Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?

Objectives: To determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses. Methods: 105 consecutive patients, prospectively referred for biopsy within a specialist sarcoma centre, underwent B-mode, quantitative (m/s) and qualitative (colour map) shear wave elastography. Reference was histology from subsequent biopsy or excision where possible. Statistical modelling was performed to test elastography data and/or B-mode imaging in predicting malignancy. Results: Of 105 masses, 39 were malignant and 6 had no histology but benign characteristics at 12 months. Radiologist agreement for B-mode and elastography was moderate to excellent Kw 0.52-0.64; PABAKw 0.85-0.90). B-Mode imaging had 78.8% specificity, 76.9% sensitivity for malignancy. Quantitatively, adjusting for age, B-mode and lesion volume there was no statistically significant association between longitudinal velocity and malignancy (OR [95% CI] 0.40[0.10, 1.60], p=0.193), but some evidence that higher transverse velocity was associated with decreased odds of malignancy (0.28[0.06, 1.28], p=0.101). Qualitatively malignant masses tended to be towards the blue spectrum (lower velocities); 39.5% (17/43) of predominantly blue masses were malignant, compared to 14.3% (1/7) of red lesions. Conclusions: Quantitatively and qualitatively there is no statistically significant association between shear wave velocity and malignancy. There is no clear additional role to B-mode imaging currently. Key Points: • Correlation between shear wave velocity and soft tissue malignancy was statistically insignificant• B-mode ultrasound is 76.9 % sensitive and 78.8 % specific• Statistical models show elastography does not significantly add to lesion assessmen

Reproducibility of shear wave elastography measuresof the Achilles tendon.

OBJECTIVE To assess the reproducibility of shear wave elastography (SWE) measures in the Achilles tendon (AT) in vivo. MATERIALS AND METHODS Shear wave velocity (SWV) of 14 healthy volunteers [7 males, 7 females; mean age 26.5 ± 3.8 years, mean height 171.6 ± 10.9 cm, mean Victorian Institute of Sports Assessment Achilles questionnaire (VISA-A) score 99.4 ± 1.2] was measured with the foot relaxed and fixed at 90°. Data were collected over five consecutive measures and 5 consecutive days. RESULTS Mean SWV values ranged from 7.91 m/s-9.56 m/s ± 0.27-0.50 m/s. Coefficient of variation (CV), correlations and intra-class correlation coefficient (ICC) scores ranged from 2.9%-6.3%, 0.4-0.7 and 0.54-0.85 respectively. No significant differences were noted for longitudinal or transverse data with respect to protocol or time and no significant differences were noted for foot position in transverse data. Significant differences in SWV values were noted between foot positions for longitudinal scanning (p = <0.05), with a relaxed foot position providing SWV values on average 0.47 m/s faster than a fixed position. Increased reproducibility was obtained with the foot relaxed. ICC between operators was 0.70 for transverse and 0.80 for longitudinal scanning. CONCLUSIONS Reproducible SWE measures were obtained over a 1-h period as well as a period of 5 consecutive days with more reliable measures obtained from a longitudinal plane using a relaxed foot position. SWE also has a high level of agreement between operators making SWE a reproducible technique for quantitatively assessing the mechanical properties of the human AT in vivo

Poor reproducibility of compression elastography in the Achilles tendon: same day and consecutive day measurements.

OBJECTIVE To determine the reproducibility of compression elastography (CE) when measuring strain data, a measure of stiffness of the human Achilles tendon in vivo, over consecutive measures, consecutive days and when using different foot positions. MATERIALS AND METHODS Eight participants (4 males, 4 females; mean age 25.5 ± 2.51 years, range 21-30 years; height 173.6 ± 11.7 cm, range 156-189 cm) had five consecutive CE measurements taken on one day and a further five CE measures taken, one per day, at the same time of day, every day for a consecutive 5-day period. These 80 measurements were used to assess both the repeatability and reproducibility of the technique. Means, standard deviations, coefficient of variation (CV), Pearson correlation analysis (R) and intra-class correlation coefficients (ICC) were calculated. RESULTS For CE data, all CVs were above 53%, R values indicated no-to-weak correlations between measures at best (range 0.01-0.25), and ICC values were all classified in the poor category (range 0.00-0.11). CVs for length and diameter measures were acceptably low indicating a high level of reliability. CONCLUSIONS Given the wide variation obtained in the CE results, it was concluded that CE using this specific system has a low level of reproducibility for measuring the stiffness of the human Achilles tendon in vivo over consecutive days, consecutive measures and in different foot positions

