American Institute of Ultrasound in Medicine <strong>Proceedings</strong>J Ultrasound Med 32(suppl):S1–S134, 2013SPECIAL INTEREST SESSIONSSUNDAY, APRIL 7, 2013, 7:30 AM–11:30 AMRecent Innovations in Gynecologic Ultrasound,Including 3-Dimensional ImagingModerator: Beryl Benacerraf, MDIn this session, advances in 3-dimensional sonography will bediscussed, including practical applications for use in many aspects of gynecologypractice and many conditions.Ultrasound-Guided Procedures for the PediatricPatient: From the Perspective of Both Point-of-Careand Traditional ApproachesModerators: Alyssa Abo, MD, Beth Kline-Fath, MDThe objective of this session is to describe the use of ultrasoundto guide interventions and manage therapy in the pediatric patient by bothpoint-of-care and traditional approaches.SPECIAL INTEREST SESSIONSUNDAY, APRIL 7, 2013, 8:00 AM–9:30 AMHands-on Basic Obstetric Ultrasound and SimulationModerator: Jude Crino, MDParticipants will scan second-trimester pregnant models withsupervision by sonographer and physician experts. Skills taught in thisbasic-level session include image optimization, fetal biometry, and thebasic fetal anatomic survey. Simulation stations for endovaginal scanning,amniocentesis, and fetal blood sampling will be available.SPECIAL INTEREST SESSIONSUNDAY, APRIL 7, 2013, 9:45 AM–11:15 AMHands-on Advanced Obstetric Ultrasound andSimulationModerator: Jude Crino, MDThis session is appropriate for those with experience in basiclevelobstetric ultrasound or who have attended the basic-level hands-onsession. Participants will scan second-trimester pregnant models withsupervision by sonographer and physician experts. Skills taught in thisadvanced-level session include detailed fetal anatomy, Doppler velocimetry,and basic 3- and 4-dimensional techniques. Simulation stationsfor endovaginal scanning, amniocentesis, and fetal blood samplingwill be available.S1
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013SPECIAL INTEREST SESSIONSSUNDAY, APRIL 7, 2013, 3:15 PM–5:00 PMAdvanced Point-of-Care Cardiac Ultrasound in theEmergency and Critical Care PatientModerator: Robert Arntfield, MD, RDMSEfficient and Effective Point-of-Care Transesophageal Echocardiography:A Proposed Algorithm for Critical CareScott Millington University of Ottawa, Ottawa, Ontario,CanadaIntroduction—The use of transesophageal echocardiography(TEE) in the intensive care unit (ICU) is becoming more prevalent aspoint-of-care ultrasound applications expand in general and as specificproviders seek more advanced training.Problem Identification—Point-of-care TEE differs significantlyfrom comprehensive TEE in that it is goal directed and time sensitive andseeks to integrate ultrasound images with real-time physiology. As such,the traditional sequence of image acquisition applied to comprehensiveTEE exams may not be ideal.Summary—A goal-directed algorithm for point-of-care TEE isproposed, comprising 4 core views applied to all patients and 4 additionalviews that are useful in specific clinical circumstances. The goals are: (1)to efficiently identify pathologies that are common in the ICU; and (2) toidentify those pathologies that are less common but that mandate a majorchange in clinical management strategy.Clinical Applications of Ultrasound Contrast, Part 1Moderator: Richard Barr, MD, PhDContrast Imaging of Abdominal TransplantsPaul Sidhu Radiology, King’s College London, London,EnglandUltrasound examination of liver and renal transplants has revolutionizedpatient management with the addition of color Doppler ultrasound,establishing this technique as paramount in interpreting andinvestigating vascular abnormalities of any transplant organ. The earlypostoperative period is crucial for the establishment of good vascular perfusionto the transplant organ, a cornerstone of further medical management.In liver transplantations, the hepatic artery is crucial to the transplantand the long-term viability of the biliary system. Contrast-enhanced ultrasound(CEUS) will establish the patency of the hepatic artery, identifyareas of stenosis, and identify any potential hepatic pseudoaneurysm. Theintegrity of the portal and hepatic veins may be ascertained. Focal areas ofliver necrosis, abscess formation, and biliary duct dilatation are all clearlydelineated on the CEUS examination. With renal transplantation, theCEUS examination will readily delineate areas of infarction, will depictvascular complications, and has the potential to assess regional and globalperfusion. Similarly with pancreatic transplants, the addition of CEUSmay be seen as an aid in the assessment of the vascular pedicle. Longtermfollow-up is aided with the depiction of recurrence of disease, thedevelopment of hepatocellular carcinoma, and post-transplant lymphoproliferativedisorder. This presentation will detail the use of CEUS intransplants and will adhere to the guidelines issued by the European Federationof Societies for Ultrasound in Medicine and Biology on liver andnonliver applications of CEUS.Hands-on Renal and Mesenteric ImagingModerator: Jennifer McDowell, MM, RDMS, RT, RVTUltrasound Criteria for Renal DiseaseMargarita Revzin Diagnostic Radiology, Yale UniversityHospital, Wilton, Connecticut USADuring this session, we will focus on the spectrum of renal diseasesdetected and diagnosed with Doppler ultrasound, with special emphasison renal artery stenosis. The anatomy and principles of examinationof the native renal vessels will be considered first, followed by a discussionon renal vascular disorders, including renal artery stenosis. In detail,we will review multiple Doppler-based criteria that are used in diagnosisof renal artery stenosis, including peak systolic velocity, renal to aorticratio, waveform analysis, as well as secondary signs of renal artery stenosis.We will review current literature that validates the proposed criteria forrenal artery stenosis and analyze potential pitfalls that may lead to misinterpretationof the findings affecting the number of false-positive or -negativediagnoses.How Does Ultrasound Compare in Safety andRadiation Dose to Other Imaging Modalities?Moderators: George Lewis Jr, PhD, Thaddeus Wilson, PhDFood and Drug Administration Perspective on Diagnostic UltrasoundSafetyKeith Wear, Gerald Harris Center for Devices and RadiologicalHealth, US Food and Drug Administration, SilverSpring, Maryland USADiagnostic ultrasound does not produce ionizing radiation, andit has an excellent safety record over several decades of use. Potential bioeffectsfrom diagnostic ultrasound are categorized into thermal and nonthermalmechanisms. Thermal mechanisms involve heating of tissue. Theconcept of the thermal dose, which involves both a temperature rise andthe duration of exposure, is a useful tool in the study of thermal effects.Nonthermal mechanisms involve mechanical effects, which includestreaming and cavitation. The likelihood of bioeffects is related to acousticoutput. The 1976 Medical Device Amendments require new devices to besubstantially equivalent in terms of safety and effectiveness to legally marketeddevices. Consequently, recommended acoustic output levels arebased on levels produced by devices on the market prior to the enactmentof the 1976 Medical Device Amendments. The thermal index and mechanicalindex, which are indicators of the likelihood of bioeffects, areoften displayed in real time next to the ultrasound image. However, the extentto which these indexes are used to guide examinations is unknown.Several studies indicate the occurrence of observable bioeffects at diagnosticoutput levels.Radiation: The Two-Edged SwordEric Hall Columbia University, New York, New York USAModern medicine would be unimaginable without the use ofx-rays for diagnosis, especially computed tomographic (CT) scans, whichhave revolutionized radiology. Radiation is often described as a two-edgedS2
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