Tag Archives: dermatologic ultrasound

The 2025 AIUM Annual Convention: The Foremost Ultrasound Learning and Networking Opportunity

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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).

Why Should We Use Ultrasound for Nail Evaluation

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Nowadays, with the development of high- and ultra-high-resolution linear transducers, nail ultrasound has gained relevance in the identification of traumatic injuries, tumors, and inflammatory conditions, among others, providing useful information for clinical management, surgical planning, and monitoring disease inflammatory activity and effectivity of the treatment.

Which technical considerations do we need to keep in mind?

In all areas of dermatological ultrasound, the evaluation of the nail must be performed with a high-resolution linear transducer, ideally between 15 and 24 MHz, which allows for a perfect anatomical definition of all the components on the nail unit. It is expected to use enough gel between the transducer and the surface of the nail in order to be able to correctly see all the components of the nail (Figure 1), some authors have used other techniques such as immersing the nail in water or the use of pads, but in my practice I consider the first one to be more practical. It is always important to analyze in gray scale, Doppler, Duplex, and color; of course in axial and longitudinal view.

Figure 1. Adequate technic for nail ultrasound.

Ultrasound Anatomy of the Nail

The nail unit is made up of three main components: nail plate, nail bed, and matrix, as seen in Figure 2. Each of these has a precise sonographic definition. We also need to evaluate the periungual area compound for periungual folds. Furthermore, it’s important to include the distal phalanx, the distal interphalangeal joint, and the extensor tendon in the evaluation, mainly for inflammatory diseases such as psoriasis.

Figure 2A: Gray scale ultrasound longitudinal view of normal anatomy of a nail. Abbreviations: dp, dorsal plate; vp, ventral plate; nb, nail; m, matrix; npf, nail proximalfold.
Figure 2B: Color Doppler ultrasound longitudinal view of normal vascularization of the nail unit. Abbreviations: nb nail; pnf, proximal nail proximal fold; ipj, interphalangeal joint.

Why use ultrasound in the nail unit for inflammatory diseases?

The clinical findings of inflammatory nail diseases such as psoriasis, lichen, scleroderma, arthritis, and lupus may be very similar and difficult to differentiate. The use of biopsy leads to scarring and deformation of the nail. The morphological changes shown on ultrasound for these diseases are very characteristic, and, with adequate clinical correlation, we can avoid the use of biopsy. In psoriasis for example, five sonographic stages are described for the identification of the stage of the disease, and we have the ability to monitor the inflammatory activity by using Doppler evaluation and analyze the distal enthesis of the extensor tendon and synovial proliferation in the interphalangeal space. This is very important to develop early findings of psoriatic arthritis, even in subclinical stages, and this information can be crucial for the prognosis and treatment of patients.

Why use nail ultrasound in tumors?

Most nail tumors (73%) are ungular tumors and 27% are periungual. Ultrasound can show the classic appearance of multiple tumors to allow a clear diagnosis and information for surgical planning and treatment. Some studies have shown that ultrasound can change the clinical diagnosis in 35% of cases. For glomus tumors or exostoses, ultrasound can have a specificity of 100% (Figure 3).

Figure 3A: Ultrasound greyscale, longitudinal view shows well-defined hyperechoic nodule with scalloping of the bone margin of the distal phalanx.
Figure 3B: Color Duplex ultrasound (longitudinal view) shows hypervascularity within the nodule.

Why use nail ultrasound for trauma?

The nail unit is very prone to micro and macro-trauma. Micro-trauma can produce dystrophic changes in the nail plate that can simulate other nail diseases such as onychomycosis or nail psoriasis, retronychia and onychomadesis, being able to differentiate them adequately with ultrasound (Figure 4). In macro-trauma, fragmentation of the plate, hematomas, and even fractures of the distal phalanges can be diagnosed.

Figure 4A: Gray scale ultrasound longitudinal view. The arrow indicates a big fragment of retronychia with thickening of the proximal nail fold.
Figure 4B: Gray scale ultrasound longitudinal view with Onychomadesis. There are two fragments of the nail plate.

As we can see, ultrasound can give us sufficient and very clear information on all the components of the nail unit. Nail ultrasound may be more widely available than other diagnostic tools like MR, it also has more spatial resolution and there is no need for contrast. Of course, ultrasound nail evaluation should be performed following the technical recommendations for Dermatological ultrasound, and the study needs to be performed by a qualified individual with training and knowledge of nail pathology, which can be very challenging. In that scenario, it can be considered the first-line modality to clear up multiple nail pathologies.

