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