bluuebunny/crossref_metadata_2025 huggingface dataset:
Complementary and alternative medicine and rheumatology nurses: A survey of current use and perceptions
Authors: Osborn Caroline , Baxter G. David , Barlas Panos , Barlow Julie
Published: March 2006

A questionnaire-based survey of rheumatology nurses was undertaken to investigate the use, and perceptions, of the effectiveness of complementary and alternative medicines (CAM) in the management of patients with rheumatic diseases (RD). A total of 192 rheumatology nurses (response rate 76.2%) completed the questionnaire, which included sections on qualifications and clinical experience, perceptions of, training in, and use of CAM in the management of RD patients. CAM was provided by 8.3% of respondents, principally aromatherapy, massage and reflexology. Furthermore, over half of respondents (51.6%) provided advice to patients about CAM, primarily to patients with rheumatoid arthritis (RA). Perceptions of the benefits of CAM are overwhelmingly positive: 89.8% of respondents considered it to have a role in the NHS. Current barriers to wider use of CAM include budgetary constraints in the health service, limited availability of published evidence, and the current lack of a clear and adequate regulatory framework for its practice.
Examining the benefits of aromatherapy massage as a pain management strategy for patients with multiple sclerosis
Authors: Howarth Amanda L. , Freshwater Dawn
Published: March 2006

The pain experienced by patients who have multiple sclerosis (MS), remains a poorly understood phenomenon, although it is becoming more clearly defined. It is often the case that the pain patients with MS experience does not easily respond to traditional therapeutic treatments, and may therefore remain unrelieved. Patients may be reluctant to take additional medication to that they are taking for their MS-related symptoms, which means that many choose complementary therapies to help them manage their pain. However, like the pain experience, the nature of complementary therapies and their effectiveness in treating illness and alleviating symptoms is also poorly understood. Thus, while many patients choose treatments such as aromatherapy, there is little research evidence to support its application in a systematic and rigorous way. This paper reports the progress of a qualitative research study that aims to examine the benefits of aromatherapy massage in the management of chronic pain in patients diagnosed with MS. Patients were recruited to the study from a group of individuals attending a specialist pain management clinic led by the researcher (AH). The paper outlines the methods and processes undertaken, and points to the preliminary findings.
Challenges of collecting data in the clinical setting
Authors: Casey Dympna
Published: March 2006

Undertaking a piece of research in the clinical setting is often far more difficult than it appears from descriptions in textbooks. This paper describes some of the challenges faced in the course of completing a non-participant observational study that examined how health promotion practice was carried out by hospital-based nurses in an acute setting. The challenges included deciding which observational role to adopt, whether to use structured or unstructured observations, which observational position to adopt, how long observation sessions should be and how to deal with ethical issues when the researcher is also a nurse. It is concluded that the answers to some dilemmas and challenges are not always found in the literature and that decisions taken often depend on the researcher's morality and pure common sense.
The re-casualisation of the nursing labour force at the end of the 20th century: A comparison with the end of the 19th century
Authors: Maggs Christopher
Published: March 2006

The development and definition of the profession of nursing required, inter alia,the extinction of a casual nursing workforce that, in the main, provided the nursing staff of the hospitals in England up to the 1860s. That process was a 'moral crusade' as well as an attempt at organizational efficiency. As the end of the 20th century approached, the picture appeared to have turned full circle, and many more nursing staff are employed on anything but full-time contracts. There are major implications for the way the profession defines itself and for the future of nursing work.
Awareness of the health needs of prisoners
Authors: Mead Donna , Moseley Laurence
Published: March 2006

This study reports on a small scale survey among discipline officers in three prisons in Wales to try to estimate the extent of their knowledge about health problems among prisoners; how they glean information, and how they communicate with prison healthcare staff.

The results indicate that these officers are concerned for inmates' welfare, are knowledgeable about, and are competent to identify and handle, problems of physical health. By contrast, they find mental health problems unpredictable and mystifying, and are not confident that in the prison context professionals can solve those problems. Discipline officers are well placed to act as front-line health surveillance staff and feel that they communicate well with healthcare staff. However, they feel that information does not flow freely in the opposite direction, and are concerned about the problems that arise from healthcare staff adhering to the 'medical in confidence' principle by which information on a prisoner's condition should not be shared outside strictly professional health-care groups, thus excluding discipline groups.

In trying to elaborate on our results by looking at two recent review papers on mental health in prisons, we discovered that it is not clear exactly how prevalent such problems are: there is no evidence to contradict the views of the discipline officers, yet some to support them.
Ultrasonographic Demonstration of an Intestinal Duplication Cyst As a Leading Point for Intussusception
Authors: Barzilai Menashe , Kovacs Zeharya , Lerner Aaron
Published: March 2006

In the past, leading points causing intussusception were identified either during barium enema performed for reduction of the invaginated bowel or during surgery. A persistent filling defect in the ileocecal region or in the colon was the hallmark of a possible causative factor for the intussusception. In recent years, the ultrasonographic features of intussusception have been defined, and occasionally a leading point has been shown. We present a 4-month-old child in whom an intussusception was diagnosed by ultrasound examination. A duplication cyst was identified in close proximity to the intussusception and was suspected to be the causative factor. This was shown by computed tomography and confirmed at surgery.
Transvaginal Sonography Made Easier
Authors: Hasko Sam
Published: March 2006

