Point-of-care Ultrasound Is Useful In Pneumonia

I had pneumonia over the holidays.  So did my son.  The doctor wanted a chest x-ray, and I said I will ultrasound my chest when I get back to the office.  I am now at the office, and I picked up a little fluid in my lateral posterior chest cavity consistent with the pain I experienced over the last few days.  We are both on antibiotics, and I will monitor the fluid collection with ultrasound rather than a chest x-ray.  Saves time, money and x-rays.  BTW, I feel much better now.  Here's an article about ultrasound and pneumonia.



Point-of-care ultrasound is more accurate than the traditional method of auscultation by stethoscope in diagnosing pneumonia in children and young adults, and can even detect small pneumonias that a chest x-ray may miss, a Mount Sinai researcher reports in an article titled, "Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults" in the online edition of Archives of Pediatrics & Adolescent Medicine published December 10, 2012.
These findings have important public health implications, especially in the developing world, as pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.
"The World Health Organization has estimated as many as three-quarters of the world's population, especially in the developing world, does not have access to any diagnostic imaging, such as chest x-ray, to detect pneumonia," said senior author James Tsung, MD, MPH, Associate Professor of Emergency Medicine and Pediatrics at Mount Sinai School of Medicine. "Many children treated with antibiotics may only have a viral infection-- not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope."

http://www.eurekalert.org/pub_releases/2012-12/tmsh-pui120712.php

Wives Are Great When Men Are Sick

Update.  My wife hauled the whole family to the clinic where she is a nurse.  She is getting the prescriptions filled while I try to drink water.  Our whole family was hit by a bug.  We are not sure if it is viral or bacteria.  I am not feeling like Tarzan, but I can tell you my right sided lung pain will be dealt with using ultrasound in the morning if I make it to my office.  We will all have lack of appetite, and have smelly urine for a few days due to antibiotics and an expectorant.  I will spend a few hours thanking God for my family.  The picture is from one of my collections.  Anyone guess where?   Be at Peace.  Gizz

Merry Christmas to Sonographers

Merry Christmas all.  I  am sorry for not posting for a bit.  My whole family was hit by a nasty virus over the last few days leading up to the birth of Christ.  I got a lung infection (bacterial pneumonia ) that had to send us about the house looking for a round of antibiotics.  I spat up blood and the wife said you are sick.  I am still having wild dreams and sleeping most day and night.  Thank yourselves for a great spouse whoever you are if you are married with family.  Trust friends if you are single.  And thank God for being here.  I will return.

Pulmonary Ultrasound: New Territory

I am excited about a new technique involving ultrasound and the lungs.  I did some research after meeting a student of mine who is a lung doctor here in Houston.  It seems we are now able to identify, evaluate and biopsy the lymph nodes near the Carina.  Techniques and procedures have been invented to stage patients with lung and mediastinal cancers using ultrasound techniques.  These procedures involve ultrasound bronchoscopy.  I am researching companies who provide the equipment for these procedures.  This article I am posting is the first for me, and truly cutting edge.

Here is an article I picked up on the google creature.

For many years the lung has been considered off-limits for ultrasound. However, it has been recently shown that lung ultrasound (LUS) may represent a useful tool for the evaluation of many pulmonary conditions in cardiovascular disease. The main application of LUS for the cardiologist is the assessment of B-lines. B-lines are reverberation artifacts, originating from water-thickened pulmonary interlobular septa. Multiple B-lines are present in pulmonary congestion, and may help in the detection, semiquantification and monitoring of extravascular lung water, in the differential diagnosis of dyspnea, and in the prognostic stratification of chronic heart failure and acute coronary syndromes. 

Thanks Cardiovascular Ultrasound

 http://www.cardiovascularultrasound.com/content/9/1/6

Point Of Care Ultrasound and Radiologists

Radiologists are experts at interpreting ultrasound and have been on the cutting edge of everything dealing with medical imaging for many years.  Point of care ultrasound is a relatively new variety of ultrasound and is seen as a first response form of diagnostic imaging.  Interest is growing among first responders such as paramedics in point of care ultrasound now that the equipment is portable.  The company I work for has been teaching point of care ultrasound now for going on three years.



“Radiologists are not involved in ultrasound education and promoting its use in point of care or elsewhere, but it would be nice to have more involvement,” Michael Blaivas, MD, an emergency medicine physician and past chair of the American College of Emergency Physicians ultrasound section, said during a presentation at RSNA 2012 this week. “It’s better to be seen as proponents of an application, guide it, and help with it, especially an application that is seen as critical at the bedside.”
Radiologists are the ultrasound imaging experts, Blaivas said, and should be the first to share their expertise. The specialties shouldn’t be fighting each other, he said, but working to make sure the modality thrives for all clinicians. If radiologists were more involved in teaching, they could ensure quality in its use.
“There really is a need for ultrasound education, and this is somewhere we can meet,” he said.

