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Intussusception is typically considered an acute emergency; however, the increased utilisation of medical imaging has revealed that intussusceptions can also be transient, asymptomatic and possibly physiologic. Sonographers should be aware of three categories of intussusceptions: (i) persistent intussusceptions resulting in acute abdomen and requiring urgent intervention, (ii) transient symptomatic intussusceptions which may be amenable to a 'wait‐and‐see' strategy and (iii) transient asymptomatic intussusceptions which almost always involve the small bowel. In particular, the incidental discovery of enteroenteric intussusceptions in children should not be confused with acute pathology. In adults, sonographers should be mindful of the frequent presence of pathological lead points and further investigations may be warranted. In this literature review, we provide an overview of transient intussusceptions, highlight important differences between children and adults and describe sonographic appearances of various intussusceptions and their mimics. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound (US) plays a key role in the detection of testicular tumours. However, reliable characterisation of testicular tumours with US is difficult. The purpose of this study was to investigate the morphological patterns of testicular tumours as seen on modern US imaging and correlate these with histology. Methods: The imaging features of 50 testicular tumours were analysed and compared with histology. The US appearance was categorized into 15 distinct morphological patterns. Results: Patient's age ranged from 0.5 to 85 years. Of the 50 tumours in our series, 49 were malignant. Nearly half of the malignancies were seminomatous germ cell tumours (SGCTs). Tumours ranged in size from 10 to 130 mm with considerable overlap of size between tumours of different histological type. Even small (10 mm) tumours in our cohort were malignant. SGCTs demonstrated a narrower range of morphological appearances than non‐seminomatous germ cell tumours (NSGCTs). Calcification was common in both SGCT and NSGCTs. Multicomponent cystic‐solid appearance was only seen in NSGCTs. Conclusion: The differentiation of testicular tumours with US continues to be challenging. In this paper, we have demonstrated the diverse morphological patterns of testicular neoplasms and have proposed the study of tumour morphological features as a promising research direction. [ABSTRACT FROM AUTHOR]

Introduction: Practitioners of US routinely include a survey of the abdominal aorta during abdominal US in accordance with international guidelines. Such practice is of uncertain value in younger patients. Methodology: This study was a retrospective review of 2000 abdominal US examinations which included visualisation of the aorta in patients <50 years of age. Patient demographics and referral details were recorded, and US images and reports were reviewed for the presence of aortic and periaortic pathology. Results: The most common indications for US were abdominal pain (1337, 44%), deranged liver function tests (453, 15%), nausea and/or vomiting (229, 8%), elevated inflammatory markers (146, 5%), pancreatitis (134, 4%) and pyrexia (127, 4%). Fewer than half (977, 49%) of the reports contained a comment regarding the aorta. Aortic pathology was reported in 2 (0.1%) cases. Both were reported as aortic ectasia and both represented a false‐positive diagnosis. One male patient had a known abdominal aortic aneurysm with endovascular aortic repair. No new aortic aneurysms were found. All cases of atherosclerotic disease were ignored, and none were reported. Periaortic pathology was encountered on 1 patient, but this was known. No case of new periaortic pathology was detected. Conclusion: Routine and indiscriminate imaging of the abdominal aorta during abdominal US in patients <50 years of age is not evidence based. No new case of abdominal aortic aneurysm or new para‐aortic pathology was detected, all cases of atherosclerosis were ignored, and two false‐positive diagnoses of aortic ectasia were made. [ABSTRACT FROM AUTHOR]

Introduction: Conventional ultrasound (US) is a common imaging investigation of the kidneys; however, the current diagnostic performance of US in the visualisation of focal renal lesions is unknown. Methods: This study was a retrospective sequential review of 518 focal renal lesions (FRLs) in 200 patients aged 50 years or older who received an US of the kidneys followed by contrast‐enhanced computed tomography (CECT). Results: Patient's age ranged from 50 to 94 years. The majority were hospital inpatients. 518 FRLs were identified on CECT ranging from 3 to 165 mm (median 8 mm). The majority of FRLs (96.1%) were benign. The visualisation rate of FRLs on US was size‐dependent: <5 mm, 10.2%; 5–9 mm, 22.3 mm; 10–14 mm, 48.0%; 15–19 mm, 82.1%; and 20–24 mm, 100%. The visualisation of simple cysts was 49.1% and hyperdense lesions 81.8%. Follow‐up was available on 58% of lesions. Benign lesions generally remained stable. Seven patients had concerning heterogeneous hyperdense masses on CECT, and US had visualised six of these (85.7%). Conclusion: Visualisation of FRLs is size‐dependent. High rate of visualisation is achieved once the lesion exceeds 15 mm in size. Small FRLs are associated with a low rate of visualisation on ultrasound; however, they are rarely concerning. Hyperdense lesions on CECT that carry high suspicion of malignancy are associated with a high rate of US visualisation. [ABSTRACT FROM AUTHOR]