Anatomy that is not located textbook-perfect in the pelvis gives sonographers difficulty. This article will provide methods to achieve a good transvaginal examination on all patients.
Where Does Ultrasound Stand in Technology Assessment and Outcomes Research
Authors: Waggoner Alan D.
Published: March 2006

Although diagnostic ultrasound has been widely applied for various clinical conditions and diseases, its clinical effectiveness remains less well defined. Technology assessment can be applied to ultrasound and includes several criteria such as techologic capability, range of possible uses, diagnostic accuracy, impact on health care providers, therapeutic impact, and patient outcome. A review of each of these criteria is provided to raise sonographer awareness as to the need for further reserch in this area.
The Four-Chamber View of the Fetal Heart
Authors: Persutte Wayne H. , Jones Oliver W.
Published: March 2006

Although the four-chamber view of the fetal heart is the most widely used prenatal screening tool for the identification of congenital heart disease, its accuracy and reliability remains shrouded in confusion. A recent report suggested the four-chamber view of the fetal heart is obtainable in virtually all cases after 24 weeks of gestatin. In the largest series to date, we report our experience concerning the detection reate of the four-chamber view. In 7739 consecutive second and third trimester ultrasonographic examinations, we found a detection rate of 75%. This rate was lower before 20 weeks of gestation and after 30 weeks of gestation.
Gonadal Dysgenesis in Association With Campomelic Dysplasia
Authors: Winderl Lisa M. , McGuire Tanya M. , Patel Vinu
Published: March 2006

Campomelic dysplasia is a rare skeletal malformation that is characterized by congenital shortening and bowing of the long bones of the lower extremities and that can be detected prenatally by ultrasound examination. The phenomenon of sex reversal is associated with this skeletal dysplasia, resulting in phenotypic female patients whose chromosome constitution is 46, XY. At 24 weeks' gestation, a case of gonadal dysgenesis is identified in a fetus afftected by campomelic dysplasia. The pathognomonic features of campomelic dysplasia are shown by prenatal ultrasound examination and correlation is made with postantal clinical and radiographic findings. Several skeletal dysplasias, in cluding campomelic dysplasia, can be diagnosed prenatally by evaluating the fetal long bones. Among the fetuses affected with compomelic dysplasia, a certain precentae are 46, XY female patients. Genetic amniocentesis and sex determination by ultrasound examination should be considered to identify prenatally these fetuses. Postanatlly, it is reasonable that all phenotypic female neonates diagnosed with campomelic dysplasia should undergo chromosome analysis.
Sonotraphic Diagnosis of Sigmoid Diverticulitis
Authors: Ruff Cullen , Weingardt Jeffry P.
Published: March 2006

A case of sigmoid diverticulitis diagnosed by transabdominal and endovaginal sonography is presented. Clinical findings of sigmoid diverticulitis can often overlap with other abnormal processes in the pelvis. Additionally, sigmoid diverticulitis can esily be overlooked during pelvic sonography if the examiner is not familiar with the sonographic features of this common disease. The typical findings of diverticulitis and associated complications are discussed.
Bilateral Dacrocys toceles
Authors: Winderl Lisa M. , Patel Vinu
Published: March 2006

Dacrocystoceles are uncommon abnormalities of the fetus and neonate, with bilateral involve ment even rarer, The information available in the ultrasound literature is limited, and diagnostic images in textbooks are scrce. We present one case of bilateral dacrocystoceles diagnosed early in the third trimester and summary of seven prenatally diagnosed cases of dacrocystoceles reviewed in recent literature.
Prenatal Presentation of Fetal Ovarian Torsion
Authors: Dempsey Rich
Published: March 2006

Intra-abdominal cystic masses in the fetus are often renal or ovarian in origin. Fetal ovarian cysts are relatively common and are usually small. Large ovarian cysts have the same potential for hemorrhage and torsion as their adult counterparts. The fetus is additionally at risk for lung compression and postnatal respiratory distress from large intra-abdominal masses.
Ultrasound Physics and Instrumentation in Clinical Practice and Application
Authors: Kawamura Diane M. , Boyce Kari E. , Shung Kirk K. , Calton Sharon S.
Published: March 2006

The American Registry of Diagnostic Medical Sonographers administers certification examinations in various specialty areas. To ensure that these examinations reflect the application of these principles and instrumentation to clinical practice, the American Registry of Diagnostic Medical Sonographers regularly surveys sonographers to determine current practice.

The Ultrasound Physics and Instrumentation Examination Development Task Force conducted a task analysis survey of a random sample of 7,000 registered and unregistered sonographers. The ultrasound physics and instrumentation examination content outline was revised to reflect changes in practice as evident from the survey results. This revision was also reviewed by scientists, authors, lecturers, and sonography educators. Evaluation also included assessing the feasibility of the content outline for use as an educational curriculum outline for ultrasound physics and instrumentation courses and reviewing current textbooks and other resources to ensure availability of information in each outline content area.

