Pia Iben Pietersen

Objectives: Handheld ultrasound devices (HHUDs) have increased accessibility and convenience of ultrasonography, but also raised concern regarding image quality and sufficiency for clinical use. This explorative study aims to compare image quality between 3 commercially available HHUDs in patients with pneumonia, and to compare expert agreement on image quality and sonopathological findings. Methods: Patients were scanned with 3 different HHUDs. Clips were stored, anonymized, duplicated, and randomized. Three blinded, experienced thoracic ultrasound operators independently rated the clips for image quality (1–5), sufficiency for clinical use (1–3), and presence of sonopathological findings. Results: Eleven patients were scanned, yielding 38 ultrasound clips and 76 ratings per rater. Overall image quality was 3.60 (95% CI 3.40–3.80) for Lumify , 3.32 (95% CI 3.11–3.53) for Vscan Air , and 2.78 (95% CI 2.55–3.01) for Butterfly iQ+ . Overall agreement on image quality ratings was low (27.6%). Interrater agreement for specific sonopathological findings ranged from slight for air bronchograms (kappa 0.15–0.34) to substantial for pleural effusions (kappa 0.58–0.84). Conclusion: This explorative study demonstrated a higher image quality in Vscan Air and Lumify compared to Butterfly iQ+ in patients with pneumonia. However, interrater agreement on image quality was low, while interrater agreement on sonopathological findings was moderate.

Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign tumour arising from the Schwann cells of the vestibulocochlear nerve, typically located in the cerebellopontine angle [1,2]. ...

Background: The use of ultrasound (US) to guide percutaneous thoracic interventions improves safety and effectiveness of procedures and leads to reduced healthcare costs. A taskforce was convened to produce a statement on various clinical aspects of these procedures. Methods: The taskforce included respiratory physicians and nurses, thoracic surgeons, radiologists, and patient representatives. The statement covers the following procedures: thoracentesis, chest tube/indwelling catheter, medical thoracoscopy, and percutaneous biopsies of lung, pleura, mediastinum and cervical lymph nodes. Systematic searches were carried out for 18 PICO questions under five major topics to inform the writing of the statement. Narrative synthesis of the evidence from relevant literature is presented for each topic. Surveys and interviews with patients who underwent US-guided interventions were conducted to explore patient perspectives. Results: Review of evidence is presented on: the use of US-guided interventions in diagnostic and treatment pathways for pleural and thoracic diseases (Section 1), comparative data on type/size of biopsy, chest tube size and disease outcome, optimal settings for procedures and portable ultrasound (Section 2), US specific methodology and association with outcomes, real-time US guidance for different interventions and contrast-enhanced US in procedure guidance (Section 3), diagnostic yield/treatment success and complications (Section 4) and training requirements (Section 5). Major themes emerging from patient surveys and interviews are presented in Section 6. Recommendations for future research conclude the statement. Conclusions: The use of US to guide percutaneous thoracic procedures is reported to show higher success and lower complication rates in the reviewed evidence. Further research is needed to better inform the procedural settings, techniques, and training.

Purpose: Metastasis-directed ablative therapy in oligometastatic disease has been shown to improve long-term survival. Research on minimally invasive procedures is warranted to evaluate treatment efficacy and procedure-related risks. This study evaluates the efficacy, complications, and survival outcomes of metastases-directed percutaneous cryoablation in patients with oligometastatic disease. Methods: The retrospective study included patients who underwent percutaneous cryoablation for local tumor control of oligometastases between 2016 and 2022. Eligibility was determined by multidisciplinary team consensus. Clinical data and follow-up imaging were retrieved retrospectively to analyze primary and secondary treatment efficacy, complications, and survival. Results: Data from 15 patients with 16 histologically verified metastases were analyzed. Primary tumor origins were kidney, lung, and breast, with metastases located primarily in the kidney and soft tissue. The median metastasis size was 18 mm, with an interquartile range (IQR) of 16. At a median follow-up of 23.6 months (IQR 22.3), the primary efficacy rate was 80%. The secondary efficacy rate at 28.7 months (IQR 26.5) was 93%. Two patients required overnight observation; however, no complications necessitated further interventions. The overall survival rates were 93%, 72%, and 63% at 1, 2, and 3 years, respectively. Conclusion: This study demonstrates that percutaneous cryoablation provides effective local tumor control with minimal complications and a three-year survival rate of 63% in patients with oligometastatic disease. Level of evidence: Level 4, Case-series. Graphical