From Feminist Anarchy to Decolonization: Understanding abortion health activism before and after the Repeal of the 8th Amendment

This article analyses abortion health activism (AHA) in the Irish context. AHA is a form of activism focused on enabling abortion access where it is restricted. Historically, AHA has involved facilitating the movement of abortion seekers along ‘abortion trails’ (Rossiter, 2009). Organisations operate transnationally, enabling access to abortion care across borders. Such AHA is a form of feminist anarchism, resisting prohibitions on abortion through direct action. However, AHA work has changed over time. Existing scholarship relates this to advancements in medical technology, particularly the emergence of telemedicine and the increased use of early medical abortion. This article goes beyond those explanations to explore how else AHA has changed by comparing the work of AHA before and after the Republic of Ireland’s referendum on abortion in May 2018. Based on this, I argue that there is a visible shift in the politics of AHA. Drawing on qualitative data from research on AHA organisations along the Liverpool–Ireland Abortion Corridor, specifically those based outside Ireland, the article argues that in the aftermath of the referendum, Irish AHA has increasingly moved towards decolonising feminist activism, thus drawing attention to the relationship between abortion health activists (AHAs) and broader political discourses entangled with abortion law reform

Real-Time Elastography of the Prostate

Palpation of organs is one of the oldest clinical examination techniques, for instance, if you think of the palpation of the breast or the digital rectal examination of the prostate, where hard palpable regions are suspicious for cancer. This is the basic principle of real-time elastography, an ultrasound technique, which is able to visualise tissue elasticity. Since prostate cancer features an increased stiffness due to the higher cell and vessel density than the normal surrounding tissue, real-time elastography has been used for several years for prostate cancer detection. This review introduces the different techniques of ultrasound elastography and furthermore summarises its limitations and potentials

Representações e experiências sobre aborto legal e ilegal dos ginecologistas-obstetras trabalhando em dois hospitais maternidade de Salvador da Bahia Representations and experiences of obstetrician/gynecologists with legal and illegal abortion in two maternity-hospitals in Salvador da Bahia

O objetivo deste estudo qualitativo, realizado em dois hospitais-maternidade de Salvador da Bahia, foi investigar a experiência e as representações do aborto legal, analisadas em contraste com as representações do aborto ilegal, dos profissionais de saúde, em particular dos ginecologistas-obstetras.Usou-se como instrumentos um questionário e entrevistas semi-estruturadas com 25 profissionais de saúde (dos quais 13 ginecologistas-obstetras) num hospital que oferece um serviço de aborto legal (P), e 20 profissionais de saúde (dos quais 9 ginecologistas-obstetras) em outro hospital, que não oferece este serviço (F). Os fatores que mais influenciam as representações dos ginecologistas-obstetras entrevistados acerca do aborto e que explicam a alta taxa de objeção de consciencia no hospital P foram: 1- a criminalização do aborto e o medo de serem denunciados; 2- a estigmatização do aborto por certos grupos religiosos e pelos proprios médicos; 3- o treinamento em obstetrícia e a falta de uma formação boa no campo da epidemiologia da morbi-mortalidade materna e do aborto; 4- as representações acerca das relações de gênero. Os fatores principais associados à atitudes liberais foram: a idade - abaixo de 30/acima de 45 anos - a experiência com altas taxas de mortalidade materna devidas ao aborto e a experiência com o aborto legal.<br>The objective of this qualitative study, carried out in two maternity-hospitals in Salvador da Bahia, was to investigate the experience and representations of health professionals, and particularly obstetricians-gynecologists, regarding legal abortion in comparison with their representations and experience with illegal abortion. A questionnaire was distributed and semi-structured interviews were conducted with 25 health professionals (13 obstetricians-gynecologists) in a hospital providing legal abortion (P) and with 20 health professionals (9 obstetricians-gynecologists) in another hospital that does not provide this service (F). The factors that influence the representations and experience of abortion of most obstetricians-gynecologists and explain the high rate of conscientious objection at Hospital P were: 1- the criminalization of abortion and the fear of being denounced; 2- the stigmatization of abortion by certain religious groups and by the physicians themselves; 3- training in obstetrics and the lack of good training in the epidemiology of maternal morbidity-mortality and abortion; 4- representations on gender relations. The main factors associated with liberal attitudes were: age - under 30 and over 45 years of age - experience with high maternal mortality rates due to abortion and experience with legal abortion