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Giangregorio F, Mosconi E, Debellis MG, Palermo E, Provini S, Mendozza M, Ricevuti L, Esposito C. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10:a21961599. [PMID: 38304447 PMCID: PMC10829908 DOI: 10.1055/a-2196-1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/22/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.
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Lophatananon A, Light A, Burns-Cox N, Maccormick A, John J, Otti V, McGrath J, Archer P, Anning J, McCracken S, Page T, Muir K, Gnanapragasam VJ. Re-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways. JOURNAL OF CLINICAL UROLOGY 2023; 16:264-273. [PMID: 37614642 PMCID: PMC7614972 DOI: 10.1177/20514158211059057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Introduction Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds. Methods PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa - histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. Results: Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL2, respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50-59 years, 60-69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, p < 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort (n = 541). Conclusion The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups. Level of evidence IV.
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Affiliation(s)
- Artitaya Lophatananon
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK
| | - Alexander Light
- Division of Urology, Department of Surgery, University of Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK
| | | | | | - Joseph John
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - Vanessa Otti
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust and University of Exeter, UK
| | - Pete Archer
- Department of Urology, Southend Hospital, UK
| | | | - Stuart McCracken
- Department of Urology, South Tyneside and Sunderland NHS Trust, UK
| | - Toby Page
- Department of Urology, Newcastle Hospitals NHS Trust, UK
| | - Ken Muir
- Division of Population Health, Health Services Research & Primary Care Centre, University of Manchester, UK
| | - Vincent J Gnanapragasam
- Division of Urology, Department of Surgery, University of Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Addenbrooke’s Hospital, UK
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Aghabaglou F, Ainechi A, Abramson H, Curry E, Kaovasia TP, Kamal S, Acord M, Mahapatra S, Pustavoitau A, Smith B, Azadi J, Son JK, Suk I, Theodore N, Tyler BM, Manbachi A. Ultrasound monitoring of microcirculation: An original study from the laboratory bench to the clinic. Microcirculation 2022; 29:e12770. [PMID: 35611457 PMCID: PMC9786257 DOI: 10.1111/micc.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/08/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Monitoring microcirculation and visualizing microvasculature are critical for providing diagnosis to medical professionals and guiding clinical interventions. Ultrasound provides a medium for monitoring and visualization; however, there are challenges due to the complex microscale geometry of the vasculature and difficulties associated with quantifying perfusion. Here, we studied established and state-of-the-art ultrasonic modalities (using six probes) to compare their detection of slow flow in small microvasculature. METHODS Five ultrasonic modalities were studied: grayscale, color Doppler, power Doppler, superb microvascular imaging (SMI), and microflow imaging (MFI), using six linear probes across two ultrasound scanners. Image readability was blindly scored by radiologists and quantified for evaluation. Vasculature visualization was investigated both in vitro (resolution and flow characterization) and in vivo (fingertip microvasculature detection). RESULTS Superb Microvascular Imaging (SMI) and Micro Flow Imaging (MFI) modalities provided superior images when compared with conventional ultrasound imaging modalities both in vitro and in vivo. The choice of probe played a significant difference in detectability. The slowest flow detected (in the lab) was 0.1885 ml/s and small microvasculature of the fingertip were visualized. CONCLUSIONS Our data demonstrated that SMI and MFI used with vascular probes operating at higher frequencies provided resolutions acceptable for microvasculature visualization, paving the path for future development of ultrasound devices for microcirculation monitoring.
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Affiliation(s)
- Fariba Aghabaglou
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ana Ainechi
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Haley Abramson
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Eli Curry
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Tarana Parvez Kaovasia
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Serene Kamal
- HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Molly Acord
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Smruti Mahapatra
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Beth Smith
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Javad Azadi
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jennifer K. Son
- Department of Radiology and Radiological Science, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ian Suk
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nicholas Theodore
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Betty M. Tyler
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Amir Manbachi
- Department of Neurosurgery, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,HEPIUS Innovation Laboratory, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA,Department of Mechanical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
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Ossola C, Piacentino F, Fontana F, Curti M, Zorzetto G, Coppola A, Carcano G, Venturini M. Pocket-sized, wireless-Bluetooth ultrasound system to perform diagnostic and low-complexity interventional procedures in bedridden patients during the COVID-19 pandemic: from intensive care unit to domiciliary service? Eur Radiol Exp 2022; 6:20. [PMID: 35534781 PMCID: PMC9085369 DOI: 10.1186/s41747-022-00273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
The use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tablet facilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to perform diagnostic and interventional procedures in bedridden patients. The device is equipped with a battery-powered probe without cables that transmits images to a tablet (or a cell phone) through a dedicated App. We hypothesise in future to extend diagnostic and low-complexity interventional procedures from hospitalised patients to at-home patients who are not able to mobilise out of bed or are difficult to transport. This domiciliary service might also reduce the overhead of hospital accesses.
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Affiliation(s)
- Christian Ossola
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Giada Zorzetto
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Giulio Carcano
- Department of General, Emergency and Transplants Surgery, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, Varese, Italy.
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Schoen S, Kilinc MS, Lee H, Guo Y, Degertekin FL, Woodworth GF, Arvanitis C. Towards controlled drug delivery in brain tumors with microbubble-enhanced focused ultrasound. Adv Drug Deliv Rev 2022; 180:114043. [PMID: 34801617 PMCID: PMC8724442 DOI: 10.1016/j.addr.2021.114043] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023]
Abstract
Brain tumors are particularly challenging malignancies, due to their location in a structurally and functionally distinct part of the human body - the central nervous system (CNS). The CNS is separated and protected by a unique system of brain and blood vessel cells which together prevent most bloodborne therapeutics from entering the brain tumor microenvironment (TME). Recently, great strides have been made through microbubble (MB) ultrasound contrast agents in conjunction with ultrasound energy to locally increase the permeability of brain vessels and modulate the brain TME. As we elaborate in this review, this physical method can effectively deliver a wide range of anticancer agents, including chemotherapeutics, antibodies, and nanoparticle drug conjugates across a range of preclinical brain tumors, including high grade glioma (glioblastoma), diffuse intrinsic pontine gliomas, and brain metastasis. Moreover, recent evidence suggests that this technology can promote the effective delivery of novel immunotherapeutic agents, including immune check-point inhibitors and chimeric antigen receptor T cells, among others. With early clinical studies demonstrating safety, and several Phase I/II trials testing the preclinical findings underway, this technology is making firm steps towards shaping the future treatments of primary and metastatic brain cancer. By elaborating on its key components, including ultrasound systems and MB technology, along with methods for closed-loop spatial and temporal control of MB activity, we highlight how this technology can be tuned to enable new, personalized treatment strategies for primary brain malignancies and brain metastases.
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Affiliation(s)
- Scott Schoen
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - M. Sait Kilinc
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hohyun Lee
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Yutong Guo
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - F. Levent Degertekin
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Graeme F. Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, College Park, MD 20742, USA,Fischell Department of Bioengineering A. James Clarke School of Engineering, University of Maryland
| | - Costas Arvanitis
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA,Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
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