Ultrasound Scanning Competencies in Midwifery Education in Zambia: Findings from a Desk Review and Needs Assessment

Introduction: Ultrasound is an essential component of antenatal care. Midwives provide most of the antenatal care but they do not perform ultrasound as it has been beyond their scope of practice. This leaves many women in Low and Middle-Income Countries without access to ultrasound scanning. The aim of this study was to identify competencies in ultrasound scanning in midwifery education. Methods: A desk review and needs assessment were conducted between July and October 2023. Articles and curricula on the internet, Google scholar and PubMed were searched for content on ultrasound scanning competencies. A Google form consisting of 20 questions was administered via email and WhatsApp to 135 participants. Descriptive statistics were used to analyse data. Results: The desk review showed that it is feasible to train midwives in ultrasound scanning. The training programs for midwives in obstetric ultrasound were conducted for 1 week to 3 months with most of them running for 4 weeks. Content included introduction to general principles of ultrasound, physics, basic knowledge in embryology, obstetrics, anatomy, measuring foetal biometry, estimating amniotic fluid and gestational age. Experts like sonographers trained midwives. Theory and hands on were the teaching methods used. Written and practical assessments were conducted. Needs assessment revealed that majority of participants 71 (53%) knew about basic ultrasound training for midwives. All participants (100%) said it is necessary to train midwives in basic ultrasound scan in Zambia. Some content should include, anatomy, measuring foetal biometry, assessing amniotic fluid level, and gestational age determination. Most participants 91 (67%) suggested that the appropriate duration of training is 4 - 6 weeks. Conclusion: Empowering every midwife with ultrasound scanning skills will enable early detection of any abnormality among pregnant women and prompt intervention to save lives.

Assessing gestational age of babies: Performance of obstetric ultrasound scan compared to that from the combination of Naegle’s rule and Dubowitz score in the 21st century

Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS;and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic random sampling and the GA of babies was determined using obstetric USS, NR, and DS. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eightyfive mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -?3.14) kg. The overall mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -?38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 -?38.99), 38.09 (4.13) at 95%CI (37.20-?38.99) and 38.82 (2.02) at 95%CI (38.39 -?39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -?38.95). Comparing this mean with mean GA obtained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.

Fazari’s Sign in Ultrasound Scan of Morbid Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

Ultrasound Diagnosis of Primary Epiploic Appendagitis: A Case Report

A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.

B-scan ultrasound and cytology of the vitreous in primary central nervous system lymphoma with vitreoretinal involvement

AIM: To evaluate the diagnostic value of B-scan ultrasound and explore the cytological characteristics of patients with vitreoretinal lymphoma(VRL) and primary central nervous system lymphoma(PCNSL).METHODS: The clinical data and pathologic specimens from patients with VRL diagnosed at the North Huashan Hospital from 2016 to 2017 were retrospectively reviewed. The patients were diagnosed by slit lamp ophthalmoscopy, B-scan ultrasound, cytology of the vitreous, which was obtained by vitrectomy, and cytokine measurements of interleukin(IL)-10 and IL-6.RESULTS: Twenty-six eyes(19.4%) out of 134 eyes of 67 patients(47 men and 20 women) with PCNSL were diagnosed with VRL by B-scan ultrasound, and 14 eyes(10.4%) were diagnosed by slit lamp ophthalmoscopy. Twenty-four eyes(17.9%) of 17 patients were confirmed as having VRL with cytology. No difference in the association between intracranial lesion location and ocular involvement was found. VRL patients had higher levels of vitreous IL-10 and IL-10/IL-6 when compared with macular hole cases, but the difference was not statistically significant.CONCLUSION: A total of 25.4% of the PCNSL patients had VRL, B-scan ultrasound examination had characteristic features and is recommended over slit lamp ophthalmoscopy for the screening diagnosis of PCNSL with intraocular involvement. Moreover, the cytological and immunohistochemical analyses performed after 25-gauge diagnostic vitrectomy were accurate diagnostic techniques.

Development of a High-frequency Ultrasound System for High-speed Image Scanning

High-frequency image technique has been widely applied in medical diagnosis recently. For high voltage protection, high speed stage and trigger control circuitry are difficult to implement a high-frequency ultrasound imaging system. In this study, we utilized a linear servo with high noise tolerance and a novel multi-depth expression method to overcome those issues in developed high-speed image system. B-mode image of the chicken phantom by 25 MHz transducer shows the resolution of lateral and axial resolutions are up to 123 μm and 59 μm respectively. In addition, the experiment demonstrates that the axial resolution and depth of field (DOF) can be improved by time gain compensation(TGC) and multi-depth method. The results indicate that the proposed system could achieve over 24 fps for 1 mm scan distance and 100 lines per frame. In the future, the developed system is potential for other clinical applications such as ophthalmology and dermatology.

