Dr Shawn Choong
The use of STIC workshop
This workshop covers the basic concepts of practical application of volume imaging
for fetal cardiac scanning. In particular Dr Choong will demonstrate the use of the
spatio‐temporal image correlation (STIC) technology for the fetal heart examination
including volume acquisition, multiplanar reconstruction and of line analysis. There
will be an emphasis on hands on instruction.
Assoc Prof Robert Cincotta
Cincotta RB, Ashton LJ, Marr SM, Stemm AY
Antenatal detection of vasa praevia: we can make a difference
Vasa praevia is a condition in which fetal vessels, unsupported by the umbilical cord
or placenta, run on the fetal membranes in the lower uterine segment near the cervix.
Rupture of these vessels prior to or at the time of delivery can be associated with
a very high perinatal mortality rate. Antenatal diagnosis of this condition with ultrasound
is readily available, alters management and significantly decreases the risk of fetal
loss.
We performed an audit of prenatally diagnosed cases of vasa praevia and the clinical
outcomes from a tertiary referral ultrasound centre, over a five‐year period. There
were 34 cases suspected in 25,492 scans over five years. There was one loss from an
APH, which occurred prior to planned elective admission to hospital. The characteristics
of these cases that led to their diagnosis, outcomes and the risk factors will be
described.
The presentation will discuss how to identify vasa praevia on ultrasound. Demonstration
of the various artifacts that sonographers encounter that may lead to a misdiagnosis
will be discussed.
Diagnosis of this uncommon condition can make such a huge impact on survival. We will
present guidelines for sonographers when performing an obstetric examination, to help
identify vasa praevia.
Dr Wes Cormick
Ductal breast cancer
Ductal cancer is the most common form of breast cancer. Cure relies on finding cancers
when they are small and have not yet spread. I will describe the high resolution imaging
of the breast ducts and abnormal findings in different diseases.
Enlargement of Ducts: fibrocystic disease, apocrine metaplasia, duct hyperplasia,
cancer
Duct Fibrosis: intraductal fibrosis, periductal fibrosis, fibrous obliteration of
ducts
Inflammation: periductal oedema, iso/hypo‐echoic wall thickening, flow within and
around wall, periductal calcification
DCIS: Distended duct, solid material in duct, periductal inflammation, periductal
fibrosis.
Dr Wes Cormick
Breast implants
I will discuss the ultrasound assessment of breast implants.
Based upon findings in the:
Capsule
Folds
Soft tissues.
The plastic implant has an envelope. This becomes surrounded by a fibrous capsule.
If the implant leaks there are intracapsular ruptures, which result in various stages
of collapse. If the silicone gets out of the capsule there is extracapsular rupture.
Dr Wes Cormick
Thyroid FNA and recurrence
I will discuss the technique of performing thyroid FNA then cover the important features
of postoperative recurrence of thyroid cancer.
Criteria for doing FNA include: solitary, indistinct contour, hypoechoic, heterogenous,
microcalcifications, edge shadowing, no halo, thick halo, increased perfusion, chaotic
perfusion, taller than wide, ectopic thyroid tissue, contradictory reports, crowing,
PET positive, Non Dx FNA, abnormal nodes, family Hx, radiotherapy, PHx cancer, male,
< 20 years, > 70 years, elastography.
Important features are local recurrence in the thyroid bed or abnormal lymph nodes.
I will discuss relevant findings in the nodes: size, site, shape, septations, cystic,
calcium, cortex, colloid, hilum, echogenicity, mobility and perfusion.
Dr Wes Cormick
Paediatric renal ultrasound
I will discuss normal anatomy of the neonatal and paediatric kidney, how high resolution
imaging of the cortex and pyramids is important, and the patterns in different pathologies.
I cover findings in:
Urinary infection
Hydronephrosis
Cystic renal disease
Congenital abnormalities
Renal tumors.
In infection, “cortical” scarring may involve the columns of Bertin. Renal involvement
in a lower urinary infection raises the possibility of urinary reflux and includes:
Echogenic pyramids
Echogenic central sinus
Thickened pelvi calyceal system.
Dr Wes Cormick
Enthesis score
By introducing a score system for the enthesis we hope to bring uniformity to reporting
and it can act as a checklist when performing the examination. I will discuss each
point and show how we use it:
1
Enthesophytes
2
Fibrocartilage
3
Bone erosions
4
Tendinitis
5
Tendon perfusion
6
Tendon tears
7
Tendon calcification
8
Adjacent bursa/synovium
9
Muscle
10
Other.
