breathing and other influences cause a constant movement of the tissue to be irradiated. Thus, a continuous position control is required which could be handled by the usage of 3D ultrasound imaging. For this purpose, two approaches for target tracking in 3D ultrasound (US) sequences of the liver are analyzed in this study. Therefore, an image-by-image localization of the target is performed using a deep localization network. A singletarget and a multiple-target approach are investigated where deep localization networks are trained for locating one specific and multiple specific targets, respectively. Training the networks and evaluating the tracking algorithm is performed on the basis of a labeled 3D US liver data set in 2-fold crossvalidation experiments. The single-target and multiple-target approaches performed comparable with a mean tracking error of 2.28±1.20mm and 2.23±1.28 mm, respectively. The proposed tracking algorithm is real-time capable with a mean runtime per 3D ultrasound image of 68ms. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the diagnostic accuracy of median nerve cross‐sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic‐based (EDX) classification systems. Methods: Retrospective analysis of cross‐sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX‐based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability. Results: Binary categorizations of CTS (ie, "Normal" vs "Absent") were statistically superior to consolidated categorizations of CTS severity (ie, "Normal," "Mild," "Moderate," or "Severe"). Binary categorizations established consistent CSA cutoff values across all EDX‐based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: <7 or <1 mm2 to rule out and >13 or >7 mm2 to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: ≤10 or ≤3 mm2 to rule out and ≥11 or ≥4 mm2 to rule in CTS, respectively. Conclusions: Using median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, binary categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX‐based classifications examined. [ABSTRACT FROM AUTHOR]

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

In the coming decades, the number of people in the Australian population over the age of 65 is predicted to increase to 23% by the year 2066. The process of physiological ageing is associated with an increase in the presentation of disease pathologies, an increased potential for physical and cognitive deficits and a decrease in health literacy. The ageing of the Australian population presents challenges for the sonography profession including an increasing age gap between the sonographer and their patient as well as increasing complexities in performing ultrasounds on older patients. The natural changes that accompany ageing can create barriers to effective communication between sonographers and their patients. Ageist beliefs can lead to conscious and unconscious bias and unfounded judgements by sonographers decreasing the quality of patient care. To combat the decline in the quality of healthcare that is reported for older patients, sonographers can endeavour to put into place deliberate practical tools and strategies to avoid ageism and improve communication with older patients. Conversely, institutional awareness, education and policies that address age related judgements and bias from older patients towards younger sonographers can foster respectful dialogue, promote understanding and stimulate positive communication across different age groups. [ABSTRACT FROM AUTHOR]

Reflection and reflective practise are well recognised tools that are utilised by healthcare professionals to support self‐awareness and self‐care. In turn, self‐care is a critical component of the wellbeing and the capacity for resilience of healthcare professionals in response to day‐to‐day exposure to emotionally and psychologically challenging situations. Affective reflection, the process of considering and analysing thoughts, feelings and emotions though written dialogue (the act of reflective writing), has been shown to be beneficial for promoting and building resilience in healthcare professionals. Despite the known benefits of these strategies for maintaining wellbeing and avoiding compassion fatigue and burnout, the discourse on the use of affective reflection and reflective writing in the sonography profession is limited. Interventions such as reflection, reflective practise and reflective writing should not be underestimated as tools to promote the adaptive abilities and the degree of individual emotional resilience of sonographers. Long term positive outcomes supported by utilising and practising reflection include the maintenance of emotional stability and an increase in the scope for empathy and subsequently, an enhancement of quality of practise and patient care. This article aims to provide a broad discussion on the practise of affective reflection and showcase the process of reflective writing using written reflective dialogue guides with practical examples relevant to sonography practise. In addition, this paper outlines how these strategies can be incorporated and enacted in the sonography workplace to build resilience. [ABSTRACT FROM AUTHOR]

Background: Fractures of the clavicle are the most common birth injury among newborns. Aim of this systematic review was to provide a comprehensive analysis of the role of ultrasound (US) in diagnosing clavicular fractures in neonates. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Embase, including studies focusing on US in neonatal clavicle fracture. Age at US, number of cases examined by US and X-ray, US and X-ray diagnoses, US probe used, fracture site were systematically extracted. Results: A total of 231 articles were found. We ultimately selected 7 publications that satisfied the inclusion criteria, involving 136 patients examined between 3 days and 3 weeks of age, with 135 confirmed fractures. US was performed on all patients and correctly diagnosed all fractures (135/135, 100%). X-ray was performed on 94/136 patients (69.1%) and correctly diagnosed 89/93 fractures (95.7%). Fracture site was: medial in 2/79, middle in 37/79, and lateral in 40/79. In the remaining 57 cases, site was not reported. Conclusions: This review indicates that ultrasound is extremely reliable in diagnosing clavicle fractures in newborns and should be considered as the gold standard in this context. [ABSTRACT FROM AUTHOR]

