Australasian Journal of Ultrasound in Medicine最新文献

{"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}

{"title":"Ultrasound diagnosis of hypertrophic pyloric stenosis – Time to change the criteria","authors":"Lino Piotto,&nbsp;Roger Gent,&nbsp;Ajay Taranath,&nbsp;Giovanni Bibbo,&nbsp;Day Way Goh","doi":"10.1002/ajum.12305","DOIUrl":"10.1002/ajum.12305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ultrasound is the examination of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). A correct diagnosis is dependent on the technique and measurement accuracy. However, in the world literature there is a wide range of values suggested for the diagnosis of this condition. The current minimum measurements used to diagnose HPS seem excessively large, and therefore, we set out to redefine these values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was performed on 607 patients (615 scans) being investigated for HPS. The length and transverse diameter of the pyloric canal, and thickness of the pyloric muscle were measured. All results were correlated with clinical and surgical findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study, the muscle thickness in the normal group was &lt;2.0 mm than in HPS infants having a muscle thickness of 2.0–5.0 mm. All the pyloric canal lengths in the normal group were &lt;5.0 mm than in those with HPS having a length of 10.0–24.0 mm. The transverse diameters ranged from 6.0 to 11.0 mm in the normal group compared with those with HPS having a diameter between 8.0 and 16.0 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current criteria for sonographic diagnosis of HPS should be redefined. The canal length is the single most important discriminator, with a clear separation between normal and abnormal. The commonly used 16.0-mm measurement is too long and should be reduced to 10.0 mm (without the risk of false positives). In many cases, the muscle thickness in those with HPS is as low as 2.0 mm, considerably less than the 3.0 mm that is currently used. The transverse diameter is not a useful discriminator for HPS. The use of current values will delay the diagnosis and timely treatment of this condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"116-126"},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351432/pdf/AJUM-25-116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9601118","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":"Consistency in the transabdominal ultrasound measurement of cervical length in mid-pregnancy","authors":"Michelle K. Pedretti,&nbsp;Elizabeth A. Nathan,&nbsp;Dorota A. Doherty,&nbsp;Jan E. Dickinson","doi":"10.1002/ajum.12303","DOIUrl":"10.1002/ajum.12303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Western Australian Preterm Birth Prevention Initiative recommends a transabdominal cervical length (TACL) measurement at the mid-pregnancy ultrasound to screen low-risk women for preterm birth risk. In view of this recommendation, we assessed the inter-observer consistency of TACL screening in mid-pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Routinely collected mid-pregnancy TACL ultrasound images were graded from 0 to 4 according to the anatomical landmarks identified by a single expert. A random selection of 10 images of each grade were disseminated in an electronic survey to determine inter- and intra-observer variations in the classification of the cervical image.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 244 participants graded 50 TACL images. Six participants repeated the grading. Overall agreement to the exact initial grade for all images was 49.6%, highest for images at both ends of the spectrum (83% Grade 0 and 70.4% for Grade 4). Overall agreement to the initial diagnostic Grades 3 and 4 was 75.3% (95% CI 74.5–76.0%) and was higher when the maternal bladder was empty. There was moderate inter-rater agreement (κ = 0.42) for Grades 3 and 4 (diagnostic) or Grades 1 and 2 (non-diagnostic). The intra-rater agreement was fair to good (κ = 0.59, 95% CI 0.49–0.70) for those who repeated the assessment (including the expert grader).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sonographic CL screening is considered an important tool for the identification of women at high risk of preterm birth. Image classification of TACL performed poorly compared with previous studies assessing transvaginal cervical length. Improved reliability and measurement consistency may be achieved through high levels of quality assurance, ongoing training and image audit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 3","pages":"127-136"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351434/pdf/AJUM-25-127.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9565312","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":"Surgical applications of ultrasound use in low- and middle-income countries: A systematic review","authors":"Sergio M. Navarro,&nbsp;Hashim Shaikh,&nbsp;Hodan Abdi,&nbsp;Evan J. Keil,&nbsp;Simisola Odusanya,&nbsp;Kelsey A. Stewart,&nbsp;Eugene Tuyishime,&nbsp;Dennis Mazingi,&nbsp;Todd M. Tuttle","doi":"10.1002/ajum.12302","DOIUrl":"10.1002/ajum.12302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ultrasound is a portable technology able to deploy health care effectively in low resource settings. This study presents a systematic review to determine trends in the utility and applicability of this technology in low- and middle-income countries (LMIC), specifically for surgical applications. The review includes characterising and evaluating trends in the geographic and specialty-specific use of ultrasound