bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethics and Pragmatism: China's Television Producers Confront the Cultural Market
Authors: Keane Michael
Published: March 2018

Since its beginnings in 1958, television in China has been hailed as the ‘mouthpiece of the Party, the government and the people’. The rapid expansion of the television industry since deregulation policies were introduced in 1983 has significantly compticated this relationship. New doctrines of accounlability and supply–demand economics have been prescribed as blueprints for the success of cultural institutions now forced to survive without state funding. Whilst the Chinese Communist Party (CCP) is anxious to see the television industry ‘stand on its own feet’ and respond to the challenges of market economics, there are also fears that its role as ‘mouthpiece’ might be diminished. The Communist Party has thus sought to curb the excesses of what it considers ‘unhealthy influences’, while at the same time learning from the successes of the market. This paper examines the emergence of Chinese ‘popular’ serial drama in the 1990s and the manner in which this form of television has been co-opted by the Communist Party as a means of inculcating new modes of ethical behaviour appropriate to a modern commodity economy.
Dazzled by the Sun: Corporatising Queensland Film Culture
Authors: Dawson Jonathan
Published: March 2018

In the wake of economic rationalism and the failed cyber-fantasies of Creative Nation, there has been an increasing tendency towards the corporatisation of film funding bodies at a time when a loosening of self-defensive bureaucratic systems might have been expected.

For example, the Film Finance Corporation has created increasingly complex ‘professional’ systems of management and has foreshadowed a ‘last stage’ script assessment process that has created dismay in industry guilds. After exhaustive prior script development (and many funding and script editing stops), a project will face yet another barrier immediately prior to shooting.

In addition, the increasing invocation of ‘craft skills' themselves as somehow learnable and precisely quantifiable processes, has dug an even deeper moat around funding bodies.

The winding down of Film Queensland and the enhanced corporatisation of the Pacific Film and Television Commission (even to office dress codes!) and incorporation of events such as the Brisbane International Film Festival into an Events Corporation are signs that many largely discredited constructs of The Market are still being applied — to strengthen the power base of the apparatchicks at the expense of their local clients.

The events sketched in this paper are paradigmatic of over-regulated and inner-focused arts funding systems that have lost sight of who their real clients should be.
Genre Anxiety in the Postmodern Public Sphere
Authors: Lumby Catharine
Published: March 2018

This paper examines the roots of contemporary concerns about the influence of poststructuralist theories and aligned disciplines such as cultural studies on media studies, exemplified here by Keith Windschuttle's attack on the latter. Rather than taking detailed issue with Windschuttle's attack on critical theory, I examine the roots of what, I argue, is an anxiety about the shifting boundaries between conventional institutional and discursive arenas. Far from identifying a schism between academic and professional practice in media studies, I argue that recent developments in both fields have fostered a far closer relationship between the two arenas, and that it is precisely this proximity which is engendering anxiety among some commentators.
What is a Journalist in a University?
Authors: Bacon Wendy
Published: March 2018

This paper argues that those who see no place for media theory in journalism education have adopted an intellectual approach to journalism which is both inappropriate in a university context and serves neither journalism nor audiences well. Rather, the interaction between the professional practice of journalism and theory and research into journalism can be a close and dynamic one in which research can produce innovative journalism and the professional practice of journalism and experiences of audiences can feed into a research agenda. Links between journalism research and journalism professional practice can be found in journalism about journalism and in the everyday talk of journalists and audiences. Three case studies which have arisen during recent experience in teaching journalism at the University of Technology, Sydney are used to demonstrate these points.
The Arts as Industry
Authors: Gibson Lisanne
Published: March 2018

There is a discursive split in Australian arts policy between subvention of the arts justified in terms of ‘humanistic’ objectives and subvention of the arts justified in terms of ‘economic’ objectives. It is possible to locate the emergence of this particular split to the 1976 Industries Assistance Commission Report, Assistance to the Performing Arts. Over the last two decades, these policy objectives have been constructed as in competition. This paper traces the history of the construction of the ‘arts as industry’ in Australian arts policy. In conclusion, it queries the more recent terms in which ‘arts as industry’ policy objectives have been set as in opposition to ‘public provision’ models of arts subvention.
Spaceship Triple J: Making the National Youth Network
Authors: Albury Katherine
Published: March 2018

This article explores Triple J's evolution from radical Sydney radio station to ‘National Youth Network'. In particular, it discusses Triple J's successful construction of a ‘national youth audience', according to Thornton's (1994, 1995) definitions of ‘subcultural capital'.
The Lure of Laws: An Analysis of the Audience Appeal of the John Laws Program
Authors: Appleton Gillian
Published: March 2018

Talkback personality John Laws has dominated morning radio in Sydney for several decades, and his program is now networked to more than 70 stations around the country. A detailed analysis of this program based on six weeks' monitoring spread over more than one year (1996–97) attempts to identify the factors which may be decisive in attracting and keeping substantial audiences. The analysis will make reference to theories of uses and gratifications among media audiences, with suggestions for possible further research.
Australian Music and the Parallel Importation Dedate
Authors: Homan Shane
Published: March 2018

