Grey scale Imaging – High frequency Transducers are used for most of peripheral veins (9 MHz). for iliac or inf venacava , transducer of 4-6 MHz are used. Superficial veins such as saphenous vein, calf veins need even higher frequency transducers ( 9-15 MHz).
Doppler Sonography – quantitative (duplex spectral) & qualitative (color Dopler) .
This combination of anatomic and physiologic information makes US-CD such a powerful tool in evaluation of vascular pathology.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.
Fundamentals of Vascular Ultrasound.
Looking at the basics of carotid, lower extremity arterial, renal, celiac, SMA studies, as well as touching on venous insufficiency. Part I of series.
In this part of presentation we will discuss the role of Doppler Ultrasound in the Diagnosis of other causes of stenosis and variable pattern in circulation.
In my opinion this presentation will help u to identify even rare pathologies.
Detecting Deep Venous Disease with Duplex UltrasoundVein Global
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.
Fundamentals of Vascular Ultrasound.
Looking at the basics of carotid, lower extremity arterial, renal, celiac, SMA studies, as well as touching on venous insufficiency. Part I of series.
In this part of presentation we will discuss the role of Doppler Ultrasound in the Diagnosis of other causes of stenosis and variable pattern in circulation.
In my opinion this presentation will help u to identify even rare pathologies.
Detecting Deep Venous Disease with Duplex UltrasoundVein Global
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The upper and lower extremity arteries , easy to examine, becoz of good imaging window.
Doppler frequencies are typically more than 3 MHz.
Though real-time gray-scale sonography is useful for evaluating the presence of atherosclerotic plaque or confirming the presence of extravascular masses. Color flow Doppler sonographic imaging allows the clinician to survey the area of interest rapidly, determine if vascular structures are present, and if so, characterize their blood flow patterns
Data science is an interdisciplinary field that uses algorithms, procedures, and processes to examine large amounts of data in order to uncover hidden patterns, generate insights, and direct decision making.
Normal thyroid on US-
Homogenous with medium level echogenicity.
Thin hyperechoic capsule, which becomes calcified in pts with uremia or calcium metabolism disorder.
Superior and inferior thyroid artery and vein.
Mean diameter of artery 1-2 mm with PSV of 20-30 cm/s
Veins can ne dilated upto 10 mm.
The recurrent laryngeal nerve runs with inf thyroid artery and passes between esophagus and thyroid lobeon left side & logus coli and thyroid lobe on righjt side.
Scrotal Masses
98-100% accuracy in distinguishing intra and extra-testicular masses.
*** Most extratesticular masses are benign & most intratesticular masses are malignant
Malignant lesions are msotly hypoechoic.
Malignant neoplasia pts usually presents as
painless , unlateral testicular mass .
Clinically it is important to differentiate between Seminomas and Non Seminomatous germ cell tumors.
Nuchal translucency
It is a sonographic pre natal screening scan to detect cardiovascular abnormality in a fetus.
NT can also detect altered extra cellular matrix composition and limited lymphatic drainage
G Sac seen within the thickened decidua .
Eccentric location within endometrium
Should abut the endometrial canal ( to differentiate it from decidual cyst )
On TVS -4& half -5 weeks
Thresold level – identifies the earliest one can expect to see a sac -4w3d
Discriminatory level – identifies when one should always see the sac- 5w 2d .
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
By using transvaginal sonography, the bladder can be seen as early as 11 weeks of gestation. By 12 to 13 weeks, the bladder is visualized in 98% of cases using both transabdominal and transvaginal sonography.
Sonographic evaluation of fetal face is a part of anatomic survey in mid pregnancy
However , little is required; b/c according to american institute of ultrasound in modern practice guidelines, only visualization of fetal upper lip is mandatory during anatomy survey.
3D & 4D images are more informatory in cases where fetal face is hard to evaluate in 2D scan due to fetal position.
Malformations of Cortical Development
Cortex under goes complex development at neuronal/cellular level.
Neurons on outer surface of cortex undergoes 3 overlapping phases from 5th to 28th week.
Proliferation
Migration
organisation
Error of Dorsal Induction
Results in defect of closure of neural tube which leads to various anomalies like anencephaly, encephalocoele, spinal dysraphism and chiari malformations.
