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Christensen D, Pazol K, Overwyk KJ, England LJ, Alexander AA, Croen LA, Dowling NF, Schieve LA, Tian LH, Tinker SC, Windham GC, Callaghan WM, Shapira SK. Prenatal ultrasound use and risk of autism spectrum disorder: Findings from the case-control Study to Explore Early Development. Paediatr Perinat Epidemiol 2023; 37:527-535. [PMID: 37483151 PMCID: PMC10527947 DOI: 10.1111/ppe.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Studies evaluating the association between prenatal ultrasounds and autism spectrum disorder (ASD) have largely produced negative results. Concern remains due to the rising identification of children with ASD and ultrasound use. OBJECTIVE To evaluate the association between prenatal ultrasound use and ASD. METHODS We used data from the Study to Explore Early Development, a multisite case-control study of preschool-aged children with ASD implemented during 2007-2012. We recruited cases from children receiving developmental disability services and randomly selected population controls from birth records. ASD case status was based on in-person standardised assessments. We stratified analyses by pre-existing maternal medical conditions and pregnancy complications associated with increased ultrasound use (ultrasound indications) and used logistic regression to model case status by increasing ultrasound counts. For pregnancies with medical record data on ultrasound timing, we conducted supplementary tests to model associations by trimester of exposure. RESULTS Among 1524 singleton pregnancies, ultrasound indications were more common for ASD cases than controls; respectively, for each group, no indications were reported for 45.1% and 54.2% of pregnancies, while ≥2 indications were reported for 26.1% and 18.4% of pregnancies. The percentage of pregnancies with multiple ultrasounds varied by case status and the presence of ultrasound indications. However, stratified regression models showed no association between increasing ultrasound counts and case status, either for pregnancies without (aOR 1.01, 95% CI 0.92, 1.11) or with ultrasound indications (aOR 1.01, 95% CI 0.95, 1.08). Trimester-specific analyses using medical record data showed no association in any individual trimester. CONCLUSIONS We found no evidence that prenatal ultrasound use increases ASD risk. Study strengths included gold-standard assessments for ASD case classification, comparison of cases with controls, and a stratified sample to account for conditions associated both with increased prenatal ultrasound use and ASD.
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Affiliation(s)
- Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine J. Overwyk
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucinda J. England
- National institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aimee A. Alexander
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa A. Croen
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Nicole F. Dowling
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gayle C. Windham
- California Department of Public Health, Division of Environmental and Occupational Disease Control, Richmond, California, USA
| | - William M. Callaghan
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart K. Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tembelis M, Frederick-Dyer KC, Dyer JL, Planz VB, Moshiri M. Medicolegal considerations associated with cancer during pregnancy. Abdom Radiol (NY) 2023; 48:1637-1644. [PMID: 36538081 DOI: 10.1007/s00261-022-03776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 05/01/2023]
Abstract
The management of pregnant patients with cancer is complex and requires a multidisciplinary team to effectively diagnose, stage, and manage the cancer while also being cognizant of the potential harm that diagnosis and treatment may have on the maternal and fetal well-being. Beyond the complex clinical management of these patients is additional medicolegal consideration. Radiologists play a crucial role in the management of these patients as their knowledge of diagnostic and interventional radiology techniques allows for appropriate and safe imaging for both the mother and fetus. In addition, radiologist are able to educate patient on the different imaging modalities and techniques, thus allowing patients to make informed decisions and maintain autonomy over there care. This article will review safety considerations associated with different imaging modalities, contrast agents, interventional radiology procedures and moderate sedation related to the imaging of pregnant patient with cancer with specific attention paid to the medicolegal aspects.
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Affiliation(s)
- Miltiadis Tembelis
- Department of Radiology, NYU Langone Hospital Long Island, Mineola, NY, 11501, USA.
| | - Katherine C Frederick-Dyer
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Virginia B Planz
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Mariam Moshiri
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Collins K, Hamlyn T, Bruxner G, Kothari A. Dangers in the dark: Calling for a safer practice of transvaginal ultrasonography. Australas J Ultrasound Med 2021; 24:5-12. [PMID: 34765410 DOI: 10.1002/ajum.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background The intimate examination is an important component of the assessment of a patient presenting with obstetric or gynaecological concerns. Ultrasound practitioners, like any other medical practitioner, are in a unique and privileged position. During the examination, the sonographers engage in a very close and personal interaction with an individual whom they have likely never met. They are also most likely unfamiliar with their social situation, cultural background, previous experiences with the healthcare profession and more importantly, any history of sexual trauma. It is an extremely sensitive area of practice which places a great deal of responsibility on the clinician to ensure that they not only protect their patient from psychological distress, but also themselves, from the threat of litigation arising from such distress. Aims This paper highlights the current governance requirements for sonographers and makes suggestions to support them in safeguarding their patients and themselves from allegations of unprofessional conduct, until such a regulatory body exists. Materials and Methods A wide-ranging review of the literature exploring the perceptions of female patients regarding intimate sonographic examination was performed using standard search engines. Additionally, grey literature was searched for policy statements and government regulatory documents for guidance on the topic. Results Although much research has been undertaken in this field across diverse cultures and knowledge in this area is ever increasing; however, the guidelines for sonographers appear to be site specific and variable. At present, there is no overarching governance for sonographers, as there is with practitioners registered with the Australian Health Practitioner Regulation Agency. Discussion While there are practice standards for the purposes of Medicare set out by the Diagnostic Imaging Accreditation Scheme, there is no regulatory professional standard that sonographers are held accountable to. This is problematic and has the potential for inadvertent boundary transgression by the practitioner, as there is also no existing framework for management of such incidents in an equitable manner. Conclusion The intimate examination is generally well tolerated; however, there is a subset of the population who are vulnerable to psychological distress arising from the examination. The sonographer must be astute to signs of distress and act in accordance with the intimate examination guidelines set out by AHPRA, for the dual purpose of protecting their patients against harm and also themselves from the threat of litigation.
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Affiliation(s)
- Kelly Collins
- Wesley Hospital Auchenflower Queensland Australia.,University of Queensland St Lucia Queensland Australia
| | - Tina Hamlyn
- Redcliffe Hospital Redcliffe Queensland Australia
| | - George Bruxner
- University of Queensland St Lucia Queensland Australia.,Metro North Mental Health Service Brisbane Queensland Australia
| | - Alka Kothari
- University of Queensland St Lucia Queensland Australia.,Redcliffe Hospital Redcliffe Queensland Australia
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Goel L, Wu H, Zhang B, Kim J, Dayton PA, Xu Z, Jiang X. Safety Evaluation of a Forward-Viewing Intravascular Transducer for Sonothrombolysis: An in Vitro and ex Vivo Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3231-3239. [PMID: 34446331 PMCID: PMC8487993 DOI: 10.1016/j.ultrasmedbio.2021.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/14/2021] [Accepted: 07/23/2021] [Indexed: 05/03/2023]
Abstract
Recent in vitro work has revealed that a forward-viewing intravascular (FVI) transducer has sonothrombolysis applications. However, the safety of this device has yet to be evaluated. In this study, we evaluated the safety of this device in terms of tissue heating, vessel damage and particle debris size during sonothrombolysis using microbubbles or nanodroplets with tissue plasminogen activator, in both retracted and unretracted blood clots. The in vitro and ex vivo sonothrombolysis tests using FVI transducers revealed a temperature rise of less than 1°C, no vessel damage as assessed by histology and no downstream clot particles >500 µm. These in vitro and ex vivo results indicate that the FVI transducer poses minimal risk for sonothrombolysis applications and should be further evaluated in animal models.
