Comparison of a Portable and Non-Portable Ultrasound Machine in the Evaluation of Children with Sickle Cell Disease: A Pilot Study

Background: Transcranial color Doppler (TCCD) ultrasound is used to identify children with sickle cell disease (SCD) at high risk of developing stroke. There is anecdotal evidence to suggest that different ultrasound equipment can give different blood flow velocities. The purpose of this study was to compare two different TCCD ultrasound machines. Methods and Results: A flow phantom was used to compare PSV measurements from a Philips IU-22 and Zonare Z-One ultrasound machine. Twenty-five children with SCD (aged between 2 and 16 years) attending the outpatient clinic at St. Mary’s Hospital, Imperial College Healthcare NHS Trust, as part of the NHS Sickle Cell & Thalassaemia (SC&T) screening program were studied. The two ultrasound machines compared the TAMM velocities in the middle cerebral artery and stroke risk categorization. PSV measurements using a flow phantom were underestimated by Philips IU-22 (31%) and Zonare Z-One (53%). TAMM velocities varied considerably between machines, with a poor agreement in stroke risk categorization. As a result, three children identified at increased risk of stroke by Philips IU-22 were not identified by Zonare Z-One. Conclusion: Two ultrasound machines were found to underestimate PSV using a flow phantom. The two ultrasound machines were shown to positively correlate, and this was statistically significant. However, there was variation in the TAMM velocities recorded by the machines which resulted in the different categorization of the stroke risk of a small number of the subjects. This pilot study confirms the feasibility and clinical significance of this investigation.

Abdominal aorta measurements by a handheld ultrasound device compared with a conventional cart-based ultrasound machine

BACKGROUND: Ultraportable or pocket handheld ultrasound devices (HUD) may be useful for large-scale abdominal aortic aneurysm screening. However, the reproducibility of measurements has not been compared with conventional cart-based ultrasound machines. OBJECTIVES: Investigate the intra- and inter-operator reproducibility of a HUD compared with a conventional ultrasound machine for aortic screening. DESIGN: Analytical, cross-sectional. SETTING: Ultrasound department at a large tertiary care hospital in Riyadh. PATIENTS AND METHODS: Eligible male participants aged ≥60 years were invited to participate upon arriving for a non-vascular ultrasound appointment. Three repeated anteroposterior measurements of the transverse aorta were made at the proximal and distal locations for each machine before repeating the measurements on a subset of participants by a second blinded operator. Intraclass correlation coefficients (ICC) and the Bland-Altman method were used to analyze reproducibility. MAIN OUTCOME MEASURE: Inter-system and intra- and inter-operator ICCs. SAMPLE SIZE: 114 males with repeated measurements by second operator on a subset of 35 participants. RESULTS: The median age (interquartile range) of participants was 68 years (62–74 years). The intra- and inter-operator ICCs were all >0.800 showing almost perfect agreement except for the inter-operator reproducibility at the proximal location using a conventional machine (ICC= 0.583, P =.007) and the Butterfly device (ICC=0.467, P =.037). The inter-system ICCs (95% CI) were 0.818 (0.736–0.874) and 0.879 (0.799–0.924) at the proximal and distal locations, respectively. The mean difference in aortic measurement between the ultrasound systems was 0.3 mm (1.7%) in the proximal location and 0.6 mm (3.6%) in the distal location. In total, >91% of the difference in measurements between the machines was <3 mm. The mean scanning time was 4:16 minutes for the conventional system and 3:53 minutes for the HUD ( P =.34). CONCLUSIONS: Abdominal aortic screening using a HUD was feasible and reliable compared with a conventional ultrasound machine. A pocket HUD should be considered for large-scale screening. LIMITATIONS: No cases of abdominal aortic aneurysm in the sample and lack of blinding. CONFLICT OF INTEREST: None.

