Ultrasound

Lung Ultrasound for Diagnosis of Primary Graft Dysfunction in Lung Transplantation Recipients (2024)

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Type of publication:
Conference abstract

Author(s):
O'Brien E.; Curry S.; Rubino A.; Barker A.; *Miller A.; Parmar J.

Citation:
Journal of Heart and Lung Transplantation. Conference: ISHLT 44th Annual Meeting and Scientific Sessions Prague Congress Centre. Prague Czechia. 43(4 Supplement) (pp S345), 2024. Date of Publication: April 2024.

Abstract:
Purpose: To determine if lung aeration scores calculated using LUS correlate with the identification and grading of PGD in lung transplantation recipients identified on bedside chest radiography (CXR) and PaO2/FiO2 as the reference standard. Method(s): This is a two-year, single-centre, prospective observational study investigating lung transplantation patients admitted post-operatively to Critical Care at Royal Papworth Hospital (RPH). LUS assessments to examine 12-lung regions were conducted at specified timepoints and scored retrospectively. Differences between LUS aeration scores for PGD and non-PGD were tested for and correlation of LUS score and PGD grading was assessed. Result(s): To date, data has been collected from 29 consecutive adult patients in 12 months. A total of 816 lung ultrasound clips have been collected for analysis. The mean aeration scores in PGD patients was higher than non-PGD (t(42) = 4.58, p < 0.001). PGD severity grading and LUS score shows a moderate positive linear association r(42) =.67, p < 0.01. Conclusion(s): This interim data analysis demonstrates exciting potential of LUS as an imaging modality in this cohort for PGD. This study is set to continue for a further 12 months, to allow for a larger sample size and further analysis of the utilisation of LUS in this cohort.

CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19 (2022)

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Type of publication:Journal article

Author(s):Parulekar P.; Powys-Lybbe J.; Aron J.; Knight T.; Lasserson D.; Smallwood N.; Rudge G.; *Miller A.; Peck M.

Citation:Journal of the Intensive Care Society; 2022 [epub ahead of print]

Abstract:Background: Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart – formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method(s): Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Result(s): 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusion(s): In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.

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Case report: Evaluating the role of ultrasound in the diagnosis of bilateral persistent sciatic arteries (2020)

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Type of publication:
Conference abstract

Author(s):
*Bell S.

Citation:
Ultrasound; 2020; vol. 28 (no. 2)

Abstract:
Peripheral vascular disease (PVD) affects 13% of the population aged over 50 in the western world and can be divided into two main groups: organic and functional. Other less common causes to include in the differential diagnosis in younger patients are Buerger's disease and anatomical variants such as duplication of the superficial femoral artery and persistent sciatic arteries (PSAs). PVD is a major cause of morbidity and mortality globally. Symptoms vary from cold extremities, intermittent claudication, to acute and critical ischaemia. All of these have a significant financial burden on critical healthcare resources. This case report evaluates the role of ultrasound in the diagnosis of bilateral PSAs. A 16-year-old female was referred by her GP to the vascular clinic presenting with bilateral intermittent claudication. On examination, missing dorsals pedis pulses were noted bilaterally. No previous imaging was available and the patient was referred for a lower limb Doppler ultrasound. Initial ultrasound scanning demonstrated no evidence of diseased vessels causing the patient's pain, but unusual arterial anatomy. Both superficial femoral arteries tapered to the distal thigh, where collaterals were demonstrated. Following the scan a diagnosis of persistent bilateral sciatic arteries was made. Ultrasound, due to its many advantages, is usually the first line imaging investigation to assess the peripheral arteries. In this case ultrasound was able to demonstrate that there was no evidence of any organically diseased vessels, but an anatomical variant causing the patient's symptoms. However, it was unable to demonstrate the overall view of the lower limb vasculature, the origin of the PSA, or provide all information to classify the sub type in view of any potential treatment or surgery. Although ultrasound is useful in the diagnosis of PSA, it lacks the ability to assess the whole of the peripheral circulation.

Haemorrhoidal artery ligation and/or suture mucopexy for haemorrhoidal disease with or without the use of Doppler ultrasonography: a meta-analysis of randomized, controlled trials (2019)

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Type of publication:
Conference abstract

Author(s):
*Rehman S.; Miles W.; Sains P.; Sajid M.; Baig M.

