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Lalzad A, Wong F, Schneider M. Neuroinflammation in the Rat Brain After Exposure to Diagnostic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:961-968. [PMID: 38685265 DOI: 10.1016/j.ultrasmedbio.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/19/2023] [Accepted: 02/11/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To date there have been no studies exploring the potential for neuroinflammation as an intracranial bio-effect associated with diagnostic ultrasound during neonatal cranial scans in a mammalian in vivo model. The study described here was aimed at investigating the effects of B-mode and Doppler mode ultrasound on inflammation in the rat brain. METHODS Twelve Wistar rats (7-9 wk old) were divided into a control group and an ultrasound-exposed group (n = 6/group). A craniotomy was performed, followed by 10 min of B-mode and spectral Doppler interrogation of the middle cerebral artery. The control group was subjected to sham treatment, with the transducer held stationary over the craniotomy site, but the ultrasound machine switched off. Animals were euthanized 48 h after exposure, and the brains formalin fixed for immunohistochemical analysis using allograft inflammatory factor 1 (IBA-1) and glial fibrillary acidic protein (GFAP) as markers of microglia and astrocytes, respectively. The numbers of IBA-1- and GFAP-immunoreactive cells were manually counted and expressed as areal density (cells/mm2). Results were analyzed using Student's unpaired t-test and one-way repeated-measures analysis of variance. RESULTS The ultrasound-exposed brain exhibited significant increases in IBA-1 and GFAP immunoreactive cell density in all regions of B-mode and Doppler mode exposure compared with the control group (p < 0.001). CONCLUSION Ten minutes of B-mode and Doppler mode ultrasound may induce neuroinflammatory changes in the rat brain. This suggests that exposure of brain tissue to current diagnostic ultrasound intensities may not be completely without risk.
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Affiliation(s)
- Assema Lalzad
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, Cabrini Hospital, Malvern, Victoria, Australia
| | - Flora Wong
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia; The Ritchie Centre, Hudson's Institute of Medical Research, Melbourne, Victoria; Department of Pediatrics, Monash University, Clayton, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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König J, Rahn A, Schätzel J, Frank M, Stahnke T, Witt M, Stachs A, Stachs O, Langner I, Lindner T, Beller E, Fischer DC, Streckenbach F. Effects of prenatal Doppler ultrasound on the retina of the chick embryo in ovo. Anat Histol Embryol 2023; 52:1003-1009. [PMID: 37668174 DOI: 10.1111/ahe.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
Currently, the effect of prenatal ultrasound on foetal development is intensively discussed and the guidelines for prenatal diagnostics have been changed. However, data supporting these concerns are scarce. Therefore, we used an established in ovo model of the chicken embryo to investigate cell proliferation and apoptosis within the retina. A total of 21 chicken eggs were fenestrated on Day 5 and allocated to either the control (n = 8) or exposition group (n = 13). The exposition group was treated with pulsed-wave Doppler ultrasound (PWD) for 10 min while controls remained without treatment. After subsequent incubation (6-48 h), the eggs were sacrificed, and chicken embryos were examined morphologically (HE-staining) and immunohistochemically. Counting of apoptotic and proliferating cells per retina was performed using antibodies specific for phospho-histone-H3 and active caspase-3 in combination with a biotin-labelled secondary antibody and peroxidase conjugated avidin-biotin complex for chromogenic detection. Due to a rather low number of specimens at each time point after ultrasound exposition, we neglected the effects of incubation time and focused on treatment effects. This approach revealed that the median number of proliferating cells is reduced after 10 min of exposure to PWD (569 vs. 766), while the number of apoptotic cells is fairly comparable between groups (5 vs. 6). Our data contribute to a better understanding of prenatal US on foetal development by suggesting that PWD could have an impact on the number of proliferating cells in the developing chicken retina and therefore justify further investigations.
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Affiliation(s)
- Julia König
- Department of Anesthesia and Intensive Care, University Hospital Rostock, Rostock, Germany
| | - Anja Rahn
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Jana Schätzel
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Marcus Frank
- Medical Biology and Electron Microscopy Centre, Rostock University Medical Center, Rostock, Germany
- Department of Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Thomas Stahnke
- Institute for Implant Technology and Biomaterials-IIB e.V., Rostock, Germany
| | - Martin Witt
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
- Department of Anatomy, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
- Department of Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Inga Langner
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Lindner
- Core Facility Multimodal Small Animal Imaging, Rostock University Medical Center, Rostock, Germany
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Ebba Beller
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Felix Streckenbach
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany
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Sun H, Wu A, Lu M, Cao S. Liability, risks, and recommendations for ultrasound use in the diagnosis of obstetrics diseases. Heliyon 2023; 9:e21829. [PMID: 38045126 PMCID: PMC10692788 DOI: 10.1016/j.heliyon.2023.e21829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
This literature review will summarize the liability issues, risks, and ultrasound recommendations for diagnosing obstetrics diseases. One liability issue is related to misdiagnosis or failure to detect abnormalities during an ultrasound examination. Ultrasound images can be subjective interpretations, and errors may occur due to factors such as operator skill, equipment limitations, or fetal positioning. Another liability concern is related to the potential adverse effects of ultrasound exposure on both the mother and fetus. While extensive research has shown that diagnostic ultrasound is generally safe when used appropriately, there are still uncertainties regarding long-term effects. Some studies suggest a possible association between prolonged or excessive exposure to ultrasound waves and adverse outcomes such as low birth weight, developmental delays, or hearing impairment. Additionally, obtaining informed consent from patients is crucial in mitigating liability risks. Patients should be informed about the purpose of the ultrasound examination, its benefits, limitations, potential risks (even if minimal), and any alternative diagnostic options available. This ensures that patients know the procedure and can make informed decisions about their healthcare. Proper documentation helps establish a clear record of the care provided and can serve as evidence in any legal disputes.
