Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 20131541066 Maximum Effort of the Multifidi Muscles in the PronePosition Using Musculoskeletal Ultrasound Imaging andElectromyographyRose Smith,* Dervarshi Patel, Susan Kotowski, Dexter Witt,Lauren Farwick, Erin Rathje, Ryan Steiner RehabilitationSciences, University of Cincinnati, Cincinnati, Ohio USAObjectives—The lumbar paraspinal muscles play a critical rolein supporting the trunk during functional activities. Rehabilitative ultrasoundimaging (RUSI) has been found to be a valid and noninvasivemethod to measure the activation of these muscles. RUSI of the multifidihas shown 19% to 43% of maximum effort on electromyography (EMG)while measuring muscle thickness. No study has compared EMG withRUSI using the trace method. The purpose of this study was to look at therelationship of EMG activity of the multifidi using RUSI by measuring thecross-sectional area (CSA) using the trace method.Methods—A sample of convenience consisted of 22 volunteers(11 female and 11 male) with a mean age of 25 years. Exclusion criteriaincluded current or recent history (within 6 months) of shoulder, lumbar,or lower extremity pathology/surgery or pregnancy. Musculoskeletal ultrasoundimages of the multifidi were obtained using the Biosound Esaotemodel MyLab 25 Gold. The area was found using the trace method of theright and left multifidus during an arm raise, arm raise with weight, andleg raise activity while the subject lay prone. A simultaneous DataLINK(Biometrics, Ltd) EMG system was used to measure muscle activity. EMGsensors were placed over the belly of the muscle in the line of action. Maximumvoluntary contractions (MVCs) were taken at the start of data collectionby having the subject lie prone and raise the opposite arm and legagainst manual resistance. The measured trace area of each image wasnormalized against the measured area of the MVC trial.Results—Analysis showed that overall, RUSI trace-measuredCSA muscle activity ranged from ≈22% MVC (trial maximum) to ≈28%MVC (trial average), which corresponded to a measured area of the multifidusof 100% MVCs. Minimal nonsignificant differences were notedbetween the 3 activities with RUSI and EMG activity.Conclusions—The change in trace-measured CSA as comparedto EMG activity is consistent with measuring muscle thickness viaRUSI. This information can be helpful in guiding clinical practice but cannotbe applied without considering its limitations.1541115 Ocular Ultrasound Simulation Lab: Does It Translate tothe Bedside?Kevin O’Rourke,* Sharon Yellin, Adam Vytykac, TimothyMooney, Larry Melniker, Athena Mihailos, Andrew Balk,Gerardo Chiricolo Emergency Department, New YorkMethodist Hospital, Brooklyn, New York USAObjectives—Two percent of emergency department visits areeye-related complaints. Ocular ultrasound (US) gives the emergencyphysician the ability to noninvasively assess the eye for a variety of diseaseprocesses. The Council of Residency Directors Emergency UltrasoundConsensus Committee does not identify ocular US as a core UScompetency for emergency medicine resident graduation but recommendsthat it is incorporated into the resident curriculum. The accuracy of bedsideocular US has been studied, and published reports of models used forsimulation exist. The breadth of knowledge about the effectiveness ofusing simulation for ocular US is limited. The goal of this study was toevaluate if an ocular US lecture and simulation lab led to increased use atthe bedside and what diagnoses were found.Methods—In this retrospective review, we compiled data fromour US database for all ocular US examinations performed the 6 monthsbefore and after an ocular US lecture and simulation lab. We included allpatients who had US between September 21, 2011, and September 22,2012. Data collection included when the US was performed and what thediagnosis was based on US.Results—In the 6 months before the lecture and lab, 18 ocularUS examinations were performed. The findings included 9 normal USfindings, 2 vitreous hemorrhages (1 with posterior vitreous detachment),3 with an increased optic nerve sheath diameter, 2 retinal detachments, 1with postoperative changes, and 1 with a foreign body. In the 6 monthsafter the lab, 28 ocular US examinations were performed. The findingsincluded 11 normal US findings, 7 with an increased optic nerve sheath diameter,5 with vitreous hemorrhage, 1 globe rupture, 1 with choroidal detachment,1 with vitreous detachment, and 2 incomplete studies. Therewere 10 more US examinations performed in the emergency departmentafter the intervention, which equates to a 55% increase in US use.Conclusions—An ocular US lecture and simulation lab led toincreased use of bedside US for patients. In the future, we anticipate thisskill to decrease inappropriate transfers and increase appropriate andtimely evaluations by an ophthalmologist.1541203 Factors Influencing Intraoperator Variability When AssessingFibroid GrowthMalana Moshesh,* Shyamal Peddada, Donna BairdNational Institute of Environmental Health, Research TrianglePark, North Carolina USAObjectives—To assess factors associated with intraoperatorvariability (measured by the coefficient of variation [CV]) of fibroid measurementsand apply this to current practice.Methods—Study participants, recruited through communityoutreach and health care facilities were young African American women,aged 23 to 34 years, who had never been diagnosed with fibroids. All participantsunderwent transvaginal ultrasound to screen for the presence ofuterine fibroids (≥0.5 cm in diameter). The fibroid diameter was measuredin 3 perpendicular planes (longitudinal, sagittal, and transverse) at 3separate times during the examination. Volume was calculated using theellipsoid formula. Intraobserver variability as measured by the CV for fibroiddiameter and volume was calculated for each fibroid, and factorsassociated with the CV were assessed using regression models adjustingfor fibroid characteristics and individual participant characteristics.Results—Ninety-six women out of 300 women initiallyscreened were found to have at least 1 fibroid, yielding a total of 174fibroids for this analysis. The median CV for the 3 measurements of thefibroid maximum diameter was 4.9%, and the mean CV was 5.9%. Themedian CV for fibroid volume was 10.5%, and the mean CV was 12.7 %.Fibroid size contributed significantly to the prediction of the CV for bothfibroid diameter (P = .04) and volume (P = .005). The CV was greater forsmaller fibroids. Individual participant factors and the fibroid type were notsignificantly associated with intraobserver measurement variability.Conclusions—When assessing fibroid growth, baseline fibroidsize should be considered. Small fibroids have greater measurement variabilitythan large fibroids. Thus, a small fibroid must have a proportionatelygreater increase in size compared to a large fibroid to conclude thatit is growing.1541265 Role of Transvaginal Ultrasound in the Diagnosis of CesareanSection and Its ComplicationsLourdes Hereter,* M. Angela Pascual, Betlem Graupera,Pere Barri-Soldevila, Cristina Pedrero, Maria Fernandez-CidObstetrics, Gynecology, and Reproduction, Institut UniversitariDexeus, Barcelona, SpainObjectives—To describe the findings of transvaginal ultrasound(TUS) in cesarean scar defects and their complications in nonpregnantwomen.Methods—Nonpregnant premenopausal women with a historyof a previous cesarean section, referred to TUS for an annual checkup,were included in this study. A cesarean scar defect was defined as a hypoechoicindentation at the anterior wall of the lower uterine segment,S118