RPS 1014b - An array of applications: ultrasound and dual-energy x-ray absorptiometry

Purpose:

The European Federation of Radiographer Societies (EFRS) are carrying out 3 on-line surveys to determine current views and practice of radiographers undertaking ultrasound examinations. The results of the first survey of EFRS national societies is presented here.

Methods and materials:

An on-line survey was sent to 54 EFRS radiographer societies, asking for opinions and practice within their country to explore the actual and perceived role of radiographers within ultrasound.

Results:

27 countries responded (50% response rate) with 40 individual respondents providing valuable information. Radiologists perform ultrasound examinations in all but one county, ‘specialist doctors’ scan in 80% of countries followed by radiographers in 59%. Limitations to radiographer ultrasound practice included shortages of high-quality educational opportunities, legislation stating that only doctors can scan, and resistance from some clinical colleagues. Team working with radiology colleagues was seen as good practice to develop radiographers’ skills and competence in ultrasound. Further advice was to gradually develop radiographer skills led by a few centres, ensure a rigorous audit is undertaken, and publish the outcomes to help build the case for wider implementation.

Conclusion:

Radiographers’ role extension into ultrasound is evident in some countries to a high level of independent practice. In other countries, radiographers either have some involvement in ultrasound scanning but not independent report writing or have no involvement at all. The results of the survey will be discussed within the presentation and suggestions provided for countries wanting to explore radiographer advancement in ultrasound.

Limitations:

The survey was in English, which led to different interpretation of some questions.

Ethics committee approval

GDPR and consent were explained at the beginning of the voluntary, anonymous survey.

Funding:

No funding was received for this work.

Purpose:

To analyse and characterise ocular structures, namely the eyeball, optic nerve head, and periorbital fat by B-mode ultrasound and sonoelastography in healthy young subjects.

Methods and materials:

240 images were collected by B-mode ultrasound and by elastography in 30 healthy subjects. The exclusion criteria was an eye surgery whose procedure leaves this very sensitive. After collection, measurements were made for the thickness and echogenicity of the intraorbital fat, eyeball, and optic nerve, as well as the colour (RGB) fraction and strain-ratio elastography of the globe and ocular nerve.

Results:

The values of elasticity vary from 36.24±11.71 a.u. for the red colour in the right eyeball to 102.42±15.72 a.u. for the green colour in the left eyeball, whereas for the optic nerves they range from 38.57±8.22 a.u. for the red colour of the left optic nerve up to 141.26±23.65 a.u. for the blue colour of the right optic nerve.

Conclusion:

Sonoelastography is an imaging ultrasound exam capable of analysing ocular structures and measuring values that in the future may serve as a comparison for the analysis of ophthalmological pathologies.

Limitations:

It is important to have a higher age range.

Ethics committee approval

Participants were fully informed of the purpose and procedures of the study and provided written informed consent. The study conformed to the guidelines of the declaration of Helsinki and was approved by the ethics committee of the Polytechnic Institute of Coimbra (No 42/2018).

Funding:

No funding was received for this work.

Purpose:

Testicular microlithiasis (TML) and its clinical significance is not fully understood. TML and risk factors have been associated with testicular cancer. This study investigated the association between TML and socioeconomic and other pre-diagnostic factors.

Methods and materials:

All men who had a scrotal ultrasound examinations at the department of radiology, Vejle Hospital, from 2001-2013 were included. They were categorised as patients with and without TML and compared with pre-diagnostic data from a nationwide registry.

Results:

A total of 2,404 men (283 (11.8%) with TML and 2,121 (88.2%) without TML) were included. Overall, we found no statistically significant differences in demographics, socioeconomic characteristics, or testicular diseases in men with and without TML. Men with TML had more often been treated for infertility (OR 2.09, 95% CI 0.84-5.24) and testicular torsion (OR 1.58, 95% CI 0.34-7.36) compared to men without TML.

Conclusion:

Treatment for infertility and torsion was non-significantly associated with TML and no other association was found. This data does not suggest early exposure to be related to TML.

Limitations:

No information in the Danish National Patient Registry or PACS was available on testicular volume, because the testicular volume is not a standard record. Selection bias may be present. However, to compensate for this, a high number of patients were included in this study and the patients were included from a long interval (2001-2013).

Ethics committee approval

The study was approved by the Danish Data Protection Agency (2008-58-0035/2009-41-3471). According to Danish law, the study did not require patients consent or approval from the Committee on Health Research Ethics of Southern Denmark, since no biomedical intervention was performed.

