Contrast-enhanced ultrasound uses microbubbles and ultrasound to improve visualization of blood vessels and assessment of vascular perfusion. Microbubbles are spherical gas-filled shells approximately 1-4 micrometers in size composed of materials such as albumin or lipids. When combined with ultrasound imaging, they enhance the contrast between blood pools and surrounding tissues. This technique is useful for evaluation of organ perfusion and differentiation of benign and malignant lesions. Targeted microbubbles also show promise for molecular imaging applications.
Ultrasound Physics Made easy - By Dr Chandni WadhwaniChandni Wadhwani
History of ultrasound, Principle of Ultrasound.
Ultrasound wave and its interactions
Ultrasound machine and its parts, Image display, Artifacts and their clinical importance
what is Doppler ultrasound, Elastography and Recent advances in field of ultrasound.
Safety issues in ultrasound.
Ultrasound elastography is a relatively advanced technique used to know the stiffness of the tissue. It is a non-invasive technique. Broadly classified into Quasistatic and Dynamic elastography.
Ultrasound Physics Made easy - By Dr Chandni WadhwaniChandni Wadhwani
History of ultrasound, Principle of Ultrasound.
Ultrasound wave and its interactions
Ultrasound machine and its parts, Image display, Artifacts and their clinical importance
what is Doppler ultrasound, Elastography and Recent advances in field of ultrasound.
Safety issues in ultrasound.
Ultrasound elastography is a relatively advanced technique used to know the stiffness of the tissue. It is a non-invasive technique. Broadly classified into Quasistatic and Dynamic elastography.
presentation on ultrasound elastography-introduction ,techniques,physics,application, interpretation and future prospects.sourced from multiple articles.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
Application Brief: Tumor Microenvironment Imaging with Photoacoustic TechnologyFUJIFILM VisualSonics Inc.
Photoacoustics (PA) combines optical contrast with the high spatial resolution and deep tissue penetration offered by ultrasound. Such applications are especially beneficial for monitoring tumor development, measuring blood concentration changes within it, and quantifying networks of vasculature formation and carcinoma growth over time.
Application Brief: Tumor Microenvironment Imaging with Photoacoustic TechnologyFUJIFILM VisualSonics Inc.
Combining photoacoustic technology with high-resolution ultrasound projections offered by the Vevo 2100 system provides tremendous benefits for cancer screening. Researchers can now benefit from the combined high-resolution ultrasound and optical contrast ability of the Vevo® LAZR photoacoustic imaging system to achieve clear, deep, images in 2D and 3D for optimal in vivo visualization and quantification of internal anatomy, tumor tissue, and hemodynamics.
presentation on ultrasound elastography-introduction ,techniques,physics,application, interpretation and future prospects.sourced from multiple articles.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
Application Brief: Tumor Microenvironment Imaging with Photoacoustic TechnologyFUJIFILM VisualSonics Inc.
Photoacoustics (PA) combines optical contrast with the high spatial resolution and deep tissue penetration offered by ultrasound. Such applications are especially beneficial for monitoring tumor development, measuring blood concentration changes within it, and quantifying networks of vasculature formation and carcinoma growth over time.
Application Brief: Tumor Microenvironment Imaging with Photoacoustic TechnologyFUJIFILM VisualSonics Inc.
Combining photoacoustic technology with high-resolution ultrasound projections offered by the Vevo 2100 system provides tremendous benefits for cancer screening. Researchers can now benefit from the combined high-resolution ultrasound and optical contrast ability of the Vevo® LAZR photoacoustic imaging system to achieve clear, deep, images in 2D and 3D for optimal in vivo visualization and quantification of internal anatomy, tumor tissue, and hemodynamics.
Tumor angiogenesis is currently one of the key focal points in biomedical research. It is based upon the hypothesis laid out by Judah Folkman in 1971 that neovasculature is needed to support the growth and metastasis of tumors, and thus anti-angiogenic treatment might be an effective way to cure cancer. Genentech’s anti-VEGF-A drug Avastin a great demonstration of this concept, generating more than $2.7 billion of sales in 2008.
