Category Archives: AIUM

Ovarian Cancer Awareness: Risk Factors and Screening Techniques

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There’s nothing lighthearted about ovarian cancer.

Ovarian cancer is often referred to as a ‘silent killer’ because it is usually diagnosed at an advanced stage, when treatment is less likely to result in a complete cure and full recovery.

Why is a reproductive endocrinology and infertility (REI) specialist discussing ovarian cancer? While this disease most commonly affects postmenopausal women over the age of 60 who have completed childbearing, about 10% of cases occur in women under 45, during their reproductive years. This makes ovarian cancer a highly relevant concern within my field.

Although the exact causes of ovarian cancer remain unclear, in women of reproductive age, it is often linked to genetic mutations such as BRCA1, BRCA2, or Lynch syndrome. Other contributing factors may include conditions like endometriosis (particularly endometriomas, where endometrial tissue grows within the ovary), or a family history of ovarian, breast, or colorectal cancer, even in the absence of a confirmed genetic mutation.

There is a common misconception that fertility treatments cause ovarian cancer; however, this is not supported by evidence. It’s important to clarify that women undergoing fertility treatments often have underlying conditions such as endometriosis, which are independently associated with an increased risk of ovarian cancer. The link is one of association, not causation. In fact, ovarian cancer is occasionally first detected by reproductive endocrinology and infertility (REI) specialists during the course of evaluating or treating infertility.

If you have a strong family history of cancer, talk to your doctor about genetic counseling and start early surveillance.

So, how should we approach surveillance for ovarian cancer? Pelvic exams alone are limited in sensitivity and often cannot detect ovarian masses smaller than 5 cm, even in experienced hands. While serum markers such as CA-125, CA 19-9, CA 72-4, CA 15-3, HE4 (human epididymis protein 4), and CEA (carcinoembryonic antigen) are more specific to malignancy, they are not all specific to ovarian cancer and are typically only ordered after a mass has already been identified. These markers are not routinely used in serial testing for early detection.

In contrast, imaging, particularly transvaginal ultrasound with Doppler flow analysis, can detect even small ovarian abnormalities and raise early suspicion for malignancy. When performed regularly in reproductive-age women at risk, ultrasound may aid in detecting ovarian cancer in its earliest stages, when it remains confined to the ovary and before local or distant spread occurs.

Why, then, are physicians hesitant to adopt ultrasound for early ovarian cancer detection? First, from a financial standpoint, performing annual ultrasounds on all women of reproductive age is not cost-effective. Second, because ovarian cancer is relatively rare in this population, the low incidence reduces the test’s sensitivity and positive predictive value, ultimately limiting its effectiveness as a widespread screening tool.

Still, it is essential for physicians to recognize when an ovarian lesion displays features suggestive of malignancy. Two diagnostic tools have significantly advanced the role of ultrasound in evaluating ovarian conditions: the International Ovarian Tumor Analysis (IOTA) group, established in 1999, and the Ovarian-Adnexal Reporting and Data System (O-RADS), introduced in 2021. Both systems provide structured frameworks for assessing and scoring ultrasound characteristics of ovarian lesions, offering a more objective and standardized interpretation.

When an ultrasound-detected lesion raises suspicion for malignancy, further imaging, such as CT or MRI, can offer additional detail, help identify local or distant spread, and support initial staging to guide surgical planning.

As a reproductive endocrinologist, I feel a strong responsibility to support early detection during initial ultrasounds. Ongoing ultrasound surveillance empowers women to take an active role in advocating for their health.

September is Ovarian Cancer Awareness Month, but awareness should be year-round. Speak up about symptoms, intensify surveillance, support research, donate, or simply share this post, as every action counts.

Ovarian cancer may be elusive, but knowledge empowers, and imaging provides proof. Advocate for your health. Support the women in your life. Early detection saves lives, and awareness is the first step.

Laura Detti, MD, is a Professor of Obstetrics and Gynecology, the Division and Fellowship Director of Reproductive Endocrinology and Infertility at Baylor College of Medicine, and Chief of Reproductive Endocrinology Services at the Pavilion for Women at Texas Children’s Hospital. She is also a leader of the AIUM’s Gynecologic Ultrasound Community.

Portrait of Laura Detti, MD, a reproductive endocrinologist, wearing a white lab coat with badges from Baylor College of Medicine and Texas Children's Hospital.

AI as a Clinical Assistant: Enhancing MSK Ultrasound Interpretation and Reporting

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If you haven’t yet tried using an AI assistant in your clinical practice, now is the time to start.

We are standing at the threshold of a shift in how we work. The rise of large language models (LLMs)—text-based AI systems like Chat GPT that can interpret, generate, and summarize content—offers clinicians a remarkable opportunity: to work faster, think broader, and document smarter. I want to be clear that these tools are still evolving, but their usefulness in the day-to-day reality of musculoskeletal ultrasound is already tangible, even resulting in substantial changes.