The most notable change is the broad use of electronic and Doppler instrumentation by sonographers. As a result, the transducer, instrumentation, and Doppler sections of the outline have been significantly revised, while reference to mechanical transducers have been reduced and static scanners eliminated. Increased use of digital and semidigital image archive systems provided the rationale to expand the image storage and display portion of the outline. The artifacts section has been reorganized to reflect the way each artifact appears within an image. Quality assurance has been expanded to include Doppler equipment and statistical indices. Lastly, the section on bioeffects and safety now includes the acoustic output labeling standards, thermal and mechanical indices.
An Easily Implemented Method to Improve Detection of Ultrasound Contrast in Body Tissues
Authors: Merton Daniel A.
Published: March 2006

The recent commercial availability of ultrasound contrast agents poses new challenges to ultrasound lprofessionals. There is a need to identify the most:relevant clinical applications for which the agents are indicated, as well as ways jin which to use existing ultrasound technology with contrast. Herein is described la new imaging tehnique frame-one maging that: imp rovsthe detection of contrast in bo0d:tissues. Frame-one imaging was attempted in six examin attons of suspected renal abnormalities performed as part of the FDA Phase IcliIcIal trials of the contrast agent Definity® (DuPont Pharmaceuticals, N. Billerica,: M, A). Conventional and harmonic gray-scale imaging was perfrmed at baseline and postcntrat addm inistration. US imaging results were compared to surgical findings. U1, sing gray-scalle harm: o:nicimagg, improved depiction: of:contrast enhancement was achieved in all:cases where FOI was employed. Contrast enhancement was better demonstrated using the FOI tchnique than with continuous real-time imaging. FOI improved the display of contrast enhancement from within normal tissues and vessels as wel as:frombi tumor vessels and tumor tissue. FOI may permit improved tumor characterization using contrasenhanced sonogphy. Additiol vestigations are neede to determine if FOL can imp0rovethe diagnostic potential of contrast-enhanced sonography.
Ultrasound Imaging of Scrotal Wall Thizckening and Its Significance in the Diagnosis of Fournier's Cangrene in Older Men
Authors: Safriel Yair , Cohen Harris L. , Torrisi Jean
Published: March 2006

Scrotal sonograms of a series of older patients with scrotal wall thickening were analyzed retrospectively for associated sonographic, radiographic, and clinical features. Scrotal thickening in debilitated, older men can be a sign of more grave pathology and may be associated with a significant morbidity.
Ultrasound-guided Thrombin Injection of an AVF Pseudoaneurysm
Authors: Rama Kumara , Greene Kathleen , Nichols Sally , Berg Richard , Khoury Michael , Colaiuta Elizabeth , Flynn Lisa
Published: March 2006

The purpose of this case report is to demonstrate the effectiveness of duplex-guided thrombin injection for hemodialysis access m:ainteniance. A 72-year-old female complained of nine-month onset of pain and tenderness at the site of her left upper extremity arteriovenous fistula Prosthetic arteriovnous fistula graft body pseudoaneurysms were fund on fistulography and confirmed with color flow duplex ultrasound. Duplexguided thrombin injection was perfrmed resufiing in successful thrombosis of et graft pseudoaneurysms. The procedure was performed in an outpatient setting the patient tolerated the procdue well, and graft patency was preserved.
Contrast-Enhanced Sonography in Patients with Renal Pathology
Authors: Peterson Cynthia L. , Barr Richard G.
Published: March 2006

Ultrasound contrast agents are currently being evaluated for many potential clinical applications. One such application is in patients with indeterminate renal masses. Patients who do not have simple cysts by sonographic criteria often undergo multiple imaging procedures or intervention to achieve a diagnosis. This study examined the impact of the addition of an intravenous contrast agent on sonographic imaging in patients who had renal masses. This study was performed utilizing solely fundamental imaging and the continued evolution of contrast-specific software coupled with intravenous ultrasound contrast agents has the potential to increase diagnostic capabilities in sonography of renal pathology.
The Role of Ultrasound in the Diagnosis of Joint Hip Effusions in Small Children
Authors: Zabala Valerie A.
Published: March 2006

There are a variety of causes for hip pain in children, including slipped capital femoral epiphysis (SCFE), toxic synovitis, septic arthritis, Perthes disease, fracture, and juvenile rheumatoid arthritis. Several of these processes can result in hip joint effusions. Although radiography is initially performed and is often diagnostic, the plain radiograph may be normal in the presence of a small joint effusion. Sonography can be used to determine whether an effusion is present and when deemed clinically appropriate, to guide a diagnostic or therapeutic arthrocentesis. When patients show signs of sepsis and effusion, an ultrasound-guided arthrocentesis can help differentiate between septic arthritis and toxic synovitis. In the evaluation of difficult cases, a bone scan or magnetic resonance imaging may be helpful to exclude the possibility of underlying osteomyelitis.
Contrast Echocardiography in the Diagnosis of Partial Anomalous Pulmonary Venous Return
Authors: Scotton Michael
Published: March 2006

