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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131539989 The Work Flow Impact of Universal Transvaginal CervicalLength Screening With Anatomic Surveys in an UltrasoundUnitEileen Wang,* Alexander Friedman, Samuel Parry, NadavSchwartz Obstetrics and Gynecology, University of Pennsylvania,Philadelphia, Pennsylvania USAObjectives—Low-risk women with a short cervix transvaginallyat time of the second-trimester anatomic survey may have an increasedrisk of preterm birth. Vaginal progesterone may be offered toreduce this risk. Cost-effective analyses of universal transvaginal cervicalscreening (TVCL) have not included the impact of the extra time to performTVCLs on the work flow of an ultrasound (US) lab. We comparethe times for anatomic surveys and growth scans in periods before andafter universal TVCLs were instituted.Methods—This is a prospective observational study done in anurban tertiary care center. In our 4-room US unit, after sonographers (SGs)scan, the images are reviewed by the physician (MD), who then sees thepatient to either scan or discuss results. After implementation of TVCL, patientsvoid prior to TVCL after the anatomic survey. Durations of studieswere recorded for quality improvement. Studies by maternal-fetal medicinefellows or with missing times were excluded. The times for anatomicsurveys, for growth scans, and for patients to void were collected and categorizedper SG (n = 8) and per supervising MD (n = 9). Data from 5weeks before and from a convenience sample of 6 weeks after implementationwere compared. The data are presented as mean ± SD. The Studentt test and 1-way analysis of variance were used to evaluate pre-CL andpost-CL study times.Results—The time difference in anatomic surveys before (n =275) vs after (n = 340) universal TVCL screening was statistically significant,46.9 ± 11.6 vs 58.3 ± 11.9 minutes (P < .0001), regardless of MD.Seventy-three percent of postimplementation anatomic surveys includedTVCLs with a mean duration of 61.0 ± 10.5 minutes. Mean voiding timewas 9.1 ± 6.2 minutes, ranging from 2 to 35 minutes. The mean time increaseper SG per scan with TVCL was 9.1 ± 3.8 minutes. As expected,there was no difference in the duration of growth scans in the 2 time periods(pre, 27.8 ± 11.2 vs post, 28.4 ± 9.6 minutes; P = .5).Conclusions—Universal TVCL lengthens each anatomic surveyby almost 15 minutes, primarily due to the time to void. This must beaccounted for when exploring ways to optimize work flow. The potentialto impact the number of scans that can be accommodated should be consideredin future cost-benefit studies.1540030 Association of Ultrasonographic Twin Estimated FetalWeight Discrepancies With Early Neonatal OutcomesPedro Roca, 1 * Allen Kunselman, 2 Anthony Ambrose, 1Ian Paul, 3 Dennis Mujsce, 3 Serdar Ural, 1 Kari Whitley 11Obstetrics and Gynecology, 2 Public Health Science, 3 Pediatrics,Penn State Hershey, Hershey, Pennsylvania USAObjectives—Determine the association between increased fetalsize discrepancy during routine second-trimester ultrasound and poor perinataloutcomes.Methods—We designed a retrospective study including all twinpregnancies from our institution before December 2009. We excludedpregnancies with major fetal anomalies. A total of 98 pregnancies met theinclusion criteria. The second-trimester ultrasound was performed on averageat 20.0 weeks (SD, 2.5). The average estimated fetal weight (EFW)of twin A was 356 g (SD, 271) and for twin B was 351 g (SD, 247). Themedian percent discrepancy in EFW relative to the lighter twin in eachpregnancy was 6.8% (25th percentile, 3.8%; 75th percentile, 25.0%). Thirteen(13.3%) of the pregnancies were at least 20% discordant.Results—Generalized estimating equations with a logit linkwere used to assess the association of 4 predictors. There was no associationof the deviation from the mean EFW for twins with gestationalage at delivery (P = .84) or for twins with admission to the neonatal intensivecare unit (adjusted odds ratio [AOR], 1.00; 