The 2025 AIUM Annual Meeting promises to be an extraordinary gathering for the medical community, spotlighting technological advancements and groundbreaking research in medical ultrasound. Central to this event will be the keynote speakers, each of whom has made significant contributions in their respective fields. From space medicine to neurotherapeutics, these thought leaders will share their unique insights and provoke discussions that extend beyond traditional medical paradigms. Here’s a closer look at the distinguished keynote speakers you won’t want to miss.
Dr. Leroy Chiao, PhD – “Is It SADS, or Am I in Space? Medical Considerations for Spaceflight”
Dr. Leroy Chiao, former NASA astronaut and commander of the International Space Station (ISS), will help kick off the event on March 30, 2025, with his keynote presentation, “Is It SADS, or Am I in Space? Medical Considerations for Spaceflight.” Dr. Chiao’s pioneering experience as one of the first astronauts to use and study ultrasound in space has positioned him uniquely to discuss the challenges faced by humans in extraterrestrial environments. His session will delve into the physiological effects of space travel, weaving together his personal experiences and stories from his missions. He will also highlight the dual advancements made in operational countermeasures and diagnostic ultrasound during space missions, and how these innovations have been adapted for healthcare solutions on Earth.
Attendees will gain insights into how space-based medical research contributes to groundbreaking practices that benefit terrestrial healthcare. Dr. Chiao’s expertise and captivating storytelling will shed light on the often-overlooked yet critical connection between space exploration and medical innovation.
Dr. Scott Dulchavsky, MD, PhD – “Extraterrestrial Medical Care”
Following Dr. Chiao’s presentation, Dr. Scott Dulchavsky will present his keynote, “Extraterrestrial Medical Care.” A leader in surgery and aerospace medicine, Dr. Dulchavsky is a professor of surgery, molecular biology, and genetics at Wayne State University and Michigan State University, and a principal investigator for NASA. His contributions have earned him a place in the Space Technology Hall of Fame, emphasizing his pivotal role in translating space medicine technologies for Earth-bound use.
Dr. Dulchavsky’s talk will focus on the vital role of ultrasound as a diagnostic tool in space missions. Point-of-care ultrasound has become an indispensable resource for managing potential clinical conditions in space—enabling immediate, noninvasive diagnostics. This capability is crucial for long-duration missions where traditional medical facilities are not accessible. His presentation will provide attendees with a deeper understanding of how these space-driven advancements in ultrasound can enhance medical practices and patient care back on Earth.
Dr. Ali Rezai, MD – “Focused Ultrasound: Breaking Barriers in Neurotherapeutics”
On the second day of the meeting, Dr. Ali Rezai, a visionary neurosurgeon and the head of the Rockefeller Neuroscience Institute, will present his keynote, “Focused Ultrasound: Breaking Barriers in Neurotherapeutics.” Dr. Rezai is a pioneering figure in the field of neuroscience, known for developing treatments for complex brain disorders such as Parkinson’s disease. His research has been featured in prominent media outlets including The New York Times, The Washington Post, BBC, Good Morning America, and 60 Minutes.
In his session, Dr. Rezai will explore how focused ultrasound is being used to treat some of society’s most pressing neurological challenges, including Alzheimer’s disease and addiction. He will share the latest developments in soundwave therapy, illustrating how noninvasive focused ultrasound can offer new solutions to slow the progression of Alzheimer’s and manage its debilitating symptoms. Additionally, Dr. Rezai will discuss how these innovative treatments are opening doors for addressing addiction, showcasing the versatile power of ultrasound in neurotherapeutics.
Don’t Miss This Unparalleled Opportunity
The 2025 AIUM Annual Meeting is not just an event—it’s a platform to explore the intersection of advanced ultrasound technology and its revolutionary applications in healthcare. With keynote speakers like Dr. Leroy Chiao, Dr. Scott Dulchavsky, and Dr. Ali Rezai, attendees will be inspired by stories that span from space to the operating room and will walk away with newfound knowledge applicable to advancing their own practices.
This is a unique opportunity to learn from the world’s leading minds and be part of conversations that shape the future of medical ultrasound and patient care. Learn more about The Ultrasound Event and register to join us from March 30 to April 1, 2025.
Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).
With the advent of large language models (LLMs), such as the well-known ChatGPT, there has been a surge of interest in how to leverage these technologies in healthcare. These queries are far from baseless, as LLMs have already demonstrated significant value in various non-clinical fields. It is entirely reasonable to explore their potential in medical imaging. The biomedical industry has begun to innovate and propose solutions based on the perceived needs of physicians and the medical imaging workforce, often from an engineering standpoint. However, LLMs offer a unique opportunity to develop solutions through a collaborative approach that includes both physicians and industry professionals.
In other words, only by integrating insights from clinicians can we ensure that the benefits of LLMs are realized in ways that genuinely enhance clinical practice. This collaborative approach is particularly relevant in the field of ultrasound imaging, where the unique real-time nature of the modality, combined with operator-dependent variability, presents both opportunities and challenges. This blog post explores the exciting possibilities of LLMs in ultrasound imaging through two specific approaches: scan-time AI assistance and review-time AI assistance.
The Dream: Scan-Time AI by Real-Time Integration of LLMs
Imagine having a smart assistant right by your side during an ultrasound exam, processing data in real time and offering insights instantaneously. This “scan-time AI” is not a distant dream but an emerging reality. By integrating LLMs into ultrasound machines, clinicians can receive immediate feedback on the screen. This AI-powered assistance can highlight areas of interest, suggest potential diagnoses, and recommend additional views or techniques to optimize image quality, making the diagnostic process more accurate and efficient.