pertaining to surgical disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The databases such as Medline OVID, EMBASE and Cochrane were searched from 2010 through March 2019 for studies available in English, French and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. A categorical analysis of ultrasound use for surgical disease in LMICs was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6276 articles were identified, with 4563 studies included for the final review. A total of 221 studies were selected researching ultrasound use in LMICs to treat surgical disease. Most studies identified ultrasound usage focused on general surgery, acute care surgery and surgical ICU topics (52%, 115) followed by computed tomography surgery studies (20%, 44). Most studies were retrospective in nature, with 81% (180) of research studies generated in four countries (India, Pakistan, Nigeria and Egypt). Ultrasound proved to be a feasible technique for utility in pre-operative diagnosis, cost-effectiveness and prediction of surgical outcomes. Findings are limited by the limited number of randomised clinical trials reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion and global health implications</h3>\u0000 \u0000 <p>Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilisation of this relatively low-cost, portable imaging technology in low resource settings for surgical disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 2","pages":"80-97"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201203/pdf/AJUM-25-80.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560843","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":"Urgent and emergent breast lesions – A primer for the general radiologist, on-call resident and sonographer","authors":"Asha A. Bhatt,&nbsp;Genevieve A. Woodard,&nbsp;Christine U. Lee,&nbsp;Gina K. Hesley","doi":"10.1002/ajum.12296","DOIUrl":"10.1002/ajum.12296","url":null,"abstract":"<p>There are very few true breast emergencies. While infrequent, women do present to emergency departments or urgent care centres with breast-related concerns. In this case-based review, both common and uncommon urgent and emergent breast lesions are presented, emphasising ultrasound characteristics and imaging optimisation to improve accurate diagnosis and appropriate recommendations.</p>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 2","pages":"54-65"},"PeriodicalIF":0.0,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800423","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":"Comparison of knee arthrocentesis first-attempt success between Ultrasound-Guided, Ultrasound-Localised and Landmark-Guided techniques in the novice: A crossover study with random order of events","authors":"Edward Matthew Delesky,&nbsp;John Gaughan,&nbsp;Brian Roberts,&nbsp;Sarab Sodhi","doi":"10.1002/ajum.12294","DOIUrl":"10.1002/ajum.12294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>To compare knee arthrocentesis first-attempt success using landmark-guided, ultrasound-localised and ultrasound-guided techniques when performed by third-year medical students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, crossover study with randomised order of events, medical students performed three different arthrocentesis techniques on knee models: landmark-guided, ultrasound-localised and ultrasound-guided. Each subject attempted the techniques in a randomly assigned permutation at both high- and low-volume simulated knee effusions. The data were analysed with general estimating equations, which produced odds ratios comparing first-attempt success between different techniques at all effusion volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety four of 111 third-year medical students were enrolled. Proportions of first-attempt success for the landmark-guided, US-localised and US-guided were 72%, 86% and 75%, respectively. For all effusion volumes, US-localised demonstrated a statistically significant increase in first-attempt success over the landmark-guided technique, OR = 2.38 (95% CI: 1.52–3.70). There was a greater increase in first-attempt success at low-volume effusions, OR = 2.86 (95% CI: 1.47–5.56), but no significant increase at high-volume effusions: OR = 1.85 (95% CI: 1.00–3.45). For all effusion volumes, US-guided demonstrated no difference to first-attempt success compared with landmark, OR = 1.15 (95% CI: 0.71–1.85). At low-volume effusions, US-guided demonstrated a statistically significant increase in first-attempt success over landmark-guided, OR = 2.17 (95% CI: 1.10–4.35), with no significant difference at high volumes, OR: 0.55 (95% CI: 0.28–1.06).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The data presented here suggest that in this simulated knee model of arthrocentesis, ultrasound-guided approaches tend to have best efficacy at lower volume effusions, while ultrasound localized tends to do best at higher volume effusions, and both tended to perform better than the landmark technique. This study specifically looked at novices to both arthrocentesis and ultrasound, so extrapolating these results to other groups would require more study, but suggests that ultrasound incorporation into arthrocentesis benefits may offer some benefits for success rates and first attempt success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In simulated k","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"25 2","pages":"74-79"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201202/pdf/AJUM-25-74.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9704951","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}