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Affiliation(s)
- Leela Goel
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Huaiyu Wu
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Bohua Zhang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Jinwook Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA.
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Mogren I, Ntaganira J, Sengoma JPS, Holmlund S, Small R, Pham Thi L, Kidanto HL, Ngarina M, Bergström C, Edvardsson K. Maternal health care professionals' experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study. BMC Health Serv Res 2021; 21:789. [PMID: 34376210 PMCID: PMC8356395 DOI: 10.1186/s12913-021-06758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study, undertaken in Rwanda, aimed to investigate health professionals' experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. METHODS A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). RESULTS Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. CONCLUSIONS Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
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Affiliation(s)
- Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Department of Women’s and Children’s and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Lan Pham Thi
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187 Umeå, Sweden
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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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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V S S, Panigrahy N, Rath SN. Recent approaches in clinical applications of 3D printing in neonates and pediatrics. Eur J Pediatr 2021; 180:323-332. [PMID: 33025224 DOI: 10.1007/s00431-020-03819-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023]
Abstract
Neonates and pediatric populations are vulnerable subjects in terms of health. Proper screening and early optimal treatment would reduce infant and child mortality, improving the quality of life. Researchers and clinicians all over the world are in pursuit of innovations to improve the medical care delivery system. Infant morphometrics changes drastically due to the rapid somatic growth in infancy and childhood, demanding for patient-specific customization of treatment intervention accordingly. 3D printing is a radical technology that allows the generation of physical 3D products from digital images and addresses the patient-specific requirement. The combination of cost-effective and on-demand customization offers a boundless opportunity for the enhancement of neonates and pediatric health.Conclusion: The advanced technology of 3D printing proposes a pioneering breakthrough in bringing physiologically and anatomically appropriate treatment strategies addressing the unmet needs of child health problems. What is Known: • The potential application of 3D printing is observed across a multitude of fields within medicine and surgery. • The unprecedented effect of this technology on pediatric healthcare is still very much a work in progress. What is New: • The recent clinical applications of 3D printing provide better treatment modalities to infants and children. • The review provides an overview of the comparison between conventional treatment methods and 3DP regarding specific applications.
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Affiliation(s)
- Sukanya V S
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad (IITH), Kandi , Sangareddy, Telangana, 502285, India
| | | | - Subha Narayan Rath
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad (IITH), Kandi , Sangareddy, Telangana, 502285, India.
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Schwarze V, Froelich MF, Marschner C, Knösel T, Rübenthaler J, Clevert DA. Safe and pivotal approaches using contrast-enhanced ultrasound for the diagnostic workup of non-obstetric conditions during pregnancy, a single-center experience. Arch Gynecol Obstet 2021; 303:103-112. [PMID: 32761368 DOI: 10.1007/s00404-020-05735-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Conventional ultrasound is the main imaging modality in obstetrics for assessing the maternal and fetal status. Up to date, contrast-enhanced ultrasound (CEUS) has not found widespread use in gynecology and obstetrics, but recent studies demonstrate promising results. The aim of the present study is to assess safe and valuable application of CEUS during pregnancy to investigate non-obstetric conditions. METHODS Five pregnant patients on whom CEUS was performed between 2019 and 2020 were included in this retrospective single-center study. A total of six CEUS examinations were performed including one CEUS-guided biopsy (mean age: 31 years, mean weeks of pregnancy: 18 weeks). CEUS examinations were performed by a consultant radiologist (EFSUMB level 3). RESULTS All included pregnant women safely underwent CEUS. Neither maternal nor fetal adverse effects were detected. CEUS critically helped in the diagnostic workup of a desmoid tumor of the abdominal wall, hepatic hemangioma, amebic hepatic abscess, uncomplicated renal cyst and post-inflammatory alteration of the renal cortex and for excluding active abdominal bleeding. In addition, CEUS-guided biopsy was performed to prevent intratumoral hemorrhage. Findings from CEUS prompted immediate treatment in two women, whereas in three women regular obstetric monitoring of the women could be conducted. CONCLUSION Our results demonstrate safe and crucial application of off-label CEUS in pregnant women to assess different non-obstetric conditions allowing to prevent additional ionizing CT or application of (gadolinium-based) contrast agent in MRI. Hence, CEUS might add pivotal value for evaluating obstetric and non-obstetric conditions and thereby directing clinical management of pregnant women in the future.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany.
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Constantin Marschner
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
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Issaoui M, Miloro P, Balandraud X, Rivens I, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Elevation in an Instrumented Phantom Insonated by B-Mode Imaging, Pulse Doppler and Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3317-3326. [PMID: 32962891 DOI: 10.1016/j.ultrasmedbio.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Diagnostic ultrasound is the gold standard for obstetric scanning and one of the most important imaging techniques for perinatal and neonatal monitoring and diagnosis. Ultrasound provides detailed real-time anatomic information, including blood flow measurements and tissue elasticity. The latter is provided through various techniques including shear wave elastography (SWE). SWE is increasingly used in many areas of medicine, especially in detection and diagnosis of breast, thyroid and prostate cancers and liver disease. More recently, SWE has found application in gynaecology and obstetrics. This method mimics manual palpation, revealing the elastic properties of soft biological tissues. Despite its rising potential and expanding clinical interest in its use in obstetrics and gynaecology (such as for assessment of cervical ripening or organ development and structure during pregnancy), its effects on and potential risks to the developing fetus remain unknown. Risks should be evaluated by regulatory bodies before recommendations are made on the use of SWE. Because ultrasound is known to produce thermal and mechanical effects, this study measured the temperature increase caused by B-mode, pulse Doppler (PD) and SWE, using an instrumented phantom with 11 embedded thermocouples. Experiments were performed with an Aixplorer diagnostic ultrasound system (Supersonic Imagine, Aix-en-Provence, France). As expected, the greatest heating was detected by the thermocouple closest to the surface in contact with the transducer (2.9°C for SWE, 1.2°C for PD, 0.7°C for B-mode after 380-s excitation). Both conduction from the transducer face and direct heating owing to ultrasound waves contribute to temperature increase in the phantom with SWE associated with a larger temperature increase than PD and B-mode. This article offers a methodological approach and reference data for future safety studies, as well as initial recommendations about SWE safety in obstetrics and gynaecology.
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Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Piero Miloro
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, UK
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Ian Rivens
- Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - 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
| | - Amélie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, CHU de Clermont-FerrandClermont-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, CHU de Clermont-FerrandClermont-Ferrand, France
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Lo PA, Huang K, Zhou Q, Humayun MS, Yue L. Ultrasonic Retinal Neuromodulation and Acoustic Retinal Prosthesis. MICROMACHINES 2020; 11:mi11100929. [PMID: 33066085 PMCID: PMC7600354 DOI: 10.3390/mi11100929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/11/2020] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
Ultrasound is an emerging method for non-invasive neuromodulation. Studies in the past have demonstrated that ultrasound can reversibly activate and inhibit neural activities in the brain. Recent research shows the possibility of using ultrasound ranging from 0.5 to 43 MHz in acoustic frequency to activate the retinal neurons without causing detectable damages to the cells. This review recapitulates pilot studies that explored retinal responses to the ultrasound exposure, discusses the advantages and limitations of the ultrasonic stimulation, and offers an overview of engineering perspectives in developing an acoustic retinal prosthesis. For comparison, this article also presents studies in the ultrasonic stimulation of the visual cortex. Despite that, the summarized research is still in an early stage; ultrasonic retinal stimulation appears to be a viable technology that exhibits enormous therapeutic potential for non-invasive vision restoration.