Despite vigorous protest from the local recording industry and musicians, the Australian federal government passed the Copyright Amendment Bill (No. 2) 1997 into law in June 1998. The Bill is designed to remove the neo-oligopolistic practices of the multinational recording companies, and reduce the prices of compact discs for local consumers. The music industry believes that the Bill removes the value of artists' copyright as the primary means of income and as a mechanism in identifying and protecting intellectual property. This article analyses the benefits and costs of the recent copyright changes, and the effects of consumer reform for local producers. It is argued that the music industry provides a rich site of tension in regard to global cultural economies, where notions of consumer sovereignty do not complement broader ideologies of cultural citizenship and economic nationalism.
Prize or Punishment: The Ethical Challenges for Journalism in the New Millennium
Authors: Heilbuth Derryn
Published: March 2018

In an environment where cultural diversity, globalisation of the media, societal attitudes towards the media and the impact of technology on journalistic practice have heightened the ethical dilemmas journalists face in the practice of their profession as they head towards a new millennium, this paper examines two cases of Australian journalists using deception and misrepresentation in news-gathering which resulted in two decidedly different outcomes. It also explores the challenges for journalism associations and educators in their approach to the dissemination and teaching of ethics.
News
Authors: Leitch Shirley , Leitch Shirley
Published: March 2018

The last ANZCA conference of the millennium celebrated the association's twentieth year of existence. Special events to mark the anniversary induded a gathering of ANZCA's past-presidents and a display of ANZCA memorabilia, courtesy of Bill Ticehurst.
Telling the Truth, Laughing
Authors: Fitzgerald Justice Tony
Published: March 2018

This paper centres on three themes: the lack of a constitutional bill of rights in Australia, especially a right to freedom of speech; the suitability of the judiciary to arbitrate social values; and the importance of public humour, and its relations to Australian defamation law. These themes are illustrated by a discussion of the Queensland Court of Appeal's recent finding that Ms Pauline Hanson was defamed on the ABC by Ms Pauline Pantsdown.
The ‘Digital/Life’ Moral Panic
Authors: Spurgeon Christina
Published: March 2018

This paper attempts to make sense of recent debates concerning broadcast media self-regulation of sex and nudity. It focuses on a period in mid-1998 when Sex/Life disappeared from Australian TV screens. Specifically, it tracks a ‘moral panic’ in progress at the time the Ten Network announced its decision to cancel this program. It describes and summarises findings of a quantitative analysis of the editorial content of 17 Australian newspapers monitored in 1998 for references to media portrayal of sex and nudity. The particular role of The Australian in this panic is considered. Its quest for a popular national readership is highlighted and the question of media influence is raised. This report also contrasts the political responses to Sex/Life with more recent responses to Bay Watch and concludes with some speculative remarks about the economic impact of censorship and program classification regimes.
Instant Sexpert: Academic Experts and Media Experience
Authors: Albury Kath
Published: March 2018

This paper investigates the notion of academic expertise in relation to medico/sexual matters within the context of an anecdotal account of the author's transformation from scholarly academic researcher to satirist and media ‘sexpert'. In examining these different modes of knowing about sex and sexuality, the paper raises questions about their relative value, and explores the nature of both academic and media expectations of experts. What, the paper asks, is the relationship between expertise and experience within the domain of the ‘sexpert'?
The ‘New’ Men's Magazines and the Performance of Masculinity
Authors: Schirato Tony , Yell Susan
Published: March 2018

In Australia in the 1990s, following on from the phenomenon of the ‘new woman's magazine', a new market in lifestyle magazines for men has emerged, distinct from magazines such as Penthouse, Playboy and Picture. This paper examines the phenomenon of the ‘new’ men's magazines, and argues that these magazines are a site in which contemporary performances of masculinities can be analysed, just as feminist and other analyses have examined and critiqued the production of feminine subjectivities through women's magazines. We introduce the market positioning and profile of these magazines, then analyse shifts in the available discourses for constructing masculine subjectivities as they are exemplified in one of the most successful of these magazines, Ralph. Making use of Judith Butler's concept of performance and her critique of Pierre Bourdieu's notion of the habitus, toe analyse a story in Ralph, concluding that Ralph's performances of ‘stereotypical’ masculinity are self-conscious ‘over-performances’ of a set of discourses and subjectivities which it recognises are already in a sense obsolete.
Farming on Air: New Zealand Farmers and Rural Radio Programming
Authors: Fountaine Susan
Published: March 2018

In the light of funding cuts for New Zealand and Australian public service broadcasters, this article examines the impact of Radio New Zealand's restructuring on one key audience group: farmers. The results of a mail survey of the agricultural community indicate that the recent changes have had a negative effect on the specialist rural programs. Supporting the notion that the specialist news media are an important component in the information-sharing process, agricultural publications were judged the most important source of news overall, and Radio New Zealand's rural programming the most important broadcast source.
It's Never a Five-Day Shoot: Queensland Screen Funding Policy and the Local Animation Industry
Authors: Farley Rebecca
Published: March 2018

A number of structural and policy changes have swept through Queensland's film funding organisations since 1996. Nonetheless, a monocular, rose-tinted view of what constitutes ‘industry’ has remained. Animation is one of many areas which are under-served, if not actively restricted, by this romantic view of industry.