Because of the complex circumstances in pregnancy, obstetric (OB) sonography requires dissemination of results, often during the examination, and the sonographer can be highly involved in that reporting. This creates a complex set of work responsibilities, in which patient support is of utmost importance, especially when the results are unfavorable. While patient experiences of receiving a negative outcome, during an OB sonogram, have been widely reported, there is a lack of literature on the experience of the sonographers involved in delivering this information. Thus, it is important to identify variables that impact providing ethical care for grieving OB patients. Sonographers in a maternal-fetal medicine clinic work very closely with a group of physicians, and other providers, in delivering unfavorable results, making communication, and understanding of roles of the utmost importance. Conversely, sonographers in a general OB/gynecology practice may not have the support of colleagues when communicating with the grieving patient. These demands may cause feelings of guilt, uncertainty, and stress, contributing to the experience of burnout for the OB sonographer. To prevent these feelings, it is important to consider ways to create a positive work environment and provide resources to protect sonographer mental health. Health care systems must ensure employee access to resources for managing stress, because of caring for grieving patients, and prioritize a healthy work environment, even during challenging times. Future studies are needed that investigate possible training materials, beyond basic hospital training, which targets the skill set needed to properly care for the grieving OB patient. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate whether serial evaluations of cervical length (CL) have the potential to determine preterm labor in women with threatening preterm labor (TPL). Materials and Methods: This prospective study included pregnant women at 24 to 37 weeks of gestation referred to our institute because of TPL. Cervical length was measured at three successive time points using transvaginal sonography (upon admission, one-, and two-weeks post-admission). Data were analyzed using both parametric and non-parametric statistics. Results: The mean age of the 126 patients included was 25.60 ± 6.48 years, with age ranging from 14 to 42 years. The mean pregnancy age, at the time of the sonogram, was 33.54 ± 2.78 weeks. The initial CL had an area under the receiver operating characteristic curve (AUROC) of 0.854. The CLs measured one and two weeks later had AUROCs of 0.868 and 0.870, respectively. Based on these data, the cut-off points of 28.5 and 27.5 mm were identified for the initial and subsequent two-week CL measurements, respectively, capable of predicting preterm delivery. If the CL measured at initial admission was >28.5 mm, the likelihood of timely delivery was 92.22%. However, if the CL measured at initial admission was <28.5 mm, the chance of premature preterm delivery increased by 2.3 times. Patients with a CL <27.5 mm in the second week were 18.75% more likely to have a preterm delivery. If the CL was >27.5 mm, the probability of timely delivery was 89.7%. Conclusion: In this cohort of women, serially measured CLs taken during transvaginal sonography demonstrated promise as a method for indicating the possible risk of preterm delivery. Thus, measured CL may be a useful diagnostic component for prenatal care, as well as for classifying the risk of preterm delivery. Nevertheless, further studies are required to confirm the effectiveness and safety of these sonographic measures in larger and more diverse patient cohorts. [ABSTRACT FROM AUTHOR]

Thrombosis of the portomesenteric veins is an uncommon condition that can lead to serious complications, if left untreated. Bariatric reduction surgeries increase the probability for occurrence of this rare condition. This case study focuses on a patient who underwent a biliopancreatic diversion with duodenal switch procedure and consequently developed an occlusive thrombus in the superior mesenteric vein (SMV), which required stent placement. The patient ultimately developed a secondary thrombus, within the stent. Sonographic imaging aided in the diagnosis of occlusion of the SMV stent. [ABSTRACT FROM AUTHOR]

Mosaic trisomy 14 or partial trisomy 14 is a rare genetic abnormality that occurs when only a portion of cells have an additional copy of chromosome 14. It has a female prevalence of 3:1 and is associated with a wide range of related disorders. In this case, severe polyhydramnios because of borderline micrognathia was correlated to the diagnosis of mosaic trisomy 14. Early sonographic detection of associated findings can prompt the genetic testing required for diagnosis. Combining sonography and genetic testing leads to an accurate diagnosis, proper management, and postnatal planning for the patient. [ABSTRACT FROM AUTHOR]