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Affiliation(s)
- Haiting Sun
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - An Wu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Minli Lu
- Department of Ultrasound, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, 315700, Zhejiang Province, PR China
| | - Shan Cao
- Department of Obstetrics, The Affiliated Second People's Hospital of Yuhang District, Hangzhou City, Hangzhou, 311100, Zhejiang Province, PR China
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4
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Perri A, Fattore S, D’Andrea V, Sbordone A, Patti ML, Nobile S, Tirone C, Giordano L, Tana M, Priolo F, Serrao F, Riccardi R, Prontera G, Vento G. Lowering of the Neonatal Lung Ultrasonography Score after nCPAP Positioning in Neonates over 32 Weeks of Gestational Age with Neonatal Respiratory Distress. Diagnostics (Basel) 2022; 12:diagnostics12081909. [PMID: 36010259 PMCID: PMC9406690 DOI: 10.3390/diagnostics12081909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal lung ultrasonography score (nLUS) can be used in the diagnostic process, but some authors hypothesise that it is also useful for the management of some neonatal RD. The aim of this study is to analyse the changes in nLUS score before (T0) and after (T1) the start of respiratory support with nasal CPAP in neonates over 32 weeks of age with RD. Thirty-three newborns were enrolled in this retrospective study. LU was performed before and after the start of CPAP. The median nLUS scores at T0 and T1 were 9 (IQR 7−12) and 7 (IQR 4−10), respectively, and showed a significant difference (p < 0.001). The magnitude of reduction in nLUS score, expressed as a percentage, was inversely related to the need for subsequent administration of exogenous surfactant. The study suggests the usefulness of the nLUS score in assessing the response to CPAP in neonates over 32 weeks gestational age.
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Affiliation(s)
- Alessandro Perri
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Simona Fattore
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vito D’Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154357; Fax: +39-063383211
| | - Annamaria Sbordone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Letizia Patti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Tirone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lucia Giordano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Milena Tana
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Priolo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Serrao
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Riccardi
- Neonatal Intensive Care Unit, “San Giovanni Calibita Fatebenefratelli” Hospital, Isola Tiberina, 00186 Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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5
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Mezrai N, Houdelier C, Bertin A, Calandreau L, Arnould C, Darmaillacq AS, Dickel L, Lumineau S. Impact of natural and artificial prenatal stimulations on the behavioural profile of Japanese quail. J Exp Biol 2022; 225:274521. [PMID: 35213895 DOI: 10.1242/jeb.243175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022]
Abstract
As the sensory systems of vertebrates develop prenatally, embryos perceive many environmental stimuli that can influence the ontogeny of their behaviour. Whether the nature and intensity of prenatal stimuli affect differently this ontogeny remains to be investigated. In this context, this study aimed to analyse the effects of prenatal auditory stimulations (natural stimulations "NS": predator vocalisations, or artificial stimulations "AS": metallic sounds) on the subsequent behaviour of young Japanese quail (Coturnix coturnix japonica). For that, behavioural variables recorded during ethological tests evaluating emotional and social reactivity were analysed using a principal component analysis. This analysis revealed significant differences between the behavioural profile of stimulated chicks and that of non-exposed chicks. Indeed, chicks exposed to NS expressed more intense emotional responses in fearful situations, but less neophobia in the presence of a novel environment or object, whereas chicks exposed to AS appeared more sensitive to social isolation. Our original results show that the acoustic environment of embryos can influence the way young birds subsequently interact with their social and physical environment after hatching, and face challenges in changing living conditions.
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Affiliation(s)
- Nawel Mezrai
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
| | - Cécilia Houdelier
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
| | - Aline Bertin
- INRAE, UMR 85 Physiologie de la Reproduction et des Comportements, CNRS, UMR 7247, IFCE, Université F. Rabelais, Nouzilly, France
| | - Ludovic Calandreau
- INRAE, UMR 85 Physiologie de la Reproduction et des Comportements, CNRS, UMR 7247, IFCE, Université F. Rabelais, Nouzilly, France
| | - Cécile Arnould
- INRAE, UMR 85 Physiologie de la Reproduction et des Comportements, CNRS, UMR 7247, IFCE, Université F. Rabelais, Nouzilly, France
| | - Anne-Sophie Darmaillacq
- Normandie Univ, Unicaen, CNRS, EthoS, 14000 Caen, France.,Univ Rennes, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
| | - Ludovic Dickel
- Normandie Univ, Unicaen, CNRS, EthoS, 14000 Caen, France.,Univ Rennes, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
| | - Sophie Lumineau
- Univ Rennes, Normandie Univ, CNRS, EthoS (Éthologie animale et humaine) - UMR 6552, F-35000 Rennes, France
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Sande R, Jenderka KV, Moran CM, Marques S, Jimenez Diaz JF, Ter Haar G, Marsal K, Lees C, Abramowicz JS, Salvesen KÅ, Miloro P, Dall'Asta A, Brezinka C, Kollmann C. Safety Aspects of Perinatal Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:580-598. [PMID: 34352910 DOI: 10.1055/a-1538-6295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.