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Affiliation(s)
- Pei-An Lo
- Roski Eye Institute, University of Southern California, Los Angeles, CA 90033, USA; (P.-A.L.); (K.H.); (Q.Z.); (M.S.H.)
- Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Kyana Huang
- Roski Eye Institute, University of Southern California, Los Angeles, CA 90033, USA; (P.-A.L.); (K.H.); (Q.Z.); (M.S.H.)
| | - Qifa Zhou
- Roski Eye Institute, University of Southern California, Los Angeles, CA 90033, USA; (P.-A.L.); (K.H.); (Q.Z.); (M.S.H.)
- Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Mark S. Humayun
- Roski Eye Institute, University of Southern California, Los Angeles, CA 90033, USA; (P.-A.L.); (K.H.); (Q.Z.); (M.S.H.)
- Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Lan Yue
- Roski Eye Institute, University of Southern California, Los Angeles, CA 90033, USA; (P.-A.L.); (K.H.); (Q.Z.); (M.S.H.)
- Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
- Correspondence:
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11
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Abramowicz JS. Biosafety of Sonography: Still a Mystery to Most Obstetrics (and Other) Providers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1683-1685. [PMID: 32277498 DOI: 10.1002/jum.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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12
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Miller DL, Abo A, Abramowicz JS, Bigelow TA, Dalecki D, Dickman E, Donlon J, Harris G, Nomura J. Diagnostic Ultrasound Safety Review for Point-of-Care Ultrasound Practitioners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1069-1084. [PMID: 31868252 DOI: 10.1002/jum.15202] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Potential ultrasound exposure safety issues are reviewed, with guidance for prudent use of point-of-care ultrasound (POCUS). Safety assurance begins with the training of POCUS practitioners in the generation and interpretation of diagnostically valid and clinically relevant images. Sonographers themselves should minimize patient exposure in accordance with the as-low-as-reasonably-achievable principle, particularly for the safety of the eye, lung, and fetus. This practice entails the reduction of output indices or the exposure duration, consistent with the acquisition of diagnostically definitive images. Informed adoption of POCUS worldwide promises a reduction of ionizing radiation risks, enhanced cost-effectiveness, and prompt diagnoses for optimal patient care.
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Affiliation(s)
| | - Alyssa Abo
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Timothy A Bigelow
- Center for Nondestructive Evaluation, Iowa State University, Ames, Iowa, USA
| | - Diane Dalecki
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Eitan Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - John Donlon
- Acoustic Measurements, Philips Healthcare, Bothell, Washington, USA
| | - Gerald Harris
- Center for Devices and Radiological Health, United States Food and Drug Administration (retired), Silver Spring, Maryland, USA
| | - Jason Nomura
- Department of Emergency Medicine, Christiana Hospital, Newark, Delaware, USA
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13
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Rodrigues Simões AP, Cristina Maronezi M, Andres Ramirez Uscategui R, Garcia Kako Rodrigues M, Sitta Gomes Mariano R, Tavares de Almeida V, José Correia Santos V, Del Aguila da Silva P, Ricardo Russiano Vicente W, Antonio Rossi Feliciano M. Placental ARFI elastography and biometry evaluation in bitches. Anim Reprod Sci 2020; 214:106289. [PMID: 32087915 DOI: 10.1016/j.anireprosci.2020.106289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 02/05/2023]
Abstract
Placental rigidity and biometry of twelve pregnant bitches were evaluated using B-mode and Acoustic Radiation Force Impulse (ARFI) ultrasonography, performed once daily, from day 15 of gestation until parturition. Specific software (Virtual Touch Tissue Quantification® VTTQ and Virtual Touch Tissue Imaging Quantification® VTTIQ) were used. Values for results for variables were correlated and regression models related to gestational day were used to make evaluations. Maternal-fetal placental thickness increased to day 63 (P < 0.0001; R² = 0.91); maternal placental thickness increased until day 40 (P = 0.0340; R² = 0.54); and fetal placental thickness increased to day 50 (P < 0.0001; R² = 0.83) of gestation. Shear wave velocity (SWV) of the dorsal (P < 0.0010) was greater than lateral, which in turn was greater (P = 0.020) than the ventral area. The SWV of the dorsal area as determined using VTTQ, decreased from day 21-35 and increased to day 56 of gestation (P = 0.0291; R² = 0.4021); lateral SWV decreased from day 24-45 and increased until the time of parturition (P < 0.001; R² = 0.6055). The SWV of the dorsal area, as determined using VTTIQ, decreased from day 21-43 and then increased to day 60 of gestation (P = 0.0016; R² = 0.5075); and ventral area SWV increased from day 21-23 and decreased until the time of parturition (P < 0.001; R² = 0.8055). Placental alterations reflect structural and biochemical gestational adaptations and can become useful techniques for obstetrics.
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Affiliation(s)
- Ana Paula Rodrigues Simões
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil.
| | - Marjury Cristina Maronezi
- Department of Veterinary Surgery, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | | | - Mariana Garcia Kako Rodrigues
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Renata Sitta Gomes Mariano
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Vivian Tavares de Almeida
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Victor José Correia Santos
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Priscila Del Aguila da Silva
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Wilter Ricardo Russiano Vicente
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Marcus Antonio Rossi Feliciano
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil; Department of Large Animals Clinic and Surgery. Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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14
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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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Kamimura HAS, Aurup C, Bendau EV, Saharkhiz N, Kim MG, Konofagou EE. Iterative Curve Fitting of the Bioheat Transfer Equation for Thermocouple-Based Temperature Estimation In Vitro and In Vivo. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:70-80. [PMID: 31514131 PMCID: PMC6944748 DOI: 10.1109/tuffc.2019.2940375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Temperature measurements with thin thermocouples embedded in ultrasound fields are strongly subjected to a viscous heating artifact (VHA). The artifact contribution decays over time; therefore, it can be minimized at late temperature readings. However, previous studies have failed to demonstrate a rigorous method for determining the optimal time point at which the artifact contribution is negligible. In this study, we present an iterative processing method based on successive curve fittings using an artifact-independent model. The fitting starting point moves at each iteration until the maximum R2 indicates where the viscous heating is minimum. A solution of the bioheat transfer equation is used to account for blood perfusion, thus enabling in vivo measurements. Three T-type thermocouples with different diameters and sensitivities were assessed in an excised canine liver and in the mouse brain in vivo. We found that the artifact constitutes up to 81% ± 5% of wire thermocouple readings. The best-fit time varied in the liver samples ( n = 3 ) from 0 to 3.335 ± 0.979 s and in the mouse brain ( n = 5 ) from 0 to 0.498 ± 0.457 s at variable experimental conditions, which clearly demonstrates the need of the method for finding the appropriate starting time point of the fit. This study introduces a statistical method to determine the best time to fit a curve that can back-estimate temperature in tissues under ultrasound exposure using thermocouples. This method allows temperature evaluation in vivo and in vitro during a validation and safety assessment of a wide range of therapeutic and diagnostic ultrasound modalities.