Funding:

The Region of Southern Denmark, the Danish Council of Radiographers, and the Lillebaelt Hospital Research Council.

Purpose:

To evaluate the effects of pulmonary rehabilitation (PR) on the structure and function of the diaphragm, quadriceps, and biceps brachii muscles in people with chronic obstructive pulmonary disease (COPD).

Methods and materials:

People with COPD were recruited from primary centres and hospitals. A group of age- and gender-matched healthy people were recruited. An US equipment (LogiqP6PRO, GE) with linear (11L) and convex (4C) probes was used. Rectus femoris and biceps brachii thickness (RFT, BBT) and their cross-sectional areas (RFCSA, BBCSA) were measured 3 times. Right diaphragmatic thickness at maximal inspiration (DTInsp) and expiration (DTExp) were obtained. Diaphragmatic excursion (DE) was measured during normal breathing (DE_NB) and at maximal inspiration (DE_max_insp) using M-mode US. Quadriceps (QMS) and elbow (EMS) muscle strength were assessed with a handheld dynamometer, exercise tolerance with the 6-min walk test (6MWT) and 1-min sit-to-stand, before (T0) and after a 12-weeks PR programme. Non-parametric tests were used for data analysis (statistical significance was set to p<0.05).

Results:

25 people with COPD (9 female) aged 66.3±10.4 years, BMI=24.7±4.5 kg/m2, and 10 healthy volunteers (4 female) aged 65.9±7.3 years, BMI=28.4±3.4 kg/m2, were enrolled. Significant differences between COPD and healthy volunteers at baseline (T0) were found for thickness, RFCSA, and BBCSA. Significant increases were observed in people with COPD after PR for RFT, RFCSA, BBT, BBCSA, DTInsp, 1 min sit-to-stand, 6MWT, and QMS (0.001≤p≤0.019). No other significant differences were found. Significant and moderate correlations were found between strength measures and muscle size (0.404≤rs≤0.580).

Conclusion:

There was an overall increase in muscle sizes after the PR programme. US measurements have shown to be a promising outcome measure for pulmonary rehabilitation.

Limitations:

n/a

Ethics committee approval

Study received ethical approval from the Health Administration North and Centre, Portugal

Funding:

3R Project-Ref. FCT (SAICT-POL/23926/2016).

Purpose:

To evaluate the aging changes of the skin by ultrasound with B-mode.

Methods and materials:

28 participants were divided into 2 groups: 18-35 years and 35-70 years. Participants who had scars and/or tattoos were excluded. All participants answered personal and sociodemographic questions, such as age, ethnicity, sun exposure, and their use of sunscreen among others. Then, an ultrasound examination was performed on different areas of the skin.

Results:

There was a higher subepidermic low echogenicity band index in the age group 18-29 years in the right hand, flexing of the right and left arms, and the neck. The epidermis was superior in the age group 37-64 years and, in relation to the neck, the hyperechogenic line was less visible also in this age group, which is suggestive of cutaneous aging.

Conclusion:

This study showed that there are layers of skin, especially in the age group 18-29 years, that are aged. High-frequency ultrasound is an effective method for identifying and evaluating the different layers of the skin.

Limitations:

The inability to have older individuals, upwards of 70 years, for comparing with the other age ranges.

Ethics committee approval

Participants were fully informed of the purpose and procedures of the study and provided written informed consent. The study conformed to the guidelines of the declaration of Helsinki and was approved by the ethics committee of the Polytechnic Institute of Coimbra (No 36/2019).

Funding:

No funding was received for this work.

Purpose:

In children, FibroScan transient elastography (TE) and acoustic radiation force impulse (ARFI) ultrasound elastography techniques are attractive, non-invasive tests for liver disease assessment. Since repeatability and reproducibility are hallmarks of any clinical test, this study aimed to determine the normal range of liver TE and ARFI measurements in healthy children and evaluate their repeatability and reproducibility.

Methods and materials:

Healthy volunteer children had 2 independent measurements of liver stiffness, utilising FibroScan TE and ARFI imaging-based elastography, independently performed by two operators according to a protocol designed to reduce measurement confounders. For each elastography technique, the upper limit of normal (ULN) liver stiffness was determined. Measurement repeatability and reproducibility for both methods and multiple operators were examined with Bland and Altman plots and Lin’s concordance correlation coefficient (CCC).