However, the journey to seamless real-time AI integration comes with its own set of challenges. The primary hurdle is ensuring that the AI operates with split-second precision, as any lag could disrupt the examination flow. Additionally, the integration must be intuitive, ensuring that AI suggestions complement the clinician’s expertise without causing distraction. The ultimate goal is to create a harmonious partnership where AI augments the clinician’s skills and enhances patient care.
As their name implies, LLMs are designed to communicate with language at the center. Early examples include chat-like communication with the user, which, at first glance, may not seem viable for medical imaging workflows. However, LLM literature is advancing very rapidly, and with the invention of multi-modal LLMs, communication with ultrasound systems will no longer be limited to text but also extend to other modalities such as voice and images. Voice commands can streamline the process, allowing clinicians to focus on the patient and the probe without needing to manipulate controls manually. For instance, a clinician could say, “Compare the thickness of the renal cortex with the medulla” and the ultrasound machine would reason through the command, detect the said anatomical structures, perform the measurement, and display the results, thus improving efficiency and ergonomics. However, voice interaction in a clinical environment brings its own set of complexities. The bustling background noise, the need for precise and unambiguous commands, and the potential for AI misinterpretation are significant factors to consider. Furthermore, voice interaction must be evaluated for its impact on privacy within the clinical setting. When these issues with voice communication in clinical settings are addressed, using LLMs through voice commands for ultrasound examinations will become much smoother and more efficient.
We’re There: Review-Time AI for Post-Examination Analysis
While real-time AI offers immediate benefits during the scan, “review-time AI” focuses on the critical post-scan phase. LLMs can meticulously review ultrasound images and generate detailed reports, highlighting key findings and suggesting differential diagnoses. This application can significantly alleviate the documentation burden on clinicians, allowing them to dedicate more time to patient care.
The necessity for LLMs in review-time AI stems from the sheer volume and complexity of data clinicians must analyze. By automating the initial review and providing structured reports, LLMs enhance the consistency and quality of ultrasound interpretations. This approach also facilitates collaborative care, as AI-generated reports can be easily shared and reviewed by other specialists, ensuring a comprehensive evaluation of the patient’s condition.
A Call to Action for Physicians
Physicians play a pivotal role in shaping the future of AI technologies. While engineers and data scientists provide the technical backbone, clinicians’ insights and feedback are crucial in developing AI systems that truly address healthcare needs. Physicians are encouraged to experiment with these new-age AI tools in their daily routines, providing critical feedback that will steer the evolution of AI in a direction that genuinely enhances clinical practice.
Integrating LLMs into ultrasound imaging is not merely a technological advancement but a paradigm shift that requires active collaboration between clinicians and technologists. By exploring the exciting possibilities of scan-time and review-time AI and addressing the challenges of voice interaction, we can pave the way for a more efficient and accurate diagnostic process. Physicians, your involvement and insights are crucial. Together, we can shape a future where AI not only complements but also elevates the art and science of ultrasound imaging. Let’s embrace this transformative journey and lead the way to a new era of medical innovation.
Utku Kaya is a Co-founder and Chief Executive Officer of SmartAlpha.
The American Institute of Ultrasound in Medicine (AIUM) is excited to welcome its new CEO, Steven R. Meyers, PhD, a visionary leader with a wealth of experience in healthcare and medical technology. As ultrasound technology continues to evolve, so does the role AIUM plays in shaping its future. In this exclusive interview, we sit down with Steve to discuss his vision, leadership approach, and the exciting opportunities ahead for AIUM and the field of ultrasound medicine.
What inspired you to take on this role as CEO of the AIUM?
I’ve always had a deep passion for science and medicine, but what drives me most is the desire to make a meaningful impact on the world. Associations like the AIUM uniquely offer the opportunity to blend those passions, advancing both the field and the broader good. After spending years in the for-profit sector, transitioning to a non-profit like the AIUM has been incredibly rewarding. It allows me to work closely with dedicated professionals and serve the members in a way that feels purposeful and mission-driven.
Since stepping into the CEO role, I’ve focused on listening—meeting with members and staff to understand their needs and aspirations. What has struck me most is the shared passion across the organization: a passion for the profession, the transformative potential of ultrasound technology, and the far-reaching impact of our mission on global healthcare. It’s this energy and commitment that not only validated my decision to join the AIUM but also fuels my vision for its future.
I believe we have the potential to harness this collective passion to build a sustainable organization, one that both nurtures the ultrasound profession and continues to make significant contributions to healthcare worldwide. With the AIUM’s rich history and strong foundation, the opportunity to help shape its next chapter is one I’m truly excited about. Who wouldn’t want to be part of leading this organization into the next 70 years of innovation and global impact?
How has your previous experience prepared you for this role, and what are some of your proudest professional accomplishments?
I see my career in two distinct phases. The first is rooted in hands-on science and medicine. I hold dual degrees in biomedical engineering and computer science, and I earned my doctorate in biomedical engineering, specializing in implanted medical devices and their interaction with human tissue. My work at the interface of technology and healthcare has been foundational. After graduate school, I gained experience in startups, working in ophthalmology and later founding a company focused on maternal and child health. This phase of my career gave me firsthand experience in research, publishing, conferences, business development, and clinical work—the very activities many of our members engage in. I saw the challenges and opportunities from their perspective, which was invaluable.
However, a pivotal moment came when I shifted into a role managing research funding for a transnational program in polymer chemistry, distributing $7 million to support cutting-edge work. This exposed me to a new way of contributing to science—through supporting others’ innovation. It was during this time that I began speaking at international conferences and made my first association contacts, leading to the next phase of my career in the nonprofit space.
In this second phase, I’ve led various facets of association management: membership, professional education, leadership development, CMEs, conferences, publishing, accreditation, and governance. Having been a researcher, attendee, author, and learner myself, I understand what support members need for their careers and how associations can best deliver it.