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16
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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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17
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Mashiane SE, van Dyk B, Casmod Y. Ultrasound biosafety: Knowledge and opinions of health practitioners who perform obstetric scans in South Africa. Health SA 2019; 24:1028. [PMID: 31934395 PMCID: PMC6917423 DOI: 10.4102/hsag.v24i0.1028] [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: 12/01/2017] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnostic ultrasound is generally considered as a safe test in pregnancy. To date there is no evidence that ultrasound has caused harm to the developing foetus. However, with the number of obstetric scans on the rise and the steep increase in acoustic output achieved by modern machines, the lack of evidence of absolute safety remains a concern. Acoustic output is under the direct control of the operator and is therefore the operator's responsibility to keep the intensity as low as reasonably achievable. A situation analysis in the South African context was deemed necessary to determine end user knowledge and opinions on safe antenatal ultrasound practice. AIM The aim of this quantitative descriptive, cross-sectional study was to evaluate the knowledge and practice of health practitioners who perform antenatal scans regarding safety aspects of diagnostic ultrasound. SETTING A self-administered questionnaire was distributed at two national congresses, hosted by the South African Society of Ultrasound and Obstetrics (SASUOG) and South African Society of Obstetricians (SASOG) committees. METHOD Quota non-probability sampling allowed for the identification of professional categories capable of providing information relevant to the study objectives. The sample represented a population with experience in obstetric ultrasound. RESULTS Compared to international studies, South African end users demonstrated better knowledge of safety indices than their international counterparts. It is, however, discouraging that end users still demonstrate insufficient knowledge regarding factors contributing to adverse biological effects. CONCLUSION With room for improvement, an effort should be made to comply with international standards through increased training efforts and raising awareness.
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Affiliation(s)
- Salome E Mashiane
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Barbara van Dyk
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Yasmin Casmod
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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18
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Focused Ultrasound Effects on Osteosarcoma Cell Lines. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6082304. [PMID: 31236409 PMCID: PMC6545756 DOI: 10.1155/2019/6082304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
MRI guided Focused Ultrasound (MRgFUS) has shown to be effective therapeutic modality for non-invasive clinical interventions in ablating of uterine fibroids, in bone metastasis palliative treatments, and in breast, liver, and prostate cancer ablation. MRgFUS combines high intensity focused ultrasound (HIFU) with MRI images for treatment planning and real time thermometry monitoring, thus enabling non-invasive ablation of tumor tissue. Although in the literature there are several studies on the Ultrasound (US) effects on cell in culture, there is no systematic evidence of the biological effect of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) treatment on osteosarcoma cells, especially in lower dose regions, where tissues receive sub-lethal acoustic power. The effect of MRgFUS treatment at different levels of acoustic intensity (15.5-49 W/cm2) was investigated on Mg-63 and Saos-2 cell lines to evaluate the impact of the dissipation of acoustic energy delivered outside the focal area, in terms of cell viability and osteogenic differentiation at 24 h, 7 days, and 14 days after treatment. Results suggested that the attenuation of FUS acoustic intensities from the focal area (higher intensities) to the “far field” (lower intensities) zones might determine different osteosarcoma cell responses, which range from decrease of cell proliferation rates (from 49 W/cm2 to 38.9 W/cm2) to the selection of a subpopulation of heterogeneous and immature living cells (from 31.1 W/cm2 to 15.5 W/cm2), which can clearly preserve bone tumor cells.
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Van den Brom R, Klerx R, Vellema P, Lievaart-Peterson K, Hesselink JW, Moll L, Vos P, Santman-Berends I. Incidence, possible risk factors and therapies for pseudopregnancy on Dutch dairy goat farms: a cross-sectional study. Vet Rec 2019; 184:770. [PMID: 31221918 DOI: 10.1136/vr.105346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/26/2019] [Accepted: 05/13/2019] [Indexed: 11/04/2022]
Abstract
Pseudopregnancy is a frequently diagnosed reproductive disorder in (dairy) goats. This cross-sectional study evaluates the incidence, possible risk factors and therapies for pseudopregnancy on Dutch dairy goat farms. Two questionnaires, one for farmers and one for veterinarians, were designed and included questions about general farm demographics, breeding management, hormonal oestrous induction, treatment, measures for reduction and stress moments in dairy goats in the period June 1, 2016-May 31, 2017. In total, 43 farmers (21.5 per cent response rate) and 27 veterinarians (22.5 per cent response rate) completed the questionnaire. The annual incidence of pseudopregnancy varied between 1 and 54 per cent per farm, with a mean annual incidence of 17 per cent (95 per cent CI 0.14 to 0.21). In this study, we found a significant association between incidence of pseudopregnancy and a higher percentage of goats with an extended lactation (p<0.0001) and between incidence of pseudopregnancy and the number of ultrasound examinations per year (p<0.0001). The recommended therapy in literature consists of two administrations of prostaglandins. This was only correctly applied by 10 per cent of the farms. On 52 per cent of the farms, an overdose was used comparing to the recommended dose in literature.
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Affiliation(s)
- René Van den Brom
- Department of Small Ruminant Health, Gezondheidsdienst voor Dieren BV, Deventer, Overijssel, The Netherlands
| | - Rianne Klerx
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Piet Vellema
- Department of Small Ruminant Health, Gezondheidsdienst voor Dieren BV, Deventer, Overijssel, The Netherlands
| | - Karianne Lievaart-Peterson
- Department of Small Ruminant Health, Gezondheidsdienst voor Dieren BV, Deventer, Overijssel, The Netherlands
| | | | - Lammert Moll
- Department of Small Ruminant Health, Gezondheidsdienst voor Dieren BV, Deventer, Overijssel, The Netherlands
| | - Peter Vos
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Inge Santman-Berends
- Department of Epidemiology, Gezondheidsdienst voor Dieren BV, Deventer, The Netherlands
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20
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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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21
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Harris GR. Safety Considerations for Diagnostic Ultrasound in the Eye. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1163-1165. [PMID: 30835859 DOI: 10.1002/jum.14977] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
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22
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Efectos biológicos adversos y seguridad del ultrasonido en el embarazo. Revisión sistemática. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Coskun ME, Coskun KA, Tutar Y. Determination of Optimum Operation Parameters for Low-Intensity Pulsed Ultrasound and Low-Level Laser Based Treatment to Induce Proliferation of Osteoblast and Fibroblast Cells. Photomed Laser Surg 2018; 36:246-252. [PMID: 29466082 DOI: 10.1089/pho.2017.4354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mehmet Emre Coskun
- Department of Prosthodontics, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - Kubra Acikalin Coskun
- Department of Biochemistry, Faculty of Pharmacy, Cumhuriyet University, Sivas, Turkey
| | - Yusuf Tutar
- Department of Nutrition and Dietetics, Health Sciences Faculty, University of Health Sciences, Istanbul, Turkey
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24
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Rosman NP, Vassar R, Doros G, DeRosa J, Froman A, DiMauro A, Santiago S, Abbott J. Association of Prenatal Ultrasonography and Autism Spectrum Disorder. JAMA Pediatr 2018; 172:336-344. [PMID: 29435580 PMCID: PMC5875374 DOI: 10.1001/jamapediatrics.2017.5634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Abstract