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Affiliation(s)
- Ragnar Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Norway
| | | | - Carmel M Moran
- Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Susana Marques
- Department of Gastroenterology and Digestive Endoscopy, Champalimaud Foundation, Lisboa, Portugal
| | - J F Jimenez Diaz
- Sport Sciences Faculty, Castilla La Mancha University Education Faculty of Toledo, Spain
- Sport Medicine Department, UCAM, Murcia, Spain
| | - Gail Ter Haar
- Physics, Institute of Cancer Research, Sutton, United Kingdom of Great Britain and Northern Ireland
| | - Karel Marsal
- Department of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Christoph Lees
- Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago Medical Center, CHICAGO, United States
- Safety Committee, World Federation for Ultrasound in Medicine and Biology, Chicago, United States
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Piero Miloro
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, United Kingdom of Great Britain and Northern Ireland
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, Universita degli Studi di Parma, Italy
| | - Christoph Brezinka
- Department of Obstetrics and Gynecology, Medical University Innsbruck Department of Gynecology, Innsbruck, Austria
| | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
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Steele LM, Kotsch TJ, Legge CA, Smith DJ. Establishing C. elegans as a Model for Studying the Bioeffects of Therapeutic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2346-2359. [PMID: 34006439 DOI: 10.1016/j.ultrasmedbio.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Ultrasound is widely used in diagnostic and therapeutic medical procedures and it is becoming an important tool in biomedical research. During exposure, as an ultrasound beam interacts with the tissues in its path, changes known as "bioeffects" can result. Animal studies have suggested that these changes can alter survival, movement, reproduction, development and learning in various species. Additional studies in animals could provide valuable information about the mechanisms of therapeutic ultrasound and may contribute to the development of additional exciting laboratory techniques. Therefore, we developed methods for exposing C. elegans nematode worms to ultrasound and observed that they exhibited exposure-dependent reductions in movement, fecundity and survival. These effects were prevented by polyvinyl alcohol, which suggested that cavitation was the main mechanism of damage. This work provides a foundation for capitalizing on the advantages of C. elegans as a model to thoroughly characterize ultrasound's bioeffects at the cellular and molecular levels.
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Affiliation(s)
- Louise M Steele
- Department of Biological Sciences, Kent State University at Salem, Salem, OH, USA.
| | - Troy J Kotsch
- Department of Biological Sciences, Kent State University at Salem, Salem, OH, USA
| | - Catherine A Legge
- Radiologic & Imaging Sciences Program, Kent State University at Salem, Salem, OH, USA
| | - Delores J Smith
- College of Nursing, Kent State University at Salem, Salem, OH, USA
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8
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Wear KA. Hydrophone Spatial Averaging Correction for Acoustic Exposure Measurements From Arrays-Part I: Theory and Impact on Diagnostic Safety Indexes. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:358-375. [PMID: 33186102 PMCID: PMC8325172 DOI: 10.1109/tuffc.2020.3037946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article reports underestimation of mechanical index (MI) and nonscanned thermal index for bone near focus (TIB) due to hydrophone spatial averaging effects that occur during acoustic output measurements for clinical linear and phased arrays. TIB is the appropriate version of thermal index (TI) for fetal imaging after ten weeks from the last menstrual period according to the American Institute of Ultrasound in Medicine (AIUM). Spatial averaging is particularly troublesome for highly focused beams and nonlinear, nonscanned modes such as acoustic radiation force impulse (ARFI) and pulsed Doppler. MI and variants of TI (e.g., TIB), which are displayed in real-time during imaging, are often not corrected for hydrophone spatial averaging because a standardized method for doing so does not exist for linear and phased arrays. A novel analytic inverse-filter method to correct for spatial averaging for pressure waves from linear and phased arrays is derived in this article (Part I) and experimentally validated in a companion article (Part II). A simulation was developed to estimate potential spatial-averaging errors for typical clinical ultrasound imaging systems based on the theoretical inverse filter and specifications for 124 scanner/transducer combinations from the U.S. Food and Drug Administration (FDA) 510(k) database from 2015 to 2019. Specifications included center frequency, aperture size, acoustic output parameters, hydrophone geometrical sensitive element diameter, etc. Correction for hydrophone spatial averaging using the inverse filter suggests that maximally achievable values for MI, TIB, thermal dose ( t 43 ), and spatial-peak-temporal-average intensity ( [Formula: see text]) for typical clinical systems are potentially higher than uncorrected values by (means ± standard deviations) 9% ± 4% (ARFI MI), 19% ± 15% (ARFI TIB), 50% ± 41% (ARFI t 43 ), 43% ± 39% (ARFI [Formula: see text]), 7% ± 5% (pulsed Doppler MI), 15% ± 11% (pulsed Doppler TIB), 42% ± 31% (pulsed Doppler t 43 ), and 33% ± 27% (pulsed Doppler [Formula: see text]). These values correspond to frequencies of 3.2 ± 1.3 (ARFI) and 4.1 ± 1.4 MHz (pulsed Doppler), and the model predicts that they would increase with frequency. Inverse filtering for hydrophone spatial averaging significantly improves the accuracy of estimates of MI, TIB, t 43 , and [Formula: see text] for ARFI and pulsed Doppler signals.