The diagnosis of partial anomalous pulmonary venous return is usually made by cardiac catheterization. Diagnosis of partial anomalous pulmonary venous return requires analysis of multiple blood samples for demonstration of increase in blood oxygen saturation and contrast venography to identify the anomalous vein. Transesophageal echocardliography can identify partial anomalous pulmonary venous return in some cases, but, in many cases, the absence or inability to demonstrate one or more of the pulmonary veins draining directly into the left atrium only implies the diagnosis. Because this condition may require surgical correction, a more definitive demonstration of the anomalous venous return is often needed. The following case study presents a novel approach to the diagnosis of partial anomalous pulmonary venous return, using transthoracic echocardiography and administration of the contrast agent Optison (Mallinckrodt Pharmaceuticals, St. Louis, MO) directly into the pulmonary artery.
Effectiveness of a Sonography Distance-Learning Event for Continuing Medical Education Credit
Authors: Evans Kevin D. , Sachs Larry
Published: March 2006

Continuing education for sonographers is a requiremeint for them to maintain their national registry. Satellite teleconferences are an example of a distance-learning activity that provides access ad information to sonographers regardliess of the location of the participant. The difficulty with this type of continuing medical education activity is that it is unmeasured for satisfaction, relevance, and knowledge gain for sonographers. Using previous research into effective physician continuing medical education, a study was designed as an investigation of the effectiveness of a commercially sponsored distance-learning event.

The results of this study suggest that a more structurd: study is necessary to validate satisfaction and relevance scores for this type of continuing medical education activity for all job titles. It is also important to begin to describe the efetiveness of continuing education distance-learning events for sonographers and other allied medical professionals.
Unusual Appearance of a Neonatal Brain Lesion
Authors: Bryant Sean O. , Drose Julia A. , Rubinstein David , Cajade-Law Ana
Published: March 2006

Sonography plays an integral role in evaluation of the brain in premature infants. Screening premature infants for intracranial hemorrhage has been proven to be extremely sensitive and specific. Sonography also plays a critical role in the evaluation of intracranial lesions in this population. We present a case of an unusual manifestation of a brain lesion in a premature infant.
The Role of Ultrasound in the Management of a Twin Gestation with One Fetus Affected with Anencephaly
Authors: Hubacz Deborah A.
Published: March 2006

Anencephaly is the most common type of neural tube defect seen during prenatal development. This condition results from a failure of the neural tube to close at its cephalad end between the second and third weeks of embryonic development.1 Sonographically, anencephaly presents as the absence of the cranial vault and cerebral hemispheres. It is believed to be multifactorial in origin but usually not associated with chromosomal abnormalities.2 The condition is invariably lethal; 50% are stillborn, and the remainder die in the newborn period.3

We present a case of a twin gestation, with one fetus affected with anencephaly and the other with no apparent abnormalities.
Obstetrical Sonography: Opportunities for "Teachable Moments" in Patient Care
Authors: Having Karen
Published: March 2006

The routine obstetric ultrasound examination can provide multiple opportunities to promote good prenatal health habits. Four common scenarios (Obtaining Routine Fetal Measurments, Obsering Fetal Breathing Mvements Demonstrat the Umbilical Cord, and Demonstrate the Plaenta) are presented as "teachable moments" that ithe sonographer mayuse to promote principles ofigood health care:durin preancy.
Prenatal Diagnosis of Lethal Shor-limbed Dwartism
Authors: Garten Katrina J. , Pulliam Robert P.
Published: March 2006

Nine of 23 established types of short-limbed dwarfism are always incompatible with life. Current state-of-the-art ultrasonic equipment and techniques combined with the establishment of longitudinal growth curves for fetal long bones have made possible the early prenatal diagnosis of lethal skeletal dysplasias. In addition to significantly shortened and/or bowel femurs, features include hydramnios, fetal hydrops, and protuberant fetal abdomen, all easily identifiable with ultrasound. The availability of early prenatal diagnosis of these skeletal dysplasias has placed increased importance on early ultrasonic evaluation of at-risk populations, providing an additional diagnostic parameter to complete the genetic workup.
Sonographic Assessment of the Renal Growth and Changing Appearances in the Newborn Infant
Authors: Pohlable Mary
Published: March 2006

The author evaluated kidneys in 85 children ranging in age from a 27-week premature infant to a child 10 years old to identify renal length and sonographic characteristics. Three categories of sonographic appearance were demonstrated, ranging from kidneys that were more dense than normal liver, with prominent pyramids and no sinus echoes, to kidneys that were less dense than normal liver, with less prominent pyramids and an echogenic sinus. Two growth patterns were also identified, demonstrating a rapid growth before 40 weeks (term age) and a slower change in renal length after 40 weeks.
An Introduction to Magnetic Resonance Imaging (MRI) for Sonographers
Authors: Sen Swapan K. , Mitchell Matthew D. , Kressel Herbert Y.
Published: March 2006

Magnetic resonance imaging (MRI) promises to become a valuable diagnostic tool for both diagnostic imaging and in vivo spectroscopy. MRI systems are already in place at a number of hospitals, and more units are expected to be installed when they receive FDA approval. Sonographers should understand the principles of MRI, since its use will interface with diagnostic medical ultrasound. A brief introduction to the physics of NMR is given. Typical MRI imaging equipment is described, including a comparison between superconducting, resistive, and permanent magnet systems. Some potential uses of this new technology are discussed. The safety and biologic effects of MRI are considered, and basic instructions for patient screening and preparation are given.
Contributions of Ultrasound to In Vitro Fertilization Programs
Authors: Warner Roger W. , Roth Patricia M.
Published: March 2006