Importance The prevalence of autism spectrum disorder (ASD) has been increasing rapidly, with current estimates of 1 in 68 children affected. Simultaneously, use of prenatal ultrasonography has increased substantially, with limited investigation into its safety and effects on brain development. Animal studies have demonstrated that prenatal ultrasonography can adversely affect neuronal migration. Objective To quantify prenatal ultrasound exposure by the frequency, timing, duration, and strength of ultrasonographic scans in children with later ASD, developmental delay, and typical development. Design, Setting, and Participants This case-control study included 107 patients with ASD, 104 control individuals with developmental delay, and 209 controls with typical development. Participants were identified from medical records based on prenatal care and delivery at Boston Medical Center, a diverse, academic, safety-net medical center, from July 1, 2006, through December 31, 2014, with a gestational age at birth of at least 37 weeks. Data were analyzed from May 1, 2015, through November 30, 2017. Exposures Ultrasonographic exposure was quantified by the number and timing of scans, duration of exposure, mean strength (depth, frame rate, mechanical index, and thermal index), and time of Doppler and 3- and 4-dimensional imaging. Main Outcomes and Measures Among participants with ASD and controls with developmental delay and typical development, ultrasound exposure was quantified and compared per trimester and for the entire pregnancy, with adjustment for infant sex, gestational age at birth, and maternal age. Results A total of 420 participants were included in the study (328 boys [78.1%] and 92 girls [21.9%]; mean age as of January 1, 2016, 6.6 years; 95% CI, 6.5-6.8 years). The ASD group received a mean of 5.9 scans (95% CI, 5.2-6.6), which was not significantly different from the 6.1 scans (95% CI, 5.4-6.8) in the developmental delay group or the 6.3 scans (95% CI, 5.8-6.8) in the typical development group. Compared with the typical development group, the ASD group had shorter duration of ultrasound exposure during the first (290.4 seconds [95% CI, 212.8-368.0 seconds] vs 406.4 seconds [95% CI, 349.5-463.3 seconds]) and second (1687.6 seconds [95% CI, 1493.8-1881.4 seconds] vs 2011.0 seconds [95% CI, 1868.9-2153.1 seconds]) trimesters but no difference in the number of scans. The ASD group had greater mean depth of ultrasonographic penetration than the developmental delay group in the first trimester (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.1-12.1 cm]). The ASD group had greater mean depth than the typical development group during the first (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.3-12.0 cm]) and the second (12.9 cm [95% CI, 12.6-13.3 cm] vs 12.5 cm [95% CI, 12.2-12.7 cm]) trimesters. Conclusions and Relevance This study found significantly greater mean depth of ultrasonographic penetration in the ASD group compared with the developmental delay group in the first trimester and compared with the typical development group in the first and second trimesters. Further research is needed to determine whether other variables of ultrasound exposure also have adverse effects on the developing fetus.
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Affiliation(s)
- N. Paul Rosman
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Medical Center, Boston, Massachusetts
| | - Rachel Vassar
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - James DeRosa
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Allison Froman
- graduate student at Boston University School of Public Health, Boston, Massachusetts
| | - Audrey DiMauro
- medical student at Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Sherry Santiago
- Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Pediatric Neurology, Puerto Rico Children’s Hospital, Bayamón, Puerto Rico
| | - Jodi Abbott
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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Schenone M, Ziebarth S, Duncan J, Stokes L, Hernandez A. Effects of a proposed quality improvement process in the proportion of the reported ultrasound findings unsupported by stored images. J Matern Fetal Neonatal Med 2018; 32:2328-2331. [PMID: 29402162 DOI: 10.1080/14767058.2018.1432587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the proportion of documented ultrasound findings that were unsupported by stored ultrasound images in the obstetric ultrasound unit, before and after the implementation of a quality improvement process consisting of a checklist and feedback. METHODS A quality improvement process was created involving utilization of a checklist and feedback from physician to sonographer. The feedback was based on findings of the physician's review of the report and images using a check list. To assess the impact of this process, two groups were compared. Group 1 consisted of 58 ultrasound reports created prior to initiation of the process. Group 2 included 65 ultrasound reports created after process implementation. Each chart was reviewed by a physician and a sonographer. Findings considered unsupported by stored images by both reviewers were used for analysis, and the proportion of unsupported findings was compared between the two groups. Results are expressed as mean ± standard error. A p value of < .05 was used to determine statistical significance. RESULTS Univariate analysis of baseline characteristics and potential confounders showed no statistically significant difference between the groups. The mean proportion of unsupported findings in Group 1 was 5.1 ± 0.87, with Group 2 having a significantly lower proportion (2.6 ± 0.62) (p value = .018). CONCLUSIONS Results suggest a significant decrease in the proportion of unsupported findings in ultrasound reports after quality improvement process implementation. Thus, we present a simple yet effective quality improvement process to reduce unsupported ultrasound findings.
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Affiliation(s)
- Mauro Schenone
- a Department of Obstetrics and Gynecology , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Sarah Ziebarth
- b Department of Obstetrics and Gynecology , Methodist Olive Branch Women's Center , Olive Branch , MS , USA
| | - Jose Duncan
- a Department of Obstetrics and Gynecology , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Lea Stokes
- a Department of Obstetrics and Gynecology , University of Tennessee Health Science Center , Memphis , TN , USA
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Adambounou K, Bathily EHAL, Adigo AMY, Gbandé P, Bakpatina-Batako KD, Sonhaye L, Tapsoba TL, Adjenou K. Knowledge of Togolese Doctors on Biological Effects of Ultrasound and Their Attitudes towards the Ultrasonographic Explorations Performed in Lome (Togo). ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojbiphy.2018.81001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Russameecharoen K, Nawapun K, Phithakwatchara N. Three-dimensional ultrasound for prenatal assessment of conjoined twins: additional advantages? J Perinat Med 2017; 45:667-691. [PMID: 28231064 DOI: 10.1515/jpm-2016-0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
Conjoined twins are a rare, but serious, complication of monozygotic twins. Early prenatal diagnosis of conjoined twins is increasingly made with transvaginal ultrasound and color Doppler studies. Most prenatally diagnosed conjoined twins are terminated due to the high perinatal mortality, but advancement in pediatric surgery has allowed for successful postnatal separation in a small number of cases, and some parents may consider this option over termination of pregnancy. It is important to get a detailed prenatal ultrasound for the site and extent of fusion for an accurate categorization. Three-dimensional ultrasound (3DUS) provides images that can facilitate counselling for the parents. Additional information that impacts on diagnosis, prognostication, and perinatal management of conjoined twins could be obtained from selective use of 3DUS, particularly those with atypical fetal union. Most of the proposed additional benefits of 3DUS are based on case reports. Magnetic resonance imaging (MRI) has been increasingly used for the purpose of identifying intricate organ sharing. Because of the rarity of this condition, and the heterogeneity of fetal fusion, added benefits of either 3DUS or MRI for prenatal diagnosis and perinatal management of conjoined twins have not been demonstrated by well-conducted clinical trials. This article aims to review clinical application of various 3DUS display modes in prenatal assessment of conjoined twins, focusing on their potential additional benefits, risks and misuses. 3DUS may help detecting additional findings that are not possible with 2DUS, but, it has not been scientifically shown to improve the survival rate of the twins or reduce maternal morbidity.
