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2084979 Effects of Needle And Catheter Size on Commercially Available Ultrasound Contrast Agent Enhancement In Vitro
S134
Ultrasound in Medicine and Biology
Objectives: Anatomical intelligence uses the very latest in ultrasound technology to perform regular tasks in standard ultrasound. As the term suggests, automated analysis of solid organs allows for routine measurements to be performed automatically at the time of examination, without the sonographer/radiologist needing to perform physical measurements themselves, or even be aware that they are being made. Not only are these measurements seamlessly integrated into the examination, but such is the precision of the software, tasks are performed more accurately than by a human operator. This technology has already been implemented in foetal heart navigation, and is in the process of development in a more generalised setting. Length and volume measurements of the renal tract, aorta and renal transplants are amongst the many scans performed that require accurate and potentially time consuming measurements, which if performed automatically would reduce scan time and increase accuracy and reproducibility. Limitations are that the structure it is looking for must conform to the model, or it will not be recognized. However, as more cases are included, the model can adapt the parameters and will detect a greater degree of variation. Methods: Here we discuss how the technology works, our experiences with the early versions of this technology and where we see the applications and limitations. 2084979 Effects of Needle And Catheter Size on Commercially Available Ultrasound Contrast Agent Enhancement In Vitro John Eisenbrey,1 Annemarie Daecher,1,2 Michael R. Kramer,1,3 Flemming Forsberg1 1 Radiology, Thomas Jefferson University, Philadelphia, PA, United States, 2Villanova University, Villanova, PA, United States, 3School of Medicine, Templee University, Philadelphia, PA, United States Objectives: The use of ultrasound contrast agents (UCAs) requires intravenous access. The purpose of this study was to investigate effects of needle and catheter size on ultrasound enhancement from 4 commercially available UCAs. Methods: Imaging was performed using a Loqiq 9 scanner with 9L linear probe fixed with a positioning arm and operating in coded harmonic imaging mode (GE Healthcare, Milwaukee, WI). Contrast was imaged within a 6mm vessel at a depth of 2cm in a flow phantom (ATS Laboratories, Bridgeport, CT) connected to a stirred reservoir and a peristaltic pump. Definity (Lantheus Medical Imaging, N. Billerica, MA), Optison (GE Healthcare, Princeton, NJ), SonoVue (Bracco, Geneva, Switzerland), and Sonazoid (GE Healthcare, Oslo, Norway) were investigated. The UCA was injected via 1 ml syringe (BD, Franklin Lakes, NJ) into a 3 way stopcock (Smith Medical, Dublin OH) and flushed with 10 ml saline through an 18 cm infusion extension tube connected to either a 16, 18, 20, 22 or 24 gauge catheter (BD) or a 18, 20, 21, or 25 gauge needle (BD). An infusion rate of 2.5 ml/s was used (based on timing of physician injections during a large, UCA imaging trial. Still images were collected for 20 minutes and enhancement expressed in dB. Results: No statistically significant differences were observed between all catheter sizes and 18-21 gauge needles for SonoVue and Sonazoid. A significant decrease in enhancement was observed for all 4 UCAs (p , 0.001), when administration was performed through a 25 gauge needle, with an approximate drop in enhancement of 4-7 dB at injection and 7-18 dB 20 minutes post injection. Administration of Optison through a 24 gauge catheter resulted in significant loss of enhancement relative to all larger catheter and needles (p , 0.016). For Definity, administration through a 24 gauge catheter resulted in significant decreases in enhancement relative to the 16, and 18 gauge catheters and 18, 20, and 21 gauge needles (p , 0.001). Conclusions: Administration of UCAs through a 25 gauge needle significantly decreases in vitro enhancement, and should not be used. The minimal catheter size during administration required to maximize in vitro enhancement appears to be agent specific.
