Ultrasound training for medical students and internal medicine residents—A needs assessmentKessler, Chad; Bhandarkar, Stephen
doi: 10.1002/jcu.20719pmid: 20572065
Purpose While sonography has been a mainstay of certain medical specialties, such as obstetrics and gynecology, internal medicine has been slower to integrate this technology into practice. No standardized training in sonography exists for either medical students or internal medicine residents, and little is known about the current competency and utilization of ultrasound among these groups. The goal of this article is to examine the present state of ultrasound education among internal medicine residents and medical students at a major university hospital. Methods Third‐year medical students from the University of Illinois at Chicago and senior medicine residents from University of Illinois at Chicago and Northwestern University were invited to complete a Likert‐type survey regarding their attitudes, competence, and interest in ultrasound, the nature of previous training, and areas where incorporation of ultrasound would be useful. Results One hundred sixty‐three students and 40 residents participated (81.8% response rate). Students and residents generally felt incompetent in the use of ultrasound; objective competency in the resident group, as evaluated by an emergency physician certified by the American College of Emergency Physicians, was equally low. However, interest in additional training was high. Nearly 50% of the respondents had no prior sonography training; however, those with previous training rated it highly. Areas in which sonography was most sought‐after include central line placement, paracentesis, and thoracentesis. Conclusions There is a clear desire for training in sonography among the medical students and internal medicine residents surveyed. As ultrasound is further integrated into clinical practice, students and residents would strongly benefit from formal didactic and hands‐on training in the modality. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:401–408, 2010
Novel parameter for the diagnosis of distal middle cerebral artery stenosis with transcranial Doppler sonographyAhn, Suk‐Won; Park, Sang‐Soon; Lee, Yong‐Seok
doi: 10.1002/jcu.20711pmid: 20533446
Purpose Transcranial Doppler sonography (TCD) is commonly used for the diagnosis of middle cerebral artery (MCA) stenosis. However, TCD indices to predict distal MCA (M2) stenosis have not yet been established. We compared TCD and magnetic resonance angiography (MRA) to validate a new index for the diagnosis of M2 stenosis. Methods Consecutive patients who underwent TCD and MRA were included. Based on MRA, M2 stenosis was defined as >50% narrowing beyond the bifurcation area. TCD index of the M2/M1 ratio was defined as the ratio between the mean flow velocity (MFV) obtained at a depth of 30–44 mm (M2) and a depth of 45–65 mm (M1). Sensitivity and specificity of the M2/M1 ratio were calculated from the receiver operating characteristic curve. The diagnostic yield of elevated MFV (>80 cm/s) and asymmetry index of >30% for M2 stenosis were also investigated. Results Among the consecutive patients, 105 with M2 stenosis were compared with 123 without MCA stenosis. The M2/M1 ratio was significantly higher in the M2 stenosis group (1.10 versus 0.86, p < 0.001). Sensitivity and specificity for M2 stenosis were most satisfying when the M2/M1 ratio of 0.97 was adopted as the cutoff value. Diagnostic yield of the M2/M1 ratio was better than MFV or asymmetry index. Conclusions The M2/M1 ratio may be a highly specific parameter for assessing M2 stenosis with TCD. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:420–425, 2010
Use of a low profile ultrasound transducer for coronary sinus cannulation: A pilot studyChandraratna, Premindra A.; Kosar, Erol; Gajanayaka, Ranil; Makkena, Surendra M.; Gupta, Anjlie; Ranasinghe, Sachini
doi: 10.1002/jcu.20729pmid: 20683938
Background. Cardiac resynchronization therapy with biventricular pacing has been shown to be beneficial in improving heart failure in patients with prolonged QRS duration (≥120 ms) and low ejection fraction (≤35%). Unsuccessful cannulation of the coronary sinus (CS) has been reported in up to 10% of cases. The feasibility of the transthoracic continuous cardiac imaging for coronary sinus cannulation has not been previously demonstrated. Methods and Results. We developed a 2.5‐MHz hemi‐spherical continuous cardiac imaging transducer (CONTISON), mounted in an external housing, to permit steering in 360°. The transducer was attached to the chest wall using an adhesive ring. The CS was easily imaged by echocardiography by placing the transducer just medial to the apex and tilting it dorsally. The feasibility study was done in 11 patients. CS ostium and body were imaged in all patients. Cannulation was successfully achieved in nine patients with a mean cannulation time of 1 minute 16 seconds. In two patients, poor image quality precluded adequate visualization of CS. Fluoroscopy was not used for cannulation. Conclusion. We demonstrated the feasibility of using the CONTISON echography transducer for the guidance CS cannulation. This technique could expedite CS cannulation and reduce radiation exposure. Further studies comparing ultrasound versus fluoroscopy for CS cannulation appear warranted. