Association Between Muscle Strength and Modeling Estimates of Muscle Tissue Heterogeneity in Young and Old Adults.

OBJECTIVES: Assessing aging muscle through estimates of muscle heterogeneity may overcome some of the limitations of grayscale analyses. The objectives of this study included determining statistical model parameters that characterize muscle echogenicity and are associated with strength in younger and older participants. METHODS: Thirty-three community-dwelling participants were assigned to younger and older groups. Quantitative B-mode ultrasound scanning of the rectus femoris and isometric grip strength testing were completed. Shape or dispersion parameters from negative binomial distribution, Nakagami, gamma, and gamma mixture models were fitted to the grayscale histograms. RESULTS: The mean ages ± SDs of the younger and older groups were 24.0 ± 2.3 and 65.1 ± 6.5 years, respectively. Statistical model shape and dispersion parameters for the grayscale histograms significantly differed between the younger and older participants (P = .002-.006). Among all of the statistical models considered, the gamma mixture model showed the best fit with the grayscale histograms (χ2 goodness of fit = 62), whereas the Nakagami distribution displayed the poorest fit (χ2 goodness of fit = 2595). Grayscale values were significantly associated with peak grip strength force in younger adult participants (R2 = 0.36; P < .008). However, the negative binomial dispersion parameter k (adjusted R2 = 0.70; P < .001) and gamma shape parameter α (adjusted R2 = 0.68; P < .01) showed the highest associations with peak grip strength force in older adult participants. CONCLUSIONS: The negative binomial dispersion parameter k and the gamma shape parameter α have clinical relevance for the assessment of age-related muscle changes. Statistical models of muscle heterogeneity may characterize the association between muscle tissue composition estimates and strength better than grayscale measures in samples of community-dwelling older adults.

Radiological findings of abnormalities associated with congenital Zika virus infection: conclusions from World Radiology Day 2016

[ABSTRACT]. In July 2015, Brazil reported an association between Zika virus infection and Guillain-Barré syndrome, and then in October 2015, between Zika and microcephaly. Most countries and territories in the Region of the Americas were later affected by the virus, creating a public health emergency. Each year, the Pan American Health Organization (PAHO), Regional Office of the World Health Organization commemorates World Radiology Day (WRD), which highlights the role of radiology in public health. In 2016, PAHO devoted its WRD efforts to the Zika infection. Experts and partners presented and discussed the various radiological findings of Zika infection, the crucial role of obstetric ultrasound in the screening and monitoring of abnormalities associated with confirmed Zika virus infection, and the appropriateness of utilizing other neuroimaging technologies to study brain abnormalities in neonates and infants with prenatal Zika virus infection. The conclusions of WRD 2016 recommend that upon confirmation, prenatal ultrasound be used as the main tool to investigate and monitor suspected cases, with subsequent multidisciplinary postnatal assessments that include neuropediatric clinical studies and relevant neuroimaging. Additionally, radiology technicians should be adequately trained and a quality assurance program should be implemented to ensure timely, safe, and accurate diagnosis.

[RESUMEN]. En julio del 2015, Brasil informó una asociación entre la infección por el virus del Zika y el síndrome de Guillain-Barré y luego, en octubre 2015, entre la infección por el virus del Zika y la microcefalia. Posteriormente, la mayoría de los países y territorios de la Región de las Américas se vio afectada por el virus, lo que dio lugar a una emergencia de salud pública. Todos los años, la Organización Panamericana de la Salud (OPS), la Oficina Regional de la Organización Mundial de la Salud, conmemora el Día Mundial de la Radiología, en el que se reconoce la importancia de la radiología en la salud pública. En el 2016, la OPS dedicó las actividades en el marco del Día Mundial de la Radiología a la infección por el virus del Zika. Diversos expertos y asociados presentaron los distintos signos radiográficos de la infección por el virus del Zika, y debatieron sobre esto, así como sobre el papel fundamental que desempeñan las ecografías obstétricas en el tamizaje y el seguimiento de las anomalías asociadas con la infección por el virus del Zika confirmada, y sobre la pertinencia de utilizar técnicas de neurodiagnóstico por imágenes para estudiar las anomalías cerebrales en recién nacidos y lactantes con infección por el virus del Zika prenatal. Las conclusiones del Día Mundial de la Radiología del 2016 recomiendan que, tras la confirmación de la infección, se utilicen las ecografías prenatales como herramienta principal para investigar y hacer un seguimiento de los casos presuntos, seguida por una evaluación posnatal multidisciplinaria en la que se incluyan estudios clínicos neuropediátricos y las técnicas de neurodiagnóstico por imágenes pertinentes. Además, se debe capacitar adecuadamente a los técnicos de radiología y se debe ejecutar un programa de garantía de la calidad para asegurar el diagnóstico oportuno, seguro y certero.