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The Use of Intracranial Doppler as a Cause for Intraoperative Hyperthermia. J Neurosurg Anesthesiol 2017; 29:363-364. [DOI: 10.1097/ana.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ntusi NA, Samuels P, Moosa S, Mocumbi AO. Diagnosing cardiac disease during pregnancy: imaging modalities. Cardiovasc J Afr 2017; 27:95-103. [PMID: 27213857 PMCID: PMC4928175 DOI: 10.5830/cvja-2016-022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/04/2016] [Indexed: 01/20/2023] Open
Abstract
Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. The accepted maximum limit of ionising radiation exposure to the foetus during pregnancy is a cumulative dose of 5 rad. Concerns related to imaging modalities that involve ionising radiation include teratogenesis, mutagenesis and childhood malignancy. Importantly, no single imaging study approaches this cautionary dose of 5 rad (50 mSv or 50 mGy). Diagnostic imaging procedures that may be used in pregnancy include chest radiography, fluoroscopy, echocardiography, invasive angiography, cardiovascular computed tomography, computed tomographic pulmonary angiography, cardiovascular magnetic resonance (CMR) and nuclear techniques. Echocardiography and CMR appear to be completely safe in pregnancy and are not associated with any adverse foetal effects, provided there are no general contra-indications to MR imaging. Concerns related to safety of imaging tests must be balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of ionising radiation, the clinical manifestations of existent CVD in pregnancy and features of new CVD. The cardiologist/physician must understand the indications for and limitations of, and the potential harmful effects of each test during pregnancy. Current evidence suggests that a single cardiovascular radiological study during pregnancy is safe and should be undertaken at all times when clinically justified. In this article, the different imaging modalities are reviewed in terms of how they work, how safe they are and what their clinical utility in pregnancy is. Furthermore, the safety of contrast agents in pregnancy is also reviewed.
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Affiliation(s)
- Ntobeko A Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - Petronella Samuels
- Cape University Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Ana O Mocumbi
- Instituto Nacional de Saúde and Department of Medicine, University Eduardo Mondlane, Maputo, Mozambique
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Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja OH, Dong Y, Abramowicz JS, Vinayak S, Westerway SC, Nolsøe CP, Chou YH, Blaivas M. Point of Care Ultrasound: A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:49-58. [PMID: 27472989 DOI: 10.1016/j.ultrasmedbio.2016.06.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice. However, its use and teaching are different from continent to continent and from country to country. This World Federation for Ultrasound in Medicine and Biology position paper discusses the current status and future perspectives of PoC-US. Particular attention is given to the different uses of PoC-US and its clinical significance, including within emergency and critical care medicine, cardiology, anesthesiology, rheumatology, obstetrics, neonatology, gynecology, gastroenterology and many other applications. In the future, PoC-US will be more diverse than ever and be included in medical student training.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China.
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Liliana Chiorean
- Département d'imagerie médicale, Clinique des Cévennes 07100 Annonay, France
| | - Xin Wu Cui
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jacques S Abramowicz
- Section of Ultrasound, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Sudhir Vinayak
- Department of Imaging & Diagnostic Radiology, WFUMB COE, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Christian Pállson Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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Quarello E, Lacoste R, Mancini J, Melot–Dusseau S, Gorincour G. ShearWave elastography of fetal lungs in pregnant baboons. Diagn Interv Imaging 2016; 97:605-10. [DOI: 10.1016/j.diii.2015.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 10/21/2022]
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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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Harris GR, Church CC, Dalecki D, Ziskin MC, Bagley JE. Comparison of Thermal Safety Practice Guidelines for Diagnostic Ultrasound Exposures. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:345-357. [PMID: 26626492 DOI: 10.1016/j.ultrasmedbio.2015.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
This article examines the historical evolution of various practice guidelines designed to minimize the possibility of thermal injury during a diagnostic ultrasound examination, including those published by the American Institute of Ultrasound in Medicine, British Medical Ultrasound Society and Health Canada. The guidelines for prenatal/neonatal examinations are in general agreement, but significant differences were found for postnatal exposures. We propose sets of thermal index versus exposure time for these examination categories below which there is reasonable assurance that an examination can be conducted without risk of producing an adverse thermal effect under any scanning conditions. If it is necessary to exceed these guidelines, the occurrence of an adverse thermal event is still unlikely in most situations because of mitigating factors such as transducer movement and perfusion, but the general principle of "as low as reasonably achievable" should be followed. Some limitations of the biological effects studies underpinning the guidelines also are discussed briefly.
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Affiliation(s)
- Gerald R Harris
- Center for Devices and Radiological Health, U.S. Food and Drug Administration (Retired), Silver Spring, Maryland, USA.
| | - Charles C Church
- National Center for Physical Acoustics, University of Mississippi, University, Mississippi, USA
| | - Diane Dalecki
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Marvin C Ziskin
- Center for Biomedical Physics, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer E Bagley
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Tulsa, Oklahoma, USA
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Helmy S, Bader Y, Koch M, Tiringer D, Kollmann C. Measurement of Thermal Effects of Doppler Ultrasound: An In Vitro Study. PLoS One 2015; 10:e0135717. [PMID: 26302465 PMCID: PMC4547707 DOI: 10.1371/journal.pone.0135717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
Objective Ultrasound is considered a safe imaging modality and is routinely applied during early pregnancy. However, reservations are expressed concerning the application of Doppler ultrasound in early pregnancy due to energy emission of the ultrasound probe and its conversion to heat. The objective of this study was to evaluate the thermal effects of emitted Doppler ultrasound of different ultrasound machines and probes by means of temperature increase of in-vitro test-media. Methods We investigated the energy-output of 5 vaginal and abdominal probes of 3 ultrasound machines (GE Healthcare, Siemens, Aloka). Two in-vitro test objects were developed at the Center for Medical Physics and Biomedical Engineering, Medical University Vienna (water bath and hydrogel bath). Temperature increase during Doppler ultrasound emission was measured via thermal sensors, which were placed inside the test objects or on the probes’ surface. Each probe was emitting for 5 minutes into the absorbing test object with 3 different TI/MI settings in Spectral Doppler mode. Results During water bath test, temperature increase varied between 0.1 and 1.0°C, depending on probe, setting and focus, and was found highest for spectral Doppler mode alone. Maximum temperature increase was found during the surface heating test, where values up to 2.4°C could be measured within 5 minutes of emission. Conclusions Activation of Doppler ultrasound in the waterbath model causes a significant increase of temperature within one minute. Thermally induced effects on the embryo cannot be excluded when using Doppler ultrasound in early pregnancy.