X-ray imaging protocols in radiology departments often exhibit variability in exposure parameters and geometric setups, leading to inconsistencies in image quality and potential variations in patient dose. Objectives: This study aimed to harmonise and optimise chest and pelvis X-ray imaging protocols by standardising exposure parameters and geometric setups across departmental systems, minimising radiation dose while ensuring adequate image quality for accurate diagnosis. Methods: The image quality of five pelvic and three chest protocols across different radiographic systems was evaluated both quantitatively and visually. Visual image quality for both chest and pelvis protocols was assessed by radiologists and radiographers using the Visual Grading Analysis (VGA) method. Additionally, the quantitative image quality figure inverse (IQF_inv) metric for all protocols was determined using the CDRAD image quality phantom. Moreover, the patient radiation dose for both chest and pelvis protocols was evaluated using dose area product (DAP) values measured by the systems’ built-in DAP metres. Results: Different quantitative image quality and radiation dose to patients were achieved in various protocol settings for both chest and pelvis examinations, but the visual image quality assessment showed satisfactory image quality for all observers in both the pelvis and chest protocols. The selected protocols for harmonising chest radiography across all imaging systems result in reduced radiation exposure for patients while maintaining adequate image quality compared to the previously used system-specific protocol. Conclusions: The clinical protocol for chest and pelvis radiography has been standardised and optimised in accordance with patient radiation exposure and image quality. This approach aligns with the ALARA (As Low As Reasonably Achievable) principle, ensuring optimal diagnostic information while minimising the radiation risks.

Background: Computerized tomography-guided transthoracic needle biopsy (CT-TTNB) plays an important role in the diagnostic work-up of lung lesions. The literature reports varying results on complication rates, severity of complications, and diagnostic yield. Purpose: To evaluate CT-TTNB as a radiological outpatient clinic procedure and explore diagnostic yield and complication rates. Material and methods: Between January 2017 and October 2019, a total of 559 patients underwent CT-TTNB. Patient records and CT scans were retrospectively reviewed and patient characteristics, lesion characteristics, biopsy procedure, and per- and post-procedural complications, as well as pathological diagnosis, were registered. Results: Of 559 patients included, 511 had biopsies performed. Thereby, 48 biopsies (8.6%) were discontinued because of patient compliance issues and/or the occurrence of pneumothorax before the biopsy was performed. The overall pneumothorax rate was 49.2% ( n = 275 of 559 patients). Insertion of a drainage catheter was needed in 85 of the 275 patients with pneumothorax. Parenchymal bleeding was seen in 26.5% of the patients and haemoptysis in 5.5%. No cases of bleeding or haemoptysis required intervention or admission. Small mean lesion size and increased distance from pleura to the lesion were associated with a higher occurrence of complications. A conclusive pathological diagnosis was obtained in 278 of 511 (54.4%) biopsies. No patients were re-admitted after the two-hour observational period in the radiological department. Conclusion: CT-TTNB as an outpatient clinic procedure is feasible but has a moderate diagnostic yield and relatively high complication rates for minor complications.

Background: Pneumothorax is a common complication after CT-guided transthoracic lung biopsy. Pneumothorax is most often diagnosed with a conventional chest X-ray after a two-hour observation period. Ultrasound has been shown to be superior to conventional X-rays in diagnosing pneumothorax in some settings and it can be repeated without radiation exposure. Purpose: The aim of the study was firstly to explore the sensitivity and specificity of thoracic ultrasound compared to conventional chest x-ray following CT-guided transthoracic lung biopsy, and secondly to investigate the dynamic changes of pneumothorax size using ultrasound. Methods: This prospective study was conducted at Odense University Hospital in the Department of Radiology. Adult patients undergoing CT-guided lung biopsy were eligible for inclusion. A total of 26 patients were included in the study and were scanned five times in sitting upright and supine positions during the two-hour observation time using the FLUS Protocol. Results: Pneumothorax was diagnosed via chest x-ray in 11 (42%) patients. With the patient in an upright position, the ultrasound had a sensitivity of 63.6% and a specificity of 93.3%. These numbers rose to 72.3% and 100% in the supine position. Monitoring the pneumothoraces showed a slight increase in size during the two hours. Conclusions: Ultrasound can be used to diagnose pneumothorax after CT-guided lung biopsy. All pneumothoraxes that were identified by ultrasound were detected within the first 30 min. The dynamic changes of pneumothoraxes showed that the size of the pneumothorax did not increase to a level where the patient needed intervention or admittance.

This systematic review examines educational strategies in clinician‐performed abdominal point‐of‐care ultrasound (POCUS), a critical skill with increasing relevance in medical care. Analyzing 28 studies, we highlight the strategies as well as advantages and disadvantages of various theoretical and practical components, including, for example, e‐learning and simulation in training programs. The findings emphasize the necessity of blending various educational methods to enhance effectiveness and adaptability in training environments. Ultimately, robust training frameworks are essential to maximize diagnostic accuracy and improve patient outcomes in abdominal POCUS.