Ultrasound

This paper reports the results of an audit to assess the possible thermal hazard associated with the clinical use of ultrasound scanners in UK Hospitals for transvaginal ultrasound imaging.

An anatomically relevant phantom composed of a block of agar-based tissue mimicking material with embedded thermal sensors was developed. Seventeen hospitals around the UK were visited and a total of 64 configurations were tested. A representative typical scanning protocol was adopted, which primarily used B-mode with 30 s periods of colour-flow and pulsed Doppler modes for both gynaecology and obstetrics pre-sets.

The results confirmed that the highest temperature increase is always at the surface. The greatest temperature rise measured across all the systems was 3.6℃, with an average of 2.0℃ and 2.16℃ for gynaecology and obstetrics pre-sets, respectively. For some systems, the temperature increased rapidly when selecting one of the Doppler modes, so using them for longer than 30 s will in many cases lead to greater heating. It is also shown that, in agreement with previous studies, the displayed thermal index greatly underestimates the temperature rise, particularly close to the transducer face but even to distances approaching 2 cm.

Overall, the results of the audit for the temperature rise during transvaginal ultrasound at clinical settings fell within the limits indicated by the national and international standards, for the pre-sets tested and following a representative typical scanning protocol. Only selected pre-sets were tested and the scanner outputs were not maximised (for example by using zoom, greater depth or narrow sector angles). Consequently, higher temperatures than those measured can certainly be achieved.

Although ultrasound systems generally archive to Picture Archiving and Communication Systems (PACS), their archiving workflow typically involves storage to an internal hard disk before data are transferred onwards. Deleting records from the local system will delete entries in the database and from the file allocation table or equivalent but, as with a PC, files can be recovered. Great care is taken with disposal of media from a healthcare organisation to prevent data breaches, but ultrasound systems are routinely returned to lease companies, sold on or donated to third parties without such controls.

In this project, five methods of hard disk erasure were tested on nine ultrasound systems being decommissioned: the system’s own delete function; full reinstallation of system software; the manufacturer’s own disk wiping service; open source disk wiping software for full and just blank space erasure. Attempts were then made to recover data using open source recovery tools.

All methods deleted patient data as viewable from the ultrasound system and from browsing the disk from a PC. However, patient identifiable data (PID) could be recovered following the system’s own deletion and the reinstallation methods. No PID could be recovered after using the manufacturer’s wiping service or the open source wiping software.

The typical method of reinstalling an ultrasound system’s software may not prevent PID from being recovered. When transferring ownership, care should be taken that an ultrasound system’s hard disk has been wiped to a sufficient level, particularly if the scanner is to be returned with approved parts and in a fully working state.

The Royal College of Radiologists and the Society and College of Radiographers in the United Kingdom published ‘Standards for the provision of an ultrasound service’, including application-specific limiting values for resolution and penetration. No measurement methods were detailed. We aimed to explore a possible theoretical basis for the standards and to develop a measurement protocol.

Since application-specific standards fail to account for probes of different frequencies used for similar applications and no evidence for the standards was provided, we developed generic standards based on theoretical considerations. In a trial implementation of the published standards, automated measurements were made on four recently purchased scanners with a total of eight probes, results being assessed against the standards. Measurements were made on 15 modern probes and used to develop our generic standards.

Automated measurements showed less inter- and intra-observer variability than manual/visual measurements. Four new ultrasound scanners with a total of eight probes all failed to meet the published axial and lateral resolution standards; three failed to meet the penetration standard. Our generic standards were tested on 15 probes, four probes failing to meet the revised standards.

Automated methods are essential for measurements against standards. New generic standards with a theoretical basis have been proposed. Further work is required to refine standards and methods and to determine the appropriate contributions of objective and subjective equipment selection methods.

Ultrasonic imaging is an integral and routine procedure in many medical applications. An increased awareness of the need for quality assurance in this field has led to numerous tests being proposed. Due to the complexity of the problem, the tests directly measuring the important parameters of resolution and contrast of low-echoic structures are not unified, often more qualitative than quantitative, and are performed at large periodic intervals. Uniform sensitivity of an array transducer is a necessary but insufficient requirement for imaging quality of an ultrasound probe. Good probe uniformity should in no way be confused with meaning the ultrasound probe is working as it should.

In this paper, side lobes in the elevation direction and side and grating lobes in the lateral direction are discussed. Both may provide uniform element response across the scanner, yet result in a loss of resolution and contrast. To resolve problems of these resolution and contrast-relevant parameters being overlooked, a crossed filament phantom is introduced.

The cross-filament phantom provides the determination of resolution- and contrast-relevant parameters of a scanner, by directly measuring the main, side and grating-lobes of the beam in 3D. The main lobe 3D-data allows the determination of lateral and elevational resolution at different depths and thus the focal settings. In combination with the side and grating lobe information, the contrast for a small non-echoic object (i.e. a cyst) in an echoic environment may be explained.

We argue that regarding system acceptance, system baseline quality assurance and routine quality assurance, the analysis of the beam shape should be part of the comprehensive assessment. Combining the results with void resolution and contrast measurements is recommended.

Ultrasound can be used to facilitate lumbar puncture, especially in obese patients.

In this study, midline and paramedian approaches with curved and linear transducers were compared in patients with Body Mass Index (BMI) above 25 kg/m² for the identification of spinal landmarks. In each view, six major landmarks, including spinous process, ligamentum flavum, laminae, epidural space, subarachnoid space and posterior longitudinal ligament, were detected by emergency medicine residents and were then reviewed by radiologists.

Sixty patients with a mean BMI of 29.18 enrolled in the study. This study showed that a curved transducer detected major landmarks more accurately compared to a linear transducer. There was also a poor kappa correlation between these transducers in the midline and paramedian approaches.

This study showed that ultrasound can detect lumbar landmarks in overweight and obese patients, with the paramedian approach and a curved transducer being superior to the midline approach and a linear transducer in detecting these landmarks.