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Fetal Ultrasound and Magnetic Resonance Imaging: Collision Course or Superhighway
SPECIAL INTEREST SESSIONS 1:00 PM – 3:00 PM ALARA (as Low as Reasonably Achievable): Do I Meet the Standards?
Pediatric musculoskeletal (MSK) sonography (US) now includes requests for studies which although ‘‘routine‘‘ for adult practices are still ‘‘new’’ for pediatric practices. We in pediatric imaging can learn from our adult colleagues. Technique with attention to orientation and knowledge of anatomy (becoming ever more detailed) are critical to perform and understand MSK US. Anatomy of the elbow and ankle will be illustrated as examples of how one uses an organized regional approach to these joints including ligaments, muscles and tendons extending to, from, and across the joints, nerves, and blood vessels. Ulnar, median, musculocutaneous, and radial nerves and branches are seen at the elbow. Biceps, brachialis, and triceps insertions, forearm supinators and pronators, and wrist flexors and extensors comprise functional muscle groups at the elbow. Likewise, ligaments at and tendons crossing the ankle joint require proper US technique for optimal identification and evaluation. Recognizing anisotropy, muscle and tendon echotexture and performing dynamic maneuvers are critical in MSK US. Some of the sports related extremity pathology which we have seen in pediatrics includes: avulsion injuries, myotendinous strain, tendinopathy, ulnar nerve instability (snapping triceps and dislocating ulnar nerve), ulnar neuritis, snapping hip, snapping knee, excessive peroneal tendon movement (subluxation and dislocation), and ankle instability
Moderator: Jacques Abramowicz, MD The objectives of this session are to: (1) define risks of ultrasound; (2) explain how power is altered by various settings on the ultrasound scan; and (3) educate on how to keep ultrasound safe. ALARA: The Clinical View Jacques Abramowicz Obstetrics and Gynecology, Wayne State University, Detroit, Michigan In clinical obstetric ultrasound, the ALARA (As Low As Reasonably Achievable) principle is what should guide the end-user in his/her daily practice. Ultrasound is a form of energy that will cause effects in every tissue it traverses (bioeffects), most likely via two mechanisms: thermal and non-thermal. These effects are not necessarily harmful if certain rules, such as ALARA, are followed. ALARA is based on two very different approaches: some risk/benefit analysis of how much acoustic energy is tolerable to obtain diagnostic information and the precautionary principle which states that benefit must be proven before certain actions are executed. When comparing images obtained at various acoustic output levels, as documented by on-screen thermal (TI) and mechanical (MI) index, it is evident that excellent clinical information may be obtained at very low outputs. Knowledge of clinical end-users continues to be sorely lacking both in the USA ad throughout the world.
Ultrasound Evaluation of Vascular Emergencies Moderator: Srikar Adhikari, MD, MS This session will review the role of ultrasound evaluation in a variety of vascular emergencies.
Fetal Ultrasound and Magnetic Resonance Imaging: Collision Course or Superhighway Moderators: Wesley Lee, MD, Christopher Cassady, MD, FRANZCR
Ultrasound of the Gallbladder and the Biliary Tract
The objectives of this session are to: (1) evaluate challenging obstetric cases in which magnetic resonance imaging (MRI) and prenatal ultrasound are used in case diagnoses; (2) discuss a stepwise approach in evaluation of challenging fetal cases; (3) discuss imaging clues and pitfalls in common fetal abnormalities and when to refer a patient for fetal MRI; and (4) describe pros and cons of the use of MRI as an adjunct to ultrasound in managing difficult fetal cases.
Moderator: Shweta Bhatt, MD This session will cover the following topics: basic gallbladder imaging; advanced gallbladder imaging; and benign and malignant diseases of the bile ducts.