I’m proud of accomplishments in both phases. On the science side, I contributed to research and patents that have advanced ophthalmologic treatments for conditions like keratoconus. I also played a role in diagnostic research aimed at helping families with infants suffering from failure to thrive.
On the association side, I’m especially proud of the relationships I’ve built with members—chemists, endocrinologists, and others—at my previous organizations. I believe associations thrive when they are truly member-driven, and fostering meaningful volunteer opportunities has led to impactful collaboration. I’m also proud of leading the overhaul of a 140-year-old membership program to make it more inclusive and relevant, as well as launching new, targeted conferences that provided platforms for members to share their passions and research.
Tell us about your educational background and where your love of science came from.
My love for STEM started early. Even as a child, I was always drawn to science, experimenting in the kitchen and building simple machines—much like the kinds of experiments you’d see on shows like Mr. Wizard. It was a lot of self-directed tinkering, encouraged by my parents, who nurtured my curiosity. In elementary school, we didn’t have a formal science curriculum beyond a visiting science teacher, but by middle school, I finally had the chance to take dedicated science courses. That’s when I truly realized that a career in STEM was where I was headed.
By high school, my path became clearer. I had a deep interest in both biology and computers, so biomedical engineering seemed like the perfect way to combine those passions. At the time, I didn’t fully understand what a biomedical engineer did, and I didn’t have any STEM role models in my family or social circle—most people I knew worked in business. Still, my family was very supportive of my unconventional choice, and I became the first in my family to earn a degree in a STEM field and the first to earn an advanced degree of any sort.
What trends in medical ultrasound are you most excited about, and how will the AIUM support research and development in these areas?
While it’s been a while since I engaged deeply with ultrasound technology, my background in biomedical engineering gave me a solid foundation in the field. The advancements since my early experiences—particularly in cardiac catheter tracking—have been extraordinary. As I reacquaint myself with the current state of ultrasound in 2024, I’m excited to see how far it’s come. What really stands out to me now is the potential for ultrasound to revolutionize care in rural and underserved regions, where its portability and cost-effectiveness can provide critical diagnostic support. Additionally, the growing role of ultrasound in therapeutic and curative applications is a major breakthrough that could reshape how we think about noninvasive treatment options.
As I continue to immerse myself in the latest trends, I’m convinced that ultrasound science and practice are on the verge of even more transformative breakthroughs. I’m excited to collaborate with our members, leaders, and staff to ensure the AIUM stays at the forefront of supporting these innovations.
The AIUM is uniquely positioned to support these emerging trends. We have a rich history and unparalleled convening power within the ultrasound community. Whether it’s through our conferences, which serve as incubators for cutting-edge ideas, our highly regarded journal and publications, or our communities of practice, the AIUM is the hub for advancing ultrasound knowledge and implementation. We also provide critical infrastructure, such as accreditation, continuing education, and member networks, all of which are essential for fostering research and development. As ultrasound technology continues to evolve, the AIUM will be leading the charge, ensuring that these advancements are realized and disseminated across the global healthcare landscape.
What is your leadership style and philosophy?
My leadership philosophy is rooted in passion and service. I believe that passion is something you can’t teach, and I’ve been deeply impressed by the enthusiasm and dedication of every AIUM member I’ve met. Their commitment to the profession, the field, and this organization is remarkable. Case in point, not a single person among the dozens upon dozens I’ve met with has been late to our discussions—I’ve never seen that before. Everyone is really busy but everyone ensured they made time to share with me about the AIUM and the good that it can do.
I believe associations exist to serve their members, and my leadership approach reflects that. My focus is on ensuring that everything we do directly benefits our members and advances the field of ultrasound. To achieve this, I prioritize transparency and open communication, making sure that members are informed about what’s happening within the organization and why. I also rely heavily on data and information to guide decision-making, ensuring that our actions are grounded in what will have the most positive impact.
I’m a firm believer in an open-door policy. I genuinely enjoy connecting with our members and hearing their thoughts, and I view these interactions as invaluable for shaping our direction. As we continue to evolve, member feedback is essential, which is why I encourage everyone to participate in our upcoming survey and share how we can best serve their needs.
Are there any new initiatives or programs you plan to introduce to enhance the member experience?
It’s still early in my tenure, and my first priority is to truly understand the diverse needs of our members before implementing any new initiatives. The AIUM exists to serve its members, and I want to ensure that any enhancements we introduce are fully aligned with what will bring the most value to our community. Membership is the lifeblood of our organization, and I believe we have significant opportunities to increase both the emotional and practical benefits we provide.
In collaboration with the Board of Governors and our dedicated staff, I’m excited to explore ways to strengthen our offerings over the coming months and years. We are committed to continually improving the member experience, and I want to make sure our efforts reflect what matters most to you.
To that end, we’ll soon be launching a comprehensive survey to better understand our members’ needs, how they’re engaging with the AIUM, and what we can do to enhance their experience. I encourage all members to participate, as your feedback will guide our decisions and help shape the future of the AIUM’s programs and services. Members, please keep an eye out for the survey, and in the meantime, feel free to share your thoughts directly with me at ceo@aium.org.
Give us a few fun facts that members may find interesting!
I’m the kind of person who likes to keep my hands busy, so I’m often tackling DIY projects around the house. Over the years, I’ve built sheds, repaired appliances, and dabbled in everything from electrical work and plumbing to HVAC and landscaping. Of course, I’m not too proud to call in the experts when a job is beyond my expertise, but I enjoy the challenge of fixing things myself.
