Storing Blood as a Dry Powder

Did you know that blood can only be stored for up to 6 weeks when refrigerated? Because synthetic blood is not available in the clinic, blood supplies must be continually replenished from healthy donors. Even if there is a surge in blood donations at one point in time, 6 weeks later there could be shortages if continued donations do not meet the current demand. Blood can be frozen for a decade or more but significant challenges in processing blood for frozen storage limit this option to specific situations such as for rare blood types or military use. The freezing process currently utilizes high concentrations of glycerol to protect red blood cells during frozen storage but this compound must be removed prior to transfusion, and the de-glycerolization process is very sensitive and time-consuming. Therefore, most hospitals and medical centers utilize refrigeration for blood storage.

What if, instead of refrigerating or freezing blood, there was a method to freeze-dry blood for long-term storage as a dry powder, similar to the process used for astronaut food? This could enable long-term blood storage at room temperature, and when the blood is needed for transfusion the cells could be quickly re-constituted simply by adding sterile water. Not only would this offer another option for long-term storage, it would be particularly useful in situations where refrigeration or freezing is not available, such as in some remote medical centers or for the military in far-forward settings. In addition, this method could enable stockpiles of strategic blood reserves in order to maintain an adequate blood supply during disasters such as hurricanes, which disrupt blood donations.

Blood cells dried

Electron microscopy image of red blood cells after drying/rehydration following ultrasound-mediated loading with preservative compounds.

The idea of turning blood into a dry powder and then rehydrating it for transfusion may sound like science fiction, but could it become a reality? Can nature provide clues to help us solve this problem? There are many cases in history where significant scientific breakthroughs were achieved by studying nature. For example, the Wright brothers studied the characteristics of birds’ wings during flight to discover an effective design for airplane wings. Also, Alessandro Volta invented the battery after carefully studying the electric organ in torpedo fish. In the context of cell preservation, it has been found that some organisms can survive complete desiccation for long periods of time. For example, tardigrades and brine shrimp (“water bears” and “sea monkeys”) can be dried out and remain in a state that approaches “suspended animation” for decades, but when they are rehydrated they return to normal physiological function and can even reproduce. This led us to ask the question, if these complex multicellular animals can survive desiccation, why not individual red blood cells? Scientists have found that these organisms produce protective compounds, including certain sugars and proteins, which prevent damage to their membranes during drying and rehydration.

Unfortunately, human cells do not have the transporters in their membranes that enable internalization of the protective compounds found in organisms that can survive desiccation. Therefore, an active loading method is required. We realized that the process of ultrasound-mediated drug delivery via sonoporation could potentially be applied to solve this problem and enable delivery of protective compounds into human red blood cells. In the past, most ultrasound research has either ignored red blood cells or attempted to minimize sonoporation in these cells. But what if we could intentionally sonoporate red blood cells outside of the body in order to actively load them with protective compounds so that they could be stored as a dry powder at room temperature until needed for transfusion?

Our initial efforts to load red blood cells with protective compounds for storage as a dry powder have been promising. We prepared solutions containing red blood cells, preservative compounds, and microbubbles followed by treatment with B-mode ultrasound for ~60 seconds. After ultrasound treatment, the cells were freeze-dried and stored as a dried powder at room temperature (21–23 °C) for 6 weeks or longer. Cells were rehydrated with water and we measured up to 30% recovery of viable red blood cells. In addition, we performed electron microscopy imaging of the rehydrated red blood cells and observed evidence of normal biconcave-discoid shape. Our next steps involve testing the rehydrated cells in an animal model of acute hemorrhage in order to assess the function and safety of the red blood cells in vivo after dry storage at room temperature.

Research studies are currently ongoing and much more work remains to be done before clinical translation is possible, but if it is successful this approach could have a significant impact on blood supply, particularly in locations where refrigeration and freezing is not available. In addition, this approach could potentially enable dry storage of other cell products. As I consider the possibilities of this approach, I wonder if there are other things that we can learn from nature that could also transform medical practice.

 

Have you learned something else from nature that has been incorporated into your medical practice? Do you have any ideas that could potentially transform medical practice? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jonathan Kopechek is an Assistant Professor of Bioengineering at the University of Louisville. His Twitter handle is @ProfKope.