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Affiliation(s)
- Samir Helmy
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
- * E-mail:
| | - Yvonne Bader
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Clinic of Saarland, Homburg, Germany
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
- Karl Landsteiner Society, Austria
| | - Denise Tiringer
- Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria
| | - Christian Kollmann
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
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Quarello E, Lacoste R, Mancini J, Melot-Dusseau S, Gorincour G. Feasibility and reproducibility of ShearWave(TM) elastography of fetal baboon organs. Prenat Diagn 2015; 35:1112-6. [PMID: 26194174 DOI: 10.1002/pd.4655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/14/2015] [Accepted: 07/11/2015] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Edwin Quarello
- Unité d'échographie de diagnostic prénatal, Hôpital Saint Joseph, Marseille, France.,Institut de Médecine de la Reproduction, Marseille, France.,LIIE (Laboratoire d'Imagerie Interventionnelle Expérimentale) - CERIMED - Faculté de Médecine, Campus Santé/Aix Marseille Université, Marseille, France
| | - Romain Lacoste
- Station CNRS UPS846 de primatologie, Rousset-en-Arc, France
| | - Julien Mancini
- Service Biostatistique et Technologies de l'Information et de la Communication (BiosTIC), Hôpital de la Timone, APHM, Marseille, France.,Aix-Marseille Université, Inserm, IRD, UMR912 SESSTIM, Marseille, France
| | | | - Guillaume Gorincour
- LIIE (Laboratoire d'Imagerie Interventionnelle Expérimentale) - CERIMED - Faculté de Médecine, Campus Santé/Aix Marseille Université, Marseille, France
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Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2015; 123:1070-1082. [PMID: 24785860 DOI: 10.1097/aog.0000000000000245] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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[Shear waves elastography of the placenta in pregnant baboon]. ACTA ACUST UNITED AC 2015; 43:200-4. [PMID: 25724446 DOI: 10.1016/j.gyobfe.2015.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/15/2015] [Indexed: 11/22/2022]
Abstract
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.
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Church CC, Labuda C, Nightingale K. A theoretical study of inertial cavitation from acoustic radiation force impulse imaging and implications for the mechanical index. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:472-85. [PMID: 25592457 PMCID: PMC4297318 DOI: 10.1016/j.ultrasmedbio.2014.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 05/10/2023]
Abstract
The mechanical index (MI) attempts to quantify the likelihood that exposure to diagnostic ultrasound will produce an adverse biological effect by a non-thermal mechanism. The current formulation of the MI implicitly assumes that the acoustic field is generated using the short pulse durations appropriate to B-mode imaging. However, acoustic radiation force impulse (ARFI) imaging employs high-intensity pulses up to several hundred acoustic periods long. The effect of increased pulse durations on the thresholds for inertial cavitation was studied computationally in water, urine, blood, cardiac and skeletal muscle, brain, kidney, liver and skin. The results indicate that, although the effect of pulse duration on cavitation thresholds in the three liquids can be considerable, reducing them by, for example, 6%-24% at 1 MHz, the effect on tissue is minor. More importantly, the frequency dependence of the MI appears to be unnecessarily conservative; that is, the magnitude of the exponent on frequency could be increased to 0.75. Comparison of these theoretical results with experimental measurements suggests that some tissues do not contain the pre-existing, optimally sized bubbles assumed for the MI. This means that in these tissues, the MI is not necessarily a strong predictor of the probability of an adverse biological effect.
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Affiliation(s)
- Charles C Church
- National Center for Physical Acoustics and Department of Physics and Astronomy, University of Mississippi, University, Mississippi, USA.
| | - Cecille Labuda
- National Center for Physical Acoustics and Department of Physics and Astronomy, University of Mississippi, University, Mississippi, USA
| | - Kathryn Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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Bioeffects Reference Tool May Not Improve Sonographers’ Monitoring of Mechanical and Thermal Indices in Obstetric Sonography Examinations. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314567308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This research examines whether using a reference tool alters the monitoring of the mechanical index (MI) and thermal index (TI) during obstetric (OB) sonograms. A presurvey regarding users’ behavior patterns of monitoring MI/TI indices was emailed to sonographers who were registered in a clinical database affiliated with an accredited sonography program. The presurvey included a reference tool which respondents were asked to print and use when performing OB sonograms. A postsurvey was sent to the same respondents to determine if behavior patterns regarding MI/TI monitoring improved after using the reference tool. There were no significant changes in how often sonographers monitored MI/TI from the pre- to the postsurvey.
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Forward H, Yazar S, Hewitt AW, Khan J, Mountain JA, Pesudovs K, McKnight CM, Tan AX, Pennell CE, Mackey DA, Newnham JP. Multiple prenatal ultrasound scans and ocular development: 20-year follow-up of a randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:166-170. [PMID: 24789332 DOI: 10.1002/uog.13399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 04/14/2014] [Accepted: 04/20/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Through comprehensive ophthalmic examination of adult offspring we sought to determine the impact of multiple prenatal ultrasound scans on ocular development. METHODS 2743 pregnant women recruited to the Western Australian Pregnancy (Raine) Cohort study during 1989-1991 were randomized to receive at King Edward Memorial Hospital, Western Australia either multiple prenatal ultrasound scans and Doppler flow studies (intensive group) or a single ultrasound scan at 18 weeks' gestation. Neonatal birth weight of the offspring and other physical measurements were collected prospectively. At age 20 years, participants underwent a comprehensive ophthalmic examination including measurement of ocular biometry and visual acuity. RESULTS Complete data were available for 1134 adult offspring participants. The mothers of 563 of these had been randomized to receive multiple prenatal ultrasound scans. The mean age of participants at follow-up was 20.0 years. There was no statistically significant difference between the two groups with regard to ocular biometric or visual outcomes, except for slightly higher intraocular pressure identified in individuals exposed to multiple ultrasound scans (P = 0.034). Although infants in the intensive-ultrasound arm were more likely to have birth weights in the lower quartiles, this was not reflected in adult eye development. Axial length, lens thickness, corneal curvature and thickness and optic cup to disc ratio (a risk factor for glaucomatous optic neuropathy) were not significantly influenced by the more frequent ultrasound protocol. CONCLUSIONS Prior to this study, there was a paucity of safety data for ultrasound with regard to eye development. We found that frequent in-utero exposure to ultrasound, including B-mode imaging and the use of spectral Doppler mode from 18 weeks' gestation, had no significant impact on visual outcomes or ocular biometry.
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Affiliation(s)
- H Forward
- Centre for Ophthalmology and Vision Science, University of Western Australia, Perth, Australia; Lions Eye Institute, Perth, Australia
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Bromley B, Spitz J, Fuchs K, Thornburg LL. Do clinical practitioners seeking credentialing for nuchal translucency measurement demonstrate compliance with biosafety recommendations? Experience of the Nuchal Translucency Quality Review Program. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1209-1214. [PMID: 24958407 DOI: 10.7863/ultra.33.7.1209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate compliance with the ALARA (as low as reasonably achievable) principle by practitioners seeking credentialing for nuchal translucency (NT) measurement between 11 and 14 weeks' gestation. METHODS Nuchal Translucency Quality Review Program credentialing requires quantitative scoring of 5 NT measurements from 5 different fetuses. Images submitted by 100 consecutive practitioners were retrospectively evaluated for the output display standard (ODS). The thermal index (TI) type (bone [TIb] or soft tissue [TIs]) and numeric value of the index were recorded. The TIb was considered the correct index for this study. Compliance with the numeric value was evaluated in several ways. Collectively, a TIb lower than 0.5 was considered optimal, lower than 0.7 compliant, and 1.0 or lower satisfactory. RESULTS An ODS was present in at least 1 image submitted by 77 practitioners. The TIb was used exclusively by 15 (19.5%), the TIs by 37 (48.1%), and 25 used a combination of the TIb and TIs. Only 4 of 77 providers (5%) used the correct TI type (TIb) at lower than 0.5 for all submitted images, 5 of 77 (6%) at lower than 0.7, and 9 of 77 (12%) at 1.0 or lower. A TI (TIb or TIs) higher than 1.0 was used by 15 of 77 providers (19.5%). Proficiency in NT measurement and educational background (physician or sonographer) did not influence compliance with ALARA. CONCLUSIONS Clinicians seeking credentialing in NT do not demonstrate compliance with the recommended use of the TIb in monitoring acoustic output.