Before we had kids, my wife and I lived in Boston and loved hiking with our dog on weekends. We found ourselves hitting the same trails, so to mix things up, we started geocaching. For those unfamiliar, geocaching is like a global treasure hunt where people hide small containers and share clues on how to find them. It’s a great way to discover new places! I’ve made it a goal to find a geocache in every state and country I visit. So far, I’ve found them in 29 states and 17 countries. While I’ll see you all in Florida for the Advanced OB course in February and the 2025 AIUM national conference in April, I’ve already found one there—so the hunt will have to continue elsewhere!
When my wife and I were looking for our first dog, we couldn’t agree on a breed. I grew up with Golden Retrievers and she had a Shetland Sheepdog. One day we saw a photo of a dog that looked like a combination of the breeds, which is how we discovered what Nova Scotia Duck Tolling Retrievers were. We agreed they were the ones for us, and now over 15 years later, we’re firmly a Toller family and welcomed our second three-and-a-half years ago.
Maya, the Meyers family Nova Scotia Duck Tolling Retriever when she was a puppy.
Steven R. Meyers, PhD, is the CEO of the American Institute of Ultrasound in Medicine (AIUM).
Whether you are a seasoned clinician or new to the field of ultrasound, the 2025 AIUM Annual Convention, happening March 29 to April 1, 2025, offers something for everyone. Join us at the Signia by Hilton Orlando Bonnet Creek in Orlando, Florida, for the premier event for ultrasound professionals. This gathering offers a unique opportunity to connect with colleagues, learn from experts across various specialties, and explore cutting-edge advancements in ultrasound technology and its applications.
The ultimate ultrasound learning and networking event starts off on March 29 with in-depth, professional Pre-Convention courses on critical ultrasound topics in musculoskeletal ultrasound, detailed first-trimester ultrasound, and dermatologic ultrasound. Then, the main convention begins on March 30, showcasing the latest technological breakthroughs, clinical applications, and the influence of artificial intelligence in diagnostic practices.
In addition to a plethora of educational sessions, the convention offers ample opportunities to network with other professionals and industry leaders. This event is the ultimate platform to exchange knowledge, explore the latest innovations, and collaborate with peers in the ultrasound field.
The 2025 convention features a lineup of keynote speakers presenting groundbreaking insights. Former NASA astronaut and International Space Station commander, Leroy Chiao, PhD, will share fascinating stories about spaceflight’s impact on human physiology, highlighting the connections between space medicine and healthcare innovations on Earth. Scott Dulchavsky, MD, PhD, a professor and NASA investigator, will delve into the use of ultrasound as a diagnostic tool in space, with lessons that have transformed care on Earth. Neuroscience pioneer Ali R. Rezai, MD, will present his work on using ultrasound to treat neurodegenerative conditions like Alzheimer’s, offering promising new therapeutic applications for the technology.
In the Exhibit Hall, a dynamic marketplace where prominent companies will display their latest innovative ultrasound products and services, attendees can get a firsthand look at new technologies and solutions.
The event also features supplemental interactive, hands-on learning labs that allow participants to practice skills in real time with expert guidance. Among the offerings are sessions on musculoskeletal (MSK) ultrasound, essential obstetric ultrasound techniques, gynecologic techniques, advanced echo imaging, and more. Additionally, participants can learn valuable procedures like ultrasound-guided nerve blocks and MSK interventions. These labs provide an invaluable opportunity to enhance practical skills under the supervision of skilled instructors, with a focus on improving clinical outcomes.
Don’t miss out on this exceptional opportunity to advance your skills and stay at the forefront of ultrasound innovation. Mark your calendar and register for the 2025 AIUM Annual Convention—the year’s most exciting ultrasound learning and networking event!
Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).
Medical Ultrasound Awareness Month, sponsored by the American Institute of Ultrasound in Medicine (AIUM), 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), is held every October to raise public awareness about the importance and value of ultrasound in health care. While many are familiar with its use during pregnancy, the initiative aims to highlight the broader applications of ultrasound across all life stages and medical conditions.
This event also serves as an opportunity for ultrasound professionals to educate the public and healthcare providers about the technology’s diverse uses. The sponsoring organizations encourage medical professionals to participate through activities and materials that inform and celebrate the vital role of ultrasound in modern medicine.
In honor of Medical Ultrasound Awareness Month, we recommend the following resources:
In closing, we welcome you to learn more about medical ultrasound, its safety, and its many applications in honor of Medical Ultrasound Awareness Month.
Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).
The ability to diagnose and treat musculoskeletal (MSK) conditions with accuracy and efficiency is crucial for both practitioners and patients. Enter musculoskeletal ultrasound, a tool that has revolutionized how we approach these challenges, offering unparalleled real-time imaging and diagnostic capabilities.
Cristy Nicole French, MD, Chair of the AIUM’s Musculoskeletal Ultrasound Community, encapsulates the essence of this powerful technology: “The real-time nature of ultrasound provides the opportunity to interact with the athlete and correlate symptoms with sonographic findings. Patients enjoy this opportunity to ‘share their story’ and often provide critical information to the diagnostic puzzle.” Her words highlight one of the key advantages of MSK ultrasound—its ability to engage patients actively in their care. The immediate feedback loop between the patient’s symptoms and the visual data from the ultrasound helps clinicians piece together the diagnostic puzzle with greater accuracy.