An AI-generated image of Dr Wilcox scanning a patient with an AI avatar in the background

In my own sports medicine practice, AI has become a quiet but powerful assistant. It’s not replacing clinical expertise; it’s extending it. Over time, I’ve found a sweet spot—not in making decisions for me, but in helping me think more clearly. One of the most practical ways I use LLMs is for differential generation. I paste in my ultrasound findings and impression and ask for a possible differential diagnosis list. The results are consistently thought-provoking. Typically, it reflects five or six diagnoses I already had in mind; throws in a couple I disagree with outright; and adds two or three that surprise me, and deserve a closer look. Especially in complex or uncertain cases that prompt a pause and consideration of something new that can be invaluable.

Some mainstream AI platforms even promise image interpretation. My experience? These are not yet ready for prime time. Results can be inconsistent; accuracy is still highly variable. But for text-based assistance—where language, not pixels, is the primary input—LLMs can make the difference.

One area where AI shines is in reducing the friction of tedious or repetitive tasks. Prior authorizations, for example, used to eat up valuable time and mental bandwidth. Now, I can copy a de-identified clinical summary and the insurance denial into an LLM and request a short appeal letter. It generates a polished draft that often needs only light editing. Occasionally, I’ll even ask the AI why it thinks the request was denied—it often gives helpful insight I can use in peer-to-peer calls.

The same applies to documentation templates. I’ve built standard templates for common joints, but what about when a patient presents with something less routine, such as a region I haven’t scanned often enough to have a template, like the sternoclavicular joint? I give the model an existing template and ask it to adapt it to the new joint. The results? Fast, accurate, and easy to refine. Here’s a quick look at how I use AI in daily practice:

  • Differential support: Expands my diagnostic horizons, especially in unusual or complex cases.
  • Template generation: Converts existing structures into less common regions or patient types with minimal effort.
  • Prior auths & letters: Speeds up appeal writing; reduces emotional exhaustion from repetitive documentation.
  • Note polishing: Transforms shorthand findings into clean, communicative notes for specialists or patients.

But let’s be clear: none of this replaces the responsibility we carry as clinicians. AI is a powerful tool, but it must be used wisely. A recent study from MIT (Your Brain on ChatGPT) found that users writing essays with AI support showed lower brainwave activity, suggesting a reduction in active cognitive processing. The lesson here is sharp: when we outsource too much thinking, our ability to reason, synthesize, and create diminishes.

We cannot allow that to happen in medicine. What we document, what we diagnose—these remain our responsibility. AI can offer suggestions, but only we can make decisions. Every recommendation must be filtered through our personal, sound clinical judgment.

So yes—use AI to sharpen your workflow, expand your thinking, and save time. But use it with intention. Let it challenge your thinking, not do your thinking. Let it shape your creativity, not replace it. When used well, AI doesn’t flatten our clinical voice; it amplifies it. It helps us become more precise, more efficient, and, most importantly, more present with the people we serve.

References: Kosmyna N, Hauptmann E, Yuan YT, et al. Your brain on ChatGPT: accumulation of cognitive debt when using an AI assistant for essay writing task. Preprint. Submitted June 10, 2025. Accessed 7/8/2025. Available from: https://arxiv.org/abs/2506.08872

James Wilcox, MD, RMSK, is a family medicine and sports medicine physician in the United Arab Emirates, where he is the Director of the ProMotion Sports Medicine Clinic at Specialized Rehabilitation Hospital in Abu Dhabi, and Assistant Professor of Family Medicine at UAE University..

This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the view of their employer or the American Institute of Ultrasound in Medicine.

Ensuring High Standards in Ultrasound Practice: Building a Strong Personnel QA Program 

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Quality ultrasound imaging begins with the people behind the probe. Whether you’re a small clinic or a large multi-specialty practice, developing and maintaining a strong Personnel Quality Assurance (QA) program is vital to ensuring safe, consistent, and accurate ultrasound exams. 

A comprehensive QA program evaluates the performance of all ultrasound personnel, including sonographers, interpreting physicians, and other involved staff, through regular, structured peer reviews. These evaluations go beyond technical ability to include documentation accuracy, adherence to protocols, and diagnostic performance. 

At the heart of any successful QA initiative is leadership. Oversight is typically provided by an Ultrasound Director (often a physician or advanced practitioner, depending on the setting) alongside a Lead Sonographer or technologist. This team is responsible for managing assessments, tracking competency, and guiding staff development. 

Reviews should be conducted at least annually, with many practices opting for quarterly or semi-annual check-ins. These reviews may also be triggered by events such as new staff onboarding, changes in equipment or protocols, or the identification of performance issues. During evaluations, practices should assess metrics such as image quality, labeling, anatomical coverage, report accuracy, and compliance with established guidelines. 

