Ultrasound’s Hidden Superpowers and Why We Celebrate Them Every October

Posted on October 14, 2025 by aium1952

Every October, the medical imaging community comes together to observe Medical Ultrasound Awareness Month (MUAM), a period dedicated to raising public understanding of the ultrasound’s vital role in healthcare. Sponsored by organizations such as the American Institute of Ultrasound in Medicine (AIUM), the American Registry of Diagnostic Medical Sonographers (ARDMS), the American Society of Echocardiography (ASE), Cardiovascular Credentialing International (CCI), the Society of Diagnostic Medical Sonography (SDMS), and the Society for Vascular Ultrasound (SVU), MUAM seeks to dispel the common misconception that ultrasound is mainly for pregnancy and to shine a light on its many other life-changing uses.

While many people immediately think of fetal imaging when they hear “ultrasound,” that’s only one of many applications. In fact, ultrasound helps patients at every stage of life, from newborns to seniors, across numerous medical fields. MUAM is a perfect time to celebrate the often-unseen breadth of ultrasound and the professionals who use it.

Why a Special Month for Ultrasound?

Ultrasound is safe, widely available, and cost-effective. Because it doesn’t rely on ionizing radiation (as with X-rays or CT scans), it offers a gentler imaging option, particularly for soft tissues.

The purpose of MUAM is to encourage professionals to educate patients, colleagues, and the public about how ultrasound supports diagnosis, monitoring, and treatment across a diversity of conditions.

Beyond Babies: Diverse Applications of Medical Ultrasound

Here’s a look at just a few of the many ways ultrasound is used outside obstetrics:

1. Cardiac / Echocardiography

Ultrasound is widely used to visualize the heart’s structure and function, assess valve integrity, detect fluid around the heart (pericardial effusion), and monitor things like left ventricular ejection fraction.
Doppler ultrasound can also show blood flow velocities, helping to detect stenosis or regurgitation in valves.

2. Vascular and Circulatory Imaging

Doppler vascular ultrasound can assess veins and arteries, detecting blockages, clots (eg, deep vein thrombosis), or stenosis.
It’s used to examine carotid arteries (for stroke risk), peripheral arteries (leg circulation), and vascular grafts.

3. Abdominal and Pelvic Imaging

Ultrasound is often used to evaluate organs like the liver, gallbladder, spleen, kidneys, pancreas, and bladder.
It can detect gallstones, kidney stones, hydronephrosis, liver masses, or fluid collections (eg, ascites).
In the pelvis outside pregnancy, it helps assess uterine/ovarian pathology, fibroids, pelvic fluid, or masses.

4. Musculoskeletal (MSK) Imaging

Ultrasound is used to image muscles, tendons, ligaments, joints, and nerves.
It helps in diagnosing tendon tears, bursitis, muscle strain, nerve entrapment (eg, carpal tunnel), and joint inflammation.
It also guides injections or aspirations.

5. Pediatric Imaging

In infants and children, ultrasound is often the first-line imaging for soft tissues, head/neck, hips (developmental dysplasia), and neonatal brain (via fontanelles).
Because it’s radiation-free, it’s especially favorable for young patients.

6. Point-of-Care Ultrasound (POCUS)

In emergency, critical care, and bedside settings, physicians use handheld or portable ultrasound to rapidly evaluate ailments such as fluid around the lungs (pleural effusion), free fluid in the abdomen, cardiac tamponade, or guidance during central line placement.
This real-time use can expedite diagnosis and treatment.

7. Interventional / Intraoperative Ultrasound

Surgeons sometimes use ultrasound during procedures to locate lesions, guide resections, or assist in biopsies or ablations.
Interventional radiologists may use ultrasound guidance for needle placements (biopsy, drainage) and local therapies.

8. Therapeutic Ultrasound & Special Applications

Beyond imaging, ultrasound has therapeutic uses (eg, high-intensity focused ultrasound, ultrasound-assisted drug delivery).
In neurology and neuroscience, for example, therapeutic ultrasound is being explored in treating conditions like Alzheimer’s disease or other brain disorders.
In space medicine, ultrasound is one of the few imaging options available aboard the International Space Station (ISS). As part of the Advanced Diagnostic Ultrasound in Microgravity project, astronauts use ultrasound to assess various organ systems in microgravity.

