Safety assurance in obstetrical ultrasound

Ultrasound-Induced Membrane Hyperpolarization in Motor Axons and Muscle Fibers of the Crayfish Neuromuscular Junction

OBJECTIVE

Focused ultrasound (FUS) can modulate neuronal activity by depolarization or hyperpolarization. Although FUS-evoked depolarization has been studied extensively, the mechanisms underlying FUS-evoked hyperpolarization (FUSH) have received little attention. In the study described here, we developed a procedure using FUS to selectively hyperpolarize motor axons in crayfish. As a previous study had reported that these axons express mechano- and thermosensitive two-pore domain potassium (K2P) channels, we tested the hypothesis that K2P channels underlie FUSH.

METHODS

Intracellular recordings from a motor axon and a muscle fiber were obtained simultaneously from the crayfish opener neuromuscular preparation. FUSH was examined while K2P channel activities were modulated by varying temperature or by K2P channel blockers.

RESULTS

FUSH in the axons did not exhibit a coherent temperature dependence, consistent with predicted K2P channel behavior, although changes in the resting membrane potential of the same axons indicated well-behaved K2P channel temperature dependence. The same conclusion was supported by pharmacological data; namely, FUSH was not suppressed by K2P channel blockers. Comparison between the FUS-evoked responses recorded in motor axons and muscle fibers revealed that the latter exhibited very little FUSH, indicating that the FUSH was specific to the axons.

CONCLUSION

It is not likely that K2P channels are the underlying mechanism for FUSH in motor axons. Alternative mechanisms such as sonophore and axon-specific potassium channels were considered. Although the sonophore hypothesis could account for electrophysiological features of axonal recordings, it is not consistent with the lack of FUSH in muscle fibers. An axon-specific and mechanosensitive potassium channel is also a possible explanation.

Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation?

Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.

A Study on a Parameter Estimator for the Homodyned K Distribution Based on Table Search for Ultrasound Tissue Characterization

OBJECTIVE

The homodyned K (HK) distribution is considered to be the most suitable distribution in the context of tissue characterization; therefore, the search for a rapid and reliable parameter estimator for HK distribution is important.

METHODS

We propose a novel parameter estimator based on a table search (TS) for HK parameter estimates. The TS estimator can inherit the strength of conventional estimators by integrating various features and taking advantage of the TS method in a rapid and easy operation. Performance of the proposed TS estimator was evaluated and compared with that of XU (the estimation method based on X and U statistics) and artificial neural network (ANN) estimators.

DISCUSSION

The simulation results revealed that the TS estimator is superior to the XU and ANN estimators in terms of normalized standard deviations and relative root mean squared errors of parameter estimation, and is faster. Clinical experiments found that the area under the receiver operating curve for breast lesion classification using the parameters estimated by the TS estimator could reach 0.871.

CONCLUSION

The proposed TS estimator is more accurate, reliable and faster than the state-of-the-art XU and ANN estimators and has great potential for ultrasound tissue characterization based on the HK distribution.

Evaluation of antenatal Point-of-Care Ultrasound (PoCUS) training: a systematic review

INTRODUCTION

There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies.

METHODS

A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF).

RESULTS

Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4.

CONCLUSION

PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.

Effects of Osmolarity on Ultrasound-Induced Membrane Depolarization in Isolated Crayfish Motor Axon

We have previously identified a novel non-selective membrane conductance (g_US) opened by focused ultrasound (FUS) in crayfish motor axons. In the work described here, we studied g_US properties further by comparing FUS-evoked depolarization (FUSD) in control and hypotonic saline with 75% of control osmolarity. The FUS was a train of 20 FUS bursts (2.1 MHz and 50 µs per burst) delivered at 1 kHz. The amplitude, onset latency, frequency of occurrence and duration of FUSD were compared in a 15-min time window before and after switching to hypotonic saline. Significant increases were observed for amplitude (p < 0.001) and frequency of occurrence (p < 0.01) while the onset latency exhibited a significant decrease (p < 0.001). FUSD duration did not significantly differ. These results support predictions based on our hypothesis that g_US is mediated by opening of nanopores in the lipid bilayer and that stretching of axonal membrane caused by swelling at low osmolarity should increase the probability of nanopore formation under FUS. The FUSD parameters, in addition, exhibited time-dependent trends when the window of observation was expanded to 45 min in each saline. The statistical significance of amplitude and duration differed between 15- and 45-min time windows, indicating the presence of adaptive responses of axonal membrane to osmotic manipulation.

Ultrasound-assisted ocular drug delivery: A review of current evidence

Efficient ocular drug delivery is a challenging clinical problem with various therapeutic options but no clearly preferred methodology. Given the ubiquity of ultrasound as a diagnostic technique, the safety profile of ultrasound in an ocular context, and the prospect of custom-made ultrasound-sensitive contrast agents, ultrasound presents an attractive ocular drug delivery modality. In this review, we evaluate our present understanding of ultrasound as it relates to ocular drug delivery and significant knowledge gaps in the field. In doing so, we hope to call attention to a potentially novel drug delivery pathway that could be manipulated to treat or cure ocular diseases.