Thanks "Diagnostic Imaging"

http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2117117

Sudden Cardiac Death And Athletes

I came across an article in New Scientist about sudden cardiac death (SCD) and athletes.  The article addressed the cost of screening athletes for cardiac abnormalities which could cause them to have a fatal heart attack while playing sports.  We echocardiographers are familiar with at least one family of diseases which affect the heart in this manner.  Collectively known as hypertrophic cardiomyopathies, they are difficult to screen for with routine EKG.  It is definitively identified by an echocardiogram, or cardiac MRI.  I have personally been part of a team of health care professionals charged with screening entire junior high schools for this disease.  I believe a focused limited echocardiogram should be part of a pre-athletic physical for all students entering junior high.  I also believe that the cost of this limited echocardiogram can be manageable if civic group, schools and other organizations raise money to deffer the costs associated with this wonderful screening tool.  There have been attempts in the recent past to organize these screening events with limited success.  The benefits seem to outweigh the costs.

"When it comes to professional footballers, problems of the heart are often to do with their latest tryst. But lately, they have taken a much more serious nature.

Last week, 27-year-old Mitchell Cole died of heart disease, a year after he was forced to retire from professional soccer in the UK because of a known heart condition. This follows a report last week that another British footballer, Radwan Hamed, who was only 17 when he had a heart attack on the pitch, will be suing his former club, Tottenham Hotspur, over the brain damage that he suffered as a result."

Thanks New Scientist

http://www.newscientist.com/article/dn22568-screening-athletes-for-heart-problems-much-too-pricey.html

Spinach Is Safer Thanks To Ultrasound

Excellent!  Spinach is now safer than ever to eat thanks to ultrasound sterilization.  A few years back spinach got a bad rap because a batch got contaminated with some bacteria and made many people sick.  New ultrasound technology allows farmers to better eliminate bacteria and other pathogens by using ultrasound energy to destroy these bugs without harming the spinach.  I am a spinach lover, and glad for this because I especially love fresh spinach salads.  Here is my recipe for a fresh bag of cooked spinach:



1 bag of fresh spinach
balsamic vinegar
butter
black pepper
MAGGI liquid seasoning

Wash the bagged spinach (Even though it says it is already washed) then pat dry.  Melt 2 tablespoons of butter in a pot and dump the whole spinach in and cook over low-medium heat about 5 minutes and stir.  Add MAGGI to taste, then 2 tablespoons of balsamic vinegar. black pepper to taste.  Enjoy!

"By combining continuous ultrasound treatment with chlorine washing, we can reduce the total number of food-borne pathogenic bacteria by over 99.99 percent," said Hao Feng,professor of food science and human nutrition."

Here is the link.  Thanks Sonoworld 

http://phys.org/news/2012-11-safer-spinach-scientist-technique-coli.html

Safer spinach? Scientist's technique dramatically reduces E. coli numbers November 27, 2012 University of Illinois scientists have found a way to boost current industry capabilities when it comes to reducing the number of E. coli 0157:H7 cells that may live undetected on spinach leaves.

Read more at: http://phys.org/news/2012-11-safer-spinach-scientist-technique-coli.html#jCp

According to Feng, the USDA is looking for proposed technologies that can achieve a 4 to 6 log reduction in pathogen cells (a 6 log reduction would achieve a million-fold reduction in pathogenic bacteria). The food processing industry can now achieve a 1 log or tenfold reduction. In comparison, the U of I technique yields a 4 log reduction. "Combining technologies is the key to bridging the gap between our current capacity and what USDA would like to see. The use of ultrasound exposure during chlorine washing gives the industry a way to significantly enhance microbial safety," he said.

Read more at: http://phys.org/news/2012-11-safer-spinach-scientist-technique-coli.html#jCp

"By combining continuous ultrasound treatment with chlorine washing, we can reduce the total number of foodborne pathogenic bacteria by over 99.99 percent," said Hao Feng, a U of I professor of food science and human nutrition. According to Feng, the USDA is looking for proposed technologies that can achieve a 4 to 6 log reduction in pathogen cells (a 6 log reduction would achieve a million-fold reduction in pathogenic bacteria). The food processing industry can now achieve a 1 log or tenfold reduction. In comparison, the U of I technique yields a 4 log reduction. "Combining technologies is the key to bridging the gap between our current capacity and what USDA would like to see. The use of ultrasound exposure during chlorine washing gives the industry a way to significantly enhance microbial safety," he said.

Read more at: http://phys.org/news/2012-11-safer-spinach-scientist-technique-coli.html#jCp

4-D ultrasound? Took The Media Long Enough To Notice

Happy Thanksgiving all. I have been away for a few days because this is our traditional rush for CME time.  Being a teacher is certainly  fun.  I would like to thank all my students and support staff for a great year.  Here is a post I had to make because we sonographers see it all the time.  A baby yawning on 4-D. It's still cute.

LONDON (Reuters) - Growing into a fully formed human being is a long process, and scientists have found that unborn babies not only hiccup, swallow and stretch in the womb, they yawn too.

Researchers who studied 4D scans of 15 healthy fetuses also said they think yawning is a developmental process which could potentially give doctors a new way to check on a baby's health.
While some scientists have previously suggested that fetuses yawn, others disagree and say it is nothing more than a developing baby opening and stretching its mouth.