 

 

Real-time Ultrasound in Physical Therapy

In the past 20 years, there are very few pieces of equipment I can say unequivocally changed how I practice as a physical therapist (PT); without question, real-time ultrasound (RTUS) is one. A sports/orthopedic colleague introduced RTUS to my practice 8 years ago. As a pelvic PT, I thought it would be a nice adjunct to my current practice with biofeedback, exercise, and manual techniques. I was wrong. It was a game changer. What initially started out as an exercise in interpreting black & white ink-blot-like images has evolved into so much more.Lisa-Damico-Portraits-Carrie-Pagliano-0413-LOW-RES

For those unfamiliar with pelvic floor physical therapy, typical pelvic floor assessment, without RTUS, includes an external assessment of the perineal region. Frequently, internal digital assessment is used to identify pelvic floor muscle strength, endurance, coordination, tender points, and presence of pelvic organ prolapse. Biofeedback assessment can give a general sense of local muscle activity, via either internal or external electrodes. Absent from this data collection, however, is the ability to assess function. What is the effect of pelvic floor activity on the bladder? What specific muscles in the pelvis and abdomen are activating and when? What do you do when a patient is unable to tolerate an internal assessment? RTUS addresses all of these questions. Via a transabdominal approach, I am able to assess the function of pelvic, abdominal, hip, and back musculature in the context of breath and movement. I am able to make an assessment without an internal approach, which may be threatening or uncomfortable for patients with pelvic pain. I am able to determine the function of the pelvic floor and its effect on the bladder and urethra as well.

My practice includes RTUS primarily for evaluation of movement of the pelvic floor, abdominals, hip and spine. The primary goal is to find and address neuromuscular dysfunction in the context of urinary/fecal incontinence, pelvic pain, diastasis recti, and pelvic girdle pain. Beyond helping me identify inefficient movement strategies, coordination variances, and relevant dysfunction, RTUS has been an enormous help in educating my patients about their own bodies and how they function. I never anticipated how much a little black and white image would help patients make this connection! For example, many people have no idea where their pelvic floor is, much less what its relationship is to their bladder, pelvis, or breath. With just a quick look at the screen and a little orientation, RTUS can give patients a window into the simple yet complex connections within their own bodies.

The most striking patient activity with RTUS is using imaging to show the relationship between breath and the pelvic/abdominal region. Patients who are visual learners especially find this an invaluable tool. I use focused exhalation (cued blowing through a straw), vocalization, and varying volumes and octaves to get automatic activation of transverse abdominal and pelvic floor musculature. Patients see, in real time, the effect of their breathing (or breath-holding) strategies have on activation of muscles in the pelvic region. Patients no longer have to try to cognitively process how to turn these muscles on or off (which is laborious and practically impossible to be consistent), but rely on something as simple as breath to assist in activating or relaxing their muscles.

As you can see, RTUS provides both patients and clinicians a window into the pelvic region, providing additional insight into the patient’s function and dysfunction. Having AIUM recognize physical therapists in the AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures is an outstanding step toward including PTs in this area of practice. I’ve been privileged to work alongside physical therapists working in the area of RTUS education, facilitated diagnostics and real-time needle tracking within our profession. I’m excited that the area of pelvic physical therapy is being included in using RTUS in progressive physical therapy practice. I am looking forward to more integration of RTUS in physical therapy patient care as well as physical therapy education! The more physical therapists have knowledge and skill using this unique tool, the more comprehensive care and outcomes PTs can provide!

 

Have you included real-time ultrasound in you physical therapy practice? If so, how has it impacted your practice? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Carrie Pagliano, PT, DPT, MTC, is a Board Certified Women’s Health & Orthopaedic Clinical Specialist, and is owner of Carrie Pagliano PT, LLC, in Arlington, VA.

