ARDMS: NewsWire January 6, 2012

American Institute of Ultrasound in Medicine (AIUM) and American Urological Association (AUA) Develop Joint Guidelines for the Performance of an Ultrasound Examination in the Practice of Urology

The American Institute of Ultrasound in Medicine (AIUM) and American Urological Association (AUA) are pleased to announce the collaborative development of the Practice Guideline for the Performance of an Ultrasound Examination in the Practice of Urology. This guideline has been developed to assist practitioners performing an ultrasound examination in the practice of urology and provides direction in the areas of kidney, bladder, prostate, scrotal and penile ultrasound. The guideline also addresses key issues relating to documentation, quality control and improvement, safety, infection control and patient education.

The AUA and AIUM are also pleased to announce collaborative development of Training Guidelines for urologists who perform ultrasound. The above guidelines serve as a roadmap for practices wishing to voluntarily seek accreditation for ultrasound through the AIUM.

"The AIUM is dedicated to ultrasound the modality, and we have a unique opportunity to associate with colleagues in multiple diverse specialties. It has been very rewarding working with the AUA to develop joint performance and training guidelines so that urologic patients will receive high quality ultrasound studies," said Harvey L. Nisenbaum, MD, AIUM Immediate Past President and key facilitator of the collaboration with the urologists.

"Urologists were pleased to participate in the development of guidelines for the ultrasound imaging studies we routinely perform in the office setting," said Pat Fulgham, MD, urologist and member of the guideline task force. "We look forward to working with the AIUM in the development of new guidelines and protocols to ensure the high quality of imaging in the practice of urology.

American Institute of Ultrasound in Medicine (AIUM) and American Urological Association (AUA) Develop Joint Guideline for the Performance of an Ultrasound Examination in the Practice of Urology

View the article online.

Article written by staff at modermedicine.com and adapted for the purposes of this newsletter.

Back To Top

European, US Societies Publish Three-Dimensional (3D) Echocardiography Guidelines
A joint committee of the European Association for Echocardiography and the American Society of Echocardiography has issued the first joint guidelines for image acquisition using 3D echocardiography.

The recommendations, published in the Journal of the American Society of Echocardiography , are a practical guide for acquiring, analyzing, and displaying various cardiac structures using 3D echo. Dr. Roberto Lang from Mount Sinai Medical Center in New York City and colleagues discuss the advantages and limitations of the technique, as well as current and potential uses of the technology, exploring novel image acquisition and display techniques.

The paper details data acquisition modes ranging from simultaneous multiplane mode to real-time 3D mode, as well as narrow to focused wide-sector zoom. The authors also discuss challenges of 3D acquisition, including 3D gating and breath-hold and 3D optimization tips.

In addition, the group discusses the problems associated with low- and high-gain settings, advising that practitioners begin in the midrange (50 units), then optimize settings with slightly higher time-gain compensation to enable the greatest flexibility in postprocessing.

Transthoracic and transesophageal exam techniques also are covered in detail. In transthoracic 3D echo, for example, the authors advise that clinicians acquire images from multiple transthoracic echo transducer positions to overcome the limitations of poor temporal and spatial resolution. For transesophageal exams, gated 3D modes, including 3D color-flow Doppler, also should be used whenever ECG and respiration gating requirements permit, in order to benefit from the improved spatial and temporal resolution of the wide-angled acquisitions, the authors stated.

Foremost among 3D echo's limitations are that spatial and temporal resolution remain poor, but this is expected to improve as the technology advances, they concluded. Live 3D echo color Doppler acquisition is limited to small color Doppler volumes, generally with limited temporal resolution of 10 to 15 voxels/sec.

"Alternatively, multiple-beam full-volume acquisition of color Doppler providing larger color Doppler volumes and volume rates (up to 40 voxels/sec) are limited by stitching artifacts, resulting in significant displacement between different subvolumes," Lang and colleagues wrote.

Although 3D echocardiography has been a research interest for more than three decades, recent improvements in imaging technology have made it suitable for clinical use, they concluded.

In a statement accompanying release of the article, Dr. Alan Pearlman, wrote: "I believe that real-time volumetric imaging using 3D echocardiography now provides a practical way to measure ventricular volumes and ejection fraction without making any assumptions about chamber geometry, and suspect that one day this imaging method will surpass current 2D echo imaging, just as 25 years ago 2D imaging supplanted M-mode echocardiography."

View the article online.

Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

Back To Top

Automated Breast Ultrasound Finds More Cancer than Mammography Alone

Automated breast ultrasound (ABUS) finds cancers in dense breast tissue that mammography alone would not, according to a recent study. The findings indicate that ABUS could have a role in a screening environment for women with dense breasts.

Ultrasound has demonstrated its value as an adjunct to conventional mammography for screening women, particularly those with dense breast tissue, said Dr. Judy Dean, a radiologist in private practice in Santa Barbara, CA. However, radiologists are concerned that using the technology manually for screening will take too much time.

"Numerous studies beginning in the 1990s have shown the value of ultrasound in detecting cancers not seen on mammography in women with dense breast tissue, but radiologists have not embraced the modality because of the time and training it takes to perform the examinations," Dean told attendees at a session at the RSNA 2011 meeting. "[But we found that] cancer detections increased by 63% with [ABUS] after radiologists received only four hours of training."

Automated breast ultrasound acquires overlapping scan rows in an axial plane, Dean said. The images are reviewed by the radiologist as a cine loop, and cancers are identified by the disruption of structures. Spatial registration allows for localization of identified findings.

For the current study, Dean and colleagues examined asymptomatic women having routine mammography. The study included 3,778 digital mammograms and ABUS studies; all women had dense breast tissue (BI-RADS 3 or 4 density score) or a high risk of breast cancer. Diagnostic yield and specificity of mammography were compared to results with ABUS and the two modalities combined. The study was blinded but not randomized, she said.

All imaging studies were performed by technical staff and interpreted later by a radiologist, Dean told session attendees. The exams were handled as screening studies, with recall for workup of suspicious findings.

Mammography alone found 4.5 nonpalpable cancers per 1,000 women; adding ABUS increased the number to 7.9 per 1,000, an increase in yield of 76%. ABUS found 13 additional cancers, all of which were invasive, Dean said. The average size of the invasive cancers found was 14 mm with digital mammography and 9 mm with ABUS.

There were no significant changes in specificity and positive predictive value (PPV) between the two modalities. Mammography's specificity was 99.5% and its PPV was 50%; the specificity of ABUS was 99.4% and its PPV was 43.6%. The combined specificity of the modalities was 99%, while their combined PPV was 44.1%, according to Dean.

While early detection of breast cancer with mammography can prevent breast cancer deaths, ABUS can help find those cancers mammography might miss in high-risk or dense-breasted women, Dean concluded.