[RESUMO]. Em julho de 2015, o Brasil informou existir associação entre a infecção por vírus zika e síndrome de Guillain-Barré e, em outubro do mesmo ano, entre o vírus zika e microcefalia. A maioria de países e territórios na Região das Américas foi subsequentemente afetada pelo vírus, constituindo emergência de saúde pública. Todos os anos, a Organização Pan-Americana da Saúde (OPAS), Escritório Regional da Organização Mundial da Saúde (OMS) comemora o Dia Internacional da Radiologia destacando o papel da radiologia em saúde pública. Em 2016, a OPAS dedicou este dia à infecção por vírus zika. Especialistas e parceiros apresentaram e debateram os diversos achados radiológicos na infecção por vírus zika, o papel fundamental do exame de ultrassom obstétrico na detecção precoce e monitoramento de anomalias associadas à infecção confirmada e quando convém usar outras técnicas de neuroimagem para estudar as anomalias cerebrais nos recém-nascidos e lactentes com infecção pré-natal. O painel do Dia Internacional da Radiologia 2016 recomenda que, com a confirmação da infecção, o ultrassom pré-natal seja o principal método usado para investigar e monitorar os casos suspeitos, com subsequente avaliação pós-natal multidisciplinar incluindo estudos clínicos neuropediátricos e exames de neuroimagem. Além disso, o pessoal técnico em radiologia deve ser adequadamente capacitado e implantado um programa de garantia da qualidade para assegurar o diagnóstico preciso, seguro e oportuno.

Radiological findings of abnormalities associated with congenital Zika virus infection: conclusions from World Radiology Day 2016.

In July 2015, Brazil reported an association between Zika virus infection and Guillain-Barre syndrome, and then in October 2015, between Zika and microcephaly. Most countries and territories in the Region of the Americas were later affected by the virus, creating a public health emergency. Each year, the Pan American Health Organization (PAHO), Regional Office of the World Health Organization commemorates World Radiology Day (WRD), which highlights the role of radiology in public health. In 2016, PAHO devoted its WRD efforts to the Zika infection. Experts and partners presented and discussed the various radiological findings of Zika infection, the crucial role of obstetric ultrasound in the screening and monitoring of abnormalities associated with confirmed Zika virus infection, and the appropriateness of utilizing other neuroimaging technologies to study brain abnormalities in neonates and infants with prenatal Zika virus infection. The conclusions of WRD 2016 recommend that upon confirmation, prenatal ultrasound be used as the main tool to investigate and monitor suspected cases, with subsequent multidisciplinary postnatal assessments that include neuropediatric clinical studies and relevant neuroimaging. Additionally, radiology technicians should be adequately trained and a quality assurance program should be implemented to ensure timely, safe, and accurate diagnosis.

En julio del 2015, Brasil informó una asociación entre la infección por el virus del Zika y el síndrome de Guillain-Barré y luego, en octubre 2015, entre la infección por el virus del Zika y la microcefalia. Posteriormente, la mayoría de los países y territorios de la Región de las Américas se vio afectada por el virus, lo que dio lugar a una emergencia de salud pública. Todos los años, la Organización Panamericana de la Salud (OPS), la Oficina Regional de la Organización Mundial de la Salud, conmemora el Día Mundial de la Radiología, en el que se reconoce la importancia de la radiología en la salud pública. En el 2016, la OPS dedicó las actividades en el marco del Día Mundial de la Radiología a la infección por el virus del Zika. Diversos expertos y asociados presentaron los distintos signos radiográficos de la infección por el virus del Zika, y debatieron sobre esto, así como sobre el papel fundamental que desempeñan las ecografías obstétricas en el tamizaje y el seguimiento de las anomalías asociadas con la infección por el virus del Zika confirmada, y sobre la pertinencia de utilizar técnicas de neurodiagnóstico por imágenes para estudiar las anomalías cerebrales en recién nacidos y lactantes con infección por el virus del Zika prenatal. Las conclusiones del Día Mundial de la Radiología del 2016 recomiendan que, tras la confirmación de la infección, se utilicen las ecografías prenatales como herramienta principal para investigar y hacer un seguimiento de los casos presuntos, seguida por una evaluación posnatal multidisciplinaria en la que se incluyan estudios clínicos neuropediátricos y las técnicas de neurodiagnóstico por imágenes pertinentes. Además, se debe capacitar adecuadamente a los técnicos de radiología y se debe ejecutar un programa de garantía de la calidad para asegurar el diagnóstico oportuno, seguro y certero.