Results:

101 healthy children had two valid, independent liver stiffness measurements with TE and ARFI (Mean age: 12.4 years, SD: 2.57, M:F: 36%:65%). ULN values for liver stiffness were TE: 6.5 kPa and ARFI: 1.21 m/s. For repeat measurements, the 95% limits of agreement ranged from -0.72 kPa-+0.79 kPa for TE and from -0.13 m/s-+0.15 m/s for ARFI. Lin’s CCC was p=0.85 (95%CI 0.81-0.89) for TE and p=0.61 (95%CI: 0.46-0.71) for ARFI-derived measures.

Conclusion:

Despite operator expertise and efforts to reduce confounders, TE and ARFI measurements of liver stiffness in healthy volunteer children were not repeatable. Prescriptive elastography technique guidelines and the evaluation of the operator training protocol with a continued review of the operator performance to identify less expert operators is recommended to maintain and enhance diagnostic accuracy.

Limitations:

n/a

Ethics committee approval

Full institutional ethical approval was obtained. Written informed consent from parents and informed assent from children were obtained.

Funding:

The Health Research Board (Ireland) partly funded this research.

Purpose:

To evaluate quadriceps and biceps brachii muscle mass and quality in athletes and sedentary young controls in ultrasound (US) images. Furthermore, we aimed to establish a correlation between US and strength variables.

Methods and materials:

16 male handball players (20.25±1.77 years; BMI=26.16±3.02 kg/m2) and 16 sedentary age-matched university students (20.94±2.96 years; BMI=23.35±3.10 kg/m2) volunteered to participate in this study. An US equipment (LogiqP6PRO, GE) with linear (11L) probe was used. Three measures of quadriceps thickness (QT), rectus femoris thickness (RFT), RF cross-sectional area (RFCSA), vastus lateralis thickness (VLT), and pennation angle of the RF (RFPA) and VL (VLPA) were obtained. Of the upper limb, biceps brachii thickness (BBT) and BBCSA were measured. The echo intensity of the RF and BB were evaluated (RFEI, BBEI). Isometric knee extension strength (IKES), isometric elbow flexor strength (IEFS), and handgrip strength (HGS) were determined with a hand-held dynamometer. Statistical significance was set to 0.05.

Results:

Statistically significant differences between athletes and controls were found in BMI (p=0.015) and in the strength variables HS, IEFS, and IKES (p<0.001), and in the US variables RFT, RFCSA, RFPA, BBCSA (p<0.001), VLT (p=0.008), and VLPA (p=0.004). There was no significant difference between groups regarding muscle echo intensity variables BBEI and RFEI.

Positive and strong correlations were found for BBCSA and IEFS (r=0.75; p<0.001) and RFCSA and IKES (r=0.76; p<0.001). A moderate correlation was found between HGS and RFCSA (r=0.57; p=0.001) and BBCSA(r=0.58; p=0.001).

Conclusion:

The results shows that regular exercise has great impact in muscle size and strength. Furthermore, muscle architecture parameters evaluated with US can be used to non-invasively evaluate athlete performance.

Limitations:

n/a

Ethics committee approval

Institutional board approval and written inform consent obtained.

Funding:

No funding was received for this work.

Purpose:

To characterise and evaluate the morphological changes of the hamstring muscles through ultrasound parameters such as the pennation angle, fascicle length, cross-sectional area, echo-intensity, and muscle thickness.

Methods and materials:

22 young female divided into two groups (control group=11; athletes group=11) were submitted an ultrasound examination at 50% of the posterior region of the thigh for the semimembranosus and long portion of the femoral biceps muscles in the longitudinal and panoramic views.

Results:

22 athletes with a mean age of 23.27 years were evaluated. There were significant differences between the two groups in muscle morphology. The athletes' group showed higher values for muscle thickness, cross-sectional area, pennation angle, and fascicle length, and a lower values for muscle echo intensity.

Conclusion:

Physical exercise causes changes in muscle morphology and ultrasound is a good method for the musculoskeletal assessment of athletes' performance since it is an imaging modality that allows the carrying out of comparative bilateral studies for athletes' performance follow-up and for preventive strategies to fight sedentarism.

Limitations:

The low number of participants.

Ethics committee approval

Participants provided written informed consent. The study conformed to the guidelines of the declaration of Helsinki and was approved by the ethics committee of the Polytechnic Institute of Coimbra.

Funding:

No funding was received for this work.