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9
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Zhang C, Li N, Li C, Li J. A Safety Study of the Effects of 2-Dimensional Shear Wave Elastography on Synaptic Morphologic Characteristics and Function in the Hippocampus of Neonatal Mice. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:163-173. [PMID: 32681671 DOI: 10.1002/jum.15387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to determine the effects of 2-dimensional (2D) shear wave elastography (SWE) on synaptic morphologic characteristics and function in the neonatal mouse hippocampus and whether it affects the capacity for learning and memory later in life. METHODS We divided neonatal mice into a control group and a 2D SWE group scanned for 10, 20, or 30 minutes. Hippocampal morphologic characteristics were assessed by hematoxylin-eosin and Nissl staining. Ultrastructures of hippocampal neurons were visualized by electron microscopy. Protein and messenger RNA expression levels of synaptophysin, N-methyl-d-aspartate receptor 1 (NMDAR1), NMDAR2A, and NMDAR2B were quantified by a western blot and polymerase chain reaction, respectively. Learning and memory of adult mice were evaluated by the Morris water maze and the novel object recognition task. RESULTS Compared with the control group, the hippocampal morphologic characteristics of the experimental groups did not differ under light microscopy, and the synaptic structures assessed by electron microscopy appeared normal. Western blot and polymerase chain reaction results showed that expression of synaptophysin, NMDAR1, NMDAR2A, and NMDAR2B were downregulated after exposure to 2D SWE, but there were no statistical differences between the experimental groups. This downregulation disappeared within 24 hours. The results of the Morris water maze and novel object recognition suggested that the 2D SWE scanning on neonatal mice had no effect on learning and memory in adulthood. CONCLUSIONS This study demonstrated that when the mice were exposed to neonatal cranial ultrasound by 2D SWE lasting for longer than 10 minutes, the expression of genes involved in synaptic function was affected, but this effect lasted no longer than 24 hours and did not affect learning and memory in adulthood.
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Affiliation(s)
- Cheng Zhang
- Department of Ultrasound, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Changtian Li
- Department of Ultrasound, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junlai Li
- Department of Ultrasound, Second Medical Center of Chinese PLA General Hospital, Beijing, China
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10
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Lalzad A, Wong FY, Singh N, Coombs P, Brockley C, Brennan S, Ditchfield M, Rao P, Watkins A, Saxton V, Schneider M. Surveillance Practice for Sonographic Detection of Intracranial Abnormalities in Premature Neonates: A Snapshot of Current Neonatal Cranial Ultrasound Practice in Australia. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2303-2310. [PMID: 32616429 DOI: 10.1016/j.ultrasmedbio.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total number of scans, scan duration and frequency and duration of colour and spectral Doppler mode, were extracted. A total of 196 scans formed the final cohort. The median (range) number of scans for each neonate was 1 (1-12). The median (range) overall total scan duration was 309 (119-801) s. Colour mode with or without spectral Doppler mode was used in approximately half of the cohort (106/196, 54%). Our findings comport with our hypotheses. Operators performing neonatal cranial scans in Australia have low overall scan durations. Although the use of Doppler mode during neonatal cranial scans is not standard practice in all neonatal intensive care units, it is used widely irrespective of the degree of prematurity or the presence of brain pathology. Further efforts are required to incorporate recommendations on scan duration and the routine use of Doppler mode during neonatal cranial scans. This is especially imperative given that the most vulnerable neonates with the greater neural tissue sensitivity are likely to be scanned more often.
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Affiliation(s)
- Assema Lalzad
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, St. Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia; Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Y Wong
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia; The Ritchie Centre, Hudson's Institute of Medical Research, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Coombs
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Sonja Brennan
- Department of Medical Imaging, Townsville General Hospital, Douglas, Queensland, Australia
| | | | - Padma Rao
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Andrew Watkins
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Salem S, Lim K, Van den Hof MC. No. 304-Joint SOGC/CAR Policy Statement on Non-medical Use of Fetal Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:e1-e3. [PMID: 30638559 DOI: 10.1016/j.jogc.2018.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Issaoui M, Balandraud X, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Rise Caused by Shear Wave Elastography, Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:325-335. [PMID: 31735465 DOI: 10.1016/j.ultrasmedbio.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, "heat tunnels" crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.
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Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Grédiac
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Benoit Blaysat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique, Unité de Biostatistique et Informatique Médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amelie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique et Environnement, Université Clermont-Auvergne, UFR Pharmacie, Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Bagley JE, Nematzadeh F, Spitz JL, Baldwin J. Written Feedback on Thermal Index During the First-Trimester Nuchal Translucency Examination Does Not Improve Compliance With the “as Low as Reasonably Achievable” Principle. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319871252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The null hypothesis was that there would be no change in as low as reasonably achievable (ALARA) behavior based on feedback from comments on the nuchal translucency quality review (NTQR) image submissions. Methods: A review of the Perinatal Quality Foundation Database found 206 practitioners who failed their first credential attempt and received ALARA comments as feedback. The second submissions of the same subjects were reviewed to determine if compliance with ALARA improved following written feedback. Results: Seventeen percent of all second submissions addressed ALARA. Sixty-one percent of second submissions passed, however only 18.4 % of those addressed ALARA. Among those who submitted thermal index at bone values on both first and second submissions, the mean values on the second submission were 0.20 lower compared to the first submission ( P = .0288). Second submission mean thermal index at bone values were 0.68 lower among those submissions with ALARA concerns addressed compared to those not addressing these concerns ( P < .001). Conclusions: Written feedback without consequences on the ALARA principle did not improve compliance.
