Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement

The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.

Radiology Report Comparator: a novel method to augment resident education

Attending radiologists routinely edit radiology trainee dictated preliminary reports as part of standard workflow models. Time constraints, high volume, and spatial separation may not always facilitate clear discussion of these changes with trainees. However, these edits can represent significant teaching moments that are lost if they are not communicated back to trainees. We created an electronic method for retrieving and displaying changes made to resident written preliminary reports by attending radiologists during the process of radiology report finalization. The Radiology Information System is queried. Preliminary and final radiology reports, as well as report metadata, are extracted and stored in a database indexed by accession number and trainee/radiologist identity. A web application presents to trainees their 100 most recent preliminary and final report pairs both side by side and in a "track changes" mode. Web utilization audits showed regular utilization by trainees. Surveyed residents stated they compared reports for educational value, to improve future reports, and to improve patient care. Residents stated that they compared reports more frequently after deployment of this software solution and that regular assessment of their work using the Report Comparator allowed them to routinely improve future report quality and improved radiological understanding. In an era with increasing workload demands, trainee work hour restrictions, and decentralization of department resources (e.g., faculty, PACS), this solution helps to retain an important part of the educational experience that would have otherwise run the risk of being lost and provides it to the trainees in an efficient and highly consumable manner.

Color Doppler hemodynamic evaluation of flow to normal hip

This study was aimed to quantitate hemodynamic flow to the normal proximal femur and to evaluate the effect of internal rotation on blood flow measurements in the hip to assess the capability of Doppler ultrasonography to detect a simulated ischemic situation. Forty hips in 20 adult healthy volunteers age 22 to 62 years (mean age, 39.5 years) were examined in the supine position in neutral position and during internal rotation (simulated ischemia). Medial and lateral circumflex arteries and veins were examined using standard ultrasound equipment with color and power Doppler capabilities. Arterial pulsatility index and maximal arterial and venous velocities were determined. Pulsatility index values in the medial circumflex artery were significantly (P < 0.05) changed during internal rotation of the leg. A drop in pulsatility index of more than 1.4 on the right and 2.2 on the left hip with respect to the normal neutral position was considered abnormal. The peak systolic velocity did not change significantly. The venous return showed a consistent increase in flow velocity during internal rotation, but this was borderline in terms of significance. Participants older than 40 years showed more prominent changes in pulsatility index during internal rotation. Repeat measurements performed in 10 hips showed only a 5% mean change in the pulsatility index values from the previous series of measurements. Changes in pulsatility index values occurred when flow in the proximal femur was compromised (internal rotation). These changes were particularly significant in the medial circumflex artery, which is the primary vascular supply of the femoral head and neck. Changes also were observed in the circumflex veins (velocity increased) on internal rotation; however, they were not statistically significant. Doppler ultrasonography of the medial circumflex artery is a potential tool for the assessment and follow-up of hip vascularity.

How much does inferior capsular shift reduce shoulder volume?

The purpose of this study was to quantitate the effect of inferior capsular shift on shoulder volume. Four fresh frozen cadaveric shoulders were analyzed. Volume before and after shift was determined using 3 techniques: (1) Magnetic resonance imaging sequences were digitized to computer and analyzed for volume via a 35-mm camera using Cue 2 software. The capsule was delineated by contrast between light and dark regions. Volume was calculated by summing the total area of respective slices. (2) Ultrasound images, obtained after surgical exposure of the capsule, were digitized. Volume was calculated using the formula for a prolate ellipsoid. (3) An 18-gauge needle was used to inject and evacuate saline via an anterior approach. Quantity of aspirated fluid provided a direct measure of volume. Inferior capsular shift was performed. After the operation, measurements were repeated. Inferior capsular shift reduced volume in all shoulders with each technique. On average, inferior capsular shift reduced joint volume by 57 %). A measurable reduction in shoulder joint volume is an effect of capsular shift. This measurement may have clinical application if volume is an indicator of instability or laxity.

Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography

This study evaluated the ability of laparoscopic ultrasonography to detect, localize, and characterize focal liver masses. Laparoscopic ultrasonography and CT portography of the liver were performed in 13 patients with known or suspected malignancy. Laparoscopic ultrasonography directly influenced surgical management in four (31%) cases; three by detection of small focal masses and one by exclusion of masses suspected on CT portography. Laparoscopic ultrasonography provided guidance for biopsy or added important anatomic information in three cases. Laparoscopic ultrasonography was complementary to CT portography but added no additional information in three cases, and it failed to provide any information in two cases. Laparoscopic ultrasonography was falsely negative in one case. In this preliminary series, laparoscopic ultrasonography assisted surgeons in critical decision-making by either providing important new information, clarifying questionable areas, or complementing CT portography.

The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice

We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasi-experimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch. During the baseline year, patients who would join the independent practice association plan already had 19% more acute-illness visits than control patients. During the second year, patients in the independent practice association plan averaged 42% more acute-illness visits, 22% more well child-care visits, 93% more chronic-illness visits, 27% more after-hours visits, 53% more weekend visits, 185% more laboratory studies, and 70% more referrals. The shift toward independent practice association plans in this open-market setting increased use of ambulatory medical care for pediatric patients.

Compliance with short-term antimicrobial therapy: some techniques that help

The effect of two reminder devices on compliance with a ten-day antimicrobial prescription was investigated in a health center population. The reminders, a clock printed on the prescription label with appropriate times circled and a 5 X 7 inch bright red sticker to be posted at home, were compared to a control group. A total of 158 patients were interviewed at home on the ninth or tenth day of therapy, and compliance estimated by measuring the amount of remaining medication. For children, both reminders improved compliance about two-fold over controls. The findings suggest that (1) several simple reminder devices can be effective and (2) the nature of the patient population may be a more important influence on compliance than the relationship to a physician or the type of health care system. In addition, the study demonstrates the influence of the pharmacist on patients' medication-taking behavior.