Volume 41, Number 4S, 2015 2084998 A Review of The Diagnostic Accuracy of Fetal Cardiac Anomalies Frances Miceli, Perinatal, Nepean Hospital, Hazelbrook, NSW, Australia Objectives: In order to assess the diagnostic accuracy of fetal cardiac anomalies in our Department we undertook a retrospective analysis and compared our results with those of the pediatric cardiologists in the same cases. The purpose of this audit was to track our improvement over the years and modify training as necessary. Methods: Sixty five patients referred for fetal echocardiographic scans were identified in our database from Nov 2005 –Feb 2014. Of these 6 scans were found to be normal by ultrasound and not referred on to the pediatric cardiologist. An additional 6 scans were diagnosed to have complex congenital heart disease (CHD) with or without extracardiac abnormalities and/or aneuploidy. These 6 patients opted for termination of pregnancy and were also not seen by the pediatric cardiologist. The remaining 53 cases were referred to the pediatric cardiologist. Our results were analysed and then compared to the cardiologist’s findings. Results: The ultrasound findings of the 53 cases scanned in our department were analysed and compared to the findings in the cardiologist’s reports. The scans performed in the earlier years of the study tended to describe the abnormal anatomy but showed a reluctance to name any pathology. As training and confidence levels increased the less complex pathologies were correctly identified by our department and confirmed by the cardiologist. Overall our level of diagnostic accuracy has increased from 34 % in the first half of the study to 60% in the second half. Conclusions: The skills, training and level of confidence required to diagnose fetal cardiac anomalies in our Department have improved over the 8 years of the study period, particularly in regards to some of the less complex cardiac pathologies. However the more complex pathologies remain difficult to assess and further improvement is required although differential diagnoses are now offered. We believe that audits such as these offer an important learning tool and encourage all ultrasound departments to undertake a similar excercise. 2085220 Quantitative Assessment of The Quadriceps Femoris Muscle For Early Detection of Musculoskeletal Disorder Using Ultrasonography Tsuneo Watanabe,2,1 Nobuo Terabayashi,3 Daisuke Fukuoka,4 Hiroki Murakami,4 Tamotsu Yabumoto,1 Sohee shin,1 Hiroyasu Ito,2 Toshio Matsuoka,1 Mitsuru Seishima2 1 Department of Sports Medicine and Sports Science, Gifu University Graduate School of Medicine, Gifu, Japan, 2Division of Clinical Laboratory, Gifu University Hospital, Gifu, Japan, 3Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan, 4Department of Regeneration and Advanced Medical Sciences, Gifu University Graduate School of Medicine, Gifu, Japan Objectives: Aging of the population has been one of the major issues in developed nations in recent years. Early detection of musculoskeletal disorders is expected to help the well-being promotor and self-reliance of elderly people, and to reduce the need for nursing care. The aim of this study was to assess the quadriceps femoris muscle (QM) quality using ultrasonography (US), and to evaluate the relationship between aging, muscle strength, and sonographic findings in healthy volunteers. Methods: Seventy-four healthy volunteers were examined. The subjects were classified into two groups on the basis of the age as follows: under 55 years old (younger group; age: 23.6 6 6.9 years; n 5 28) and over 55 years old (elderly group; age: 70.4 6 7.5 years; n 5 46). For the assessment of the muscle quality, texture analysis was used; muscle quality was expressed as Intramuscular texture characteristics (ITC). The knee extension force in sitting position, ITC, and the muscle thickness of QM (QMT: rectus femoris thickness + vastus intermedius thicness) were measured in this study.
Ultrasound in Medicine and Biology
Objectives: Anatomical intelligence uses the very latest in ultrasound technology to perform regular tasks in standard ultrasound. As the term suggests, automated analysis of solid organs allows for routine measurements to be performed automatically at the time of examination, without the sonographer/radiologist needing to perform physical measurements themselves, or even be aware that they are being made. Not only are these measurements seamlessly integrated into the examination, but such is the precision of the software, tasks are performed more accurately than by a human operator. This technology has already been implemented in foetal heart navigation, and is in the process of development in a more generalised setting. Length and volume measurements of the renal tract, aorta and renal transplants are amongst the many scans performed that require accurate and potentially time consuming measurements, which if performed automatically would reduce scan time and increase accuracy and reproducibility. Limitations are that the structure it is looking for must conform to the model, or it will not be recognized. However, as more cases are included, the model can adapt the parameters and will detect a greater degree of variation. Methods: Here we discuss how the technology works, our experiences with the early versions of this technology and where we see the applications and limitations. 2084979 Effects of Needle And Catheter Size on Commercially Available Ultrasound Contrast Agent Enhancement In Vitro John Eisenbrey,1 Annemarie Daecher,1,2 Michael R. Kramer,1,3 Flemming Forsberg1 1 Radiology, Thomas Jefferson University, Philadelphia, PA, United States, 2Villanova University, Villanova, PA, United States, 3School of Medicine, Templee University, Philadelphia, PA, United States Objectives: The use of ultrasound contrast agents (UCAs) requires intravenous access. The purpose of this study was to investigate effects of needle and catheter size on ultrasound enhancement from 4 commercially available UCAs. Methods: Imaging was performed using a Loqiq 9 scanner with 9L linear probe fixed with a positioning arm and operating in coded harmonic imaging mode (GE Healthcare, Milwaukee, WI). Contrast was imaged within a 6mm vessel at a depth of 2cm in a flow phantom (ATS Laboratories, Bridgeport, CT) connected to a stirred reservoir and a peristaltic pump. Definity (Lantheus Medical Imaging, N. Billerica, MA), Optison (GE Healthcare, Princeton, NJ), SonoVue (Bracco, Geneva, Switzerland), and Sonazoid (GE Healthcare, Oslo, Norway) were investigated. The UCA was injected via 1 ml syringe (BD, Franklin Lakes, NJ) into a 3 way stopcock (Smith Medical, Dublin OH) and flushed with 10 ml saline through an 18 cm infusion extension tube connected to either a 16, 18, 20, 22 or 24 gauge catheter (BD) or a 18, 20, 21, or 25 gauge needle (BD). An infusion rate of 2.5 ml/s was used (based on timing of physician injections during a large, UCA imaging trial. Still images were collected for 20 minutes and enhancement expressed in dB. Results: No statistically significant differences were observed between all catheter sizes and 18-21 gauge needles for SonoVue and Sonazoid. A significant decrease in enhancement was observed for all 4 UCAs (p , 0.001), when administration was performed through a 25 gauge needle, with an approximate drop in enhancement of 4-7 dB at injection and 7-18 dB 20 minutes post injection. Administration of Optison through a 24 gauge catheter resulted in significant loss of enhancement relative to all larger catheter and needles (p , 0.016). For Definity, administration through a 24 gauge catheter resulted in significant decreases in enhancement relative to the 16, and 18 gauge catheters and 18, 20, and 21 gauge needles (p , 0.001). Conclusions: Administration of UCAs through a 25 gauge needle significantly decreases in vitro enhancement, and should not be used. The minimal catheter size during administration required to maximize in vitro enhancement appears to be agent specific.
