American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013asis, abdominal pain, and hematuria was performed. Descriptive statisticswere used for all subjects. Normalcy for data was calculated, and all continuousdata were evaluated utilizing the Student t test or analysis of variance,when appropriate. All categorical data were calculated using theFisher exact test or χ 2 analysis.Results—We found 153 cases of kidney stones among the pediatricpopulation from January 2007 to 2011. The mean age was 19 years.Patients were evaluated by 24% ED physicians, 66% pediatric emergencyphysicians, and 10% midlevel providers (MLPs). Though there was anoverall increase in the incidence of renal colic in 2011 compared to 2007,it was not found to be statistically significant by the Fisher exact test(P = .11). The use of ultrasound increased with each progressive year(from 10% in 2007 to 27% in 2011). The type of provider (ED attendingvs pediatric attending vs MLP) had no significant effect on the use of computedtomography (CT) or US (P = .15; P = .15, respectively). The typeof provider or diagnostic modality did not affect the ED length of stay ofpatients (P = .08).Conclusions—There has been an overall increase in renal colicamong the pediatric emergency patient population over the past 5 years.CT was more frequently used in the diagnostic workup compared to US.We plan to use these data to educate health care providers on the use of USin patients suspected of having nephrolithiasis to further minimize the useof CT scans.1540672 Prenatal Stomach Size: Association With Cleft Lip and/orCleft PalateKristin Burhans, 1 * Lauren Mack, 1 Peter Koltz, 2 StephanieHenderson, 1 John Girotto, 2 Loralei Thornburg 1 1 Obstetricsand Gynecology, 2 Plastic Surgery, University of Rochester,Rochester, New York USAObjectives—Cleft lip/palate is listed as associated with an absentstomach due to poor fetal swallowing; however, it is unclear if a“small” stomach is also associated, especially without concurrent brainabnormalities.Methods—Records were reviewed for all nonanomalous infantsat Strong Memorial Hospital from 2003 to 2011 with cleft lip/cleftpalate with available second- or third-trimester images. In each abdominalcircumference, stomach width (W) and anterior-posterior (AP) measurementswere measured by a single author (L.M.), and polyhydramniosor “absent” stomach was recorded. Nondiabetic controls matched 2:1 forall but 9 patients (1:1) for the gestational age (GA) of measurement within1 week. As per prior nomograms, mean W and AP were compared in 3-to 5-week GA groups between infants with clefts and those without.Results—Of 32 infants with clefts, 108 measurements matched207 control measurements. The majority of infants received 2 or 3 prenatalultrasound examinations. There were only 3 infants with cleft with anabsent stomach at any point in gestation, 1 with polyhydramnios. Themean W and AP were both significant at 19 to 21 and 22 to 24 weeks’ gestation,W only at 25 to 27 and 37 to 40 weeks, and AP only at 28 to 30 and31 to 36 weeks.Conclusions—Few nonanomalous infants with clefts had anabsent stomach on ultrasound, suggesting this is an insensitive marker;however, mean W and AP stomach measurements were significantlysmaller in the mid trimester between 19 and 24 weeks when manyanatomic ultrasound examinations are performed. Abnormalities in prenatalstomach measurements, especially during this period, should promptevaluation for cleft lip/palate. Stomach size at 16 to 18 weeks did not differin either dimension, suggesting this is a poor marker prior to 19 weeks.Table 1. Stomach (mm), Mean ± SDInfants With Cleft Infants Without CleftGA, wk W AP W AP P, W P, AP16–18 5.0 ± 3.1 6.5 ± 5.3 6.8 ± 2.4 9.1 ± 4.5 .09 .1519–21 5.9 ± 2.8 6.4 ± 3.3 8.3 ± 2.4 9.3 ± 2.7 .01 .0122–24 4.9 ± 3.0 8.0 ± 4.9 9.4 ± 2.3 12.4 ± 4.3
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Fusion software was used had mean mA of 8574 and DLP of 1676 vs mAof 16,219 and DLP of 3342 in the group where solely CT-guided biopsieswere performed. Total reductions of 52% in mA and 50.1% in DLP wereachieved using Smart Fusion software.Conclusions—After examining the data gathered, we concludethat Smart Fusion software improves patients’ safety through radiationdose reduction as well as having a positive impact in interventional radiologyresource utilization. Multimodality imaging is a promising tool thatmight also decrease the cost of patient care. A larger sample will documentthe value of Smart Fusion software.1540683 Ultrasound of Musculoskeletal Conditions That ClinicallyMimic Lower Extremity Deep Venous ThrombosisGowthaman Gunabushanam, 1 * Vijayanadh Ojili, 2 LeslieScoutt 1 1 Diagnostic Radiology, Yale University School ofMedicine, New Haven, Connecticut USA; 2 Radiology, Universityof Texas Health Science Center, San Antonio, Texas USAObjectives—Venous Doppler examination is the first imagingstudy done to evaluate patients presenting with clinical symptoms (pain,swelling, tenderness, or erythema) of lower extremity deep venous thrombosis(DVT). This review presents a systematic approach to the ultrasounddiagnosis of musculoskeletal conditions that can clinically present as DVT.Methods—The exact anatomic location (groin, thigh, knee,calf, or ankle) of the patient’s symptoms provides useful clues to the diagnosis.The sonographic findings of common musculoskeletal conditionsthat mimic DVT are described, including: Baker’s cyst (ruptured, hemorrhagic,or infected); muscle tear, hematoma, or other injury; tendon inflammationand/or rupture; bursitis and infectious and inflammatoryarthritis; and primary and metastatic muscle and bone tumors.Results—Not applicable as this is a