This paper looks at the capacity of Queensland's film funding bodies to fulfil the Arts Office's slogan: ‘to ensure success for Queensland's cultural industries’, both in their previous (1997) incarnation and since the implementation of the Weekes Report recommendations in 1998. It then engages with the aspects of industrial practice which are hampered by these gaps in policy.
MRI for peripheral artery disease: Introductory physics for vascular physicians
Authors: Roy Trisha L , Forbes Thomas L , Dueck Andrew D , Wright Graham A
Published: March 2018

Magnetic resonance imaging (MRI) has advanced significantly in the past decade and provides a safe and non-invasive method of evaluating peripheral artery disease (PAD), with and without using exogenous contrast agents. MRI offers a promising alternative for imaging patients but the complexity of MRI can make it less accessible for physicians to understand or use. This article provides a brief introduction to the technical principles of MRI for physicians who manage PAD patients. We discuss the basic principles of how MRI works and tailor the discussion to how MRI can evaluate anatomic characteristics of peripheral arterial lesions.
“I tend to forget bad things”: Immigrant and refugee young men’s narratives of distress
Authors: Hilario Carla T , Oliffe John L , Wong Josephine P , Browne Annette J , Johnson Joy L
Published: March 2018

Distress among young immigrant and refugee men has drawn increasing research attention in recent years. Nuanced understandings of distress are needed to inform mental health and public health programming. The purpose of this research was to examine distress from the perspectives of young immigrant and refugee men living in Greater Vancouver, British Columbia, Canada. Thirty-three young men (aged 15–22 years) from diverse immigrant and refugee backgrounds participated in interviews, which were conducted between 2014 and 2015. Data were examined using narrative analysis and theories of masculinities. Three narratives were identified—norming distress, acknowledging distress as ongoing, and situating distress. The findings reveal that the narratives offer different frames through which distress was rendered a norm, or acknowledged and situated in relation to the participants’ relationships and to masculine discourses that shaped their expressions of distress. The findings can inform initiatives aimed at providing spaces for diverse young men to acknowledge their distress and to receive support for mental health challenges.
Playing the game: How young people moderate influences in accommodating asthma in their lives
Authors: Hughes Mary , Savage Eileen , Andrews Tom
Published: March 2018

This article presents moderating influences, one of the sub-core categories from the theory of accommodating interruptions. This theory emerged in the context of young people who have asthma, explaining how they develop behaviours in their everyday lives (Hughes 2014; Hughes et al., 2017). The aim of this research was to develop a theory on the behaviours of young people who have asthma, in relation to the impact of asthma on the lives and the issues affecting them. This research was undertaken using a classic grounded theory approach. Data were collected through in-depth interviews, participant diaries and clinic consultations with young people aged 11–16 years who had asthma for over one year. Moderating influence accounts for how social influences and social culture affect what young people who have asthma wish to achieve and how they want to be perceived by others. Young people moderate influences by their features or attributes in order to meet their own needs.
Explaining MPs’ communication to their constituents: Evidence from the UK House of Commons
Authors: Auel Katrin , Umit Resul
Published: March 2018

Everyone agrees that members of parliaments (MPs) should keep in touch with the people they represent. Yet some MPs invest more in communication with their constituency than others. We approach this problem with data from the parliamentary communication allowance in the United Kingdom, where all MPs had the same amount of budget to reach out proactively to their electors. We base our analysis on two fundamental assumptions: that re-election is the main goal of legislators and that communication to signal trustworthiness is one way of securing their re-election. We then examine the impact of electoral prospects, constituency characteristics, and parliamentary behaviour on communication to constituents. We find evidence that, even in the absence of budgetary constraints, MPs’ constituency communication depends on challenges to their re-election.
‘Making voices heard …’: Index on Censorship as advocacy journalism
Authors: Steel John
Published: March 2018

The magazine Index on Censorship has sought, since its launch in 1972, to provide a space where censorship and abuses against freedom of expression have been identified, highlighted and challenged. Originally set up by a collection of writers and intellectuals who were concerned at the levels of state censorship and repression of artists in and under the influence of the Soviet Union and elsewhere, ‘Index’ has provided those championing the values of freedom of expression with a platform for highlighting human rights abuses, curtailment of civil liberties and formal and informal censorship globally. Charting its inception and development between 1971 and 1974, the article is the first to situate the journal within the specific academic literature on activist media. In doing so, the article advances an argument which draws on the drivers and motivations behind the publication’s launch to signal the development of a particular justification or ‘advocacy’ of a left-libertarian civic model of freedom of speech.
In-home use of personalized music for persons with dementia
Authors: Kulibert Danica , Ebert Alexandria , Preman Sharayah , McFadden Susan H
Published: March 2018