Determining Umbilical Cord Blood Flow

Umbilical cord blood flow is among the most highly desired parameters for monitoring fetal well-being. This is because cord blood flow directly reflects placental volume flow, which is considered to be as important in the fetus as cardiac output and lung perfusion are in adults.1 Yet, presently employed noninvasive methods, such as umbilical artery Doppler waveform analyses, use surrogate flow evaluation parameters, such as systolic/diastolic ratios, which do not directly reflect placental-fetal blood flow.2,3 Volume flow estimation overcomes this by measuring true flow, and it has been shown that volume flow changes in the umbilical vein occur before umbilical artery flow indices become abnormal.4

Yet, the present volume flow measurement method has severe problems limiting its utility. These include technical difficulties in flow measurement in umbilical cords and faulty assumptions employed in the measurement. The present method using spectral Doppler is

                 Q = V × A                    (1),

where Q is volume flow, V is the mean velocity through the Doppler sample volume, and A is the cross-sectional area of the vessel of interest. This formula assumes that the 2D flow profile is cylindrically symmetric with a circular cross-section, and the line of the Doppler sampling cuts perfectly through the center of the sampled vessel. The velocity estimates require angle correction, and if the vessel is tortuous, as in umbilical cords, the sampling position placement and angle correction are hard to perform. Multiple investigators have warned that small errors in volume flow components can result in large errors in the calculation of volume flow.5-7

A new, easy-to-perform volume flow method overcomes almost all of the limitations of the standard technique. The new method is angle independent, flow profile independent, and vessel geometry independent. It works as follows:

Volume flow is defined as the total flux across any surface, S, intersecting the vessel. This is written as

Eq2

where Q is again volume flow, V is the local velocity through each area element dA, and “” is the dot product which projects the local velocity V onto the normal vector for each area element. This is known as Gauss’s theorem. The intersecting surface, known as the “C” surface, is very simple to obtain using 3D ultrasound (Figure8). In order to validate this method, we obtained an AIUM EER-funded research grant.

Fig

Figure: (A) Four-panel view of a single 3D color flow acquisition of the umbilical cord. The four views are as follows: upper-left is axial-lateral, upper-right is axial-elevational, bottom-left is elevational-lateral (ie, the c-surface), and bottom-right is a rendered 3D reconstruction. Arteries are shown in blue and the vein is shown in red. The schematic in (B) illustrates the orientation of the probe and the corresponding c-surface in the elevational-lateral imaging plane. The vessel colors in (B) match the directionality in (A). The entire umbilical cord passes through the c-surface but only the cross-sections of the umbilical arteries and umbilical vein are illustrated in (B). The two arteries are separated in power Doppler (not shown). (Printed with permission from Pinter et al. J Ultrasound Med. 2012;31(12):1927-34. © 2016 by the American Institute of Ultrasound in Medicine)

We had 2 specific aims: 1) Test the reproducibility of the volume flow measurement, and 2) evaluate the relationship of volume flow to clinical outcome in a high-risk patient population.

In the first aim, we performed studies on 35 subjects between the gestational ages of 22–37 weeks, 26 high risk and 9 normal.9 We attempted to measure umbilical cord blood flow at 3 sites in the cord in each subject, and we averaged 28.3 ± 3.3 (mean ± standard deviation) samples per site. We used a GE LOGIQ E9 ultrasound system with a 2.0–8.0 MHz bandwidth convex array transducer to acquire multiple volume 3D color and power mode data sets. Since we were measuring mean blood flow, we assessed variability using relative standard error (standard error /mean) (RSE). The average RSE for blood flow at each cord position was ±5.6% while the average RSE among the measurements in each subject was ±12.1%.

For the second aim, we compared the volume flow measurements in 5 subjects that developed preeclampsia with the 9 normal subjects. Even with these small numbers, we detected a significant difference between the mean depth-corrected, weight-normalized umbilical vein blood volume flows in the two groups (P = .035). Further, blood flow abnormalities were detected either at the same time or preceded the hypertensive disorder in 4 of the 5 subjects. This is consistent with our prior publication where blood flow changes preceded the onset of pre-eclamptic symptoms in a study subject.8

With the introduction of 2D array transducers, umbilical cord volume flow estimates can be performed in seconds and given the valuable information provided by this method, umbilical cord volume flow will hopefully become a standard component of fetal examinations.