Thanks Yahoo Canada

http://ca.news.yahoo.com/4d-scans-show-fetuses-yawn-womb-230336359.html

 

Sonographer Awarded For Doing A Good Job

I just picked this up, and I am in a merry mood for it.  A sonographer has been hailed as a life saver for using the FAST scan for detecting free fluid in the abdomen due to trauma or other reasons.  The media needs to give more attention to ultrasound because we are truly a gift to health care in terms of triage.  I hope to visit New Zealand soon and perhaps meet some sonographers down under.  I teach the FAST and E-FAST at my place of employment.  E-Mail me if you want to learn ultrasound as I do not list my employer on this blog as a courtesy.

Rex de Ryke, charge sonographer, Radiology Service, Canterbury District Health Board, has won two prestigious awards from the Australasian Society of Ultrasound in medicine.
Mr de Ryke received an Honorary Fellowship award for his continuous contributions to the society in ultrasound education and for promoting excellence in diagnostic ultrasound.
He has also been given a special Humanitarian award for the use of ultrasound in a mass trauma event, being the February 22 earthquakes, and for teaching and sharing experiences gained during these events with the wider ultrasound community. 

Thanks Sonoworld

http://www.starcanterbury.co.nz/news/sonographer-awarded-excellence-and-quake-response/1614329/

Breast Ultrasound Better Than Mammo In Certain Patients

Breast ultrasound has proven to be more helpful in overtly symptomatic patients in screening for breast cancers.  This study reflects the mind set of European doctors who use breast ultrasound in lieu of mammography in a younger population because of the risks associated with radiation.


SEATTLE, Oct. 22 (UPI) -- For women ages 30-39 with symptoms of possible breast cancer, ultrasound is a superior diagnostic tool to mammography, U.S. researchers say.
Dr. Constance Lehman, director of radiology at Seattle Cancer Care Alliance and professor and vice chair of radiology at the University of Washington, said the use of ultrasound in women ages 30-39 who have overt breast symptoms -- palpable lumps, localized pain and tissue thickening -- is common practice in Europe, where guidelines typically recommend ultrasound as the primary diagnostic imaging tool.
The risk for malignancy among women in this age group is small, but real, at about 1.9 percent, Lehman said.

Read more: http://www.upi.com/Health_News/2012/10/22/Breast-cancer-Ultrasound-better-for-some/UPI-55691350940734/#ixzz2Aod0XtZw

Ultrasound Screening

There are companies who go to churches and offer "ultrasound screenings" for various diseases for bargain prices.  Many of them will target a church or  school and perform various tests such as ABI, and carotid screenings.  I have seen a few advertise in my area.  I would never get involved with this because the risk is great that something may be missed by the testers.  The point is they run people through these tests
very rapidly because these companies rely on high volumes to generate a profit.  Here is a great article I found on www.sonoworld.com 

You may have seen the advertisements in your local paper, or even on your local hospital's website. Ads that boast "Important screening tests that COULD SAVE YOUR LIFE. All for $129! NO DOCTOR'S ORDER NECESSARY!"
I love America and the free market. I love companies that make a buck with hard work and ingenuity. I love the idea that people are free to spend their money on whatever they want. I'm even open to the idea of DIY medicine. But I don't love when innocent people get fleeced in the name of bad medicine that pretends to be good.
Worse yet, when it happens at church. Commercial screening companies fiendishly target churches to find parishioners looking for healthy bargains. If your local church is endorsing a "health screening fair," it must be good, right? 

Thanks Sonoworld

http://www.theatlantic.com/health/archive/2012/10/on-the-sordid-sale-of-screening-tests/263703/

Halloween Ultrasound

OK, It is a nice time of the year in south Texas.  The weather is crisp and the leaves are turning.  We had the chance to attend an outdoor concert last night (REO Speedwagon).  An older band from the 70's.  Tonight my wife insists we see ZZ Top.  Same outdoor theater.  Great.  I am taking my vitamins.  She got some great seats off an internet budget re-seller.  We had a blast last night.  Tonight will be great since I have not seen the beard brothers since I was 17 years old.  Here is my Saturday post.  Click the link to continue.  Happy Halloween.  BTW the picture on the left is an unhappy testicle ultrasound image.  Can you see the grimace?  Be safe on Halloween.  Thanks to the SUN for the post.

A FATHER-to-be has told how the ghost of his dead mother appeared to him – in his unborn daughter’s ultrasound scan.

Shocked Marcelo de Souza said the old face mysteriously appeared in the left corner of the scan, which was taken just four months after his mother suddenly died.

Read more: http://www.thesun.co.uk/sol/homepage/news/4594166/dead-mum-appears-in-baby-scan.html#ixzz29qquKjaU

HIFU To Be Guided By MRI

In yet another study, Philips and the Medical Center of Utrecht are teaming up to test the effects of high intensity focused ultrasound (HIFU) on breast cancers.  MRI will guide the ultrasound beam to target non-metastasized breast cancers in the hopes the HIFU will destroy the tumor and leave healthy tissue intact.  In a previous article I mention a study dealing with Parkinson's and HIFU.  Perhaps we are on to something here?  Let's hope so.