Although evidence is mounting that personalized music has beneficial effects for long-term care residents with dementia, little research has examined the effects of personalized music for the majority of persons with dementia living at home. These individuals live at home with care partners who may also benefit from having music that is personalized for their loved one. Using the Music & MemorySM program of personalized playlists delivered via iPod Shuffles®, the current study examined the effects of the Music & Memory program for persons with dementia by using the Bath Assessment of Subjective Quality of Life in Dementia scale and a Music Listening Experience Scale developed for this study. We also administered three scales that captured care partner experiences. Transcripts of the Bath Assessment of Subjective Quality of Life in Dementia administrations at the beginning of the study and 3 months later, plus interviews about the Music & Memory program, were then analyzed using the interpretive phenomenological analysis method. Themes about the Music & Memory program and life living with dementia for from diagnosed persons and their care partners are discussed.
An enhanced dynamic Gaussian mixture model–based damage monitoring method of aircraft structures under environmental and operational conditions
Authors: Qiu Lei , Fang Fang , Yuan Shenfang , Boller Christian , Ren Yuanqiang
Published: March 2018

Gaussian mixture model–based structural health monitoring methods have been studied in recent years to improve the reliability of damage monitoring under environmental and operational conditions. However, most of these methods only use the ordinary expectation maximization algorithm to construct the Gaussian mixture model but the expectation maximization algorithm can easily lead to a local optimal solution and a singular solution, which also results in unreliable and unstable damage monitoring especially for complex structures. This article proposes an enhanced dynamic Gaussian mixture model–based damage monitoring method. First, an enhanced Gaussian mixture model constructing algorithm based on a Gaussian mixture model merge-split operation and a singularity inhibition mechanism is developed to keep the stability of the Gaussian mixture model and to obtain a unique optimal solution. Then, a probability similarity–based damage detection index is proposed to realize a normalized and general damage detection. The method combined with guided wave structural health monitoring technique is validated by the hole-edge cracks monitoring of an aluminum plate and a real aircraft wing spar. The results indicate that the method is efficient to improve the reliability and the stability of damage detection under fatigue load and varying structural boundary conditions. The method is simple and reliable regarding aviation application. It is a data-driven statistical method which is model-independent and less experience-dependent. It can be used by combining with different kinds of structural health monitoring techniques.
Representing the People: British Democracy in an Age of Political Ignorance
Authors: Parvin Phil
Published: March 2018

The article evaluates the arguments presented in Jason Brennan’s Against Democracy, Ilya Somin’s Democracy and Political Ignorance and Achen and Bartels’ Democracy for Realists and their implications for democratic theory and practice. The article uses their work to shine a light on ongoing and contradictory trajectories of democratic reform in Britain at the local and national levels, and to argue against the widespread view that British democracy should be reformed in ways that give citizens more control over political decisions. These books point to ways in which democracy might be salvaged, rather than replaced, and in which British democracy in particular might be reformed in order to better meet the challenges of the twenty-first century, by focusing less on participation and more on representation. This requires a two-pronged strategy. First, that we reform liberal democratic institutions in ways which better harness the power of non-majoritarian institutions, strengthen formal epistocratic checks and balances, and embrace the move towards greater political elitism in order to appropriately constrain the popular will and to ensure rigorous scrutiny within a traditionally configured representative democratic system. Second, that we explore ways of incorporating citizens’ voices at different points in the democratic system in order to circumvent some of the problems these authors describe and to ensure that the strengthening of representative institutions does not unfairly marginalise citizens.

Achen CH and Bartels LM (2016) Democracy for Realists: Why Elections Do Not Produce Responsive Government. Princeton, NJ: Princeton University Press.

Brennan J (2016) Against Democracy. Princeton, NJ: Princeton University Press.

Somin I (2016) Democracy and Political Ignorance: Why Smaller Government Is Smarter, 2nd edn. Palo Alto, CA: Stanford University Press.
Aggregated Randomly Generated Math Curriculum–Based Measurements for Middle School Students: Reliability, Predictive Validity, and Cut Score Precision
Authors: Strait Gerald G. , Smith Bradley H. , McQuillin Samuel D.
Published: March 2018

Approximately, 283 sixth-grade students completed four randomly generated Math Curriculum–Based Measures (M-CBMs) from interventioncentral.org twice during a fall semester. These M-CBMs measured foundational skills in addition, subtraction, multiplication, and division. We found that using mean fluency or accuracy scores from four M-CBMs produced more reliable test–retest estimates (e.g., r = .86–.88) in comparison with using individual scores (e.g., r = .55–.73). We also found that aggregated (mean or median) and individual M-CBM scores were strongly correlated (e.g., r = .82–.85) with the Palmetto Achievement Challenge Test (PACT) math section, an annual state standardized test. However, only aggregated M-CBMs produced efficient cut scores useful in detecting students who would pass or fail the PACT.
Variability of Doppler Velocity Ratios as a Function of Location in the Common Carotid Artery: Potential Problems When Quantifying Significant Internal Carotid Artery Stenoses
Authors: Scissons Robert P. , Gillis Joseph C. , Patterson Robert B. , Weyman Albert K.
Published: March 2018

Introduction

The use of the internal carotid artery (ICA) to common carotid artery (CCA) peak systolic velocity ratio (ICApsv/CCApsv) to quantitate ICA stenosis has been challenged based on the variability of Doppler-derived velocities at various locations within the CCA. We investigated these alleged differences to determine whether they affect actual classification of significant ICA stenoses.