Transcranial ultrasonography as a reliable instrument for the measurement of the cerebral ventricles in rats with experimental hydrocephalus: a pilot study

PURPOSES

Demonstrate that transcranial ultrasonography (TUS) scanning is viable and useful as a diagnostic method in experimental hydrocephalus, as well as to compare measurements of cerebral and ventricular width obtained from TUS scans of hydrocephalic rats with post-mortem anatomical specimens, aiming for the development of accurate criteria to establish ventricular enlargement and progression of hydrocephalus subsequently.

METHODS

Thirty-five male Wistar rats were used. Following hydrocephalus induction, they underwent a transcranial ultrasound scan to measure cerebral and ventricular dimensions, in the fourth and 21 post-induction days. By the end of the experiments, measurements obtained from TUS scans were compared with actual values as seen in the post-mortem specimens of each animal.

RESULTS

Ventricular dilation could be clearly visualized in hydrocephalic animals. We performed intraclass correlation coefficient and linear regression analyses that have demonstrated a precise correlation between measurements of TUS scans and post-mortem specimens; we have found a similarity of 0,95 for the cerebral diameter and 0,97 for ventricular width.

CONCLUSIONS

Transcranial ultrasonography is a useful and reliable diagnostic tool for experimental hydrocephalus; also, it can be used to assess the progression of ventriculomegaly in animal models of hydrocephalus.

Imaging during pregnancy: What the radiologist needs to know

During the last decades, there has been a growing demand for medical imaging in gravid women. Imaging of the pregnant woman is challenging as it involves both the mother and the fetus and, consequently, several medical, ethical, or legal considerations are likely to be raised. Theoretically, all currently available imaging modalities may be used for the evaluation of the pregnant woman; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review article is focused on the current safety guidelines and considerations regarding the use of different imaging modalities in the pregnant population; also presented is an imaging work-up for the most common medical conditions of pregnant women, with emphasis on fetal and maternal safety.

Shortening of Overall Orthodontic Treatment Duration with Low-Intensity Pulsed Ultrasound (LIPUS)

The aim of this retrospective clinical study was to determine if there is a reduction in the overall treatment duration in orthodontic patients using low-intensity pulsed ultrasound (LIPUS) and Invisalign SmartTrack® clear aligners. Data were collected from the first thirty-four patients (9 males, 25 females; average age 41.37 ± 15.02) who finished their orthodontic treatment using an intraoral LIPUS device and Invisalign clear aligners in a private clinic. The LIPUS parameters used by patients at home for 20 min/day were: ultrasonic frequency 1.5 MHz, pulse duration 200µs, pulse repetition rate 1 kHz, and spatial average-temporal average intensity 30mW/cm². A control group (11 males, 23 females; average age 31.36 ± 14.41) matching for the same malocclusions was randomly selected from finished treatment cases of the same clinician. The date of first Invisalign attachment placement and first use of LIPUS application was recorded as T0, and the date of retainer delivery was recorded as T1. The treatment duration (T1–T0) and treatment reduction percentage with LIPUS device were collected and analyzed using two-sample t-test in Microsoft Excel. Treatment duration was significantly reduced in the LIPUS group (541.44 ± 192.23 days) compared to control group (1061.05 ± 455.64 days) (p < 0.05). The LIPUS group showed on average 49% reduction in the overall treatment time as compared to the control group. The average compliance of the patients using LIPUS was 66.02%. Patients who used LIPUS showed a clinically significant reduction in the overall orthodontic treatment duration compared to the control group who used Invisalign clear aligners only.

An Implantable Ultrasonically Powered System for Optogenetic Stimulation with Power-Efficient Active Rectifier and Charge-Reuse Capability

This paper presents a novel micro-scale ultrasonically powered optogenetic microstimulator with the vision of treating Parkinson's Disease. This system features a power-efficient active rectifier benefiting from a novel powering approach for its comparators. The main basis of the idea is to lower the Rail-to-Rail supply voltage of the comparators, thereby lowering their propagation delays. This technique improves the power conversion efficiency of the active rectifiers in two ways. First by decreasing the propagation delay of the comparators, and second by reusing the consumed power by the active diodes. The proposed system including the active rectifier, a novel double-pass regulator, a current reference, and a burst detection circuit is designed, simulated and fabricated in TSMC [Formula: see text]m CMOS technology with a total silicon area of [Formula: see text]. Based on the experimental results, the proposed active rectifier exhibits a voltage conversion ratio of [Formula: see text]% for input voltages of around 3 V, and a power conversion efficiency of up to [Formula: see text]% for a load of [Formula: see text] and over the frequency range of [Formula: see text]. A proof-of-concept system including the fabricated chip, a [Formula: see text]-sized lead zirconate titanate (PZT-4) piezoelectric receiver, and a custom-designed [Formula: see text] blue μ LED is designed and measured in a Water tank. For an acoustic intensity of [Formula: see text], the available electrical power at the crystal terminals, the output DC power, and the output light intensity were measured equal to [Formula: see text], [Formula: see text], and [Formula: see text], respectively. The quiescent current of the chip in absence of power bursts is measured equal to [Formula: see text]A.