References

Aluja Jaramillo F, Quiasúa Mejía DC, Martínez Ordúz HM, González Ardila C. Nail unit ultrasound: a complete guide of the nail diseases. J Ultrasound 2017; 20:181–192. doi:10.1007/s40477-017-0253-6

González CP. Ultrasonido de alta resolución en enfermedades benignas de la piel. Revista De La Asociación Colombiana De Dermatología Y Cirugía Dermatológica 2018; 26:230–239. doi.org/10.29176/2590843X.124

Kromann CB, Wortsman X, Jemec GBE. High-Frequency Ultrasound of the Nail. In: Humbert P, Maibach H, Fanian F, Agache P (eds). Agache’s Measuring the Skin. Springer, Cham; 2015.

Wortsman X, Alfageme F, Roustan G, et al. Guidelines for performing dermatologic ultrasound examinations by the DERMUS Group. J Ultrasound Med 2016; 35:577–580.

Claudia Gonzalez, MD, is a Radiologist at Rosario University in Bogota, Colombia, is Vice Chair of the Dermatologic Ultrasound AIUM Interest Group, and has a Private Practice for high-resolution dermatological and MSK ultrasound in Bogotá, Colombia.

Interested in reading more about POCUS medical education? Check out these posts from the Scan:

How I Became Involved in Dermatologic Ultrasound

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There are certain moments in time when your gut tells you that your life is about to change. It happened to me in 1999.

I was on a training visit to the Musculoskeletal Ultrasound Section of the Department of Diagnostic Radiology at the Henry Ford Hospital in Detroit when Dr WortsmanI saw a “hockey stick” probe. Instinctively, I decided to use it on my fingernails. The images I saw on the screen were so fantastic that I ran to the library to see if there were any papers or publications that focused on ultrasound of the nail.

Surprisingly, I discovered a few Italian and Danish dermatologists who were working with smaller types of high frequency ultrasound devices on experimental settings. Wanting to learn more, I wrote to them. I was thrilled when Professor Gregor Jemec responded and agreed to collaborate.

However, getting an ultrasound machine for a dermatology project proved to be more difficult. It took almost 2 years before an ultrasound machine was installed and available for me to use while I was at the Department of Dermatology at Bispejerg Hospital in Copenhagen.

After securing the machine, I had the opportunity to scan dermatologic patients on a daily basis and I realized the great potential this imaging modality had within dermatology.

Once I returned to Chile, I really got to work. I studied the sonographic patterns, began to correlate the ultrasound images with the clinical and histologic findings, and started to publish the results.

That also proved difficult at first because radiology journals felt the content was better suited for dermatology journals and dermatology journals recommended radiology journals since the content involved imaging. Probably these journals had a difficult time even finding someone to review this material.

It was during this rough beginning that I reached out to my uncle Jacobo. I was telling him how difficult publishing could be and he simply reiterated President Truman’s famous quote, “If you can’t take the heat, get out of the kitchen.”

That just made me more committed. I created an educational website and continued to practice, learn, research, and write. In 2010, the Journal of the American Academy of Dermatology published our paper that analyzed more than 4,000 dermatologic ultrasound cases with histologic correlation. In 2013, our book Dermatologic Ultrasound with Clinical and Histologic Correlations was published.

Since that time, a lot has changed. I used to hear radiologists and dermatologists comment that they had never heard of dermatologic ultrasound. Now, the use of ultrasound in dermatology is expanding rapidly with colleagues from around the world using this tool to diagnose common dermatologic conditions earlier and more precisely.

For me, the dermatologic ultrasound journey mirrored my family’s immigration journey. We both left something familiar and ended up in a distant land. While the journey has not been easy, the results have been more than worthwhile.

But our work continues. Now, one of our challenges is how to share what we have learned to inspire and train a new generation of dermatologic ultrasound professionals. As a specialty, we are excited by AIUM’s support through the development of a dermatologic ultrasound interest group. Here we will share information, research, and resources. Please join us!

Why did you becoming interested in ultrasound? Have you participated in your AIUM Community? What struggles have you overcome in your career? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Ximena Wortsman, MD, Radiologist, Chair of Dermatologic Ultrasound AIUM Interest Group, Senior Member of AIUM, Department of Radiology and Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.