Introduction: Sonographers demonstrate a high standard of diagnostic performance and work with a considerable degree of professional independence. In Australasia, sonographers typically generate a preliminary report which is reviewed by the radiologist who issues a final report. The aim of this study was to determine whether radiologist's review is required in cases reported as normal by the sonographer. Methods: This study was a retrospective review of 1000 abdominal US examinations considered normal by sonographers that were subsequently reported by radiologists. Any findings reported by radiologists that were not reported by sonographers were analysed and separated into errors or discrepancies according to commonly accepted definition. Results: The 1000 abdominal examinations included 244 complete abdominal, 200 hepatobiliary, 506 urinary tract and 50 other abdominal examinations. Patients' age ranged from < 1 to 94 years (mean = 35 years, median = 32 years). US examinations were performed by any one of 14 sonographers with 1–21 years (mean = 6 years, median = 7 years) of clinical experience. Two diagnostic errors were made by sonographers and two errors by radiologists. In no single case did the radiologist uncover a case of an acute or serious illness, illness requiring admission or urgent clinical review, nor did the radiologist identify the cause for the presenting symptoms. Eighteen discrepancies were found, but these were of trivial nature and most were rated by specialist clinicians as irrelevant. Conclusion: Sonographers are accurate in distinguishing normal abdominal US examinations. The involvement of a radiologist in a second reading of normal abdominal US examinations is unnecessary. [ABSTRACT FROM AUTHOR]

Background: Biological safety of ultrasound is a complex and nuanced subject that is poorly understood by ultrasound users. Little is known about the acoustic output and thermal index levels during the routine use of modern ultrasound machines in prenatal scanning. Methodology: This study was a retrospective review of thermal index (TI) values encountered during 300 prenatal ultrasound examinations (100 in each trimester) performed on any one of 13 Philips Epiq 7 or Epiq 5 systems, representing approximately 106.5 h of real‐time scanning. The TI levels were compared to three international guidelines on the biological safety of ultrasound. Results: The routine use of current Philips systems was associated with low TI levels. Of the 300 examinations reviewed, virtually all were compliant with the BMUS and Nelson safety guideline. Whether the examination was compliant with the WFUMB guideline is open to interpretation. The highest level of TI encountered was 1.1. In no instance did the TI level incur into the 'not recommended' range or into a range where specific user action was required to reduce the TI within 1 min. The most frequent action associated with TI > 0.7 was the use of M‐mode to document the fetal heart rate. In the four instances where TI peaked at 1.1, 3 were associated with the use of M‐mode and one with B‐mode. Spectral Doppler was not implicated in high TI levels. These results are surprising and open up a range of opportunities for future study. [ABSTRACT FROM AUTHOR]

Contrast‐enhanced ultrasound (CEUS) is an important part of current ultrasound imaging practice. Sonographers, radiologists and other sonologists should consider CEUS as a standard tool in the diagnostic toolbox of ultrasound and utilise it liberally to solve a wide range of imaging problems whilst reducing the need to resort to CT or MRI. Setting up a CEUS service is within easy reach of all motivated practitioners. The initial process requires assessment of the demand for CEUS, ensuring staff readiness, preparing administrative processes and obtaining CEUS supplies. The CEUS examination includes gaining informed consent, ensuring authorisation to administer contrast agent (preferably by means of a standing order), conventional pre‐scan of the area of interest, insertion of a peripheral IV cannula, preparation of the contrast agent, initiation of the contrast imaging mode, administration of the contrast agent, performance of the examination and aftercare. A number of other important considerations are discussed including cannulation and IV certification, scopes of practice for sonographers performing CEUS, contrast dosing, scheduling, training, interpretation, reporting and quality control. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A patient's eligibility for carotid endarterectomy (CEA) is determined primarily by the degree of carotid stenosis detected on duplex ultrasound. The Australasian Society for Ultrasound in Medicine (ASUM) criteria are widely used to grade carotid stenoses in many practices throughout Australasia. Methods: We sought to investigate the potential impact on the grading of carotid artery stenosis if practitioners switched from the ASUM criteria to the United Kingdom's joint recommendation (UKJR) criteria by reviewing 100 patients with a haemodynamically significant carotid artery stenosis. Results: We found agreement between the criteria in 100% of cases for stenoses <50%, in 80% of cases for stenoses 50–69%, in 89% of cases for stenoses ≥70% and in 100% of cases for stenoses ≥80%. While there was variation in grading of stenoses in 16% of cases, reclassification resulted in no change in the number of patients eligible for CEA. The UKJR guideline enabled more precise categorisation of haemodynamically significant stenosis into deciles. Discussion: Because the UKJR guideline is more comprehensive, we believe that adopting this guideline would enable the ultrasound practitioner to grade carotid stenoses more precisely, better understand the nuances of carotid duplex imaging and more successfully navigate and interpret complex carotid examinations, without impacting the number of patients eligible for CEA. [ABSTRACT FROM AUTHOR]