Bone marrow basics
Bone marrow targeting strategies along with case studies
Bone marrow based formulations
Bone marrow targeting based marketed formulations
Radiotherapy and chemotherapy aim at killing tumor cells or at least stopping their multiplication. Those therapies have strong limitations: first, their inherent toxicity is not limited to tumoral cells, but also affects healthy tissue; second, only the strongest and most resistant tumoral cells are able to survive, leading to increasingly aggressive tumors.
VisualSonics has introduced a revolutionary micro-ultrasound and photoacoustic imaging system that allows researchers to collect a plethora of important data over the lifespan of animals, thereby significantly reducing the number of animals needed.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Contrast enhanced ultrasound
1.
2. Contrast-enhanced ultrasound (CEUS)
involves the administration of intravenous
contrast agents containing microbubbles of
perfluorocarbon or nitrogen gas.
The microbububbles affect ultrasound
backscatter and increase vascular contrast in
a similar manner to intravenous contrast
agents used in CT and MRI
3. Microbubble shell material determines how
easily the microbubble is taken up by
the immune system.
The material for microbubble determines its
time in circulation and elasticity.
Microbubble shells are composed
of albumin, galactose, lipid, or polymers
Microbubble gas core is the most important
part because it determines the echogenicity.
4. Size of Microbubble is around 1 - 4 μm.
The Microbubble is nearly around the size of
RBCs as it should not cross the vascular
endothelium.
6. Echovist- Used in Right heart Myocardium,
Liver and gynaecological applications.
Albunex- used in Liver, Kidneys and heart
contrast imaging.
SonoVue- Most Commonly used in INDIA.
Used in study of Liver, Kidneys and
Gynaecological studies.
7. DOSE- . SonoVue is a kit including 1 vial
containing 25 mg of lyophilised powder and
second vial contains suspension medium
(Galactose solution)
For I.V. use dose for SonoVue is 2.4 ml
(0.04ml/kg).
For renal and pancreatic evaluation low dose
1.0ml is used.
10ml 0.9% N.S should be flushed after the
administration of the contrast agent.
8. PROCEDURE-
The suspension should be administered
before 15mins after preparation.
The target organ is focused on B-mode US
and then contrast-specific imaging mode is
turned on.
On Ultrasound after the contrast is
administered the tissue is divided on basis of
Perfussion i.e Hyperenhancing, isoenhancing,
hypoenhancing.
10. More common method
In this the microbubbles will remain in the
systemic circulation for a certain period of
time. During that time, ultrasound waves
are directed on the area of interest. When
microbubbles in the blood flow past the
imaging window, the
microbubbles’ compressible reflect a
unique echo.
11. To enhance the contrast at the interface
between the tissue and blood. A clearer
picture of the structure of an organ
Evaluating the degree of blood perfusion
and evaluating the blood volume in an
organ or area of interest.
Differentiation between benign and
malignant focal liver lesions
12. Typical appearance of liver hemangioma (arrows). CEUS
shows globular peripheral enhancement 40
seconds after microbubble injection (A) and progressive,
centripetal fill-in after 90 seconds (B). The central
portion of the lesions remains unenhanced because of
incomplete filling in.
13. Appearance of prostate cancer at CEUS. (A) Baseline transrectal
US of the prostate shows no focal abnormalities in the peripheral
portion of the gland. (B) Twenty-eight seconds after microbubble
injection a hypervascular area is recognized in the right prostate
lobe (arrowheads). Cancer was found at biopsy
14. Acute splenic infarction from septic embolism in a patient with
aortic valve prosthesis infection and bacterial endocarditis. (A)
No defined abnormalities of the splenic parenchyma are seen on
baseline US. (B)CEUS image obtained 30 seconds after
microbubble injection shows a large, nonperfused area (*)
involving the dome of the spleen
15.
