Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013Methods—USI images of the LT were captured bilaterally in 20normal subjects at the T7 level. With the arm in 120° of abduction, imageswere taken in the prone position with the subject’s arm at rest, activelyholding the position and while holding a weight. This process was repeated3 times on both shoulders by a single examiner. Within 7 days, 10 of thesubjects returned. The same testing sequence was repeated on the dominantarm by the original examiner and by a second examiner. Images werestored electronically and analyzed offline. Reliability was assessed via intraclasscorrelation coefficients (ICCs).Results—Intersession intra-rater reliability agreement wasgood, with ICC values of 0.835, 0.871, and 0.909 at rest, during an activehold, and holding the weight, respectively. Same-session inter-rater reliabilitywas also good, with ICC values of 0.864, 0.881, and 0.891 in the respectivestates of rest, active hold, and holding the weight.Conclusions—The USI methodology used in this studyachieved LT measurements with high inter-rater and intra-rater reliabilityat rest and with the addition of active contraction and resistance. Benefitsfor having this reliability method include: (1) identification of percentchanges of thickness between rest and contraction; (2) an adjunct to electromyographyin the determination of muscle changes during activities; (3)a viable tool for clinical facilitation of LT activation; and (4) documentingatrophy of the LT.1540998 Evaluation of Acquisition and Interpretation of FocusedAssessment With Sonography for Trauma Scans in anUrban Level 1 Trauma CenterZachary Robinson, 1 * Lem Smith, 1 Eliza Beal, 1 Brian Abbott, 2Creagh Boulger, 2 Daniel Eiferman, 3 David Bahner 21College of Medicine, 2 Emergency Medicine, 3 Critical Care,Trauma, and Burn Surgery, Wexner Medical Center, Ohio StateUniversity, Columbus, Ohio USAObjectives—Focused assessment with sonography for trauma(FAST) has become the standard of care in the evaluation of traumapatients. A review of recent literature showed sensitivity of 84% to 94%,specificity of 96% to 98%, a positive predictive value of 61% to 87%, anda negative predictive value of 98% to 100%. A formalized ultrasound trainingprogram has been introduced at our institution for surgical residents toensure proper acquisition and interpretation of ultrasound images. A qualityreview process was initiated to evaluate accuracy in using FAST intrauma patients.Methods—Trauma FAST exams are wirelessly saved to a picturearchiving and communication system, and generated reports are savedto an electronic medical record. Patients who presented as a level 1 or level2 trauma between January and March 2012 and received a FAST scan aspart of their assessment were included in the quality review. The results ofthe FAST scan and any other imaging performed during the same encounterwere recorded and reviewed. The results of FAST were comparedto confirmatory testing of abdominal computed tomography (CT), chestCT, or operative reports. The results of FAST were then determined to betrue-positive, true-negative, false-positive, or false-negative.Results—There were 200 trauma alerts during the study period.One hundred twenty-one patients were eligible for review with bothsaved images and a generated report in the chart. Fifteen patients were excludedbecause the FAST scan results were not available; the FAST scanwas indeterminate; or the patient died prior to confirmatory imaging. Therewere 94 true-negatives, 2 false-negatives, 7 true-positives, and 3 falsepositivesin the remaining 106 patients reviewed, yielding sensitivity of78% and specificity of 97%. The positive predictive value was 70%; thenegative predictive value was 98%; and the accuracy was 95%.Conclusions—Our results confirm that FAST has a high negativepredictive value for abdominal injury in patients experiencingtrauma. These quality results, collected after a focused training program,show the training to be effective in educating surgical residents on theproper acquisition and interpretation of FAST in trauma patients.1541009 An Educational Model for Teaching Focused AssessmentWith Sonography for Trauma to Surgical ResidentsEliza Beal, 1 * Ashley Zielinski, 1 Creagh Boulger, 2 SereanaDresbach, 3 David Bahner, 2 Daniel Eiferman 4 1 College ofMedicine, 2 Emergency Medicine, 3 Pulmonary, Allergy, CriticalCare, and Sleep, 4 Critical Care, Burn, and Trauma Surgery, WexnerMedical Center, Ohio State University, Columbus, Ohio USAObjectives—Focused assessment with sonography for traumahas become indispensable in the evaluation of trauma patients. Few surgicaltraining programs have specific courses to teach the FAST exam.The Wexner Medical Center at Ohio State University has established apilot program with hands-on teaching sessions and self-directed learningto teach surgery residents the skills needed to accurately obtain and interpretFAST scan images.Methods—Thirteen postgraduate year 1 (PGY-1)-level residentsparticipated in an initial evaluation session, which included 10 confidencequestions, 12 ultrasound knowledge questions, and a practicalexam where they were asked to perform both the FAST exam and thelong-axis rescue cardiac view. Participants answered confidence questionson a spectrum from 1 to 8 with 1 being strongly disagree, 7 being stronglyagree, and 8 indicating that the individual had no experience with the skill.The practical exam was evaluated by 2 attending physicians with significantexperience with the FAST exam and ultrasound education. The imageswere graded on a 1 to 5 scale (1 = no image obtained and 5 = imageperfectly obtained with proper settings and labeling). The 13 PGY-1 residentswill undergo 2-hour hands-on training and will be reevaluated forknowledge and skill acquisition.Results—With little formalized training in focused ultrasound,PGY-1 residents responded with fairly low overall confidence in skills(mean = 2.08). When asked about confidence in acquiring specific views,participants generally rated their views in the “disagree” portion of thecontinuum, but the means on the 9 confidence questions ranged fromslightly to strongly disagree (3.94–1.92). No resident answered “no experience”for any question. Skills assessed by the proctors showed a generaltendency of not being able to attain the image or missing relevant anatomy,with the means ranging from 1.38 to 2.46 for the 5 images obtained.Conclusions—Preliminary data show that confidence andknowledge are low, and practical scores show an inability to performFAST scans among PGY-1 level surgical residents. The initial results suggestthat training in the FAST exam is necessary for PGY-1 surgical residentsto adequately obtain images used for clinical decision making.1541032 Cervical Length Assessment by Transabdominal and Endo -vaginal UltrasoundJennifer Thompson,* Michael Smrtka, Geeta Swamy, ChadGrotegut, Brita Boyd, Amy Murtha Duke University,Durham, North Carolina USAObjectives—Endovaginal (EV) cervical length identifies womenat risk for preterm birth (PTB) and thus eligibility for vaginal progesterone.Our objective was to compare transabdominal (TA) with EV cervicallengths to determine the degree of correlation, the capability of TA to predictan EV-detected short cervix, and the rate of cervical change over time.Methods—Retrospective review of singleton pregnancies havingTA and EV ultrasound (US) for cervical length between 16 and 28 weeks’gestation at Duke University from January to December 2011. TA measurementsare routinely obtained on midtrimester exams with EV measurementfor high PTB risk, TA