Science method

Sonography - Science method

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Is there a scoring system to assess adequacy of images acquired during the eFAST (extended Focussed Abdominal Sonography in Trauma) ultrasound scanning protocol?
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Take a look at my colleague's paper as a potential simple starting point:
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What is your distinctive clinical approaches for the management of thyroid nodules of both 10-15 mm and over 15 mm, separately, with Category III of indeterminate cytology, TBSRTC, 1st and 2nd ed., harboring high-to-intermediate suspicion sonographic pattern, low clinical risk factors, repeated FNA cytology, molecular testing, or both, are not performed or inconclusive?
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We might recommend surveillance for the management of the mentioned thyroid nodules, 10-15 mm with Category III of indeterminate cytology, TBSRTC, 1st and 2nd ed., harboring high-to-intermediate suspicion sonographic pattern, low clinical risk factors, repeated FNA cytology, molecular testing, or both, are not performed or inconclusive, comparing the ones >15 mm. This issue deserves further investigation.
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Dear Potential Participants,
For nearly a decade, I have been researching the use of bedside sonography in hemodynamic assessment of intravascular volume status (and related topics). Study logistics and getting enough critical mass at a single institution always have been my -- and probably your -- greatest limitation to collecting voluminous enough data for truly robust statistical analyses and comparisons.
Would there be interest "out there" to participate in an IRB-approved, centralized repository of standardized sonographic hemodynamic data in exchange for full access to collective data and authorship based on pre-defined criteria?
Examples of data to be collected/entered: IVC dimensions & collapsibility; Other central vein dimensions & collapsibility; Central venous pressures; Pulmonary artery catheter parameters (yes - this "dinosaur" is getting retired, but before it does, let's compare it to something we're going to use for the next 100+ years); Conventional vital signs; Ventilatory parameters (PEEP, Airway Pressures, etc).
Please let me know... Once a "coalition of the willing" is assembled, we can perhaps change and redefine the way our world views ultrasound in the ICU...
Cheers,
Stan.
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What a great idea, I am interested in this project.
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Our experience in cardiovascular ischemic heart disease is very promising using TPA in carotid sonography for very large population!!!! Dont you think to use any cardiovascular subrrogate?
This method is easy, in 2d sonography, with very low variability in inter an intra observer variation!!
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TPA and TPV has been shown to vary with population and aging.First it needs to be validated and to familiar with population variation.People are using IMT especially in diabetics as one of the marker for Atherosclerosis.TPA and TPV definately scores over IMT.
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I recently register a clinical trial in patients with liver cirrhosis. One of the study variables is hepatic vein velocity. There are three hepatic vein and determine hepatic vein velocity is possible to all three veins and in different regions (i.e. proximal to ivc or distal or in sinusoids)
Which hepatic vein velocity is more reliable in cirrhotic patient for determine of hepatic vein velocity? Which section of vein is beter for determine this value?
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The left hepatic vein can sometimes be harder to profile if the liver is echogenic and the patient is large. But no difference in the middle and right that I am aware of.
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In medical imaging we are using ultrasound for detecting abnormalities in unborn babies. Can we do same by USCT?
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No of course because of the radiation hazards
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I'm looking for a joint ultrasound dataset, it can be knees, shoulders, feet, any kind of joint is ok. I have seen different musculoskeletal ultrasound images; however, nothing more than a few images.
Thanks.
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Dear Mr. Mauro Méndez
a general joint ultrasound dataset can be found in the following site. it consists of 8 different joints:
  • Shoulder
  • Elbow
  • Wrist and carpus
  • Fingers
  • Hip groin and buttock
  • Knee
  • Ankle
  • Foot
I hope it can be useful.
Regards
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Do you use sonography of jaw joint derangements ? If so do you recommend this as a diagnostic procedure . Kindly explain Norman
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I have used sonography for an earlier study but not for this project. Based off of my study, I feel it can be used for a quick diagnosis (chairside) but it is not always reliable.
Our patients were part of an ongoing study, in which, injury was ruled out.
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A 42 yrs old man with a mass in 4cm above anus , pathology : well differentiated adenocarcinoma , in clinical exam a hard node in groin that confirmed by sonography a a hi suspicious node. metastatic work up by CT scan is negative.what do you suggest 
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This is definitely not a standard case, and should be discussed in the tumor board.
If the CT of the thorax and abdomen reveal no metastasis, PET/CT may be considered. If there is no metastasis, I think that the inguinal lymph nodes should be regarded as N+.
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A 3o yrs pregnant woman " golden baby" with a mass in right breast, CNB result: invasive ductal carcinoma grade II ER + PR+ HER2+. No familial breast cancer history. sonography axial was negative.what is your plan.
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You are welcome Dr.Mahmoodzadeh,
I recommend breast conserving surgery and SLNB then chemotherapy. If there was indication for radiation ,it will be done after delivery.The main question (for me as a surgeon) is doing sentinel node in this pregnant woman or no .Based on data , SLNB with radiolabeled drug is more safe than blue dye in pregnancy . I would discuss possible risks to the patient and if she didn't agree for SLNB ,I will do 1st level sampling and check 2nd and 3rd level by palpation.
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I've read the abstract. How do you explain that US is less sensitive but more specific than MRI in local staging of rectal cancer? I agree in full about the need of specific training (this rule is always true!), although the differences in MRI performances seem less understandable.