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:426–429, 2010
Sonographically measured hyoid bone displacement during swallow in preschool children: A preliminary studyScarborough, D. R.; Waizenhofer, Susan; Siekemeyer, Leah; Hughes, Michael
doi: 10.1002/jcu.20733pmid: 20725945
Purpose. This study explored normative parameters regarding maximum displacement of hyoid bone movement during spontaneous swallows using ultrasound (US) in a sample of healthy preschool children. We hypothesized that consistency and bolus size would influence hyoid movement, but gender would not be a factor. Methods. Parental questionnaire responses and sensorimotor examinations were utilized to determine subject eligibility. Subjects were presented randomized bolus volumes of thin liquids/puree via a spoon while the US probe was placed submentally in the midsagittal plane. Maximum hyoid bone displacement was determined following a frame‐by‐frame analysis of the US recording during spontaneous swallowing of discrete bolus sizes. Results. Twenty‐nine subjects produced 346 swallows that were subsequently analyzed. Significant findings (p < 0.05) included a gender effect with the smallest bolus of liquids presented. Bootstrap estimates based on our sample revealed that 99% of preschool children would present with hyoid bone displacement within 0.3 cm of our sample. Conclusions. Based on our early experience, we were able to observe and measure changes in hyoid bone position during swallowing in preschoolers, which may be gender related. More studies are needed to corroborate our findings. In addition, comparisons of maximum hyoid displacement are warranted in subjects that present with feeding delays. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:430–434, 2010
Sonographic diagnosis of unifocal langerhans cell histiocytosis of the skullHolley, Allison
doi: 10.1002/jcu.20695pmid: 20872938
The sonographic (US) findings of unifocal Langerhans cell histiocytosis of the occiput are described. The patient was a 3 year‐old girl who presented with a painful soft tissue mass on the scalp. US demonstrated a large soft tissue mass with destruction of the underlying bone. The mass extended through the bony defect and consisted of a solid intracranial component and a predominantly cystic extracranial component. US is not usually associated with the diagnosis of Langerhans cell histiocytosis but in this case it provided valuable information that led to the primary differential diagnosis of Langerhans cell histiocytosis, which was confirmed by bone biopsy at surgery. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:440–442, 2010
Prenatal diagnosis of vertebral deformities associated with pentalogy of Cantrell: The role of three‐dimensional sonography?Gün, İsmet; Kurdoğlu, Mertihan; Müngen, Ercüment; Muhcu, Murat; Babacan, Ali; Atay, Vedat
doi: 10.1002/jcu.20726pmid: 20607852
Pentalogy of Cantrell was diagnosed in a fetus at 14 weeks of gestation, on routine two‐dimensional sonographic examination with Doppler imaging, which revealed a midline supraumbilical abdominal wall defect including herniated liver, an ectopia cordis without intracardiac anomalies, and a large omphalocele containing intestines. Although left unilateral club foot deformity was also detected as an associated anomaly in the same examination, severe lumbar lordoscoliosis was only detected by using three‐dimensional sonography because of the spatial configuration of the deformity. After termination of the pregnancy, postnatal inspection of the fetus confirmed the diagnosis of pentalogy of Cantrell associated with skeletal deformities and revealed low implant ears as an additional finding. Although two‐dimensional sonography with Doppler imaging is sufficient to diagnose pentalogy of Cantrell, it may fail to show the complex vertebral deformities and three‐dimensional sonography may assist in visualizing the defect accurately. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:446–449, 2010