This sentiment is echoed by Humberto Gerardo Rosas, MD, former AIUM Musculoskeletal Ultrasound Community Chair (2019–2021). He emphasizes the indispensable nature of MSK ultrasound in modern medicine: “Musculoskeletal ultrasound has become an indispensable tool in diagnosing and treating musculoskeletal conditions. It provides high-resolution, real-time imaging of the muscles, nerves, tendons, and ligaments, leading to precise evaluations and accurate diagnosis at a fraction of the cost of other modalities. The dynamic capabilities, unique to ultrasound, not only improves the diagnostic accuracy and assessment of the extent of injury but also helps direct more effective and personalized treatment plans. Additionally, it allows for image-guided interventions that afford precise needle placement and medication delivery. For patients, this means quicker, more targeted interventions and better outcomes, making musculoskeletal ultrasound a vital tool in modern sports medicine and orthopedic care.”
The dynamic nature of ultrasound enhances the accuracy of diagnostics and serves as a guide for interventions, ensuring that treatments are effective and tailored to each patient’s unique needs. This level of personalized care, coupled with ultrasound’s cost-effectiveness and convenience, has made it a cornerstone of patient management in MSK medicine.
As we continue to push the boundaries of what is possible in medicine, MSK ultrasound stands out as a prime example of how technology can enhance the human element of care. By offering a window into the body that is both immediate and detailed, it enables clinicians to make informed decisions that lead to better outcomes for their patients. Whether it’s diagnosing a complex injury or guiding a precise intervention, the impact of musculoskeletal ultrasound is profound and far-reaching, cementing its place as an essential tool in the future of healthcare.
Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).
Interested in reading more about musculoskeletal ultrasound? Check out these posts from the Scan:
In recent years, the utility of intestinal ultrasound (IUS) in diagnosing and managing inflammatory bowel disease (IBD) has gained substantial momentum. The Scan featured a blog post in June 2024 describing the features and uses of IUS for diagnosing and monitoring IBD. That previous article highlighted the many features that can be monitored to assess IBD disease activity and severity right at the bedside using B-mode ultrasound, highlighting that bowel wall thickness (BWT), Doppler signaling (hyperemia), loss of stratification of bowel wall layers (BWS), and peri-intestinal hyperechoic fat are important features of inflammatory on IUS.1 However, adjunct techniques, such as using contrast with ultrasound, may permit better detection of disease complications and activity, particularly in Crohn’s disease, where patients are at risk of developing intestinal strictures (narrowing), bowel perforation, and abscesses. Indeed, these advanced ultrasound techniques push the boundaries of what noninvasive imaging can offer. This blog post delves into three promising techniques—contrast-enhanced ultrasound (CEUS), small intestinal contrast-enhanced ultrasound (SICUS), and elastography—each providing new dimensions to our understanding of IBD and its management.
Contrast-Enhanced Ultrasound (CEUS): Adding Depth to Vascular Assessment
CEUS represents a significant advancement in IUS, particularly in assessing disease activity and vascularization. By injecting a contrast composed of gas-filled microbubbles stabilized by a lipid capsule into the bloodstream, CEUS enhances the visualization of bowel wall vascularity, which is a key indicator of inflammation in IBD. The evaluation relies on the dynamic assessment of the contrast uptake in areas with increased vascular activities, whose intensity can change over time.2 Although visual evaluation can demonstrate areas of activities on CEUS, advanced software is also used to generate time-intensity curves, which measure the signal intensity from the first bubble arrival in the bowel segment of interest and progressive decline in intensity (wash-out) usually over 2 minutes of image capture.3
CEUS can be used in various clinical contexts to monitor Crohn’s disease. The time-intensity curves generated by CEUS are used to calculate the signal’s peak intensity and area under the curve (AUC). Wilkens et al demonstrated that peak intensity and AUC are increased in patients with active disease as compared to controls.4 Further studies have demonstrated promising results in differentiating Crohn’s disease lesions with active inflammation instead of lesions composed predominantly of fibrostenotic tissue.5 Variations in outcomes may be related to the type of contrast used, the quantitative CEUS value of interest analyzed, and the variability in the ultrasound system and analysis software used, which are not standardized between systems.5 However, such findings may be important in predicting response to therapy instead of prioritizing surgical options, as limited data demonstrated higher inflammation quantified by CEUS had a higher response rate to therapies.6
CEUS has emerged as a valuable tool in monitoring complications of Crohn’s disease (CD), particularly in assessing the presence and extent of fistulas and abscesses. By enhancing the visibility of vascular structures and inflammatory activity, CEUS allows for the precise identification and measurement of these complications, which can be challenging to characterize with conventional imaging methods. This enhanced visualization is crucial for guiding clinical decisions, including the need for surgical intervention or adjustments in medical therapy.7
Small Intestinal Oral Contrast-Enhanced Ultrasound (SICUS): Expanding the Reach of IUS
While CEUS focuses on enhancing vascular imaging, SICUS takes a different approach by improving the visualization of the small intestine, an area notoriously difficult to image using traditional ultrasound techniques. SICUS is performed in the fasted state and involves the oral administration of a non-absorbable contrast medium, generally a polyethylene glycol solution, that distends the small bowel loops, allowing for better visualization of the bowel wall and lumen. The exam may last 30 to 45 minutes for the contrast to arrive at the areas of interest.8
This technique is particularly valuable in the assessment of small bowel CD, where skip lesions and strictures can be challenging to detect and characterize. SICUS enhances the delineation of these abnormalities, providing a clearer picture of the disease’s extent and severity. Moreover, SICUS can be employed alongside B-mode and CEUS to offer a comprehensive assessment of the small intestine. The combined use of these modalities allows for a more nuanced evaluation of both the inflammatory and structural components of the disease, leading to more informed treatment strategies.9
Elastography: A Noninvasive Window Into Fibrosis
One of the most challenging aspects of managing IBD is differentiating between inflammation and fibrosis, particularly in chronic CD, where long-standing inflammation can lead to fibrotic changes in the bowel wall. Elastography, a technique that measures tissue stiffness, is a promising solution to this issue. By applying mechanical waves to the tissue and measuring the speed at which they propagate, elastography can provide a quantitative assessment of bowel wall stiffness—a surrogate marker for fibrosis.5 Again, this is essential in predicting lesions that would be amendable to medical therapy as opposed to surgery. However, challenges exist in the assessment of the bowel using this technique, as measurements can be affected by peristalsis, and a large body habitus can impede the penetration of the sound waves. Values are not yet standardized between ultrasound systems, making the validation of specific thresholds difficult between centers.5 As research continues to validate its accuracy and reliability, elastography may become a standard tool in the long-term management of IBD.
