Long-term medical imaging use in children with central nervous system tumors.

BACKGROUND: Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. PROCEDURE: We conducted a retrospective cohort study of children aged 0-20 years diagnosed with CNS tumors between 1996-2016 at six U.S. integrated healthcare systems and Ontario, Canada. We collected computed topography (CT), magnetic resonance imaging (MRI), radiography, ultrasound, nuclear medicine examinations from 12 months before through 10 years after CNS diagnosis censoring six months before death or a subsequent cancer diagnosis, disenrollment from the health system, age 21 years, or December 31, 2016. We calculated imaging rates per child per month stratified by modality, country, diagnosis age, calendar year, time since diagnosis, and tumor grade. RESULTS: We observed 1,879 children with median four years follow-up post-diagnosis in the U.S. and seven years in Ontario, Canada. During the diagnosis period (±15 days of diagnosis), children averaged 1.10 CTs (95% confidence interval [CI] 1.09-1.13) and 2.14 MRIs (95%CI 2.12-2.16) in the U.S., and 1.67 CTs (95%CI 1.65-1.68) and 1.86 MRIs (95%CI 1.85-1.88) in Ontario. Within one year after diagnosis, 19% of children had ≥5 CTs and 45% had ≥5 MRIs. By nine years after diagnosis, children averaged one MRI and one radiograph per year with little use of other imaging modalities. CONCLUSIONS: MRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.

Can high-frequency ultrasound combined computed tomography accurately diagnose thyroid tumor?: A protocol of systematic review and meta-analysis.

BACKGROUND: Previous clinical studies have reported that clinical value of high-frequency ultrasound combined computed tomography (HFUCT) is used for diagnosis of thyroid tumor (TT). However, no study has investigated this topic systematically. Therefore, this study will evaluate the clinical value of HFUCT for the diagnosis of TT. METHODS: We will search the databases of Cochrane Library, EMBASE, PUBMED, SCOPUS, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from any time period published to the present. We will consider all case-controlled studies that assessed the clinical value of HFUCT for diagnosis of TT. Two authors will independently scan titles and abstracts to check eligible studies, followed by full-text read. We will extract data and assess study quality using Quality Assessment of Diagnostic Accuracy Studies tool. RevMan 5.3 software will be utilized for data pooling and statistical analysis. RESULTS: This study will be performed to assess the clinical value of HFUCT for the diagnosis of TT, and will provide an evidence-based synthesis for clinical application and further study. CONCLUSION: Summary of this study will provide the latest evidence to determine whether HFUCT can be used for TT diagnosis accurately. STUDY REGISTRATION: INPLASY202040022.

EURO-MUSCULUS/USPRM Global Report on Musculoskeletal Ultrasound Publications.

The developments in technology have improved access to the use of musculoskeletal ultrasound (MSUS) in different clinical settings. Accordingly, MSUS has been applied to a wide range of musculoskeletal problems including inflammatory and degenerative diseases, sport injuries, and regional pain syndromes both for clinical practice and research. In this report, the authors aimed to globally examine the publications on MSUS among different specialties, countries, and topics. Sixteen reviewers under the umbrella of the European Musculoskeletal Ultrasonography Society Group and the Ultrasound Study Group of International Society of Physical and Rehabilitation Medicine have evaluated approximately 15,000 publications on MSUS. The authors believe that the results of this comparative analysis may provide a holistic snapshot with regard to the utility of MSUS, not only for clinicians/academicians but also for the industry. Accordingly, while aiming to further increase their awareness, this article would possibly guide future investments as well.

Ultrasound Evaluation of the Peroneal Tendons in an Asymptomatic Elite Military Population: A Prospective Cohort Study.

INTRODUCTION: The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. MATERIALS AND METHODS: The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. RESULTS: The mean sagittal distance and standard deviation was 0.48 ± 0.9 mm. No subjects demonstrated greater than 1 mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. CONCLUSION: The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.

Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades.

PURPOSE: To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS: Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS: In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS: Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.

Clinical ultrasound in the ICU: changing a medical paradigm. / Ecografía clínica en la unidad de cuidados intensivos: cambiando un paradigma médico.

In recent decades there has been an evolution from the traditional paradigm of sporadic ultrasound performed by radiologists and cardiologists in the ICU to clinical ultrasound performed by intensivists as an extension of patient evaluation rather than as a complementary test. Such clinical ultrasound aims to diagnose and treat the patient directly. All ultrasound modalities could be interesting in the ICU, either helping in decision making or guiding procedures. Clinical ultrasound training should include all the possibilities of ultrasound, and the tutelage of other trained intensivists and other specialists with more experience should be available at all times. Training should be phased into basic, advanced and expert levels, with adjustment to the contents of the CoBaTrICE Project and the recommendations of the SEMICYUC.

