The history of ultrasound in gynecology 1950-1980

Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction

PURPOSE

To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction.

METHODS

Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar-agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton's 4-step training approach. The students' theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation.

RESULTS

The MCQ results showed a significant increase of the student's theoretical knowledge (50.2-75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good).

CONCLUSION

Undergraduate student's medical education can be enhanced by teaching breast US skills.

Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review

Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.

Trial integration of combined ultrasound and laparoscopy tuition in an undergraduate anatomy class with volunteer participation - A pilot study

Anatomy is a cornerstone of medical undergraduate curricula. Due to increasing changes in various medical fields, a lot of new subjects were introduced in undergraduate curricula, while the teaching areas of basic sciences, i.e. anatomy, were reduced. The introduction of advanced diagnostic and therapeutic devices, i.e. ultrasound and laparoscopy, with outstanding imaging quality will be increasingly introduced in basic sciences. In our project, we examined the effect integrating ultrasound and laparoscopy in an anatomy undergraduate course to illustrate the female pelvis. Anatomy students that completed their practicum and cadaver dissection course were enrolled in our project. They received a theoretical introduction followed by a practical course of ultrasound or laparoscopy in the department of obstetrics and gynaecology. Following the course the students had to answer two questionnaires that evaluated their satisfaction, subjective knowledge-gain, problems and content of the course. At the end, a closing briefing was done to discuss the clinical skills and the course. The answers of the questionnaire were summed up in a Likert scale. 25 students were enrolled in the project. 52% attended laparoscopy operations, while 48% attended ultrasound examinations. After analysing the questionnaires using Likert scales (1=strongly agree, 5=strongly disagree) a general satisfaction of 1.5, a subjective knowledge gain of 2.4 and a thrive to extend these clinical skill programs in gynaecology and other specialities in basic science of 1.5 and 1.2, respectively, was reported. There were no statistically significant differences in the Likert scores between both groups (p>0.05). The introduction of ultrasound and laparoscopy in undergraduate basic science teaching programs is a promising method and should be further evaluated, standardized and expanded.

Incidence, time trends, laterality, indications, and pathological findings of unilateral oophorectomy before menopause

OBJECTIVE

Unilateral oophorectomy (UO) is a common surgical practice, yet it remains understudied. We investigated trends in incidence rates, indications, and pathological differences in the right and left ovaries in women younger than 50 years.

METHODS

The Rochester Epidemiology Project medical records linkage system was used to identify all women in Olmsted County, MN, who underwent UO between 1950 and 2007 (n = 1,838). We studied the incidence rates, indications, and pathologies of UO by laterality, and investigated trends across time.

RESULTS

Pooling all oophorectomies across a 58-year period, we found that the incidence of UO was higher than the incidence of bilateral oophorectomy through the age of 39 years; however, bilateral oophorectomy surpassed UO thereafter. The incidence of UO increased from 1950 to 1974 but decreased thereafter and was surpassed by the rate of bilateral oophorectomy after 1979. Before 1985, left ovaries were removed more frequently than right ovaries with or without a medical indication for UO. Ovaries removed with a medical indication showed pathological differences between the right ovary and the left ovary, with endometriosis being more common in the left ovary. Ovaries removed without a medical indication did not differ in pathology by side.

CONCLUSIONS

There have been major changes in incidence rates of UO across six decades. Medically indicated UO has been more common on the left side due, in part, to the higher prevalence of endometriosis. However, UO without a medical indication has also been more common on the left side because of surgical preferences and traditions. The long-term consequences of right or left UO on timing of menopause, morbidity, and mortality need further study.

Diffraction-enhanced Synchrotron Imaging of Bovine Ovaries Ex Vivo

OBJECTIVES

The objective of this study was to test the hypothesis that diffraction-enhanced imaging (DEI), a synchrotron x-ray imaging technique, would provide greater contrast for evaluating bovine ovaries compared with conventional diagnostic ultrasonography.