Extrathyroidal extension was related with worse survival for patients with papillary thyroid carcinoma. For its preoperative evaluation, we measured and compared the predicting value of sonographic method and ultrasonic radiomics method in nodules of papillary thyroid carcinoma. Data from 337 nodules were included and divided into training group and validation group. For ultrasonic radiomics method, a best model was constructed based on clinical characteristics and ultrasonic radiomic features. The predicting value was calculated then. For sonographic method, the results were calculated using all samples. For ultrasonic radiomics method, we constructed 9 models and selected the extreme gradient boosting model for its highest accuracy (0.77) and area under curve (0.813) in validation group. The accuracy and area under curve of sonographic method was 0.70 and 0.569. Meanwhile. We found that the top-6 important features of xgboost model included no clinical characteristics, all of whom were high-dimensional radiomic features. The study showed the superior value of ultrasonic radiomics method to sonographic method for preoperative detection of extrathyroidal extension in papillary thyroid carcinoma. Furthermore, high-dimensional radiomic features were more important than clinical characteristics. [ABSTRACT FROM AUTHOR]

BACKGROUND: In long-distance spaceflight, the challenges of communication delays and the impracticality of rapid evacuation necessitate the management of medical emergencies by onboard physicians. Consequently, these physicians must be proficient in tools, such as ultrasound, which has proven itself a strong diagnostic imaging tool in space. Yet, there remains a notable gap in the discourse surrounding its efficacy in handling acute medical scenarios. This scoping review aims to present an updated analysis of the evidence supporting the role of ultrasound in diagnosing acute conditions within microgravity environments. METHODS: A systematic search was executed across three bibliographic databases: PubMed, EMBASE (Embase.com), and the Web of Science Core Collection. We considered articles published up to February 25, 2023, that highlighted the application of ultrasound in diagnosing acute medical conditions in either microgravity or microgravity-simulated settings. Exclusions were made for review papers, abstracts, and in-vitro studies. RESULTS: After removing duplicates, and filtering papers by pre-determined criteria, a total of 15 articles were identified that discuss the potential use of ultrasound in managing acute medical conditions in space. The publication date of these studies ranged from 1999 to 2020. A relatively similar proportion of these studies were conducted either on the International Space Station or in parabolic flight, with one performed in supine positioning to simulate weightlessness. The included studies discuss acute pathologies, such as abdominal emergencies, decompression sickness, deep venous thrombosis, acute lung pathologies, sinusitis, musculoskeletal trauma, genitourinary emergencies, and ocular emergencies. CONCLUSIONS: While ultrasound has shown promise in addressing various acute conditions, significant knowledge gaps remain, especially in gastrointestinal, cardiac, vascular, and reproductive emergencies. As we venture further into space, expanding our medical expertise becomes vital to ensure astronaut safety and mission success.

Abstract Introduction The job of sonographers exposes them to numerous ergonomic risk factors, making the sonography profession one of the high-risk job groups vulnerable to musculoskeletal disorders (MSDs). The present systematic review and meta-analysis specifically examined the prevalence of MSDs among sonographers. Materials and methods The present review study was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The protocol of the study was registered in the international prospective register of systematic review (PROSPERO) with the code CRD42024507972. Searches were conducted in databases including PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar, without imposing a time limit until February 7th, 2024. The random-effects model was employed for meta-analysis, and the I2 index was used to assess heterogeneity among studies. Finally, data analysis was performed using STATA (version 14). Results Based on the search in different databases, a total of 4367 articles were identified. Finally, after screening, selecting, and quality evaluation of the studies, 30 studies were considered for meta-analysis in which 13,916 sonographers were examined. According to the results of the meta-analysis, the overall prevalence of MSDs among sonographers was reported as 75.80% (95% CI: 65.37–86.23, I2 = 99.7%, P