A Flexible and High Speed Digital Scan Converter for High Frequency Ultrasound Imaging

This paper presents a flexible and high speed digital scan converter (DSC) with the ability to handle high frequency ultrasound imaging in real-time. The characteristics in imaging system such as focus length of transducer, the swing radius and sampling length etc. could be changed easily in compliance with the researcher's application based on this flexible digital scan converter. Linear interpolation is employed to achieve the coordinate transformations algorithm. Custom-built software is programmed to preliminarily handle the algorithm according to different ultrasound imaging applications. High performance FPGA will implement high speed interpolation calculation based on the preliminary data which are stored in the DDR2 SDRAM from the software. 64 bit 66 MHz PCI is employed to accomplish high speed data transmission. Experiment has shown that more than 500 frame rate could be achieved based on this high speed digital scan converter. The designed flexible and high speed digital scan converter could be used in current FPGA based high frequency ultrasound imaging system.

肝癌的影像学检查研究进展

肝癌是全球范围内的主要癌症之一,其早期筛查和诊断对于提高患者的生存率至关重要。影像学检查在肝癌诊断与治疗中占据核心地位。本文综述了肝癌的影像学检查方法的研究进展。首先介绍了影像学检查的重要性,然后详细阐述了超声、计算机断层扫描、磁共振成像、放射性核素显像等检查方法的发展现状和趋势,以便更好地为患者提供诊疗方案。

AL-Scan、IOL-Master和A超测量白内障患者眼轴长度的准确性和一致性分析

目的比较AL-Scan、IOL-Master和A超测量白内障患者眼轴长度(axial length,AL)的准确性和一致性。方法选取年龄相关性白内障患者95例(142眼),术前分别应用AL-Scan、IOL-Master和A超进行AL测量。根据AL将患者分为AL≤22 mm(20眼)、22mm<AL≤26 mm(98眼)和AL>26 mm(24眼)3组。应用方差分析对3种方法测量的结果进行比较,应用Bland-Altman法对其一致性进行分析。结果 AL≤22 mm组AL-Scan、IOL-Master和A超测得AL结果分别为(21.53±0.30)mm、(21.54±0.29)mm及(21.51±0.30)mm,差异无统计学意义(P>0.05);22 mm<AL≤26 mm组分别为(23.68±0.76)mm、(23.71±0.77)mm及(23.65±0.75)mm,差异无统计学意义(P>0.05);AL>26 mm组分别为(28.46±1.60)mm、(28.50±1.62)mm及(28.40±1.63)mm,差异无统计学意义(P>0.05)。AL测量的95%一致性界限范围是0.20 mm(AL-Scan和IOL-Master)、1.12 mm(IOLMaster和A超)和1.12 mm(AL-Scan和A超)。结论 AL-Scan、IOL-Master和A超测量白内障患者AL同样准确,但AL-Scan与IOL-Master之间具有良好的一致性。

多模态超声校正BI-RADS 4类乳腺肿块的价值

目的 探讨乳腺自动容积成像(ABVS)、超声弹性评分(UES)及两者联合在校正乳腺影像报告和数据系统分级(BI-RADS) 4类乳腺肿块BI-RADS分级中的应用价值。方法 收集我院经常规超声诊断为BI-RADS 4类的乳腺肿块患者109例,共113个肿块。经ABVS及UES校正BI-RADS分级后,与病理结果对比,绘制ROC曲线,比较常规超声、ABVS、UES、ABVS联合UES诊断BI-RADS 4类乳腺肿块的差异。结果 109例患者113个肿块中包含良性78个,恶性35个,ABVS联合UES校正后的敏感度、特异性、准确性、ROC曲线下面积分别为94.29%、93.59%、93.80%、0.975。结论 ABVS联合UES有助于提高BI-RADS 4类肿块的总体诊断效能。两者联合诊断可以取长补短,提高诊断率。

油气混输管道在线腐蚀检测及安全评估

针对塔河油田单井管线油气混输介质长期停用存在腐蚀问题,通过腐蚀因素和腐蚀原因初步分析,认为该管道存在内腐蚀风险。通过采用在线腐蚀检测技术,对单井管线开展腐蚀检测及评价,通过现场对管道5个开挖探坑的检测,开挖检测部分的管道安全强度达到继续使用的等级。但是由于仅是局部探坑检测,不排除管道其他部位存在极严重腐蚀,建议对该管线进一步开展试压,通过试压确定管线的承压能力和排查薄弱点,为下一步开展腐蚀治理提供依据。