ENP Newswire - 09 October 2012

Release date- 08102012 - Utrecht, The Netherlands - The University Medical Center Utrecht (Utrecht, The Netherlands) and Royal Philips Electronics (NYSE:PHG, AEX:PHIA) today announced that they have started a pilot clinical study to evaluate a new treatment for breast cancer based on a technology called MR-guided High Intensity Focused Ultrasound (MR-HIFU).

To facilitate this study, Philips has built a dedicated investigational system optimized for the anatomy of the female breast. The first patient in the study has already been treated using the system.

Thanks to Equities.com

http://www.equities.com/news/headline-story?dt=2012-10-09&val=569301&cat=hcare

HIFU To Be Used In Parkinson's Disease

High intensity focused ultrasound (HIFU) has been used to treat prostate tumors for a few years with promising results.  Now doctors the the University of Virgina Health System will begin studying the effects of HIFU on Parkinson's disease.  HIFU uses ultrasound technology to selectively heat tumors until the cancer cells die, and leave healthy tissues alone.  This technique has been used a few times in experiments on humans with great results using MRI to locate the precise area of the abnormality in the brain that causes Parkinson's disease.  More information can be found at the link,



 http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html

The phase 1 clinical trial has been approved by the U.S. Food and Drug Administration and is expected to enroll 30 subjects with medication-resistant Parkinson's disease. The subjects will undergo an investigational procedure using focused sound waves delivered within a magnetic resonance scanner to target a small area deep in the brain. Unlike traditional brain surgery, there is no need to cut into the skull. "We are very encouraged by our initial experience with MRI-guided focused ultrasound. There is a tremendous amount of enthusiasm from our patients and the public for treatments without incisions," Dr. Jeff Elias, the trial's principal investigator, said. "Parkinson's disease is the next logical step on our roadmap of investigation."

Read more at: http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html#jCp

The phase 1 clinical trial has been approved by the U.S. Food and Drug Administration and is expected to enroll 30 subjects with medication-resistant Parkinson's disease. The subjects will undergo an investigational procedure using focused sound waves delivered within a magnetic resonance scanner to target a small area deep in the brain. Unlike traditional brain surgery, there is no need to cut into the skull. "We are very encouraged by our initial experience with MRI-guided focused ultrasound. There is a tremendous amount of enthusiasm from our patients and the public for treatments without incisions," Dr. Jeff Elias, the trial's principal investigator, said. "Parkinson's disease is the next logical step on our roadmap of investigation."

Read more at: http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html#jCp

The new Parkinson's trial will test focused ultrasound's safety and efficacy in treating tremor related to Parkinson's disease, an incurable, neurodegenerative condition characterized by tremor and uncontrollable movements. Surgery can, in some cases, alleviate symptoms when medications have become ineffective. The current frontline surgical option is deep brain stimulation, which involves drilling holes in the skull and implanting a pacemaker system in the brain. U.Va.'s new Parkinson's trial is sponsored jointly by the Focused Ultrasound Foundation, the Heller Foundation, the Commonwealth of Virginia and InSightec, the maker of the ultrasound device. Trial participants must have Parkinson's disease with tremor that is resistant to standard medical therapy. More information: To learn more about focused ultrasound at U.Va., visit uvahealth.com/focusedultrasound. The site includes a link to a database where those interested in being considered for the Parkinson's trial should submit their information.

Read more at: http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html#jCp

(Medical Xpress)—After a promising clinical trial of focused ultrasound as a potential treatment for essential tremor, the University of Virginia Health System is launching a new study to investigate the scalpel-free technology's safety and effectiveness in reducing tremor related to Parkinson's disease.

Read more at: http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html#jCp

The phase 1 clinical trial has been approved by the U.S. Food and Drug Administration and is expected to enroll 30 subjects with medication-resistant Parkinson's disease. The subjects will undergo an investigational procedure using focused sound waves delivered within a magnetic resonance scanner to target a small area deep in the brain. Unlike traditional brain surgery, there is no need to cut into the skull. "We are very encouraged by our initial experience with MRI-guided focused ultrasound. There is a tremendous amount of enthusiasm from our patients and the public for treatments without incisions," Dr. Jeff Elias, the trial's principal investigator, said. "Parkinson's disease is the next logical step on our roadmap of investigation." Elias previously conducted the first focused ultrasound trial for treatment of essential tremor. All 15 trial participants were discharged the day after their procedures, and tremor improvement has been seen throughout follow-up.

Read more at: http://medicalxpress.com/news/2012-10-focused-ultrasound-parkinson-disease.html#jCp

Ultrasound Used to Diagnose Bone Problems In Children

Ultrasound has been known to be effective in finding bone fractures involving superficial structures like the nasal bone and ribs.  The field of musculo-skeletal ultrasound is exploding and benefits like treatment of sprains, and arthritis are obvious.  I ran across an article discussing the use of ultrasound in the diagnosis of pediatric fractures.  An X-ray is not always adequate when detecting these subtle injuries because the bone of children sometimes lack  calcium the X-ray needs to visualize the fracture.  Ultrasound can identify the subtle inflammatory reaction of

the bone to the abnormal displacement of bone or joint cartilage.  Pictured above is an image of a broken rib.  Notice the displacement of the two fragments.  This is an obvious example.