95% confidence interval[CI], 0.99–1.01; P = .53) after adjusting for EFW, week ofsecond-trimester ultrasound, and birth order. The only significant effectwas the association of the deviation from the mean EFW of twins withnecrotizing enterocolitis.Conclusions—For every 1-g increase in the deviation from themean EFW of twins, the odds of NEC increase by 1.03 (or 3%), adjustingfor EFW, week of second-trimester ultrasound, and birth order (AOR,1.03; 95% CI, 1.01–1.07; P = .02). This unique study shows that deviationfrom the mean EFW of twins during second-trimester ultrasound is a poorpredictor for early neonatal complications.Table 1. Predictor of OutcomesAOR (95% CI) [P]IV CatheterRDS MV Days (≥1 vs 0) NEC TPN NGTEFW (g) 0.998 1.00 0.996 0.98 0.995 0.997(0.994–1.002) (0.99–1.01) (0.991–1.001)(0.96–0.99) (0.991–1.000)(0.992–1.001)[.36] [.92] [.15] [.004] [.04] [.12]Deviation 1.00 1.01 1.00 1.03 1.01 1.00from (0.99–1.01) (1.00–1.02) (0.99–1.01) (1.01–1.07) (1.00–1.02) (0.99–1.01)mean [.48] [.13] [.46] [.02] [.06] [.41]EFW oftwins (g)Week of 1.36 1.14 1.81 5.32 1.76 1.552nd- (0.86–2.16) (0.56–2.35) (0.98–3.35) (2.12–13.28) (1.07–2.88) (0.92–2.62)trimester [.18] [.71] [.06] [
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Conclusions—There are few published cases, and almost allshow ultrasonographic findings similar to our cases. Until more evidencebecomes available regarding the echo pattern and blood flow mimickinga malignant ovarian tumor, surgical treatment cannot be avoided. In our experience,conservative surgery has had satisfactory results; all patientsgave birth without complications.Table 1Patient1 2 3 4 5 6Age, y 34 36 32 31 36 38Gestation, wk 21 8 23 16 8 12Laterality Right Bilateral Left Left Right LeftSize, mm 87 60/75 55 49 59 39Papillae Present Present Present Present Present PresentBlood flow Present Present Present Present Present PresentCA-125, IU/mL 43.71 22 40.20 26 — —Surgery During During During During No Nopreg- preg- preg- pregnancynancy nancy nancy1540162 Correcting for Acoustic Cavitation and Acoustic Streamingin Ultrasound CalibrationVictor Frenke, l * Thanh Nguyen, 2 Loan Bui, 1 Nghia HuuTran 2 1 Biomedical Engineering, 2 Electrical Engineering,Catholic University of America, Washington, DC USAObjectives—Commercial power meters for calibrating ultrasoundtransducers are used ubiquitously in clinical and laboratory settings.These devices are inherently inaccurate in that they do not compensate forthe effects of acoustic cavitation (AC) and acoustic streaming (AS). Bothphenomena can alter displacements generated on the meter’s target, introducingerrors in power measurement. The objectives of this study wereto investigate these phenomena and to propose a standardized procedureto marginalize their effects on power measurement.Methods—The experimental setup included a nonreflecting targetsuspended from an analytical balance, reproducing the procedure employedin commercial devices. Measurements were performed at 1 and 3.3MHz, where intensities employed precluded the onset of AC at the higherfrequency. The attenuating effect of AC bubbles in the ultrasound beamwas quantified by using a transmitting and receiving ultrasound transducerto determine the power loss within the beam. Evidence of the contributionof AS to erroneous measurements was demonstrated using an acousticallytransparent membrane positioned immediately above the target.Results—AS was found to significantly increase the powerbeing sensed, indicating its dependence on the attenuating effects of AC.The acoustically transparent membrane above the target effectively eliminatedthese effects. AC was found to significantly decrease the powerbeing measured where discrepancies with noncavitation measurementscorrelated positively with intensity. AC activity, itself, also correlated withintensity, as demonstrated using passive detection of harmonic emissions.Conclusions—This study demonstrated that AC and AS cansignificantly introduce errors in standard calibration measurements. Theseeffects were consistent with acoustic