Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013tients with solid breast masses (139 benign, 31 malignant) were prospectivelyincluded in this study. For each lesion, B-mode ultrasound (US) andSE images were obtained. For each lesion, elasticity scores were determinedwith a 5-point scoring method by SE. The findings were comparedwith histopathology. The diagnostic performances for the elasticity scoringand B-mode US methods were determined.Results—The mean scores on SE were 2.58 ± 0.57 for benignlesions and 3.85 ± 0.69 for malignant lesions. Sensitivity, specificity, andaccuracy for the 5-point scoring method were 78%, 92%, and 88%, respectively;88%, 74%, and 84% for B-mode US when a cutoff point betweenscores 3 and 4 was used.Conclusions—After B-mode US analysis, qualitative evaluationwith the 5-point scoring method by SE is a complementary methodthat increases specificity when differentiating between benign and malignantbreast masses.1538946 Masses in Pregnancy: Blood Flow Provides Vascular Cluesto DiagnosisConstance Bitters,* Beth Kline-Fath Ultrasound, Radiology,Cincinnati Children’s Hospital Medical Center, Cincinnati,Ohio USAObjectives—Determining the etiology of an intrauterine masscan be difficult. The goal of this study was to determine if the origin ofthese masses can be established via color Doppler flow.Methods—An Institutional Review Board–approved retrospectivereview was performed by searching our fetal database from 2004to 2012. Twelve cases of intrauterine soft tissue masses without identifiablefetal parts were discovered. The lesions were evaluated with ultrasoundfor location and echo texture. Doppler was used to determine thevascular supply, site of supply, number of vessels (hypervascular ≥3 vessels),and waveforms.Results—The lesions were 8 proven chorioangiomas (CA), 2twin reversed arterial perfusion (TRAP), 1 fibroid, and 1 chronic intrauterinedemise (IUD). In the CA, the soft tissue mass was hypervascularand embedded in the placenta with the fetal placental cord insertionalong the margin. Six were heterogeneous and 2 homogeneous. Vascularityextended primarily from the placental cord insertion and superficialplacenta with less extending to the deep placenta. Five contained low-resistancearteries, and all had pulsatile veins. The 2 TRAP were heterogeneousand abutted the placenta contained in an encircling membrane. Bothhad 2 vessel feeders with a single artery and vein centralized in the mass.In 1 pregnancy, the arterial waveform was documented as reversed whencompared to the normal fetus. The fibroid was homogeneous and in themyometrium along the placental edge with a supplying artery and veinextending deep myometrium. The chronic IUD showed heterogeneoustissue with no color flow. A membrane was noted, supporting diamniotictwin gestation.Conclusions—The vascular supply can be helpful in evaluationof amorphous intrauterine masses. In CA, the lesion is hypervascularand embedded in the placenta, with vessels originating from the placentalsurface and fetal placental cord. In TRAP, the lesion demonstrates a centralizedvascular supply, with diagnosis supported by the presence of reversedarterial flow. Fibroids demonstrate vessels extending into the deepmyometrium. Chronic IUD should be considered in the absence of vascularflow, especially in the presence of a separating membrane.1539098 Ultrasound-Guided Vascular Access on a Phantom: ATraining Model for Medical Student Education—Trends inData, 2010–2012Lydia Sahlani, 1 * Eric Adkins, 1,2 David Bahner 1 1 EmergencyMedicine, 2 Internal Medicine, Ohio State University WexnerMedical Center, Columbus, Ohio USAObjectives—Patient safety and prevention of medical errorshave been emphasized as an integral part of medical education. Focusingon ultrasound-guided vascular access (USGVA) in the medical school curriculumcan improve patient safety and prevent errors. We reviewed a cohortof second-year medical students (MS2) to assess their proficiencywith USGVA access in 2010, 2011, and 2012.Methods—This study was an observational cohort study ofMS2s during their Introduction to Clinical Medicine program during 2010,2011, and 2012. Students reviewed an online training module from EM-SONO.com about USGVA, completed a quiz, and participated in a didacticsession using a Blue Phantom block gel model. Students were dividedinto groups and allowed to practice the skills. After the practice session,they were graded by a proctor using a standardized scoring sheet. The studentswere evaluated on their ability to visualize the simulated vessel indifferent planes, perform vascular cannulation in both the short and longaxes, the number of needle sticks attempted, and successful cannulation.Results—A total of 600 MS2s with complete data from 2010through 2012 were included. Students were able to cannulate the vessel inthe long axis with a mean of 1.25 sticks (SD, 0.60; 95% confidence interval[CI], 1.20–1.30). They were able to cannulate the vessel in the shortaxis with a mean of 1.33 sticks (SD, 0.67; 95% CI, 1.27–1.38). A nonparametrictest, the Wilcoxon signed rank test, for paired data was used forfurther analysis. We tested the hypothesis that the median of differencebetween the number of sticks in long and short axes would equal 0. Combineddata show there was a significant difference (P = .0007) between thenumber of long- and short-axis sticks.Conclusions—A structured ultrasound curriculum can helpMS2s learn the psychomotor skills necessary to cannulate a vessel on aphantom using ultrasound guidance. Results indicate that there is a significantdifference between long- and short-axis sticks, with the short axisrequiring more sticks to cannulation. Future studies could focus on improvementof short-axis sticks to cannulation and retention of the skill astested at various intervals of training.1539608 Bayesian Methods for Streamlining and Enhancing theAnalysis and Presentation of Myocardial Strain and StrainRate DataOlga Neyman, 1 * Michelle Milne, 2 Gautam Singh, 3 RaviRasalingam, 4 James Miller, 2 Mark Holland 2,3 1 BiomedicalEngineering, 2 Physics, 3 Pediatrics, 4 Internal Medicine, WashingtonUniversity, St Louis, Missouri USAObjectives—Quantitative evaluation of global and regional myocardialstrain has been shown to be feasible in the echocardiographic laboratory.In spite of the potential for such strain-based evaluation, cliniciansfrequently find the time required to analyze the data to be prohibitive andthe amount of data to be far too large and unwieldy to permit routine clinicaluse. The goal of this work is to present to the physician a concise summaryof physiologically meaningful results (eg, values of the maximumstrain, strain rate, and time to maximum strain) as well as significantly improvedstrain rate vs time curves to facilitate meaningful interpretations.Methods—We introduce Bayesian methods for model selectionand parameter estimation that result in improved quality of automateddata reduction and reporting. Bayesian probability-based methods thatpermit modeling strain and strain rate curves such that analysis, interpretation,and identification of specific features in these data are simplified,less time intensive, less affected by anomalous noise, and less operatordependent than current manual interpretation approaches will be describedand illustrated.Results—Bayesian-based analysis methods were applied tomyocardial strain data collected from the left ventricle of 49 adolescents.Echocardiographic data were acquired using a GE Vivid 7 imaging system,and the strain data were generated using the GE EchoPac system.Initial results show strain curves derived from model functions constructedusing the Bayesian parameter estimation approach to be in good agreementwith the acquired strain data. The strain rate data derived from theS100