Dr Fabricio Costa
Technique for T3 spectral Doppler
The addition of Doppler flow studies of maternal and fetal vessels has provided a
tool where the physiology of the maternal‐fetal unit can be assessed. This information
can provide the physician and the patient with vital information for a subsequent
approach to the pregnancy. The purpose of this presentation is to describe an overview
of Doppler ultrasonography and clinical utility of Doppler flow studies in the prediction
of adverse pregnancy outcomes in low‐ and high‐risk populations. The use of fetal
Doppler blood flow studies has become common in the evaluation and management of pregnancies
complicated by conditions such as suspected fetal growth restriction and red blood
cell isoimmunisation to guide intrauterine therapy and delivery.
Assoc Prof Julia Drose
Basic cardiac anatomy
This lecture reviews the fetal cardiac anatomy that should be recognised and evaluated
when performing a fetal echocardiogram. The standard ultrasound views necessary to
thoroughly evaluate the fetal heart will be discussed. Additionally, technical factors
that may influence the performance of a fetal echocardiogram will be discussed.
Sonographic criteria and characteristics of normal findings and structures are presented.
Assoc Prof Julia Drose
Common fetal heart abnormalities
This lecture covers some of the more frequently encountered fetal cardiac abnormalities.
Specific ultrasound characteristics will be reviewed, as well as subtle findings that
may alert the sonographer or sonologists that an abnormality is present.
The lecture will consist of several case reviews.
Assoc Prof Julia Drose
Basic fetal cardiac Doppler
This lecture reviews when colour/spectral Doppler should be utilised in performing
fetal echocardiography. Structures that should be evaluated with Doppler will be covered,
as well as proper cursor placement. Normal and abnormal waveform patterns and colour
Doppler appearances arecovered, as well as normal velocity ranges where applicable.
Prof Jill Cook
The Role of compression in tendinopathy
Tensile overload is thought to be the key factor in the onset of tendinopathy. Despite
this, the pathology is fibrocartilage‐like suggesting that compressive loads may be
another form of overload. The lecture will examine the load imposed on tendons and
present evidence to support compressive load as an aetiological factor in tendinopathy.
Dr Richard Dowling
Testicular ultrasound
This mainly pictorial presentation on testicular imaging covers the imaging findings
of torsion, infection, trauma and tumors, as these are the commonest pathologies encountered.
Attention will also be made to less common entities such as epididymal masses, rarer
testicular pathologies and some pitfalls in scrotal imaging.
Dr Julie Gregg
Ultrasound of the foot and ankle
The foot and ankle perform important and complex roles. Bony fractures, tendon and
ligament injuries are common. Ankle impingement is a common complaint characterised
by a painful reduction in ankle motion that is caused by pathology that is osseous
or soft tissue in nature, either developmental or acquired. In this presentation,
the sonographic evaluation of the foot and ankle will be reviewed. The importance
of dynamic assessment will be discussed, with particular reference to ligament integrity
and degree of laxity.
Assoc Prof Martin Healey
Does pelvic ultrasound have a role in management of pelvic pain?
The symptoms of acute and chronic pelvic pain in women are associated with a range
of possible diagnoses that span multiple specialties. Assessment of pelvic pain therefore
requires a thorough history and examination so that investigations can be appropriately
focused. A scattergun approach tends to become expensive and time‐consuming without
often providing clear answers.
Pelvic ultrasound on the surface has revolutionised investigation of pelvic pain,
with increasingly crisp imaging as the underlying technology has improved. The research
needed to obtain the full potential from such improvements has been marked by its
paucity.
This presentation will briefly review the relevant possible diagnoses in acute and
chronic pelvic pain. The role of ultrasound in these situations will be discussed
as well as areas where there is potential for ultrasound to have a much greater impact.
Ms Elvie Haluszkiewicz
Ultrasound in the Indigenous population
Prof Fiona Stanley recently said: “It's not a surprise to know that most of the services
provided to aboriginal people – and we don't just mean health, but education, child
protection, juvenile justice and so on – are failing to turn around the poor outcomes
for aboriginal health.”
Over many years there have been a host of services, projects, programs, plans and
missions undertaken to address this situation, and we could be forgiven for sensing
despair that we have failed to make a difference.
This presentation considers ultrasound, and medicine in general, in the indigenous
population and canvasses possible reasons which may contribute to the poor outcomes
so widely reported.
Ms Elvie Haluszkiewicz
Interpreting/performing the vascular ultrasound
During an ultrasound examination, a great deal of information is gathered and processed
for documentation. Haemodynamic Doppler information is acquired as a separate electronic
process but displayed together with B‐mode information in the resultant image. Understanding
and applying the associated physics is pivotal to performing and interpretation of
a Doppler study.