But what happens when gaps or deficiencies are identified? A strong QA program doesn’t just identify problems; it addresses them constructively. Feedback, targeted training, and follow-up evaluations are all essential components of continuous improvement. Training might include one-on-one mentorship, workshops, or online modules, and should be tailored to specific performance concerns. 

To maintain momentum, practices should reinforce learning through periodic reviews, mentorship, and easy access to updated educational materials. When QA becomes a regular part of performance discussions and professional development, it creates a culture of accountability and excellence. 

Ultimately, a well-structured Personnel QA program not only ensures compliance with accreditation requirements, such as those from the American Institute of Ultrasound in Medicine (AIUM), but also enhances patient care and safety. Through thoughtful leadership, structured reviews, and a commitment to ongoing education, ultrasound practices can raise the bar for quality and deliver better outcomes for every patient they serve. 

Catherine Knight, BS, RDMS, is the Senior Accreditation Manager for the American Institute of Ultrasound in Medicine (AIUM). 

Enhancing Diagnostic Accuracy With Musculoskeletal Ultrasound

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Imagine this: a new patient, Sarah, walks into my clinic. She’s a weekend warrior, an avid tennis player, and for the past month, persistent right shoulder pain has kept her off the court. She’s frustrated and a little scared, worried about a serious tear.

During my initial examination, several possibilities jump out—rotator cuff tendinopathy? Subacromial bursitis? Maybe even a partial tear of her supraspinatus? Traditionally, my next step would involve a series of special tests, which can be helpful but sometimes ambiguous.

Now, however, I have a powerful ally: diagnostic musculoskeletal ultrasound. As I gently guide the transducer over Sarah’s shoulder, the structures beneath her skin come alive on the screen. We can see her rotator cuff tendons in real-time. Is there thickening? Fluid? A visible tear?

In Sarah’s case, the ultrasound quickly helped me rule out a significant rotator cuff tear – a huge relief for her! Instead, we observed inflammation around her biceps tendon and a thickened bursa. This clarity was invaluable. Not only did it allow me to formulate a precise plan of care targeting her specific issues, but Sarah was right there, watching the screen with me. Seeing the actual images of her shoulder, with my explanations, transformed her understanding and fostered immediate buy-in for the rehabilitation plan. That “Aha!” moment, for both patient and therapist, is priceless.

My journey incorporating diagnostic musculoskeletal ultrasound into both my sports physical therapy and outpatient settings has been a game-changer, extending far beyond that initial diagnostic puzzle. Its impact on my diagnostic capacity is profound. While our hands and clinical reasoning skills are paramount, ultrasound offers a direct visual confirmation (or refutation) of our hypotheses. It allows me to pinpoint the exact location and extent of soft tissue injuries – a tendinopathy versus a tear, the degree of inflammation in a bursa, or even subtle nerve entrapments.

This isn’t about replacing our clinical skills; it’s about augmenting them, adding a layer of precision that was previously unattainable without more expensive or invasive imaging.

This enhanced diagnostic accuracy directly translates into a greater capacity to carry out effective treatments. Knowing precisely what structure is involved, and to what extent, allows for highly targeted interventions. For instance, if ultrasound identifies a specific area of neovascularization within a tendon (a sign of tendinopathy), I can more accurately guide interventions like eccentric exercises or instrument-assisted soft tissue mobilization to that precise area. 

Perhaps one of the most rewarding aspects of using musculoskeletal ultrasound is the significant improvement in patient rapport and trust. Like Sarah, patients are no longer just passive recipients of my diagnostic opinion. They become active participants in their own understanding. When they can see the image of their injured tendon or inflamed bursa on the screen, and I can point out exactly what’s happening and how our treatment plan will address it, their comprehension and confidence in the plan soars.

This visual evidence demystifies their pain and empowers them. It transforms the conversation from “I think this is what’s wrong” to “Let me show you what’s going on.” This shared understanding builds a stronger therapeutic alliance, leading to better adherence to home exercise programs and a more collaborative approach to rehabilitation.

Musculoskeletal ultrasound has become an indispensable tool in my practice. It sharpens my diagnostic skills, refines my treatment strategies, and, most importantly, empowers my patients by allowing them to truly see and understand their path to recovery. It’s an investment that pays daily dividends in clinical certainty and patient trust.

Pablo Borceguin Jr., PT, DPT, is a doctor of physical therapy with an emphasis on orthopedics and sports.

This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the views of their employer or the American Institute of Ultrasound in Medicine.