Efectos de dos métodos de termoterapia sobre la respuesta vascular aguda y parámetros hemodinámicos en un grupo de sujetos sanos / Effects of two methods of heat therapy on the acute vascular response and hemodynamics in healthy subjects

Objetivo. Recientemente determinados recursos no farmacológicos, como el paquete caliente (PC) y los ultrasonidos (US), son utilizados en el alivio del dolor con alto grado de aceptación en la práctica clínica. Sin embargo, la evidencia experimental que apoye los posibles mecanismos por los que se producen estos beneficios es escasa. El objetivo de este estudio fue comprobar los efectos de dos métodos de termoterapia (PC y US) sobre la respuesta vascular aguda y parámetros hemodinámicos en sujetos sanos. Materiales y métodos. Estudio experimental en 20 sujetos sanos (10 hombres y 10 mujeres; edad media, 22,54±1,70 años). Se aplicaron dos intervenciones de forma aleatoria: a) PC (n=10): 15min a 60°C, y b) US (n=10): 15min a 1Mhz, y se realizaron mediciones vasculares mediante ecografía doppler con transductor de 7Mhz, antes y después de cada intervención. Parámetros vasculares: distensibilidad arterial (Da), módulo elástico (Ep), índice beta de rigidez (β), diámetro arterial sistólico y diastólico, velocidad del flujo sistólico (Vfs) y diastólico (Vfd), relación sístole/diástole (RSD), índice de resistencia (IR) e índice de pulsatilidad (IP) en la arteria braquial, y monitorización hemodinámica de la frecuencia cardiaca y de las presiones arteriales sistólica, diastólica y media. Resultados. Se encontraron diferencias en la Vfd y en el IP (p<0,05), en la intervención con PC, mientras que la intervención con US mostró cambios en la Vfd, la RSD, el IR y la Da (p<0,05). No se encontraron cambios en los parámetros hemodinámicos. Conclusiones. La fisiología del sistema vascular se modifica por la aplicación del PC y los US, sin afectar los parámetros hemodinámicos en sujetos sanos(AU)

Objective. Recently, non-pharmacological resources to relieve pain like hot packs and ultrasound (US) have become common in clinical practice. However, little experimental evidence is available about the possible mechanisms through which these methods bring about pain relief. We aimed to determine the effects of hot packs and US on the acute vascular response and on hemodynamic parameters in healthy subjects. Materials and methods. We conducted an experimental study in 20 healthy subjects (10 men and 10 women; mean age, 22.54±1.70 years). The two interventions were randomly applied: a) hot packs (n=10): 15min at 60°C and b) US (n=10): 15min at 1Mhz. Before and after each intervention, the following vascular parameters were measured in the brachial artery using Doppler ultrasonography with a 7MHz probe: arterial compliance, elastic modulus, beta stiffness index, systolic and diastolic arterial diameters, systolic flow velocity and diastolic flow velocity, systolic/diastolic ratio, resistance index, and pulsatility index. The following hemodynamic parameters were monitored: heart rate and blood pressure (systolic, diastolic, and mean). Results. After the application of hot packs, we observed changes in diastolic flow velocity and in the pulsatility index (P<05). After the application of US, we observed changes in diastolic flow velocity, systolic/diastolic ratio, resistance index, and arterial compliance (P<05). No changes in hemodynamic parameters were observed after either intervention. Conclusions. Applying hot packs or US modifies the physiology of the vascular system but does not affect hemodynamic parameters in healthy subjects(AU)

Extracción de cuerpo extraño guiada con ecografía / No disponible

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Actualización en técnicas de imagen cardiaca: ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores / Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography

En este artículo se revisan las publicaciones más relevantes sobre la imagen cardiaca que han aparecido en2008. Hemos asistido a la introducción en la clínica de la ecocardiografía transesofágica tridimensional en tiempo real a la selección de casos y la monitorización ecocardiográfica de pacientes sometidos a sustitución percutánea de la válvula aórtica, aún en fase de aprendizaje para la mayoría de los centros que la practican, y a la irrupción en el campo clínico de las técnicas de estudio de deformación miocárdica. Se realiza también un resumen de lo más relevante en el ecocardiograma de la cardiopatía isquémica y la resincronización y de dos técnicas en expansión constante: la cardiorresonancia magnética y la tomografía computarizada cardiaca con multidetectores. Este trabajo de revisión termina con la descripción del estado de los contrastes ecocardiográficos, con especial énfasis en cuanto a su seguridad, tras las recomendaciones realizadas a finales de 2007 por la Food and Drug Administration (AU)

This article contains a review of the most importantpublications on cardiac imaging that have appearedduring 2008. During the year, we assisted with theclinical implementation of three-dimensional realtimetransesophageal echocardiography, with the useof echocardiography for selecting patients for andmonitoring those who underwent percutaneous aorticvalve replacement (the majority of centers performingthe technique were still in the learning phase), andwith the emergence in the clinic of techniques forstudying myocardial deformation. Also reviewed arethe most significant developments in the application ofechocardiography to coronary heart disease and cardiacresynchronization therapy and in 2 other techniqueswhose use is constantly increasing: cardiac magneticresonance and multidetector cardiac computedtomography. The review ends with a description of thecurrent state of the art in contrast echocardiography,with particular emphasis on safety in the context ofrecommendations made by the US Food and DrugAdministration at the end of 2007 (AU)

Ultrasonography in pain medicine: a critical review.

Recently, ultrasonography has been increasingly used in the field of regional anesthesia to assure reliable blockade of peripheral nerves and to visualize neuroaxial structures. As its popularity is steadily increasing, it may become a standard of care for both intraoperative analgesia and postoperative pain control. The application of ultrasound in chronic pain management, however, remains underutilized. Multiple reasons can be suggested to explain this situation. Nonetheless, numerous articles have been published and some interventionalists have gained experience and started to spread their knowledge through hands-on workshops and medical meetings. It, therefore, seems timely to describe the techniques of ultrasound-guided injections for chronic pain, to review accumulated experience in this field, to reappraise the scientific and clinical value of this method, and to outline potential future developments.