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Affiliation(s)
- Jennifer E. Bagley
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
| | - Freshta Nematzadeh
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
| | | | - Jonathan Baldwin
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK, USA
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M M, M B, A P, A E, M Z, A R, H G, F Z. Biological Effect of Modern Fetal Ultrasound Techniques on Human Dermal Fibroblast Cells. J Biomed Phys Eng 2019; 9:335-344. [PMID: 31341879 PMCID: PMC6613153 DOI: 10.31661/jbpe.v0i0.1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/30/2018] [Indexed: 11/16/2022]
Abstract
Background: Diagnostic ultrasound has been used to detect human disease especially fetus abnormalities in recent decades. Although the harmful effects of diagnostic ultrasound on human have not been established so far, several researchers showed it has had bioeffects in cell lines and in experimental animals. Three-dimensional (3D), four-dimensional (4D), and color Doppler sonography are new techniques which are widely used in diagnostic fetal ultrasonography.
Objective: The study aims to evaluate some bioeffects of 3D, 4D, and color Doppler sonography in different exposure times according to the acoustic output which is set as ultrasound scanner’s default for fetal sonography in the second trimester on human dermal fibroblast (HDF) cells.
Material and Methods: Exposure times selected consist of 10, 40, 70, and 100 seconds for 3D sonography, 10, 20, and 30 minutes for 4D sonography, and 10, 30, and 50 seconds for color Doppler. Cell viability, cell proliferation, and apoptosis induction on HDF cells were assessed using MTT assay, immunocytochemistry of Ki-67, and Terminal Transferase-mediated dUTP End-labeling (TUNEL) assay, respectively.
Results: Exposure of cells to 3D, 4D, and color Doppler modes led to decreased cell viability and increased proliferation rate of HDF. None of the diagnostic ultrasound modes induced cell apoptosis. .
Conclusion: The results indicated that 3D, 4D, and color Doppler techniques may affect the cell viability and proliferation of HDF cells, however, have no effects on the induction of apoptosis probability. Further long-term studies with other molecular endpoints are required.
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Affiliation(s)
- Morshedi M
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bakhshandeh M
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Piryaei A
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Emami A
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Zangeneh M
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Razzaghdoust A
- Urology and Nephrology Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghadiri H
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Zayeri F
- Department of biostatistics and proteomics research center, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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No 304 - Déclaration de principe commune SOGC/CAR sur l'utilisation non médicale de l’échographie fœtale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e4-e6. [DOI: 10.1016/j.jogc.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Retz K, Kotopoulis S, Kiserud T, Matre K, Eide GE, Sande R. Measured acoustic intensities for clinical diagnostic ultrasound transducers and correlation with thermal index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:236-241. [PMID: 27608142 DOI: 10.1002/uog.17298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/14/2016] [Accepted: 08/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate if the thermal index for bone (TIB) displayed on screen is an adequate predictor for the derated spatial-peak temporal-average (ISPTA.3 ) and spatial-peak pulse-average (ISPPA.3 ) acoustic intensities in a selection of clinical diagnostic ultrasound machines and transducers. METHODS We calibrated five clinical diagnostic ultrasound scanners and 10 transducers, using two-dimensional grayscale, color Doppler and pulsed-wave Doppler, both close to and far from the transducer, with a TIB between 0.1 and 4.0, recording 103 unique measurements. Acoustic measurements were performed in a bespoke three-axis computer-controlled scanning tank, using a 200-μm-diameter calibrated needle hydrophone. RESULTS There was significant but poor correlation between the acoustic intensities and the on-screen TIB. At a TIB of 0.1, the ISPTA.3 range was 0.51-50.49 mW/cm2 and the ISPPA.3 range was 0.01-207.29 W/cm2 . At a TIB of 1.1, the ISPTA.3 range was 19.02-309.44 mW/cm2 and the ISPPA.3 range was 3.87-51.89 W/cm2 . CONCLUSIONS TIB is a poor predictor for ISPTA.3 and ISPPA.3 and for the potential bioeffects of clinical diagnostic ultrasound scanners. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Retz
- Department of Obstetrics and Gynecology, Helse Stavanger, Stavanger, Norway
| | - S Kotopoulis
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - K Matre
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - G E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Sande
- Department of Obstetrics and Gynecology, Helse Stavanger, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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17
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Ultrasound in Assisted Reproductive Technologies and the First Trimester: Is There a Risk? Clin Obstet Gynecol 2017; 60:121-132. [DOI: 10.1097/grf.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Lalzad A, Wong F, Schneider M. Neonatal Cranial Ultrasound: Are Current Safety Guidelines Appropriate? ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:553-560. [PMID: 27979665 DOI: 10.1016/j.ultrasmedbio.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
Ultrasound can lead to thermal and mechanical effects in interrogated tissues. We reviewed the literature to explore the evidence on ultrasound heating on fetal and neonatal neural tissue. The results of animal studies have suggested that ultrasound exposure of the fetal or neonatal brain may lead to a significant temperature elevation at the bone-brain interface above current recommended safety thresholds. Temperature increases between 4.3 and 5.6°C have been recorded. Such temperature elevations can potentially affect neuronal structure and function and may also affect behavioral and cognitive function, such as memory and learning. However, the majority of these studies were carried out more than 25 y ago using non-diagnostic equipment with power outputs much lower than those of modern machines. New studies to address the safety issues of cranial ultrasound are imperative to provide current clinical guidelines and safety recommendations.