The process of in vitro fertilization (IVF) and embryo transfer (ET) has gained worldwide attention since the birth of the first "test-tube baby" in 1978. Many couples with a history of infertility have elected to undergo this procedure. This article examines the process of IVF/ET and the role of ultrasound in monitoring follicular growth and in the retrieval of the oocytes by laparoscopy or sonographically guided transvesical or transvaginal needle aspiration.
Ultrasound-Guided Prenatal Punctures
Authors: Bader Birgit , Graham David
Published: March 2006

Ultrasound was used in three cases to assist the physician in performing fetal puncture for decompression of abnormal fluid collections in the fetus. The use of real-time ultrasound guidance can help prevent trauma to the mother and fetus due to such procedures.
Fetal Biometry
Authors: DuBose Terry J.
Published: March 2006

This paper proposes a method of approximating the fetal calvarial volume (CV) by measuring the vertical calvarial diameter in addition to the biparietal diameter and the fetal long skull diameter. The methods of measurement and calculation are discussed, and graphic analysis is presented. The approximate CV and the sum of the three fetal skull diameters (3D) correlate well with fetal gestational age regardless of individual variations in fetal skull shape and normal molding. Two least squares regressions for estimating fetal ages from the CV and 3D are given. Three cephalic indices in the transverse, sagittal, and coronal planes are also discussed.
Ergonomic Design Considerations for Ultrasound Real-Time Scanners
Authors: Shawker Thomas H. , Russell Mary Ann
Published: March 2006

The existing design of ultrasound real-time scanners is not satisfactory from the standpoint of operator comfort or efficient use. As currently configured, these units are cumbersome and fatiguing to use and require unnecessarily complex and time-consuming movements on the part of the operator. Redesigning ultrasound scanners so that they conform to accepted principles of ergonomics or human-factor engineering should make it possible to achieve increased efficiency and improved study quality.
Report of a Study Correlating the Performance of Sonographers with Their Cognitive Abilities
Authors: Berman Mimi C.
Published: March 2006

A study was undertaken to determine whether practicing sonographers who are regarded as being effective by their peers, supervising physician, and themselves have special abilities. Eighty-three sonographers and echocardiographers agreed to take the written tests and be evaluated on their performance. The results indicated that sonographers who received the highest ratings also performed well on the tests of general reasoning (General Reasoning) and the ability to pick out an image hidden in other patterns (Flexibility of Closure). The correlations with the other two abilities, which represented visual skills, were weak to nonexistent. Relationships were also seen between Registry status, years of scanning experience, sex, and educational background.
Spectrum of Hyperirophic Cardiomyopathy Viewed by M-Mode, 2D, and Doppler Echocardiography
Authors: Rowell Helen , Racker Holly , Bansal Ramesh C.
Published: March 2006

Hypertrophic cardiomyopathy is a primary myocardial disease that is characterized by a hypertrophied and nondilated left ventricle. Echocardiography has proved to be a valuable noninvasive tool in the diagnosis, follow-up, assessment of therapy, and family study of hypertrophic cardiomyopathy. A complete M-mode, 2D, and Doppler examination should be performed to define the structural, functional, and flow abnormalities in this condition.
Lower Urinary Tract Ultrasound
Authors: Carroll Barbara A.
Published: March 2006

Renal ultrasound for the detection of mass lesions, diffuse renal disease, and hydronephrosis is widely accepted. Less attention has been devoted to sonography of the lower urinary tract; however, recent studies have shown that ultrasound is useful in imaging the renal pelvis, ureters, bladder, and urethra. A variety of instruments are now used to image these areas, and a number of pathologic and physiologic processes can now be imaged. The normal anatomy of the lower urinary tract as visualized by ultrasound and a number of abnormalities which involve this region are discussed.
Quality Assurance for Real-Time Ultrasound Equipment
Authors: Hykes D. L. , Hedrick W. R. , Milavickas L. R. , Starchman D. E.
Published: March 2006

Quality assurance is the routine monitoring of diagnostic imaging equipment to insure proper and consistent performance. Quality assurance programs have proven beneficial by producing high quality images consistently as well as by reducing costs because fewer repeat examinations are necessary. The purpose of this article is to describe a quality assurance program for real-time ultrasound equipment in terms of testing procedures and practical performance limits.
The Role of Ultrasound in Chorionic Villus Sampling
Authors: Jeffery Michael F.
Published: March 2006

The use of ultrasound as a guidance tool for chorionic villi sampling for prenatal diagnosis in the first trimester is discussed. Three sampling techniques used in the first trimester are reviewed: endoscopy, blind aspiration, and the combination of endoscopy and aspiration with ultrasound guidance. A review of the literature found that ultrasound guidance provided the highest success rate in obtaining chorionic villi for chromosomal analysis and enzyme determination. Concerns regarding proper scanning technique for localizing the implantation site for sampling are discussed.
Cardiac Doppler
Authors: McInerney Nakevin P.
Published: March 2006