By Helen Albert, Senior medwireNews Reporter

Ultrasound is a safe and accurate alternative to X-ray for detecting metaphyseal forearm fractures in children, say researchers.
Although an individual X-ray involves exposure to a fairly low dose of radiation, there is still concern about how harmful such exposure may be in the long term. This is a particular concern in children due to the proliferative nature of their bone tissue.
Building on previous studies that have demonstrated a good accuracy of fracture diagnosis using ultrasound, Kolja Eckert (Elisabeth Hospital Essen, Germany) and colleagues compared ultrasound and radiographic imaging of 76 German children, aged from 1 to 14 years, with suspected forearm fracture.

Thanks News-Medical

http://www.news-medical.net/news/20120925/Ultrasound-effective-for-visualizing-fractures-in-children.aspx

Recognizing the importance of increasing public awareness of medical ultrasound and promoting its value in health care, UltrasoundSchoolsInfo.com is celebrating Medical Ultrasound Awareness Month in October by providing articles designed to raise medical ultrasound awareness.
With ultrasound’s increasing role in medicine, one of the main goals of the campaign is to provide the public with a better understanding of what ultrasound is, its many uses in health care, and to guide them toward locating and utilizing the best ultrasound practitioners and resources available.

http://www.ultrasoundschoolsinfo.com/medical-ultrasound-awareness-month/

Retrospective Part Four

Saturday morning.  5 AM.  Coffee and memories.  My supervisor L.C. came to me one morning and asked me if I wanted to look at a heart on an ultrasound machine.  I told him I was trying to find gall bladders on a B-Scanner.  We laughed like pirates because he knew what I was dealing with.

I said we can see the heart with ultrasound now?

He said he did not know, but a new machine was on the second floor.  I made my way up the east stair well where many cardiologists smoked ciggies to find a great friend of mine who is now married to a prominent cardiologist. I saw her amidst  a machine and packing boxes all about the floor.  She asked me "what are all these paper rolls?" 

I said  "let's read the instructions".

Turned out the machine was better than Keith Emerson's monster moog. Well not quite.  I still loved my Johnson and Johnson B scanner.

 The piezo electric crystal is directed into the chest cavity and the ultrasound makes an image which is stored to thermal paper.  I thought  WOW!  This is the late 70's ok?  Everything is cool.
this was before the LED, (light emitting diode).

Turns out the pink paper was thermal paper used to identify and semi-quantify heart motion on the new Irex ultrasound machine we had purchased.  I was in the game. We purchased a Cardiologist to come up and look at the new machine.  He was not impressed.  Soon, I read up on mitral valve motion, aortic valve leaflets and left atrial measurements, and the bugger of all echocardiographers; RV/LV measurements.  Yes.

Duh Duh DUUUUUUUH

RV/LV measurements which are still a hassle even with anatomical correction offered by a few ultrasound machine companies.

Back in those days it was easy to bribe a cardiologist or radiologist to read the M-Mode echos.  I learned quick that accurate measurements were essential to good cardiac management of the patient  with a heart problem.

Please note:  M-Mode echocardiography was an essential learning step for me.  I think I would have freaked out if I saw a living heart on a 2-D machine at that point in my life.  My students know this point very well.


Next:  2-D ultrasound  Please subscribe.  I make NO money on my blog.  Yet.

Thanks to Presurfer

My thanks to Gerard Vlemmings.  One day I will visit the Netherlands.  My wife and I thank all people who visit my Blog.  We all thank the wonderful Bloggers that share our thoughts and words.  We are all stunned that Gerard has included me on his Blog roll.  Thanks. My wife approved this post.

Medical Mistakes

Yesterday I was seeing patients at a medical clinic that treats people with lymphedema (swelling due to fluid accumulation usually in the legs).  I was performing lower extremity venous ultrasound to make sure patients are clot free before being treated with special pressure cuffs designed to reduce fluid in the extremities.  The reasoning being that an occult clot could be dis-lodged and potentially cause a pulmonary embolism which could be fatal.  As I was examining an elderly gentleman, I came across a clot in his left popliteal vein.  This is remarkable because the patient stated as I was beginning the examination that he had  the same ultrasound test run a few days ago at a prestigious hospital here in Houston, and that he was puzzled that I was doing the same test on him again.  I explained that it was standard procedure at this clinic to screen all new patients for DVT prior to treatment.  I made my preliminary report to the physician and left the facility.  When I got back to my office my boss told me the physician would like a courtesy call from the interpreting radiologist to confirm my preliminary findings.  The physician in charge of the lymphedema clinic had explained that he wanted to be sure of the finding before confronting the patient with the news that the prestigious hospital had "missed" the blood clot.

I was cruising the internet this morning when I came upon an article from the Wall Street Journal that addressed this very issue.  With health care on the precipice of vast change, it caused me to worry that we health care professionals are going to be very busy in the coming years with the retirement of the baby-boomers.  Not like we are not already busy enough.  It is most important that we stop a moment and examine the reason we are health care providers.  The following is a snip-it from the article by Dr. Marty Makary:

By MARTY MAKARY

When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.
The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.