Abstract: The reporting roles of sonographers in Australasia vary considerably. A large number of sonographers already routinely produce formal reports, while others are moving into clinical ultrasound roles where reporting is expected. This article summarises the best practice in reporting of ultrasound examinations based on international literature and addresses key topics including report structure, clinical content, style and language. Numerous examples and sample phrases are provided and common pitfalls are discussed. [ABSTRACT FROM AUTHOR]

The head and neck represents the most complex anatomical region with contributions from virtually all body systems. For this reason, the pathology of the head and neck tends to be correspondingly complex and wide-ranging. In this presentation, we will review numerous vascular pathologies that can affect the head and neck including microvascular disease of the: carotid, vertebral, subclavian and jugular veins, graft and aneurysm and well as vascular anomalies, vascular tumors and malformations. In this presentation, we will look at a wide variety of interesting and unusual cases to showcase how diagnostic ultrasound can assist with clinical problem-solving. [ABSTRACT FROM AUTHOR]

Ultrasound is the most common imaging technique for the assessment of the thyroid gland. Thyroid disease can be focal (nodule) or diffuse (multinodular thyroid, Grave's, Hashimoto's thyroiditis, subacute viral thyroiditis). While ultrasound provides excellent anatomical depiction of the thyroid gland, ultrasound is not a histological examination. Because virtually any nodule containing solid tissue represent a malignancy, numerous rules, guidelines and scoring systems have been used in an effort to stratify the risk based on a wide variety of anatomical features including: size, composition, shape, echogenicity, echotexture, margins, presence and nature of calcifications. Two different strategies have been used in the development of thyroid nodule classification systems. One strategy relies on pattern-recognition and the other relies on numerical scoring of each nodule. In this presentation, we will review and compare these strategies and discuss what they mean for the practitioner. Specific advice will be provided for non-clinician practitioners (sonographers) on how to improve the efficiency of the thyroid examination and avoid becoming paralysed by the high-level of cognitive detail in patients with multinodular thyroid glands. [ABSTRACT FROM AUTHOR]

Bowel ultrasound is a powerful clinical problem-solving tool. In patients with lower abdominal pain, bowel ultrasound can help determine whether the cause of pain is urological, gynaecological or intestinal in origin. The presence of bowel wall thickening, surrounding inflammatory changes (creeping fat), associated lymphadenitis and free fluid are all features of bowel inflammation and can be seen both in inflammatory bowel disease (IBD) and infection. In patients with Crohn's disease, bowel ultrasound can also demonstrate loss of wall stratification signaling the presence of transmural ulcers as well as other complications such as fistula tracks and collections. There are numerous other specific applications of bowel ultrasound in different patient groups including pre-term neonates (assessment for necrotising enterocolitis, bowel obstruction), children (intussusception, appendicitis, bowel obstruction), adults (IBD, appendicitis, infection, diverticular disease, obstruction), patients with known IBD (disease activity monitoring, fistulating disease, collections) and others. It is essential that all practitioners of general abdominal ultrasound gain familiarity with the basics of bowel ultrasound in order to adequately assess patients with abdominal pain. In countries where non-clinician sonographers are performing diagnostic ultrasound (UK, USA, Australia and New Zealand), it is particularly important that patients with lower abdominal pain do not get "protocolled" into either upper abdominal or gynaecological ultrasound because protocol-based approaches may restrict the scope of examination resulting in bowel pathology being inadvertently skipped. Instead, sonographers should always perform clinically-focused ultrasound examination that specifically addresses the cause of pain and includes bowel survey in all patients with lower abdominal pain. In this presentation, we will look at a wide variety of bowel pathologies using high-resolution video clips. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound. Method: We examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women. Results: In total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys). Conclusion: Indiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence‐based and represents a low‐yield examination with extremely low rate of incidental findings of clinical significance. [ABSTRACT FROM AUTHOR]