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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013SCIENTIFIC E-POSTERS1426579 Process for Selection and Implementation of a New UltrasoundImaging SystemDonald Tradup, 1 * Scott Stekel, 1 Deirdre King, 1,2 NicholasHangiandreou 1 1 Radiology, Mayo Clinic, Rochester,Minnesota USA; 2 Trust Addenbrooke’s Hospital, Cambridge,EnglandObjectives—Many factors come into play when selecting a newultrasound (US) imaging system, including image quality, work flow efficiency,ergonomics and system usability, and system serviceability. Thispresentation will describe a comprehensive process for US equipment selectionand implementation in the practice.Methods—(A) Assessment of practice requirements. (B) Keyscanner features to consider: (1) available transducers; (2) imaging features;(3) work flow efficiency and ergonomic enhancements; (4) technicalcharacteristics and features. (C) In-house prepurchase scannerevaluation: (1) performance testing; (2) volunteer imaging and image qualityassessment; (3) patient imaging.Results—Clinical implementation after purchase: (1) acceptancetesting; (2) configuration of image presets and exam protocols; (3)user training.Conclusions—This presentation will describe a comprehensiveprocess for selection and implementation of new US imaging systems.Key elements of the selection process include a practice needsassessment, review of available scanner features and capabilities, and anin-house evaluation of all candidate systems prior to purchase. After purchase,acceptance testing, system configuration, and user training must allbe addressed.1427024 Usefulness of 4-Dimensional Ultrasonogaraphy to EvaluateEffects of Therapeutic Radiofrequency Ablation for HepatocellularCarcinomaNaoki Hotta Gastroenterology, Masuko Memorial Hospital,Nagoya, JapanObjectives—Studies to evaluate the tumor vascularity in hepatocellularcarcinoma (HCC) have been done extensively with various imagingmodalities because the finding of the vascularity is helpful toevaluate the biological features of the tumor. In the present study, we investigatedwhether 4D real-time flow imaging is useful to display the accurateposition of the radiofrequency ablation (RFA) needle in the tumorand evaluated the efficacy of RFA therapy in patients with HCC.Methods—Fifty-eight patients with 58 HCC lesions admitted toour Masuko Memorial Hospital between November 2007 and February2011 were enrolled in the present study. Their diagnosis was confirmed bydynamic computed tomography and celiac angiography. All patients gavewritten informed consent, and this protocol had been approved by theHuman Studies Committee at Masuko Memorial Hospital. For ultrasound(US) imaging, we used Voluson 730 (GE Medical Systems, Milwaukee,WI), Aplio XG (Toshiba Medical Systems, Tokyo, Japan), and iU22 (PhilipsHealthcare, Bothell, WA) systems for RFA therapy with a convex probe asUS systems. The Aplio and Voluson machine probe is mechanical probe, andthe iU22 probe is matrix array probe. 4D real-time refers here to the displayof 3D moving images composed of 3 orthogonally intersecting scans in thetransverse, longitudinal, and horizontal planes. RFA was carried out underreal-time US guidance. We used an RF generator with 200 W of power connectedto a 17-gauge perfusion needle (Radionics Inc, Burlington, MA); thecircuit was closed through a dispersive electrode.Results—It was possible to obtain an accurate position of thecool-tip needle and to perform the RFA procedure in all 58 HCC patientswith 58 nodules using 4D real-time US machines. We confirmed by variousangles that the needle was inserted into the center of the tumor nodule.The simultaneous study before RFA therapy showed the inflow ofarterial blood and tumor stain, and importantly, it appeared that 4D realtimeUS provided much perceptible information on the spatial relationshipbetween the RFA needle and the target lesion.Conclusions—We experienced the treatment of 58 patient withHCC by RFA using 4D real-time US systems. Application of this methodallowed more accurate cauterization of the tumor.1463047 Using Lung Ultrasound in the Diagnosis of TransientTachypnea of the Newborn and Hyaline Membrane Diseasein Neonates at 28 Weeks’ Gestation and LaterClaudia Cadet,* James Tsung, Ian Holzman Neonatology,Mount Sinai School of Medicine, New York, New York USAObjectives—Hyaline membrane disease (HMD) and transienttachypnea of the newborn (TTN) are common neonatal respiratory disorderswith overlapping clinical presentations, gestational ages, and radiographicpictures. Ultrasonographic findings may distinguish thesedisorders; however, data comparing diagnoses and disease severity bylung ultrasound with those by chest radiography and clinical impressionare lacking. This study aimed to determine if ultrasound (1) can predict theseverity of the clinical course and (2) is diagnostically consistent withchest radiography and the clinical impression.Methods—We