Abstract Background Posterior globe flattening (PGF) is a specific neuroimaging sign in patients with idiopathic intracranial hypertension (IIH), but its detection is based on subjective qualitative neuroradiological assessment. This study sought to evaluate the utility of transorbital ultrasound to detect and quantify PGF in IIH patients using the Posterior Globe Angle (PGA). Methods Consecutive IIH patients and healthy controls were enrolled in a prospective case-control study. Transorbital ultrasound was performed to assess the presence of PGF. For quantification of PGF, an angular measurement (PGA) was performed with the vertex centering the optic nerve at a predefined distance from the lamina cribrosa and angle legs tangentially aligned to the borders of the vitreous body. PGA measurements were compared between IIH patients and healthy controls. Additionally, the diagnostic accuracy of PGA measurements in detecting PGF was evaluated using ROC analysis. Results Thirty-one IIH patients (37.3 ± 12.3 years, 29 female) and 28 controls (33.3 ± 11.8 years, 21 female) were compared. PGF was present in 39% of IIH patients and absent in the control group. PGA3mm measurements significantly differed between IIH and controls (116.5° ± 5.5 vs. 111.7° ± 2.9; p

Abstract Background Point-of-care ultrasound (POCUS) is steadily growing in use in prehospital emergency medicine. While currently used primarily by emergency physicians, POCUS could also be employed by paramedics to support diagnosis and decision-making. Yet to date, no paramedicine-targeted POCUS curricula exist in Germany. Furthermore, given time and resource constraints in paramedic training, it is unclear whether paramedics could feasibly learn POCUS for prehospital deployment. Hence, this study outlines the development and implementation of a comprehensive POCUS curriculum for paramedics. Through this curriculum, we investigate whether paramedics can attain proficiency in POCUS comparable to other user groups. Methods In this prospective observational study, we first developed a blended learning-based POCUS curriculum specifically for paramedics, focusing on basic principles, the RUSH-Protocol and ultrasound guided procedures. Participants underwent digital tests to measure their theoretical competence before (T1) and after the digital preparation phase (T2), as well as at the end of the on-site phase (T3). At time point T3, we additionally measured practical competence using healthy subjects and simulators. We compared the theoretical competence and the practical competence on a simulator with those of physicians and medical students who had also completed ultrasound training. Furthermore, we carried out self-assessment evaluations, as well as evaluations of motivation and curriculum satisfaction. Results The paramedic study group comprised n = 72 participants. In the theoretical test, the group showed significant improvement between T1 and T2 (p

ObjectiveThe objective of this study was to develop a sonographic technique using two-dimensional (2D) markers for detecting isolated fetal cleft palate (no cleft lip) and to evaluate the ability of 2D and three-dimensional (3D) sonography to image the normal and abnormal palate. Methods Seventy-three fetuses with a high risk of cleft palate at 12-39 weeks of gestation were referred for specialist ultrasound. A detailed evaluation of the palate was performed through 2D ultrasound, which revealed the appearance of the palatine line in the sagittal plane; the palate and alveolar ridge in the coronal plane of the fetal face; the horizontal plate of the palatine bone in the axial maxillary plane; and the soft palate in the transverse plane of the cavum pharyngis. Subsequently, 3D ultrasound imaging of the palate was performed in all fetuses. Antenatal diagnoses were compared with postnatal findings or autopsy findings. Results Visualization of 2D markers was accomplished in all fetuses, and 3D assessment was achieved in 97% of fetuses. Cleft palate was suspected in 16 cases (21.9%), among which 14 were suspected on the basis of both 2D and 3D evaluation, and two were suspected only on the basis of 3D evaluation. A normal palate was observed in 57 fetuses (78.1%). The mean gestational age was 27 weeks (range of 12 weeks to 39 weeks). All 16 fetuses with suspected cleft palate were confirmed by postnatal or autopsy findings, no false-positives were observed, and one case with a bifid uvula was missed among 57 fetuses with a presumed normal palate. Conclusions The fetal palate can be evaluated with 2D markers and 3D sonography. The detection of isolated cleft palate is more sensitive when 2D markers are present in all four planes.

