Australasian Journal of Ultrasound in Medicine最新文献

{"title":"Paediatric orbital ultrasound: Tips and tricks","authors":"Amit Gupta,&nbsp;Shilpa Khanna Arora,&nbsp;Rachna Seth,&nbsp;Rakesh Kumar,&nbsp;Manisha Jana","doi":"10.1002/ajum.12314","DOIUrl":"10.1002/ajum.12314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The orbital structures are ideally suited for ultrasound examination due to their superficial location and cystic composition of the eye. However, orbital ultrasound remains an underutilised modality due to preference for other cross-sectional modalities in general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In this article, we review the basic principles, clinical uses and technique of orbital ultrasound in peadiatric patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>The clinical utility of orbital ultrasound in peadiatric patients is demonstrated using selected cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ultrasound is useful in the diagnosis of various posterior segment pathologies, especially in conditions causing opacification of light-conducting media of the eye. It is also beneficial in diagnosing various orbital pathologies, particularly in differentiating solid from cystic lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The added advantages of its use in children include lack of ionising radiation and reduced requirement of sedation or general anesthesia. Ultrasound is the most practical initial investigation in cases where ophthalmoscopy is limited by opacification of ocular media. The addition of color Doppler on ultrasound can give additional information about the vascularity of the lesion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Use of ultrasound can be streamlined into the workup of various orbital and ocular pathologies either as an initial investigation or as a problem-solving tool in cases with a diagnostic dilemma on other modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 4","pages":"200-206"},"PeriodicalIF":0.0,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644437/pdf/AJUM-25-200.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10417674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of endometrial thickness by transvaginal ultrasound and baseline risk factors as a predictor for endometrial abnormalities in postmenopausal women","authors":"Jyothirmayi Yerrisani,&nbsp;Anoushka Kothari,&nbsp;Kelly Collins,&nbsp;Emma Ballard,&nbsp;Alka Kothari","doi":"10.1002/ajum.12311","DOIUrl":"10.1002/ajum.12311","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>To evaluate the endometrial thickness (ET) as a predictor of endometrial abnormalities in postmenopausal women and whether consideration of baseline risk factors increases diagnostic accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective observational study of postmenopausal women presenting with bleeding or thickened endometrium (≥4 mm) on ultrasound, between 2003 and 2012. Risk factors for endometrial abnormality were analysed using logistic regression. Of 301 women, 220 were symptomatic and 81 were asymptomatic. The median ET was 6 mm (IQR 4–9) for symptomatic women and 9 mm (IQR 6–12) for asymptomatic women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Abnormal pathology was found in 35 symptomatic (15.9%) and 6 asymptomatic women (7.4%). For each 1 mm increase in ET, the odds of an abnormal diagnosis increased by 16.3% (95% CI 9.6–23.5) for symptomatic and 19.9% (95% CI 3.1–39.3) for asymptomatic women. The Youden's index method identified an ET threshold of ≥7.1mm for symptomatic and ≥14.5mm for asymptomatic women. In symptomatic women the sensitivity was 88.6% (95% CI 72.3–96.3) and specificity 69.2% (95% CI 61.9–75.6), while in asymptomatic women the sensitivity was 50.0% (95% CI 13.9–86.1) and specificity was 89.3% (95% CI 79.5–95.0). The addition of age in the symptomatic women model reduced the sensitivity (82.9% (95% CI 65.7–92.8)) but increased the specificity (72.4% (95% CI 65.3–78.6)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ET is a significant predictor of abnormality. In the absence of risk factors, our study suggests that invasive procedures may be withheld until the ET is ≥7.1 mm with bleeding and ≥14.5 mm in asymptomatic women with no bleeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 4","pages":"186-194"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10042397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound research – Sometimes you win, sometimes you lose","authors":"Gillian Whalley","doi":"10.1002/ajum.12310","DOIUrl":"10.1002/ajum.12310","url":null,"abstract":"<p>Since diagnostic ultrasound imaging became widely available in the 1970s, it has become an indispensable and essential diagnostic tool. Initially, it was acceptable to simply see a structure: eventually, the clinical utility grew alongside the technological advancements of the imaging itself. As new technology was added, we found new applications: new diagnostic uses and new prognostic measures. And we continue to do so. Yet, perhaps, unlike our predecessors, we need to demonstrate that any new ultrasound is not only efficacious (i.e. it works in a controlled setting) but also effective (i.e. it works in an uncontrolled setting under normal clinical conditions), while at the same time, it does not add unnecessary delays or costs to patient care. And as we introduce new techniques, these are compared with existing approaches and potentially allow us to abandon the old ways. An important part of this is documenting that different operators get the same results, in the same patients or when reviewing the same images. That is where clinical ultrasound research comes into its own.