Citation:
British Journal of Surgery; Sep 2019; vol. 106, S5; p. 27-28

Abstract:
Aims: The objective of this article is to compare the surgical outcomes following haemorrhoidal artery ligation
and/or suture mucopexy for haemorrhoidal disease with or without the use of Doppler ultrasonography.
Method(s): The data retrieved from the published randomized, controlled trials (RCT) comparing the surgical
outcomes following haemorrhoidal artery ligation and/or suture mucopexy for haemorrhoidal disease with or
without the use of Doppler ultrasonography (DUS) was analysed using the principles of meta-analysis. The
summated outcome of dichotomous variables was expressed in risk ratio (RR) and continuous data was
presented in standardised mean difference (SMD).
Result(s): Four RCTs on 270 patients comparing the surgical outcomes following haemorrhoidal artery ligation
and/or suture mucopexy for haemorrhoidal disease with or without the use of Doppler ultrasonography were
analysed using the statistical software Review Manager 5.3. In the random effects model analysis no-DUS
group had shorter procedure time (SMD, 3.69; 95% CI, 2.73, 4.64; z = 7.56; P = 0.00001), better symptomatic
relief rate (RR, 1.95; 95% CI, 1.07, 3.56; z = 2.19; P = 0.03) and lower risk of short or long term haemorrhoidal
bleed (RR, 2.27; 95% CI, 1.25, 4.11; z = 2.70; P = 0.0007). The recurrence rate (RR, 1.87; 95% CI, 0.66, 5.30; z =
1.18; P = 0.24), post-operative pain score and complication rate were similar in both groups.
Conclusion(s): The use of DUS in haemorrhoidal artery ligation and/or suture mucopexy for haemorrhoidal
disease is not mandatory and better clinical outcomes may be achieved without its use.

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Point-of-care lung ultrasound in patients with COVID-19 - a narrative review (2020)

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Type of publication:
Journal article

Author(s):
Smith, M J; Hayward, S A; Innes, S M; *Miller, A S C

Citation:
Anaesthesia; Aug 2020, vol. 75 (no. 8); p. 1096-1104

Abstract:
Ultrasound imaging of the lung and associated tissues may play an important role in the management of patients with COVID-19-associated lung injury. Compared with other monitoring modalities, such as auscultation or radiographic imaging, we argue lung ultrasound has high diagnostic accuracy, is ergonomically favourable and has fewer infection control implications. By informing the initiation, escalation, titration and weaning of respiratory support, lung ultrasound can be integrated into COVID-19 care pathways for patients with respiratory failure. Given the unprecedented pressure on healthcare services currently, supporting and educating clinicians is a key enabler of the wider implementation of lung ultrasound. This narrative review provides a summary of evidence and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID-19-associated lung injury. Mechanisms by which the potential lung ultrasound workforce can be deployed are explored, including a pragmatic approach to training, governance, imaging, interpretation of images and implementation of lung ultrasound into routine clinical practice.

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Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? (2018)

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Type of publication:
Journal article

Author(s):
*Lumsden, Gordon; *Lucas-Garner, Kerry; *Sutherland, Sarah; *Dodenhoff, Ron

Citation:
Musculoskeletal care; Mar 2018; vol. 16 (no. 1); p. 209-213

Abstract:
AIMSPhysiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem.METHODS A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis.RESULTSPatients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them.CONCLUSION Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

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Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination (2014)

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Type of publication:
Journal article

Author(s):
Kammar H., *Carmont M.R., Kots E., Laver L., Mann G., Nyska M., Mei-Dan O.

Citation:
Orthopedics, March 2014, vol./is. 37/3(e298-e301), 0147-7447 (March 2014)

Abstract:
Sural nerve injury is a relatively common complication after surgery on the Achilles tendon. Studies to determine the course of the sural nerve have been performed on cadaveric specimens. The purpose of this cross-sectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. The authors performed ultrasound examination of the posterior triangle of the ankle and Achilles tendon to determine the course of the sural nerve relative to the Achilles tendon in healthy participants. The mean distance between the nerve and the tendon was 21.48, 11.47, 5.8, and 0.81 mm lateral to the Achilles tendon as measured at the insertion and 4, 8, and 11 cm proximally, respectively. Male participants tended to have a nerve that was initially more lateral to the Achilles insertion compared with women. The distance between the sural nerve and the Achilles tendon was found to be lower in older participants, with the nerve passing significantly closer to the tendon at all levels (P

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