A Machine Learning Ensemble Based on Radiomics to Predict BI-RADS Category and Reduce the Biopsy Rate of Ultra-sound-Detected Suspicious Breast Masses

We developed a machine learning model based on radiomics to predict the BI-RADS category of ultrasound-detected suspicious breast lesions and support medical decision making towards short-interval follow-up versus tissue sampling. From a retrospective 2015-2019 series of ultrasound-guided core needle biopsies performed by four board-certified breast radiologists using six ultrasound systems from three vendors, we collected 821 images of 834 suspicious breast masses from 819 patients, 404 malignant and 430 benign according to histopathology. A balanced image set of biopsy-proven benign (n = 299) and malignant (n = 299) lesions were used for training and cross-validation of ensembles of machine learning algorithms supervised during learning by histopathological diagnosis as a reference standard. Based on a majority vote (over 80% of the votes to have a valid prediction of benign lesion), an ensemble of support vector machines showed an ability to reduce the biopsy rate of benign lesions by 15% to 18%, always keeping a sensitivity over 94%, when externally tested on 236 images from two image sets: 1) 123 lesions (51 malignant and 72 benign) obtained from the same four ultrasound systems used for training, resulting into a positive predictive value (PPV) of 45.9% (95% confidence interval 36.3-55.7%) versus a radiologists' PPV of 41.5% (p < 0.005), combined with a 98.0% sensitivity (89.6-99.9%); 2) 113 lesions (54 malignant and 59 benign) obtained from two ultrasound systems from vendors different from those used for training, resulting into a 50.5% PPV (40.4-60.6%) versus a radiologists' PPV of 47.8% (p < 0.005), combined with a 94.4% sensitivity (84.6-98.8%). Errors in BI-RADS 3 category (i.e., assigned by the model as BI-RADS 4) were 0.8% and 2.7% in the Testing set I and II, respectively. The board-certified breast radiologist accepted the BI-RADS classes assigned by the model in 114 masses (92.7%) and modified the BI-RADS classes of 9 breast masses (7.3%). In 6 of 9 cases the model performed better than the radiologist, since it assigned a BI-RADS 3 classification to histopathology-confirmed benign masses that were classified as BI-RADS 4 by the radiologist.

Study on Morphometry of Adrenal Glands in live fetuses by Ultrasonography

Introduction: Development of adrenal gland is always peculiar as it involves the complex process. It has an intriguing role in the harmonious development of fetus. Ultrasonographic Studies on fetal supra renal glands help in understanding the embryology of Suprarenal glands and are also useful in obstetrics, perinatology and fetopathology. Risk factors associated in the pregnancy like maternal diabetes and hypertension could impair the growth of adrenal glands. The nomograms of adrenal glands observed by ultrasonography are of clinical importance and help us in planning prevention and management of a fetus in high-risk pregnancies. This requires a feasible and repeatable screening test. Objective: To estimate various suprarenal gland measurements such as length, width, thickness, volume, surface area, circumference, thickness of cortex and medulla Materials and methods: Present study conducted with62 live normal human fetuses of different gestational ages ranging from 20 – 40 weeks, through ultrasonographic study using real time 4D and B mode Ge Voluson 730 pro ultra sound macine. Probes used were AB-2-7 Convex 2d abdominal Probe and RABA 4-8 Convex 4D abdominal probe. After obtaining the prior permission from the institutional ethics committee, consent from pregnant woman. Sex of the fetus was not revealed during ultrasonographic study. Fetal parameters of supra-renal gland were recorded and documented. Results: Suprarenal gland length, width, thickness, cortico-medullary thickness, surface area and circumference of both right and left side revealed significant difference (p<0.01). the detailed data analysis was presented in the subsequent headings. Conclusion: The data obtained from this study, may useful to understand the suprarenal morphometry in live fetuses thus the database useful in obstetrics, perinatology and fetopathology.