Advanced Imaging of the Fetal Heart

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Following the first demonstration of the fetal face in 1989 and the advent of fast processors around 2000, 3D and 4D ultrasound have become important tools in obstetric imaging over the past decade. Unlike 2D imaging, 3D ultrasound provides a volume of a region of interest that contains an infinite number of 2D planes. Mechanical and electronic transducers have the ability to acquire volumes of target organs through sweeps, and fast processors are able to display the acquired information within seconds. The operator can then choose to display this information in a multiplanar format of 2D images or as a spatial volume projecting the external or internal anatomic features on the screen.

Static 3D, spatiotemporal image correlation (STIC), or 4D imaging can be used to acquire a cardiac volume with a mechanical or electronic transducer. The best cardiac volumes are acquired using the STIC technique. Ideally, it can be used for offline assessment of cardiac structures and movements. Color Doppler, power Doppler, bidirectional power Doppler (high-definition flow), and B-flow modes can be combined with STIC acquisitions.

These volumes can be displayed with the color information alone, the grayscale information alone, or a combination of both, referred to as “glass-body” mode. A light source can emphasize the effect of depth.

If anomalies involving the four-chamber anatomy can be visualized similarly to the 2D image with color Doppler, anomalies involving the great vessels clearly demonstrate the superiority of 3D. Size difference, flow direction, and spatial relationship of the great vessels are some of the information that can be visualized with 3D color Doppler and “glass-body” mode. 3D imaging can, therefore, be used to explain anomalies to future parents and explore treatment options with colleagues.

The major limitations of the STIC technique include delayed acquisition time and movement artifacts due to fetal movements or maternal breathing movements.

Here are two examples where 3D color Doppler and “glass-body” mode are superior to 2D imaging in the assessment of fetal heart anomalies. 

A double aortic arch results from the persistence of right and left aortic arches. The left ductus arteriosus persists while the right ductus arteriosus regresses. Each aortic arch gives rise to a subclavian and a common carotid artery. A double aortic arch forms a tight vascular ring around the trachea and esophagus. This condition requires surgical intervention postnatally.

3D ultrasound image displaying major fetal heart structures, including the left and right aortic arches (LAo and RAo), pulmonary artery (PA), ductus arteriosus (DA), and superior vena cava (SVC).
3D ultrasound with the grayscale information alone in a fetus with the diagnosis of double aortic arch. The aorta can be seen bifurcating into a right and left aortic arch, forming a complete vascular ring around the trachea.

The part of the complete ring behind the trachea is not seen in this plane. It is better demonstrated with 3D color Doppler.

3D ultrasound image showing a fetus diagnosed with a double aortic arch, labeling the right aortic arch (RAo), left aortic arch (LAo), ductus arteriosus (DA), and pulmonary artery (PA). The image highlights the complete vascular ring formed around the trachea.
3D ultrasound in color Doppler in the same fetus. Note the bifurcation of the aortic arch into right and left aortic arches with the left ductus arteriosus, thus forming a vascular ring surrounding the trachea.

A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or a great vessel.

3D color Doppler ultrasound image showing the positioning of the pulmonary artery (PA) and aortic arch (Ao) in fetal heart anatomy.
3D color Doppler image showing fetal aortic arch (Ao) and pulmonary artery (PA) with visual indicators of blood flow direction.
3D ultrasound image of a fetal heart showing the right ventricle (RV), left ventricle (LV), right atrium (RA), and left atrium (LA) with color Doppler overlay.

3D color Doppler and “glass-body” mode allowed the visualization of the CAF over an entire cardiac cycle.

References:

Chaoui R, Heling K-S. 3D Ultrasound in Prenatal Diagnosis: A Practical Approach. 2nd ed. Berlin, Germany: DeGruyter; 2024.

Abuhamad A, Chaoui R. A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts. 4th ed. Philadelphia, PA: Lippincott-Williams Wilkins; 2022.

Tekesin I, Uhlemann F. Prenatal diagnosis of coronary artery fistula using 2D and 3D/4D ultrasound. Ultrasound Obstet Gynecol 2017; 51:274-275.

Vladimir Lemaire, MD, RDMS (Ob/Gyn, FE), is a Maternal-Fetal Medicine Sonographer at UT Southwestern Medical Center in Dallas, Texas.

This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the view of their employer or the American Institute of Ultrasound in Medicine.

Focused Ultrasound as a Therapeutic Tool

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Ultrasound, long regarded as a diagnostic mainstay, is now poised to reshape how the medical community approaches treatment, particularly in the field of neurology. In a keynote presentation at the American Institute of Ultrasound in Medicine (AIUM) annual meeting, Dr. Ali Rezai of West Virginia University offered a compelling overview of how focused ultrasound is rapidly gaining traction as a therapeutic tool. His message was clear: the future of ultrasound will not be limited to imaging. It will play an increasingly vital role in treating complex brain disorders.