Here is the link:    http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html?mod=googlenews_wsj

Contrast Enhanced Prostate Cancer Detection

Ultrasound contrast is in the headlines again.  This time it has been used to determine which prostate masses are most likely to be aggressive cancers. This research recently carried out at Thomas Jefferson is significant in that it may lower the number of diagnostic needle biopsies of prostate masses by weeding out low suspicion masses.  Currently, 12 or more individual biopsies are carried out per procedure when doctors suspect prostate cancer.  This may lower the total number of biopsies per patient per procedure as the highly vascular contrast enhanced suspicious lesions can be seen much better with the intravenous micro-bubbles.






"Today, a physician may sample 12 to 18 tissue cores from the prostate in order to help diagnose a patient. But with contrast-enhanced, that number drops to six or even less," says lead author Ethan Halpern, M.D. (insert link into full name: http://www.jeffersonhospital.org/Healthcare%20Professionals/Ethan-J-Halpern.aspx), co-director of the Prostate Diagnostic Center Thomas Jefferson University Hospital and professor of Radiology and Urology at Thomas Jefferson University. "So it's less invasive, and a more effective guidance tool. We've found that with contrast-enhanced ultrasound, we are much more likely to detect cancers on the image, and in this case, the higher grades."


Thanks Science Newsline

http://www.sciencenewsline.com/articles/2012092719120046.html

 

TAVR Performed At UCLA First In The USA

One of the many diseases we echocardiographers find when we examine a patients heart is aortic stenosis. Aortic stenosis results when the aortic valve leaflets are unable to open properly allowing blood to flow from the heart to the body with vital oxygen. Aortic stenosis (AS) is fairly common and can seriously affect a persons life by limiting physical activities.   Symptoms such as shortness of breath, syncope, and peripheral edema are common.  Until recently, open heart surgery to replace the damaged aortic valve had to be performed to alleviate the most serious form of this cardiac valve disease.  Now, doctors at UCLA have performed a successful minimally-invasive aortic valve replacement on a human. Enjoy the link!




http://medicalxpress.com/news/2012-08-ucla-device-aortic-valve-patients.html

(Medical Xpress) -- UCLA has performed its first transcatheter aortic valve replacement (TAVR), using a new device approved by the U.S. Food and Drug Administration to replace an aortic valve in a patient who was not a candidate for open-heart surgery. The procedure took place on Aug. 9.

Read more at: http://medicalxpress.com/news/2012-08-ucla-device-aortic-valve-patients.html#jCp

Ronald Reagan UCLA Medical Center is part of a growing trend of hospitals nationwide offering this new minimally invasive procedure. As the U.S. population ages, an increasing number of patients will develop aortic stenosis, a narrowing of the heart's aortic valve caused by calcium deposits, which impedes blood flow, causing the heart to work harder to pump blood to the body and placing patients at higher risk of heart failure or death.

Read more at: http://medicalxpress.com/news/2012-08-ucla-device-aortic-valve-patients.html#jCp

Ronald Reagan UCLA Medical Center is part of a growing trend of hospitals nationwide offering this new minimally invasive procedure. As the U.S. population ages, an increasing number of patients will develop aortic stenosis, a narrowing of the heart's aortic valve caused by calcium deposits, which impedes blood flow, causing the heart to work harder to pump blood to the body and placing patients at higher risk of heart failure or death.

Read more at: http://medicalxpress.com/news/2012-08-ucla-device-aortic-valve-patients.html#jCp

Ronald Reagan UCLA Medical Center is part of a growing trend of hospitals nationwide offering this new minimally invasive procedure. As the U.S. population ages, an increasing number of patients will develop aortic stenosis, a narrowing of the heart's aortic valve caused by calcium deposits, which impedes blood flow, causing the heart to work harder to pump blood to the body and placing patients at higher risk of heart failure or death.

Read more at: http://medicalxpress.com/news/2012-08-ucla-device-aortic-valve-patients.html#jCp

Retrospective Part Three

Note:  Many writers compose thoughts when they are not thinking.  I am one.  I am part of the cadre of writers who write when they do not really intend to write.  Thus I begin the third installment of Retrospective.  Please refer to this link to catch up on the story:

Ultrasound and Evolution: a Personal retrospective ( Part 2)

I Remember flying home on Brannif airlines after skiing in A-Bason with a nice lady who was a great skier that did not seduce me, or give me bath salts.  Bath salts were not known in the 70's.  A zombie was only in a movie.  My goal was to meet with the hospital administrator to explain my issues.  I had trepidations.  I was not trained to be a sonographer.  I failed.....

We met and I explained that I had no idea how to perform a sonogram.  "You did attend three days of instruction?"  He said.  "Of course"!  I replied.  I did not skip out.  He called the chief of Staff.

COS asked if I had any hands-on.

No.

Why not?

No machines.... (Nervous)  this CME event provided no hands-on.

Shuffling of feet...

"You will make yourself known to the Pathologist." (Drum roll)

Notes that here my stomach dropped to my Valves of Houston (look that one up medical students). Hodor

"A Pathologist deals with dead things." I said.