Methods

Data from consecutive patients for an 18-month period were prospectively entered into a database. Only initial studies were included in this investigation. Follow-up examinations, postendarterectomy vessels, ICA occlusions, and CCA vessels with a PSV of >150 cm/sec were excluded from analysis. CCApsvand ICApsv/CCApsvwere obtained and based on Doppler analysis at both the proximal most visualized CCA segment (proximal), and 1.5 cm proximal to the ICA flow divider (distal). ICApsv/CCApsv values of ≥ 2, ≥ 3, and ≥ 4 were used as threshold values for ≥ 50%, ≥ 60%, and ≥ 70% diameter stenoses.

Results

A total of 383 patients and 588 vessels were analyzed. CCApsv -proximal values, 75 ± 20 cm/sec, were significantly higher than CCApsv -distal, 68 ± 16 cm/sec (p < 0.001). ICApsv/ CCApsv -distal ratios, 2.36 ± 2.77, were significantly higher than ICApsv/ CCApsv -proximal, 2.11 ± 2.46, (p < 0.001). The average absolute difference between CCApsv -proximal and CCApsv -distal was 15% ± 13% (range, 0%–93%). For an ICApsv/CCApsv ≥ 50%, proximal and distal ratios would both be < 2 in 66%, ≥ 2 in 29%, and 5% were contradictory. For an ICApsv/CCApsv ≥ 60%, proximal and distal ratios would both be < 3 in 78%, ≥ 3 in 18%, and 4% contradictory. For an ICApsv/CCApsv ≥ 70%, proximal and distal ratios would both be < 4 in 85%, ≥ 4 in 12%, and in 3% contradictory.

Conclusions

Significant differences in ICApsv/CCApsv calculation as a function of location of the CCApsv measurement were confirmed. Proximal and distal sampling sites, however, did not affect ICApsv/CCApsv classifications for 95% of the vessels analyzed. For contradictory classifications, ICApsv/CCApsv -distal had more potential for a positive result. To improve accuracy and address sensitivity or specificity interpretation parameters, the influence of the CCA sampling site should be considered and standardized when using carotid ratio criteria.
Cerebral Arteriovenous Malformation: Presentation by Three-Dimensional Substraction Color Power Angiography
Authors: Sorrell Kathryn
Published: March 2018

Background

Recent advances in ultrasound technology now allow the sonographer to obtain three-dimensional color power angiography (3D-CPA) vascular images and to enhance these images by rotation and subtraction. The purpose of this report is to demonstrate the sonographic presentation of a cerebral arteriovenous malformation (AVM) using these advanced techniques.

Patient

During an emergency operation to evacuate a large subdural hematoma, the surgeon noted several aneurysmal veins, suggesting the presence of an underlying AVM. Angiography showed a compact AVM arising from a posterior temporal branch of the right posterior cerebral artery (PCA).

Findings

Transcranial color Doppler ultrasonography (CDU) revealed an AVM in the right temporal lobe with a feeder arising from the P1 segment of the right PCA. 3D-CPA images of the AVM were then developed, rotated, and subtracted. These enhanced images provided superior definition of the arterial and venous architecture and were comparable to the angiogram.

Conclusion

3D-CPA provided high-resolution, accurate, noninvasive images of a cerebral AVM. The added anatomic detail allowed by this technique was complementary to the hemodynamic information provided by CDU.
A Technique to Improve the Confidence of Color Duplex Ultrasound assessment of Aortic Endografts: The use of Contrast Agents
Authors: Nelms Courtney , Carter Kathleen , Meier George , Gayle Robert , Parent F. Noel , DeMasi Richard , Marcinczyk Michael
Published: March 2018

Introduction

Color duplex ultrasound (CDU) is routinely used in the evaluation of aortic endografts in many centers. CDU compliments computed tomography (CT) and selective angiography in the identification of persistent endoleaks in these grafts. Because of the complexity of these procedures and the subtle nature of endoleaks, CDU can be time-consuming and challenging. Contrast agents can improve the ease of imaging by rapidly detecting low flow endoleaks. The application of ultrasound contrast agents has been studied in other specialties, such as cardiac echocardiography. This article describes our technique and early experience using contrast-enhanced CDU in aortic endograft assessment.

Methods

Nineteen patients being seen for a routine CDU examination after endovascular aortic aneurysm repair were evaluated according to published protocol. An initial CDU examination was completed, thoroughly assessing for the presence of graft patency, limb dysfunction, and endoleak. After patient consent, a focused ultrasound was performed using a Food and Drug Administration–approved contrast agent (Optison). The residual aneurysm sac was closely inspected after a 0.3-ml intravenous injection. A maximum of three injections were given in 10-min intervals, with careful evaluation in transverse and sagittal views of the residual aortic sac. Contrast was used to confirm endoleaks noted on the baseline study and help clarify subtle perigraft flow, especially on suboptimal examinations.