Abstract Muscle mass depletion is associated with mortality and morbidity in various conditions including sepsis. However, few studies have evaluated muscle mass using point-of-care ultrasound in patients with sepsis. This study aimed to evaluate the association between thigh muscle mass, evaluated using point-of-care ultrasound with panoramic view in patients with sepsis in the emergency department, and mortality. From March 2021 to October 2022, this prospective observational study used sepsis registry. Adult patients who were diagnosed with sepsis at the emergency department and who underwent point-of-care ultrasounds for lower extremities were included. The thigh muscle mass was evaluated by the cross-sectional area of the quadriceps femoris (CSA-QF) on point-of-care ultrasound using panoramic view. The primary outcome was 28 day mortality. Multivariable Cox proportional hazard model was performed. Of 112 included patients with sepsis, mean CSA-QF was significantly lower in the non-surviving group than surviving group (49.6 [34.3–56.5] vs. 63.2 [46.9–79.6] cm2, p = 0.002). Each cm2 increase of mean CSA-QF was independently associated with decreased 28 day mortality (adjusted hazard ratio 0.961, 95% CI 0.928–0.995, p = 0.026) after adjustment for potential confounders. The result of other measurements of CSA-QF were similar. The muscle mass of the quadriceps femoris evaluated using point-of-care ultrasound with panoramic view was associated with mortality in patients with sepsis. It might be a promising tool for determining risk factors for mortality in sepsis patients in the early stages of emergency department.

Background: Posterior globe flattening (PGF) is a specific neuroimaging sign in patients with idiopathic intracranial hypertension (IIH), but its detection is based on subjective qualitative neuroradiological assessment. This study sought to evaluate the utility of transorbital ultrasound to detect and quantify PGF in IIH patients using the Posterior Globe Angle (PGA). Methods: Consecutive IIH patients and healthy controls were enrolled in a prospective case-control study. Transorbital ultrasound was performed to assess the presence of PGF. For quantification of PGF, an angular measurement (PGA) was performed with the vertex centering the optic nerve at a predefined distance from the lamina cribrosa and angle legs tangentially aligned to the borders of the vitreous body. PGA measurements were compared between IIH patients and healthy controls. Additionally, the diagnostic accuracy of PGA measurements in detecting PGF was evaluated using ROC analysis. Results: Thirty-one IIH patients (37.3 ± 12.3 years, 29 female) and 28 controls (33.3 ± 11.8 years, 21 female) were compared. PGF was present in 39% of IIH patients and absent in the control group. PGA3mm measurements significantly differed between IIH and controls (116.5° ± 5.5 vs. 111.7° ± 2.9; p < 0.001). A PGA3mm cutoff of ≥ 118.5° distinguished IIH patients from controls with 100% specificity, while retaining a sensitivity of 37.5%. Conclusions: Transorbital ultrasound may be applied to detect and quantify PGF in IIH patients. Prospective, multicenter studies with extended cohorts and blinded design are needed to validate these preliminary findings and confirm the diagnostic utility of transorbital ultrasound for the assessment of PGF in IIH. [ABSTRACT FROM AUTHOR]

We assessed the effects of a 12-week shoulder corrective training program for shoulder flexibility and strengthening on pitching loads and sonographic morphology of the elbow joints in youth baseball players. Seventeen subjects were recruited and underwent evaluations before and after the training program. We found that following training, subjects demonstrated significantly increased ranges of shoulder internal rotation (38.9 ± 12.9° vs. 69.2 ± 10.8°, p < 0.001), external rotation (91.2 ± 14.6° vs. 107.3 ± 9.5°, p = 0.004), and horizontal adduction (21.5 ± 8.0° vs. 32.7 ± 7.3°, p = 0.002); improved strength in the shoulder internal rotators (8.7 ± 1.6 kg vs. 9.8 ± 2.1 kg, p = 0.04), external rotators (6.5 ± 1.9 kg vs. 7.5 ± 2.8 kg, p = 0.04), middle trapezius (12.7 ± 2.1 kg vs. 14.3 ± 2.4 kg, p = 0.04), and middle deltoid muscles (10.8 ± 3.3 kg vs. 14.8 ± 3.2 kg, p = 0.001); and decreased thickness of the ulnar collateral ligament (6.1 ± 0.6 mm vs. 4.8 ± 0.7 mm, p = 0.002). Although there was no substantial change in elbow torque and arm speed, significantly increased ball speed (51.2 ± 4.6 mph vs. 54.1 ± 4.5 mph, p < 0.001) and decreased arm slot (63.8 ± 11.9° vs. 53.0 ± 12.7°, p = 0.02) were observed. We suggest that adequate corrective training should be performed regularly to minimize or mitigate adverse soft tissue changes at the elbow in youth baseball players. Balanced shoulder strength and flexibility may decrease medial elbow stress during pitching. Future studies should consider the kinetic and kinematic effects of other corrective training programs on the shoulder or elbow joint during pitching. [ABSTRACT FROM AUTHOR]