</p><p>In this issue of AJUM, we have an example of a new technique that looks very promising when applied to a heterogeneous group of real-world patients. Srigandan <i>et al</i>.<span>¹</span> present real-world evidence of the application of attenuation imaging (ATI) to diagnose hepatic steatosis beyond hepatorenal index, which is an older technique. Ferraioli <i>et al</i>.<span>²</span> showed in 2019 that this ATI was very promising in a pilot study under carefully controlled conditions, and Srigandan <i>et al</i>.<span>¹</span> found that when this was applied to their clinical cohort, in usual clinical practice, it also outperformed the hepatorenal index.</p><p>In another large clinical cohort, Piotto <i>et al</i>.<span>³</span> present their data, suggesting that the pyloric muscle reference values used as part of the workup for hypertrophic pyloric stenosis may be outdated and, indeed, incorrect, which can lead to delays in diagnosis. The published reference values have not changed much in three decades, yet ultrasound techniques and imaging quality have surged ahead, so this is not surprising that measurement thresholds have changed. Their study is one of the largest in the literature, and they recommend a significantly lower threshold for diagnosis, which will lead to earlier diagnosis; since this is often diagnosed in the few months of life, early and correct diagnosis is essential.</p><p>Continuing the theme of measurement, Pedretti <i>et al</i>.<span>⁴</span> present data about consistency, or inter-measurer reliability, of cervical length. They invited 244 ultrasound professionals (94% sonographers) to grade 50 randomly selected transabdominal images and found significant variation with poor agreement compared to that reported by transvaginal imaging. The message is clear – operators need to be well train","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"105-106"},"PeriodicalIF":0.0,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351433/pdf/AJUM-25-105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 10-year retrospective cohort study of non-tubal ectopic pregnancy management outcomes in an Australian tertiary centre","authors":"Wei-Guo Nicholas Loh,&nbsp;Alan Maurice Adno,&nbsp;Shannon Reid","doi":"10.1002/ajum.12312","DOIUrl":"10.1002/ajum.12312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Non-tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence-based guidelines for the management of NTEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys-MTX) and/or local ultrasound-guided injection of MTX and/or KCl intra-sac (L-MTX, L-MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non-statistically significant greater mean time to serum ß-human Chorionic Gonadotrophin &lt;5 IU/L, mean length of hospitalisation, mean number of follow-up visits and hospital re-presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 4","pages":"166-175"},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644438/pdf/AJUM-25-166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9932068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Realistic and inexpensive ultrasound phantoms to demonstrate aortic aneurysm and aortic dissection","authors":"Kimberly M. Rathbun,&nbsp;Claire F. Harryman,&nbsp;Corey Moore","doi":"10.1002/ajum.12309","DOIUrl":"10.1002/ajum.12309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Using ultrasound to evaluate for the presence of aortic pathology is a common procedure in the emergency department. Phantoms are models that are used to simulate clinical conditions for teaching ultrasound-related skills. To date, no ‘homemade’ phantom has been created to model aortic aneurysms, and no phantoms exist to model aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used several readily available, inexpensive ingredients to create ultrasound phantoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>These phantoms realistically mimic aortic aneurysm and aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These are the first ‘homemade’ phantoms that demonstrate aortic pathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have created realistic, affordable, easily reproducible phantoms for use in teaching clinicians to use ultrasound