Doppler echocardiography, when used alone and in conjunction with two-dimensional echocardiography, provides information pertaining to intracardiac blood flow dynamics. Pulsed Doppler techniques have the ability to localize intracardiac blood flow velocity patterns. This allows for the interrogation of specific cardiac chambers for both normal and abnormal flow. Disorders such as intracardiac shunts, valvular regurgitation, and stenotic lesions can be detected and evaluated with this technique. The location, duration, and timing of flow velocity information can be assessed, allowing diagnoses to be made with this technique that could not be made with imaging alone. Continuous-wave Doppler allows for evaluation of maximal velocity information, which can be used to quantitate intracardiac pressure information such as the gradient across a stenotic valve or the pressure drop across a regurgitant valve. A new twodimensional color flow mapping system provides a noninvasive method for evaluating intracardiac blood flow in ways that previously could only be accomplished through the use of angiographic techniques. This technique has shown promise in allowing evaluation of blood flow dynamics never before available with noninvasive techniques. When combined with two-dimensional echocardiography, Doppler echocardiographic techniques provide information which allow for a more complete and accurate noninvasive evaluation of cardiovascular disorders.
Laboratory Values Associated with Renal Function and Disease Processes
Authors: Starrett Edward S.
Published: March 2006

In many instances, the pertinent clinical history and laboratory assessment of patients prior to beginning a sonographic study are not clearly understood or are completely overlooked. It is imperative that these prelim- inary avenues be exhausted upon approaching and ob- taining a clinical differential diagnosis of the patient's condition for the interpreting physician. The purpose of this article is to provide 1) a review of renal anatomy and basic function; 2) further explanation of laboratory tests and values related to the diagnostic evaluation of the kidneys; 3) encouragement for sonographers to better understand and correlate available laboratory data to aid in approaching a sonographic diagnosis.
The Utility of Hand-held Real-time Scanners for Breast Sonography
Authors: Gordon Linda
Published: March 2006

Sonographic mammography is a diagnostic tool used in conjunction with radiographic mammography. It is economically advantageous to utilize existing equipment versus purchasing a dedicated breast scanner. This article reviews the diagnostic contributions that can be made by real-time examinations of palpable breast masses and compares the advantages and disadvantages of using a real-time unit versus a dedicated scanner. Two hundred eighty-eight patients were scanned after radiographic mammography; scanning provided additional information that contributed to the diagnosis. Four types of lesions are discussed and demonstrated: lesions in a dense breast, lesions indeterminate on radiographic mammography, probable cystic lesions, and palpable lesions for which aspiration has failed.
The Fetal Heart
Authors: Cartier Mark S.
Published: March 2006

The purpose of this article is to inform the sonographer about how to evaluate the normal fetal heart during routine obstetric examinations. With basic knowledge of how the fetal heart should appear, a sonographer can perform an adequate basic examination in a short period of time, depending on experience. The ventricles, atria, atrioventricular valves, pulmonary artery, aortas, and semilunar valves should be identified in a normal basic evaluation. Their sizes and relationships to each other must be distinguished and may be compared with normal values already established and documented. Techniques on how to identify the structures of the fetal heart when the fetus is in various positions will give the sonographer guidance in establishing the views needed to evaluate the normal heart in fetuses beyond 16 weeks' gestation. With adequate knowledge of normal anatomy and circulation, anomalies may be detected and a more detailed cardiac study can be recommended. Accurate antenatal diagnosis may lead to better perinatal management.
Designing and Conducting Research in Diagnostic Ultrasound
Authors: Berman Mimi C. , Berlin Louise A.
Published: March 2006

Sonographers have been participating with physicians in conducting research, but are just beginning to design and implement their own projects. Many clinical, technical, sociologic, ethical, and administrative issues should be examined scientifically by sonographers. This article describes basic research methodology and provides concrete guidelines and examples for applying it in examining phenomena related to diagnostic ultrasound.
A Proposed New Sonographic Sign to Aid in Further Differentiation of Gastric Neoplasms
Authors: Johnston Beverley A.
Published: March 2006

The results of three cases of gastric neoplasms demonstrated by ultrasound are presented. A new sign was observed to establish gastric origin and to aid in the further differentiation of the mucosal or intramural origin of gastric masses. A mucosal mass shows evidence of mucosa insinuating between the mass and the muscularis. An intramural mass shows the mucosa draped over the mass on one side and the serosa draped over the other side. Widening of the intramural tissues between the mucosal and the serosal layers immediately adjacent to the junction of the mass to the gastric wall layers was seen. This sign will be helpful in the differential diagnosis of gastric neoplasms.
The Role of Two-Dimensional Echocardiography in Coronary Arlery Disease
Authors: Brimhall Robyn M.
Published: March 2006

Echocardiography is a noninvasive procedure that plays a major role in the evaluation of coronary artery disease and its complications. In this manuscript four areas will be discussed and illustrated: visualization of the coronary arteries, myocardial infarction, left ventricular function in myocardial infarction, and the complications of myocardial infarction.
Quantitative Sonographic Assessment of Scoliosis and Its Correlation with Radiographic Findings
Authors: Cann Rosemarie P.
Published: March 2006