Used with permission from AuntMinnie.com

The use of focused ultrasound, whether high- or low-intensity, is opening new avenues in managing diseases like Parkinson’s, Alzheimer’s, epilepsy, and even addiction. These technologies deliver targeted soundwaves to precise regions of the brain, allowing clinicians to modify neural activity, open the blood-brain barrier for drug delivery, or ablate diseased tissue, all without a surgical incision.

High-intensity focused ultrasound (HIFU), which uses frequencies ranging from 20 kHz to 200 MHz, is already being used to treat patients with movement disorders such as essential tremor and Parkinson’s disease. The procedure is performed under MRI guidance, with patients wearing a specialized helmet containing around 1,000 ultrasound transducers. These transducers concentrate energy on specific brain structures involved in abnormal motor control. According to Dr. Rezai, patients often see immediate improvement, regaining function within hours and returning home the same day, an outcome that significantly reduces both recovery time and risk.

On the other end of the spectrum, low-intensity focused ultrasound (LIFU) is being investigated for its ability to transiently open the blood-brain barrier, which is a major challenge in the treatment of central nervous system conditions. This technique allows therapeutic agents that would otherwise be blocked to reach their targets more effectively. One area of active research is Alzheimer’s disease. Clinical trials suggest that LIFU can reduce amyloid plaque burden, a hallmark of the disease, simply by enabling targeted delivery or enhancing the brain’s own clearance mechanisms. In one study led by Dr. Rezai, patients receiving both focused ultrasound and anti-amyloid antibody therapy experienced greater reductions in plaque levels with minimal side effects.

LIFU is also being explored for neuromodulation—altering brain activity to treat psychiatric and behavioral disorders. By targeting deep brain structures involved in reward and craving, ultrasound has the potential to help patients with substance use disorders or behavioral addictions. Preliminary data from a small clinical study show that even a single treatment session aimed at the brain’s nucleus accumbens reduced cravings, with some patients reporting sustained effects.

Dr. Rezai emphasized that these breakthroughs are not theoretical. His team at the Rockefeller Neuroscience Institute is performing these procedures weekly, and demand is increasing. “We’re in desperate need for therapeutic strategies because people are living longer,” he said.

As this field matures, the implications extend far beyond traditional neurology. Focused ultrasound for therapeutic use is drawing interest from neurosurgeons, psychiatrists, biomedical engineers, and data scientists. The integration of real-time imaging, precision targeting, and noninvasive energy delivery makes it a uniquely versatile platform. It may not be long before therapeutic ultrasound becomes a standard tool in multidisciplinary care, ushering in a new era where sound not only reveals what’s happening inside the body but also helps restore function and quality of life.

The future is very bright for therapeutics and using focused ultrasound
— Dr. Ali Rezai

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Abdominal Aortic Aneurysms and Ultrasound

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An abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta that, if undetected or untreated, can lead to life-threatening rupture. Often asymptomatic, AAAs can lead to catastrophic outcomes if they rupture, making early detection and monitoring crucial. Fortunately, ultrasound imaging plays a central role in early diagnosis, ongoing surveillance, and even postoperative management, making it a cornerstone in efforts to reduce AAA-related deaths.

What is an Abdominal Aortic Aneurysm?

The abdominal aorta is the largest artery in the abdomen, supplying blood to the lower body. An AAA occurs when a segment of this artery becomes weakened and bulges outward. An aortic diameter of 3.0 cm or more is typically considered aneurysmal. Risk factors include age (especially over 65), male sex, smoking, high blood pressure, and a family history of aneurysms.

Because most AAAs do not cause symptoms, routine screening is essential in high-risk populations. Men over 65 who have ever smoked are commonly advised to undergo a one-time screening, which is most effectively conducted using ultrasound.

The Role of Ultrasound in Diagnosis

Ultrasound is the first-line imaging modality for AAA screening due to its noninvasive nature, lack of ionizing radiation, cost-effectiveness, and accuracy. It can detect an aneurysm with high sensitivity and specificity, and provide precise measurements of the aorta’s diameter, helping determine whether an aneurysm is present and how large it is.

A recent study published in an article in the Journal of Ultrasound in Medicine (JUM; doi:10.1002/jum.15401) underscores the value of ultrasound in identifying aortic pathology early. This study showed that ultrasound training using low-cost, realistic phantoms improved detection accuracy, supporting the widespread use of ultrasound screening programs and skill development among clinicians.

In emergency settings, ultrasound can be deployed at the bedside for rapid diagnosis in patients with suspected AAA rupture. This is particularly valuable in hemodynamically unstable patients, where time is critical. Real-time imaging allows clinicians to confirm the presence of an aneurysm and initiate life-saving interventions without delay.

Monitoring and Surveillance

Not all AAAs require immediate surgery. For aneurysms under 5 cm in diameter, regular monitoring is typically recommended. Ultrasound allows for safe, repeatable, and accurate measurements over time to assess growth rates and determine when intervention is necessary.