I met with the pathologist and we agreed to a structured regiment of anatomical training.  I was dealt a hand which included autopsies and sonograms.  Specifically, I would take a corpse out of the fridge, and work it on to a gurney, then dress it with white muslin for decorum.  I would then wheedle it up the elevator to my lab much to the guffaws of my fellows (they called me Doctor Frankenstein) whence I would perform a sonogram on the corpse and make notes and Polaroids of my findings. I used a "Sharpy" magic marker to point to interesting areas.  My notes in hand, I would wheel that corpse back down to the morgue and call the pathologist on the phone (Real phone) and announce I had performed the sonogram much to the delight of administration.  This was before HIPPA of course.

The pathologist always arrived with a touch of bourbon in her breath, but she was a relentless task master.  "What did you see?"

"A mass on the superior pole of the right kidney"

"Then poke it!" she said while she was running the bowel under the vent-a-hood.

"Use the scalpel.  that thing with the green plastic handle"!

OK.... (poke)...poke poke

"What is the contents of the mass?"

Yellow fluid.  Yeccch.   

Grats.... a renal cyst...

Moments later after we had taken the liver to the dissection table.....

The first time she showed me the common bile duct I was floored.  The CBD is connected to the gall bladder, a source of many ED visits.

Gall bladder disease is rampant in the USA and many modern countries. Gall bladder surgeries are a staple of a general surgeons pay-check.  I will post a separate article on gall bladder disease.

The CBD is only 3 mm wide in normal patients.  Pancreatic duct?  LOL.  I could not see Wirsungs duct when she showed it to me.  I have an admiration for pathologists.  They see things many people are not aware of.  We went on to examine the pancreas (Looks like a pork tenderloin to me), the liver, the spleen, and some fun stuff with ruptured aortic aneurysms.  Wonderful stuff for people in search of anatomical knowledge.  A look into the abdominal cavity of a human is a wonderful look at what God creates.  So pretty, compact, and elegant. 

Weeks went by.  My pathologist friend revealed to me many secrets to include the anatomical relationships of the organs of the abdomen, chest and cranium.  I will never forget finding my first gallstones.They looked like smurfs.  She laughed and said "These are very common".  Little did I know how correct she was.  She said "Fast food is a scourge, and is making people very sick."  This was back in the 70's.  How true her predictions were.

Next installment: the Heart.

Gizz note:  this blog is a labor of love, and is always a work in progress

3-D Fetus Sculpture

Just when you thought medical imaging had run out of novelty ideas, here we have yet another way to put a dent in your credit card courtesy of the Japanese: The 3-D Trophy Fetus!  In Japan, you can purchase a miniature resin replica of your intrauterine fetus rendered by a 3-D printer for only 1,250 dollars.  Currently, the technique involves a 3-D MRI of the gravid uterus rendered into the sculpture.  Can a 3-D ultrasound be far behind?

So, you’ve been trying for quite a while, and the delightful news arrives that soon you will have a small, squishy hybrid of you and your partner for your very own.

In glee, you go for a scan, clutch the ultrasound image to your heart –and probably immediately upload it to Facebook.

But what if you could have a 3D model of your growing bundle of joy?

In Japan, this dream is now a reality due to three dimensional printing technology. Japanese firm Fasotec, in collaboration with Parkside Hiroo Ladies Clinic in Mintao-ku, Tokyo, have come up with a product to fill this niche for, er, consumer demand — and have called it “Shape of the Angel”.

Thanks Sonoworld and SmartPlanet

http://www.smartplanet.com/blog/smart-takes/printing-takes-a-creepy-turn-a-3d-replica-of-your-fetus/28092

An interesting article appeared in Forbes the other day regarding my profession.  Sonographers are pretty busy, and pretty well paid.  I have known this fact for over thirty years.  Considering the amount of work, and responsibilities Sonographers are subjected to it is not surprising to know that most Sonographers I know are happy.  Tired but happy!


A recent report by the McKinsey Global Institute found that while low-skill jobs are on the decline, by 2020 employers around the globe will need an estimated 45 million more mid-level workers who have a high school education and vocational training. Meanwhile, a highly cited study by the Harvard Graduate School of Education last year concluded that in the U.S. “we place far too much emphasis on a single pathway to success: attending and graduating from a four-year college.” According to the report, 30% of the 47 million new jobs expected to be created in the U.S. by 2018 will only require an associate’s degree or a certificate.


Here is the link.  Thanks Forbes

http://www.forbes.com/sites/jennagoudreau/2012/06/21/the-best-jobs-that-dont-require-a-bachelors-degree/

 

HIFU Shows Promise

New research out last week confirms my suspicions that targeted High Intensity Focused Ultrasound (HIFU) may be an exciting new alternative to treatment of tumors that are hard to get to, or surgically unpleasant to treat.  In the case of prostate cancer, I would certainly want an alternative to the radical prostatectomy procedure in common use because of the side effects of surgery which includes, pain, incontinence, and other nasty issues.  New research suggests this non-invasive procedure is safe and effective.  Of course further research is needed, but I am excited about the possibilities in other difficult to treat lesions such as certain brain tumors, pancreatic lesions and esophageal masses.

“Soundwaves could help 95% of prostate cancer patients … without affecting sex life,” the Daily Mirror reported today. Its story comes from a small study that looked at an experimental treatment using high-intensity focused ultrasound (HIFU) to target areas of prostate cancer in men where the disease had not spread.
Standard treatments for prostate cancer often lead to undesirable side effects, in particular erectile dysfunction and urinary incontinence. Researchers found that a year after this experimental treatment, 89% of men still had erectile function and all were still continent. Ninety-five per cent of the men showed no evidence of disease on an MRI scan.