This presentation follows on from Knobology with the vascular study, de‐coding Doppler
and explaining waveforms.
Mr Phillip James
Musculoskeletal ultrasound – shoulder
Shoulder ultrasound can be a difficult and challenging discipline. The workshop will
demonstrate a simple systematic approach to shoulder ultrasound. Participants will
all get an opportunity to practise shoulder scanning and will see examples of common
shoulder pathology.
Ms Jane Keating and Ms Catherine Fennell
Portal venous Doppler workshop
This workshop will demonstrate the scanning technique essential to a successful interrogation
of the liver and portal system for the assessment of portal hypertension. It will
also include discussion on the criteria to diagnose the evidence of portal hypertension,
including research performed by Prof Robert Gibson at the Royal Melbourne Hospital.
Ms Jane Keating
Benign liver lesions, when can we be sure?
Conventional ultrasound, being readily available, economical and safe remains the
imaging modality most widespread throughout the world in detecting liver lesions.
Differentiation of benign and malignant liver lesions on ultrasound provides a persistent
challenge, due to similar imaging characteristics and extensive differential diagnosis.
Why is it so important to be “sure” that the lesion is benign on ultrasound alone?
With a correct diagnosis we can eliminate additional imaging, and thus provide the
patient with the least possible risk and cost, and most importantly decrease patient
anxiety.
When can we be “sure” that the lesion is benign on ultrasound alone? This paper will
attempt to answer this question, and will include requirements for an effective diagnostic
scan, as well as describe the typical ultrasound features of benign liver lesions,
including pseudo lesions, cystic lesions, haemangiomas, adenomas, and focal nodular
hyperplasia.
Reference will also be made to our experience at the Royal Melbourne Hospital with
contrast enhanced ultrasound (CEUS). The development of CEUS has dramatically extended
the role of ultrasound to enable definitive liver lesion characterisation and has
increased our diagnostic confidence of benign liver lesions.
Ms Paula King
Ultrasound signs of acute cholecystitis: myth, mindset or fact
In an acute general hospital setting, the ultrasound request “RUQ pain F.I. ?? Cholecystitis”
is a regular event. How well are we doing this routine examination and do we answer
the question?
The ultrasound criteria for assessment of acute cholecystitis will be looked at in
this presentation with attention paid to the landmark paper for this pathology. Images
from the “real world” of the afterhours emergency department scan will be shown.
Results from an in‐house survey of sonographers and sonologists favorite ultrasound
pointers for acute cholecystitis will be reviewed.
The question is: have we led ourselves up the wrong garden path?
Ms Paula King
Carotid Doppler workshop
Carotid duplex in an everyday test in ultrasound practice… Let's look at what we do…
Scanning techniques…
Criteria used
Worksheet obsession and cases that don't fit in will be looked at in this session…
All with your hands on the probe…
Ms Paula King
Renal and Mesenteric Vessels Workshop
Let's look at what renal artery and mesenteric duplex involves in the real world.
Get your hand on the probe and this session will provide you with lots of handy hints
to get the best out of an abdominal duplex examination…
Possible criteria for mesenteric and renal artery duplex will be discussed…
Mr Ryan Kiss
Ultrasound of the Elbow Workshop
This workshop will involve a live scanning demonstration with a focus on patient positioning,
locating key anatomical landmarks and diagnosing various pathologies encountered during
an ultrasound study of the elbow. Attendees will have the opportunity to scan a patient's
elbow during this session.
Mr Greg Lammers
Musculoskeletal hand ultrasound workshop
Ultrasound of the hand is not necessarily a difficult exam and can make a big impact
on patient management.∗∗∗The two things you need to do are:
1
Like all our ultrasound, be well read. Below are references that will let you do this.
2
You all (well should have) eight fingers and two thumbs to practice on.
References / further reading
1
Clavero
JA
,
Golanó
P
,
Fariñas
O
,
Alomar
X
,
Monill
JM
,
Esplugas
M
. Extensor Mechanism of the Fingers: MR Imaging – Anatomic Correlation. Radiographics
2003; 23: 593–611.12740463
2
Clavero
JA
,
Alomar
X
,
Monill
JM
,
Esplugas
M
,
Golanó
P
,
Mendoza
M
,
Salvador
A
. MR Imaging of Ligament and Tendon Injuries of the Fingers. Radiographics
2002; 22: 237–56.11896215
3
Hauger
O
,
Chung
CB
,
Lektrakul
N
,
Botte
MJ
,
Trudell
D
,
Boutin
RD
,
Resnick
D
. Pulley System in the Fingers: Normal Anatomy and Simulated Lesions in Cadavers at
MR Imaging, CT, and US with and without Contrast Material Distension of the Tendon
Sheath. Radiology
2000; 217: 210–12.