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Affiliation(s)
- Assema Lalzad
- Department of Medical Imaging and Radiation Sciences, Monash University, Malvern, Victoria, Australia; Department of Medical Imaging, St. Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia; Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Wong
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia; The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia; Department of Pediatrics, Monash University, Clayton, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Malvern, Victoria, Australia.
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19
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Salem S, Lim K, Van den Hof MC. Déclaration de principe commune SOGC/CAR sur l'utilisation non médicale de l'échographie fœtal. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S404-S406. [PMID: 28063551 DOI: 10.1016/j.jogc.2016.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Ventre DM, Koppes AN. The Body Acoustic: Ultrasonic Neuromodulation for Translational Medicine. Cells Tissues Organs 2016; 202:23-41. [DOI: 10.1159/000446622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2016] [Indexed: 11/19/2022] Open
Abstract
For the greater part of the last century, ultrasound (US) has seen widespread use in applications ranging from materials science to medicine. The history of US in medicine has also seen promising success in clinical diagnostics and regenerative medicine. Recent studies have shown that US is able to manipulate the nervous system, leading toward potential treatment for various neuropathological conditions, a phenomenon known as ultrasonic neuromodulation (NM). Ultrasonic NM is a promising alternative to pharmaceuticals and surgery, due to high spatiotemporal resolution combined with the potentially noninvasive means of application. Current advances have made progress in establishing effective dosage limits, waveform parameters, and stimulus regimes in order to achieve desired effects in a variety of tissue and cell types. However, to date there has been limited systematic analysis of the complex variables involved in creating a therapeutic US stimulation regime specifically tailored to the nervous system. Without a fundamental understanding of the effects of US on neural tissue, including the surrounding bone, musculature, and vasculature, the safety and efficacy of US as an NM tool is yet to be determined. Advances in imaging technology and focusing hardware highlight new avenues for potential clinical applications for therapeutic ultrasonic stimulation. US may be an alternative to electrical and magnetic means of NM for targets in the central nervous system as well as in the peripheral and autonomic nervous systems. This review provides a historical perspective on the past, present, and future of US as a translational therapeutic.
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21
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Schneider ME, Lombardo P. Brain Surface Heating After Exposure to Ultrasound: An Analysis Using Thermography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1138-1144. [PMID: 26924696 DOI: 10.1016/j.ultrasmedbio.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/05/2015] [Accepted: 01/05/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound is the imaging modality of choice to monitor brain pathologies in neonates after complicated deliveries. Animal studies have indicated that ultrasound may cause heating of brain tissues. To date, no study has explored brain surface heating by ultrasound during clinically relevant exposure. Hence, we investigated heating effects of B-mode and pulsed Doppler (PD) mode on ex vivo lamb brains using thermography. Five brains were scanned for 5 min in B-mode or for 3 min, 1 min, 30 s or 15 s in PD mode. Brain surface temperature was measured pre- and post-exposure using thermography. The highest mean temperature increase was recorded by B-mode (3.82 ± 0.43°C). All five PD exposure protocols were associated with surface temperature increases of 2.1-2.7°C. These outcomes highlight for the first time that B-mode ultrasound can contribute to brain surface heating during a routine cranial scan. Scan duration should be minimised whenever possible.
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Affiliation(s)
- Michal E Schneider
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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22
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Nightingale KR, Church CC, Harris G, Wear KA, Bailey MR, Carson PL, Jiang H, Sandstrom KL, Szabo TL, Ziskin MC. Conditionally Increased Acoustic Pressures in Nonfetal Diagnostic Ultrasound Examinations Without Contrast Agents: A Preliminary Assessment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1-41. [PMID: 26112617 PMCID: PMC4822701 DOI: 10.7863/ultra.34.7.15.13.0001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The mechanical index (MI) has been used by the US Food and Drug Administration (FDA) since 1992 for regulatory decisions regarding the acoustic output of diagnostic ultrasound equipment. Its formula is based on predictions of acoustic cavitation under specific conditions. Since its implementation over 2 decades ago, new imaging modes have been developed that employ unique beam sequences exploiting higher-order acoustic phenomena, and, concurrently, studies of the bioeffects of ultrasound under a range of imaging scenarios have been conducted. In 2012, the American Institute of Ultrasound in Medicine Technical Standards Committee convened a working group of its Output Standards Subcommittee to examine and report on the potential risks and benefits of the use of conditionally increased acoustic pressures (CIP) under specific diagnostic imaging scenarios. The term "conditionally" is included to indicate that CIP would be considered on a per-patient basis for the duration required to obtain the necessary diagnostic information. This document is a result of that effort. In summary, a fundamental assumption in the MI calculation is the presence of a preexisting gas body. For tissues not known to contain preexisting gas bodies, based on theoretical predications and experimentally reported cavitation thresholds, we find this assumption to be invalid. We thus conclude that exceeding the recommended maximum MI level given in the FDA guidance could be warranted without concern for increased risk of cavitation in these tissues. However, there is limited literature assessing the potential clinical benefit of exceeding the MI guidelines in these tissues. The report proposes a 3-tiered approach for CIP that follows the model for employing elevated output in magnetic resonance imaging and concludes with summary recommendations to facilitate Institutional Review Board (IRB)-monitored clinical studies investigating CIP in specific tissues.