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Affiliation(s)
- Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B.); Departments of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (B.B.); Nuchal Translucency Quality Review Program, Perinatal Quality Foundation, Oklahoma City, Oklahoma USA (J.S.); Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York USA (K.F.); and Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York USA (L.L.T.).
| | - Jean Spitz
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B.); Departments of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (B.B.); Nuchal Translucency Quality Review Program, Perinatal Quality Foundation, Oklahoma City, Oklahoma USA (J.S.); Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York USA (K.F.); and Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York USA (L.L.T.)
| | - Karin Fuchs
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B.); Departments of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (B.B.); Nuchal Translucency Quality Review Program, Perinatal Quality Foundation, Oklahoma City, Oklahoma USA (J.S.); Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York USA (K.F.); and Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York USA (L.L.T.)
| | - Loralei L Thornburg
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B.); Departments of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (B.B.); Nuchal Translucency Quality Review Program, Perinatal Quality Foundation, Oklahoma City, Oklahoma USA (J.S.); Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York USA (K.F.); and Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York USA (L.L.T.)
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210:387-97. [PMID: 24793721 DOI: 10.1016/j.ajog.2014.02.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and magnetic resonance imaging in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost-effectiveness and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Alfred Z Abuhamad
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - Deborah Levine
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - George R Saade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:745-757. [PMID: 24764329 DOI: 10.7863/ultra.33.5.745] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 4B03F, Bethesda, MD 20892-7510 USA.
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Cibull SL, Harris GR, Nell DM. Trends in diagnostic ultrasound acoustic output from data reported to the US Food and Drug Administration for device indications that include fetal applications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1921-1932. [PMID: 24154895 DOI: 10.7863/ultra.32.11.1921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES A survey was conducted of acoustic output data received by the US Food and Drug Administration for diagnostic ultrasound devices whose indications for use include fetal applications to assess trends in maximum available acoustic output over time. METHODS Data were collected from 124 regulatory submissions received between 1984 and 2010. Data collection excluded transducers not indicated for diagnostic fetal imaging. The output parameters of ultrasonic power, mean center frequency, and bone thermal index (TIB) were extracted or computed from the submissions for 3 periods: 1984-1989, 1992-1997, and 2005-2010. The data were stratified according to the following imaging modes: M-mode, B/M-mode, pulsed wave Doppler, color flow Doppler, and continuous wave Doppler. RESULTS Ultrasonic power and maximum TIB values have increased roughly an order of magnitude from pre-1991 to post-1991 periods; the center frequency has decreased somewhat (4.2 to 3.4 MHz). The percentage of Doppler-mode transducers has increased substantially over time, with the majority of the diagnostic fetal imaging transducers currently designed to operate in Doppler modes; this increase is particularly important, since Doppler modes generate much higher TIB levels than B/M-modes. Color flow Doppler ultrasound currently operates at the highest mean ultrasonic power level (with a 14-fold increase over time). CONCLUSIONS The observed trends in increased acoustic output for both Doppler and non-Doppler modes underscore the widely recognized importance of adherence to the ALARA (as low as reasonably achievable) principle and prudent use in fetal ultrasound imaging.
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Affiliation(s)
- Sarah L Cibull
- US Food and Drug Administration, 10903 New Hampshire Ave, Room WO62-2104, Silver Spring, MD 20993-0002 USA.
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Sienkiewicz Z. International Workshop on Non-Ionizing Radiation Protection in Medicine. Med Phys 2013; 40:117001. [DOI: 10.1118/1.4824921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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LIU HAITAO, HOU FENG, LIANG HAIYING, LIU GUOCHENG, LI YUNFEI. Effects of diagnostic ultrasound on HSP70 expression in chorionic villi in rats during early pregnancy and the role of HSP70 in apoptosis in chorionic villi. Int J Mol Med 2013; 32:1085-92. [DOI: 10.3892/ijmm.2013.1489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/06/2013] [Indexed: 11/06/2022] Open
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Miller DL, Zhou W. A system for investigation of biological effects of diagnostic ultrasound on development of zebrafish embryos. Zebrafish 2013; 10:459-65. [PMID: 23848997 DOI: 10.1089/zeb.2013.0883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Douglas L Miller
- 1 Department of Radiology, University of Michigan Health System , Ann Arbor, Michigan
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Wilson A, Tabrizi JS, Gholipour K, Farahbakhsh M. Technical Quality of Maternity Care: the Pregnant Women's Perspective. Health Promot Perspect 2013; 3:23-30. [PMID: 24688949 PMCID: PMC3963679 DOI: 10.5681/hpp.2013.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/18/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Improving adherence to care standards is one way to improve quality of delivered care. This study aimed to determine the degree of providers' adherence to maternity care standards from the perspective of pregnant women. METHODS This cross-sectional study was conducted on 185 pregnant women in their ninth month of pregnancy who received maternity care from health centres in Tabriz, Iran. Participants were selected randomly from 40 health centres. Data collection used a researcher-developed questionnaire based on Iranian Ministry of Health (MOH) standards for maternity care. Questionnaire validity was reviewed and confirmed by 10 experts. RESULTS About 69% of pregnant mothers during their 9-month pregnancy received at least six items of standard maternity care. Almost two-thirds of participants received recommended maternity care at or above minimal standards for some aspect, such as the number of care during pregnancy, referral to health centre physician, and weight and blood pressure measurement. Some other services such as measuring uterus height, review for oedema and varicosities, referral to a dentist, listening for fetal heart sound and vaginal examination, were reported at very low adherence to the Ministry of Health guidelines Conclusion: A notable proportion of pregnant mothers reported receiving suboptimal care indicating significant room for improving the quality of maternity care based on Iranian MOH standards and guidelines. The results indicate potential benefits from interventions to improve health care providers training and the awareness of pregnant women about the standards for good maternity care.
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Affiliation(s)
- Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Centre, Department of Health Service Management, Faculty of Management and Medical Informatics,
Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Department of Health Services Management, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Ziskin MC. Millimeter waves: acoustic and electromagnetic. Bioelectromagnetics 2012; 34:3-14. [PMID: 22926874 DOI: 10.1002/bem.21750] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/29/2012] [Indexed: 11/12/2022]
Abstract
This article is the presentation I gave at the D'Arsonval Award Ceremony on June 14, 2011 at the Bioelectromagnetics Society Annual Meeting in Halifax, Nova Scotia. It summarizes my research activities in acoustic and electromagnetic millimeter waves over the past 47 years. My earliest research involved acoustic millimeter waves, with a special interest in diagnostic ultrasound imaging and its safety. For the last 21 years my research expanded to include electromagnetic millimeter waves, with a special interest in the mechanisms underlying millimeter wave therapy. Millimeter wave therapy has been widely used in the former Soviet Union with great reported success for many diseases, but is virtually unknown to Western physicians. I and the very capable members of my laboratory were able to demonstrate that the local exposure of skin to low intensity millimeter waves caused the release of endogenous opioids, and the transport of these agents by blood flow to all parts of the body resulted in pain relief and other beneficial effects.
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Affiliation(s)
- Marvin C Ziskin
- Center for Biomedical Physics, Temple University Medical School, Philadelphia, Pennsylvania, USA.
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