4
Klauser
A
,
Frauscher
F
,
Bodner
G
,
Halpern
EJ
,
Schocke
MF
,
Springer
P
,
Gabl
M
,
Judmaier
W
,
zur Nedden
D
. Finger Pulley Injuries in Extreme Rock Climbers: Depiction with Dynamic US. Radiology
2002; 222: 755–61.11867797
5
Gabl
M
,
Rangger
C
,
Lutz
M
,
Fink
C
,
Rudisch
A
,
Pechlaner
S
. Disruption of the Finger Flexor Pulley System in Elite Rock Climbers. Am J Sports
Med
1998; 26: 651–55.9784811
6
Marco
RA
,
Sharkey
NA
,
Smith
TS
,
Zissimos
AG
. Pathomechanics of Closed Rupture of the Flexor Tendon Pulleys in Rock Climbers.
J Bone Joint Surg
1998; 89: 1012–19.9698006
7
Boutry
N
,
Titécat
M
,
Demondion
X
,
Glaude
E
,
Fontaine
C
,
Cotten
A
. High‐Frequency Ultrasonographic Examination of the Finger Pulley System. J Ultrasound
Med
2005; 24: 1333–39.16179615
8
http://www.emedicine.com/orthoped/topic571.htm
9
http://www.emedicine.com/orthoped/topic313.htm
10
http://www.physsportsmed.com/issues/1998/06jun/lairmore.htm
11
http://www.handuniversity.com/topics.asp?Topic_ID=29
12
www.anatomy.tv
13
www.eatonhand.com
14
Further Information can be obtained from: http://tinyurl.com/ASUM2011HandWorkshop.
Dr Barry Leahey
Topic aortic endoluminal stent grafting
Abdominal aortic aneurysms are a common and potentially fatal condition, particularly
in the elderly. Endoluminal stent grafting has become much more widespread in the
treatment of this condition. This talk will briefly review etiology, incidence and
complications of abdominal aortic aneurysms and then discuss in more detail the mechanics
of endoluminal stenting. Postoperative complications and follow up and the role of
postoperative ultrasound will be addressed.
Dr Wayne Lemish
Breast ultrasound: beyond the black hole
Sonography is an important imaging modality in the detection of breast cancer. However
cancer of the breast has a variable appearance on ultrasound examination. The common
and less common sonographic signs of breast cancer will be reviewed.
Techniques will be discussed to improve the sensitivity and specificity in the diagnosis
of both malignant and benign breast lesions.
Ms Kimberly McConchie
Ultrasound monitoring of IVF cycles – what parameters are we measuring and what does
it all mean?
Approximately 57,000 IVF cycles are conducted in Australia annually. This means that
thousands of IVF women will pass through our ultrasound doors every year. By better
understanding the IVF process, in particular the workings of both stimulated and frozen
embryo transfer cycles, we can provide IVF clinics with the most accurate anatomical
and physiological data possible to guide their treatment decisions.
IVF can be a potentially harrowing experience for our patients. This session aims
to offer the participant insight into what these women must go through before they
reach our doors and how as practitioners, we can help to make their journey as smooth
as possible.
Ms Tanya McDonald
Contrast enhanced ultrasound
The workshop will be a practical guide to the use of contrast in ultrasound. Covering
aspects such as preparing the contrast and setting up ideal parameters on the ultrasound
unit, the workshop should be useful to those just starting to use contrast, as well
as those wanting to optimise the examination. The workshop will also focus on liver
lesions and enhancement patterns for various liver pathologies.
Mr Martin Necas
Carotid artery imaging
Carotid artery duplex has a leading role in the assessment of patients suspected to
harbor a carotid stenosis. Duplex scanning can accurately characterise the degree
of stenosis, which is crucial in determining the management pathway. In fact, carotid
duplex is so well trusted as a diagnostic examination that vascular surgeons are generally
happy to operate on the basis of a duplex scan alone. This presentation will review
the rationale for performing carotid duplex imaging, haemodynamic considerations,
techniques for stenosis assessment, interpretation and criteria and some of the less
common carotid pathologies.
Mr Martin Necas
Interpreting arterial waveforms
Detailed understanding of haemodynamics, Doppler technology and spectral Doppler waveform
interpretation can be tremendously useful during vascular assessment of just about
any body region in patients from first trimester fetuses through to the end of life.
Spectral Doppler waveforms contain a tremendous amount of diagnostic information.