MATERIALS AND METHODS

Bovine ovaries were evaluated ex vivo as follows: fresh without radiographic arterial contrast (n = 2), fresh with contrast (n = 1), preserved in 10% formalin without contrast (n = 2), and preserved with contrast (n = 1). Each ovary was imaged with DEI and subsequently with ultrasonography and histology. The ability to visualize and differentiate preantral and antral follicles, corpora lutea (CL), and cumulus oocyte complexes (COCs) were compared using DEI, ultrasonography, and histology. The diameter of follicles and CL were measured and compared using ultrasonography, DEI, and histology. The diameter of the smallest follicle detected was reported using each of the three imaging methods. The number of antral follicles (antral follicle count ≥2 mm) was compared between ultrasonography and DEI.

RESULTS

DEI enabled the detection of 71% of follicles and 67% of CL that were detected ultrasonographically. However, DEI did not allow the detection of COCs and cell layers of the follicle wall that were visualized histologically. Luteal tissues were not easily distinguished using DEI, and DEI was inferior for differentiating follicles and CL compared with ultrasonography. The mean follicle diameter was similar between DEI (4.00 ± 0.35 mm, fresh with contrast; 9.62 ± 2.43 mm, fresh without contrast) and ultrasonography (3.85 ± 0.28 mm, fresh with contrast; 8.97 ± 2.60 mm, fresh without contrast) (P > .05). However, the mean follicle diameter was greater using both DEI (4.00 ± 0.35 mm) and ultrasonography (3.85 ± 0.28 mm) compared with histology (2.21 ± 0.38 mm; P = .01, fresh ovaries with contrast). The mean CL diameter was similar between DEI (11.64 ± 1.67 mm), ultrasonography (9.34 ± 0.35 mm), and histology (9.59 ± 0.36 mm) (P > .05). The mean diameter of the smallest follicle detected was similar between DEI (3.06 ± 0.45 mm) and ultrasonography (2.95 ± 0.74 mm); both DEI and ultrasonographic measurements were greater than histology (0.39 ± 0.04 mm, P < .0001). The mean antral follicle count was similar between ultrasonography (6.50 ± 0.71 mm, fresh with no contrast; 6.50 ± 2.50 mm, preserved with no contrast) and DEI (4.50 ± 0.50 mm, fresh with no contrast; 6.50 ± 0.50 mm, preserved with no contrast) (P > .05).

CONCLUSIONS

The contrast resolution of antral follicles, CL, and COCs in bovine ovaries was inferior using DEI compared with ultrasonography and histology. Alternative synchrotron techniques, such as phase-contrast computed tomography and DEI computed tomography, may prove more effective than DEI for imaging ovaries ex vivo.

Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations

While the etiology of most childhood cancers is largely unknown, epidemiologic studies have consistently found an association between exposure to medical radiation during pregnancy and risk of childhood cancer in offspring. The relation between early life diagnostic radiation exposure and occurrence of pediatric cancer risks is less clear. This review summarizes current and historical estimated doses for common diagnostic radiologic procedures as well as the epidemiologic literature on the role of maternal prenatal, children's postnatal and parental preconception diagnostic radiologic procedures on subsequent risk of childhood malignancies. Risk estimates are presented according to factors such as the year of birth of the child, trimester and medical indication for the procedure, and the number of films taken. The paper also discusses limitations of the methods employed in epidemiologic studies to assess pediatric cancer risks, the effects on clinical practice of the results reported from the epidemiologic studies, and clinical and public health policy implications of the findings. Gaps in understanding and additional research needs are identified. Important research priorities include nationwide surveys to estimate fetal and childhood radiation doses from common diagnostic procedures, and epidemiologic studies to quantify pediatric and lifetime cancer risks from prenatal and early childhood exposures to diagnostic radiography, CT, and fluoroscopically guided procedures.