when evaluating patients for aortic aneurysm and/or aortic dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 4","pages":"195-199"},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithm-based approach to focal liver lesions in contrast-enhanced ultrasound","authors":"Kheng Song Leow,&nbsp;Christine Ying Kwok,&nbsp;Hsien Min Low,&nbsp;Rahul Lohan,&nbsp;Tze Chwan Lim,&nbsp;Su Chong Albert Low,&nbsp;Cher Heng Tan","doi":"10.1002/ajum.12306","DOIUrl":"10.1002/ajum.12306","url":null,"abstract":"<p>Focal liver lesions are commonly encountered. Grey-scale and Doppler sonographic characteristics of focal liver lesions are often non-specific and insufficient to conclusively characterise lesions as benign or malignant. Contrast-enhanced ultrasound is useful for the characterisation of FLLs in patients who are unable to undergo contrast-enhanced computed tomography or magnetic resonance imaging. It is also easily available and relatively cheap. However, interpretation of contrast-enhanced ultrasound can be challenging without a systematic approach. In this pictorial essay, we highlight an algorithm-based approach to FLLs and discuss the characteristic contrast-enhanced ultrasound features of commonly encountered and clinically significant focal liver lesions.</p>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"142-153"},"PeriodicalIF":0.0,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351431/pdf/AJUM-25-142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound-guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report","authors":"Elinor Cripps,&nbsp;Alan Fahey,&nbsp;Peter James Snelling","doi":"10.1002/ajum.12308","DOIUrl":"10.1002/ajum.12308","url":null,"abstract":"<p>Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard-volume point-of-care ultrasound-guided pericapsular nerve group (PENG) block performed in the emergency department. The standard-volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.</p>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"154-156"},"PeriodicalIF":0.0,"publicationDate":"2022-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9738758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis","authors":"Shrivuthsun Srigandan,&nbsp;Marilyn Zelesco,&nbsp;Steven Abbott,&nbsp;Christopher J Welman","doi":"10.1002/ajum.12297","DOIUrl":"10.1002/ajum.12297","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hepatic steatosis screening is required to assess high-risk populations, identify those for intervention, monitor response and prevent disease progression and complications. Liver biopsy and magnetic resonance imaging proton density fat fraction are current gold standards, but are limited by biopsy risk factors, patient tolerance and cost. Non-invasive, cost-effective, semi-quantitative and quantitative ultrasound assessment exists. The aim of this study was to assess the correlation between the semi-quantitative hepatorenal index (HRI) to assess hepatic steatosis using the quantitative attenuation imaging (ATI) as a reference standard, in adults with varied suspected liver pathologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected prospectively between April 2019 and March 2020 at a tertiary institution on any patient &gt;18 years referred to US assessment of suspected liver pathology. The only exclusion criteria were absent or invalid HRI or ATI measurements. Three hundred fifty eight patients were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a significant weak positive correlation between HRI and ATI (r = 0.351, P &lt; 0.001) and between HRI steatosis grade (SG) and ATI SG (r = 0.329, P &lt; 0.001), using previously established cut-off values. With ATI as the reference standard, there was no significant correlation between HRI and hepatic steatosis within steatosis grades, nor for no (SG = 0) or any (SG &gt; 0) hepatic steatosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study in a typical heterogeneous clinical population suggests the semi-quantitative HRI is of limited use in hepatic steatosis imaging. As HRI is the objective measure of the subjective brightness (B)-mode assessment, this imaging feature may not be as reliable as previously thought. Quantitative ATI may be the preferred non-invasive technique for hepatic steatosis assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"107-115"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351430/pdf/AJUM-25-107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diastolic flow in the left ventricular outflow tract – A normal physiological and underappreciated echocardiographic finding","authors":"Brian Cowie,&nbsp;Ben Costello,&nbsp;Leah Wright,&nbsp;Kristel Janssens,&nbsp;Erin Howden,&nbsp;Darragh Flannery,&nbsp;Steve Foulkes,&nbsp;Roman Kluger,&nbsp;Andre La Gerche","doi":"10.1002/ajum.12307","DOIUrl":"10.1002/ajum.12307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Diastolic waveforms in the left ventricular outflow tract (LVOT) are commonly observed with Doppler