Welcome to the May 2014 issue of Ultrasound. We begin this issue with the article that won the “Best paper submitted by a student competition 2013”. Reliability of aortic aneurysm screening measurements, by Rachel Weston Smith and colleagues from Leeds, reports on the impact of various image processing operations on measurements of aortic diameter. The robustness of algorithms for measuring between the surfaces of the anterior and posterior walls was tested. Functions that enhanced boundaries appeared to have the largest effect and measurements of outer to inner walls were the most robust. This work highlights the importance of ensuring consistency in the use of machine settings and may inform efforts to automate aortic aneurysm screening measurements. At a time of unprecedented financial pressure on healthcare services, such automation creates opportunities to reduce costs by allowing deskilling of operators and reducing measurement time.
D’Onofrio et al. from the University of Verona, report on a study to compare the accuracies of contrast-enhanced ultrasound and contrast-enhanced MR in distinguishing benign from malignant lesions of the liver. This retrospective study of 147 solid lesions found that misdiagnosis rates, compared to histology, were similar for both techniques (8.8% and 8.2%, respectively) but much lower (2%) when the techniques were combined. The third research paper in this issue is from the Nippon Medical School in Tokyo. Izumi Miki and colleagues report on the anatomical relationship between the common carotid artery (CCA) and the internal jugular vein (IJV) during head rotation. During percutaneous puncture of the right IJV, the head is rotated to the left, causing overlap of the two vessels on the right. This study on 30 volunteers showed that to minimise the risk of accidental puncture of the CCA, head rotation should be kept to <45° for puncture at 2 cm above the clavicle. Overlap of the two vessels and rounding of the IJV are significantly increased at larger angles of rotation.
Ultrasound is commonly the first line cross-sectional imaging modality for investigation of acute right iliac fossa pain. Emily White and colleagues, from University Hospitals of South Manchester, show that it can be used successfully to distinguish between acute appendicitis and other possible causes. Their pictorial review, entitled “Seeing past the appendix: the role of ultrasound in right ilia fossa pain”, reviews the typical ultrasound appearances of possible gastrointestinal, gynaecological, urological and miscellaneous causes of this symptom as well as those of acute appendicitis. They conclude that by following a systematic approach, it is possible to detect a number of findings that can aid diagnosis. The non-ionising nature of ultrasound is particularly important in investigating conditions that affect the young.
Another area where cost pressures are being felt acutely is in Higher Education Institutions, where some training courses for sonographers have been forced to close. One of the costly elements of such training is the rigorous assessment of clinical competence. In the first of two articles in this issue on Education and Training, Vivien Gibbs, from the University of the West of England, proposes a new clinical assessment framework for diagnostic medical ultrasound students. This framework, which has been accredited by CASE, involves the use of an ultrasound simulator to aid clinical assessments. This approach should help to reduce subjectivity during assessments as well as running costs, another example of the benefits of modern technology. In the second Education and Training article, Alexander Field from the Broomfield Hospital in Chelmsford, discusses the potential use of the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees. This model, originally developed for use in aviation training, maps the progress of students in acquiring competence through five distinct stages from novice to master. The author proposes that application of this model may help to understand the stages that learners go through and hence how they might be helped to make progress.
Two case studies complete this May issue of Ultrasound. The first by Strehle et al. from North Tyneside General Hospital, describes a case of acute acalculous cholycystitis associated with Epstein-Barr virus in a teenager. The second, by Sieczko et al. from the Lister Hospital, Stevenage, describes ultrasound diagnosis of a rare form of ectopic pregnancy within a Caesarean section scar. Although still rare, it seems that incidence of this form of ectopic pregnancy is rising, possibly due to the rising number of Caesarean sections.