Always Scan Where It Hurts

To Sonographers.  Always scan the area that the patient says they have pain.  When we do DVT studies we look at the major vessels of the lower extremities, and many of us stop at the knee.  I have found many hematomas, and ruptured ligaments below the knee when I have been asked to to do a routine venous ultrasound.  Do not forget Baker's cysts behind the knee.  And do not forget to scan below the knee for other pathologies.  Blessings.  TW

Sonography The New Gold Standard For Hernias?

I have been seeing patients with vague abdominal pain for many years.  The ultrasound machine is a versatile engine that we are just tapping into regarding its diagnostic and therapeutic capabilities.  Many times I have been asked to see patients with vague abdominal pain.  I always ask them where it hurts.  Message to sonographers.  Always scan where it hurts.  Here is a great article that bolsters my message.  Look for the finer things with a high frequency probe.  Be aware of the stuff that is close to the probe.  Always use the Valsalva maneuver to provoke a hernia.  Document it.

Ultrasound as Gold Standard for Hernia Diagnosis?

Group finds It Better Than CT; But Will It Be Widely Adopted?

By Christina Frangou
Surgeons from Vanderbilt University are recommending that dynamic abdominal sonography for hernia (DASH) replace computed tomography (CT) as the gold standard for the radiographic identification and characterization of incisional hernia.
“The DASH examination is an accurate alternative to the CT scan for diagnosing abdominal wall hernias, with additional benefits of no radiation exposure and instant bedside interpretation,” concluded Benjamin K. Poulose, MD, MPH, assistant professor of general surgery, Vanderbilt University Medical Center, Nashville, Tenn., and his colleagues in a report published in the March edition of the Journal of the American College of Surgeons (216:447-453).


Thanks Sono World and general surgery news.

Peace.

Bugs Hear Better Than Bats

Here is a great one!  Moths can hear better than the NSA!  That current news about the wiretapping by the US government is disconcerting enough, but it might not just be the ghost of J. Edgar Hoover you need to worry about.  Moths clock in at having the most sensitive hearing for any creature (That I know of) on earth.  I am one for trivia, so this will work well in my lectures.  Use this article for your next current events/science argument with your drinking buddies.

Many moths have evolved sensitive hearing that can pick up the ultrasonic probes of bats that want to eat them. But one species comes pre-adapted for anything that bats might bring to this evolutionary arms race. Even though its ears are extremely simple — a pair of eardrums on its flanks that each vibrate four receptor cells — it can sense frequencies up to 300 kilohertz, well beyond the range of any other animal and higher than any bat can squeak.

“A lot of previous work has suggested that some bats have evolved calls that are out of the hearing range of the moths they are hunting. But this moth can hear the calls of any bat,” says James Windmill, an acoustical engineer at the University of Strathclyde, UK, who discovered the ability in the greater wax moth (Galleria mellonella). Hisstudy is published in Biology Letters.

Thanks SA and Sonoworld

http://www.scientificamerican.com/article.cfm?id=moth-smashes-ultrasound-hearing-record

New Ultrasound Procedure For Treating Pain

This is an interesting article I ran across.  It seems focused ultrasound may alleviate pain associated with bone tumors by burning out the nerve endings where the tumor is invading.  It seems this is another use for HIFU (high intensity focused ultrasound).  Perhaps this technology can be used in pancreatic pathologies where pain is omnipotent?  Let's wait and see.

CHICAGO, IL (May 29, 2013)—A high-dose of ultrasound targeted to painful bone metastases appears to quickly bring patients http://www.sciencecodex.com/new_technique_alleviates_painful_bone_metastases-113165relief, and with largely tolerable side effects, according to new research presented by Fox Chase Cancer Center scientists at the 49th Annual Meeting of the American Society of Clinical Oncology on Monday, June 3.

During the procedure, known as MR-guided focused ultrasound, doctors direct a concentrated beam of energy to specific nerve endings that are causing pain in bone metastases. These patients typically have a significant amount of discomfort—half of study participants rated their pain at least a 7 out of 10—but within a handful of days, most said they felt significant relief.

Thanks Sonoworld and ScienceCodex

http://www.sciencecodex.com/new_technique_alleviates_painful_bone_metastases-113165

Ultrasound Education (Editorial)

The state of ultrasound education is pitiful.  I am an educator, and I have a right to whine because offices and hospitals are buying ultrasound machines, but not sending the health care professionals who operate the equipment to school to learn how to operate the machines.  We teachers need to make a living also!  Enough of that stuff.  I can pay the mortgage by seeing patients but my point is made.  Buy an ultrasound machine then pretend you know what you are looking at through all the gel?  Ultrasound manufacturers are recording great sales.  Many doctors offices are buying them and telling an employee to "see what you can see with the machine", and billing for it.  No wonder health care insurance premiums are going up like a volcano!  It does not help that this current administration is promoting WELFARE healthcare.  I am a registered sonographer, and I am worried that if we are cutting corners here, where else are we cutting corners in quality health care?  One day I will be old and in the hands of a health care professional.  I intend to ask that person of he or she is licensed or registered in that aspect of health care.

