Journal of Diagnostic Medical Sonography (JDMS)

Concern for patient safety and increased demands on health professionals have resulted in challenges for the clinical training of sonography students. The purpose of this study was to examine simulation use in Commission on Accreditation of Allied Health Education Programs (CAAHEP)–accredited sonography programs. A prospective cross-sectional study was conducted. Program directors were sent a survey that addressed the use of simulation and the perception of simulation’s educational value. Of the 230 sonography programs identified, 137 responded, for a response rate of 60%. Of the respondents, 75% indicated they used simulation and 89% reported that it was a good teaching tool. The programs indicated that 81% recorded a positive student experience using simulation. Simulation was rated most useful for improved anatomic identification (55%) and transducer manipulation (64%). Simulation is commonly used for educational training in CAAHEP-accredited sonography programs and is perceived as a positive tool to enhance education of students. More research is needed to establish best use and educational practice.

Ergonomic training is necessary to help reduce work-related upper limb disorders (WRULD) in sonographers. This study provided an ergonomic training session for sonographers, to determine whether a teaching intervention changed the grip force used to hold a transducer. Thirteen practitioners participated and were placed into two groups (intervention group n = 7). Participants were asked to scan the same simulated transabdominal early pregnancy case. An ergometer was used, which enabled all participants to hear the effect of holding the transducer tightly. Their matched grip force was measured before and after the intervention using a dynamometer. The intervention group reviewed videos and photographs taken during the scan to see if this affected the matched grip force further. Study findings showed that the short ergonomic training session with the use of an ergometer significantly reduced the matched grip force applied to a transducer (P < .05) for all participants. The video/photo review did not result in any further significant changes.

A preexperimental cohort study was conducted with 67 overweight cancer survivors. This cohort of participants was screened for baseline body composition and anthropometrics based on a variety of techniques, including body mass index (BMI), dual X-ray absorptiometry–percentage body fat (DXA-android %BF), diagnostic medical sonography (DMS), and waist circumference (WC). The combination of subcutaneous fat layer at the xyphoid and umbilicus compared with BMI, WC, and DXA-android %BF. These variables demonstrated moderately positive association and were statistically significant. A total maximum mean score of DMS measures of subcutaneous and visceral fat was also compared with BMI, WC, and DXA-android %BF. The aforementioned comparison had a moderately positive association and was statistically significant. The sonographic measure of mesentery fat was compared with WC and demonstrated a strongly positive strength of association and was statistically significant. Sonography may be an inexpensive, noninvasive, portable, and valid body composition measure for overweight patients.

The purpose of this research was to employ the audit method to measure performance and identify targets of change, setting a template for future large-scale investigations that may inform decisions involving sonographer role expansion in Canada. The authors conducted an audit of 433 sonographic examinations performed in the ultrasound department of a Canadian hospital. Sonographer reports were contrasted with radiologist final reports, and a degree of agreement (DoA) 1 to 4 was assigned to each exam package. In total, 322 of 429 (75%) exam packages were ranked as DoA 1 (complete agreement between sonographer and radiologist), 86 of 429 (20%) were ranked as DoA 2, 16 of 429 (4%) were ranked as DoA 3, and 5 of 429 (1%) were ranked as DoA 4 (significant discrepancy between sonographer and radiologist). The results revealed a 75% agreement between sonographer and radiologist on imaging findings as they are recorded in technical impression sheets and reports. Discrepancies are usually minor and involve the omission of incidental findings by the radiologist.

This issue of the Journal of Diagnostic Medical Sonography is dedicated to women’s health.

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.

This study aimed to identify the barriers that prevent currently practicing credentialed sonographers from using industry standard ergonomic scanning techniques. A quantitative descriptive design was used with data collected through an anonymous online survey of members of the Society of Diagnostic Medical Sonography. A total of 1234 members participated in the survey. The results confirmed previous reports that a high percentage (85.5%) of sonographers scan in pain, with the shoulder most commonly affected. Four barriers to ergonomic scanning practice were identified by more than 25% of the respondents, including being too busy, patient obesity, portable exams, and patients who are unable to cooperate. Some barriers are not within the control of the sonographer, such as patient obesity and patient condition, while other barriers are within moderate control, such as scheduling and lack of equipment. The focus should be placed on correcting and improving those barriers that can be controlled, thereby reducing the risk of work-related musculoskeletal injuries in sonographers.

Ventricular septal rupture (VSR) is a rare life-threatening mechanical complication secondary to acute myocardial infarction that usually occurs 2 to 8 days after infarction and frequently precipitates cardiogenic shock. The mortality rate for VSR has been reported to be between 41% and 80%; therefore, immediate surgical intervention should be considered. Furthermore, VSR is a complication of 0.17% to 0.31% of patients who present with an anterior myocardial infarction. Because of the rarity of this pathology, the role of transthoracic echocardiographic investigation will help to improve what is already considered a poor prognosis for these types of patients. This case study illustrates how transthoracic echocardiography plays an essential role in the rapid assessment and diagnosis of VSR in clinical practice.