 

References:

  1. Tchirikov M, Rybadowski C, Huneke B, Schoder V, Schroder HJ. Umbilical vein blood volume flow rate and umbilical artery pulsatility as ‘venous-arterial index’ in the prediction of neonatal compromise. Ultrasound Obstet Gynecol. 2002;20:580-5.
  2. Newnham JP, Patterson LL, James IR, Diepeveen DA, Reid SE. An evaluation of the efficacy of Doppler flow velocity waveform analysis as a screening test in pregnancy. Am J Obstet Gynecol. 1990;162:403-10.
  3. Acharya G, Wilsgaard T, Bernsten GKR, Maltau JM, Kiserud T. Doppler-derived umbilical artery absolute velocities and their relationship to fetoplacental volume blood flow: a longitudinal study. Ultrasound Obstet Gynecol. 2005;25:444-53.
  4. Rigano S, Bozzo M, Ferrazzi E, Bellotti M, Battaglia FC, Galan HL. Early and persistent reduction in umbilical vein blood flow in the growth-restricted fetus: a longitudinal study. Am J Obstet Gynecol. 2001;185:834-8.
  5. Evans DH. On the measurement of the mean velocity of blood flow over the cardiac cycle using Doppler ultrasound. Ultrasound Med Biol. 1985;11(5):735-41.
  6. Gill R. Measurement of blood flow by ultrasound: accuracy and sources of error. Ultrasound Med Biol. 1985;11:625-41.
  7. Lees C, Albaiges G, Deane C, Parra M, Nicolaides KH. Assessment of umbilical arterial and venous flow using color Doppler. Ultrasound Obstet Gynecol. 1999;14:250-5.
  8. Pinter SZ, Rubin JM, Kripfgans OD, Treadwell MC, Romero VC, Richards MS, Zhang M, Hall AL, Fowlkes JB. Three-dimensional sonographic measurement of blood volume flow in the umbilical cord. J Ultrasound Med. 2012;31(12):1927-34.
  9. Pinter SZ, Kripfgans OD, Treadwell MC, Kneitel AW, Fowlkes JB, Rubin JM. Evaluation of umbilical vein blood volume flow in preeclampsia by angle-independent 3D sonography [published online ahead of print December 15, 2017]. J Ultrasound Med. doi:10.1002/jum.14507.

 

How do you determine umbilical cord blood flow? What problems have you encountered using the traditional method? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jonathan Rubin, MD, PhD, FAIUM, is Professor Emeritus of Radiology at University of Michigan.

 

Sonographers and Contrast-Enhanced Ultrasound

Now that contrast-enhanced ultrasound (CEUS) has been approved in the United States for several abdominal applications in adults and pediatrics, I decided to take a deeper look into the sonographer’s role in CEUS. Traditionally, sonographers perform ultrasound examinations based on a protocol, construct a preliminary ultrasound findings worksheet, and perhaps discuss the findings with a radiologist. And now CEUS has transformed traditional ultrasound and gives physicians and sonographers additional diagnostic information related to the presence and patterns of contrast enhancement.DSC00125

Based on sonographers’ traditional scope of practice, some questions came to mind. What is the training process for sonographers to learn CEUS? How should CEUS images be obtained and stored? How should CEUS findings be communicated?

I envision CEUS training for sonographers broken down into stages, where they begin by learning the basics and eventually transition to where they can perform and record the studies independently. The first stage for sonographers is the ‘CEUS learning curve.’ In this stage, sonographers become familiar with basic CEUS concepts, eg, understanding physics of contrast agents and contrast-specific image acquisition modes, CEUS protocols, and typical patterns of contrast enhancement seen in various organs. In addition, an important part of the training is recognizing contrast reactions, and learning IV placement, documentation and billing related to CEUS.

The next stage involves sonographers performing more patient care and gaining scanning responsibilities. Sonographers place the IV and prepare the contrast agent. The scope of sonographer responsibilities does not generally include contrast injection (although it is reasonable since CT, MR, nuclear medicine, and echocardiography technologists routinely place IV lines and inject contrast). It should be noted that CEUS examination usually requires an additional person (physician, nurse, or another sonographer) to assist with contrast injection while the sonographer performs the ultrasound examination. In the beginning of sonographer training, it is very beneficial to have a radiologist present in the room to guide scanning and appropriate image recording.