Anyone in the USA can purchase a gun in the USA unless they are a felon.  When you buy a gun do you automatically know how to use it responsibly?  NO.  You must take a gun safety course to learn to use it for hunting or self defense.  The same is true for an ultrasound machine.  You get a day of apps from the manufacturer, then you are on your own.  Apps specialists do not train you how to do a sonogram, they show you how to operate the equipment.  To learn how to use an ultrasound machine requires rigorous education and training accompanied by many patient encounters.  Too many physicians and imaging facilities think the ultrasound machine is like an EKG machine: put the electrodes on the chest and let the machine do the work.  I want you all to embrace ultrasound as a valid and useful tool in diagnostic medicine, but get some training on how to use the equipment!  Just my thoughts.  Have a great holiday weekend.

Ultrasound Breaks Bubbles Releasing Clot Busting Medication

In another novel study, ultrasound has been proven to release clot busting agents in blood clots potentially reducing or eliminating the effects of the clots on the brain, or other organs.  This is great news for people who suffer from strokes caused by blood clots to the brain.  We have known for years that medications can be encapsulated in lipids and released when irradiated by ultrasound.  This article takes it a step further.

CINCINNATI—A new study from the University of Cincinnati (UC) College of Medicine has found that, when delivered via ultrasound, the natural enzyme plasmin is more effective at dissolving stroke-causing clots than the standard of care, recombinant tissue plasminogen activator (rt-PA).

The novel delivery method involved trapping plasmin into bubble-like liposomes, delivering them to the clot intravenously and bursting it via ultrasound. That method is necessary, says UC associate professor of emergency medicine George "Chip” Shaw III, MD, PhD, because plasmin cannot be delivered through traditional methods. Intravenous delivery of rt-PA is designed to solve that problem by catalyzing the conversion of existing plasminogen inside the body to plasmin, which in turn degrades blood clots.

"Plasmin is the enzyme that actually chews up the fibrin in clots,” says Shaw. "The problem is you can only give plasmin inter-arterially, which has safety risks and takes longer to deliver. IV therapy is always easier and quicker, but if you give plasmin intravenously, the body inhibits it immediately. If you can encapsulate it, it doesn’t get inhibited and you can target it to the clot.”

Thanks UC and Sonoworld

http://healthnews.uc.edu/news/?/22587http://healthnews.uc.edu/news/?/22587

Fast Scan Gets a Boost With New Software

Nice stuff coming from the computer generation.  Now they have a graphics program to guide the health care provider on how to perform a FAST exam.  I think it is great for the bloody savage generations the liberal media think we should all worry about. The software and hardware machine guides the health care provider to do an assessment of a person abdomen in the case of trauma looking for free fluid using a graphical guide as to where the probe should be pointed.  I would agree this is great, but in the hands of a person who is not trained in ultrasound it could cost money and lives. Take for instance the person with chronic ascites. Ascites is a build up of abdominal fluid which is linked to any kind of liver disease.  I still think people need education when they use any kind of ultrasound machine.  You make the call my friends.  Here is the link.  Nasty font  but here it is:

Under this project an advanced software system will be developed to improve detection of life-threatening internal bleeding after blunt abdominal trauma.

Clifton Park, NY (PRWEB) May 09, 2013

Kitware, a leading-edge medical imaging software provider, today announces new Phase I SBIR funding from the National Institutes of Health for the development of hardware and image analysis algorithms that will allow novice ultrasound operators to perform life-saving Focused Assessment with Sonography for Trauma (FAST) procedures.

FAST procedures are rapid ultrasound examinations for identifying abdominal hemorrhaging, which is often associated with blunt abdominal trauma (BAT). Detection of this free fluid is done via ultrasound images of four specific abdominal areas. Patients with positive FAST results are in urgent need of treatment, whereas negative results indicate more stable patients.

Read more: http://www.virtual-strategy.com/2013/05/09/kitware-improve-focused-assessment-sonography-trauma-fast-procedures#ixzz2TDh6N1vT
Read more at http://www.virtual-strategy.com/2013/05/09/kitware-improve-focused-assessment-sonography-trauma-fast-procedures#Ku02LvF8914SJbf1.99