Postoperative Follow-Up

In cases in which surgery was needed, however, ultrasound is also integral in post-treatment monitoring, especially following endovascular aneurysm repair (EVAR). It can identify complications such as endoleaks—continued blood flow into the aneurysm sac outside the stent graft—which may increase the risk of rupture. Surveillance protocols often rely on ultrasound to reduce the need for repeated CT scans, limiting patient exposure to radiation and contrast agents.

Another article in the JUM (doi:10.1002/jum.16374) examined advanced ultrasound methods for identifying endoleaks, highlighting how innovations like coded-excitation imaging can improve diagnostic clarity and reliability in follow-up care.

Ultrasound image showing a localized abdominal aortic aneurysm (AAA) with measurements indicated, displaying the cross-section of the aorta.

Evolving Techniques and Considerations

Ultrasound technology continues to evolve. For instance, recent investigations into the effects of transducer pressure on aortic wall stiffness measurements (arXiv:2312.07980) indicate that even subtle operator-dependent variables can impact results. Standardization in measurement techniques will enhance consistency and accuracy in monitoring AAAs, particularly as stiffness metrics gain interest for their potential to reflect aneurysm stability.

Additionally, the development of realistic and inexpensive ultrasound phantoms has facilitated better training and demonstration of aortic pathology detection, improving diagnostic accuracy and clinician proficiency.

Final Thoughts

Ultrasound’s versatility, safety profile, and diagnostic precision make it indispensable in the detection and management of abdominal aortic aneurysms. From identifying at-risk individuals during routine screenings to guiding urgent interventions and long-term follow-up, ultrasound’s role in vascular care continues to grow. As research and technology refine its capabilities, the potential to further improve outcomes for patients with AAAs becomes ever more promising.

Ultrasound Imaging in Sport: Seeing the Unseen to Shape the Season

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May – the month when athletic champions are crowned, summer training programs ignite, and our collective spirit turns toward movement – is also National Physical Fitness and Sports Month. As we spotlight peak performance and injury prevention, one tool continues to gain ground in the world of sports medicine: ultrasound imaging.

Ultrasound imaging, long valued as a point-of-care diagnostic tool providing real-time evaluation of a variety of neuromusculoskeletal structures, has rapidly become an important component of the assessment and care of athletes in a variety of fitness and sports settings. Not only is ultrasound imaging used as a diagnostic tool to evaluate soft tissue injuries, but it has become increasingly important in the hands of sports medicine specialists for identifying risk factors for sports injuries before symptoms arise. This is where the conversation gets interesting!

A Season in the Life of a Tendon

A recent study by Savage et al (Inter J Physiother, 2024) used high-resolution ultrasound imaging to examine changes in tendon and bone health among Division I female volleyball athletes across their competitive season. The study examined body regions most injured in competitive volleyball players, including shoulders, knees, ankles, and feet, which have soft tissues that are under the most stress from the cumulative demands of repetitive jumping, landing, and hitting.

The findings? Over 90% of the athletes had preseason tendon or bony abnormalities despite most not reporting significant symptoms. Tendon cross-sectional area changed significantly over the course of the competitive season, particularly the Achilles and patellar tendons.

Ultrasound image displaying intrasubstance defects in a tendon, highlighting areas of concern for sports medicine assessment.

Significantly more athletes ended the season with sonographic abnormalities in four or more body regions than when they began the season.

Ultrasound image showing a cortical defect and hypoechoic tendon thickening in a patient's tendon, aiding in sports medicine diagnostics.

What does this mean? These Division I athletes had sonographic signatures of soft tissue strain and adaptation related to the physical demands of the competitive volleyball season. While many of these athletes remained asymptomatic or mildly symptomatic, most were able to finish the competitive season.

However, recent study by Cushman et al (Orthop J Sports Med, 2024) found that baseline sonographic tendon abnormalities in athletes are predictive of future injury.

Ultrasound as a Performance Barometer

So, what are we looking at when we point the transducer? Tendon thickening? Focal hypoechoic zones? Calcaneal enthesophytes? Perhaps. But more broadly, we are capturing a physiological fingerprint of sport-specific loading. In this context, ultrasound imaging is more than just a diagnostic tool, it becomes a training and screening tool by:

  • Detecting early soft tissue changes before symptoms develop
  • Guiding load management strategies during the competitive season
  • Tracking recovery and response to training and interventions
  • Providing real-time comparison between limbs and soft tissues over time
Ultrasound image showing hypoechoic tendon thickening, indicating possible soft tissue changes.

These are just some examples of the value of ultrasound imaging in fitness and athletic settings, but this conversation echoes a growing trend in the sports medicine world: pairing point-of-care ultrasound imaging with athlete monitoring is an innovative application to better train and manage athletes before an injury sends them to the training room or sports medicine clinic.