In many fetal skeletal dysplasias ,the skin and s/c tissue continues to grow at a rate proportionately greater than the long bones resulting in relatively thickened skin folds (on occasion mistaken for hydrops fetalis ) .
Polyhydraminos –common .cause –variable combination of the following –oesophageal compression by the small chest ,GI abnormalities ,micrognathia ,or hypotonia .
Generally occurs secondary to pulmonary atresia with intact IVS .
Pathophysiology- it develops because of a reduction in the blood flow secondary to inflow impedence from tricuspid atresia or outflow impedence from pulmonary arterial atresia .
Typical findings- a small , hypertrophic RV and a small or absent pulmonary artery
To study the morphological characteristics and enhancement patterns of probably malignant breast lesions on dynamic contrast enhanced MRI and to correlate the findings with Color Doppler imaging and histopathologically.
To evaluate importance of DWI in improving specificity of MR Breast.
4 BASIC TYPES OF DENSITY - air , water /soft tissues, metal /bone , fat
Two substances of the same density, in direct contact, cannot be differentiated from each other on an x-ray.
This phenomenon, the loss of the normal radiographic silhouette (contour), due to loss of difference in density is called the silhouette sign.
2 types (a) cellular NSIP
(b) Fibrotic NSIP (more common)
Fibrosis may involve alveolar septa, peribronchivascular interstitium, interlobular septa and visceral pleura.
Prognosis of fibrotic NSIP is worse , cellular NSIP has good prognosis.
HRCT finding may show both, airspace and interstitial patterns
Despite recent declines in its popularity, excretory urography still remains the cornerstone of radiological diagnosis of urinary tract
The strength of urography lies in its ability to provide overall survey of urinary tract; anatomic definition of the kidney, collecting system, and the lower urinary tract; as well as information about renal function
Pleural effusion
Is the commonest abn of pleura
Pathogenesis off pleural effusion
Inc cap HP – CHF
Dec cap OP - hypoalbuminemia.
Inc cap perm- inflammation.
Obst lymphatics - tumor.
Movement of fluid from extrathoracic site
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
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2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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The peripheral veins
1. Presented by Dr Vrishit Saraswat
Guided by Prof. Dr Dharmraj Meena
2. 1 - Non invasive- Non imaging Physiologic Methods.
These rely basically on the physiology and
hemodynamics which indirectly detects the presence
of venous disease.
Ex- Plethysmography
Drawbacks- Low sensitivity, Low specificity, fail to
define the anatomy.
3. 2 – Invasive Imaging Methods
Conventional Venography- displays the anatomy and is
the historical standard of venous imaging , against
which other techniques are measured.
C/I – risk of contrast reaction and phlebitis, cant provide
physiologic information.
4. 3 – Noninvasive imaging Methods
B-mode US witgh duplex Doppler and color Doppler
provides both physiologic(venous hemodynamics) and
anatomical information (conventional venography.)
***PIOPED – Prospective Investigation of Pulmonary
Embolism Diagnosis –> combined CTv and US-CD of
lower limb venous system has high specificity and
sensitivity in prospective diagnosis in suspected pts.
Cont…
5. **So, sonography is the primary imaging technique
for lower extremity venous evaluation. MRI and
CT serve a secondary role. Conventional venography is
kept reserved for unusual problems.
6. 1. Grey scale Imaging – High frequency Transducers are
used for most of peripheral veins (9 MHz). for iliac
or inf venacava , transducer of 4-6 MHz are used.
Superficial veins such as saphenous vein, calf veins
need even higher frequency transducers ( 9-15 MHz).
7. 2. Doppler Sonography – quantitative (duplex spectral)
& qualitative (color Dopler) .
This combination of anatomic and physiologic
information makes US-CD such a powerful tool in
evaluation of vascular pathology.
8.
9. Superficial Venous Sys
1. Great Saphenous Vein- *** 1-3&3-5 mm
2. Short Saphenous Vein- *** 1-2&2-4 mm
**Both these vessels can become abnormally enlarged or
varicose when superficial venous incompetent.
10. Deep Venous System-
Evaluation of lower limb venous system is typically
directed towards deep system.
