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American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013measured in 3 dimensions. The number of previous cesarean sections andcomplications were reviewed. These included dehiscence (separation ofthe scar that does not disrupt the uterine serosa), uterine rupture (a completedisruption of the myometrium and serosa), and ectopic pregnancy inthe cesarean section scar.Results—Thirty-eight women were diagnosed with a cesareanscar defect at TUS. The number of previous cesarean sections in patientswith uterine dehiscence and ectopic pregnancy in the cesarean scar isshown in Table 1. Eleven patients (29%) showed uterine dehiscence.Seven cases were repaired by laparoscopy, and 4 cases required hysterectomy.Five ectopic pregnancies (13%) were diagnosed at TUS. Two patientsrequired hysterectomy; 2 were treated with local methotrexateguided by TUS; and 1 was surgically sutured. Two patients (5%) had acomplete uterine rupture. One of them was diagnosed 6 months after thecesarean section and required hysterectomy. The other was diagnosed duringthe puerperium period and was treated by surgical repair.Conclusions—TUS is useful for detecting cesarean scar defects,providing information for treatment in case of complications.Table 1Previous Cesarean1 2 3 4Dehiscense 5 4 1 1Ectopic pregnancy 3 0 1 11541304 Ultrasound-Guided Dorsal Approach for Chemodenervationof the Psoas MuscleDavid Spinner Rehabilitation Medicine, Mount Sinai Schoolof Medicine, New York, New York USAObjectives—To directly treat the primary motor end plates ofthe psoas muscle for spasticity.Methods—Case report with description of procedure. Bilateralultrasound-guided psoas muscle injections were performed. An axial orshort-axis view was used for both the right- and left-sided injections. Theright psoas muscle was injected with an out-of-plane approach where onlythe needle tip was visualized. We then turned the probe 90° to visualize thelength of the needle in addition to using electromyography (EMG) forconfirmation. The left psoas muscle was injected using an in-plane techniquewith EMG confirmation.Results—The left and right psoas muscle injections were confirmedwith EMG. The patient gained 30° of extension from baseline tobilateral hip joints. The patient had overlying hip contractures that did notallow for further range of motion.Conclusions—The ultrasound-guided dorsal approach for performingpsoas muscle chemodenervation is a novel approach for treatinghip flexor spasticity while targeting the primary motor end plates.1541312 The BUILD Project: Bringing Ultrasound Internationallyfor Long-Term DevelopmentKeith Rosenberg, Fadi Kasyouhanan, David Bahner*Emergency Medicine, Ohio State University College of Medicine,Columbus, Ohio USAObjectives—With technological advances in imaging, ultrasound(US) equipment is increasingly affordable and portable. Studieshave shown that portable US can be an effective modality in low-resourceenvironments. Bringing Ultrasound Internationally for Long-term Development(BUILD), a global outreach project, is an attempt to collaboratewith Ohio State University’s (OSU’s) Office of Global Health to providethird- and fourth-year medical students from OSU’s College of Medicinethe opportunity to enroll in a longitudinal US program.Methods—BUILD creates a collaboration between the Collegeof Medicine and the Office of Global Health. The group combines existingmedical mission programs and promotes an effort to coordinate bothgroups. Current US resources were centralized, streamlined, and madeavailable to the program.Results—The Office of Global Health has funded 51 trips overthe past 5 years, while the medical school has sent 244 trips, to >25 developingcountries. BUILD’s team of 2 senior medical students and 1physician US expert acts to bridge these separate but similar programs.Approximately 6 of these trips have incorporated US. The program developeda needs assessment survey of current US resources for medicalmissions. BUILD has fostered interest among students traveling abroad tointegrate US into their trips.Conclusions—As trends in medicine shift toward more prudentuse of resources, US will become an integral part of medical training.It is increasingly common for students and residents to gain exposure toUS early in their schooling. Studies have shown that physicians and medicalstudents have successfully used portable US to determine medicalmanagement. BUILD intends to establish a protocol for students and facultyto bring US to underserved areas. The group will design didactics toteach travelers US skills and enable them to become teachers at their sites.BUILD will create partnerships leading to opportunities for travelers tobring donated equipment. The findings of this study will be used to showthat US can be successfully incorporated into global health programs.BUILD hopes to integrate this into the medical student curriculum as anoptional course.1541434 Trained Simulated Ultrasound Patients: Medical Studentsas Models, Learners, and