Abstract
This year Ultrasound is launching a new feature. From time to time, compilations of past papers with a common theme will be made available free of charge electronically. The release of these special issues will be advertised in the printed edition of Ultrasound. The first two compilations, one paediatric and one vascular, are available now and are kindly introduced by the following experts:
Special Vascular Edition
Elaine Young BSc (Hons) MSc AVS
Principal Vascular Scientist
President 2008–2009, The Society of Vascular Technology of Great Britain & Ireland
Welcome to this special vascular issue of Ultrasound. I was delighted to hear that Ultrasound was going to produce a vascular-themed issue. As a member of BMUS and a reader of Ultrasound for a number of years, I usually scan the contents page of each journal in the hope that I will find a vascular-related article. Ultrasound has published a number of excellent vascular ultrasound papers in the past, and this vascular special brings together an outstanding collection of eight previously published papers.
This issue includes papers that cover a diverse range of vascular ultrasound topics ranging from well-established techniques, such as deep vein thrombosis (DVT) assessment, to more recent technologies such as the vascular applications of ultrasound contrast agents. Three of the papers are themed around renal dialysis ultrasound techniques, all of which I would suggest as essential reading for ultrasound professionals involved in performing renal access ultrasound. I have been involved in establishing such services in the past and there is great satisfaction to be gained from providing a high quality service to this particular group of patients. The first paper ‘Ultrasound in Haemodialysis access’ by Freedman and Deane is a comprehensive overview and ‘howto’ paper that covers all the aspects of imaging protocols for fistula planning, monitoring and post procedure. It is an exceptional learning and reference article for this particular ultrasound application and gives criteria, tips and pitfalls alongside a collection of detailed images to support the text. The second paper ‘Ultrasound of Haemodialysis Radiocephalic Fistula: A Pictorial Essay’ by Lapman is, as the title suggests, a detailed pictorial review explaining the anatomy and flow dynamics of the radiocephalic fistula. This paper is extremely informative and provides an overview of the complications and associated pathologies. The final paper on this topic is a very comprehensive practical and useful service review paper by Healy and colleagues ‘Development of a Duplex Ultrasound Service for Dialysis Patients with Vascular Access Problems’ which details the issues surrounding the delivery and management of a dialysis ultrasound service. The paper describes the importance of the multidisciplinary team and emphasizes the need for protocols and pathways to be optimally designed to improve the outcomes and reduce the waiting times for renal patients.
Transcranial Doppler (TCD) is a topic that I have a particular interest in having spent a couple of years working in research in this specialty in the past. I was very pleased to see the paper ‘Transcranial Doppler Embolus Detection: A Primer’ by Emma Chung. TCD appears on the surface to be a simple technique, however, to use TCD effectively and accurately in the clinical setting requires a good understanding of the physics involved in the technique in addition to strong interpretative skills. This is an accomplished technical paper which not only details the principles behind the TCD technique it also considers the clinical applications and areas of future development.
Another relatively new and expanding area of practice in vascular ultrasound is endovascular aortic aneurysm repair (EVAR). As this is a developing area there is a need for a solid reference article on this topic for those embarking on providing this service or indeed those already routinely performing this examination. All clinical specialists involved in this area would benefit from reading this consummate ‘how to’ paper by Tim Hartshorne ‘Endovascular Aortic Aneurysm Repair and the Role of Ultrasound Surveillance’. It is a comprehensive paper which outlines what is expected from the examination and I would consider it a ‘must read’ for all those involved in performing EVAR ultrasound examinations.
The assessment of DVT using ultrasound has been undertaken in clinical practice for a number of years, however, the technique has evolved with improved ultrasound image quality. Often the DVT ultrasound assessment may be the only diagnostic examination performed for a patient with lower limb pain or swelling. This examination is therefore an important opportunity to identify other possible common causes for patients’ symptoms. The paper ‘Diagnoses in Patients Presenting via the Fast-track Deep Vein Thrombosis Service: A Pictorial Review’ by Wilde and Wilson highlights the importance of identifying co-existing or differential diagnoses in this group.
Many vascular scientists/sonographers providing ultrasound services in centres where carotid endarterectomies (CEA) are performed are likely to have been involved in providing, or may have been asked to consider providing, a service for ultrasound follow-up after CEA. In the 1990s this assessment was carried out routinely in many UK vascular centres, however this trend for routine use has declined in recent years. The evidence and rationale for this examination is reviewed and considered in Rachel Walker's paper ‘Duplex Surveillance of Patients Following Carotid Endarterectomy’. Ms Walker considers the arguments for and against and examines the evidence or ‘lack of’ for this practice. This paper covers most, if not all of the factors that need to be taken into consideration.
The final paper by Satchithananda et al. ‘Microbubble Ultrasound Contrast Agents in the Visualization of Peripheral Vasculature in ‘Doppler Rescue': A Review’ considers the recent technological advance in ultrasound contrast agents. At present this application tends to be used concomitantly with regular colour Doppler ultrasound in centres with a specialist interest. However, the wider vascular ultrasound community could benefit from the addition of this technique to their practice to further optimize and enhance diagnostic information in difficult examinations. The paper highlights some particular vascular applications where such agents markedly increased the Doppler signal acquired and increased diagnostic yield.
I hope you all enjoy reading this vascular special and I would like to take this opportunity to encourage the vascular scientists and sonographers reading this issue to consider submitting your papers to Ultrasound in the future.
EY
To access this collection please go to http://ult.rsmjournals.com/cgi/content/full/18/1/DC1.
Special Paediatric Edition
Rose de Bruyn
Consultant Radiologist
Great Ormond Street hospital for Children NHS Trust, WC1N3JH
This special edition is a collection of specially commissioned paediatric ultrasound articles printed in the Ultrasound journal over the last five years and written by specialists in their fields.
The articles remain relevant and up-to-date today and cover a wide range of topics important in paediatric ultrasound. If I were to choose a favourite, always an unwise move, it would be the ‘Twinkling sign’ by Kassa Darge – simply because I don't think this helpful ultrasound sign is widely taught or used in clinical practice.
This is a very useful collection on topics not usually available in one volume, and my advice is to add this link immediately onto your ‘favourites’ list.
RdeB
To access this collection please go to http://ult.rsmjournals.com/cgi/content/full/18/1/DC2.