Ultrasound image showing a tendon defect and a cortical defect with labeled arrows indicating their locations.

Don’t Diagnose in a Vacuum

Of course, not every tendon or bony abnormality seen on ultrasound imaging is teetering toward meaningful damage or an injury. As with all imaging modalities, ultrasound must be interpreted alongside the clinical examination, sport-specific demands, body composition variables, prior injuries, and functional status. That’s what makes the sports medicine specialist’s job so interesting! Being valuable stewards of this safe and cost-effective point-of-care technology means that ultrasound imaging can be used to amplify our clinical reasoning.

Let’s Keep the Conversation Going
As we celebrate athleticism this month, consider how ultrasound imaging can play a larger role in your sports medicine practice or training program by asking:

  • Can preseason scanning inform an athlete’s training program and load adjustments?
  • Can ultrasound imaging identify athletes at risk for developing an injury?
  • What stories are hidden beneath the surface – Are there other innovative applications of ultrasound imaging that can benefit fitness and sports enthusiasts?
  • How have you used ultrasound imaging to guide decisions about fitness programs or to the training and care of an athlete?

What have you seen? I would love to hear your comments and insights about how you are integrating ultrasound imaging into the science of movement! Comment or connect with me on LinkedIn (www.linkedin.com/in/nathan-savage-wssu) or X (@DrNathanJSavage).

Dr. Nathan J. Savage, PhD, DPT, RMSK, is an Associate Professor of Physical Therapy with expertise in neuromusculoskeletal ultrasound. His research focuses on integrating imaging into clinical decision-making for injury prevention, rehabilitation, and sports performance.

This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the view of their employer or the American Institute of Ultrasound in Medicine.

Understanding the Impact of Preeclampsia on Fetal Heart Health

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Preeclampsia, a serious condition marked by high blood pressure and potential organ damage during pregnancy, affects about 4–5% of pregnancies worldwide. While its dangers to mothers are well-documented, growing attention is being paid to how it affects unborn children, particularly their heart health.

A study in 2023 explored how the severity of preeclampsia and the level of proteinuria (protein in urine) influence fetal cardiac function.

Why Fetal Heart Health Matters in Preeclampsia

The fetal heart plays a critical role in adapting to the stressors of an abnormal intrauterine environment caused by preeclampsia. With placental blood flow compromised due to poor vascular development and high resistance, the fetus often experiences hypoxia and increased pressure. These conditions can subtly alter heart function even before birth.

Previous research has suggested that fetuses exposed to preeclampsia may have a higher risk of cardiovascular disease later in life. But how early do these changes start? And does the severity of the mother’s condition make a difference?

Signs of Stress in the Fetal Heart

In the 2023 study, fetuses in the preeclampsia group showed notable changes in both systolic (pumping) and diastolic (filling) heart functions compared to the control group. Specifically, the researchers observed:

  • Reduced ventricular relaxation and compliance — evidenced by lower early and late diastolic velocities (E and A waves) and longer isovolumetric relaxation times.
  • Diminished myocardial contractility — reflected in reduced mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) and lower systolic velocities (S0 values).

These findings suggest that even before birth, the hearts of fetuses in preeclamptic pregnancies may be under increased strain.

The Role of Proteinuria and Severity

Interestingly, the study also revealed that more severe preeclampsia and higher proteinuria levels (>3 g/24 hr) were associated with more pronounced changes in fetal heart function. This is especially relevant given that proteinuria was removed from the official diagnostic criteria for preeclampsia in 2013. Yet, clinical observations and studies like this one highlight its continued relevance in assessing risks to both the mother and the fetus.

For example, fetuses in the group with higher proteinuria had significantly lower values in key diastolic function markers, suggesting reduced ventricular compliance. This could mean that fetuses in these pregnancies rely more on atrial contraction to fill their ventricles, which is an early sign of cardiac strain.

A Call for Enhanced Monitoring

One of the study’s most significant takeaways is the value of tissue Doppler imaging (TDI) in detecting early and subtle changes in fetal heart function. Because TDI can assess the movement of myocardial tissue independently of blood flow, it’s particularly useful in identifying subclinical dysfunction before more overt signs of distress appear.

Given these findings, enhanced fetal cardiac monitoring may be warranted in pregnancies complicated by preeclampsia, especially those with higher levels of proteinuria or classified as severe. Earlier detection could guide better perinatal care and potentially inform follow-up strategies after birth.

For More Information

The full research article, titled “Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions?” by Derya Uyan Hendem et al., is published in the Journal of Ultrasound in Medicine (2023). You can read the detailed study here.

