Advances in Modern Clinical Ultrasound

Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In parallel, advanced applications of ultrasound imaging have arisen. These include high frequency superficial sonograms to diagnose dermatologic pathologies as well as various intra-cavitary or lesional interrogations by contrast-enhanced ultrasound. Properties such as real­time definition and ease-of-access have spumed procedural and interventional applications for vascular access. This narrative review provides an overview of these advances and potential future directions of ultrasound

Contrast-Enhanced Endoscopic Ultrasound for Identification of Sentinel Lymph Nodes in Esophageal Cancer

Introduction: In esophageal carcinoma, lymph node involvement is a crucial aspect of nodal staging and determining treatment strategies. Although grayscale endoscopic ultrasound (EUS) is the standard of care for staging, it is unable to identify lymph node drainage from primary tumors or sentinel lymph nodes (SLN). The goal of this study was to determine if Contrast Enhanced Endoscopic Ultrasound (CE- EUS) is superior to EUS in the identification of SLNs and nodal staging in esophageal carcinoma. Methods: In the unblinded pilot study, patients with newly diagnosed esophageal carcinoma were recruited to undergo CE-EUS and standard EUS. EUS was performed and visible lymph nodes were noted. The contrast agent, Sonazoid was injected peri-tumorally. Fine needle aspiration (FNA) was performed on all lymph nodes considered suspicious by either modality. Specimens were compared, using cytology as a reference. Results: 55 peri-esophageal lymph nodes were collected from 14 enrolled patients, with tumor staging of T2 and T3. 10 nodes identified as suspicious by EUS and 19 nodes identified as suspicious by CE-EUS were sampled by FNA. 4 nodes (40% cytologic yield) identified by EUS and 12 nodes (63% cytologic yield) identified by CE-EUS showed signs of metastatic disease. Nodal staging was upgraded in 4 patients (29%) with the addition of SLNs identified by CE-EUS. Discussion: CE-EUS may increase the identification of SLNs and increase cytologic yield that would not have normally been biopsied using EUS. This increase in SLN identification and cytologic yield can provide more accurate lymph node staging in esophageal carcinoma. Further study is indicated

CMUT/CMOS-based Butterfly iQ – A Portable Personal Sonoscope

With the development of bioengineering technologies, medical ultrasound systems have evolved and advanced over the years, including the transition of ultrasound machines from analog devices to digital systems and improvements in transducer assembly from piezoelectric ceramics to single crystals. In the past several years, the further miniaturization of ultrasound units has become possible with the advancement of computer chip manufacturing and production. Most recently, a new handheld ultrasound system has been developed by the startup company Butterfly Network, using an innovative CMUT/CMOS-based probe technique. This paper will review the history, technology and features of this new device, as well as discuss its future potential as a personal sonoscope