Volume 41, Number 4S, 2015 2084998 A Review of The Diagnostic Accuracy of Fetal Cardiac Anomalies Frances Miceli, Perinatal, Nepean Hospital, Hazelbrook, NSW, Australia Objectives: In order to assess the diagnostic accuracy of fetal cardiac anomalies in our Department we undertook a retrospective analysis and compared our results with those of the pediatric cardiologists in the same cases. The purpose of this audit was to track our improvement over the years and modify training as necessary. Methods: Sixty five patients referred for fetal echocardiographic scans were identified in our database from Nov 2005 –Feb 2014. Of these 6 scans were found to be normal by ultrasound and not referred on to the pediatric cardiologist. An additional 6 scans were diagnosed to have complex congenital heart disease (CHD) with or without extracardiac abnormalities and/or aneuploidy. These 6 patients opted for termination of pregnancy and were also not seen by the pediatric cardiologist. The remaining 53 cases were referred to the pediatric cardiologist. Our results were analysed and then compared to the cardiologist’s findings. Results: The ultrasound findings of the 53 cases scanned in our department were analysed and compared to the findings in the cardiologist’s reports. The scans performed in the earlier years of the study tended to describe the abnormal anatomy but showed a reluctance to name any pathology. As training and confidence levels increased the less complex pathologies were correctly identified by our department and confirmed by the cardiologist. Overall our level of diagnostic accuracy has increased from 34 % in the first half of the study to 60% in the second half. Conclusions: The skills, training and level of confidence required to diagnose fetal cardiac anomalies in our Department have improved over the 8 years of the study period, particularly in regards to some of the less complex cardiac pathologies. However the more complex pathologies remain difficult to assess and further improvement is required although differential diagnoses are now offered. We believe that audits such as these offer an important learning tool and encourage all ultrasound departments to undertake a similar excercise. 2085220 Quantitative Assessment of The Quadriceps Femoris Muscle For Early Detection of Musculoskeletal Disorder Using Ultrasonography Tsuneo Watanabe,2,1 Nobuo Terabayashi,3 Daisuke Fukuoka,4 Hiroki Murakami,4 Tamotsu Yabumoto,1 Sohee shin,1 Hiroyasu Ito,2 Toshio Matsuoka,1 Mitsuru Seishima2 1 Department of Sports Medicine and Sports Science, Gifu University Graduate School of Medicine, Gifu, Japan, 2Division of Clinical Laboratory, Gifu University Hospital, Gifu, Japan, 3Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan, 4Department of Regeneration and Advanced Medical Sciences, Gifu University Graduate School of Medicine, Gifu, Japan Objectives: Aging of the population has been one of the major issues in developed nations in recent years. Early detection of musculoskeletal disorders is expected to help the well-being promotor and self-reliance of elderly people, and to reduce the need for nursing care. The aim of this study was to assess the quadriceps femoris muscle (QM) quality using ultrasonography (US), and to evaluate the relationship between aging, muscle strength, and sonographic findings in healthy volunteers. Methods: Seventy-four healthy volunteers were examined. The subjects were classified into two groups on the basis of the age as follows: under 55 years old (younger group; age: 23.6 6 6.9 years; n 5 28) and over 55 years old (elderly group; age: 70.4 6 7.5 years; n 5 46). For the assessment of the muscle quality, texture analysis was used; muscle quality was expressed as Intramuscular texture characteristics (ITC). The knee extension force in sitting position, ITC, and the muscle thickness of QM (QMT: rectus femoris thickness + vastus intermedius thicness) were measured in this study.