Purpose:

Dual-energy x-ray absorptiometry (DXA) is broadly used to evaluate mineral bone density and consequently diagnose osteoporosis. DXA technology has evolved throughout time, implying differences in the acquisition mode and radiation exposure levels. This study aims to evaluate the examination and staff dose values in different DXA examinations performed in different technological equipment.

Methods and materials:

2 different DXA scanners, Lunar iDXA and Lunar DPX with narrow fan-beam and pencil-beam systems, respectively, were used in this study. Whole-body, lumbar spine, and left hip DXA acquisitions were performed on a PBU-60 anthropomorphic phantom and six Raysafe I3 dosimeters were placed in different positions in the room, in order to evaluate effective dose values in the possible room positions of the staff.

Results:

The highest examination dose values were obtained on the Lunar iDXA scanner. The staff exposures values were higher on hip examinations and no exposure was detected during a whole-body examination.

Conclusion:

The lower exposure values in DXA when compared to other medical imaging examinations are not negligible. The narrow fan-beam DXA scanner presented higher exposure values when compared with the pencil-beam technology.

Limitations:

It was not possible to compare all DXA technology scanners.

Ethics committee approval

Ethical commmite approval was obtained.

Funding:

No funding was received for this work.

Purpose:

To compare athletes from sports contrasting in mechanical impact: soccer versus swimming.

Methods and materials:

Bone mineral content (BMC) and density (BMD), lean soft tissue, and fat tissue were assessed using dual-energy x-ray absorptiometry. Anthropometric measures such as stature, sitting height, body mass, and 6 skinfolds were also measured. A Shapiro-Wilk test was performed to assess normality distribution. Descriptive statistics consisted of the median, standard deviation, maximum, minimum, frequency, and mode. A comparison between soccer players and swimmers was performed using t-tests for independent samples.

Results:

Soccer players (n=40) exhibit higher BMC for the whole body (1,528.4±108.3 vs 1,404.1±50.3) than swimmers (n=36) and for all specific regions of the body, except the upper limbs where swimmers exhibit higher BMC (195.7±35.2 vs 191.8±36.7). Soccer players have higher body mass (53.0±11.7 vs 44.2±9.6) and body mass index percentile for age (61.6±24.9 vs 42.5±27.2). Whole-body DXA shows a higher fat-free mass for soccer players (40.2±6.7 vs 35.5±5.4) and fat mass (20.9±3.5 vs 18.5±2.8).

Conclusion:

Physical activity seems to promote and benefit bone mass gains during growth for specific regions of the skeleton. Soccer has a greater impact on specific regions of the pelvis and swimming on the upper limbs.

Limitations:

The sample size.

Ethics committee approval

The ethics committee approved the study and written informed consent was obtained.

Funding:

No funding was received for this work.

Purpose:

To compare between normal and overweight/obese male adolescents.

Methods and materials:

Bone mineral content (BMC) and density (BMD), lean soft tissue, and fat tissue were assessed using dual-energy x-ray absorptiometry. Anthropometric measures such as stature, sitting height, body mass, and 6 skinfolds were also measured. Descriptive statistics consisted of the median, interquartile range, maximum, and minimum. A comparison between overweight/obese and normal-weight male adolescents was performed using a Mann-Whitney U test.

Results:

Overweight/obese (n=12, body mass index ≥85% percentile for age and gender) male adolescents exhibit higher BMD for the whole-body (1.110±0.137 vs 0.967±0.166; p=0.001) and specific regions of the skeleton than normal weight male adolescents (n=27, body mass index <85% percentile for age and gender) except for the upper limbs (0.741±0.160 vs 0.731±0.029; p=0.124) and the femoral shaft (1.122±0.200 vs 1.144±0.090; p=0.315). The mean body mass for overweight/obese subjects was 73.8±10.5 kg and for normal-weight subjects was 46.0± 3.8 kg. Body composition by DXA showed that overweight/obese subjects exhibit higher fat mass (FM) for the whole body (28.2±4.0 vs 17.7±5.3; p<0,001) but shows similar values for the upper limbs (1.9±0.01 vs 1.9±0.01; p=0.411). Overweight/obese subjects also exhibited higher lean soft tissue (LST) for the whole-body (54.2±7.7 vs 33.9±10.1; p<0.001) and specific regions.

Conclusion:

Excess body mass may have an osteogenic effect on bone mass gains due to the extra load exerted on the skeleton.

Limitations:

The sample size.

Ethics committee approval

The ethics committee approved the study and written informed consent was obtained.

Funding:

No funding was received for this work.