However, it is also important to recognise that spectral Doppler waveforms represent
flow events obtained at selected sample sites over short periods of time, so extrapolation
of volume perfusion of the target arterial bed from waveforms alone must be done with
caution. This presentation will review a wide range of interesting haemodynamic circumstances
in both arterial and venous system and will demonstrate how subtle waveform observations
can provide critical diagnostic clues to a more accurate and more efficient diagnosis.
Mr Martin Necas
Upper limb arterial and venous workshop
The upper limb presents some unique challenges to sonographers. The limb is remarkably
easy to scan from the axilla peripherally, however, most of the pathology affecting
the arteries and veins is usually confined to the area of the upper chest and thoracic
outlet where access is very difficult. The purpose of this workshop is to demonstrate
the techniques involved in accessing these difficult areas and to provide the participants
with the necessary technical and diagnostic skills to successfully tackle duplex scans
in this region with confidence.
Mr Martin Necas
Imaging upper limb arteries and veins
The upper limb presents some unique challenges to sonographers. While the limb is
remarkably easy to scan from the axilla peripherally, most of the pathology affecting
the arteries and veins is usually confined to the area of the thoracic outlet where
access is very difficult. The purpose of this presentation is to review the range
of pathologies affecting the arteries and veins of the upper extremities with a focus
on the underlying pathological processes, duplex techniques, auxiliary techniques,
diagnostic pitfalls and some of the less common pathologies that one may encounter.
Mr Martin Necas
Deep vein thrombosis workshop
Assessment of the deep veins for DVT is one of the most common radiology examinations.
The purpose of this workshop will be to provide a detailed overview of the techniques
involved in accurate and time efficient deep vein examination with focus on detailed
modern colour Doppler techniques for the assessment of the difficult regions including
the calf veins and Iliac veins.
Ms Jenny Parkes
Breast and axilla ultrasound in breast cancer
This workshop will display the scanning techniques of the axilla and extended axillary
scanning for higher‐level lymphadenopathy. Scanning techniques for the breast will
also be reviewed if required by the attendees.
Ms Jenny Parkes
Salivary gland workshop
Today's workshop will outline the scanning procedure for the salivary glands (including
intraoral technique), review the reasons why we scan the salivary glands and discuss
some of the scenarios and pathology that may be encountered.
Dr Pramit Phal
Ultrasound of the tongue
The tongue is readily accessible to sonographic assessment with a small footprint,
high frequency probe. This underutilised technique demonstrates particular utility
in the assessment of squamous cell carcinoma of the tongue, where it is comparable
to MRI in assessment of local tumour staging. This talk will address relevant anatomy,
indications, sonographic technique and potential pitfalls.
Dr Sophie Piessens
Ultrasound diagnosis of deep infiltrating endometriosis – a step‐by‐step approach
Surgical treatment of deep infiltrating endometriosis is complex, particularly when
bowel nodules are present. Recent literature suggests that transvaginal ultrasound
allows accurate assessment of bowel or bladder involvement, vaginal nodules or pouch
of Douglas obliteration.
Patient care is improved by identifying the subgroup of patients who would benefit
from referral to an endometriosis expert and/or bowel surgeon. This presentation gives
a step‐by‐step approach to the preoperative transvaginal ultrasound diagnosis of deep
infiltrating endometriosis involving the bowel, the bladder and the uterosacral ligaments.
Dr Jayshree Ramkrishna
The fetal heart
My presentation for the Obstetric Registrars Skill Day will focus on the clinical
implications and management of fetal cardiac abnormalities.
Mr Rex de Ryke
The Christchurch earthquake: the ultrasound story
There are hundreds of stories, positive and negative, tragic and inspiring following
the Christchurch Earthquake on 22nd February 2011. This is the story of the Christchurch
Radiology Ultrasound Department. This presentation covers events within the hospital
and the use of ultrasound imaging as the initial imaging modality for large numbers
of casualties via the FAST ultrasound scanning technique.
Ms Michelle Rodeh
Introductory lower limb arterial duplex scan workshop
Arterial duplex scanning provides direct anatomic and physiologic information for
the referring doctor to aid in the determination of whether surgical or conservative
treatment is required when a patient presents with peripheral vascular disease.
The purpose of this workshop is to help those performing arterial duplex scans by
giving information and hints on how to perform this type of scan and reinforcing the
difficulties in performing the procedure by live scanning. The main aim is to give
the relevant details that should be obtained from an arterial duplex scan.
Ms Michelle Rodeh
Advanced lower limb arterial duplex scan workshop
The purpose of this workshop is to give a background in the surgical procedures being
carried out by the surgeons and the requirements of post‐surgical ultrasound surveillance.