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Affiliation(s)
- Kathryn R Nightingale
- Department of Biomedical Engineering, Duke University, PO Box 90281, Durham, NC 27708 USA
| | - Charles C Church
- National Center for Physical Acoustics and Department of Physics and Astronomy, The University of Mississippi, University, MS 38677 USA
| | - Gerald Harris
- US Food and Drug Administration (Retired), Current Address: 132 S Van Buren St, Rockville, MD 20850 USA
| | - Keith A Wear
- US Food and Drug Administration, 10903 New Hampshire Ave, Building 62, Room 2104, Silver Spring, MD 20993-0002 USA
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St, Seattle WA 98105 USA
| | - Paul L Carson
- Department of Radiology, University of Michigan Health System, 3218C Med Sci I, B Wing SPC 5667, Ann Arbor, MI 48109-5667 USA
| | - Hui Jiang
- Fujifilm SonoSite, 21919 30th Dr SE, Bothell, WA 98021 USA
| | - Kurt L Sandstrom
- Samsung Medison Co, Ltd, Building, 42, Teheran-ro, 108-gil, Gangnam-gu, Seoul 135-851, Korea
| | - Thomas L Szabo
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215 USA
| | - Marvin C Ziskin
- Emeritus Professor of Radiology and Medical Physics, Temple University School of Medicine, Philadelphia, PA 19140 USA
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23
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Joint SOGC/CAR Policy Statement on Non-medical Use of Fetal Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:184-185. [DOI: 10.1016/s1701-2163(15)30666-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Salem S, Lim K, Van den Hof MC, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S, Vickar D, Salem S, Harris A, Lautner D, O’Sullivan J, Patenaude Y, Keough V. Déclaration de principe commune SOGC/CAR sur l’utilisation non médicale de l’échographie foetale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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McClintic AM, King BH, Webb SJ, Mourad PD. Mice exposed to diagnostic ultrasound in utero are less social and more active in social situations relative to controls. Autism Res 2013; 7:295-304. [PMID: 24249575 DOI: 10.1002/aur.1349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/20/2013] [Indexed: 11/05/2022]
Abstract
Clinical use of diagnostic ultrasound imaging during pregnancy has a long history of safety and diagnostic utility, as supported by numerous human case reports and epidemiological studies. However, there exist in vivo studies linking large but clinically relevant doses of ultrasound applied to mouse fetuses in utero to altered learning, memory, and neuroanatomy of those mice. Also, there exists a well-documented significant increase in the likelihood of non-right-handedness in boys exposed to diagnostic ultrasound in utero, potentially relevant given the increased prevalence of autism in males, and reports of excess non-right-handedness in this population. Motivated by these observations, we applied 30 minutes of diagnostic ultrasound to pregnant mice at embryonic day 14.5 and assayed the social behavior of their male pups 3 weeks after their birth. The ultrasound-exposed pups were significantly (P < 0.01) less interested in social interaction than sham-exposed pups in a three-chamber sociability test. In addition, they demonstrated significantly (P < 0.05) more activity relative to the sham-exposed pups, but only in the presence of an unfamiliar mouse. These results suggest that fetal exposure to diagnostic ultrasound applied in utero can alter typical social behaviors in young mice that may be relevant for autism. There exist meaningful differences between the exposure of diagnostic ultrasound to mice versus humans that require further exploration before this work can usefully inform clinical practice. Future work should address these differences as well as clarify the extent, mechanisms, and functional effects of diagnostic ultrasound's interaction with the developing brain.
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Affiliation(s)
- Abbi M McClintic
- Department Neurological Surgery, University of Washington, Seattle, Washington
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Abstract
Ultrasound is, arguably, the most commonly used diagnostic procedure in obstetrics. It is convenient, painless, yields immediate, extensive results, and is widely considered to be safe. Some (but not all) benefits described in the literature have been validated by evidence-based analysis, such as pregnancy dating. Others are considered clinically useful, although objective evidence may be less strong. As is the case with almost any medical procedure, however, its performance carries some risks: misdiagnosis on the one hand and possible undesired effects on the other. The general belief exists that diagnostic ultrasound (DUS) does not pose any risk to the pregnant patient nor to her fetus. Nonetheless, ultrasound is a form of energy and, as such, demonstrates effects in biological tissues it traverses (bioeffects). The physical mechanisms responsible for these effects are thermal or non-thermal (mechanical). It is the role of science to show whether any of these bioeffects may be harmful. A risk-benefit analysis may also be important, as well as education of the end users to assure patients' safety.
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Affiliation(s)
- Jacques S Abramowicz
- Department of Ob/Gyn, Division of Maternal Fetal Medicine and Center for Fetal diagnosis and Therapy, Wayne State university, Detroit, MI.
