American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Fisher test was used to assess the significance of the morphologic changesbetween the exposed and nonexposed groups.Results—Twenty hemangiomas in 18 patients (66% female/34% male; age range, 1 month–1 year) were studied. Nine patients were in theexposed group and 9 in the nonexposed group. Single lesions: 89%; 2 lesions:11%. Location: 75% head and neck (20% cheek, 20% lips, 13.6% nose, 13.3%scalp, 13.3% temple, 6.6% eyelid, 6.6% neck, 6.6% submandibular), 15%trunk, 5% upper extremity, 5%lower extremity. The exposed group showed asignificant decrease (P < .05) of the volume (P = .033) and transverse axis (P= .033) of hemangiomas in comparison with the nonexposed group. The restof the P values were thickness, P = .057; longitudinal axis, P = .37; thicknessof vessels, P = 1; and peak systolic velocity, P = 1.Conclusions—Sonography can register the changes in the morphologyof cutaneous hemangiomas of infancy that are medically treated.Propanolol can significantly reduce the volume and transverse axis of hemangiomasof infancy in comparison with the nontreated group of patients.1537671 Natural History of Fetal Pyelectasis and Risk of InfantUropathyEmily Neri, 1 * Jean Goodman, 1,3 Jennifer Peck 2 1 Obstetricsand Gynecology, 2 School of Public Health, University of OklahomaHealth Sciences Center, Oklahoma City, Oklahoma USA;3Obstetrics and Gynecology, Loyola University Medical Center,Maywood, Illinois USAObjectives—The objectives of this study were to (1) determinethe rate of resolution of fetal pyelectasis identified in the second trimesterprior to delivery and (2) determine the predictive value of varied degreesof pyelectasis identified in the antenatal period and infant uropathy.Methods—A retrospective study was designed, with review ofall prenatal ultrasounds with a diagnosis of second-trimester pyelectasis inour established database between May 2010 and January 2011. Per ourroutine for this diagnosis, repeat ultrasounds in the third trimester wereperformed and also reviewed. Maternal and newborn records from ourelectronic medical record and infant renal ultrasound records were examined.Exclusion criteria were chromosome abnormalities, fetal anomalies,multiple pregnancies, and delivery not at our facility. The incidences of pyelectasisin the second trimester, persistence in the third trimester, and persistenceafter delivery were defined. Varied pyelectasis measure cut pointswere determined to assess the utility of pyelectasis as a screening test forpostnatal uropathy.Results—During the 9-month period, there were 119 secondtrimesterultrasounds with isolated pyelectasis identified with subsequentthird-trimester ultrasound and delivery at our facility. The incidence of pyelectasiswas 1%, with a mean anteroposterior renal pelvis diameter of 5.2mm in the second trimester and 6.0 mm in the third trimester (range, 4–10mm). Twelve percent of second-trimester pyelectasis resolved by the thirdtrimester, and 45% resolved by delivery. Of third-trimester follow-up scans,all those who resolved by delivery had measured diameters
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Table 1. Fluid Location in Relation to the Lateral Femoral Epicondyle at 0° and 30°of Knee Flexion (N = 40 Knees)Supine Supine 30° Standing Standing 30°Presence of Fluid Extended (%) Flexed (%) Extended (%) Flexed (%)No fluid 13 (32.5) 28 (70) 2 (5) 31 (77.5)Anterior only 3 (7.5) 4 (10) 0 (0) 6 (15)Anterior and deep 19 (47.5) 6 (15) 28 (70) 3 (7.5)Deep only 5 (12.5) 2 (5) 10 (25) 0 (0)Posterior 0 (0) 0 (0) 0 (0) 0 (0)1538060 Three-Dimensional Ultrasound of the Cumulus OophorusKyle Beiter, 1 * Thomas Hilgers, 2 Jeanine Johnson, 2 RachelStites 2 1 Saint Peter’s Healthcare System, New Brunswick,New Jersey USA; 2 Reproductive Ultrasound Center, Pope PaulVI Institute for the Study of Human Reproduction, Omaha, NebraskaUSAObjectives—The ability to observe the cumulus oophorus byultrasound has been controversial over the years. The Pope Paul VI Institutefor the Study of Human Reproduction’s Reproductive UltrasoundCenter has been very interested in this topic for a number of years and haspublished on it. This e-poster introduces the first published photos of thecumulus oophorus taken by 3D ultrasound.Methods—Examination was performed using a Medison AccuvixV20 Prestige ultrasound system. A 3D endovaginal 5–9-MHz transducerwas used. After 2D scanning of the cumulus oophorus wascompleted, a 3D acquisition with the region of interest set to encompassthe area of the dominant follicle and cumulus oophorus was acquired.SonoView Pro software was used to manipulate the 3D volumetric data byrotating the x-, y-, and z-axes to obtain a 3D rendering of the cumulusoophorus.Results—A 3D image of the mature follicle with the eccentricallylocated cumulus oophorus was obtained and is shown. This image isthen rotated on its axis, and it can be seen from different directions.Conclusions—This presentation shows that 3D ultrasound canprovide extraordinary pictures of the cumulus oophorus in a way thatleaves the determination of its presence inescapable. Further refinement ofthis technique should help in the ultrasound evaluation of normal ovulationpatterns and the various disorders of human ovulation.1538125 