This is an opportunity for the attendees to learn more about the procedures and obtain
the necessary information from the duplex scan to give to the surgeon with live scanning.
Mr Peter Russell
Ultrasound in the evaluation of erectile dysfunction
Erectile dysfunction (ED) is described as the inability to obtain or maintain an erection
sufficient for intercourse. ED can be the result of endocrinologic, psychogenic, pharmacologic,
neurogenic and vasogenic factors
1
.
Following careful clinical evaluation to exclude factors other than vasogenic, colour
Duplex examination (CDE) may be performed to evaluate the integrity of the vascular
anatomy. CDE may be used to determine the quality of arterial inflow as well as the
efficiency of the veno‐occlusive mechanism
2
.
By understanding the anatomy and physiology of the erectile mechanism, a more meaningful
duplex examination can be performed.
This presentation will review the anatomy, physiology and mechanism of erectile function
as well as the aforementioned factors that may be implicated in ED. The technique
and diagnostic criteria of both normal and abnormal findings, as well as the interpretation
of results, will be discussed.
References
1
Fitzgerald
SW
,
Erickson
SJ
,
Foley
WD
,
Lipchik
EO
,
Lawson
TL
. Colour Doppler Sonography in the Evaluation of Erectile Dysfunction. Radiographics
1992; 12: 3–17.1734478
2
Pavlica
P
, et al. US Evaluation of Erectile Dysfunction. Colour Doppler Sonography of the Penis.
Bertolotto
M
editor; Springer pp 39–52.
Dr Anthony Schelleman
Hepatic ultrasound before, during and after RFA of liver tumours
This session covers patient, lesion, ablation procedure and equipment selection in
local treatment of malignant hepatic tumours, particularly radio‐frequency ablation,
in both metastatic disease and primary liver tumours. Contraindications and special
precautions will be reviewed, as well as tips to optimise localisation of subtle lesions.
Dr Anthony Schelleman and Dr Tom Sutherland
Radiofrequency ablation and biopsy of the liver – a practical guide workshop
Radiofrequency ablation (RFA) of tumours is a rapidly expanding field with an increasing
body of evidence to support its use as a minimally invasive alternative to surgery.
Initial studies focused on RFA of focal liver lesions, however the techniques have
been employed in multiple sites including lung, kidney, adrenal, bone and breast.
This workshop offers a practical hands‐on experience and “buttonology” for those interested
in RFA techniques. Multiple different needle types and units will be available with
models to allow practice on liver samples. Participants will be offered guidance and
advice with respect to needle selection, needle positioning, treatment times and patient
preparation and selection.
Dr Melanie Seale
Urinary tract obstruction
Urinary tract obstruction (UTO) is a common clinical problem and indication for ultrasound
examination. Relevant clinical terms will be defined, a brief outline given of imaging
modalities available for assessment of UTO, with the main focus on ultrasound, which
is the imaging modality of choice for assessment of most cases of UTO. Technique and
potential pitfalls will be discussed and illustrated with clinical cases.
Ms Martine Shields‐Chadwick
Musculoskeletal ultrasound – knee workshop
A patient often can tell you the how, when and where of acute/overloaded/chronic knee
pain. There is tendency to target knee ultrasound in good faith to the sore spot leaving
the global assessment to MRI.
Not today… beyond the patellar tendon. This workshop challenges the participant to
perhaps revise or extend their scanning techniques. To revisit global anatomy of the
anterior thigh/quadriceps muscles in particular and an advanced knee protocol.
Discussion will include detailed anatomy, terminology and the clinical correlation
of common sporting injuries.
Mr Mark Smyth
Musculoskeletal ultrasound – ankle workshop
This workshop will demonstrate scanning technique for evaluating the tendons, ligaments,
and bony landmarks of the ankle. Common sites of pathology will be shown, including
acute and chronic conditions. Techniques for dynamically assessing the ankle will
be discussed.
Hands‐on participation will be encouraged in a supportive environment.
Dr Manfred Spanger
Interventional radiology in the investigation and management of cerebral venous insufficiency
Much popular attention has recently been focused on the entity of chronic cerebrospinal
venous insufficiency (CCSVI). While the understanding of this condition is being developed,
many Multiple Sclerosis patients have been fixated on a single Italian study showing
benefit in certain patient groups. This has led to overwhelming pressure from patient
advocacy groups to offer treatments for CCSVI despite evidence not yet at a level
to satisfy most radiologists or any neurologists. As a consequence, treatment is difficult
to find, unfunded and always under threat. I will go through the theoretical underpinning
of the condition and the treatment thereof.
Dr Nicola Stephens
Thyroid nodules: to FNA or not to FNA?