788 Reverse McConnell’s sign in biventricular Takotsubo cardiomyopathy: how echo can guide the diagnosis

An 89-years-old woman presented at Emergency Department with a 10-h history of vertigo, headache, nausea, fatigue, and general discomfort. No chest pain or shortness of breath were reported. She had a history of hypertension, chronic kidney disease, paroxysmal atrial fibrillation (AF), osteoporosis, and hypoacusia. The patient suffered of chronic anxiety and the caregiver referred for a recent and acute emotional distress. At the admission, the patient didn’t show clinical signs of peripheral hypoperfusion. Fine crackles at lungs bases were objectivable with coherent ultra-sound lung comets and mild bilateral pleural effusion. Her usual therapy included nebivolol, apixaban, torsemide, candesartan, and D-vitamin. The EKG showed AF with a heart rate of about 110 b.p.m., no ST-segment deviation and normal QTc. The echo findings showed a slight increase in left ventricle volume with a severe reduction of the ejection fraction due to the akinesia of all apical segments with the typical aspect of the ‘apical ballooning’ and concomitant hyperkinesia of the basal segments. Despite normal dimensions, also the right ventricle showed a peculiar contractile pattern, with hyperkinetic basal movement and akinesia of the apex with the hinge point located in the free wall portion in continuity with the LV septal wall. No significant valvular disease was documented except for moderate tricuspid regurgitation. High-sensitive I troponin peaked up to 1500 pg/ml. The clinical appearance was very suggestive of TTS but INTERTAK score of 61 was not diagnostic and, according to the most recent consensus document, a coronary angiography was performed, without documentation of coronary artery disease. During the hospitalization serial electrocardiographic monitoring showed significant and transient QTc prolongation and dynamic T wave changes resulting in progressive INTERTAK score increase. No ventricular arrhythmic events occurred. The patient was treated with careful fluid support and with beta-blockers for AF rate control. Multiple echocardiographic evaluations documented a progressive recovery of systolic function up to complete normalization of biventricular global and regional systolic function. Clinical data, instrumental evidences and dynamic evolution oriented the diagnosis towards TTS with unusual and uneven impairment of right and left ventricular function. The described case focuses the attention on the reverse McConnell’s sign, an echocardiographic finding not often described in the literature, consisting of akinetic right ventricle apical segment and hyperkinetic basal and mid free wall. This discordant motion is exactly opposite to the classic echocardiographic RV aspect detected in acute significative pulmonary embolism described as McConnell’s sign, hence the name. It has been suggested that this functional variation might be a self-protection system of the heart through a mechanism of hibernation that is similar to that occurring during chronic hypoxia, consisting in a decrease in the ATP utilization and O2 consumption, as suggested by the activation of intracellular β2-induced signalling patterns documented in TTS. Recognizing this finding it’s important not only because it has been associated with a higher risk of developing haemodynamic instability but also to orient working diagnosis of TTS when initial clinical assessment through the INTERTAK score is inconclusive.

ON THE ISSUE OF DIAGNOSTIC SIGNIFICANCE OF INTESTINAL ULTRASOUND IN FOREIGN BODY DETECTION

The method of ultrasound diagnostics in suspected for-eign intestinal body in small pets is discussed. This method is characterized by its noninvasiveness. The research goal was to reveal diagnostic significance of ultrasound exami-nation of the intestine in the presence of foreign bodies. The research objectives were as following: to study basic ultrasound characteristics of foreign bodies in the intestine of small domestic animals; to study the influence of antie-metic preparation based on maropitrate citrate on the in-formative value of the study. The research was carried out in the Department of Anatomy and Physiology of the State Agricultural University of Northern Trans-Uralsand in the veterinary clinics of the City of Tyumen. Ultrasonic diagnos-tics was carried out in 73 cats and 38 dogs with suspected foreign intestinal bodies. The examination was carried out using linear, convex and microconvex transducers with different frequencies according to standard research meth-ods. Fifteen cats were given an antiemetic drug -maropi-tant citrate at a dose of 1 mg per 1 kg before the ultrasound examination. It has been found that ultrasound is an in-formative method of diagnosing linear foreign bodies; they collect the intestine in a corrugation and go as a linear hy-perechogenic formation. Solid foreign bodies give an echo-genic appearance which suggests their presence in the intestine. Other foreign bodies may be detected by indirect signs. The main indirect signs of obstruction on ultrasound examination include pendulous peristalsis, dilatation above the obstruction site, decreased peristalsis, and overflow of intestinal contents. When studying the peculiarity of ultra-sound examination when using maropitrate citrate, de-creased peristalsis was detected and subsequently poor recognition of pendulum-like movements which negatively affected the diagnostic value of the method.

Bilateral Isolated Spherophakia in Two Young East European Siblings: A Case Report

A 19-year-old Caucasian woman was referred to the emergency room and thereafter to the department of ophthalmology complaining for bilateral decrease of visual acuity and severe pain. A complete ophthalmological evaluation was performed. Best-corrected visual acuity (BCVA) was LogMAR 0.3 in the right eye (RE) and LogMAR 0.5 in the left eye (LE). Intraocular pressure (IOP) was 28 and 38 mm Hg in the RE and LE, respectively. The patient showed a shallow anterior chamber and spherical equivalent refractive error −29.0 diopters (D) in the RE and −30.0 D in the LE. The diagnosis of bilateral angle closure glaucoma, secondary to highly myopic, forward dislocated lens was made, in the setting of spherophakia. The ultra-sound biomicroscopy images confirmed the diagnosis. Clear lens extraction was promptly performed with resolution of ocular hypertension and restoration of BCVA. In view of the frequent systemic association, family members also underwent ophthalmological evaluation. The 13-year-old sibling showed mild myopia and borderline IOP. He was administered topical β-blockers and observation. Genetic counseling did not reveal mutations usually associated with spherophakia or systemic conditions. This case report highlights the variable spectrum of clinical expression in spherophakia; therefore, ophthalmological treatment should be tailored according to clinical presentation. Systemic evaluation and genetic counseling are also recommended in the suspicion of spherophakia.

