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November 10, 2020 — AuntMinnie

By Theresa Pablos

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Ultrasound has been around forever. It suffers from low resolution. It hasn’t had the same buzzworthy advancements seen in other imaging modalities. But that’s changing, thanks to new technologies redefining how ultrasound is performed — and who gets to perform it.

What’s the result? Leading radiologists are increasingly pointing to ultrasound as the imaging method of the future.

“There are a lot of interesting things happening that I hope will reelevate the status of ultrasound within radiology,” said Dr. Brian Coley, the radiologist in chief at Cincinnati Children’s Hospital Medical Center and one of the expert radiologists who think ultrasound is due for a revamp.

Numerous trends are contributing to the likely reelevation in ultrasound’s status in radiology, including a broadening of the user base, a push toward value-based care, and advancements making the technology cheaper, smaller, and more durable. The intersection of these trends presents a unique opportunity — and challenge — for radiologists.

“With the democratization of ultrasound and the ubiquity of use among other specialists, radiologists need to up their game if they want to maintain their position as the overall experts in ultrasound,” Coley said.

AI, contrast, and other ultrasound improvements at RSNA

The research presented at the RSNA 2020 virtual meeting will offer radiologists one way to learn about ultrasound innovations and up their game. The conference will cover a number of cutting-edge ultrasound topics driving improvements in quality and accuracy.

RSNA Physics Chair Jerome Liang, PhD, pointed to exciting new research on emerging sensor technology to improve image quality, as well as the use of artificial intelligence (AI) for signal processing. Meanwhile, RSNA Pediatric Radiology Chair Dr. Lynn Fordham is excited about research and discussion on contrast-enhanced ultrasound applications.

“The use of ultrasound contrasts is really an exciting new direction — everything from analyzing liver lesions to using contrast for voiding cystourethrograms,” she said.

For RSNA Vascular and Interventional Radiology Chair Dr. Ronald Arellano, miniaturization is one of the most exciting topics in all of radiology, and nowhere is that more evident than in ultrasound. It’s a revolution he’s witnessed firsthand during his vascular radiology career.

For instance, Arellano distinctly remembers a surgery internship where he held retractors for six hours while the surgeon created a surgical shunt between the portal and hepatic veins. Now, he can use intravascular ultrasound to get the same result in 20 minutes with a transjugular intrahepatic portosystemic (TIPS) shunt.

“Having intravascular ultrasound now to help to create that TIPS shunt, to watch in real-time the needle traversing the hepatic vein into the portal vein … I see that as a major advancement,” he said.

Vendors will no doubt be virtually showcasing the next generation of even-smaller tools for ultrasound systems at RSNA 2020. Arellano firmly believes that miniaturization will continue to revolutionize ultrasound-guided procedures in the future.

For instance, one day, he foresees interventional radiologists being able to use ultrasound to guide procedures in the biliary system of the liver and other small, nonvascular channels. Liang said that work to further miniaturize ultrasound equipment is already underway.

Another area ripe with research potential — and a surefire topic at this year’s RSNA meeting — is the use of artificial intelligence. AI advancements are notoriously challenging for ultrasound because the modality is highly dependent on the user, Fordham noted.

Despite the inherent difficulties, researchers and vendors have slowly expanded the number of AI applications for ultrasound. Dr. Fiona Gilbert, the RSNA chair for breast imaging, is one of the clinicians eagerly awaiting more AI ultrasound applications.

“Whole-breast ultrasound is quite a time-consuming examination for the radiologist to scroll through all the images,” she said. “To have really good AI detection tools for ultrasound would be fantastic. They’re being developed, so we’re hoping they’re going to become available shortly.”

The use of synoptic reporting — a type of structured reporting — could also expedite future ultrasound AI applications, noted Dr. Christopher Roth, a neuroradiologist and director of imaging informatics strategy at Duke Health.

“Synoptic reporting is like what you would do when filling out a survey form,” Roth said. “It’s yes/no. Structured questions with structured answers. Doing ultrasound artificial intelligence is really difficult. … Having structured data that can be associated with the pixel data does open up some possibilities.”

Other exciting areas of ultrasound include the use of one-touch features and other tools to address repetitive stress injuries experienced by sonographers. In addition, current ultrasound-guided procedures could potentially be expanded into new organ systems or use cases.

Overall, the experts are excited by the developments making ultrasound technology and image quality even better — and they don’t see that trend slowing down any time soon.

“Ultrasound may have more and more development and advances over the next 10 to 15 years,” Liang said.

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