Background: This systematic review investigates the diagnostic value of ultrasound in the evaluation of torso injuries following a penetrating trauma. Methods: We searched PubMed, Scopus, and WOS databases for related original articles until May 7, 2023, and extracted data related to diagnostic performance. The bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach were used to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Results: Seventeen studies were included, which involved a total number of 1866 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 56% (45–67%) and specificity of 96% (94–97%), positive likelihood ratio (LR +) of 13.66 (8.03–23.23), and negative likelihood ratio (LR-) of 0.45 (0.35–0.59) for detecting abdominal injuries. In pericardial penetrating trauma, pooled sensitivity was 100% (45–100%), pooled specificity was 99% (96–100%), LR + was 136.7 (24.8–752.3), and LR- was 0.00 (0.00–1.22). For thoracic penetrating trauma, pooled sensitivity was 99% (93–100%) and specificity was 100% (98–100%). Conclusions: Sonography demonstrated promising diagnostic value in the initial assessment of torso penetrating trauma, particularly in the thoracic and pericardial regions. However, the sensitivity of sonography is limited in abdominal penetrating trauma and a combination with other imaging modalities should be considered in these cases. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the use of high‐frequency sonography as a tool for detecting inflammatory and destructive changes in the hand and foot joints of patients with early and long‐term RA. Methods: This study employs a prospective cohort design involving 162 patients diagnosed with Rheumatoid arthritis (RA) who meet the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. Patients were divided into two groups based on disease duration: Group 1 (n = 74) included patients with a disease duration of up to 2 years, or early РА (ERA;), Group 2 (n = 88) consisted of patients with a disease duration exceeding 2 years, or long‐term persistent РА (LtRA). All patients underwent a clinical assessment of their joints, as well as radiography and arthrosonography, at the beginning of the study and again at 6 and 12 months later. Results: In the general group of patients, ultrasound examination revealed signs of synovitis in the joints of the hands more frequently (66%) compared with clinical examination (56% by a number of swollen joints [NSJ] and 55% by a number of painful joints [NPJ], P <.01). After 6 months of treatment, 12% of the patients achieved full US remission and 24% achieved partial US remission. Conclusions: Within the scope of comprehensive RA diagnostics, arthrosonography of the joints of the hands and feet, utilizing a combination of greyscale and power Doppler, may surpass radiography in detecting early RA. This method allows for a more accurate assessment of disease activity and progression rates. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: This randomized clinical trial study aims to compare ultrasound‐guided versus non‐guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). Material and Methods: The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non‐guided and ultrasound (US)‐guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre‐injection, 1‐, 2‐, and 6‐months postinjection. Results: Twenty‐two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non‐guided group and 24.3 ± 6.9 for the US‐guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. Conclusion: Intra‐articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US‐guided and non‐guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture. [ABSTRACT FROM AUTHOR]

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Methods Discussion Conclusion Iatrogenic and traumatic injuries to the femoral and saphenous nerves, and their branches are uncommon but can be a cause of clinically pertinent lower limb dysfunction and neuralgia. Despite this, direct sonographic imaging of these nerves is not commonly requested or performed.A review of the literature regarding the detailed relative anatomy, sonographic technique to image these nerves and their branches and their normal and abnormal appearances was conducted.These nerves are often in the direct imaging field of many ultrasound examinations including the assessment of the groin and lower limb vasculature and musculoskeletal studies. They can become entrapped at certain points throughout their path, where particular attention should be provided to these nerves.Improved knowledge regarding the sonographic imaging of the femoral and saphenous nerves and their branches can assist identification and discrimination between normal and abnormal appearances, and subsequent ultrasound‐guided nerve blockades or radiofrequency ablations for pain management where required. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is steadily growing in use in prehospital emergency medicine. While currently used primarily by emergency physicians, POCUS could also be employed by paramedics to support diagnosis and decision-making. Yet to date, no paramedicine-targeted POCUS curricula exist in Germany. Furthermore, given time and resource constraints in paramedic training, it is unclear whether paramedics could feasibly learn POCUS for prehospital deployment. Hence, this study outlines the development and implementation of a comprehensive POCUS curriculum for paramedics. Through this curriculum, we investigate whether paramedics can attain proficiency in POCUS comparable to other user groups. Methods: In this prospective observational study, we first developed a blended learning-based POCUS curriculum specifically for paramedics, focusing on basic principles, the RUSH-Protocol and ultrasound guided procedures. Participants underwent digital tests to measure their theoretical competence before (T1) and after the digital preparation phase (T2), as well as at the end of the on-site phase (T3). At time point T3, we additionally measured practical competence using healthy subjects and simulators. We compared the theoretical competence and the practical competence on a simulator with those of physicians and medical students who had also completed ultrasound training. Furthermore, we carried out self-assessment evaluations, as well as evaluations of motivation and curriculum satisfaction. Results: The paramedic study group comprised n = 72 participants. In the theoretical test, the group showed significant improvement between T1 and T2 (p < 0.001) and between T2 and T3 (p < 0.001). In the practical test on healthy subjects at T3, the group achieved high results (87.0% ± 5.6). In the practical test on a simulator at T3, paramedics (83.8% ± 6.6) achieved a lower result than physicians (p < 0.001), but a comparable result to medical students (p = 0.18). The results of the study group's theoretical tests (82.9% ± 9.2) at time point T3 were comparable to that of physicians (p = 0.18) and better than that of medical students (p < 0.01). The motivation and attitude of paramedics towards the prehospital use of POCUS as well as their self-assessment significantly improved from T1 to T3 (p < 0.001). The overall assessment of the curriculum was positive (92.1 ± 8.5). Conclusion: With our tailored curriculum, German paramedics were able to develop skills in POCUS comparable to those of other POCUS learners. Integration of POCUS into paramedics' training curricula offers opportunities and should be further studied. [ABSTRACT FROM AUTHOR]