Transcranial and Duplex Doppler Interpretation and Operating Room Applications
Transition from Adult to Pediatrics Moderator: Michael DiPietro, MD Introduction: ‘‘Adult MSK US’’ in a Pediatric World Michael DiPietro Radiology, University Michigan, Ann Arbor, Michigan, United States
Moderator: Michele Johnson, MD After this session, participants will be able to describe and discuss the indications and interpretation of carotid and transcranial Doppler ultrasound studies.
of
S102
Pediatric musculoskeletal (MSK) sonography (US) now includes requests for studies which although ‘‘routine‘‘ for adult practices are still ‘‘new’’ for pediatric practices. We in pediatric imaging can learn from our adult colleagues. Technique with attention to orientation and knowledge of anatomy (becoming ever more detailed) are critical to perform and understand MSK US. Anatomy of the elbow and ankle will be illustrated as examples of how one uses an organized regional approach to these joints including ligaments, muscles and tendons extending to, from, and across the joints, nerves, and blood vessels. Ulnar, median, musculocutaneous, and radial nerves and branches are seen at the elbow. Biceps, brachialis, and triceps insertions, forearm supinators and pronators, and wrist flexors and extensors comprise functional muscle groups at the elbow. Likewise, ligaments at and tendons crossing the ankle joint require proper US technique for optimal identification and evaluation. Recognizing anisotropy, muscle and tendon echotexture and performing dynamic maneuvers are critical in MSK US. Some of the sports related extremity pathology which we have seen in pediatrics includes: avulsion injuries, myotendinous strain, tendinopathy, ulnar nerve instability (snapping triceps and dislocating ulnar nerve), ulnar neuritis, snapping hip, snapping knee, excessive peroneal tendon movement (subluxation and dislocation), and ankle instability
Moderator: Jacques Abramowicz, MD The objectives of this session are to: (1) define risks of ultrasound; (2) explain how power is altered by various settings on the ultrasound scan; and (3) educate on how to keep ultrasound safe. ALARA: The Clinical View Jacques Abramowicz Obstetrics and Gynecology, Wayne State University, Detroit, Michigan In clinical obstetric ultrasound, the ALARA (As Low As Reasonably Achievable) principle is what should guide the end-user in his/her daily practice. Ultrasound is a form of energy that will cause effects in every tissue it traverses (bioeffects), most likely via two mechanisms: thermal and non-thermal. These effects are not necessarily harmful if certain rules, such as ALARA, are followed. ALARA is based on two very different approaches: some risk/benefit analysis of how much acoustic energy is tolerable to obtain diagnostic information and the precautionary principle which states that benefit must be proven before certain actions are executed. When comparing images obtained at various acoustic output levels, as documented by on-screen thermal (TI) and mechanical (MI) index, it is evident that excellent clinical information may be obtained at very low outputs. Knowledge of clinical end-users continues to be sorely lacking both in the USA ad throughout the world.
Ultrasound Evaluation of Vascular Emergencies Moderator: Srikar Adhikari, MD, MS This session will review the role of ultrasound evaluation in a variety of vascular emergencies.
Fetal Ultrasound and Magnetic Resonance Imaging: Collision Course or Superhighway Moderators: Wesley Lee, MD, Christopher Cassady, MD, FRANZCR
Ultrasound of the Gallbladder and the Biliary Tract
The objectives of this session are to: (1) evaluate challenging obstetric cases in which magnetic resonance imaging (MRI) and prenatal ultrasound are used in case diagnoses; (2) discuss a stepwise approach in evaluation of challenging fetal cases; (3) discuss imaging clues and pitfalls in common fetal abnormalities and when to refer a patient for fetal MRI; and (4) describe pros and cons of the use of MRI as an adjunct to ultrasound in managing difficult fetal cases.
Moderator: Shweta Bhatt, MD This session will cover the following topics: basic gallbladder imaging; advanced gallbladder imaging; and benign and malignant diseases of the bile ducts.
Transcranial and Duplex Doppler Interpretation and Operating Room Applications
Transition from Adult to Pediatrics Moderator: Michael DiPietro, MD Introduction: ‘‘Adult MSK US’’ in a Pediatric World Michael DiPietro Radiology, University Michigan, Ann Arbor, Michigan, United States
Moderator: Michele Johnson, MD After this session, participants will be able to describe and discuss the indications and interpretation of carotid and transcranial Doppler ultrasound studies.
of
S102