Browsing by Subject "Ultrasonography"
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Item Bedside ultrasonography in clinical medicine(2016-10-21) Badamosi, RazaqItem Donald W. Seldin, M.D., Research Symposium finalist presentations(2022-04-29) Almonte, Matthew; Duvalyan, Angela; McAdams, Meredith; Onyirioha, Kristeen; Saez-Calveras, Nil; Triana, TaylorThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Seventh Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 21, 2022. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2022 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality and Education at Parkland Hospital and the Social Impact Award.Item [News](1976-09-21) Land, ChrisItem Point of Care Ultrasonography by Novice Medical Students for Detecting Inferior Vena Cava Collapsibility, Aortic Diameter and Overall Left Ventricular Function in Euvolemic Pediatric Patients(2020-01-21) Dixon, Bryant; Han, Anthony; Hoang, Khiem; Cooper, Michael; Dickinson, Jennifer; Rendon, Juan Mark; Field, Steven; Roppolo, LynnBACKGROUND: Point of care ultrasound (POCUS) is a useful tool in assessing volume status and cardiac function in the emergency department (ED). Research has shown that medical students (MS) are capable of learning and performing POCUS, however further research is warranted to assess MS ability to perform POCUS, specifically in the pediatric population. METHODS: 5 MS were trained in POCUS techniques over a 2-week period. Training included a one hour lecture followed by hands on practice with the MS performing an average of 2.4 aorta scans, 4.4 IVC (inferior vena cava) scans and 6.8 cardiac scans on healthy pediatric and adult volunteers during the training period. MS then began staffing a pediatric ED 24 hours a day for 5 weeks in 12 hour shifts. The MS identified euvolemic patients age 13 years or younger and obtained written consent for 135 patients. The MS collected ultrasound images of the IVC, aorta, and heart with a parasternal long view and apical view of each patient. The MS assessed left ventricular ejection fraction, then measured IVC diameter and aorta diameter. Each scan was reviewed for quality of image acquisition and accuracy of interpretation by an ultrasound fellowship trained emergency medicine physician and reviewed by a second faculty if the first disagreed with the MS interpretation. Quality of the scans were graded based on the American College of Emergency Physician's emergency ultrasound standard reporting guidelines' 5-point scale with a score of 3 or above meeting minimum criteria for diagnosis. RESULTS: Each MS averaged 2.4 aorta, 4.4 IVC and 6.8 heart scans on healthy pediatric and adult volunteers during the training period. 135 patients age 1 week to 13 years were enrolled. Complete studies were available for 115 cardiac scans, 112 IVCs and 113 aortas. Faculty graded 110/115 cardiac scans 3 or above (95.6%; 95% CI 90.1-98.6%) and agreed with 106/112 MS interpretations (94.6%; 95% CI 88.7-98.0%). Faculty graded 95/112 IVC scans as a 3 or above (84.8%; 95% CI 76.8-90.9%) and agreed with 97/110 MS interpretations (88.2%; 95% CI 80.6-93.6%). Faculty graded 97/113 aorta scans as a 3 or above (85.8%; 95% CI 78.0-91.7%) and agreed with 99/111 MS interpretations (89.2%; 95% CI 81.9-94.3%). CONCLUSIONS: MS with minimal training can accurately detect IVC collapsibility, measure aortic size and assess cardiac contractility in euvolemic pediatric patients.Item Point-of-Care Ultrasonography by Novice Medical Students for Detecting Fractures in Pediatric Patients with Traumatic Extremity Pain(2020-01-21) Tu, Kristie Pham; Pyle, Hunter James; Narayan, Aman; Jones, Jodi; Bahga, Dalbir; Pascual, Mandy; Field, Steven; Kulstad, Christine; Roppolo, LynnBACKGROUND: Point of care ultrasound (POCUS) is an important assessment tool to make rapid critical diagnoses in the Emergency Department (ED), including in the evaluation of post-traumatic extremity pain. Several studies have demonstrated the accuracy of medical students performing POCUS examinations after limited training. OBJECTIVE: We aimed to assess the ability of medical students with minimal