Overcoming Common Ultrasound Scanning Challenges: Practical Tips for Sonographers

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Ultrasound is an essential imaging tool in modern medicine, offering visualization of soft tissues, organs, and vascular structures. However, even the most experienced sonographers encounter obstacles that can make obtaining clear images difficult. From excessive bowel gas obscuring structures to scanning patients with high body mass indexes (BMIs), these challenges require skill, adaptability, and technical adjustments. Here are some of the most common ultrasound scanning challenges and practical solutions to optimize imaging.

1.  Imaging the Aorta in Gassy Patients

Few things are as frustrating as trying to visualize the aorta when excessive bowel gas gets in the way. Gas scatters ultrasound waves, making it difficult to see vascular structures clearly.

Solutions:

  • Use an Intercostal Approach: Instead of scanning anteriorly, try navigating through the intercostal spaces on the right side to bypass gas-filled loops of bowel.
    • Apply Steady, Firm Pressure: Pressing gently on the abdomen can help displace gas and improve sound wave penetration.
  • Change the Frequency: A lower-frequency transducer (such as a curvilinear probe at 1–6 MHz or 2–5 MHz) allows deeper penetration, sometimes improving visibility despite gas interference.

Video Link: Watch here

2.  Scanning High BMI Patients

Larger patients present challenges due to increased soft tissue thickness, which can reduce image resolution and penetration.

Solutions:

  • Use a Lower Frequency Transducer: A 1–6 MHz or 2–5 MHz curvilinear transducer enhances penetration, even if it sacrifices some resolution. This is especially useful when scanning larger patients, such as when ruling out lower extremity DVTs. While linear probes are common for vascular imaging, don’t hesitate to use whatever transducer best visualizes the patient’s anatomy, whether it’s curvilinear, phased array, or another alternative.
    • Increase the Time Gain Compensation (TGC): Adjusting the TGC enhances contrast and clarity in deeper structures.
  • Optimize Patient Positioning: Having the patient roll onto their side allows gravity to shift excess tissue, improving visualization. Right Lateral Decubitus (RLD) positioning works well for imaging the spleen and left kidney, while Left Lateral Decubitus (LLD) positioning is ideal for the right kidney, gallbladder, and the dome of the liver.
  • Utilize Harmonic Imaging: This setting helps reduce artifacts and enhances contrast resolution for clearer imaging.
Ultrasound image showing a longitudinal view of the proximal aorta, used for evaluating vascular structures and potential obstructions.
Photo: This image shows the aorta of a patient with a BMI of 50+, captured using an intercostal approach. (Fun fact: “Intercostal” just means between the ribs!)

3.  Evaluating Deep or Small Vessels

Poor acoustic access can make visualizing small or deep vessels, such as the popliteal artery or small renal arteries, difficult.

Solutions:

  • Use Color and Power Doppler: Increasing Doppler sensitivity helps detect slow-moving blood flow in deep or small vessels.
  • Optimize the Angle of Insonation: Keeping the Doppler angle between 45 and 60 degrees improves velocity accuracy.
  • Apply Gentle Compression: This technique helps differentiate veins from arteries and optimize visualization. I frequently use this when assessing ankle-brachial index (ABI) ratios in calcified arteries near the ankle.

4.  Differentiating Cysts From Solid Masses

Distinguishing between cystic and solid structures can be tricky, especially when artifacts mimic fluid-filled lesions.

Solutions:

  • Use Multiple Imaging Planes: Scanning from different angles helps confirm whether a structure is truly cystic or solid. Always assess the kidneys from multiple planes—exophytic masses and cysts love to hide where you least expect them.
  • Apply Color Doppler: Cysts will not show internal blood flow, while vascularized solid masses will have detectable Doppler signals.
  • Adjust Gain Settings: Lowering overall gain can help differentiate hypoechoic solid structures from fluid-filled cysts.

Conclusion

Ultrasound scanning challenges are inevitable, but a skilled sonographer can overcome them with the right techniques. Adjusting transducer settings, modifying patient positioning, and using alternative scanning approaches can significantly improve image quality. By staying adaptable, sonographers can ensure optimal imaging, leading to more accurate diagnoses and better patient outcomes.

Let’s Stay Connected!

Theresa Jenkins, BS, RDMS, RVT

I hope these tips help you tackle ultrasound challenges with confidence! Connect with me on LinkedIn or check out my YouTube channel, Path2Passing, for more ultrasound insights and updates!

🔗 LinkedIn: Theresa Jenkins
🎥 YouTube Channel: Path2Passing
✍ Author: Theresa Jenkins, BS, RDMS, RVT

Theresa Jenkins BS, RDMS, RVT, is a seasoned sonographer with nearly seven years of experience, having worked in top facilities nationwide. Credentialed in general, vascular, and pediatric ultrasound, she is also an educator and author with plans to become a leading voice in sonography.

This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the view of their employer or the American Institute of Ultrasound in Medicine.