EFSUMB Statement on Medical Student Education in Ultrasound [long version]

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.

EFSUMB statement on medical student education in ultrasound [short version]

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.

[Functional ultrasound in gastroenterology]

Ultrasonography has become increasingly important in the routine diagnostics of gastrointestinal diseases. It is first of all a morphological diagnostic method. As it not only assesses the wall structure of the gallbladder, the pancreatic duct and the whole gastrointestinal tract but also visualises motion sequences as a real-time-method, functional processes and their disruptions can especially be examined. The present authors give a review of the capacity of functional ultrasound in different anatomic zones and critically discuss its practical relevance.

[Perianal ultrasound]

Perianal and perineal ultrasound is an effective but rarely applied diagnostic modality. Transmural inflammation, fistula and abscesses in patients with inflammatory bowel disease can be delineated and perirectal tumours can be staged. The method is complementary to endorectal ultrasound. Also oblique transsphincteric fistula can be displayed in detail.

[Current status of ultrasound in gastroenterology--bowel and upper gastrointestinal tract--part 2]

Ultrasound has gained acceptance in the diagnosis of diseases of the gastrointestinal tract beside the classical methods such as endoscopy and X-ray. In a previous publication we discussed the use of ultrasound in emergency diagnostics (e. g., acute appendicitis, diverticulitis/peridiverticulitis, ileus, invagination and perforation) (part 1). Because of the vast extent of this topic, in this overview we will focus on the current role of ultrasound in the detection and assessment of chronic inflammatory bowel diseases, rare forms of colitis (e. g., bacterial, pseudomembranous and neutropenic colitis as well as intestinal tuberculosis), ischaemic bowel diseases as well as diseases of the upper gastrointestinal tract. In chronic inflammatory bowel diseases, ultrasound can give important additional information such as extension, activity, complication (fistula, abscess, stenosis) and in differential diagnosis. It plays an important role in follow-up investigations and can possibly reduce the number of endoscopic examinations. There is still some debate going on about the significance of colour Doppler ultrasound in assessing the activity and differentiation of stenosis. Furthermore, ultrasound is used as a method to guide interventional therapies for abscesses (puncture and drainage). Colour Doppler ultrasound can diagnose ischaemic bowel diseases and also differentiate these from other aetiologies. Ultrasound plays a greater role in the follow-up and assessment of chronic intestinal ischaemia. In the diagnosis of stomach diseases under favourable conditions ultrasound can show changes of the stomach wall, tumours, ulcers and their complication (perforation, penetration) and disturbances of the motility. But an exclusion is not possible.

[Current status of ultrasound in gastroenterology--bowel and upper gastrointestinal tract--part 1]

Ultrasonography has become widely accepted as a diagnostic tool for gastrointestinal diseases. It not only assesses the lumen but more importantly also the wall and the surrounding structures of the stomach and bowel. Furthermore, functional processes (peristalsis, blood flow) can be visualised and provide important information for passage and perfusion. Modern high resolution (compressive) sonography represents an ideal complementary method besides endoscopy for the gastroenterologist. It is used in emergency diagnosis in cases of acute appendicitis and peridiverticulitis. Here sonography is the method of first choice achieving a high sensitivity. The same applies to ileus, which can be diagnosed significantly earlier by sonography than with conventional X-ray methods. Meanwhile sonography can contribute considerable information to clarify pathogenesis (e. g., invagination, intususception). The detection of a perforation depends strongly on the competence of the examiner. The main advantage is the detection of a covered perforation and the genesis (e. g., ulcer). Ultrasound is less commonly considered in celiac sprue but important complementary information can be obtained. Advanced tumours of the gastrointestinal tract can easily be visualised, although early stages can hardly be detected by means of sonography. An accurate T-staging of tumours is not possible with transabdominal sonography, not least because some parts of the bowel (colon and rectum) cannot always and completely be seen. Exclusion of tumour or early detection is not possible by ultrasound. In intestinal diseases additional information besides clinical and endoscopic aspects can be achieved by ultrasound. Sonography is important for differential diagnosis and follow-up and spares the patient from more incriminatory endoscopic operations. Ultrasound is equal to other imaging methods in detecting complications (fistulas, abscess, stenosis). Due to the complexity of the topic the following review will concentrate on giving an idea of the present status of sonography in chronic inflammatory bowel disease, some less frequent intestinal infections (bacterial, pseudomembranous, neutropenic colitis, intestinal tuberculosis), the ischaemic bowel diseases as well as diseases of the upper gastrointestinal tract.

[Ultrasound in gastroenterology--liver and spleen]

Conventional B-mode and colour duplex imaging is the first choice imaging technique after history taking and physical examination and for the interpretation of laboratory parameters. In the hands of a gastroenterologist ultrasound has become an equally important diagnostic tool as endoscopy. The constantly evolving technique with its possibility of higher resolution by use of "harmonic imaging" and signal enhancement with contrast medium is the reason for a practically relevant review of the situation. Practical references will be given for diagnostics of the liver and portal system including the spleen. The significance of the sonographic diagnosis of "fatty liver" is critically discussed. The overall importance of ultrasound to distinguish different aetiologies of diffuse liver diseases is relatively low. Nevertheless, it is a very sensitive means to detect complications of liver cirrhosis. Portosystemic shunts and typical changes in blood vessel morphology can be diagnosed by colour duplex sonography and used as indirect signs of advanced damage to liver parenchyma. In addition, ultrasound has its value in the confirmation or exclusion of dilated bile ducts as well as in the detection and differentiation of circumscribed liver lesions. The characterisation of focal liver lesions by ultrasound is sufficient in typical cases. The use of ultrasound contrast media (signal enhancers) raises the rate of differentiation and can avoid the uncritical and sequential application of radiological imaging (computed tomography [CT] or magnetic resonance imaging [MRI]). If in doubt about the nature of a lesion, a histological diagnosis remains indispensable. The examination of the spleen and its feeding vessels is regularly done in cases of diffuse parenchymal liver disease when searching for its complications, e. g., portal hypertension. Focal spleen lesions can be observed especially in the context of lymphoma (infiltration) and other bone marrow diseases. Through the application of contrast media, changes of vascularisation (e. g., infarcts) can be visualised and traumatic lesions can be diagnosed more precisely.