TeachersMatt Blickendorf, 1 * Lindsay Mooney, 2 Krista Rath, 2 EricAdkins, 1,2 David Bahner 1,2 1 Emergency Medicine, WexnerMedical Center, Ohio State University, Columbus, Ohio USA;2Ohio State University College of Medicine, Columbus, OhioUSAObjectives—Despite the increased use of bedside ultrasound(US) by clinicians, US is not fully established in undergraduate and graduatemedical education. Medical schools and residency programs mustdevelop US education programs to ensure future physicians become competentwith this operator-dependent technology. Medical educators areoften challenged to find human models for hands-on scanning sessions.The goal is to outline the educational model of a university medical centerthat uses medical students to fulfill the need for human models whilealso offering these individuals a basic introduction to US education.Methods—Second-year medical students from the Ohio StateUniversity College of Medicine serve as trained simulated US patients(TSUPs) for hands-on scanning sessions held by the college and residencyprograms at the medical center. Students are offered a didactic and handsonUS education program as an added incentive for serving as a TSUP.Students were given a postcourse 5-point Likert survey to assess their perceivedbenefit from the TSUP program.Results—During the 2011–2012 academic year, 47 secondyearand 7 first-year students served as normal models for 71 hands-onscanning sessions, while only 28 sessions were left without TSUP participation.Counting each time a TSUP was used, a total of 173 models wereused for 160 hours of scanning. The college and 7 residency programsused the TSUP program. Student volunteers were split equally male andfemale with a diverse range of specialty interests. Approximately 75% ofTSUP participants served as US models for an average of 6 to 15 hours forthe year. Most attended a majority of the US educational events, and almostall TSUP participants endorsed increased US interest, knowledge,and skill as a result of the program.Conclusions—The TSUP program is a feasible and sustainablemethod of fulfilling the need for normal anatomy models in US educationwhile serving as a valuable extracurricular US educational program forTSUP participants. The program offers a model for the establishment ofUS education programs by educators at undergraduate and graduate levels.S119
American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 20131541460 Developing and Evaluating an Ultrasound Curriculum fora Urology Residency Training ProgramJoseph Lopez, 1 * Daniel Box, 1 Geoffrey Box, 1 David Bahner 21Urology, 2 Emergency Medicine, Wexner Medical Center, OhioState University, Columbus, Ohio USAObjectives—In medicine, much has been written on ultrasound(US) use in focused settings looking for specific findings consistent withpathology and using this to make specific medical decisions. With the adventof other fields of discipline using US, some hospital infrastructureexists with US in critical care, emergency medicine, anesthesiology, andsurgery. In urology, program directors expressed a significant need for formalizedUS training. This project sought to provide an educational frameworkfrom which a urology program could incorporate US training andincrease proficiency and confidence in performing urologic US. The curriculumwas developed using the AIUM Practice Guideline for UltrasoundExaminations in the Practice of Urology developed in collaboration withthe American Urological Association.Methods—In our study, 13 urology residents were participantsin this pilot curriculum. Didactic and hands-on US training sessions onbasic US physics and techniques, kidney, bladder, scrotal, and prostate USwere undertaken, and a posttest was administered in addition to surveysevaluating their experience in the program. The implementation occurredover 1 year.Results—The results notably yielded a mean duration of approximately30 hours of hands-on, didactic, and clinic US experiences atthe bedside reported by each of the residents in the study. Approximately66% of the residents were confident in their ability to interpret their ownimages.Conclusions—We can conclude from the survey and posttestdata that the developed US curriculum for residents is beneficial for developingclinical acumen as well as confidence in making use of this imagingmodality. In the future, we hope to increase the participation in thiscurriculum and develop a more concrete timeline at which these traineesprogress through the curriculum as well as improve evaluation of the educationalefficacy of the course.1541471 Sonographic 2- and 3-Dimensional Aspects of IntrauterineDevice Evaluation: What Additional Information Can 3-Dimensional Images Provide?Claudia Maksoud Ultrasound, Colégio Estadual Padre EduardoMichelis, Rio de Janeiro, BrazilObjectives—Our goal is to show the role of identification of intrauterinedevice (IUD) positioning and integrity using 2D images and todemonstrate the possibilities 3D images can provide, by giving a betterview of the uterine cavity in the coronal plane, and also more details ofIUD location, especially with a levonorgestrel-releasing IUD.Methods—All ultrasound procedures were performed by radiologists,and the images were acquired using multifrequency transvaginaltransducers. 