Fetal Heart Rate Monitoring Implemented by Dynamic Adaptation of Transmission Power of a Flexible Ultrasound Transducer Array

Fetal heart rate (fHR) monitoring using Doppler Ultrasound (US) is a standard method to assess fetal health before and during labor. Typically, an US transducer is positioned on the maternal abdomen and directed towards the fetal heart. Due to fetal movement or displacement of the transducer, the relative fetal heart location (fHL) with respect to the US transducer can change, leading to frequent periods of signal loss. Consequently, frequent repositioning of the US transducer is required, which is a cumbersome task affecting clinical workflow. In this research, a new flexible US transducer array is proposed which allows for measuring the fHR independently of the fHL. In addition, a method for dynamic adaptation of the transmission power of this array is introduced with the aim of reducing the total acoustic dose transmitted to the fetus and the associated power consumption, which is an important requirement for application in an ambulatory setting. The method is evaluated using an in-vitro setup of a beating chicken heart. We demonstrate that the signal quality of the Doppler signal acquired with the proposed method is comparable to that of a standard, clinical US transducer. At the same time, our transducer array is able to measure the fHR for varying fHL while only using 50% of the total transmission power of standard, clinical US transducers.

Focused ultrasound transiently increases membrane conductance in isolated crayfish axon

We report a novel phenomenon produced by focused ultrasound (US) that may be important for understanding its effects on cell membranes. When a US burst (2.1 MHz, 1-mm focal diameter, 0.1-1 MPa) was focused on a motor axon of the crayfish neuromuscular junction, it consistently produced a fast hyperpolarization, which was followed or superseded by subthreshold depolarizations or action potentials in a stochastic manner. The depolarization persisted in the presence of voltage-gated channel blockers [1 µM TTX ( I_Na), 50 µM ZD7288 ( I_h), and 200 µM 4-aminopyridine ( I_K)] and typically started shortly after the onset of a 5-ms US burst, with a mean latency of 3.35 ± 0.53 ms (SE). The duration and amplitude of depolarizations averaged 2.13 ± 0.87 s and 10.1 ± 2.09 mV, with a maximum of 200 s and 60 mV, respectively. The US-induced depolarization was always associated with a decrease in membrane resistance. By measuring membrane potential and resistance during the US-induced depolarization, the reversal potential of US-induced conductance ( g_us) was estimated to be -8.4 ± 2.3 mV, suggesting a nonselective conductance. The increase in g_us was 10-100 times larger than the leak conductance; thus it could significantly influence neuronal activity. This change in conductance may be due to stimulation of mechanoreceptors. Alternatively, US may perturb the lateral motion of phospholipids and produce nanopores, which then increase g_us. These results may be important for understanding mechanisms underlying US-mediated modulation of neuronal activity and brain function. NEW & NOTEWORTHY We report a specific increase in membrane conductance produced by ultrasound (US) on neuronal membrane. When a 5-ms US tone burst was focused on a crayfish motor axon, it stochastically triggered either depolarization or a spike train. The depolarization was up to 60 mV in amplitude and 200 s in duration and therefore could significantly influence neuronal activity. Depolarization was still evoked by US burst in the presence of Na⁺ and Ca²⁺ channel blockers and had a reversal potential of -8.4 ± 2.3 mV, suggesting a nonselective permeability. US can be applied noninvasively in the form of a focused beam to deep brain areas through the skull and has been shown to modulate brain activity. Understanding the depolarization reported here should be helpful for improving the use of US for noninvasive modulation and stimulation in brain-related disease.

Virtual Dissection by Ultrasound: Probe Handling in the First Year of Medical Education

OBJECTIVES

The aim of the present study was to assess the educational plan of first-year students of medicine by analyzing their scores in ultrasound body scanning.

METHODS

Since 2009, the San Paolo Medical School (Milan, Italy) has vertically integrated the study of anatomy with ultrasound-assisted virtual body dissection. Three modules were supplied: musculoskeletal system, heart and abdomen pelvis. 653 first-year students were trained. The students alternated as mutual model and operator. A skillfulness score was assigned to each student. The scores were consequently listed. Nonparametric exact multiple contrast tests were employed to determine relative group effects.