Scoliosis is a common problem primarily affecting children. The purpose of this pilot study was to develop and test a technique to identify whether sonography can assess the lateral deviation and rotation occurring in scoliosis. If so, then it could become the diagnostic modality of choice for serial follow-up of these patients after the baseline x-ray, thus decreasing radiation exposure. Five subjects (7 to 30 years old) were scanned with real-time and static equipment. Lateral deviation could be mapped, but it was underestimated sonographically. A new finding was that the depth of soft tissue muscle mass on either side of the apical spinous process was essentially symmetrical, indicating virtually no vertebral rotation with respect to the skin. These results warrant further investigation. With a larger sample and refinements in technique, sonography may prove to be a potential tool in the management of scoliosis.
Doppler Ultrasonography and Segmental Arterial Pressures to Assess Arterial Circulation in the Lower Extremities
Authors: Malatich Gail
Published: March 2006

Utilizing Doppler ultrasound and segmental pressures, the arterial circulation of the lower extremities can be evaluated. By assessing the flow waveform patterns and the systolic pressure gradients, one can determine the presence and level of arterial disease. In this review, atherosclerosis is discussed. Techniques for Doppler ultrasound and segmental pressures are described. Two cases are presented and discussed.
Real-Time Spectral Analysis of Brachial Doppler Signals in Neonates with Patent Ductus Arteriosus
Authors: Menke James A. , Wheller John , Miller Randy R. , Bashiru Mohammed
Published: March 2006

Twenty-three Doppler examinations of the brachial artery were performed on 10 infants with patent ductus arteriosus (PDA). The continuous-wave (CW) zerocrossing recordings were compared with the waveforms obtained from spectral analysis (SA) of the audio signal from the CW flowmeter by means of the pulsatility index (PI). The CWPI correlated well with the SAPI (r = 0.89, P < 0.001). The patients were easily grouped into those infants who were normal or had clinically insignificant PDA's from those with a significant PDA using the PI. Although spectral analysis can detect and prevent sampling artifacts, the CW zero-crossing detector provided clinically-useful information.
Osteogenesis Imperfecta Type II
Authors: Bader Birgit , Warner Roger W.
Published: March 2006

Osteogenesis imperfecta (OI) type II is a form of skeletal dysplasia which results in poor skeletal ossification and multiple long bone and rib fractures. The following cases illustrate the sonographic appearances of fetuses afflicted with OI type II. The etiology of OI, suggested scanning techniques, and differential diagnosis for skeletal dysplasia are discussed.
Comparison of Fetal Head Circumference Measurements Using Standard and Long Linear-Array Transducers
Authors: Simpson Gary F. , Filly Roy A.
Published: March 2006

The authors compared relative fetal head circumference measurements between 8- and 12-cm 3.5-MHz lineararray transducers in a sonographic system that can generate a computed ellipse. The head circumference obtained from the 12-cm transducer was employed as the standard against which the 8-cm transducer was compared. Employing the computer-generated ellipse, the authors accurately predicted head circumference with the 8-cm transducer despite the transducer's inability to visualize the entire calvarial perimeter in any case.
Liver Transplant Sonography
Authors: Ehrsam Jo-Ellen , Kuntz Katie
Published: March 2006

Sonography plays a crucial role in assessing liver transplant patients for vascular patency, fluid collections, and abdominal disease. This article discusses examination techniques, a suggested scanning routine, and the appearance of pretransplant and posttransplant disease.
Sonographic Diagnosis of Dextrotransposition of the Great Arteries
Authors: Springer Paul
Published: March 2006

Ultrasonography has proved to be a clinically valuable procedure for diagnosing dextrotranspostion of the great arteries (d-TGA). In children with this congenital condition, the Rashkind procedure followed by the Mustard or Senning operation is performed to prolong life. An arterial switch procedure, without the Rashkind method, also may be the preferred type of surgery. Echocardiography has a major role during the Rashkind procedure and in monitoring patients after their corrective operation. This article attempts to help bridge the gap between inexperienced medical personnel and personnel who are knowledgeable about the sonographic appearance of the d-TGA heart. With proper medical treatment and surgical correction, affected children may survive into adulthood. Adult echocardiography, rather than pediatric echocardiography, may then be responsible for monitoring these patients as adults. All echocardiographers and cardiologists, not only pediatric personnel, therefore must understand the sonographic appearance of the heart in these patients, so that they will survive and prosper into adulthood.
Hepatic Venous Sonography
Authors: Sunder Teresa
Published: March 2006

Some normal variations of the hepatic venous anatomy were studied on 103 healthy subjects using ultrasonography. An inferior right hepatic vein (IRHV) was found in 15.5% of cases. The intercostal coronal view was helpful to demonstrate this vessel. This is of importance to the surgeon performing a subtotal right hepatectomy. The middle hepatic vein, which forms the borderline between the right and left hepatic lobes was easily identified in 100% of cases that had three major superior hepatic veins. In 31% of cases, however, there were four or five superior hepatic veins, making distinction between right and left lobes more difficult. In this situation, the relationship between the superior right portal venous branch and the hepatic veins was found to be helpful in determining the division between right and left lobes. Since the superior right portal branch is always situated in the anterior segment of the right lobe, the hepatic vein medial to it was identified to be the middle hepatic vein.
A Goal-oriented Approach to Sonography
Authors: Mills-Hudson Cheryl
Published: March 2006