conducted a prospective study of infants ≥28weeks’ gestation admitted from October 15, 2011, to June 15, 2012, withrespiratory distress. A group of similar but well patients were enrolled ascontrols. Lung ultrasound was performed on each subject in the first 24hours of life using a GE LOGIQ P5 ultrasound machine with a 10 linearprobe in both sagittal and transverse planes on anterior, axillary, and posteriorviews of each lung. Demographic data, duration of respiratory support(DRS), surfactant administration, radiographic diagnosis, and clinicaldiagnosis were collected. An expert blinded to clinical data determinedultrasonic diagnoses and percentage of B-line confluence (PBC). The primaryoutcome was to correlate ultrasound PBC with DRS. Secondary outcomeswere comparisons of ultrasound diagnoses with those byradiography and clinical impression.Results—Twenty-six neonates (1040–4430 g, 30–40 weeks)were enrolled. Sixteen had clinical diagnosis of TTN; 5, HMD; and 5, normal.DRS ranged from 0 to 797 hours. Linear regression gave a significantcorrelation of DRS with PBC (R = 0.693; P = .001), improved by gestationalage in a multivariable model (R = 0.765, P = .024) but not by birthweight, age at ultrasound, maternal steroids, and mode of delivery. Ultrasoundwas 62.5% sensitive and 100% specific in diagnosing HMD.Conclusions—PBC on lung ultrasound in the first 24 hours oflife in neonates with respiratory distress correlates well with the durationof respiratory support and thus may be a useful predictor of disease severity.Ultrasound was a moderately sensitive and extremely specific test todiagnose HMD.1464510 Central Line Confirmation With Saline and EchocardiographyErshad Elahi,* Ninfa Mehta, Shahriar Zehtabchi EmergencyMedicine, State University of New York Downstate,Brooklyn, New York USAObjectives—The purpose of this study is to determine the confirmationof central venous catheter (CVC) placement by using echocardiographyand agitated saline flushed through the catheter port.S83
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Methods—This study will be a prospective convenience sampleof adults who received either subclavian of internal jugular CVCs asdeemed necessary by the attending physician independent of the study.Enrolled patients will undergo CVC placement by a resident or attendingphysician with a study investigator present to perform echocardiographyand interpret the study of the agitated saline flush in real time A chest x-ray will be performed to confirm CVC placement as the gold standard inconfirmation. Outcome Measures: The primary outcome of the study is thecorrelation of positive interpretation of confirmation of CVC placement onecho with correct placement as seen on chest x-ray. The other outcomemeasure is time to confirmation with echo vs time to confirmation withchest x-ray. Methods of Data Analysis: Data will be presented as medianand interquartiles (25%–75% quartiles) for continuous variables and percentageswith 95% confidence intervals (CIs) for categorical variables.Operating characteristics of bedside ultrasound in confirmation of CVCwill be reported by calculating sensitivity, specificity, and positive andnegative likelihood ratios, with respective 95% CIs. The time from procedurecompletion to confirmation by bedside ultrasound and time fromprocedure completion to confirmation by chest x-ray will be presented asmedian minutes with interquartiles. The comparison of these 2 measurementswill be performed by Mann-Whitney U test. Occurrence of adverseevents will be reported as percentages with 95% CI. Sample size was calculatedwith projected sensitivity of 0.95 with a lower CI limit of 0.90; 91patients will be enrolled in the study. Bedside ultrasounds for each enrolledsubject will be saved and reviewed by a trained sonographer blindedto the chest x-ray results. The inter-rater agreement of the blinded sonographerwith the real-time sonogram interpretations will be measured byCohen’s weighted κ.Results—This study is still undergoing Institutional ReviewBoard approval.Conclusions—None yet.1489380 Vascular Imaging of Lymph Node MetastasesRobert Bard Biofoundation, New York, New York USAObjectives—To demonstrate the appearance of benign and malignantlymphadenopathy with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods—One hundred twenty-five patients with invasivebreast cancer and 221 patients with postoperative lumpectomy/mastectomyfollow-up were prospectively scanned with a GE Voluson E9 unitemploying a linear 12–18-MHz probe with conventional 3D/4D imagingusing 3D angio and glass body power Doppler image reconstruction. Allpatient images were imaged by DCE-MRI with a 3T Siemens unit within1 week of the sonogram. All lesions were later confirmed by surgery.Results—3D PDS and DCE-MRI showed the nodal neovascularityin both axillae in 56 of 346 and 80 of 346 in a unilateral axilla. Thelesions were imaged well by both modalities and showed high correlationwith surgical findings. Imaging showed 136 of 346 positive axillae ascompared to 69 of 346 clinically detectable by palpation.Conclusions—3D power Doppler imaging appears to as sensitiveas DCE-MRI in detecting axillary lymphadenopathy. Vascular mappingmay be useful in preoperative lymphadenectomy planning. 