RESULTS

Statistical analysis showed that: no gender-related differences were found (0:49; p=0.769); peer learners performed less well than peer tutors (0.677; p=0); between modules, scores in the musculoskeletal system (pMS=0.726) tend to be higher (p<0.001) than those obtained in the heart and abdomen pelvis (pH=0.398; pAP=0.375 p=0.270); significant differences were found compared to the beginning of the project's academic year.

CONCLUSION

The students considered this didactic course an engaging and exciting approach. Acceptance of peer teaching was extraordinarily high. Autonomous exercitation allowed the students to improve self-criticism and enhance their own skills. The level of expertise obtained by peer tutors and by peer learners can be considered satisfactory. The main objective of training future physicians on personal stethoechoscope with the necessary competence seems to have been successfully started.

Multiaccess In Vivo Biotelemetry Using Sonomicrometry and M-Scan Ultrasound Imaging

Objective: In this paper, we investigate the use of commercial off-the-shelf diagnostic ultrasound readers to achieve multiaccess wireless in vivo telemetry with millimeter-sized sonomicrometry crystal transducers.

METHODS

The sonomicrometry crystals generate ultrasonic pulses that supersede the echoes generated at the tissue interfaces in response to M-scan interrogation pulses. The traces of these synthetic pulses are captured on an M-scan image and the transmitted data are decoded using image deconvolution and deblurring algorithms.

RESULTS

Using a chicken phantom and 1.3 MHz sonomicrometry crystals of diameter 1 mm, we first demonstrate that a standard ultrasound reader can achieve biotelemetry data rates up to 1 Mb/s for implantation depths greater than 10 cm. For this experiment the maximum power dissipation at the crystals was measured to be 20 and bit-error-rate of the telemetry link was shown to be . We also demonstrate the use of this method for multiaccess biotelemetry where several sonomicrometry crystals simultaneously transmit the data using different modulation and coding techniques. Using a live ovine model, we demonstrate a sonomicrometry crystal implanted in the sheep 's tricuspid valve can maintain a continuous, reliable telemetry link at data rates up tob 800 Kb/s in the presence of respiratory and cardiac motion artifacts.

CONCLUSION

Compared to existing radio-frequency and ultrasound based biotelemetry devices, the reported data-rates are significantly higher considering the transducer's form-factor and its implantation depth.

SIGNIFICANCE

The proposed technique thus validates the feasibility of establishing reliable communication link with multiple in vivo implants using M-scan-based ultrasound imaging.

Left ventricle segmentation in fetal echocardiography using a multi-texture active appearance model based on the steered Hermite transform

OBJECTIVE

Fetal echocardiographic analysis is essential for detecting cardiac defects at early gestational ages. Fetal cardiac function can be assessed by performing some measurements regarding the dimension and shape of the heart cavities. In this work we propose an automatic segmentation method applied to the analysis of the left ventricle in fetal echocardiography.

METHODS

For segmentation of the left ventricle, we designed a novel multi-texture active appearance model (AAM) based on the Hermite transform (HT). Local orientation analysis is addressed by steering the coefficients obtained with the HT. The method basically consists of an AAM-based scheme which uses the steered HT to efficiently code texture patterns of the input image. A wider and detailed description of the image features can be obtained with this method. Compared with classic AAM methods, the segmentation performance is substantially improved with the proposed scheme. Since AAM-based approaches process local information, an automatic method is also proposed to initialize the multi-texture AAM. For this purpose, a database of pre-segmented images was built. Then, techniques such as thresholding, mathematical morphology and correlation are combined to identify the position and orientation of the left ventricle. Typical issues found in fetal cardiac ultrasound images such as different orientations and shape variations of the heart cavities can be easily handled with the designed method.

RESULTS

Several images of fetal echocardiography were used to evaluate the proposed segmentation method. The algorithm performance was validated using different metrics. We used a database of 143 real images of fetal hearts acquired for different phases of the cardiac cycle. We obtained an average Dice coefficient of 0.8631 and a point-to-curve distance of 2.027 pixels. The proposed algorithm was also validated by comparing it with other segmentation methods.

CONCLUSIONS

We have designed an automatic algorithm for left ventricle segmentation in fetal echocardiography. The reported results demonstrate that the proposed approach can achieve an efficient segmentation of the left ventricular cavity. Typical problems found in images of fetal echocardiography are satisfactorily handled with the proposed multi-texture AAM scheme.