"Seeing the baby": pleasures and dilemmas of ultrasound technologies for primiparous Australian women

The practice of obstetric ultrasound scans has undergone significant expansion in the last two decades and is now a standard part of many women's antenatal care in Australia as elsewhere. This article reviews recent evidence about the value of obstetric ultrasound, summarizing debates and contradictions in research literature and practitioner guidelines. Pregnant women's interpretations of the significance of ultrasound are examined through multiple interviews with 34 study participants. We find that ultrasound has become an integral part of women's embodied experience of pregnancy, with its own pleasures and dilemmas. The increasing use of the technology has augmented the role of scientific biomedicine in the government of pregnancy. This must be understood in the light of trends toward individualized risk management in which the pregnant woman increasingly takes responsibility for the successful outcome of the pregnancy, in a context where pregnancy is discursively constructed as a risky domain of gendered experience in contemporary Australian society.

Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations

Ultrasound for routine fetal malformation screening has been polemical from its early beginning because of the very broad range of diagnosis rates disclosed, i.e. from 13% to 82%, average 27.5%. A review of available studies is proposed to assess objectively the efficacy of ultrasound, considering also economical, ethical and methodological aspects as influential factors for choosing a routine screening policy. The utility of fetal malformation diagnosis before birth is brought forward, including second opinion, karyotyping, poly-disciplinary case discussion prior to management. Method and material of reviewed studies considerably vary and might influence the sensitivity results, as the choice of the population sample and selection of pregnant women, gestation age at screening, distribution of malformation among systems or tracts, exclusion of some fetal malformation and the routine practice of autopsy. Efficiency of screening studies is compared, and among them Radius and Eurofetus studies. Average sensitivity is finally considered as satisfactory in the daily practice when operated by trained personnel. The importance of additional factors for successful screening are emphasized such as education, equipment quality and fetal ultrasound examination at different gestation age for a better understanding of natural history of fetal morphology.

Surgeon-performed ultrasound imaging in acute surgical disorders

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, to narrow the differential diagnosis, or to initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients with an acute abdomen, especially those patients who are hypotensive. In the hands of the surgeon, this noninvasive, bedside tool can assess more accurately the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound imaging is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound imaging to detect a pleural effusion has virtually supplanted the lateral decubitus radiograph. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. As surgeons become more facile with ultrasound imaging, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.

Forty years of obstetric ultrasound 1957-1997: from A-scope to three dimensions

In this article, we record the history of obstetric ultrasound as it developed worldwide in the second half of the twentieth century. The technological advances during this period saw the evolution of equipment from the original adapted metal flaw detectors producing a simple A-scan to the modern, purpose built, real-time colour flow machines with three-dimensional capability (Fig. 1). Clinically, ultrasound began as a research tool, but the poor quality of the images led to the ridicule of many of the early investigators. However, because of their perseverance, ultrasound developed into an imaging modality providing immense diagnostic capabilities and facilitating with precision many invasive procedures, diagnostic and therapeutic, both of which have made significant contributions to patient care. In this history, we recall the people, the personalities, and the problems they encountered during the development of ultrasound and how these problems were resolved, so that ultrasound now is available for use in the care of pregnant women throughout the developed world.

The history of ultrasound

Diagnostic medical ultrasound may have a brief history, but its roots date back to the early nineteenth century. From its modest beginnings in military institutions where ultrasound was used to examine pathologic specimens, to the routine evaluation of the fetus, injured patients, and those with cerebrovascular disease, ultrasound has secured a position as a key diagnostic test both currently and in the future. Its ability to diagnose valvular and congenital heart disease has reduced the need for invasive cardiac angiography with its attendant risks. Furthermore, endoluminal, transvaginal, transrectal, and transesophageal ultrasound have expanded physicians' diagnostic armamentarium and ability to "look inside" their patients. Notwithstanding all these advancements, ultrasound research and development continue to be fostered, and the ideas of today will be the technology of tomorrow (Fig. 5).