Design and Evaluation of a Point-of-Care UltrasoundCurriculum for Pediatricians Involved in Global HealthSachita Shah, 1,2 * Meera Muruganandan, 3 Sachin Shah, 4Randheer Shailam, 5 Sara Stulac, 2,6 Kim Wilson 6 1 EmergencyMedicine, Harborview Medical Center, University ofWashington School of Medicine, Seattle, Washington USA;2Partners in Health, Boston, Massachusetts USA; 3 EmergencyMedicine, Rhode Island Hospital, Brown University, Providence,Rhode Island USA; 4 Cardiology, Lahey Clinic, Burlington,Massachusetts USA; 5 Radiology, Massachusetts GeneralHospital, Harvard Medical School, Boston, MassachusettsUSA; 6 Pediatric Global Health, Boston Children’s Hospital,Boston, Massachusetts USAObjectives—As ultrasound becomes more portable, durable,and affordable, point-of-care ultrasound use by nonradiologists has beenrapidly increasing both in the United States and in resource-poor developingworld settings. However, training programs for ultrasound skillsspecific to global health work and pediatrics are lacking, leading to a dangerousknowledge gap for this operator-dependent technology. We describeour response to this knowledge and training gap with a novel curriculumin bedside ultrasound focused on pediatric clinical conditions common inresource-limited settings. Our primary objective is to describe this curriculumand response to the pilot training program.Methods—The 15-hour course was taught by a multidisciplinaryfaculty and focused on bedside clinician-performed ultrasound techniquesfor assessment of the pediatric global burden of disease. Lecturedidactics were complemented by practical skills sessions using live modelsand hand-carried ultrasound machines. An anonymous postcourse selfassessmentsurvey was conducted to assess confidence and attitudes.Results—The curriculum included training on ultrasound safetyand physics, uses in trauma, including the focused assessment with sonographyfor trauma exam, hemothorax and pneumothorax, procedural guidance,echocardiography (pericardial effusion, systolic dysfunction, andrheumatic valvular disease), liver lesions, splenomegaly, appendicitis, pyloricstenosis, and skin/soft tissue infections, including pyomyositis. Postcourseself-assessments of the participants were overwhelmingly positivewith high levels of confidence in the various ultrasound techniques exploredduring the course despite no prior experience. After the training, studentsfelt the most confident with trauma, pericardial effusion, skin/softtissue ultrasound, and procedural guidance and the least confident withidentification of specific liver lesions and use of the inferior vena cava asa proxy for dehydration. One hundred percent of the participants believedultrasound would be useful in low-resource settings.Conclusions—This clinical course of ultrasound skills for pediatriciansembarking on global health careers may serve as one modelfor more effectively preparing trainees to work in developing countries.1538182 Emergency Medicine Intern Ultrasound Proficiency:A Longitudinal StudyElizabeth Pontius, 1 * Kerri Layman, 1,2 Michael Antonis 1,21Emergency Department, MedStar Washington HospitalCenter, Washington, DC USA; 2 Emergency Department, Med-Star Georgetown University Hospital, Washington, DC USAObjectives—Our goal was to determine the level of proficiencythat interns had with emergency bedside ultrasound (US) over the courseof a year.Methods—Nineteen Georgetown School of Medicine 2010graduates entered emergency medicine residencies. An e-mail was sent toeach of the 19 graduates 3 times over the course of the 2010–2011 academicyear, in July 2010, February 2011, and July 2011. The e-mail containeda link to a 6-question Web-based survey. Graduates were askedwhether they had participated in an emergency bedside US elective and ifthey had other exposure to US during medical school. They were alsoasked to rate their proficiency with bedside US at the start of residency andat the time of the survey. Last, they were asked to rate themselves againsttheir peers in bedside US proficiency.Results—Of the 19 graduates, 15 responded to the survey inJuly 2010, 12 in February 2011, and 8 in July 2011. Half of respondentshad participated in an emergency bedside US elective, and approximately75% had exposure to US in another setting during medical school. In thefirst survey, respondents reported their level of comfort as 5.67 at the startof the year and 6.47 currently on a 10-point scale. By midyear, respondentsrated their level of comfort as 4 at the start of the year and 6.83 currently.In July 2011, respondents rated their comfort level as 4.13 at the start ofthe year and 7.5 currently. The resident’s self-assessed level of proficiencywhen graded against their peers did not change appreciably, from 7.13 ona 10-point scale at the start of the year, 6.83 at the midyear mark, and 7.13at the end of the year.Conclusions—Emergency medicine interns became more proficientwith bedside US over the course of their intern year. As the year progressed,however, they rated their level of comfort at the start of the yearlower than they had initially. Further study is needed to determine if theemergency bedside US elective in medical school provides any benefit.S98
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