Aims
1
Thyroid nodule epidemiology to explain the significance of the issue
2
Clinical factors to be aware of when evaluating thyroid nodules
3
Sonographic characterisation of thyroid nodules with particular reference to benign
vs. malignant features
4
Role of scinitigraphy in determining need for FNA
5
Leave alone nodules: to furnish the listener with an approach for future practice
6
Overview of malignant nodules: to clarify which nodules do require FNA
7
Describe a report format to aid future practice.
Dr Tom Sutherland
CEUS of splenic lesions
Focal splenic pathologies are uncommon compared with disease of other abdominal viscera.
However, a diverse range of pathologies occur within the spleen and are being more
frequently encountered as imaging techniques advance and as many disease processes
are modified by new treatments.
Focal lesions may be congenital (splenunculi, cysts), infectious (bacterial, tuberculous,
parasitic and fungal), inflammatory (sarcoid), neoplastic (haemangioma, lymphoma primary
and secondary, metastatic) and vascular (infarction).
This review will discuss the evidence of contrast enhanced splenic ultrasound and
provide illustrative examples of focal splenic lesions likely to be encountered by
general radiologists and sonographers. Although many imaging findings overlap, a thorough
understanding of the underlying pathologies that involve the spleen and the use of
second generation sonographic contrast agents, can help to narrow the differential
diagnosis.
Ms Faye Temple
Liver Segments and Doppler of the Liver Workshop
It is important to be accurate when documenting liver lesions. This workshop covers
Couinauds classification of liver segments and other areas of anatomical interest
as well as assessment of the vasculature of the liver. Any other areas of interest
can be covered – come armed with questions.
Ms Sue Walker
What's new in CMV?
Congenital cytomegalovirus is now the leading infective cause of perinatal neurological
handicap. While perinatal CMV infection has potentially devastating consequences,
the prevention, diagnosis and treatment of CMV embryopathy remains challenging. This
talk will address current controversies in the management of CMV, including the role
of screening for CMV in pregnancy, fetal diagnosis following maternal seroconversion,
the role of in‐utero therapy, and the value of ultrasound and MRI in the diagnosis
of the affected fetus.
Ms Sue Walker
Ultrasound in the growth restricted fetus
It has been said that “if you are born small, you keep dying all your life”. Fetuses
that are small for gestational age are more likely to suffer perinatal death, neonatal
and childhood morbidity, and many adult diseases have their origins in fetal life.
Ultrasound has an important role in the prediction, diagnosis and surveillance of
the growth‐restricted fetus. Ultrasound can uniquely provide a window into the adequacy
of the uteroplacental circulation, as well as assessing fetal vascular and behavioral
adaptations in the face of worsening hypoxia and acidosis. This talk will address
the role of ultrasound in the diagnosis and management of preterm and term fetal growth
restriction.
Mr Daniel White
The appendix – finding the hidden treasure
Appendicitis is one of the most frequently requested referrals in any ultrasound department.
It is also one of the more difficult structures to locate. This presentation will
introduce the embryology and anatomy of the appendix with some rare anatomical variations.
In addition we will explore techniques, tricks, tips and key landmarks to improve
visualisation of the appendix. Clinical presentation, accompanying features and other
differentials will also be discussed.
Further reading
1
Kim
YS
,
Kim
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CK
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2001; 29 (3): 157–85.11329159
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Peletti
AB
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Baldisserotto
M
. Optimizing US examination to detect the normal and abnormal appendix in children.
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Werner
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Applegate
KE
. Mesenteric lymph nodes in children: what is normal?
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Klein
MD
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V
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NJ
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I
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WB
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SM
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PR
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Novelline
RA
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PJ
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MH
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KR
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GJ
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SA
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Hinder
RA
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AB
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Thapa
M
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McBroom
JA
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Garrison
MM
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Parisi
MT
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Pediatr Radiol
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AK
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Gervais
DA
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Hahn
PF
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Sagar
P
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Mueller
PR
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Novelline
RA
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Mr Robert Ziegenbein
Venous Incompetence Workshop
There are a number of ultrasound techniques at the disposal of sonographers to make
an accurate assessment of a patient's varicose veins. These include the use of colour
and spectral Doppler, augmentation techniques and altering the patient's posture.
All of these techniques are designed to augment venous blood in sufficient quantity
so that a maximal reflux duration can be observed and the criteria of significant
reflux can be accurately assigned to those veins if appropriate.
Participants will perform and be guided in these imaging techniques to achieve both
efficient and accurate assessment of venous incompetence and in the appropriate anatomical
identification of the superficial veins which contribute to venous incompetence.
