Harris L. Cohen

AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination.

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. To promote this mission, the AIUM is pleased to publish, in conjunction with the American College of Emergency Physicians (ACEP), this AIUM Practice Guideline for the Performance of the Focused Assessment With Sonography for Trauma (FAST) Examination. We are indebted to the many volunteers who contributed their time, knowledge, and energy to bringing this document to completion. The AIUM represents the entire range of clinical and basic science interests in medical diagnostic ultrasound, and with hundreds of volunteers, the AIUM has promoted the safe and effective use of ultrasound in clinical medicine for more than 50 years. This document and others like it will continue to advance this mission. Practice guidelines of the AIUM are intended to provide the medical ultra-sound community with guidelines for the performance and recording of high-quality ultrasound examinations. The guidelines reflect what the AIUM considers the minimum criteria for a complete examination in each area but are not intended to establish a legal standard of care. AIUM-accredited practices are expected to generally follow the guidelines with the recognition that deviations from the guidelines will be needed in some cases depending on patient needs and available equipment. Practices are encouraged to go beyond the guidelines to provide additional service and information as needed by their referring physicians and patients.

Ultrasonography of Pylorospasm: Findings May Simulate Hypertrophic Pyloric Stenosis

We compared sonographic images and measurements of patients diagnosed as having hypertrophic pyloric stenosis and pylorospasm among infants with projectile vomiting. Thirty‐seven patients with hypertrophic pyloric stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall thickness (mean, 5.3 mm). Thirty‐four pylorospasm patients had considerable variability in measurement or image appearance during their studies. Means of their longest or largest measurements were 14.4 mm for pylorus length and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater during some portion of their study. We concluded (after clinical follow‐up study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic hypertrophic pyloric stenosis for at least a portion of a sonographic study. Muscle wall thickness or pyloric length measurements may overlap those accepted as positive for hypertrophic pyloric stenosis. Image or measurement variability is an important clue for diagnosing pylorospasm.

Understanding bibliometric parameters and analysis.

Bibliometric parameters have become an important part of modern assessment of academic productivity. These parameters exist for the purpose of evaluating authors (publication count, citation count, h-index, m-quotient, hc-index, e-index, g-index, i-10 [i-n] index) and journals (impact factor, Eigenfactor, article influence score, SCImago journal rank, source-normalized impact per paper). Although in recent years there has been a proliferation of bibliometric parameters, the true meaning and appropriate use of these parameters is generally not well understood. Effective use of existing and emerging bibliometric tools can aid in assessment of academic productivity, including readiness for promotions and other awards. However, if not properly understood, the data can be misinterpreted and may be subject to manipulation. Familiarity with bibliometric parameters will aid in their effective implementation in the review of authors-whether individuals or groups-and journals, as well as their possible use in the promotions review process, maximizing the effectiveness of bibliometric analysis.

Pelvic inflammatory disease in adolescents.

Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachomatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydia-associated PID, those with gonococcus-associated PID had a shorter duration of pain before admission (p less than 0.05), higher mean maximum temperatures (p less than 0.01), and higher leukocyte counts (p less than 0.01). Pelvic ultrasound studies showed adnexal enlargement or tubo-ovarian abscess (TOA) in 85.2% of the patients. Of the 88 adolescents in whom adequate sonograms were obtained, 17 (19.3%) had TOA. In 12 of the 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. Our high detection rate of C. trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C. trachomatis and N. gonorrhoeae.

The swallowed toothbrush: A radiographic clue of bulimia

Swallowed toothbrushes were noted in the esophagus of one teenager and the stomach of two others with bulimia. The presence of a toothbrush in the lumen of the gastrointestinal tract should make the radiologist suspicious of bulimia/anorexia nervosa. A toothbrush shows a characteristic radiographic image with parallel rows of short metallic radiodensities due to the metallic plates that hold the bristles in place.

High-resolution imaging diagnosis and staging of bladder cancer: comparison between optical coherence tomography and high-frequency ultrasound

A comparative study between 1.3-microm optical coherence tomography (OCT) and 40-MHz high-frequency ultrasound (HFUS) is presented to enhance imaging of bladder cancers ex vivo. A standard rat bladder cancer model in which transitional cell carcinoma (TCC) was induced by intravesical instillation of AY-27 cells was followed independently with both OCT and HFUS, and the image identifications were compared to histological confirmations. Results indicate that both OCT and HFUS were able to delineate the morphology of rat bladder [e.g., the urothelium (low backscattering/echo) and the underlying lamina propria and muscularis (high backscattering/echo]. OCT differentiated inflammatory lesions (e.g., edema, infiltrates and vasodilatation in lamina propria, hyperplasia) and TCC based on characterization of urothelial thickening and enhanced backscattering or heterogeneity (e.g., papillary features), which HFUS failed due to insufficient image resolution and contrast. On the other hand, HFUS was able to stage large T2 tumors that OCT failed due to limited imaging depth. The results suggest that multimodality cystoscopy combining OCT and HFUS may have the potential to enhance the diagnosis and staging of bladder cancers and to guide tumor resection, in which both high resolution (approximately 10 microm) and enhanced penetration (> 3mm) are desirable.

Testicular Torsion in Neonates: Importance of Power Doppler Imaging

Power Doppler sonography has been shown to have greater sensitivity to blood flow than conventional color Doppler sonography. Whether this increased sensitivity provides clinically relevant information for a diagnosis of neonatal testicular torsion has been questioned. We present the case of a newborn infant who was thought to have bilateral testicular torsion and infarction based on gray scale and color Doppler ultrasonographic findings. Power Doppler imaging and surgery proved one testicle to be viable. This case both demonstrates the value of power Doppler sonography in detecting normally low flow in the neonatal testicle and shows that the finding of hypoechoic testicles may not necessarily mean infarction. Duplex sonography and color Doppler ultrasonography play key roles in the diagnosis of testicular torsion in adolescents and adults.1 In neonates, however, since testicular blood flow normally is low and often is below the sensitivity of conventional color Doppler sonography, a definitive sonographic diagnosis can be more difficult than in adolescents.2 The clinical usefulness of power Doppler sonography in such cases is being evaluated. We present a case of testicular torsion in a neonate that appeared to show bilateral infarction on gray scale and conventional color Doppler sonographic images. Only after power Doppler imaging was the diagnosis of unilateral testicular torsion and a salvageable second testicle made.

AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

Torsion of the testicular appendage : sonographic diagnosis

Torsion of the testicular appendages may simulate the clinical and physical examination findings of testicular torsion. Real‐time imaging and duplex Doppler scanning aided the diagnosis of this entity in three children. The testes appear normal on sonograms and have normal vascular flow. A circular mass of increased echogenicity with a variably sized central hypoechoic region is seen adjacent to the testicle. We could not relate variations in echogenicity to time delay between clinical pain and sonographic examination.

Imaging the pediatric pelvis: the normal and abnormal genital tract and simulators of its diseases

Imaging of the pediatric pelvis has proven of great use in defining the normal and abnormal genital tracts. Sonography is the key screening tool and often the only tool necessary for the diagnosis of problems related to ambiguous genitalia, ovarian and uterine masses, amenorrhea, and abdominal and pelvic pain. Computed tomography (CT) and magnetic resonance imaging (MRI) have key roles in the global assessment of the pelvis particularly with regard to the assessment of tumor spread.