2013 Kenneth R. Gottesfeld Award Winners

1st Place

The Impact of Education: Has the Failure to Standardize Musculoskeletal Sonography Undermined Its Value?

Tia Mapes-Gonnella, BS, RDMS

Tia Mapes-Gonnella received her Bachelor of Science in Diagnostic Medical Sonography from Adventist University of Health Sciences (formerly Florida Hospital College of Health Sciences) to whom she credits this honor of recognition. She obtained her RDMS in AB in 2004 and has been a sonographer at St. Elizabeth Health Care since 2003. Tia continues to contribute to the sonography community through the delivery of web-based education, tutoring and is also an active member on the organizing committee for Tristate Sonography (TSS).

Abstract: Sonography has had substantial technological improvements over the years, removing many of the barriers to its application in evaluation of the musculoskeletal (MSK) system. Sonography offers the advantages of a dynamic, real-time evaluation that routinely incorporates patient movement, evaluation of MSK structures in symptomatic positions with real-time feedback from patients, and a patient-friendly, noninvasive imaging modality. However, educational standards and efficacy of musculoskeletal ultrasonography (MSUS) have demonstrated as much variance as published reports of MSUS accuracy and interobserver agreement. This review focuses on the available literature on MSUS utilization and training and the need for development of international standards and protocols that will serve to improve clinical application and interpretation as well as the quality of research, improving reliability and reproducibility of data.

2nd Place

Transperineal Sonography Evaluation of Muscles and Vascularity in the Male Pelvic Floor

Shawn C. Roll, PhD, OTR/L, CWCE, RMSK

Co-Author: Jason J. Kutch, PhD

Shawn is Assistant Professor in the Division of Occupational Science and Occupational Therapy and Director of the Musculoskeletal Sonography and Occupational Performance Laboratory at the University of Southern California. Dr. Roll received his Bachelor of Science in Occupational Therapy, Master of Science in Allied Medical Professions, and Doctor of Philosophy in Health and Rehabilitation Sciences from The Ohio State University. His research investigates methods and techniques for enhancing the assessment, prevention, and rehabilitation of musculoskeletal disorders, with a focus on integrating concepts of occupational performance with musculoskeletal sonography.

Abstract: Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comparative image analysis is included. A validated protocol such as this may be useful in documenting differences in the soft tissue structures between asymptomatic individuals and patients with chronic pelvic pain to aid in diagnosis and treatment. This is the first known study to report sonographic findings of the individual muscles in the male pelvic floor, and additional research is needed to validate the techniques that have been deemed feasible.

3rd Place

Establishing an Imaging Protocol for Detection of Vascularity within the Median Nerve Using Contrast-Enhanced Ultrasound

Kevin D. Evans, PhD, RT(R)(M)(BD), RDMS, RVS, FSDMS

Co-Authors: Kevin R. Volz, MS, RVT

Shawn C. Roll, PhD, OTR/L,CWCE, RMSK

Cristina M. Hutmire, MS, NPP, RN, RT(R)

Rachel L. Pargeon, BS, RDMS

John A. Buford, PhD, PT

Carolyn M. Sommerich, PhD, CPE

Photo: R to L: Dr. Carolyn Sommerich, Dr. Kevin Evans, Rachel Pargeon, Crissie Hutmire Kevin Volz, & Dr. John Buford–not pictured Dr. Shawn Roll

The Directors of three research laboratories at The Ohio State University collaborated to execute a series of basic science experiments, designed to investigate the development of carpal tunnel syndrome. Drs. Evans, Buford, and Sommerich pooled their expertise to look at the early onset and also document these changes with MRI, Sonography, and Electrophysiology. The laboratories were funded by the National Institute for Occupational Safety and Health for the foundational experiments (R01) as well as for the Sonography imaging (R21). Drs. Evans, Buford, and Sommerich have continued their collaboration with additional projects that have been funded for continued research into the development of musculoskeletal disorders. The translational potential of their work is focused on helping to reduce the risk of health care workers who are experiencing work-related musculoskeletal injuries. The labs also have a conjoined mission of training the next generation of young scientists. We are very proud of Dr. Roll, Mr. Volz, Ms. Hutmire, and Ms. Pargeon as they have used their research emersion to further their individual education and scientific endeavors.

Abstract: This preclinical study was conducted to develop discrete sonographic instrumentation settings and also safe contrast dosing that would consistently demonstrate perineural vascularity along the median nerve. This set of imaging studies was conducted with a convenience cohort of young adult female monkeys (Macaca fascicularis). Sonographic equipment settings and dosing were refined throughout the imaging series to ensure consistent contrast-enhanced ultrasound imaging. A mechanical index of 0.13 was consistently used for imaging. Perineural vessels were imaged with a suspension solution of 0.04 mL Definity/0.96 mL saline introduced over 5 minutes for a total dose of 0.8 mL of contrast solution. Blinded studies of high and low dose contrast, along with saline injections, were correctly identified by two experienced sonographers. This preclinical study established adequate equipment settings and dosing that allowed for a valid demonstration of vascularity surrounding the median nerve.