In the third stage, a well-trained sonographer is more independent. At the completion of the examination, the sonographer will either send clips or still images to a physician to document the CEUS findings and discuss the procedure. Ideally a worksheet is filled out, comparable to what is done today with “regular” ultrasound.

The majority of CEUS examinations are performed based on pre-determined protocols, usually requiring a 30–60-sec cineloop to document contrast wash-in and arterial phase enhancement. After that continuous scanning should be terminated and replaced with intermittent acquisition of short 5–10-sec cineloops obtained every 30–60 sec to document late phase contrast enhancement. These short clips have the advantage of limiting stored data while providing the interpreting physician with real-time imaging information. Detailed information on liver imaging CEUS protocols could be found in the recently published technical guidelines of the ACR CEUS LI-RADS committee.[i] Some new users might acquire long 2–3-minute cineloops instead, producing massive amounts of CEUS data. As a result, studies can slow down a PACS system if departments are not equipped to deal with large amounts of data. In addition, prolonged continuous insonation of large areas of vascular tissue could result in significant ultrasound contrast agent degradation limiting our ability to detect late wash-out, a critical diagnostic parameter required to diagnose well differentiated HCC. Any solution requires identifying and capturing critical moments, which will be determined by a sonographer’s expertise. Exactly how sonographers can ensure CEUS will successfully capture the most important images is a critical question that must be answered and standardized.

Ideally, leading academic institutions should provide CEUS training for physicians and sonographers. I have seen and attended CEUS continuing medical education courses and they are a great way for physicians and sonographers to learn CEUS imaging. CEUS is a step forward for sonographers and will potentially transform our scope of practice. The technology will advance the importance of sonographers and diagnostic ultrasound, and importantly it will improve the care of our patients.

Acknowledgements:
Dr. Laurence Needleman, MD
Dr. Andrej Lyshchik, MD
Dr. John Eisenbrey, PhD
Joanna Imle, RDMS, RVT

[i] Lyshchik A, Kono Y, Dietrich CF, Jang HJ, Kim TK, Piscaglia F, Vezeridis A, Willmann JK, Wilson SR. Contrast-enhanced ultrasound of the liver: technical and lexicon recommendations from the ACR CEUS LI-RADS working group. Abdom Radiol (NY). 2017 Nov 18. doi: 10.1007/s00261-017-1392-0. [Epub ahead of print]

Has CEUS helped your sonography career? How do you envision CEUS being incorporated in your work? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Corinne Wessner BS, RDMS, RVT is the Research Sonographer for Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Corinne has an interest in contrast-enhanced ultrasound, ultrasound research, medical education, and sonographer advocacy.

How to Commercialize Ultrasound Technology

A few years ago, I had the opportunity to commercialize an ultrasound technology. Reflecting upon this process, I am very grateful that there were so many team members and things (including those beyond our control) that contributed to the success of the project. By sharing our journey from the research bench to public use, I hope that people will get an idea of what is involved in a commercialization process and appreciate the importance of team work.Chen_Shigao_2016

It started with our research team who sketched out an idea of using multiple push beams spaced out like a comb to generate multiple shear waves at the same time. It could be used to improve both signal-to-noise ratio and the frame rate for ultrasound elastography. Fortunately our lab had a research scanner that came with a programmable platform. This idea was prototyped and tested on the same day and it worked! Were it not for the research scanner, it would have taken months to get this done. The alternative process involves contacting an ultrasound company (if we ever find one), gaining their support (a research agreement could take months to reach), and testing on a commercial prototype scanner (which is much harder compared to using a research scanner).

It was soon discovered afterwards that the interference of shear waves from the comb push beams make it very hard to calculate the wave speed for elasticity imaging accurately. A mathematician in our team offered to apply a signal processing algorithm that detangles the complicated shear waves into simpler component waves. It solved our problem and helped the idea pass the initial functionality test. The next step was to show the industry the translational potential of this technology and out-license it to them for further development and testing.