echocardiography. The incidence and mechanism are not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational study of 186 adult patients, athletes and non-athletes, free of known cardiac disease, presenting for comprehensive transthoracic echocardiography at a research institute. We aimed to evaluate the incidence and echocardiographic associations between LVOT diastolic waveforms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Left ventricular outflow tract early to mid-diastolic waveforms were present in 100% of athletes and 95% of non-athletes. The LVOT diastolic velocity time integral was larger in athletes than non-athletes with a mean 8.3 cm (95% CI (7.6–8.9)) vs. 5.1 cm (4.4–5.9) (P &lt; 0.0001). Multivariate predictors of this diastolic waveform were age (P = 0.002), slower heart rate (P = 0.035), higher stroke volume (P = 0.003), large mitral E (P = 0.019) and higher E/e' (P = 0.015).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>An LVOT early diastolic wave is a normal physiological finding. It is related to a flow vortex redirecting diastolic mitral inflow around anterior mitral valve leaflet into the LVOT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early to mid-diastolic LVOT waves are present in almost all patients but more prominent in young athletes than non-athletes. Diastolic LVOT waves increase with younger age, slower heart rate, larger stroke volume and enhanced diastolic function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"137-141"},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351428/pdf/AJUM-25-137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9701072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity in ultrasound practice and education","authors":"Gillian Whalley","doi":"10.1002/ajum.12304","DOIUrl":"10.1002/ajum.12304","url":null,"abstract":"<p>While reviewing this edition of the journal, I began reflecting on the diversity of ultrasound delivery. In this AJUM issue, we have a unique and rare furcate umbilical cord insertion diagnosis,<span>¹</span> a primer on emergency breast lesions,<span>²</span> a systematic review investigating the role of ultrasound in surgical patients in low and middle income countries,<span>³</span> and two articles about teaching non-experts to undertake ultrasound, including to guide knee procedures<span>⁴</span> and to diagnose bone fractures.<span>⁵</span> I can remember a time when the education was largely informal and at the bedside – the so-called ‘see one, do one’ approach. Of course, it was never a single examination, it took hundreds, even thousands of patients and hours of scanning to become proficient. Ultrasound education was subject to the type of hospital and services it provided; to the range of pathology in patients that presented; and to referral patterns. Ultrasound education was delivered by clinical experts to people wishing to become ultrasound experts. Increasingly, ultrasound education is patient-centred and focussed on clinical need rather than speciality- or profession-specific.</p><p>Initially ultrasound was used to identify anatomy, later function and blood flow, and now we find ourselves able to characterise tissue. In this AJUM edition, there is an excellent review article from colleagues at the Mayo Clinic,<span>²</span> in which they describe the ultrasound appearances and characteristics of breast lesions presenting in emergency or urgent care facilities. Not only is ultrasound being used to diagnose these breast lesions but also ultrasound is an important part of the emergency care triage pathway.</p><p>In the acute care setting, is an original research paper by Snelling and colleagues,<span>⁵</span> in which they describe the learning curve of novices for the diagnosis of distal forearm fractures in children. That ultrasound is proving to be an adjunct, even replacement, for X-ray shows how far ultrasound technology, and our knowledge, has evolved. The evolution in ultrasound users is also apparent in this paper in which they show that nurse practitioners can achieve diagnostic competency after just 15 scans. This approach has the potential to improve access and result in shorter times to diagnosis, without using ionising radiation.</p><p>Another area of clinical advancement is the use of ultrasound to support procedures. As a potential patient, it seems very logical to me that using ultrasound to guide needle or cannula placement is better than ‘going in blind’. As an ultrasound professional, and as a citizen, I want to know that the additional cost of ultrasound guidance is warranted. Deleskey <i>et al</i>.<span>⁴</span> used a bespoke knee phantom to evaluate the use of ultrasound-guided versus landmark-guided knee arthrocentesis by","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 2","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201200/pdf/AJUM-25-53.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9632435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}