Existing and Emerging Breast Cancer Detection Technologies and Its Challenges: A Review

Breast cancer is the most leading cancer occurring in women and is a significant factor in female mortality. Early diagnosis of breast cancer with Artificial Intelligent (AI) developments for breast cancer detection can lead to a proper treatment to affected patients as early as possible that eventually help reduce the women mortality rate. Reliability issues limit the current clinical detection techniques, such as Ultra-Sound, Mammography, and Magnetic Resonance Imaging (MRI) from screening images for precise elucidation. The capability to detect a tumor in early diagnosis, expensive, relatively long waiting time due to pandemic and painful procedure for a patient to perform. This article aims to review breast cancer screening methods and recent technological advancements systematically. In addition, this paper intends to explore the progression and challenges of AI in breast cancer detection. The next state of the art between image and signal processing will be presented, and their performance is compared. This review will facilitate the researcher to insight the view of breast cancer detection technologies advancement and its challenges.

Development and Remodeling of Point-of-Care Ultrasound Education for Emergency Medicine Residents in Resource Limited Countries during the COVID-19 Pandemic

The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultra-sound learning materials were useful tools which showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps, including the availability of handheld devices, as well as the re-modeling of the ultrasound rotation course, which should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade.

AN ASSESSMENT INTO THE DIAGNOSTIC VALUE OF ULTRASOUND IN THE FIRST TRIMESTER OF PREGNANCY BLEEDING

Background: One of the most prevalent obstetric issues is vaginal bleeding in the first trimester. It's also one of the most prevalent reasons for emergency admissions, as well as a reason for ultra-sound evaluation in the first trimester. In the first trimester, over a quarter of all pregnant female experience bleeding. Aims and objective: The purpose of this research was to determine the diagnostic value of ultra-sonography in first-trimester haemorrhage. Materials and method: All pregnant female who experienced per vaginal bleeding during the first trimester were included in this research. A semi-structured questionnaire was used to assess all of the selected instances. To arrive at a clinical opinion, a full history and comprehensive clinical evaluation were undertaken, including general, systemic, per abdominal, and per vaginal evaluations. In all of the cases that were chosen, ultra-sonography was used. The results of the clinical evaluation and ultra-sonography were documented. Results: On clinical evaluation, 164 cases of threatened abortion were identified, whereas ultra-sonography verified 102 cases of impending abortion. In 62 cases, there was a discrepancy in opinion. Complete abortion had a 16 percent inconsistancy, while incomplete abortion had a 4 percent inconsistancy. In 20 cases of Blighted ovum, there was a inconsistancy. Out of 214 occurrences of first trimester bleeding, abortion was diagnosed in 200 cases (93.46 percent), ectopic pregnancy in 10 cases (4.67 percent), and hydatiform mole in four cases (1.87 percent). Clinical opinion had a 100% sensitivity in diagnosing a viable intrauterine pregnancy, but only a 44.6 percent specificity. Clinical opinion has a poor statistical correlation in diagnosing nonviable pregnancies, with a sensitivity of 39%. Conclusion: Ultra-sonography has thus been established as a critical diagnostic tool in obstetrics. It is a readily available diagnostic tool that aids in the early detection of problems associated with first-trimester haemorrhage. It was established in the aforementioned research that it had an essential role in the opinion of first trimester haemorrhage. Key Word: first trimester bleeding, ultasonography, diagnostic importance

Role of Point of Care Ultra Sound (POCUS) in Assessment of Fluid Resuscitation in Septic Patients

Background: Initial fluid resuscitation in sepsis must be guided by clinical judgment based on ongoing reevaluation of the hemodynamic status (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output) and ultrasound measurements (stroke volume, cardiac output, lung ultrasound and inferior vena cava diameter) as positive fluid balance is harmful. Methods: Adults Patients (≥ 18 years old) with symptoms or signs of tissue hypoperfusion (Sequential organ failure assessment score SOFA≥ 2) are included. Patients with elevated intra-abdominal pressure (as, ascites, pregnancy), Recent abdominal operation, cannot lie flat, Patient on mechanical ventilation and patients with valvular heart disease were excluded. IVC CI, SV, COP and B mean score were measured on patient arrival and after every 10 ml/kg isotonic saline over the first hour of patient arrival. Thereafter, patients were divided into two groups high caval index and low caval index according to inferior vena cava collapsibility index. Results: Among our 50 patients,38% of patients were with high caval index and 62% have low caval index. Conclusion: POCUS has additive value in guiding of fluid resuscitation in sepsis in order to avoid fluid overload and to identify proper timing of vasopressor use.

The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome

Background Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.