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The transrectal ultrasonography (TRUS) has high resolution and can accurately identify the commitment layer of the rectal wall . Thus, it is expected that TRUS has higher specificity (83% ) compared to MRI (74 %), which is shown in the article for the skilled reader.
Honestly, greater sensitivity of 96 % (MRI ) versus 93 % (USTR ) might be only numeric, not significant from a statistical point of view. Besides, the authors consider in the article the differences between the readers, not the difference between the methods, by specialist reader .
Personally , I like TRUS for initial staging lesions only, because it allows better decision making, mainly when less agressive therapy can be performed.
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In my clinical practice of diagnostic ultrasonography at different health institutes, at primary health care or community level, I have to perform ultrasound using different ultrasound machines from various manufacturers. These machines range from being very very basic to reasonably good one and , thus, have noticeable difference among the image quality obtained. I wish to know is there any method, scale, standard or criteria to measure the image quality produced by these machines objectively.
Are there any guidelines published by any authority detailing the minimum acceptable level of an ultrasound machine suitable for a given diagnostic work. Say on a scale from 0 to 10, with cut off of (suppose) 4 below which image quality is considered insufficient to provide the minimum information needed for that diagnostic study.
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@ Nicholas and Christos ( with regards) : I was hesitant to put forth this query of mine but since it was troubling me so i wrote it here.
I observed that since radiologists graduate from different medical schools there lies gross difference in what they 'perceive' is 'perfect' and secondly the administrators are not radiologists ( and sadly they are to decide while purchasing a machine by any purchase committee). That is why I insisted on an objective criteria. Another point is to define a minimum level of performance ( not worried about what the best is offering after too much of 'algorithms stuff') , as Nicholas mentioned, should be able to do majority of the work up to a acceptable level. Our journals talk of major and big researches (and they should, for the radiology to grow) but such problems which a fresh radiologist faces while practicing radiology at grass root level with the machines which we only see ( if lucky enough) in museums, should be addressed some where. The point is to attain a 'horizontal growth' delivering some basic radiology services to all people. 
This is a good idea to evolve some guidelines stating that 'this should be seen ( fetal skull tables for examples) but till now there are guidelines  or a list of things for radiologist to look for in specific scan ( e.g. ACR guidelines for antenatal usg) but no guidelines for performance of machine. The reasons are obvious- they do not face such problems. And if we can reach a consensus for that 'bare minimum acceptable level' it will be easier to have good quality machines in any future installations or at least retire the out dated systems.
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3D ultrasonography is a much talked thing now, but the equipment involved are is costly. Is there any software available which can convert 2D usg images to 3D?
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do you mean convert 2D ultrasound imaging into 3D ultrasound volume image?
One of the approach is freehand ultrasound. A 3D position sensor is rigidly attached on the 2D ultrasound probe. Then the 2D images can be reconstructed into a volumetric images. A calibration is usually needed to estimate the transformation between the 2D image and the reconstructed volume coordinate.
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I wish to do a Doppler scan of liquid and ferrofluid in a tube. How will it affect the output image in the given cases?
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No difference if they are traveling at the same speed. May be the signal strngth could be different.
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A recent trend is to request sonography of all patients seen by residents in the ED. Frequently sonography is the 1st investigation (pending the results of biochemical investigations). As can be expected, the indications are often loose. It become a challenge for a radiology resident to direct his attention towards a particular organ system. The entire sonographic examination (without any direction) becomes an exercise in vain, putting serious time constraints on sonographic examination of other patients with seemingly localised pathology.
What is your experience? Is it an institutional phenomenon or global problem?
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Of course it is not routine. This is a case of people requesting invesatigations for which there is no scientific reason and most importantly without thinking. It is a waste of everyone's time and money. A good history and examination is far more important. Unfortunately once one person starts this nonsensical approach to patient management it can be difficult to reverse it. My advice is to nip it in the bid before it becomes an ongoing problem.
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I need to perform breast ultrasound, benign and malignant.
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Hi...I am not sure if it will help you a bit....However, I can suggest you two websites with some US images of the breast, though they do not provide a real database: http://www.medison.ru/uzi/eng/all/mammography.htm
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Does anyone know of research being done on elastography, done on the testes for general tissue properties and disease states rather than focal lesions? Does anyone know of a good reference on upto date info?
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Dear Yacov,
I've just held a presentation about the issues you indicate.
You can download it as PPT file in my page on here at the following link
Or you can see it on a video file both on YouTube at the following link
or in my website (www.masciotra.net) where you can get the PDF too.
Best regards.
Antonio
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Analyzing interview data gathered during my doctoral research on advanced practice sonography, I saw distinct differences between the work of the staff sonographer, the advanced sonographer, and the interpreting physician. Yet many sonographers out in the field have conflicting opinions as to who does what in diagnostic medical sonography. Many would argue that the sonographer diagnoses the study. Some would claim this does not happen. I make the argument that the very act of performing a sonographic scan is an act of DIAGNOSIS. Do we as sonographers diagnose disease? Or do we stop at providing sonographic findings that physicians diagnose and interpret?
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Performing sonographic scan is definitely aiding the diagnosis, however as we do not know the detailed history and the results of the other biochemocal markers and tests performed we cannot complete the picture. In Obstetrics and gynecology, more diagnosis are likely to be made.