Cardiovascular ultrasound implementation for a pragmatic approach to the diabetic patient

The tailoring of the management of diabetes is the fundamental task of the diabetologist who requires very different skills to guarantee the best diagnostic path and the best treatment for patients. To enrich the range of “measures” necessary for this customization process, it is now possible to use a tool that is now accessible to everyone: the ultrasound machine. Through some simple ultrasound scans, using a minimum amount of time, it is possible to acquire useful information for correct patient stratification and for a rational therapeutic approach, as recommended by the guidelines. The path for the certification of the skills of the diabetologist expert in the management of cardiovascular complications could be the natural context for the placement of these techniques. KEY WORDS diabetes mellitus; cardiovascular complications; tailoring of therapy; echocolordoppler; echocardiography.

Ultrasonography Evaluation of Umbilical Structures in Clinically Healthy Donkey Foals during the First Week of Life

The umbilicus is a potential access-point for pathogens in equine foal, causing umbilical infections and potentially life-threating illness. Early diagnosis based on ultrasonographic appearance and measurement is crucial to avoid severe complications and promptly implement appropriate therapy. This study ultrasonographically evaluates the umbilical remnants of donkey foals, in the first week of life. Fifteen healthy donkey foals were included in the study. The umbilical vein, arteries and urachus ultrasounds were performed at 24 h, 3 and 7 days of life, using a portable ultrasound machine and a 5–7.5 MHz multifrequency linear probe. The Kruskal–Wallis test and Dunn’s multiple comparisons test were applied to verify differences in relation to time for all the umbilical remnants measured. Statistical significance was set at p < 0.05. No statistical differences were observed in relation to time regarding umbilical remnant measurements. A correlation was found between body weight and the left artery at T0. The regression of the umbilical remnant during the first week of life was slower compared with what was reported in equine foals but was comparable with the results on calves. Thus, the different regression timing needs be considered when evaluating donkey foals with umbilical remnant diseases within the first week of life.

Ultrasound Physics and Ultrasound Machine Functionality

Chapter 1 reviews basic ultrasound physics and introduces ultrasound machine functionality. Ultrasound medical imaging (also known as sonography) is a diagnostic imaging tool that uses high-frequency sound waves to create images of structures in the body. It can show details that a still image like a radiograph cannot, such as blood flow or needle guidance to a nerve. Several tools and techniques are useful in acquiring the best ultrasound image. The chapter covers the functions of many ultrasound machine knobs, machine operation, ultrasound operating modes, and ultrasound image optimization. It also examines different types of ultrasound probes and their uses.

Ultrasonographic Findings in Common Thyroid and Parathyroid Disorders—Advantages of Real Time Observation by the Endocrinologist with their Own Ultrasound Machine

In this review we discuss the significance of the main ultrasonographic features of common thyroid and parathyroid conditions, with a focus on the advantages of real time observation. The thyroid specialist, defined as an endocrinologist with a major interest in thyroid disorders and access to a portable ultrasound machine, can correlate what they see with the thyroid blood test results and clinical findings in a way that is not available to the general endocrinologist who relies on the interpretation by the consultant radiologist of ultrasound images prepared by a technician. We also discuss the significance of the small, very bright, intra nodular microcalcifications found in benign colloid nodules, which we call “colloid spots” and the difference between these and the 3–4 mm soft microcalcifications that are 90% specific for papillary thyroid cancer and provide a new system for staging the inflammatory changes in Hashimoto thyroiditis, as observed on ultrasonography.

Sonographic assessment of uterine leiomyoma among pregnant women.

Objectives: To sonographically assess uterine leiomyoma among pregnant women. Study Design: Cross-sectional Descriptive study. Setting: Gilani Ultrasound Center, Ferozepur Road Lahore. Period: Sep to Dec 2019. Material & Methods: The sample size was all the pregnant women with fibroid. Ultrasound machine Honda 2000 HS and Toshiba xerio x4 were used. Results: Out of 73 patients, 47(64.4%) had fibroid at the anterior wall of the uterus, 14(19.2%) patients had fibroid at the posterior wall of the uterus, 5(6.8%) patients had submucosal fibroid, 2(2.7%) patients had fibroid in the lateral wall of the uterus, 2(2.7%) patients had fibroid at fundal region of the uterus and 1(1.4%) of each had fibroid in cervix, lower uterine segment and subserosal. Conclusion: The findings of this study concluded that the anterior wall of the uterus is more favorable for leiomyoma in pregnant women.