3Dmapping may permit image-guided treatment.1489474 Ultrasonic Imaging of Treated Rheumatoid and PsoriaticArthritisRobert Bard Biofoundation, New York, New York USAObjectives—To follow treatment progress of arthritis with 3Dpower Doppler sonography (3D-PDS) and dynamic contrast-enhancedmagnetic resonance imaging (DCE-MRI).Methods—Nine patients with active rheumatoid arthritis of thewrist and digits and 6 patients with psoriatic arthritis of the phalanges werestudied over a 1-year period.Results—3D-PDS and DCE-MRI showed the vascularity absentposttreatment in 8 of 9 rheumatoid patients with 80% symptomaticimprovement and 4 of 6 psoriatic patients with 80% symptomatic improvement.Inflammatory neovascularity decreases occurred 1 to 2 monthsbefore 80% improvement attained in all responders.Conclusions—Vascular imaging combining DCE-MRI andDoppler ultrasound appears useful in follow-up of medical anti-inflammatorytreatments.1489583 Multimodality Imaging of Laser-Ablated Prostate TumorsRobert Bard,* Daniel Sperling Biofoundation, New York,New York USAObjectives—To follow thermal treatment progress of prostatecancers with 3D power Doppler sonography (3D-PDS) and dynamic contrast-enhancedmagnetic resonance imaging (DCE-MRI).Methods—Fifty-nine patients with Gleason grade 3 or 4 focalprostate cancer were prospectively scanned with a GE Voluson E9 unitemploying a linear 18-MHz probe with conventional 3D/4D imagingusing 3D angio and glass body power Doppler image reconstruction. Allpatient images were imaged by DCE-MRI with a 3.0-T Siemens unitwithin 1 week of the sonogram. Patients were treated with a 980-wavelengthdiode laser with end-fire heat distribution. Safety thermal zoneswere outlined to protect the rectum and neurovascular bundles.Results—3D-PDS and DCE-MRI showed the tumor vascularityabsent posttreatment in 59 of 59 patients. No posttreatment complicationswere noted.Conclusions—Vascular imaging combining DCE-MRI andDoppler ultrasound appears useful in preoperative planning and follow-upof laser ablative treatments.1489649 Multimodality Vascular Imaging of Bladder TumorsRobert Bard,* Daniel Sperling Biofoundation, New York,New York USAObjectives—To demonstrate the appearance of benign and malignantbladder masses with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods—Ninety-five patients with a Gleason grade 4 and/or5 base of prostate cancer and 21 patients with bladder polyps and stoneswere prospectively scanned with a GE Voluson E9 unit employing a linear12–18-MHz probe with conventional 3D/4D imaging using 3D angioand glass body power Doppler image reconstruction. Contrast-enhancedultrasound was performed on 3 patients. All patient images were imagedby DCE-MRI with a 1.5-T Siemens unit within 1 week of the sonogram.All lesions were later confirmed by cystoscopy or surgery.Results—3D-PDS and DCE-MRI showed the tumor vascularconnection from the prostate extending into the bladder base. The vascularframework of transitional cell carcinomas was generally separable fromthe previously noted base of prostate tumors. The lesions of a benign naturewere imaged well by both modalities and included intravesical diseasessuch as polyps, stones, blood clots, and intraluminal prostate debrisfollowing postoperative procedures.Conclusions—3D power Doppler imaging appears to as sensitiveas DCE-MRI in detecting bladder tumors. The role of a possiblescreening test for evaluating hematuria deserves further study. Imaging inpatients with bladder base lesions may disclose unsuspected primary prostatictumors. Vascular mapping may be useful in preoperative planning.1505305 Multimodality Imaging of Microwave-Treated Prostate TumorsRobert Bard Biofoundation, New York, New York USAObjectives—To follow the thermal treatment progress of microwavedprostate cancers with 3D power Doppler sonography (3D-PDS)and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).S84
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2013Journal ofUltrasoundin Medicine
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Small-Animal Preclinical High-Frequ
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2013 AIUM Award WinnersJoseph H. Ho
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2013 AIUM Award WinnersDistinguishe
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Endowment for Education andResearch
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Rosa De Vermette, MD, RDCS,RDMS, RO
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Kee-Hak Lim, MDG. Sharat Lin, PhDTo
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David Stark, MDA. Thomas Stavros, M
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