Back then, the clinical ultrasound division at our institution was developing a strategic partnership with a leading ultrasound company, which was looking for a shear wave elastography solution for their products. The company soon decided to license our technology. To speed up the progress, our intellectual property (IP) office negotiated the licensing agreement with the company, while we worked with the company engineers on the technology in parallel. Both parties shared a common culture of openness, which allowed us to exchange codes with each other. This trusting relationship was found to be very beneficial by both sides as we shared the dedication to achieve common goals quickly.

To ensure the successful implementation of the prototype, the collaboration continues in the form of site visits and numerous teleconferences between the sites until satisfied phantom and in vivo results were yielded. When the near-end prototype was available, an independent clinical study was performed at our institution to verify the performance and establish cut points for liver fibrosis staging. It greatly exemplified the benefit of affiliating with a large medical center. The extensive interdisciplinary research and medical environment at our institution has provided a unifying framework that bridges the gap of technical creation and clinical deployment. Upon positive results from clinical trials, the company was able to launch the product in 2014. The technique was FDA-approved and released at RSNA. We are very pleased to see the research outcome has been taken from the bench to the bedside and is improving the effectiveness of patient care worldwide.

It truly takes a village to make this happen. The success came with the supports of a huge team of ultrasound physicist, PhD student, mathematician, study coordinator, sonographer, radiologist, IP staff, and licensing manager. It calls for an industrial partner that has shared appreciation of value and common core objectives. Looking back at our journey, it is without question that every step presents its own challenge. By sharing our experiences, we hope to contribute to your future successful technology commercialization.

 

Have you tried to commercialize an ultrasound technology? Have you had a different experience commercializing ultrasound technology? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Shiago Chen, PhD, is a Professor at the Department of Radiology, Mayo Clinic College of Medicine.

Bigger and Better in the Big Apple

Last week a near-record 1,500 physicians, sonographers, scientists, students, and educators from across the country and around the world gathered in New York City to network, share, and learn. It was, by all accounts, one of the biggest and best AIUM Conventions yet!

What it made so great? A variety of educational opportunities covering a wide range of topics addressing at least 19 different specialties is just the start. More interaction across disciplines to share techniques, more hands-on learning labs, new product releases, and collaborative learning events added to the excitement and collegiality.

If you were in New York City, we hope you shared your feedback in the follow-up surveys. If you were unable to make it this year, here are a few of the highlights:

New Offerings—As if putting on the AIUM Convention weren’t enough, we decided to make a host of changes. We doubled the number of hands-on learning labs (most sold out), we added the more intimate Meet-the-Professor sessions (again, most sold out), we enhanced networking by adding exhibit hall receptions, we brought back the mobile app to make navigating the event easier, and we invited our corporate partners to host Industry Symposia, which included education, networking, and food. Whew!

New Offerings

SonoSlam—In its third year, a record number of medical schools (21) sent teams to compete for the coveted Peter Arger Cup. This year’s winning team, F.A.S.T. and Furious, is from the University of Connecticut. They competed last year and had so much fun they returned and were triumphant! Save the date for next year—April 6. Big thanks to headline sponsor CoapTech.

SonoSlam 2018

Global Plenary—AIUM President Brian Coley, MD, hosted the Plenary session that featured a lecture on global health from John Lawrence, MD, President of the Board of Directors for Doctors Without Borders-USA. This was followed by Roberto Romero, MD DMedSci, who presented the William J. Fry Memorial Lecture on ultrasound imaging and computational methods to improve the diagnosis and care of pregnant women and their unborn children. The entire Plenary Session is available on the AIUM Facebook Page.

Social Media—This year was the most active social media convention ever for the AIUM. StatsFrom streaming live videos on Facebook to more than 754 individuals participating and sharing on Twitter (a 50% increase over last year), the social media scene was active and engaging.

Fun Activities—Not only was #AIUM18 educational, it was also fun. This year attendees could participate in a morning jog through Central Park; do a scavenger hunt with the AIUM app (Congrats to Offir Ben-David, RDMS, from Stamford, CT, and Jefferson Svengsouk, MD, MBA, RDMS, from Rochester, NY, for winning prizes by completing the scavenger hunt); network during 3 different AIUM receptions and the new Industry Symposia; and win prizes at the AIUM booth (Congrats to Jenna Rothblat who won a free 2019 AIUM Convention registration).