*Above knee , all deep veins lie medial to their
respective arteries.
Common fv – profunda f – (superficial) femoral v.
11. Below knee , pop. V. lies superficial to pop art.
Ant tibial vein- ant to interosseous mem and found in
ant compt of calf , ant-medially to tibia.
Tibioperoneal trunk post tibial and paired peroneal
v.
Peroneal v- post-medial to fibula
Post tv – posterior to tibia
12. Visualization of post tibial v is difficult in superior
portion, however in lower portion, the vein can be
traced retrogradly posterior to medial malleolus
Gastrocnemial and soleal v don’t hv accompanying
arteries, hence difficult to evaluate. They are high risk
site for acute DVT in post-op pts.
13. Clinical examniation and diagnosis of DVT is quite
diificult bcoz , signs and symptoms like – pain
erythema and swelling are very non specific.
The presence of “palpable cord” is most commonly d/t
superficial thrombophlebitis, which is NOT usually
associated with DVT.
Most pts with acute DVT are asymptomatic , so an
accurate non invasive method is the best choice for
diagnosis.
14. Pt in supine postion
Hip – AB-ER
9MHz linear probe
In transverse plane with mild compression(pressure
depends on the depth and s/c tissue) , every 2-3 cm
Till , when femoral v enters adductor canal.
Great saphenous vein and profunda femoris v. can also
be examined in this fashion.
15.
16.
17. For popliteal v exam, prone position with slight knee
flexion.
Valsalva Maneuver – indirect way to examine pelvic
veins.
Intra abdo.pressure increase compression of
abdominal and pelvic veins no flow in CFV.
Absense of loss of this pattern can confirm the complete
obstruction of external/common iliac vein.
18. Drawback- false neg examination can occur , if significant
collateral develop or thrombus is non occlusive.
If pelvic veins are poorly seen on CD, contrast enhanced CT
should be performed in suspicious cases.
On Color doppler , normal vein should fill the lumen
completely, with little or no aliasing outside the vessel wall.
Sometimes in calf veins, flow is seen less than actual, becoz
of surrounding muscles. Here venous flow is increased by
compressing the calf muscles, to see complete filling .
19.
20.
21.
22. Before, lower leg was not evaluated , bcoz of its rare
involvement in DVT , and is time consuming.
Althought post tibial and peroneal veins can cause
DVT, but thromus from them don’t cause significant
pulmonary embolism
Now it is mandatory to scan the posterior segment of
leg for complete evaluation.
***If post tibial and peroneal v is normal, no need to
scan ant tibial, as isolated thrombus of ant tibial v is
very rare.
23. Most of examiners don’t scan Gastro-sol vein in
general routine , however centres performing anti-
coagulation for DVT , do scan these small veins as
routine.
Still for symptomatic pts (with risk of dislodging)
short examination is needed. Here we just need to
examine femoral and pop.vein. It will be the rare
cinerio when isolated calf vein thrombsis will cause
grave symptoms & isolated iliac vein thrombosis is also
rare.
24. 1. Grey Scale – drect visualization of thrombus with
lack of compressibilty. Some acute thrombus
might be anechoic.
Therefore , lack of complete venous compression is
hallmark finding of DVT.
Venous distention is seen in acute cases. As clot
becomes organized, the distention disappears.
Cont..
25.
26.
27.
28.
29. Changes in calibre with respiration and valsalva
maneuver is lost in proximal segment of femoral vein.
But if thrombus is below bifurcation of common
femoral v, this sign is not helpful.
2. Color doppler- Persistent filling defect with thrombus
in colour column of vessel lumen or complete
absence of flow.
30. Venography is the standard imaging method .
Usg being non invasive and low comparatively low cost Is
the preferred d method.
Acute thrombus appears hypoechoic or isoechoic to vessel
wall with often complete obstruction & distention of
lumen.
As the clot ages, it under goes fibrosis with more
fibroelastic tissue in it, causing retraction of clot and
thickening of involved vessel wall.
Becoz of clot retraction compression sonography alone
has lesser role in diagnosis of chronic thrombus.