Comparison between allantochorion membrane and amniotic sac detection by per rectal palpation for pregnancy diagnosis on pregnancy loss, calving rates, and abnormalities in newborn calves

The objectives of the present investigation were to evaluate the pregnancy diagnosis by detection of either the allantochorion membrane (FMS) or amniotic sac (ASP) by per rectum palpation (PRP) during late embryonic or early fetal period on pregnancy loss (PRL) at reexamination, calving rates, and abnormalities in newborn calves. A controlled randomized blind design with 800 lactating dairy pregnant cows diagnosed by transrectal ultrasonography (TRUS) between Days 35 and 57 of gestation from one dairy farm were included. The cows were randomly divided according to detection of allantochorion membrane (FMS group; n = 264), detection of amniotic sac (ASP group; n = 266), and TRUS (control [CON] group; n = 270). TRUS was considered as the criterion standard method of comparison. The entire PRP was performed by one experienced veterinarian. Then, all the cows were reexamined only by TRUS between 2 and 4 weeks later by two independent veterinarians to assess PRL. The calving rate one (number of cows calved divided by the number of cows initially pregnant) and calving rate two (number of cows calved divided by the number of cows pregnant at reexamination) for each group was calculated. All abortions and stillborns were necropsied, and calves alive were followed for 5 days. The overall initial PRL (between initial pregnant cows and reexamination) for FMS, ASP, and CON groups was 7.4% (19/258), 8.8% (23/262), and 9.2% (24/260), respectively (P = 0.75). The overall late PRL (between reexamination and calving) for FMS, ASP, and CON groups was 4.2% (9/213), 5.7% (12/209), and 4.2% (9/216), respectively (P = 0.71). The calving rate one for FMS, ASP, and TRUS groups was 79.1% (204/258), 75.2% (197/262), and 79.6% (207/260), respectively (P = 0.63). The calving rate two for the same groups was 85.4% (204/239), 82.4% (197/239), and 87.7% (207/236), respectively (P = 0.27). The number of fetuses aborted late, premature, and mature dead from FMS, ASP, and CON groups was 6, 4, and 5, respectively (P = 0.85), and no abnormalities at necropsy were detected. One stillborn male calf with atresia coli after 281 days of gestation from a cow examined by ASP at Day 51 was diagnosed. It was concluded that the use of either FMS or ASP for pregnancy diagnosis during late embryonic or early fetal period did not increase the PRL, affect calving rates, or produce calves with congenital abnormalities.

Imaging Pregnant and Lactating Patients

As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation.

Effect of early pregnancy diagnosis by per rectum amniotic sac palpation on pregnancy loss, calving rates, and abnormalities in newborn dairy calves

The objectives of the present study were to evaluate the effect of per rectal amniotic sac palpation (ASP) for pregnancy diagnosis during the late embryonic period on pregnancy loss, calving rates, and abnormalities in newborn calves. A controlled, randomized, blocked, blind experiment containing 680 lactating pregnant dairy cows with a viable embryo diagnosed by transrectal ultrasonography was performed. Two dairy operation sites (farm A and farm B) were selected. At each farm, the cows were randomly divided into control (CON) and ASP groups. The CON group was not subjected to pregnancy diagnosis via per rectum palpation. The ASP examinations were performed by one experienced veterinarian between Days 34 and 45 after breeding. All cows were reevaluated by transrectal ultrasonography only between 2 and 4 weeks later. Two calving rates were calculated: calving rate 1 (cows that calved from the initial number of pregnant cows) and calving rate 2 (cows that calved from cows pregnant at reexamination). In farm A, the percentages of early pregnancy loss were 11.5% (19 of 165) and 13.2% (24 of 182) for the CON and the ASP groups, respectively (P = 0.64). In farm B, the percentage of early pregnancy loss was 11.2% (19 of 170) for the CON group and 8.8% (14 of 159; P = 0.48) for the ASP group. In farm A, the percentage of late pregnancy loss was 7.6% (11 of 145) for the CON group and 5.5% (8 of 155; P = 0.39) for the ASP group. In farm B, the percentage of late pregnancy loss was 3.7% (5 of 137) for the CON group and 6.3% (8 of 127; P = 0.32) for the ASP group. In farm A, early pregnancy loss was higher than late pregnancy loss (12.4% vs. 6.3%; P = 0.01), and in farm B, the same tendency was detected (10.0% vs. 4.9%, for early and late pregnancy loss, respectively; P = 0.02). In farm A, calving rate 1 was 81.2% (134 of 165) for the CON group and 80.8% (147 of 182; P = 0.92) for the ASP group. Calving rate 2 for the same groups was 92.4% (134 of 145) and 94.8% (147 of 155), respectively (P = 0.68). In farm B, calving rate 1 was 77.7% (132 of 170) for the CON group and 74.8% (119 of 159; P = 0.55) for the ASP group. Calving rates 2 for the same groups were 87.4% (132 of 151) and 82.1% (119 of 145), respectively (P = 0.20). Two female calves with atresia coli were diagnosed only in the CON group. It was concluded that ASP during the late embryonic period for pregnancy diagnosis did not increase the pregnancy loss, affect calving rates, or produce abnormalities in calves.

Feasibility and reproducibility of ShearWave(TM) elastography of fetal baboon organs

OBJECTIVES

The purpose of this study was to assess the feasibility and reproducibility of transabdominal ShearWave(TM) elastography of fetal organs in pregnant baboons.