Fun Activities

Sold-out Exhibit Hall—This year’s exhibit hall was the most exciting and active it has ever been. At least 3 companies unveiled new ultrasound machines and several others shared their insights with live video feeds. Combine that with networking receptions and New York street fare at lunch time, and the exhibit hall was always the place to be.

Award Winners—AIUM was proud to recognize the following award winners (look for upcoming blog posts and videos from some of these individuals):

Wesley Lee, MD, FAIUM—Joseph H. Holmes Clinical Pioneer Award

William D. Middleton, MD—Joseph H. Holmes Clinical Pioneer Award

Thomas R. Yellen-Nelson, PhD, FAAPM, FAIUM—Joseph H. Holmes Basic Science Pioneer Award

Tracy Anton, BS, RDMS, RDCS, FAIUM—Distinguished Sonographer Award

Alfred Abuhamad, MD, FAIUM—Peter H. Arger, MD Excellence in Medical Student Education Award

Creagh Boulger—Carmine M. Valente Distinguished Service Award

Rachel Liu—Carmine M. Valente Distinguished Service Award

Lexie Cowger—Carmine M. Valente Distinguished Service Award

Adriana Suely de Oliveira Melo, MD, PhD—AIUM Honorary Fellow

Simcha Yagel, MD, FAIUM—AIUM Honorary Fellow

E-poster winners—Every year, the AIUM supports an e-poster program. This year, a record number of abstracts were submitted and the AIUM recognized the following e-poster winners:

  • First place, Basic Science: Construction and Characterization of an Economical PVDF Membrane Hydrophone for Medical Ultrasound, presented by Yunbo Liu, PhD, from the FDA, Silver Spring, MD.
  • First place, Education: Investigation into the Role of Novel Anthropomorphic Breast Ultrasound Phantoms in Radiology Resident Education, presented by Donald Tradup, RDMS, RT, from Mayo Clinic-Department of Radiology, University of Pittsburgh Medical Center-Department of Radiology, Dublin Institute of Technology, Ireland.
  • First place, Clinical Science: Sonography of Pediatric Superficial Lumps and Bumps: Illustrative Examples from Head to Toe presented by Anmol Bansal, MD, Mount Sinai Hospital, Icahn School of Medicine.
  • Second place, Basic Science: Strain Rate Imaging for Visualization of Mechanical Contraction, presented by Martin V. Andersen, MS, from Duke University.
  • Second place, Education: Tommy HeyneSonography in Internal Medicine, Baseline Assessment (MGH SIMBA Study), presented by Tommy Heyne, MD, MSt, Massachusetts General Hospital-Department of Internal Medicine and Department of Emergency Medicine.
  • Second place, Clinical Science: Serial Cervical Consistency Index Measurements and Prediction of Preterm Birth < 34 Weeks in Twin Pregnancies, presented by Vasilica Stratulat, CRGS, ARDMS, MD, Sunnybrook Health Sciences.

Up and Comers—In addition to our national awards and our eposter winners, the AIUM also recognizes its New Investigators, which this year were sponsored by Canon.

Nonclinical
Winner— Ivan M. Rosado-Mendez, PhD, for “Quantitative Ultrasound Assessment of Neurotoxicity of Anesthetics in the Young Rhesus Macaque Brain.”

Clinical Ultrasound
Winner— Ping Gong, PhD, for “Ultra-Sensitive Microvessel Imaging for Breast Tumors:  Initial Experiences.”

Honorable Mentions
Juvenal Ormachea, MS,
for “Reverberant Shear Wave Elastography: Implementation and Feasibility Studies.”

Kathryn Lupez, MD, for “Goal Directed Echo and Cardiac Biomarker Prediction of 5-Day Clinical Deterioration in Pulmonary Embolism.”