The Future of IUS in IBD Management
The integration of CEUS, SICUS, and elastography into the IUS toolkit marks a significant step forward in the management of IBD. These advanced techniques not only enhance our ability to diagnose and monitor the disease but also provide critical insights that can tailor treatment strategies to the individual patient.
As we continue to refine these methods and validate their use in clinical practice, the future of IUS in IBD management looks promising. The ability to assess the disease’s inflammatory and fibrotic components in real-time, noninvasively, and with high accuracy will undoubtedly improve patient outcomes and quality of life. However, to move toward more widespread adoption, more training in these techniques will be necessary, and further validation of the data generated is warranted.
In conclusion, the advancements in IUS, particularly with the advent of CEUS, SICUS, and elastography, are poised to transform the landscape of IBD management. These techniques offer a more detailed and nuanced understanding of the disease, enabling us to make more informed decisions that ultimately benefit our patients. As we look to the future, the continued evolution of IUS will undoubtedly play a pivotal role in the quest for better outcomes in IBD care.
Mallory Chavannes, MD, MHSc, FRCPC, FAAP, is an Assistant Professor of Pediatrics in the Division of Gastroenterology, Hepatology, & Nutrition, and is Medical Director of the Inflammatory Bowel Disease Program, at Children’s Hospital Los Angeles.
References:
Novak KL, Nylund K, Maaser C, et al. Expert consensus on optimal acquisition and development of the international bowel ultrasound segmental activity score [IBUS-SAS]: a reliability and inter-rater variability study on intestinal ultrasonography in Crohn’s disease. J Crohns Colitis 2021; 15:609–616. doi: 10.1093/ecco-jcc/jjaa216. PMID: 33098642; PMCID: PMC8023841.
Merrill C, Wilson SR. Ultrasound of the bowel with a focus on IBD: the new best practice [published online ahead of print August 14, 2024]. Abdom Radiol (NY) doi: 10.1007/s00261-024-04496-1. PMID: 39141152.
Wilkens R, Wilson A, Burns PN, Ghosh S, Wilson SR. Persistent enhancement on contrast-enhanced ultrasound studies of severe Crohn’s disease: stuck bubbles? Ultrasound Med Biol 2018; 44:2189–2198. doi: 10.1016/j.ultrasmedbio.2018.06.018. PMID: 30076030.
Coelho R, Ribeiro H, Maconi G. Bowel thickening in Crohn’s disease: fibrosis or inflammation? Diagnostic ultrasound imaging tools. Inflamm Bowel Dis 2017; 23:23–34. doi: 10.1097/MIB.0000000000000997. PMID: 28002125.
Quaia E, Gennari AG, Cova MA, van Beek EJR. Differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn’s disease based on visual analysis: feasibility study combining conventional B-mode ultrasound, contrast-enhanced ultrasound and strain elastography. Ultrasound Med Biol 2018; 44:762–770. doi: 10.1016/j.ultrasmedbio.2017.11.015. PMID: 29331357.
Pecere S, Holleran G, Ainora ME, et al. Usefulness of contrast-enhanced ultrasound (CEUS) in inflammatory bowel disease (IBD). Dig Liver Dis 2018; 50:761–767. doi: 10.1016/j.dld.2018.03.023. PMID: 29705029.
Losurdo G, De Bellis M, Rima R, et al. Small intestinal contrast ultrasonography (SICUS) in Crohn’s disease: systematic review and meta-analysis. J Clin Med 2023; 12(24):7714. doi: 10.3390/jcm12247714. PMID: 38137782; PMCID: PMC10744114.
Mocci G, Migaleddu V, Cabras F, et al. SICUS and CEUS imaging in Crohn’s disease: an update. J Ultrasound 2017; 20:1–9. doi: 10.1007/s40477-016-0230-5. PMID: 28298939; PMCID: PMC5334271.
A patient we’ll call Janet contacted our clinic in a state of distress. What began as a seemingly benign bruise a day after her chin and jawline filler injections spread to her cheek and forehead. Subsequently, her eyelids became bruised and edematous, and purple marks appeared on her temple, tracing the path of her arteries. When she sought help from the clinic that administered the injections, the doctor was unavailable. It took days before she was finally diagnosed with vascular occlusion and began treatment, which included hyperbaric oxygen therapy, aspirin, hyaluronidase injections, and even Viagra to improve blood flow. Yet, the sinister purple marks continued to spread, and the areas remained exquisitely painful. With a growing sense of alarm, she reached out to our office.
In aesthetic medicine, few situations are true emergencies. Even with vascular occlusion, like in Janet’s case, there’s typically a treatment window of 2–3 days. However, by the time Janet reached us, that critical period had elapsed, and we found ourselves in a race against time to prevent ischemic tissue damage. Fortunately, our clinic is well equipped for such emergencies, armed with a high-resolution ultrasound device and years of experience.