pictorial review.Conclusions—In patients with focal symptoms in the lower extremities,meticulous examination of all anatomic structures in the vicinityof the symptomatic region enables an accurate alternate diagnosis ofmusculoskeletal pathologies.1540701 Implementation of Bedside Ultrasonography Within anInternal Medicine Faculty and Residency: The IMBUSProgramDavid Tierney,* Terry Rosborough Medical Education,Abbott Northwestern Hospital, Minneapolis, Minnesota USAObjectives—Describe in detail and provide a rationale for a curriculum,structure, and successful implementation of an internal medicine bedsideultrasound program (IMBUS) in a residency program and its faculty.Methods—Design: Prospective cohort study in an internalmedicine (IM) residency program at a private academic 700-bed tertiarycare center. Participants: Thirty-three residents and 13 full-time facultymembers without significant prior ultrasound experience. Intervention:(1) Development of an IM ultrasound curriculum to maximize sensitivity/specificity of our routine physical exam as well as critical time-sensitivediagnoses; (2) overlap training method using top-down and bottom-upmethodologies; (3) 35-hour “boot camp” including didactic, hands-onmodel-based, and simulator-based training; (4) bedside hands-on trainingwith faculty mentors until trainee meets a prespecified exam count in eachcomponent and is deemed competent in that exam area; (5) ongoing mentoredand remotely submitted/reviewed images until adequate technicaland interpretive sensitivity/specificity obtained; (6) final test-out usingbedside and simulator-based summative evaluation prior to certification;and (7) a robust ongoing quality assurance system. Measurements: (1)Comparative effectiveness of multiple implementation strategies; (2) timeto, variation in, and predictive factors of competence in each exam component;(3) clinical impact of chosen components on patient outcomes;(4) effect of implementation on resident/faculty work flow, efficiency, andjob satisfaction.Results—We describe in detail and rigorously critique a full ultrasoundcurriculum and implementation strategy for an IM residency.Thirty IM residents and 12 faculty were trained using the IMBUS program.Learning curves for each ultrasound exam component have beenestablished. We are analyzing multiple outcomes, including competencylearning curves, skill decay, patient outcomes and experience, and physicianimpact of bedside ultrasound.Conclusions—We hope that by describing in detail our curriculum,methods, and learning, we can help other residency programsimplement bedside ultrasound in an efficient, focused, evidence-based,politically aware, and impactful manner.1540730 Utility of Point-of-care Ultrasound in the Management ofSnake BiteSrikar Adhikari,* Mazda Shirazi, Austin Gross EmergencyMedicine, University of Arizona Medical Center, Tucson,Arizona USAObjectives—To describe the use of point-of-care Ultrasound inthe management of a snake bite case in the emergency department (ED).Methods—We present a 67-year-old male who presented to theED with a rattlesnake bite to the right index finger approximately 4 hoursprior to arrival to the ED. The patient denied any history of diabetes, hypertension,or any other medical diseases. Physical examination revealednormal vital signs. Puncture wounds were noted on the second digit at themetacarpophalangeal joint with surrounding ecchymosis. There was significantedema of the right hand and forearm, with limitation of range ofmotion. He received 4 units of CroFab (antivenom) initially. A toxicologyconsult was obtained. Per toxicologist recommendations, the leading edgeof the swelling at the envenomation site was marked. Proximal progressionof swelling and induration were monitored to determine the need foradditional doses of CroFab. Two hours later, the treating emergency physicianwas asked to mark the leading edge of the swelling and induration inthe forearm to assess for any proximal progression. Based on clinical examinationfindings, it was determined that there was no significant proximalprogression of swelling and induration. Soft tissue ultrasound of theforearm was performed by another emergency physician who was not involvedin this patient’s care.Results—Bedside ultrasound revealed edema and subcutaneousfluid extending proximally into the elbow, beyond the leading edgemarked by the treating physician. The subcutaneous tissues were also hyperechoicin appearance. These ultrasound findings were highly suggestiveof proximal progression of local findings. Based on the sonographicfindings, additional doses of CroFab were given to the patient, who wasadmitted to the hospital.Conclusions—In this case, point-of-care ultrasound helpedclinicians make an accurate assessment of proximal progression of localfindings due to a snake bite. This case highlights the utility of bedside ultrasoundin the management of snake bite in ED patients. Point-of-careultrasound can expedite the consultation and appropriate treatment in patientswith snake bite.1540763 Scaled Signal Intensity of Uterine Fibroids on T2-weightedMagnetic Resonance Images: Objective Parameter toDetermine the Suitability for Magnetic Resonance–GuidedFocused Ultrasound Surgery of Uterine FibroidsSanghee Lee, 1 * Sang-Wook Yoon, 2 Mi Hee Lee, 3 Su MinKang 1 1 Radiology, Healthcare System, Gangnam Center,Seoul National University Hospital, Seoul, Korea; 2 Radiology,CHA Bundang Medical Center, CHA University, Seongnam,Korea; 3 Radiology, Seoul Metropolitan Government–SeoulNational University Boramae Medical Center, Seoul, KoreaObjectives—Magnetic resonance–guided focused ultrasoundS112
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