How You Can Support Ultrasound Awareness
(Especially This October)

Share knowledge: If you’re a clinician or educator, talk with colleagues or patients about the many roles of ultrasound.
Use social media: Companies and organizations often use hashtags like #MUAM2025 to share educational images, infographics, or stories.
Celebrate sonographers and ultrasound technologists: Recognize the skill, dedication, and meticulous work of these professionals.
Invite engagement: Host a webinar, post Q&A content, or distribute simple “Did you know?” facts about ultrasound to patients.

Final Thoughts

Medical Ultrasound Awareness Month is more than a promotional event. It’s an opportunity to correct a common misconception: ultrasound is not just for pregnancy. From the heart to the knees to the kidneys, even to outer space, ultrasound plays a vital, versatile role in modern medicine.

Let’s use October’s spotlight to help people see inside, not just for babies but for better health at every age.

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

Ultrasound in Prostate Disease: Rethinking an Old Standard

Posted on September 30, 2025 by aium1952

When was the last time you really reconsidered the power of ultrasound in evaluating prostate disease? For many clinicians, TRUS (transrectal ultrasound) is synonymous with biopsy guidance. It’s mechanical, familiar, and perhaps even taken for granted. But prostate ultrasound is evolving. And if you haven’t revisited its capabilities lately, you may be missing a revolution happening in prostate ultrasound.

Prostate ultrasound is no longer just about finding hypoechoic lesions in the peripheral zone. Thanks to modern advancements such as shear wave elastography, micro-ultrasound, and contrast-enhanced imaging, it’s becoming a serious contender against mpMRI in diagnostic precision. These tools are changing how we assess tissue architecture, identify aggressive disease, and even rethink how biopsies are performed.

Micro-ultrasound, operating at 29 MHz, offers up to 300% higher resolution than conventional TRUS. The real-time visualization it provides is detailed enough to detect subtle architectural changes that MRI might miss. With the PRI-MUS scoring system (Prostate Risk Identification using Micro-Ultrasound), clinicians now have a structured way to risk-stratify lesions without leaving the ultrasound suite.

Meanwhile, shear wave elastography (SWE) is providing functional insight beyond what grayscale can offer. By measuring tissue stiffness, SWE can help us differentiate between benign and malignant areas, especially in the transition zone where conventional imaging often falls short. Have you considered how much additional value elastography could bring to your routine prostate assessments?

The evolving role of contrast-enhanced ultrasound (CEUS) is also noteworthy. With microbubble technology enhancing vascular detail, CEUS is proving useful in targeting suspicious areas. In some cases, it even outperforms MRI in patients with contraindications to gadolinium. Is there a place for CEUS in your practice?

And what about biopsies? While MRI fusion-guided approaches have become popular, micro-ultrasound offers a compelling, MRI-independent alternative. In experienced hands, it may not only match MRI-targeted biopsy accuracy but even outperform it in certain clinical contexts. Could this be the moment to reassess your default workflow?

Across the globe, clinicians are rethinking prostate imaging protocols. In settings where MRI is limited or inaccessible, these advanced ultrasound techniques are not just stand-ins; they are front-line modalities in their own right. We should be teaching residents and sonographers to see prostate ultrasound as more than just a guided-needle pathway.

This isn’t just about technology. It’s about mindset. Are we giving prostate ultrasound the credit it deserves as a dynamic, diagnostic-first tool?

We invite you to reflect on your current practices. Are you leveraging all that modern ultrasound has to offer in prostate disease? Are there barriers—technical, educational, or institutional—that keep your department from integrating these advancements?

Let us know what you think. Share your experiences, your questions, your doubts. The conversation around prostate ultrasound is changing, and we want your thoughts.

Bruce R. Gilbert, MD, PhD, is a Professor of Urology at Zucker School of Medicine of Hofstra/Northwell, Vice-Chair for Urology Quality, and Director of Male Reproductive and Sexual Medicine at the Smith Institute for Urology in New York.