Filler-related vascular occlusion, with the pain of ischemia, and subsequent treatments, along with the looming threat of facial necrosis and the anxiety over uncertain outcomes, can be a daunting experience for both practitioners and patients. In these situations, ultrasound becomes invaluable. Its ability to provide real-time visualization of affected vessels and the occlusive filler enables precise, ultrasound-guided hyaluronidase injections that dissolve the filler, improve arterial spasm, and restore blood flow. Once the occlusion is treated, Color Doppler can demonstrate immediate improvement in blood flow, correlating with clinical recovery and providing reassurance to both patients and medical practitioners.
Janet’s ultrasound exam revealed several areas of blockage along the facial arteries, with adjacent filler deposits. We found areas of decreased blood flow along the jaw, in her cheek, in the temple, and at the mandibular angle, with large deposits of anechoic hyaluronic acid filler adjacent to them. We also discovered and treated severely decreased flow in the facial vein, which likely explained the unusual periorbital edema and ecchymosis. You can see one area of compromised blood flow in Figure 1.
Figure 1
We treated these areas with ultrasound-guided hyaluronidase injections, as depicted in Figure 2.
Figure 2
By the following day, Janet’s condition had shown marked improvement, and the pain had subsided. Improved blood flow in both the facial artery and facial vein can be seen in Figure 3.
Figure 3
Over the last several years, we have witnessed an exponential increase in the number of aesthetic treatments. However, as we keep pushing the envelope to improve our patients’ results and the longevity of our treatments, we face a growing number of complications, including overfilled faces, filler malposition and migration, lumps, chronic edema, and vascular complications such as vascular occlusion, and even stroke and blindness. Vascular occlusion, one of the most dreaded filler complications, has been the main impetus behind the introduction of ultrasound into aesthetic medicine.
This process could not have come at a better time. The use of ultrasound offers a blend of opportunities and challenges that are reshaping our profession. From mastering facial anatomy and adopting safer injection techniques to managing complications more effectively, aesthetic practitioners can harness the power of ultrasound to advance their practice and patient care, refine techniques, enhance safety, and improve patient outcomes.
References:
Desyatnikova S, Schelke L. Treatment of filler-related vascular occlusion using handheld portable ultrasound device. J Cosmet Dermatol 2022; 21:3166–3168. doi: 10.1111/jocd.15125.
Desyatnikova S, Barrera P. High-resolution ultrasound for diagnosis and treatment of filler-related septal necrosis. Plast Reconstr Surg Glob Open 2024; 12:e5630. doi: 10.1097/GOX.0000000000005630.
Choi SY, Shin SH, Seok J, Yoo KH, Kim BJ. Management strategies for vascular complications in hyaluronic acid filler injections: A case series analysis. J Cosmet Dermatol 2023; 22:3261–3267. doi: 10.1111/jocd.15990.
Schelke LW, Velthuis P, Kadouch J, Swift A. Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers. J Am Acad Dermatol 2023; 88:79–85. doi: 10.1016/j.jaad.2019.07.032.
Stella Desyatnikova, MD, is a double board-certified facial plastic surgeon, with over 20 years’ experience. She is the founder of The Stella Center for Facial Plastic Surgery and the Ultrasonos Aesthetic Ultrasound Training Center in Seattle, WA. She is a leading authority in aesthetic ultrasound research and education, committed to expanding education and awareness of ultrasound use to optimize safety of aesthetic procedures. Her research is focused on filler injectable safety and facial ultrasound applications. She is the Secretary-elect of the Dermatology Community of the American Institute of Ultrasound in Medicine (AIUM). She is also an International Expert Board Member of the Complications in Medical Aesthetics Cooperative (CMAC) and a member of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
Musculoskeletal ultrasound (MSK US) is an invaluable diagnostic tool that provides real-time, dynamic imaging of muscles, tendons, ligaments, joints, and soft tissues. Its advantages include being non-invasive, relatively low-cost, and free of ionizing radiation. However, to maximize its benefits and ensure patient safety, it is crucial for practitioners to understand and apply certain fundamental principles, including ALARA (As Low As Reasonably Achievable) and the Mechanical Index (MI). Here, we provide an overview of these concepts and other essential information for new users of MSK US.
ALARA Principle
The ALARA principle stands for “As Low As Reasonably Achievable” and is a cornerstone of safe ultrasound practice. It emphasizes minimizing the patient’s exposure to ultrasound energy while still obtaining the necessary diagnostic information.
Key Strategies to Apply ALARA:
1. Optimize Scanning Parameters: Use the lowest possible settings for power, gain, and exposure time that still yield diagnostic quality images. Avoid unnecessary Doppler applications, which use higher energy levels.
2. Adjust the Probe Position and Angle: Efficient probe manipulation can improve image quality without increasing power output. Use proper ergonomics to maintain consistent and effective contact with the patient’s skin.
3. Limit Scan Duration: Conduct scans efficiently to minimize exposure time. Pre-plan the examination to focus on areas of interest and avoid prolonged scanning.
By adhering to the ALARA principle, practitioners ensure that ultrasound procedures are both effective and safe.
Mechanical Index (MI)
The Mechanical Index (MI) is a parameter used to evaluate the potential for mechanical bioeffects, such as cavitation, which can occur during ultrasound procedures. It is calculated based on the peak negative pressure of the ultrasound wave and the frequency of the ultrasound.
Understanding MI Values:
Low MI (<0.3): Safe for sensitive tissues; minimal risk of cavitation.
Moderate MI (0.3–0.7): Generally considered safe for routine diagnostic imaging.
High MI (>0.7): Increased risk of mechanical bioeffects; should be used with caution and justified by clinical need.
To maintain patient safety, it is essential to monitor and adjust the MI, especially during prolonged or intensive scans.
Thermal Index (TI)
Another crucial parameter in MSK US is the Thermal Index (TI), which estimates the potential for tissue heating. The TI is influenced by the duration of the ultrasound exposure and the intensity of the ultrasound beam.