超声造影与增强CT检查诊断小肝癌效能比较

目的分析比较超声造影(CEUS)与增强CT诊断对小肝细胞癌(HCC)的效能。方法2020年1月~2022年6月我院诊治的104肝脏小结节患者,病灶直径≤3.0 cm。均接受CEUS和增强CT检查,以穿刺活检或手术组织病理学检查诊断。应用2018年版肝脏影像报告和数据系统(LI-RADS)对肝脏小结节分类,分析CEUS与增强CT诊断小肝癌的效能。结果CEUS与增强CT对肝脏小结节分类有93例(89.4%)一致,一致性良好(Kappa系数=0.749,P<0.05);在104肝脏小结节患者中,经病理学检查明确诊断为HCC者42例(高分化29例,低分化13例),肝脏良性结节62例;Kappa一致性检验显示,CEUS与增强CT诊断小肝癌均有较高的效能(P均<0.05),CEUS与增强CT以LR-4/LR-5为判断HCC的标准,与金标准诊断的一致性较高(Kappa=0.861和Kappa=0.803),显示CEUS的诊断效能稍优于增强CT诊断;高分化HCC患者CEUS检查达峰时间和开始廓清时间分别为(29.4±4.8)s和(62.4±5.7)s,均显著长于低分化者【分别为(25.0±4.3)s和(51.8±5.2)s,P均<0.05】。结论CEUS和增强CT检查诊断小肝癌均有较高的效能,在某些情况下,CEUS检查可能更具优越性,对评估肿瘤细胞分化程度可能有帮助。

岳西小黄姜精油提取优化及成分分析

为了确定岳西小黄姜精油最佳提取工艺,探究不同提取方法对小黄姜精油得率和微观结构的影响,建立岳西小黄姜挥发性物质GC-MS检测方法。该研究分别采用水蒸气蒸馏法、超声辅助水蒸气蒸馏法、超声-微波协同辅助水蒸气蒸馏法、超声-酶解协同辅助水蒸气蒸馏法提取小黄姜精油。比较各方法的精油得率,选择得率最高的方法进行单因素试验和正交优化确定最佳提取工艺。结果表明,超声-酶解协同辅助水蒸气蒸馏法的精油得率最高,最佳提取工艺为:料液比1∶3.5(g/mL)、超声温度50℃、超声功率400 W、超声时间20 min、复合酶用量(半纤维素酶∶β-葡萄糖苷酶=1∶1)40 U/g、酶解温度40℃、酶解pH值5.5、酶解时间2 h、提取时间45 min。在此条件下精油得率为3.28%。对精油提取后的姜渣进行扫描电镜观察,经超声-酶解协同辅助水蒸气蒸馏法得到的姜渣细胞完整性破坏最为严重,说明该方法对精油的提取更为彻底。采用顶空固相微萃取(headspace solid-phase microextraction, HS-SPME)提取法和超声-酶解协同辅助水蒸气蒸馏法从鲜姜中共提取鉴定出75种挥发性物质,其中HS-SPME提取法鉴定出49种,超声-酶解协同辅助水蒸气蒸馏法提取鉴定出60种。本研究为小黄姜精油提取提供了新思路,并为生姜深加工利用提供了参考依据。

在体全眼微血流超声超分辨成像

多类眼科疾病的早期阶段一般伴有血管的形态学和血流动力学改变,因此,全眼微血管评估对眼科疾病的综合诊断具有重要作用。由于光学成像技术的穿透深度有限,特别是在介质透光率低的情况下,现有的光学成像技术难以对整个眼睛的微血管进行可视化。为此,该文开发了一种超声超分辨成像技术,可以微米级分辨率可视化全眼三维微血管系统。首先,用中心频率为10 MHz的线性阵列快速采集多帧序列;其次,经过微泡信号提取,中心点定位,追踪和中心点叠加得到一个剖面的超分辨率图像;最后,将机械扫描的所有剖面重建为兔全眼三维超分辨率微血管图像。实验结果证明,超声定位显微镜可以显示整个眼睛的微血管系统,这对眼科疾病的早期诊断具有重要意义。

基于相控阵超声的线路带夹板焊缝轨底检测研究

为解决带夹板焊缝线路探伤检测效率较低的问题,提出了一种基于相控阵超声的线路带夹板焊缝轨底检测方法,通过将相控阵探头放置于轨底下表面来避免夹板的拆装,同时利用相控阵探头多角度扫查来减少轨底焊缝扫查工序,从而提高检测效率。首先利用仿真研究该方法对轨底缺陷的检测覆盖性,然后针对轨底焊缝检测特点设计相控阵探头,将探头放置于轨底下表面来完成轨底焊缝检测,随后基于设计的钢轨缺陷试块进行试验测试。结果表明:该探头可实现对轨底焊缝位置7个缺陷的全覆盖检测,且检测信噪比均大于17dB。

