Quantitative Doppler in musculoskeletal ultrasonography - suboptimal performance of both experienced and in-training sonographers in selection of the highest Doppler signal image from cine-loops.

AIMS: Doppler ultrasonography assessment is mandatory nowadays for the complete description of rheumatic disease activity. Initially it was performed in semi quantitative way but recently the (fully) quantitative assessment is gaining more interest. In quantitative assessment, the ratio between total colorized and total pixels (CTR) is computed for the whole image or just for the region of interest (ROI). The frame with the highest amount of Doppler signal (also called worst case scenario image - WCSI) is usually the only one analyzed. The technique requires a very precise identification of WCSI from a certain number of consecutive frames, captured from the same position of the US probe, (and in most cases this is done manually). Our study examined the ability of both experienced and in-training sonographers to identify WCSI using a computerized analytical system as the gold standard. MATERIALS AND METHODS: The study analyzed 480 frame selections done in two distinct exercises. The WCSI and other 3 images with a 5%, 10% and respectively 20% lower level of CTR compared with WCSI were packed in one selection. All frames emerging from the same video clip were randomly presented to six experienced and six in training sonographers; the request was to select the frame with the highest CTR (WCSI) from each package (twenty packages in total). A similar exercise was performed with CTRs decreasing in steps of 2%. RESULTS: In the first exercise the WCSI was correctly identified in 79.1% cases and in 67% of cases in the 2nd exercise. The interobserver agreement between experienced and in-trainer evaluators for the 1st exercise was 0.78 and 0.4 in the 2nd exercise. CONCLUSION: Using computerized analysis as the gold standard, we demonstrated a large heterogeneity across sonographers regarding their ability to identify the best Doppler image even from a small group of frames.

The use of light reflection rheography in diagnosing venous disease and arterial microcirculation.

The use of light reflection rheography (LRR) has reached an important level in the past few years. Using the originally construed and conceived RRL 001 device, we present the basic principles, the working technique and the limits of this method. We will use two magnetic amplifiers, one for the finger tip, which measures the capillary blood flow at this level and a venous magnetic amplifier which measures the blood flow in the venous plexuses at a 1-2 mm depth. The detection of the blood flow in the subcutaneous (hypodermic) venous areas leads to the diagnosis of profound thrombophlebitis and venous valves insufficiency. The detection of the capillary flow in the finger tip, its presentation as a curve, measuring the pressure of the inter digital arteries (using Riva Rocci method), establishing the index of systolic pressure make possible the understanding of the gravity of the existing hemodynamic disorders (especially in what concerns the Raynaud syndromes), the supervision of the original disease and the efficiency of the treatment. Weindorf was the first one to use the RRL technique in medicine in 1985 and, after 1997, it has been developed through Sproule's work. Within The Medical Clinic of the Municipal Hospital, a light reflection rheograph has been built and forwarded as innovation. The device has been used for 2 years in the diagnosis of venous disorders and peripheral microcirculation disorders. In this article we present the principles of the LRR examination of the lower limb venous system and of the microcirculation of the fingers of the upper limbs, an examination based upon our own experience which includes 72 examinations.