theory, including the dependence ofAS on the attenuation effects of AC bubbles. An acoustically transparentmembrane eliminated the effects of AS. The numerical relationship betweenthe attenuation of AC bubbles, and the manner by which they affectedthe measurements, was found to accurately correct for thesediscrepancies. The setup employed for the study can easily be assembledusing standard laboratory equipment.1540166 Usefulness of Uterine Tranverse Diameter Measurement inSuspicion of Congenital Uterine AnomaliesMeritxell Vila,* M. Angela Pascual, Betlem Graupera, LourdesHereter, Cristina Pedrero, Maria Fernandez-CidObstetrics, Gynecology, and Reproduction, Institut UniversitariDexeus, Barcelona, SpainObjectives—The purpose of this study was to evaluate the potentialrole of the transverse diameter, measured by conventional ultrasonography(2DUS), of the uterus in the diagnosis of suspected congenitaluterine anomalies.Methods—Between February 2011 and June 2012, womenaged 15 to 45 years with suspected uterine anomalies such as arcuate, septate,and bicornuate with 2DUS were evaluated by 3D ultrasonography(3DUS) using multiplanar reformatted sections. The uterine anomalieswere suspected when measured by 2DUS when the transverse diameter ofthe uterus was >45 mm. Women were categorized according to the sizerange of the transverse diameter: 45 to 54, 55 to 64, and ≥65 mm. To comparethe size range rate, Pearson’s χ 2 was used, and data were expressedas percentages according to its distribution.Results—Of all the patients that had a transverse diameter >45mm, 138 of them were diagnosed by 3DUS as having uterine anomalies.Among the women diagnosed with uterine anomalies, the minimum transversediameter measured was 45 mm, and the maximum was 88 mm.Table 1 shows the distribution of the uterine anomalies diagnosed and thesize range for each type. The results show that most arcuate septate andpartial septate anomalies have a transverse diameter of 45 to 54 mm, withstatistical significance (P < .001).Conclusions—Diameter measurements of the uterus throughtransverse diameter 2DUS provide indirect information on possible uterineanomalies. It seems a transverse diameter from 45 mm is a good indicatorto suspect possible uterine anomalies and thus complete the study by 3DUSfor the diagnosis and classification of congenital uterine anomaly types.Table 1Transverse Diameter, mmAnomaly Type 45–54 55–64 ≥65 TotalArcuate, n (%) 74 (76) 19 (19.8) 3 (3.1) 96Partial septate, n (%) 12 (70.6) 4 (23.5) 1 (5.9) 17Septate, n (%) 13 (59.1) 8 (36.4) 1 (4.5) 22Bicornuate, n (%) 1 (33.3) 0 (0) 2 (66.7) 3Total 100 31 7 1381540206 Ultrasonographic Diagnosis of Ovarian Ectopic PregnancyAfter In Vitro Fertilization With Salpingectomy and LiteratureReviewM. Angela Pascual, 1 * Lourdes Hereter, 1 Betlem Graupera, 1Francisco Tresserra, 2 Alicia Perez, 1 Buenaventura Coroleu, 1Pedro Barri 1 1 Obstetrics, Gynecology, and Reproduction,2Pathology, Institut Universitari Dexeus, Barcelona, SpainObjectives—Among ectopic pregnancies, ovarian ones are extremelyrare and much less frequent with previous history of salpingectomy.Diagnosis and treatment of this condition continue to be challenginggiven that no typical risk factors exist compared with other types of ectopicpregnancy, and signs and symptoms are similar to those observed in rupturedcorpus luteal cysts. Ultrasonographic diagnosis is feasible, althoughdifferential diagnosis from the corpus luteum is difficult. In this context,the goal is to diagnose as accurately as possible to apply the surgical treatmentto remove the ectopic pregnancy, preserving ovarian tissue.Methods—This is a case of a 31-year-old woman with rightsalpingectomy, which presented a right ovarian ectopic pregnancy (OEP)after intracytoplasmic sperm injection–embryo transfer (ICSI-ET);laparoscopy was done to remove the OEP, preserving the ovary, and a re-S106
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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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