Em julho de 2015, o Brasil informou existir associação entre a infecção por vírus zika e síndrome de Guillain-Barré e, em outubro do mesmo ano, entre o vírus zika e microcefalia. A maioria de países e territórios na Região das Américas foi subsequentemente afetada pelo vírus, constituindo emergência de saúde pública. Todos os anos, a Organização Pan-Americana da Saúde (OPAS), Escritório Regional da Organização Mundial da Saúde (OMS) comemora o Dia Internacional da Radiologia destacando o papel da radiologia em saúde pública. Em 2016, a OPAS dedicou este dia à infecção por vírus zika. Especialistas e parceiros apresentaram e debateram os diversos achados radiológicos na infecção por vírus zika, o papel fundamental do exame de ultrassom obstétrico na detecção precoce e monitoramento de anomalias associadas à infecção confirmada e quando convém usar outras técnicas de neuroimagem para estudar as anomalias cerebrais nos recém-nascidos e lactentes com infecção pré-natal. O painel do Dia Internacional da Radiologia 2016 recomenda que, com a confirmação da infecção, o ultrassom pré-natal seja o principal método usado para investigar e monitorar os casos suspeitos, com subsequente avaliação pósnatal multidisciplinar incluindo estudos clínicos neuropediátricos e exames de neuroimagem. Além disso, o pessoal técnico em radiologia deve ser adequadamente capacitado e implantado um programa de garantia da qualidade para assegurar o diagnóstico preciso, seguro e oportuno.

Radiological findings of abnormalities associated with congenital Zika virus infection: conclusions from World Radiology Day 2016 / Resultados radiológicos de las anomalías asociadas con la infección congénita por el virus del Zika: conclusiones del Día Mundial de la Radiología del 2016 / Achados radiológicos de anomalias associadas à infecção congênita por vírus zika: conclusões do Dia Internacional da Radiologia 2016

ABSTRACT In July 2015, Brazil reported an association between Zika virus infection and Guillain-Barré syndrome, and then in October 2015, between Zika and microcephaly. Most countries and territories in the Region of the Americas were later affected by the virus, creating a public health emergency. Each year, the Pan American Health Organization (PAHO), Regional Office of the World Health Organization commemorates World Radiology Day (WRD), which highlights the role of radiology in public health. In 2016, PAHO devoted its WRD efforts to the Zika infection. Experts and partners presented and discussed the various radiological findings of Zika infection, the crucial role of obstetric ultrasound in the screening and monitoring of abnormalities associated with confirmed Zika virus infection, and the appropriateness of utilizing other neuroimaging technologies to study brain abnormalities in neonates and infants with prenatal Zika virus infection. The conclusions of WRD 2016 recommend that upon confirmation, prenatal ultrasound be used as the main tool to investigate and monitor suspected cases, with subsequent multidisciplinary postnatal assessments that include neuropediatric clinical studies and relevant neuroimaging. Additionally, radiology technicians should be adequately trained and a quality assurance program should be implemented to ensure timely, safe, and accurate diagnosis.

RESUMEN En julio del 2015, Brasil informó una asociación entre la infección por el virus del Zika y el síndrome de Guillain-Barré y luego, en octubre 2015, entre la infección por el virus del Zika y la microcefalia. Posteriormente, la mayoría de los países y territorios de la Región de las Américas se vio afectada por el virus, lo que dio lugar a una emergencia de salud pública. Todos los años, la Organización Panamericana de la Salud (OPS), la Oficina Regional de la Organización Mundial de la Salud, conmemora el Día Mundial de la Radiología, en el que se reconoce la importancia de la radiología en la salud pública. En el 2016, la OPS dedicó las actividades en el marco del Día Mundial de la Radiología a la infección por el virus del Zika. Diversos expertos y asociados presentaron los distintos signos radiográficos de la infección por el virus del Zika, y debatieron sobre esto, así como sobre el papel fundamental que desempeñan las ecografías obstétricas en el tamizaje y el seguimiento de las anomalías asociadas con la infección por el virus del Zika confirmada, y sobre la pertinencia de utilizar técnicas de neurodiagnóstico por imágenes para estudiar las anomalías cerebrales en recién nacidos y lactantes con infección por el virus del Zika prenatal. Las conclusiones del Día Mundial de la Radiología del 2016 recomiendan que, tras la confirmación de la infección, se utilicen las ecografías prenatales como herramienta principal para investigar y hacer un seguimiento de los casos presuntos, seguida por una evaluación posnatal multidisciplinaria en la que se incluyan estudios clínicos neuropediátricos y las técnicas de neurodiagnóstico por imágenes pertinentes. Además, se debe capacitar adecuadamente a los técnicos de radiología y se debe ejecutar un programa de garantía de la calidad para asegurar el diagnóstico oportuno, seguro y certero.