Results

Of the 19 patients given the contrast agent, none had side effects, and all tolerated contrast well. In 9 of 19 examinations, contrast-enhanced CDU confirmed the baseline results positive for perigraft endoleak. Six of nine studies had improved ease of identification of endoleak with contrast. Six of 19 studies were negative for endoleak before and after contrast. Three of 19 studies were indeterminate for endoleak by CDU only secondary to bowel gas and body habitus. The contrast agent was given and was negative for endoleak in these three cases. One study was initially negative for endoleak by CDU, and contrast revealed a small lumber artery leaking into the aneurysm sac. The contrast was easily identified within the endograft and leak sites in all patients.

Conclusions

CDU is a valuable modality in the postoperative evaluation of endovascular aortic aneurysm repairs. These examinations can be challenging and subject to limitations including bowel gas and body habitus, even when performed by experienced technologists. Color artifacts within the residual aneurysm sac can be difficult to differentiate from true endoleak. Contrast-enhanced CDU can improve the technologist's confidence in the detection of endoleaks.
Duplex Ultrasound Imaging of Iliac Venous Stents
Authors: Begelman Susan M. , Yesenko Sandra L.
Published: March 2018

Postthrombotic syndrome (PTS) is characterized by persistent leg edema, discoloration, pain, and ulceration in patients with a history of a deep vein thrombosis (DVT). We describe a 60-year-old man who had unilateral PTS develop from an iliofemoral DVT. The patient was treated with thrombolytic therapy using reteplase (Retavase, Centocor, Malvern, PA) followed by mechanical thrombectomy. Percutaneous transluminal angioplasty of the common and external iliac veins was subsequently performed, and a total of six self-expanding nitinol stents were deployed. Stent patency was assessed using an Advanced Technology Laboratories HDI 5000 (Philips Ultrasound, Bothell, WA) ultrasound machine with a curved 5-2 MHz transducer. B-mode images and color duplex ultrasonography with Doppler signals were recorded. Intraluminal echoes and the lack of vein compressibility confirmed the presence of remote thrombus more distally. However, widely patent stents with spontaneous, phasic blood flow were demonstrated in the common and external iliac veins. The patient's edema significantly improved. Deployment of stents to maintain vessel patency of diseased iliac veins is being performed with increasing frequency. Duplex ultrasonography is an inexpensive, noninvasive modality that can be used to follow patients who have had an endovascular venous intervention.
Microembolization Distal to a Basilar Artery Aneurysm Treated with Detachable Coils: A Case Study
Authors: Nicoletto Heather , Douville Colleen , Blaha Martin , Newell David
Published: March 2018

Introduction

Since 1991, treatment of cerebral saccular aneurysms with coils by means of an endovascular approach has become increasingly used as an alternative to surgery. After this procedure, thromboembolic complications of stroke and transient ischemic attack, as well as silent embolic events seen on MRI, have been reported. The detection of microemboli (MES) in the cerebral circulation in a variety of conditions has been well established and has been observed in asymptomatic and symptomatic patients. We present a case of a 41-year-old man with subarachnoid hemorrhage (SAH) from a vertebrobasilar junction aneurysm treated with Guglielmi detachable coils. Multiple MES were detected in the basilar artery during serial transcranial Power M-mode Doppler (PMD) studies. A battery of tests was done to establish the source of embolization from the coiled aneurysm.

Methods

By use of conventional techniques, diagnostic TCD studies to determine the presence of vasospasm were performed using a Neuroguard Neuroflow (Medasonics, Freemont, CA). PMD, a new technique for the detection of emboli, was then performed using Spencer Technologies TCD100M (Seattle, WA). The TCD100M is a digital Doppler and displays Doppler power as intensity in an M-mode format. PMD signals are further colored red or blue according, to direction. MES are seen as high-power tracks in the PMD image as described by Moehring et al (Ultrasound Med Biol. 2002;28:49–57).

Results

Because of the possibility of multiple sources of embolization, our efforts were aimed at proving that the source of the embolization was the coiled aneurysm. Echocardiography, bubble studies, carotid duplex ultrasonography, and emboli monitoring of both middle cerebral and vertebral arteries did not show any MES. Power M-mode examination pointed to a depth of 85 mm in the basilar artery as the point where embolization began. This battery of tests strongly supports the presumptive origin and source of MES to be the coiled aneurysm of the vertebrobasilar junction.

Conclusions

Our case presentation demonstrates continuous silent microembolization from a previously coiled aneurysm. TCD has an important role in assessing patients with cerebral aneurysms for the detection of MES.
Update: Quantitative Duplex Ultrasound Assessment of Aortic Aneurysms after Endovascular Repair
Authors: Johnson Bonnie L. , Arko Frank R. , Wolf Yehuda , Harris E. John , Zarins Christopher K.
Published: March 2018

Purpose.—

To describe the current Stanford duplex protocol for ultrasound scanning of abdominal aortic aneurysms after endovascular repair. This technique has been used for more than 7 years in the Stanford Vascular Laboratory and has been validated against computed angiography. It. provides quantitative information on aneurysm sac size and flow characteristics, as well as endograft patency and integrity.