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27
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ter Haar GR, Abramowicz JS, Akiyama I, Evans DH, Ziskin MC, Maršál K. Do we need to restrict the use of Doppler ultrasound in the first trimester of pregnancy? ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:374-80. [PMID: 23332816 DOI: 10.1016/j.ultrasmedbio.2012.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Gail R ter Haar
- Joint Department of Physics, Division of Radiotherapy and Imaging, Institute of Cancer Research, Royal Marsden Hospital, Sutton, Surrey, UK.
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Abramowicz JS. Ultrasound and autism: association, link, or coincidence? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1261-1269. [PMID: 22837291 DOI: 10.7863/jum.2012.31.8.1261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Autism spectrum disorders (ASDs) affect an estimated 1% of children in the United States. The etiology is probably multifactorial, including genetic components and exposure to infections, toxins, and other environmental factors, particularly unfavorable perinatal and neonatal conditions. There has been an increase in the frequency of diagnosis of ASDs over the last 20 years with a parallel increase in the use of obstetric diagnostic ultrasound, with prenatal ultrasound exposure mentioned as the possible main etiology for autism "epidemics." Central nervous system alterations have been described in ASDs, and certain similar changes have been described in animals after exposure to ultrasound. However, analysis of in utero exposure in humans has failed to show harmful effects in neonates or children, particularly in school performance, attention disorders, and behavioral changes. There is no independently confirmed peer-reviewed published evidence that a cause-effect relationship exists between in utero exposure to clinical ultrasound and development of ASDs in childhood. Ultrasound is a form of energy with effects in the tissues it traverses, and its use should be restricted to medical indications, by trained professionals, for as short a period and as low an intensity as compatible with accurate diagnosis.
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Affiliation(s)
- Jacques S Abramowicz
- Department of Obstetrics and Gynecology and Rush Fetal and Neonatal Medicine Center, Rush University, Chicago, Illinois 60612, USA.
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Abstract
ABSTRACT
The diagnostic ultrasound was considered safe after the intensity threshold was known and the output intensity (Ispta) was regulated to be less than 10 mW/cm2 in diagnostic devices in Japan, and diagnostic ultrasound was thought safe in USA when both thermal index (TI) and mechanical index were less than 1.0 in the obstetrical setting. Simple B-mode machine was not concerned from the thermal reason due to its extremely low ultrasound intensity, while the exposure was recommended within 30 minutes. Diagnostic ultrasound should be used after obstetrical setting in fetal study. The TI will be higher in febrile cases than nonfebrile, and the surface temperature of transvaginal scan (TVS) probe should be lower than 41°C. Simple three-dimensional or four-dimensional ultrasound imaging without pulsed Doppler studies will be as safe as Bmode when the study is within 30 minutes, because they are composed of simple B-mode images. The spectral Doppler study was not routinely used and its exposure should be short in 11 to 13 weeks of pregnancy in the statements of WFUMB and ISUOG, because experimentally early fetal animal tissue was sensitive to the studies. The use of diagnostic ultrasound should be limited for medical purposes, but not for the entertainment or keepsake of pregnancy.
How to cite this article
Maeda K, Kurjak A. The Safe Use of Diagnostic Ultrasound in Obstetrics and Gynecology. Donald School J Ultrasound Obstet Gynecol 2012;6(3):313-317.
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Salvesen KÅ, Lees C, Abramowicz J, Brezinka C, Ter Haar G, Maršál K. Safe use of Doppler ultrasound during the 11 to 13 + 6-week scan: is it possible? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:625-628. [PMID: 21618312 DOI: 10.1002/uog.9025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Animals
- Female
- Fetal Development
- Humans
- Liver/embryology
- Liver/pathology
- Pregnancy
- Pregnancy Trimester, First
- Rats
- Risk Assessment
- Time Factors
- Ultrasonography, Doppler, Color/adverse effects
- Ultrasonography, Doppler, Color/instrumentation
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Prenatal/adverse effects
- Ultrasonography, Prenatal/instrumentation
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- K Å Salvesen
- National Center for Fetal Medicine, St. Olav University Hospital of Trondheim and Department of Laboratory Medicine, Women's and Child Health, Norwegian University of Science and Technology, N 7006 Trondheim, Norway.
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Ter Haar G. Ultrasonic imaging: safety considerations. Interface Focus 2011; 1:686-97. [PMID: 22866238 DOI: 10.1098/rsfs.2011.0029] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/03/2011] [Indexed: 11/12/2022] Open
Abstract
Modern ultrasound imaging for diagnostic purposes has a wide range of applications. It is used in obstetrics to monitor the progress of pregnancy, in oncology to visualize tumours and their response to treatment, and, in cardiology, contrast-enhanced studies are used to investigate heart function and physiology. An increasing use of diagnostic ultrasound is to provide the first photograph for baby's album-in the form of a souvenir or keepsake scan that might be taken as part of a routine investigation, or during a visit to an independent high-street 'boutique'. It is therefore important to ensure that any benefit accrued from these applications outweighs any accompanying risk, and to evaluate the existing ultrasound bio-effect and epidemiology literature with this in mind. This review considers the existing laboratory and epidemiological evidence about the safety of diagnostic ultrasound and puts it in the context of current clinical usage.
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Affiliation(s)
- Gail Ter Haar
- Joint Department of Physics , Institute of Cancer Research, Royal Marsden Hospital , Sutton SM2 5PT , UK
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