RESUMO Em julho de 2015, o Brasil informou existir associação entre a infecção por vírus zika e síndrome de Guillain-Barré e, em outubro do mesmo ano, entre o vírus zika e microcefalia. A maioria de países e territórios na Região das Américas foi subsequentemente afetada pelo vírus, constituindo emergência de saúde pública. Todos os anos, a Organização Pan-Americana da Saúde (OPAS), Escritório Regional da Organização Mundial da Saúde (OMS) comemora o Dia Internacional da Radiologia destacando o papel da radiologia em saúde pública. Em 2016, a OPAS dedicou este dia à infecção por vírus zika. Especialistas e parceiros apresentaram e debateram os diversos achados radiológicos na infecção por vírus zika, o papel fundamental do exame de ultrassom obstétrico na detecção precoce e monitoramento de anomalias associadas à infecção confirmada e quando convém usar outras técnicas de neuroimagem para estudar as anomalias cerebrais nos recém-nascidos e lactentes com infecção pré-natal. O painel do Dia Internacional da Radiologia 2016 recomenda que, com a confirmação da infecção, o ultrassom pré-natal seja o principal método usado para investigar e monitorar os casos suspeitos, com subsequente avaliação pós-natal multidisciplinar incluindo estudos clínicos neuropediátricos e exames de neuroimagem. Além disso, o pessoal técnico em radiologia deve ser adequadamente capacitado e implantado um programa de garantia da qualidade para assegurar o diagnóstico preciso, seguro e oportuno.

Interrater reliability of quantitative ultrasound using force feedback among examiners with varied levels of experience.

Background. Quantitative ultrasound measures are influenced by multiple external factors including examiner scanning force. Force feedback may foster the acquisition of reliable morphometry measures under a variety of scanning conditions. The purpose of this study was to determine the reliability of force-feedback image acquisition and morphometry over a range of examiner-generated forces using a muscle tissue-mimicking ultrasound phantom. Methods. Sixty material thickness measures were acquired from a muscle tissue mimicking phantom using B-mode ultrasound scanning by six examiners with varied experience levels (i.e., experienced, intermediate, and novice). Estimates of interrater reliability and measurement error with force feedback scanning were determined for the examiners. In addition, criterion-based reliability was determined using material deformation values across a range of examiner scanning forces (1-10 Newtons) via automated and manually acquired image capture methods using force feedback. Results. All examiners demonstrated acceptable interrater reliability (intraclass correlation coefficient, ICC = .98, p < .001) for material thickness measures obtained using force feedback. Individual examiners exhibited acceptable reliability with the criterion-based reference measures (ICC > .90, p < .001), independent of their level of experience. The measurement error among all examiners was 1.5%-2.9% across all applied stress conditions. Conclusion. Manual image capture with force feedback may aid the reliability of morphometry measures across a range of examiner scanning forces, and allow for consistent performance among examiners with differing levels of experience.

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia.

INTRODUCTION: Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance. METHODS: Twenty community-dwelling female subjects participated in the study (age = 43.4 ± 20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht(2)), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m(2) determined participant assignment into the Normal LBM and Low LBM subgroups. RESULTS: The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht(2) (adj. R (2) = 0.61, p < 0.001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R (2) = 0.85, p < 0.001). Scaled peak force was associated with age and echogenicity (adj. R (2) = 0.53, p < 0.001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p < 0.05). CONCLUSIONS: Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht(2) in women. In addition, ultrasound proxy measures of muscle quality are more strongly associated with strength than muscle mass within the study sample.

The accreditation of ultrasound practices: impact on compliance with minimum performance guidelines.

OBJECTIVE: To determine the effectiveness of the American Institute of Ultrasound in Medicine (AIUM) accreditation program in improving compliance with standards and guidelines for the performance of obstetric and gynecologic ultrasound examinations. METHODS: Scores of case studies of accreditation applications were compared with their respective scores at the time of reaccreditation 3 years later. To account for the element of time, scores of applications that recently completed first-time accreditation were also compared as a control group. RESULTS: Individual obstetric case studies, as well as the average of all obstetric and gynecologic case studies, showed highly significant improvement with the reaccreditation application when compared with the initial accreditation application 3 years earlier (all P <.001). The proportion of practices successfully meeting obstetric and gynecologic AIUM accreditation requirements improved significantly with reaccreditation (obstetric, 57.3% for accreditation compared with 86.6% for reaccreditation; gynecologic, 60% for accreditation compared with 91.9% for reaccreditation; P <.001). Furthermore, reaccreditation scores were significantly higher than scores of recent first-time applications for obstetric case studies as well as scores of the average of obstetric and gynecologic case studies (all P <.05). CONCLUSIONS: Our study confirms that practices that sought and received ultrasound accreditation were able to improve the scores of case studies and compliance with published minimum standards and guidelines for the performance of obstetric and gynecologic ultrasound examinations when reevaluated 3 years after the initial application scores. This improvement should translate into an enhancement of the quality of ultrasound practice.