Diagnostic medical sonography has experienced rapid technological development since the static-scanning era of the '70s up to the current age of real-time sonography. However, some physicians have not kept pace with these advancements in technology. The result is an inefficient use of equipment and underutilization of the skills of the sonographer. This-article suggests ways in which sonographers can incorporate their own knowledge and experience into the examination process in a professionally acceptable manner.
Blunt Trauma Causing Delayed Cardiac Tamponade
Authors: Allen Mark N. , Nanna Michele , Lichtenberg Gerson S. , Meltzer Richard S.
Published: March 2006

A 17-year-old patient suffered multiple trauma from a motor vehicle accident that involved blunt chest trauma. During the initial hospitalization and laparotomy for abdominal injuries, the cardiac silhouette remained normal on chest roentgenogram and there were no signs of pericardial tamponade. He went home and returned 2 weeks later with a 3 to 4-day history of increasing dyspnea and findings of cardiac tamponade. A loculated, blood-filled mass was found by echocardiography and at surgery, compressing the right heart. This type of delayed pericardial tamponade after blunt trauma has not previously been described.
A Practical Review of Breast Anatomy and Pathology
Authors: Pearson Jerry R.
Published: March 2006

Equipment and technique that can be used in breast sonography are discussed and relative breast anatomy and common breast pathologies are reviewed.
Ultrasound Programs
Authors: Miller Vivie M.
Published: March 2006

Candidate selection to an ultrasound program is discussed in light of developing specific techniques to ensure that those selected will successfully complete the program. A combination of cognitive factors, noncognitive factors, and the personal interview is suggested for candidate evaluation.
Sonographic Correlation of Fetal Heart Rate and Gender
Authors: DuBose Terry J. , Porter Linda , Dickey Denise , Hill Larry W. , Butschek Chris M. , Poole E. K.
Published: March 2006

This study sonographically evaluates the fetal heart rate throughout gestation and the baby's sex at birth to determine if the fetal heart rate is an indicator of the baby's sex. The results of the evaluation of 365 cases indicates that the fetal heart rate is not an accurate indicator of fetal sex.
Sonography of Neural Tube Defects
Authors: Shaffer Laura , Grube Gerald , Wagner Shelia
Published: March 2006

High-resolution ultrasound has allowed increased definition and detailed study of the fetal brain. From 13 to 14 weeks gestation, congenital anomalies arising from or involving the central nervous system (CNS) can be visualized. Early detection and diagnosis of fetal neural tube defects (NTDs) are rapidly becoming an integral part of modern obstetric care. With the use of maternal serum alpha-fetoprotein (MSAFP) screening combined with high-resolution ultrasound, the potential exists to diagnose most NTDs before the 20th week of pregnancy.
Computer Fundamentals in Diagnostic Ultrasound Imaging
Authors: Hedrick W. R. , Hykes D. L.
Published: March 2006

With the incorporation of the digital scan converter in real-time instruments, the computer has assumed an expanding role in diagnostic ultrasound imaging. A knowledge of computer fundamentals is essential for understanding the operation of present day scanners. The concepts of binary notation, memory capacity, analog-to-digital conversion, and the matrix format in digital imaging are discussed in detail. The accuracy of the analog-to-digital conversion is addressed with multiple illustrative examples. Data base management as a practical tool in the clinical environment is introduced.
Prenatal Sonographic Detection of Cleft Lip and Palate
Authors: Kincaid Koby , Rouse Glenn , Wagner Shelia
Published: March 2006

With advancements in sonographic technology and in understanding of the sonographic appearance of the fetus, it is now possible to identify and characterize clefts of the lip, palate, and face. This report reviews the embryology of the lip and palate, reviews the types of clefts observed and their causes, discusses the technique used in sonographic examination of the fetal face, and illustrates the sonographic appearance of facial clefts.
Echocardiography of Cardiac Myxomas
Authors: McLeod Kimberly , DeLange Marie , Racker Holly
Published: March 2006

Myxomas are a rare cardiac tumor usually occurring in the left atrium. Echocardiography has proven to be a valuable noninvasive tool in the diagnosis and followup of cardiac myxomas. A complete M-mode and twodimensional study can be performed to demonstrate motion of the tumor within the heart as well as its position and size. Echocardiography can also aid in the differential diagnosis of mitral valve stenosis, thrombi, and valvular vegetations. When left untreated, cardiac myxomas can be fatal; therefore, identification and prompt surgical removal are essential.
The Role of Ultrasound in Third-Trimester Bleeding
Authors: Ellis Stacie , Grube Gerald L. , De Lange Marie
Published: March 2006

Bleeding in the third trimester of pregnancy occurs in approximately 4% of all pregnancies. Among these approximately 20% can be attributed to placenta previa and 30% to abruptio placentae. There is increased fetal and maternal morbidity and mortality because of the hemorrhage and placental changes which occur. Known etiologies include multiparity, advanced maternal age, and defective vascularization of the decidua for placenta previa; and a short umbilical cord, polyhydramnios, and prolonged preterm premature rupture of membranes for abruptio placentae. Diagnosis of placenta previa and abruptio placentae by sonography provides essential information for the clinician.