MATERIALS AND METHODS

Fetal ultrasounds of all pregnant baboons in a single primate research center were performed prospectively during 9 months. The visualization of fetal targeted organs (liver, proximal and distal lungs, brain white matter and periventricular gray matter) was initially performed using 2D ultrasound, and then elastography mode was activated. For each organ, three measurements were carried out by two operators. Intra-observer and inter-observer intra-class correlation coefficients (ICC) were calculated.

RESULTS

During the study period (03/2013-12/2013), 21 pregnant baboons (21 fetuses) were included. One to three ultrasound scans were performed for each fetus. The measurements were feasible by the two operators in all cases. The intra-observer and inter-observer ICC were 0.654, 95% CI (0.606 to 0.699) and 0.645, 95% CI (0.553 to 0.721) respectively.

CONCLUSION

Transabdominal ShearWave(TM) Elastography of fetal organs can be achieved in pregnant baboons. The intra-observer and inter-observer reproducibility is correct but vary according to the targeted organs.

[Shear waves elastography of the placenta in pregnant baboon]

OBJECTIVES

To evaluate tissue characteristics of the placenta by transabdominal ShearWave Elastography in pregnant baboon.

MATERIALS AND METHOD

For 9 months (03/2013-12/2013) two operators (EQ, GG) performed ultrasound of the placenta during pregnancy pregnant baboons station partner primatology project. The identification of the placenta was performed previously in 2D ultrasound. The elastography method was then activated. Three measurements were carried out by operator for each placenta. The intraclass correlation coefficients within and between observers were calculated for the objective assessment (elastography) of placental maturity.

RESULTS

During the study period, 21 pregnant baboons were included and ultrasounds were performed between 1 and 3 times each. The measurements have been carried out by two operators in 100% of cases. The intra- and inter-observer ICC for single values are respectively 0.657 - 95% CI (0.548 to 0.752) and 0.458 - 95% CI (0.167 to 0.675). The intra- and inter-observer ICC for average values are respectively 0.852 - 95% CI (0.784 to 0.901) and 0.628 - 95% CI (0.286 to 0.806).

CONCLUSION

The study by transabdominal ShearWave Elastography of placenta's pregnant baboons is possible. The intra- and inter-operator reproducibility of this method is good using the average of three measurements. The objective study via elastography ShearWave of the degree of placental maturity seems not yet be used in clinical practice. Studies of larger cohorts are needed.

Imaging for acute pelvic pain in pregnancy

Acute pelvic pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the foetus from X-rays because of their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the foetus and care must be taken to minimise these with the avoidance of contrast agents. Teaching Points • Ultrasound and MRI are the preferred investigations for acute pelvic pain during pregnancy. • Ultrasound remains the primary imaging investigation because of availability and portability. • MRI helps differentiate causes of acute pelvic pain when ultrasound is inconclusive.

Prenatal ultrasound heating impacts on fluctuations in haematological analysis of Oryctolagus cuniculus

Prenatal Ultrasound (US) is commonly used as a routine procedure on pregnant women. It is generally perceived as a safe procedure due to the use of non-ionizing radiation. However, the neurotoxicity of diagnostic prenatal US was detected to have a correlation with high susceptibility to early developing fetus. This research involved in vivo experimental model by using 3(rd) trimester pregnant Oryctolagus cuniculus and exposing them to US exposures for 30, 60, and 90 minutes at their gestational day (GD) 28-29. The output power and intensities, spatial peak temporal average intensity (ISPTA) of US were varied from 0.4 to 0.7 W and 0.13 to 0.19 W/cm(2) respectively were tested initially in free-field, water. Haematological analysis was carried out to detect any changes in blood constituents. Statistically significant differences were detected in red blood cell (RBC) count (P<0.001), haemoglobin (Hb) concentration (P<0.001) and also platelet (PLT) count (P<0.001) in newborn of Oryctolagus cuniculus. These findings indicate the possibility of US heating in causing defects on studied animal.

A system for investigation of biological effects of diagnostic ultrasound on development of zebrafish embryos

A system for scanning zebrafish embryos with diagnostic ultrasound was developed for research into possible biological effects during development. Two troughs for holding embryos were formed from agarose in a rectangular dish and separated by an ultrasound absorber. A 4.9 MHz linear array ultrasound probe was positioned to uniformly scan all the embryos at the bottom of one trough, with the other used for controls. Zebrafish embryos were scanned continuously from 10-24 h post fertilization (hpf) during the segmentation period and gross morphological parameters were measured at 30 hpf, including viability, length, number of visible axons, and the progression of the lateral line primordium (LLP). Our initial tests were encumbered by the thermal effects of probe self-heating, which resulted in accelerated development of the zebrafish embryos. After subsequent optimization, our test revealed a significant retardation of primary motor axons and the migration of the LLP in embryos scanned with ultrasound, which indicated a potential for nonthermal effects on neuronal development. This diagnostic ultrasound exposure system is suitable for further investigation of possible subtle bioeffects, such as perturbation of neuronal migration.