Background and Purpose Methods Results Conclusions The optic nerve sheath diameter (ONSD) is a commonly used estimate of intracranial pressure (ICP). The rationale behind this is that pressure changes in the cerebrospinal fluid affect the optic nerve subarachnoid space (ONSAS) thickness. Still, possible effects on other compartments of the optic nerve sheath (ONS) have not been studied. This is the first study ever to analyze all measurable compartments of the ONS for associations with elevated ICP.We measured changes in ICP and changes in ONS compartments in 75 patients treated with invasive ICP monitoring at the Karolinska University Hospital. Associations between changes in ICP and changes in ONS compartments were estimated with generalized estimating equations. The potential to identify elevated ICP was assessed with the area under the receiver operating characteristic curve (AUROC) for ONS compartments associated with ICP changes.Both ONSAS and perioptic dura mater thickness were significantly associated with changes in ICP in multivariable modeling. ONSAS was the only compartment that independently predicted changes in ICP, with an AUROC of 0.69 for predicting ICP increase. Still, both the perioptic dura mater thickness and the optic nerve diameter added value in predicting ICP changes in multivariable modeling.The results from this study challenge the current understanding of the mechanism behind the association between ICP and ONSD. Contrary to the common opinion that ONSAS is the only affected compartment, this study shows a more complex picture. It suggests that all ONS compartments may add value in predicting changes in ICP. [ABSTRACT FROM AUTHOR]

Ultrasound is a reliable imaging modality for diagnosing and assessing musculoskeletal disorders. Recent advancements in ultrasound technology have substantially improved image resolution, enabling the visualization of anatomic structures on a near-microscopic level. However, existing guidelines for standardized shoulder ultrasound primarily rely on earlier machine models and settings that may not harness the full potential of these high-resolution imaging capabilities. This article provides a simple and systematic guide to high-resolution sonography of the shoulder using anatomical and histological images from cadavers for comparison. International standard techniques are considered, and images were obtained using modern equipment. This two-article series systematically shows the examination and normal findings, presenting first the posterior, then frontal, then further anterior, followed by lateral and, optionally, the axillary examination. In this article, the focus is on the posterior and coronal shoulder. [ABSTRACT FROM AUTHOR]

Ovarian tumors can be challenging to diagnose and treat, especially in areas with limited access to advanced medical care. During routine prenatal ultrasounds, abnormal growths in the ovaries can be unexpectedly discovered. In clinical practice, it is essential to accurately differentiate between benign and malignant ovarian tumors in order to develop appropriate treatment plans. Ultrasound imaging has become the preferred diagnostic tool. The aim of this article is to examine the ultrasound characteristics of ovarian and adnexal growths and to explore how these characteristics, along with other clinical factors, can aid in predicting the likelihood of ovarian cancer. [ABSTRACT FROM AUTHOR]