Categories of TI:
TIS (Soft Tissue): Applies to imaging of soft tissues and abdominal organs.
TIB (Bone): Relevant for imaging near bone structures.
TIC (Cranial): Pertains to imaging the fetal skull or neonatal head.
For MSK US, TIB is the most relevant as it applies to imaging around bones and joints. Maintaining an appropriate TI helps prevent thermal damage to tissues.
Essential MSK US Techniques
1. Probe Selection: Use the appropriate probe for the area being examined. High-frequency linear probes (7–15 MHz) are commonly used for superficial structures like tendons and muscles, while lower-frequency probes are better for deeper structures.
2. Patient Positioning: Proper patient positioning is crucial for optimal imaging. Ensure the area of interest is accessible and the patient is comfortable to avoid movement that can degrade image quality.
3. Image Optimization: Adjust the depth, focus, gain, and time-gain compensation (TGC) to enhance image quality. Clear visualization of the anatomy is essential for accurate diagnosis.
4. Dynamic Examination: Utilize the dynamic nature of ultrasound to assess the movement and function of musculoskeletal structures. Real-time imaging can help identify abnormalities that static imaging may miss.
5. Documentation: Capture and store high-quality images and clips of the relevant findings. Proper documentation supports clinical decisions and facilitates communication with other healthcare providers.
Conclusion
Performing musculoskeletal ultrasound requires a solid understanding of key safety principles, such as ALARA and MI, as well as technical skills in image optimization and patient positioning. By adhering to these guidelines, practitioners can ensure safe and effective use of MSK US, providing valuable insights into musculoskeletal conditions and enhancing patient care.
Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).
Interested in learning more about the basics of ultrasound? Check out these resources from the American Institute of Ultrasound in Medicine:
Why is it important to read the Sonographer Scope of Practice?
A scope of practice clearly articulates the activities and processes healthcare professionals can perform.
A scope of practice limits the activities of a healthcare professional based on specific education, training, and competency requirements based on regulations, standards, and laws.
Very few states regulate the education, competency, and certification of sonographers.
The Sonographer Scope of Practice is our guiding document that describes the boundaries of our profession.
This year (2024), the Society of Diagnostic Medical Sonography (SDMS) released the latest revision of the Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer (The Scope) which encompasses the changes and growth in technology and the expansion in the roles of sonographers. I was excited to represent the American Institute of Ultrasound in Medicine (AIUM) in this revision process, and glad that the AIUM Board of Governors voted again to continue to support The Scope.
This comprehensive document sets forth the most current standards and expectations for sonographers, emphasizing patient care, safety, and the evolving role of sonographers in healthcare.
I asked colleague Jaime Taylor-Fujikawa, RDMS, RDCS, why she feels The Scope is important. Her first reason was because it is not stagnant. She stated that “the sonographer profession continues to expand and evolve, and The Scope has changed with the times.” Jaime is a sonographer of 21 years, a long-time member of the AIUM, and she lives in 1 of only 4 states that requires licensure of sonographers. She has taken certification exams in OB, Adult Echo, Pediatric Echo, and Fetal Echo.
Did you know that though certification of sonographers is considered the standard of care, it is still considered voluntary except in those states that require licensure?
The sonographer is defined as an individual who performs diagnostic exams and procedures, acquiring images and other pertinent information to provide to the interpreting physician. Sonographers do not practice independently and function as a delegate of the physician. In brief, we
Follow written policies, protocols, and guidelines.
Apply principles of safe use (ALARA) for the patient, ourselves, and the healthcare team.
Commit to ongoing education to increase competence with increasing advancements.
Acquire appropriate training and experience in examinations and specialty areas in which they perform.
This is but a brief overview of The Scope. A few areas that were added/expanded included
The role of the advanced practice sonographer (under physician supervision)
As an evolving role for those with higher levels of education, training, and experience,
Which may be identified with advanced job titles such as ultrasound practitioner, advanced cardiac sonographer, advanced sonographer, and/or with an advanced certification (currently there is only 1 advanced certification available)
The use of contrast, which has been expanded and is now woven strategically throughout the document with more succinct guidelines of the sonographer’s role.
The expansion of safety principles to increase focus on prevention of work-related musculoskeletal disorders (WRMSD) to encourage
Maintenance of an environment to avoid injuries,Implementation and participation in programs designed to reduce WRMSD, and
Reporting signs and symptoms of WRMSD.
A few areas of The Scope are outlined here, and it contains an overarching theme of essential commitment (from sonographers) to professional growth and development and adherence to our professional standards, regulations, and accreditation standards that guide our actions to serve our patients competently and safely. The Scope compels us to
Treat all patients with kindness, compassion, dignity, and respect.
Perform examinations only with a medical order.
Exceptions for educational programs, in-service training, CME activities, research
Perform only those examinations for which we are educated, trained, experienced, and competent, and (where applicable) certified.
Adhere to the scope of practice and other professional documents.
In the absence of licensure, it is imperative that sonographers follow The Scope and that employers hire certified sonographers so that patients can receive quality ultrasound examinations and excellent patient care.
Do you work with a sonographer? Are they certified? Do you know their areas of certification? You can find the complete Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer here https://www.sdms.org/about/who-we-are/scope-of-practice.
Charlotte Henningsen, MS, RT(R), RDMS, RVT, FSDMS, FAIUM, is currently an Adjunct Faculty at AdventHealth University. She has taken certification exams in Abdomen, OB/Gyn, Pediatric Sonography, Breast, Fetal Echo, and Vascular Technology. She has been a member of AIUM since 1989 and has served on the AIUM Board as 2nd Vice President, and most recently co-chaired the Practice Principles on Work-Related Musculoskeletal Disorders.