Technique.

—Abdominal aortic duplex scans are obtained after the patient has been fasting to minimize bowel gas. An internally standardized duplex scanning protocol is used for assessing the abdominal aorta. The aorta is imaged in gray scale from the diaphragm to the aortic bifurcation to determine the presence of wall defects and to measure the greatest diameter and circumference. Measurements are obtained from the largest segment of the supraceliac aorta, infrarenal aorta, and common iliac arteries. Additional measurements are obtained to document disease of the hypogastric or external iliac artery when not obscured by overlying bowel gas. Circumference measurements using calculation software tools available in most ultrasound equipment are also obtained to more easily monitor the morphologic changes in the aneurysm over time. Color and spectral Doppler are used to evaluate for potential extrastent flow. In addition, velocity waveforms are obtained from each limb to evaluate for changes suggesting potential stenosis from graft compression or outflow obstruction.

Conclusions.

—Duplex ultrasound scanning after endovascular repair of abdominal aortic aneurysms can be used successfully to determine aneurysm size and presence or absence of extrastent flow in 94% of patients. Thus, this technique is applicable to most patients after endovascular repair.
The Carotid Artery Ultrasound Report: Considerations in Evaluation and Management
Authors: Lavenson George S.
Published: March 2018

Introduction

Color duplex ultrasound (CDU) is the best means of discovering the significant, silent carotid artery lesions that are the leading cause of strokes. CDU reports routinely include flow velocity and derived percent degree of stenosis. However, failure to include inadequacies and inconsistencies of the examination coupled with knowledge of interpretation variances correlated with the clinical situation can lead to significant carotid lesions going undiscovered and leave proper management uncertain.

Methods

The author is a vascular surgeon and registered vascular technologist who specializes in the evaluation and management of carotid artery disease with opportunity to perform CDU, orchestrate additional tests required, make management recommendations, and correlate these with operative findings and clinical outcome.

Results

This experience led to the identification of important considerations relating to the CDU examination that recognize the not uncommon need for additional tests and for management recommendations. These considerations were categorized as indeterminate examinations, inconsistent examinations, interpretation variances, and individual clinical situations.

Conclusions

These considerations highlight the value of including recommendations for needed additional tests and management in the CDU report. Vascular laboratories able to make this more comprehensive report can reduce the chance of serious carotid artery lesions going undetected and better ensure appropriate management of the patient.
A Comparative Study of Clinical Outcomes of Vascular Studies Performed Using Protocols from the American College of Radiology and the Intersocietal Commission for the Accreditation of Vascular Laboratories
Authors: Wyatt Paula D.
Published: March 2018

Introduction

Confidence is placed in studies done in any vascular laboratory based on guidelines set forth by the accrediting body governing that service. Within the facilities of a newly formed health network, it was noted that vascular procedures were performed under the guidelines of two separate accrediting bodies. The larger of the two facilities is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and the satellite facility is accredited by the American College of Radiology (ACR).

Methods

A comparative review of guidelines was done in an effort to establish “best practice” across the system. Between the two sets of imaging standards, the guidelines for obtaining images vary on lower extremity peripheral venous evaluations. In the exams, calf vein images are not performed under the ACR standards and are obtained under the ICAVL standards. Though not required under the ICAVL standards, it is considered best practice to image these patients during routine unilateral and bilateral exams. Due to the differences in practice between the two facilities, a retrospective chart review was conducted to evaluate clinical outcomes between the two groups of patients. Unilateral and bilateral lower extremity venous duplex examinations had been performed by vascular sonographers on all patients included in the chart review during a period of 12 months.

Results

Of the 1222 charts reviewed, 63 patients had positive findings of calf vein thrombosis under the ICAVL guidelines and would not have been diagnosed with ultrasound imaging alone under the ACR guidelines. Four patients who had been inpatients at the satellite facility were referred to the larger facility for follow-up care. A second venous duplex exam was performed due to persistence of symptoms. In these four patients that had follow-up exams, a negative interpretation was reported under the ACR guidelines, and a positive report for unilateral deep vein thrombosis in one or more of the calf veins (DVT) was given under the ICAVL guidelines. In another group of nine patients having follow-up procedures under both standards, contralateral comparison of the common femoral vein was not performed under the ACR guidelines. Using ICAVL guidelines, three of these patients were found to have nonphasic flow in the contralateral common femoral vein.

Conclusions

Such discrepancies have potential for negative clinical outcomes. The findings support the need for standardization of protocols between the two facilities by expansion of the ACR guidelines to include calf veins in the lower extremity venous evaluation. Further revision of the ACR standards is recommended, as well, to include imaging the contralateral common femoral vein in unilateral venous duplex exams in the lower extremity.
Diagnosis and Ultrasound-Guided Repair of an Iliac Artery Dissection
Authors: Cruz Joshua , Lipsitz Evan C. , Berdejo George L.
Published: March 2018

Introduction

Although contrast arteriography (CA) has historically been considered the gold standard for imaging of the lower extremity arteries, it has known limitations and complications. Duplex ultrasound (DU) imaging has emerged as a viable, and in some instances superior, alternative to CA. The following case study describes the use of DU to diagnose and treat an iliac artery dissection not appreciated by conventional multi-planar contrast arteriography.