Prenatal ultrasound exposure and association with postnatal hearing outcomes

Objective

Prenatal ultrasound exams have become increasingly frequent. Although no serious adverse effects are known, the public health implications would be enormous should adverse effects on auditory development be shown. This study looks to establish a possible correlation between hearing loss and increased prenatal ultrasound exposure.

Design

Retrospective cohort analysis.

Setting

Tertiary academic referral center.

Methods

A retrospective review of 100 children undergoing newborn hearing screening was conducted. Extensive data collection was performed, and this data was analyzed for a potential correlation between failure of newborn hearing screening and increased prenatal ultrasound exposure, as well as for a potential correlation of other variables with hearing loss.

Main outcome measures

Postnatal hearing outcomes.

Results

A higher number of both total and 3^rd trimester ultrasound exams as well as a younger gestational age at birth were all found to be significantly associated with a higher likelihood of passing the newborn hearing screen (p<0.001 for each). No other factors were found to reach statistical significance.

Conclusions

Our results show that there is no correlation between a higher level of prenatal ultrasound exposure and hearing loss. Indeed, infants who had more prenatal ultrasounds in the third trimester were more likely to pass their screening hearing exams. The finding that children receiving more prenatal ultrasounds have a higher likelihood of passing newborn hearing screens serves as an excellent reminder of the classic statistics rule that correlation does not imply causation.

Electroacoustic response of 1-3 piezocomposite transducers for high power applications

The electroacoustic performance of 1-3 piezoelectric composite transducers with low loss polymer filler was studied and compared to monolithic Pb(Zr,Ti)O(3) (PZT) piezoelectric transducers. The 1-3 composite transducers exhibited significantly high electromechanical coupling factor (k(t) ∼ 0.64) when compared to monolithic counterparts (k(t) ∼ 0.5), leading to the improved bandwidth and loop sensitivity, being on the order of 67% and -24.0 dB versus 44% and -24.8 dB, respectively. In addition, the acoustic output power and transmit efficiency (∼50%) were found to be comparable to the monolithic PZT transducers, demonstrating potential for broad bandwidth, high power ultrasonic transducer applications.

Effects of ultrasound and ultrasound contrast agent on vascular tissue

BACKGROUND

Ultrasound (US) imaging can be enhanced using gas-filled microbubble contrast agents. Strong echo signals are induced at the tissue-gas interface following microbubble collapse. Applications include assessment of ventricular function and virtual histology.

AIM

While ultrasound and US contrast agents are widely used, their impact on the physiological response of vascular tissue to vasoactive agents has not been investigated in detail.

METHODS AND RESULTS

In the present study, rat dorsal aortas were treated with US via a clinical imaging transducer in the presence or absence of the US contrast agent, Optison. Aortas treated with both US and Optison were unable to contract in response to phenylephrine or to relax in the presence of acetylcholine. Histology of the arteries was unremarkable. When the treated aortas were stained for endothelial markers, a distinct loss of endothelium was observed. Importantly, terminal deoxynucleotidyl transferase mediated dUTP nick-end-labeling (TUNEL) staining of treated aortas demonstrated incipient apoptosis in the endothelium.

CONCLUSIONS

Taken together, these ex vivo results suggest that the combination of US and Optison may alter arterial integrity and promote vascular injury; however, the in vivo interaction of Optison and ultrasound remains an open question.

Long-term effects of in utero Doppler ultrasound scanning--a developmental programming perspective

Ultrasound scanning has been used as a diagnostic and screening tool in obstetric practice for over 50 years. There is no evidence of immediate or long-term harm to the developing fetus from exposure to B mode ultrasound. However, exposure to high levels of Doppler ultrasound during early development is increasingly common, and the full safety implications of this exposure are not clear. Doppler ultrasound exposure in utero gives rise to increased apoptosis in animal models, and there is evidence of the effects of exposure to Doppler ultrasound persisting throughout life, with increased non-right-handedness observed in human epidemiological studies. We consider the idea that there may be long-term developmental implications for fetuses exposed to Doppler ultrasound early in gestation. These effects may be mediated via thermal or mechanical disruption to the developing conceptus, giving rise to free radical damage. Excess free radical exposure early in gestation is a strong candidate for the final common pathway underlying developmental programming effects, and gives rise to concern that fetuses exposed to high levels of ultrasound are at risk of a developmental programming effect. It is suggested that there is a need for animal studies of developmental programming using exposure to Doppler ultrasound scanning as the exposure of interest, and for more observational data to be collected in the clinical setting. While these data are collected, it seems prudent to continue to adhere to the principle of 'as low as reasonably achievable' (ALARA) when exposing first-trimester fetuses to Doppler ultrasound.