超声造影与CT增强扫描在肝癌患者诊断中的应用

目的探析肝癌诊断中超声造影(UC)与CT增强扫描的应用价值。方法随机选取122例疑似肝癌的患者,所有患者均接受UC与CT增强扫描诊断,同时进行病理学筛查,病理学检查结果显示肝癌100例,良性肝疾病22例,比较不同诊断方式的灵敏度、特异度与准确率。结果CT增强扫描、UC诊断的阳性率相同,均为74.6%(91/122);CT增强扫描+UC诊断的阳性检出率为79.5%(97/122),高于两种方式单独检测(P<0.05);CT增强扫描+UC诊断的灵敏度、特异度、阳性/阴性预测值、诊断符合率分别96.0%、95.5%、99.0%、84.0%、95.9%高于CT增强扫描81.0%、54.6%、89.0%、38.7%、76.2%(χ^(2)=11.054、9.818、8.452、11.729、19.684,P=0.001、0.002、0.004、0.001、<0.001),也高于UC诊断82.0%、59.1%、90.1%、41.9%、77.9%(χ^(2)=10.010、8.282、7.317、10.266、17.408,P=0.002、0.004、0.007、0.001、<0.001)。结论UC联合CT增强扫描诊断肝癌患者的精准性较高,两者联合诊断的灵敏度、特异度与诊断符合率较高,值得推广。

脊柱旁正中短轴斜扫描超声定位行腰硬联合麻醉在肥胖产妇无痛分娩中的临床应用

目的探讨脊柱旁正中短轴斜扫描超声定位行腰硬联合麻醉在肥胖产妇无痛分娩中的临床应用效果。方法选取60例无痛分娩产妇为研究对象,采用随机数字表法分为两组,各30例。对照组采用传统手触摸体表进行标志定位,研究组采用脊柱旁正中短轴斜扫描进行标记定位,比较两组穿刺成功时间、穿刺次数及并发症发生情况。结果研究组穿刺成功时间短于对照组,穿刺次数少于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为13.33%,低于对照组的46.67%,差异有统计学意义(P<0.05)。结论脊柱旁正中短轴斜扫描超声定位行腰硬联合麻醉应用于肥胖产妇无痛分娩中,能明显缩短穿刺时间,减少穿刺次数,降低并发症发生率,值得推广与应用。

IOL Master和A-scan在白内障合并黄斑病变中的应用比较

目的:比较光学相干生物测量仪(IOL Master)和A型超声测量(A-scan)在白内障合并黄斑病变眼轴测量和人工晶体测算的准确性及术后屈光状态的评价。方法:选取白内障合并黄斑病变需行超声乳化吸出并人工晶体植入术患者38例(46只眼),分别于术前和术后3个月检查术眼的视力并比较;术前采用光学相干断层扫描(OCT)检查术眼视网膜中央厚度(CRT);术前分别用IOL Master和A-scan测量术眼的眼轴长度(AL),根据AL选择人工晶体计算公式SRK-T或Haigis公式确定植入人工晶体(IOL)的度数、目标屈光度及预留的屈光度数并比较;采用Bland-Altman法分析2种测量方法的一致性,采用Pearson相关分析2种方法AL差值与CRT的相关性;比较2种测量方法预留屈光度数、术后3个月验光的绝对屈光误差(AE)及屈光漂移类型的差异。结果:患者术眼术后3个月裸眼视力较术前提高(P<0.05);Bland-Altman分析结果显示,2种测量方法AL差值的95%医学参考范围为-0.77~0.89 mm,其中最大差值的绝对值为0.45 mm;2种测量方法AL的差异无统计学意义(Z=-1.778,P=0.075),且AL的差值与CRT无相关性(r=0.087,P=0.564);IOL Master方法术后3个月AE值较A-scan更接近于0 D(P<0.001);2种测量方法术后3个月屈光漂移均以近视漂移为主,且近视漂移检出和AE介于0.00~1.00 D的比例均表现为测量方法IOL Master>A-scan(P<0.01)。结论:IOL Master和A-scan在测量白内障合并黄斑病变患者的AL上一致性好,与CRT无相关性;术后2种测量方法的屈光漂移均表现为近视漂移为主,且IOL Master准确性优于A-scan。

AL-Scan与A型超声测量老年性白内障患者眼轴长度与前房深度的对比研究

目的比较AL-Scan与A型超声测量的眼轴长度(AL)及前房深度(ACD)的结果,验证AL-Scan的准确性及其临床应用价值。方法对白内障患者依次行AL-Scan与A型超声测量AL与ACD,比较两者的差异,数据进行统计分析。结果 AL-Scan测量的AL为(24.55±0.85)mm,A型超声测量的AL为(24.52±0.89)mm,两者的差异无统计学意义(t=0.463,P>0.05)。AL-Scan测量的ACD为(2.67±0.49 mm),A型超声测量的ACD为(2.61±0.53)mm,两者的差异无统计学意义(t=0.753,P>0.05)。结论 AL-Scan是一种在临床应用中准确性较高的生物学测量仪器,可用于眼轴及前房深度的测量。