2019

 

 

Vascular Access for Fiona

Life as a vascular access nurse can be very challenging and diverse in a pediatric hospital. A typical day is fast-paced and includes neonatal, pediatric, and adult patients. Veins may be small, tortuous and often found in unusual locations, eg an extremity or scalp vein. For many patients, imaging tools such as ultrasound are essential for successful placement of IVs, midline catheters, and PICCs. The Vascular Access Team sees patients in both the inpatient and outpatient settings. While many of our procedures are routine, a phone call in February 2017 forever changed the way we view our specialty of vascular access.

The caller on the phone was Amy from the Cincinnati Zoo Marketing Department. She described an urgent clinical situation with Fiona, a 3-week-old premature hippo who was dehydrated and needed IV access. The Zoo staff was desperate as Fiona was not taking any bottles and her IVs were only lasting 8–12 hours. Amy had previous experience with the Vascular Access Team when her daughter had surgery at our institution. She referred to our team as the “Vein Whisperer.” Amy wanted to know if we would be able to use the same tools we used on her daughter to gain IV access with Fiona.pic 8

Fiona was already a star in the eyes of the Cincinnati community. Fiona was born on January 24, 2017, the first premature hippo on record to survive. Fiona was small, around 30 pounds, and was being cared for by a specialized team of experts at the Zoo. Her day-to-day progress was being reported on social media and the local news.

My answer to Amy was, “Of course we can help Fiona!” In my mind, I was thinking of all the things we would need to bring to the Zoo. Supplies included an ultrasound machine, probe cover, ultrasound gel, skin antisepsis, varying sizes and lengths of IV and midline catheters, dressings, etc. I kept thinking…this is a premature hippo, what will we need to insert and maintain the catheter? I asked my colleague Blake to accompany me to the Zoo. Blake is an experienced vascular access nurse and is always up for a challenge! We gathered all our supplies and began our journey to the Zoo.

We arrived in the Hippo Cove area of the Cincinnati Zoo. We met two of the veterinarians who updated us on her condition. Fiona was dehydrated, on oxygen, and extremely weak. They described her condition as critical. We put on special scrubs and removed our shoes. As we were led into the small room where Fiona was, the room temperature was very warm as an effort to maintain Fiona’s body temperature. Fiona was on the floor, laying on a blanket.

Fiona was surrounded by 2–3 Hippo team specialists. Amid their worried looks, they quickly reviewed Fiona’s history, IV access issues, and her inability to take a bottle. Fiona was receiving nutrition through an intermittent naso-gastric tube.

Time was of the essence; we began setting up the 2D ultrasound machine and the necessary supplies. Initially, I scanned her head to assess for any scalp veins, there were no visible veins identified. Blake began scanning her hind leg; she was able to locate a viable vein, about 0.2 cm below the skin. The vein easily compressed and had a straight pathway. Based on her assessment and fluid requirements, we decided to use a 3Fr 8cm midline catheter.

The vein was accessed under ultrasound guidance, using a transverse approach. The midline catheter initially threaded with ease but we were unable to advance it fully. Fluids were connected to the catheter but it only lasted 20 minutes before leaking. The midline catheter was discontinued. Another vein was visualized under ultrasound guidance on the hind leg; the midline catheter was trimmed to 7 cm and threaded with ease. The midline catheter flushed and aspirated with ease.

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Due to Fiona’s occasional activity of standing up, we really wanted a secure catheter. The midline catheter was sutured to her skin and a dressing was applied. We discussed the care and maintenance with the veterinary staff, and the decision was made to infuse continuous fluids through her midline catheter to maintain patency.

Over the next 2 days, Fiona gradually began to regain her strength. She began slowly taking her bottles and standing up. Fiona received 5 liters of fluids over 6 days through her midline catheter. The catheter was discontinued on day 6.

Fast forward and now Fiona has celebrated her 1st birthday. She did so with the Hippo team that provided the delicate care that she needed. The Vascular Access Team is so proud to have been part of her care. On that cold February day, we were able to use our 20+ years of experience and knowledge to provide the right catheter under imaging to provide her with the lifesaving fluids she needed.

 

Have you preformed ultrasound in an unusual situation? Tell us your story by commenting below or letting us know on Twitter: @AIUM_Ultrasound.

Darcy Doellman MSN, RN, CRNI, VA-BC, is Clinical Manager of the Vascular Access Team at Cincinnati Children’s Hospital.