 Thanks Sonoworld for cross linking with NHS.UK  Enjoy!

http://www.nhs.uk/news/2012/04april/Pages/hifu-ultrasound-for-prostate-cancer.aspx

Starvation Linked To Cardiac Complications?

I love to post timely and factually correct information to this forum.  I am not sure the following article is correct.  I will merit the authors for doing research, but in my opinion, starvation in the animal experiments I have seen prolongs life to a certain extant. Who am I to judge?  Your opinions are welcome.  Happy Easter.

Starvation linked to greater risk of cardiac complications

London -- Russians born during the Leningrad Siege in World War II, which was responsible for some of the greatest losses of civilian life in history, are giving scientists new strategies to identify people who experienced intrauterine growth restriction (IUGR) and starvation during childhood at greatest risk of developing long term heart complications. The abstract study¹, presented at the Frontiers in CardioVascular Biology (FCVB) meeting, in London, UK, 30 March to 1 April 2012, makes use of a unique population of people exposed to extreme starvation both as foetuses and during childhood. 

 http://www.eurekalert.org/pub_releases/2012-03/esoc-slt032312.php

Polymer Releases Drugs Using Ultrasound

An interesting application of ultrasound has been discovered.  Certain polymers can change shape when ultrasound is present and the morphological change can release substances bound within these polymers.  This may be useful in delivery of drugs to certain targeted diseases.

28 March 2012

Scientists from China and Canada have found that a drug-loaded shape memory polymer can be manipulated by ultrasound and that they can control when and how the drugs are released.

Shape memory polymers (SMPs) can be deformed and fixed into a temporary shape and then recover their original permanent shape under external stimuli such as heat, explains lead researcher Hesheng Xia from Sichuan University, Chengdu. 'When a piece of polymer is placed in the body, it is subjected to heating at 37°C everywhere and the whole piece undergoes shape recovery,' he says. Xia and co-workers directed an ultrasound beam on a selected area of a polymer, causing a local rise in temperature and triggering shape recovery only in that area. Xia adds that ultrasound has the advantage of easily penetrating body tissue.

 http://www.rsc.org/chemistryworld/News/2012/March/ultrasound-triggered-drug-release-polymer.asp

A Great Freind Posted A Comment.

I have great relations with many people.  I like to post things that have made my heart skip a beat.

Thank You Jamie.  You are my Editor Now.

Be at peace all..

ja----_38+ is now offline.
Messages will be delivered when they sign on to Pal talk._38+: <<(03/03/12 6:55 PM EST)>> your blog is outstanding please have a safe trip
Gallgizzard: Jamie, I am in place at the hotel.  My 8 hour road trip gave me pause to  think about my younger years.  When i would get in a car, and gas it up and drive without a worry.  I looked everywhere on this trip for speed traps, and places to pull over if I had to pee.  There are no safe places left.  I was thankful God gave me a wide open drive this morning.  One nasty cop who had his Fish on the hook, and the usual people.  I thought it was great to be a Sunday Driver.  Thank You Dear for being a literary friend.  I will CC this to my Wife also.  I will post it to the Blog.

Note:  I have a new lap top.  I am still trying to figure out windows 7.  I am on assignment, and I ate some great tasty BBQ, but I am sick now.  I have been ill for hours..  Such is life..  I am glad to call Jamie a buddy.  I have a few buddies on the Internet.  I will take a few hours off to sleep.  Gizz

MSK Ultrasound No Longer New Kid On The Block

Statistics are a way of quantifying things and are ubiquitous in our world.  Seldom have I seen numbers like these concerning the rise in popularity of a form of medical ultrasound namely MSK.  When you think about the utility of ultrasound in the diagnosis and treatment of bone and muscle ailments, it makes perfect sense.  Please note these numbers are only from Medicare.  Thanks Auntminnie



http://www.auntminnie.com/index.aspx?sec=sup&sub=ult&pag=dis&itemId=98150



Medicare MSK ultrasound use by provider type

	2000	2009	Change
Radiologists	40,877	91,022	123%
Podiatrists	3,920	76,332	1,874%
Rheumatologists	176	22,581	12,730%
Primary care physicians	4,675	13,271	184%
All other providers	7,606	30,758	304%

Do ultrasound measurements correlate with CT and MRI?

I found an interesting article the other day which talked about correlating ultrasound measurements of kidney tumors with CT and MRI measurements.  When I thought about it, it made sense to do this study.  If ultrasound measurements correlate well with these other modalities, why not use ultrasound to monitor the effects of chemotherapy on kidney tumors and other masses.  Ultrasound costs much less, and does not use ionizing radiation.  Why not use ultrasound on all sonographically visible tumors to monitor the effects of therapy?

Objective

To evaluate whether ultrasonography was inferior in detecting the size of a renal mass preoperatively because of the increased attention on the harmful effects of ionizing radiation in medical imaging.

http://www.goldjournal.net/article/S0090-4295%2811%2902465-4/abstract