16. Contrast agents designed to bind to specific
molecules, which are then targeted at
tissues expressing that substance.
Microbubbles targeted with ligands that
bind certain molecular markers that are
expressed by the area of imaging.
Microbubbles theoretically travel through
the circulatory system, eventually finding
their respective targets and binding
specifically.
17.
18. Inflammation: Contrast agents may be designed to
bind to certain proteins that become expressed in
inflammatory diseases such as Crohn's
disease, atherosclerosis, and even heart attacks
Thrombosis and thrombolysis: Contrast Agents
specifically bind to activated platelets and allow
real-time molecular imaging of thrombosis, such
as in myocardial infarction, as well as monitoring
success or failure of pharmacological thrombolysis.
19. Cancers: If microbubbles are targeted with
ligands that bind receptors like VEGF, they
can non-invasively and specifically identify
areas of cancers.
Drug Delivery: drugs can be incorporated
into the microbubble’s lipid shell.
Gene Delivery: Vector DNA can be
conjugated to the microbubbles
20.
21. Complex hepatic cyst (curved arrows). (A) Baseline US
showing a heterogeneous round lesion with well-
defined margins but no defined posterior
enhancement. (B) After microbubble injection the lesion
does not enhance in all vascular phases.
22.
23.
24. ADVERSE EVENT FREQUENCY
0.5-5 %
FREQUENCY
<1%
SYSTEMIC HEADACHE
HYPERSENSITIVITY
ABDOMINAL PAIN
WEAKNESS
CHEST PAIN, BACK
PAIN.
CARDIOVASCULAR HYPERTENSION ATRIAL FIBRILATION
PALPITATION,
TACHYCARDIA
DIGESTIVE SYSTEM NAUSEA ANOREXIA , DIARRHEA,
DYSPEPSIA
MSK, CNS DIZINESS, DRYMOUTH,
VASODILATATION
LEG CRAMPS,
PARESTHESIA
RESPIRATORY, SKIN DYSPNOEA, SWEATING,
RASH, PRURITUS
SPECIAL SENSES ALTERED TASTE, SMELL.
25. To reduce the risk Check for
intolerance of any of the components
of the contrast agent
Use the lowest level of acoustic output
and shortest scanning time to allow a
diagnostic examination
Management of Drug reactions is
symptomatic.
26. Acoustically homogeneous. Blood and
surrounding tissues have similar
echogenicities, so it is also difficult to clearly
discern the degree of blood flow, perfusion,
or the interface between the tissue and blood
using traditional ultrasound.
Allows real-time evaluation of blood flow.
Destruction of microbubbles by ultrasound in
the image plane allows absolute
quantification of tissue perfusion.
It does not involve radiation.
27. Very cost-efficient and widely
available.
Since microbubbles can generate such
strong signals, a lower intravenous
dosage is needed, micrograms of
microbubbles are needed compared to
milligrams for other molecular imaging
modalities such as MRI contrast agents.
Targeting strategies for microbubbles
are versatile and modular.
Active targeting can be increased
(enhanced microbubbles adhesion)
by Acoustic radiation force using a
clinical ultrasound imaging system in
2D-mode and 3D-mode.
28. Microbubbles don’t last very long in circulation.
They have low circulation residence times
because they either get taken up by immune
system cells or get taken up by the
liver or spleen even when they are coated with
PEG.
Ultrasound produces more heat as the frequency
increases. Monitering Required.
Microbubbles burst at low ultrasound frequencies
and at high mechanical indices (MI), which is the
measure of the acoustic power output of the
ultrasound imaging system. Increasing MI
increases image quality, but there are tradeoffs
with microbubble destruction. Microbubble
destruction could cause local microvasculature
ruptures and hemolysis.
29. Targeting ligands can be immunogenic, since
current targeting ligands used in preclinical
experiments are derived from animal culture.
Low targeted microbubble adhesion
efficiency. This is main reasons that targeted
contrast-enhanced ultrasound remains in the
preclinical development stages.