Cont
31. CD usually needed to differentiate between the two.
US-CD findings suggesyive of Chronic DVT-
1. Irrsegular echogenic vein wall
2. Thickening of vein walls
3. Retracted thrombus( may be calcified)
4. Decrease diameter of vein lumen
5. Atretic venous segment
6. Well developed collaterals
7. Absence of distended vein containg hypoechoic
thrombus.
32.
33.
34.
35.
36.
37. Thrombus in Great or small saphenous vein.
Clinical presentation is not same as DVT
Treated symptomatically with heat and aspirin
Exception – treated with anti-coagulants when
thrombus is present with in 2cm of deep venous
system,i.e, either SFJ or SPJ.
38.
39. Deep Venous Insuff.
Following retraction of
thrombus and vein wall ,
causing damage of valve
and increasing
hydrostatic pressure in
lower leg venous sys.
Leading to swollen leg,
woddy induration,
chronic venous ulcer and
pigmentation.
Superf. Venous Insuff.
Either becoz of superficial
thrombophlebitis of long
standing deep venous
insuff.
Long standing Deep ven
insuff Leads to
incompetent perforating
veinsdistended
superficial subcut.veins
Much better prognosis.
40. At SFJ , with valsalva manuvear.
At popliteal Vein – with distal venous augmentation.
Usually there is a short phase or no reversal flow on
Spectral doppler.
But in case of insufficiency long reversal flow is noted.
41.
42.
43. For subfacial endoscopic ligation of incompetent
perforators
Majority of perforators are located below knee
Insufficient perforators on USG appears as distended
veins passing from sub cut tissue through muscle
plane into deep muscles of calf.
**Competent perforators are much smaller in calibre
and often impossible to visualize.
44.
45.
46. Cephalic vein – lateral aspect of forearm
Basilic Vein - medial aspect of forearm.
Brachial veins- smaller deeper and run adjacent to
radial artery.
Axillary Vein- superficial to Axillary artery
Subclavian vein- superficial to Subclavian artery
Medial end of subclavian vein recieves smaller ext
jugular and larger deep jugular vein
47. Internal jugular runs in carotid sheath n runs lateral to
carotid artery.
Left and right int jugular are often unequal in size.
Brachiocephalic vein formed by subclavian and int
jugular vein. {left > right}
Both brachiocephalic join to form sup vena cava.
48.
49. Cause of DVT in upper extremity- Central venous
catheterization, pacemaker lead, long standing venous
canulations, malignant obstruction.
With all these causes , the incidence of thrombosis is
around 40%
The sequele of these thrombosis is less severe than
lower extremity (pul. Emb- 10 to 12%)
cont.
50. So ; development of venous stasis, chronic swelling,
non healing venous ulcers – after DVT ; is very rare in
upper limb.
All this is becoz of extensive collateral formations and
no exposure to high hydrostatic pressure ( as in case of
lower limb).
US of upper limb venous sys also helps in venous
access for central venous cathetherization.
51. Supine
Shoulder-ABER
6-9 MHz
Int Jugular brachio-subC junction
*greater pulsatility due to close proximity of heart.
**loss of this pulsatility may suggest more central
venous occlusion.
Comparision of doppler wave form from contralateral
arm may also help in diagnosis of occlusion.
52.
53.
54. When normal pt sniffs(valsalva), the int jugular and
sub clav vein will decrease in diameter, and spectral
will show an increase in blood velocity. Occluded veins
will loose this property.
Becoz of thoracic cage and clavicle, visualization as
well as copression sono becomes impossible for
brachio- subclav veins.
A coronal, supra-clav, inf angled approachis used for
medial sec of subclavian v.
A coronal, infra-clav, sup angled approach is used for
lateral sec of subclavian v.
55. CD becomes essential in subclav becoz, no possiblity
of compression.
The examiner should also confirm the normal inf –
superficial relationship of vein with adjacent artery.
This will avoid the pitfall of confusing well developed
collateral vessels for patent subclavian vein in chronic
venous occlusion.
Typically the examination is continued till the
bifurcation of axillary vein into two brachial veins (*
for DVT)
56. Similar to the thrombosis of lower venous system.
Also abnormal response on sniff/valsalva ,
absent/decreased cardiac pulsatility and abundant
collateral development becoz of long standing venous
occlusion.