Over a span of more than two years, a collaborative expert group consisting of 9 professional societies has meticulously crafted the S2e guideline on fracture sonography. This publication encapsulates the essential insights pertaining to specific indications. A thorough and systematic literature search, covering the period from 2000 to March 2021, was conducted across PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, complemented by an evaluation of bibliographies. Inclusion criteria encompassed randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews, while guidelines, conferences, reviews, case reports, and expert opinions were excluded. The SIGN grading system (1999–2012) was applied to assess evidence, and resultant SIGN tables were presented to the expert group. Specific recommendations for the application of fracture sonography were then derived through unanimous consensus after detailed discussions. Out of the initial pool of 520 literature sources, a meticulous screening and content assessment process yielded 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) for evaluation. The comprehensive analysis identified twenty-one indications that substantiate the judicious use of fracture sonography. Ultrasound emerges as a pragmatic and user-friendly diagnostic method, showcasing feasibility across a diverse range of indications. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the association between post-cesarean sonographic uterine measures, dysmenorrhea, and bleeding disorders. Methods: This is a cross-sectional study where 500 women with a history of only one cesarean section (CS) were recruited. A transvaginal transducer, GE RIC6-12-D was used for the acquisition of volumetric datasets 18 ± 7 months postpartum. Uterine length (UL), cervical length (CL), niche length (L), niche depth (D), niche width (W), fibrosis length (FL), fibrosis depth (FD), residual myometrial thickness (RMT), endometrial thickness (EM), scar to internal os distance (SO), anterior myometrial thickness superior (sAMT) and inferior (iAMT) to the scar, and the posterior myometrial thickness opposite the scar (PMT), superior (sPMT), and inferior to it (iPMT) were measured. Logistic regression with odds ratios (OR), 95% confidence intervals (CI) and ROC curves were utilized. Results: The proportion of patients with incident post-cesarean bleeding disorders and dysmenorrhoea was 36% (CI 32%, 40%) and 17% (CI 14%, 21%) respectively. Univariate logistic regression showed that only UL was associated with bleeding disorders [OR 1.04 (CI 1.01,10.7) p value 0.005], whereas dysmenorrhea was associated with RMT [OR 0.82 (CI 0.71,0.95) p value 0.008], SO [OR 0.91 (CI 0.86,0.98) p value 0.01], and RMT ratio [OR 0.98 (CI 0.97,0.99) p value 0.03]. Multivariate logistic regression for dysmenorrhoea including SO and RMT remains statistically significant with p values <0.05 and area under the curve of 0.66. Conclusion: There is an association between sonographic appearance of CS scars and dysmenorrhoea. Nevertheless, the association is weak and other biological post-cesarean characteristics should be explored as potential causes. [ABSTRACT FROM AUTHOR]

Introduction/aim: To evaluate whether patients with haemophilia (PwH) can be enabled to perform ultrasonography (US) of their knees without supervision according to the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) protocol and whether they would be able to recognize pathologies. Methods: Five PwH (mean age 29.6 years, range 20–48 years) were taught the use of a portable US device and the HEAD‐US protocol. Subsequently, the patients performed US unsupervised at home three times a week for a total of 6 weeks with a reteaching after 2 weeks. All images were checked for mapping of the landmarks defined in the HEAD‐US protocol by a radiologist. In a final test after the completion of the self‐sonography period, participants were asked to identify scanning plane and potential pathology from US images of other PwH. Results: On the images of the self‐performed scans, 82.7% of the possible anatomic landmarks could be identified and 67.5% of the requested images were unobjectionable, depicting 100% of the required landmarks. There was a highly significant improvement in image quality following reteaching after 2 weeks (74.80 ± 36.88% vs. 88.31 ± 19.87%, p <.001). In the final test, the participants identified the right scanning plane in 85.0% and they correctly identified pathology in 90.0% of images. Conclusion: Appropriately trained PwH can perform the HEAD‐US protocol of their knee with high quality and are capable to identify pathologic findings on these standardized images. Asynchronous tele‐sonography could enable early therapy adjustment and thereby possibly reduce costs. [ABSTRACT FROM AUTHOR]

This study was a scoping review. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications. • Sonography is used to examine a range of UE conditions, structures, and etiologies. • Sonography demonstrates preliminary utility in UE rehabilitation and research. • A large body of knowledge is available to inform innovative clinical applications. • Further research is needed to determine specific clinical efficacy and impact. [ABSTRACT FROM AUTHOR]