Ms Marilyn Zelesco
Contrast Enhanced Ultrasound Assessment (CEUS) of Crohn's disease activity
The assessment of disease activity is central to the management of Crohn's disease
(CD). Transabdominal ultrasound (US) offers many advantages to patients with CD, who
are typically young and require frequent imaging. US is beneficial as it is non‐invasive,
accurate
1
and easily repeatable. Furthermore, it does not utilise ionising radiation and is
relatively inexpensive.
In recent years, second generation contrast agents in combination with low mechanical
index harmonic US allows systematic analysis of bowel wall microcirculation. Several
studies have correlated CEUS with clinical, biochemical and endoscopic measures of
inflammatory activity in CD. However, many have assessed qualitative parameters only
from CEUS and results to date have been inconsistent
2
–
5
.
The purpose of this study was:
To determine whether quantitative parameters obtained from CEUS are independent predictors
of CD activity as measured endoscopically
To assess the differences in enhancement patterns of the mucosa and submucosa of the
bowel wall
To investigate the interobserver reproducibility in measurements obtained from CEUS
To assess the utility of CEUS in the follow‐up of patients on treatment
This paper will discuss these findings.
References
1
Horsthuis
K
,
Bipat
S
,
Bennink
RJ
,
Stoker
J
. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta‐analysis
of prospective studies. Radiology
2008; 247: 64–79.18372465
2
Ripollés
T
,
Martínez
MJ
,
Paredes
JM
,
Blanc
E
,
Flors
L
,
Delgado
F
. Crohn disease: correlation of findings at contrast‐enhanced US with severity at
endoscopy. Radiology
2009; 253: 241–48.19635834
3
Girlich
C
,
Jung
EM
,
Iesalnieks
I
,
Schreyer
AG
,
Zorger
N
,
Strauch
U
,
Schacherer
D
. Quantitative assessment of bowel wall vascularisation in Crohn's disease with contrast‐enhanced
ultrasound and perfusion analysis. Clin Hemorheol Microcirc
2009; 43: 141–8.19713608
4
Kratzer
W
,
Schmidt
SA
,
Mittrach
C
,
Haenle
MM
,
Mason
RA
,
Von Tirpitz
C
,
Pauls
S
. Contrast‐enhanced wideband harmonic imaging ultrasound (SonoVue): a new technique
for quantifying bowel wall vascularity in Crohn's disease. Scand J Gastroenterol
2005; 40: 985–91.16173144
5
Quaia
E
,
Migaleddu
V
,
Baratella
E
,
Pizzolato
R
,
Rossi
A
,
Grotto
M
,
Cova
MA
. The diagnostic value of small bowel wall vascularity after sulfur hexafluoride‐filled
microbubble injection in patients with Crohn's disease. Correlation with the therapeutic
effectiveness of specific anti‐inflammatory treatment. Eur J Radiol
2009; 69; 438–44.19070446
Ms Marilyn Zelesco
ASQ – the new Hounsfield Unit?
Acoustic structure quantification (ASQ) is ultrasound software that analyses the statistical
information of the acquired (receiving) echo signals. By looking at the speckle pattern
in a certain region of interest (ROI), tissue differentiation becomes possible. ASQ
is based on raw data greyscale imaging. The raw data is collected before the scan
converter and before the lateral filter is applied. Hence minimal manufacturer image
interpolation is present.
ASQ was developed as a potential tool in the quantification of diffuse liver disease.
It was hoped it would also assist in the monitoring of regression or progression of
liver fibrosis and fibrosis treatment.
ASQ is a tool that has been developed to be less subjective and operator dependent
than conventional ultrasound liver imaging, as it is the unit that performs the analysis
on the acquired data.
Parallel clinical studies have been underway to validate ASQ in terms of its role
in the clinical setting. This talk discusses these and other potential uses for this
emerging technology in a variety of clinical areas.
Ms Marilyn Zelesco
Sonography of the gastro‐intestinal tract
In recent years, bowel ultrasound has gained importance as a reliable and non‐invasive
imaging modality for the diagnostic work‐up and clinical follow‐up of patients with
a range of gut disorders. These include inflammatory states such as Crohn's disease,
appendicitis and diverticulitis; or even malignancy. This can be attributed to the
improved resolution capabilities of ultrasound equipment and improved sonography technique.
With good cross‐sectional imaging of the gut wall and display of the surrounding mesentery,
it may be possible to detect the transmural extent of inflammation or disease.
However, uncertainty still persists concerning the accuracy of bowel ultrasound as
a primary imaging procedure in patients with suspected bowel disease. This workshop
introduces the audience to the basics of gut sonography, as well as a range of pathologies
that can be visualised by ultrasound.