training in emergency ultrasound to accurately identify bone fractures in patients presenting with traumatic extremity pain. METHODS: Five novice medical students completed a 2 week ultrasound training period consisting of lectures with ultrasound fellowship trained faculty, hands-on practice with bone models, pediatric volunteers, and medical student volunteers (~ 3 hr total training with ~ 9.4 completed bone ultrasounds). Following training, medical students continuously (24 hr / day) recruited pediatric patients presenting to the ED at Children's Medical Center with traumatic extremity pain over 5 weeks. After each ultrasound scan, at least one fellowship trained ultrasound faculty assessed the student's accuracy based on a 1-5 scale established by American College of Emergency Physicians (ACEP). RESULTS: 39 total patients were enrolled in this imaging study. From the student conducted ultrasound scans, 37 were reviewed by Ultrasound fellowship trained faculty. Faculty review revealed that fractures were accurately diagnosed on x-ray at the same location as ultrasound in 16/19 scans (84%, 95% CI, 60-97%), while non-fractures were accurately identified in 17/18 scans (94%, 95% CI, 73-99%). Overall, the students perceived their own diagnostic success in 92% of ultrasound scans, with faculty assessing students' diagnostic success rate at 89%. CONCLUSIONS: Medical students with minimal training can perform ultrasound examinations to accurately identify extremity fractures in pediatric patients. Given the success of teaching novice medical students ultrasound imaging skills, future studies might consider the timeframe / number of standardized scans required for students to obtain accurate scans using ACEP criteria.Item Sensitivity of Ultrasound and Alpha Fetoprotein for Detection of Hepatocellular Carcinoma in Patients with Cirrhosis(2017-01-17) Sasiponganan, Chayanit; Singal, Amit G.BACKGROUND: Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer related mortality in the United States. Prognosis is strongly tied to early detection, which facilitates curative treatment and long-term survival. Therefore, HCC screening is recommended in at risk patients, i.e. those with cirrhosis. Although ultrasonography is routinely used to screen at-risk patients for HCC, it is operator dependent and its sensitivity outside of prospective cohort studies is poorly described. Further, the benefit of adding serum biomarkers, such as alpha fetoprotein, has also been poorly studied. The aim of our study was to quantify the effectiveness of ultrasound and AFP for HCC detection in patients with cirrhosis. METHODS: We performed a retrospective chart review of patients newly diagnosed with HCC at UT Southwestern and Parkland Health and Hospital System between January 2009 and December 2015. We excluded patients who did not have at least one ultrasound within 12 months prior to HCC diagnosis. Ultrasounds were categorized as positive if there was a suspicious mass > 1 cm and AFP as positive if ≥20 ng/mL, the most common cut-off in clinical practice. Sensitivity was compared between ultrasound alone and combination of ultrasound + AFP using the chi-square test, with statistical significance defined as p<0.05. RESULTS: Of the 925 patients diagnosed with HCC between January 2009 and December 2015, 521 patients had an ultrasound within 12 months prior to HCC diagnosis. The overall sensitivity of ultrasound for HCC detection was 77.5% n=404/521). Of the 521 included patients, 400 had at least one AFP within 12 months of HCC diagnosis. There were 154 patients who had both positive ultrasound and AFP, 143 with positive ultrasound alone, 59 with positive AFP alone, and 44 with negative ultrasound and AFP. The sensitivity of ultrasound alone was 74.3% compared to 89.0% with ultrasound and AFP p<0.001). CONCLUSION: Ultrasound alone has suboptimal sensitivity for HCC detection in clinical practice, highlighting the need for better screening tools. Adding serum biomarkers, such as AFP, can significantly improve HCC detection in clinical practice.Item [UT Southwestern Medical Center News](2011-03-29) Russell, Robin