Accuracy of pregnancy specific protein-B test for early pregnancy diagnosis in dairy cattle

The objective was to evaluate the accuracy of an ELISA for pregnancy specific protein B (PSP-B) for early pregnancy diagnosis in dairy cattle. Blood from lactating (>100 d postpartum) dairy cows (n = 738), was collected on Days 28, 30, and 35 (Day 0 = estrus), analyzed with an ELISA for PSP-B, and the cows designated as pregnant, probable, unlikely, or non-pregnant. Immediately after blood collection, transrectal ultrasonography (TRUS) was done for pregnancy diagnosis, and the results used as a criterion standard test for comparison with PSP-B. At Day 28, 46.3% were diagnosed by TRUS as pregnant. The PSP-B sensitivity was 93.9% on Day 28 and similar on Days 30 and 35. The PSP-B specificity, positive predictive value, negative predictive value, and accuracy were all >94% on Day 28 and similar on Days 30 and 35. However, the accuracy was significantly less compared to TRUS (P < 0.01). The percentage of all samples from cows that were probably pregnant or unlikely to be pregnant was 5.6%. At Days 28, 30, and 35, percentages of uncertain samples were 8.5, 4.8, and 3.3%, respectively (P < 0.01), and Kappa values were 0.92, 0.92, and 0.95. False negative and false positive results were attributed to low concentrations of PSP-B in pregnant animals and to persistence of pregnant concentrations of PSP-B in females with pregnancy loss, respectively. In conclusion, PSP-B ELISA was a sensitive, specific, and accurate test for pregnancy diagnosis (relative to TRUS) at Days 28, 30, and 35 after breeding.

Imaging during pregnancy

The use of imaging techniques in women who are pregnant has increased greatly over the past decade. This focused review discusses the risks and indications of ultrasonography, magnetic resonance imaging, computed tomographic scanning, and fluoroscopy for the evaluation of the parturient with non-obstetric disorders. Diagnostic imaging of the pregnant woman for the evaluation of disorders not related to pregnancy is evolving, and protocols will vary from institution to institution. The potential benefit from indicated diagnostic radiological procedures in the parturient nearly always outweighs risk to the fetus because radiation exposure from a single procedure conveys little fetal risk.

First trimester ultrasound: current approaches and practical pitfalls

Revolutionary technological improvements and high-frequency transvaginal scanning have enabled the resolution of ultrasound imaging in the first trimester to increase such that detailed early fetal development can now be well visualized. This investment in imaging technology has enabled not only normal embryonic development but also chromosomal abnormalities and structural anomalies to be more easily and accurately diagnosed before the second trimester. This article is intended to help radiologists in the interpretation and clinical application of normal and abnormal first trimester ultrasound findings in early pregnancy. We review the current literature and applications and interpretations of first trimester ultrasound.

Ultrasonographic diagnosis of pregnancy in rats

The purpose of the present study was to describe the technique for and findings of ultrasonographic examination of the rat uterus for diagnosis of early and midterm pregnancy. The uterus of anesthetized Wistar rats was examined between days 9 and 16 post coitum by transabdominal real-time ultrasonography by using a 12-MHz linear transducer. Pulsed-waved color Doppler sonography was used to measure the embryonic heart rate. The embryonic vesicles were detected with 25% false-negative diagnosis on day 9, 8% on day 10, and 0% thereafter. By day 12, the embryos were detected with measurable crown-rump length and heart rate. Ultrasonographic evidence of pregnancy in the rat was present by day 9 post coitum. Diagnosis of pregnancy was confirmed by detection of the embryo heart beat by day 12. Embryo characteristics were ultrasonographically measurable between days 9 and 16.

[Hygiene in endovaginal gynecologic and obstetrical ultrasound in 2008]

Hygiene of ultrasound probes is a hot topic in obstetric and gynecologic ultrasound. The issue concerns mainly the risk of contamination and the need for specific procedures to ensure a high degree of protection against infectious diseases, even if a disposable barrier cover is used. As there are no referenced quality criteria for these disposable probe covers, it is crucial to verify that they are CE marked. The use of condoms as probe covers is not recommended even though they present a lower rate of disruption compared to commercial probe covers. The global rate of probe cover perforation is of 1 to 9%. To date, there are no case reports of contamination by ultrasound examination, be it vaginal or abdominal. Nevertheless, every patient must be regarded as a potential source of infection. The French recommendations consider endovaginal ultrasound probes as semi-critical instruments and thus require intermediate-level disinfection. Because of the risk of disruption, American as well as Canadian and Australian recommendations insist on high-level disinfection of the probe. Every operator should follow reasonable hygiene rules and appropriate precautions should be taken in order to reassure the patients about the risks of contamination during any ultrasound examination.