Case Report

The patient is a 46-year-old man with a significant smoking history and symptomatic peripheral vascular disease who has undergone percutaneous transluminal coronary angioplasty and stent placement after a myocardial infarction. He presented with complaints of progressively worsening right leg claudication. The workup included a duplex arterial mapping performed prior to diagnostic CA. DU revealed a short segment right superficial femoral artery (SFA) occlusion and normal Doppler flow characteristics in the common femoral artery. Arteriography confirmed the presence of the SFA occlusion. A follow-up duplex to rule out a groin pseudoaneurysm was then performed. This study revealed no pseudoaneurysm but identified a dissection extending from the mid external iliac artery (EIA) to the distal common femoral artery that was not appreciated by CA. Because of the DU findings, intraoperative CA to evaluate the EIA was performed at the time of SFA endarterectomy and patch angioplasty. Again, the dissection was not evident, and as a result of the inconclusive arteriogram, ultrasound was used intraoperatively to image and facilitate its repair. A 9 × 40-mm SMART stent (Cordis®, Warren, NJ) was deployed in the EIA under ultrasound guidance to seal the leading edge of the dissection. Completion DU showed sealing of the origin of the dissection and near-complete elimination of flow in the false lumen.

Conclusions

DU diagnosed an EIA dissection that was not detected on CA and was subsequently used as the sole imaging modality to guide deployment of a stent for its repair. This case illustrates that duplex evaluation can be superior to arteriography for both the diagnosis and treatment of patients with peripheral arterial disease.
The Prevalence of Aorto-iliac Disease by Duplex Ultrasound in Patients with Suspected Lower Extremity Arterial Disease
Authors: Hughes Joseph P. , Dubin Rick , Bowman Gary R. , Cochran Terence A.
Published: March 2018

Introduction

Color duplex ultrasound (CDU) is used to document the location and severity of disease in the arterial system. The purpose of this study was to determine the prevalence, location, and severity of disease in the aorto-iliac arterial segment in patients with signs and symptoms of peripheral arterial disease and undergoing routine lower extremity arterial CDU evaluation.

Methods

The charts of 45 randomly selected patients with suspected lower extremity peripheral arterial disease (PAD) who were undergoing routine extremity arterial CDU testing were retrospectively reviewed. Disease processes of the aorto-iliac segment were grouped into four categories: ectatic aorta (EA), abdominal aortic aneurysm (AAA), non–hemodynamically significant plaque (NHSP), and hemodynamically significant plaque (HSP). Disease findings were based on internally validated CDU criteria. Findings were considered significant if the patient had AAA or HSP.

Results

Of the 45 records reviewed, 8 patients did not have an aorto-iliac evaluation based on testing protocols, and 11 were excluded for nonvisualization of the aorto-iliac segment due to bowel gas or body habitus. Of the 26 remaining patients, 4 patients presented with normal findings (15%), 14 with NHSP (54%), 8 with AAA (31%), 7 with HSP (27%), and 2 with EC of the aorta (8%). When grouped by significant findings, 4 patients presented with AAA and HSP (15%), 4 with AAA only (15%), and 3 with HSP (12%).

Conclusion

Findings of disease in the aorto-iliac segment were noted in 85% of the patients in this population. Significant disease was present in 42% of the patients in this population. Evaluation of the aorto-iliac segment with CDU in patients with suspected PAD appears to have a significant yield; however, further investigation with a larger patient population and a comparison to other testing modalities is necessary.
Validation of an Automated Computerized Analyzing System for Measuring Common Carotid Artery Intima–Media Thickness by Brightness Mode Ultrasound
Authors: Fritz Helmuth F. , Jutzy Roy V. , Bansal Ramesh , Housten-Feenstra Linda
Published: March 2018

Background and Purpose

Evaluation of subclinical atherosclerosis by B-mode carotid ultrasound intima–media thickness (IMT) is an endorsed technique whose ease and precision is improved by use of automated IMT measurement algorithms. We report results of a validation study of SonoCalc, an automated IMT software program.

Methods

Three vascular sonographers measured the mean common carotid artery IMT twice of 120 near and far wall CCA segments from 30 subjects by manual electronic instrument calipers and with SonoCalc.

Results

Accuracy analysis indicated the equivalence of SonoCalc IMT measurements to those with manual electronic instrument calipers ( p < 0.0001). The coefficient of variation (CV) was calculated for each set of duplicate SonoCalc and manual electronic instrument calipers measurements. The average SonoCalc-manual electronic instrument calipers CV differences significantly favored SonoCalc ( p < 0.0001).

Conclusion

This study demonstrated that the use of the SonoCalc and the manual electronic instrument calipers produced measurements whose differences were statistically insignificant. Furthermore, the analysis to assess reproducibility of the two methods showed that the SonoCalc method was significantly more reproducible than the manual electronic instrument calipers methods.