3D images were obtained from freehand scans. The 2Dimages included both longitudinal and transverse views and 3D images thecoronal view.Results—3D images can better localize the IUD position andgive a better identification of the arms of the IUD. In the case of a levonorgestrel-releasingIUD, we can see more details of the shaft with 3Dimages than with 2D images. Problems like an IUD embedded in the myometriumare better identified in the 3D coronal view.Conclusions—2D ultrasound evaluation can be the classictechnique for IUD evaluation, but 3D images can improve the analysis,giving more spatial details of the uterine cavity, IUD integrity, and position.As freehand 3D acquisition is easy and quick to perform, once it isavailable, it can be used as a helpful tool in the evaluation of IUDs.1541516 Point-of-Care Ultrasound in the Diagnosis of ComplexSubcutaneous Abscesses Requiring Surgical InterventionSrikar Adhikari, Austin Gross* Emergency Medicine, Universityof Arizona Medical Center, Tucson, Arizona USAObjectives—We present the utility of point-of-care ultrasound(US) in the management of 2 cases of complex subcutaneous abscesses.Methods—A 45-year-old male presented to the emergency department(ED) with left thigh swelling and pain. He developed pain 10days prior to the arrival to the ED while jogging. He subsequently notedredness and swelling in the thigh. Physical examination revealed lowgradefever and a warm, tender, and swollen thigh with induration. It wasdetermined that the patient had an abscess, and an incision and drainage(I&D) was planned by the treating emergency physician. Bedside US wasperformed by the emergency physician to assist with the procedure. TheUS examination revealed a large complex fluid collection extending >10cm deep into the subcutaneous tissues and facial planes and beneath themuscles. Based on the sonographic findings, a surgical consult was obtained.The patient was taken to the operating room (OR) where the abscesswas drained under general anesthesia. The initial surgical incisionhad to be extended to drain >200 mL of pus. We report another case, a 36-year-old male presenting to the ED with left arm swelling, pain, and rednessof 3 days’ duration. He gave a history of low-grade fever. Hepresented with similar symptoms to the ED twice within 2 months priorto this ED visit. An I&D was performed during both ED visits. Clinical examinationrevealed fluctuant, tender, erythematous swelling with an openarea spontaneously draining some purulent material. Because of repeatED visits, bedside US was performed by the emergency physician, whichrevealed a 6-cm hyperechoic foreign body embedded deep in the tissuesof the upper arm along with a complex fluid collection. A surgical consultwas obtained. The patient was taken to the OR for foreign body removalwith drainage of the abscess.Results—Point-of-care US allowed visualization of the extentof the abscess and occult foreign body in these cases. It helped prevent anunderestimation of the extent of the infection and determined the need foroperative intervention.Conclusions—Point-of-care ultrasound can help determine theneed for operative intervention in ED patients with complex subcutaneousabscesses.1541519 Impact of the Maternal Body Mass Index on the Durationand Completion of Fetal Anatomic UltrasoundDana Smith,* Carmen Beamon, Kacey Eichelberger, LisaCarroll, Neeta Vora Maternal Fetal Medicine, University ofNorth Carolina, Chapel Hill, North Carolina USAObjectives—Our objective was to examine the impact of theprepregnancy body mass index (BMI) on both the duration and completionof the fetal anatomic survey.Methods—A retrospective cohort study of singleton nonanomalousgestations presenting for fetal anatomic ultrasound between 16 and25 weeks’ gestation at our institution was performed over a 3-month period.Standard BMI categories were computed using self-reported prepregnancyweight and height. Outcomes of interest were the duration ofultrasound (defined as the difference in minutes between the first and lastabdominal image) and completion of ultrasound (“incomplete” defined asa provider recommending the subject return for reevaluation). Univariateand bivariate analyses as well as logistic regression modeling were usedto determine odds ratios for having an incomplete scan among subjectswith BMI ≥25.Results—Of the 551 women analyzed, 52.7% of the cohort wasoverweight or obese, with a mean BMI of 26.8 (range, 16.6–65.2). The averageduration of basic ultrasound was 28.8 minutes vs 35.2 minutes forS120
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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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Rosa De Vermette, MD, RDCS,RDMS, RO
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