Sonographers assume an important role in providing accurate diagnosis for prompt patient management. The manual task of scanning competency is driven by a high level of cognitive function in the form of clinical decision making (CDM). It is therefore critical that sonography students are grounded in the CDM fundamentals as part of their sonography education. The aim of this article is to seek better understanding of student views on CDM learning to inform educators of strategies to better support student learning. The first part of the article describes how CDM for sonography students is being developed at The University of Auckland. The second part of the article explores student perspectives of CDM learning and the application of CDM in the workplace. Using purposive sampling, five clinical supervisors and two students participated in semistructured interviews. Focus groups with students were conducted at the end of each semester, between July 2014 and June 2016. Thematic analysis was used to analyze and make sense of the data. Based on these qualitative findings, the authors make recommendations to advance CDM within the sonography curriculum.

Molecular imaging is a form of nanotechnology that enables the noninvasive examination of biological processes in vivo. Radiopharmaceutical agents are used to target biochemical markers, permitting their detection and evaluation. Early visualization of molecular variations indicative of pathophysiological processes can aid in patient diagnoses and management decisions. Molecular imaging is performed by introducing into the body molecular probes, which are often contrast agents that have been nanoengineered to target and tether to molecules, thus enabling their radiologic identification. Through a nanoengineering process, ultrasound contrast agents can be targeted to specific molecules, extending ultrasound’s capabilities from the tissue to molecular level. Molecular ultrasound, or targeted contrast-enhanced ultrasound (TCEUS), has recently emerged as a popular molecular imaging technique due to its ability to provide real-time anatomic and functional information without ionizing radiation. However, molecular ultrasound represents a novel form of molecular imaging and consequently remains largely preclinical. This review explores the commonalities of TCEUS across several molecular targets and points to the need for standardization of kinetic behavior analysis. The literature underscores evidence gaps and the need for additional research. The application of TCEUS is unlimited but needs further standardization to ensure that future research studies are comparable.

Background: Fetal ultrasound screening for congenital heart disease has high detection rates in efficacy studies but not in practice. We investigated sonographers’ perspectives on barriers to screening and their association with intermediate measures of cardiac imaging. Methods: Barriers to fetal heart screening were identified in focus groups with obstetric sonographers. A web-based survey measured reported barriers and sonographers’ ability to interpret fetal heart screening images. Generalized linear random effect models assessed associations between barriers and image interpretation. Results: Four themes were identified: intrinsic barriers (self-efficacy), external barriers (time), informational needs, and provider and patient expectations. Among 224 sonographers surveyed, an average of 77.6% of fetal heart images were interpreted correctly. Perceptions about self-efficacy (P = .03) and ease of performing imaging (P = .01) were associated with accuracy of image interpretation. Conclusions: Several sonographer-identified barriers associated with image interpretation may be novel targets for improving prenatal detection of congenital heart disease.

High-intensity focused ultrasound (HIFU)–mediated drug delivery is a relatively novel technique used to deliver drugs to a targeted location in the body. High-intensity focused ultrasound–mediated drug delivery has a broad range of applications, such as tumor therapy, treating central nervous diseases, transsclera drug delivery, and cardiovascular treatments. Targeted treatments prove to be advantageous to systemic treatments due to the reduction in the associated side effects. Thus, this literature review focuses on the various applications of HIFU-mediated drug delivery as well as the mechanism involved. This article is intended to supply the reader with a detailed description of how this technique can be used as well as describe its potential to surpass other treatment methods. Further discussion on the efficiency, limitations, and future of HIFU-mediated drug delivery is addressed. Furthermore, the gaps in the published literature, relative to this topic, are discussed. Ultimately, HIFU-mediated drug delivery is a developing technique that could provide patients with exciting treatment options.

Severe brachiocephalic artery stenoses are relatively rare obstructions of the extracranial arteries and can cause significant changes to hemodynamics and spectral Doppler waveform patterns, complicating diagnosis. This case study presents disease progression from stenosis to occlusion and resulting complex steal phenomena extending to the contralateral upper extremity, which has not been widely reported. The sonographic findings of disease progression and collateral pathways were confirmed by magnetic resonance angiography and contrast-enhanced computed tomography.

Patients are frequently referred for pelvic sonograms to evaluate for adnexal masses. Determining the etiology of the adnexal mass can be challenging, but is necessary to establish a follow-up strategy and correct diagnosis. It is particularly important in those cases when adnexal lesions appear to be complex and the ovaries are not visualized sonographically. Perineural cysts were found incidentally by Tarlov in 1938 during autopsy. This report documents a lesion now bearing his name, Tarlov cysts (TCs). They are defined as cerebrospinal fluid-filled saccular lesions located in the extradural space of the sacral spinal canal and are formed within the nerve root sheath at the dorsal root ganglion. The perineurium and neural tissue make up the cysts’ walls. Usually asymptomatic, a TC is mostly found on magnetic resonance imaging (MRI) of the lumbar spine and sacrum. Occasionally, a TC mimics an adnexal cyst.