A professional portrait of a man in a suit and tie, smiling against a plain background.

Advocacy Works!

Posted on September 16, 2025 by aium1952

Does one voice really matter? This is a question I often hear when the Academy for Radiology & Biomedical Imaging Research and I, on its behalf, ask NIH-funded researchers to advocate for increased NIH funding.

Your Voice Matters

I know that as a busy physician, physician-scientist, or researcher, advocating for the NIH might seem like an additional and burdensome task. Still, your advocacy offers significant benefits that directly impact your work and career. Most importantly, your voice carries weight as a constituent and a trusted professional. Former Congresswoman Anna Eshoo (D-CA) stated often over the years to members of the Academy, “Congress is a reactive institution. It reacts to the push from outside. It is essential to keep sharing your stories, your experience, your work.” Thirty years ago, when the Academy was founded, this truth inspired us, and it inspires us just as strongly today. This community has a strong and important voice with expertise and experience to share.

“Yes, one voice can make a difference. Your voice. When you tell your story, you bring the issues to life—whether it’s a grant cut that ended a trial, a breakthrough that could expand access to care, or the uncertainty that makes you question your future in science. These stories have power. They can open minds, change hearts, and drive policymakers to act.”

The Academy Can Help

As a founding member society of the Academy, the AIUM understands the value of the Academy and our efforts to engage the imaging community. The Academy’s role is to ensure that medical imaging research has a seat at the table as we advocate on Capitol Hill for consistent funding at the NIH and across government agencies.

At the Academy, we encourage our advocates to engage as individuals or in cohorts with other stakeholders from their institution or in their states. We provide the tools and resources advocates need, and the Academy will facilitate meetings with you.

Four men posing for a photo in front of an American flag backdrop, smiling and dressed in professional attire.

However, even the Academy collaborates with larger organizations that engage with the entire research enterprise ecosystem, including clinicians, researchers, advocates, and patients. It’s a way to remind elected officials that, as a community, we speak with one voice. We have found through the years that when the entire research ecosystem comes together to advocate for the NIH, our message is heard, and Congress responds.

Rally for Medical Research

One such group the Academy engages with is the Rally for Medical Research (the Rally). The Rally started in 2013 when NIH funding was facing extreme budget cuts. Since then, the Rally has been instrumental in turning the tide from deep budget cuts to robust, sustained, and predictable research funding.

A rally scene with a speaker at a podium urging support for medical research, surrounded by audience members holding signs that read 'SUPPORT MEDICAL RESEARCH: YOUR LIFE DEPENDS ON IT' and 'INCREASE NIH FUNDING NOW.'

Each September, Rally participants carry the call to Capitol Hill, urging Congress to provide robust and predictable NIH funding. In these face-to-face meetings, lawmakers see what is at stake. Without sustained investment, progress halts, trials close, and patients pay the price. In 2025, the Rally will once again take over Capitol Hill with close to 500 patients, clinicians, and researchers participating. Each voice will bring an understanding of what the need is, what the opportunity can be, and why this investment is so important.

So, whether you advocate on your own or join with a larger effort, consistent individual advocacy can keep NIH’s importance in the spotlight and help sustain momentum.

For more information about the Academy, please view this brief clip about The Value of the Academy, visit our website at www.acadrad.org, and I welcome you to contact me at Rcruea@acadrad.org.

*By the time this is printed, the deadline for participating in this year’s Rally will have passed. The Rally will be held on September 18, 2025.

Renee L. Cruea, MPA, is the Executive Director of the Academy for Radiology & Biomedical Imaging Research.

Ovarian Cancer Awareness: Risk Factors and Screening Techniques

Posted on September 2, 2025 by aium1952

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

Posted on August 19, 2025 by aium1952

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.

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

Posted on August 5, 2025 by aium1952

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

Posted on July 22, 2025 by aium1952

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

Posted on July 8, 2025 by aium1952

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.

Focused Ultrasound as a Therapeutic Tool

Posted on June 24, 2025 by aium1952

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

Posted on June 10, 2025 by aium1952

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.

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.