Power and Color Doppler Ultrasound Settings for Inflammatory Flow: Impact on Scoring of Disease Activity in Patients With Rheumatoid Arthritis

Authors: Søren Torp-Pedersen, Robin Christensen, Marcin Szkudlarek, Karen Ellegaard, Maria Antonietta D’Agostino, Annamaria Iagnocco, Esperanza Naredo, Peter Balint, Richard J. Wakefield, Arendse Torp-Pedersen, and Lene Terslev

Published in: ARTHRITIS & RHEUMATOLOGY, Vol. 67, No. 2, February 2015, pp 386–395
DOI 10.1002/art.38940

Objective. To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints.

Methods. Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity.

Results. Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2.

Conclusion. The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation.

Read the Complete Article:Power and Color Doppler settings for Inflammatory Flow

Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications

Authors: Mihra S. Taljanovic, MD, PhD, Lana H. Gimber, MD, MPH, Giles W. Becker, MD, L. Daniel Latt, MD, PhD, Andrea S. Klauser, MD, David M. Melville, MD, Liang Gao, PhD, Russell S. Witte, PhD

In the past 2 decades, sonoelastography has been progressively used as a tool to help evaluate soft-tissue elasticity and add to information obtained with conventional gray-scale and Doppler ultrasonographic techniques. Recently introduced on clinical scanners, shearwave elastography (SWE) is considered to be more objective, quantitative,
and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. SWE uses an acoustic radiation force pulse sequence to generate shear waves, which propagate perpendicular to the ultrasound beam, causing transient displacements. The distribution of shear-wave velocities at each pixel is directly related to the shear modulus, an absolute measure of the tissue’s elastic properties. Shear-wave images are automatically coregistered with standard B-mode images to provide quantitative color elastograms with anatomic specificity. Shear waves propagate faster through stiffer contracted tissue, as well as along the long axis of tendon and muscle. SWE has a promising role in determining the severity of disease and treatment followup of various musculoskeletal tissues including tendons, muscles, nerves, and ligaments. This article describes the basic ultrasound physics of SWE and its applications in the evaluation of various traumatic and pathologic conditions of the musculoskeletal system.

RadioGraphics 2017; 37:855–870
Published online 10.1148/rg.2017160116

READ THE ARTICLE:  Shear Wave Elastography Physics Applications


IRIA Kerala:Subspecialty Expert Committee Formation

Dear Members,
Pleased to announce that, as discussed and decided in the state executive meeting on 22nd April, 2018, the following subspeciality expert committee formation is being planned.
Those who are interested to join subspeciality committees may please send your cv to rijomc@gmail.com
1. Neuroradiology
2.Head & Neck Radiology.
3. MSK Radiology
4. Chest Radiology.
5. Breast Imaging
6. Fetal Radiology
7. Interventional Radiology.
8. Abdominal Radiology(Gastrointestinal, Hepatobiliary and Urogenital Radiology).
9. Conventional Radiology.
10 Women’s Health & Gynec imaging.
11. Pediatric Radiology
12. Cardiac Radiology.

The objectives and guidelines for the committees include, but are not limited, to
1. To create, support and nurture a pool of subspeciality experts from Kerala.
2. To help organising committees IRIA conferences in Kerala to decide the subspeciality topics and provide state level, national and international experts as speakers.
3. To provide e- brochures and information on radiological tests in the respective specialities for patients and referring consultants.
4. To create imaging protocols in subspeciality diseases as guidelines for referring doctors after necessary discussions and consensus.
5. To design “conditions of reporting”format stating the limitations, sensitivity and specificity of tests supported by literature and statistics.
6. To promote the culture of care iniatitives and design programs that increases positive, problem solving and caring attitude between IRIA members. ToC increase awareness programs on culture of care amongst IRIA members for better patient communication and interactions.
7. To contribute and support articles to journal club of IRIA Kerala website.

Dr. Rijo Mathew, Secretary
IRIA, Kerala State

I have a dream to work, as a team, towards a vision for IRIA Kerala. We should aim to develop IRIA Kerala to be at par with the best of Global Radiology in Clinical, Diagnostic and Interventional Care, leading the way on relevant research and evidence based decision making, which translates to optimal patient care. We should aim to reach all radiologists in Kerala providing every radiologist with continuous opportunities for skill enhancement. We should also aim to develop a team of subspecialty experts that will lead the way for IRIA Kerala.
There are 3 C’s every organization has to address:
1. Confront the issues faced by the profession: The National Leadership of IRIA with Dr. K. Mohanan, President Elect Dr. Hemant Patel and Secretary General Dr. C. Amarnath have actively taken up PC-PNDT issues.
2. Creative: Contributing to the continuous educational and training opportunities for Radiologists in various subspecialties. The First National Fetal Radiology Conference was organized at Kochi in September 2018 with several experts sharing their knowledge and experience
3. Compassion. The RAKSHA initiative of IRIA has taken up several projects in Kerala. Radiologists in various districts celebrated the International Girl Child on October 11.
Over the past 6 months, a team of committed radiologists has taken the lead for several activities including
1. Membership Campaign Target 1000 initiated
2. Fetal Imaging Conference at Kollam by Trivandrum City Chapter & Kollam Radiology Club on April 22, 2018
3. Kottayam Radiology Club & Thrissur Radiology Club reactivated
4. National Fetal Radiology Conference at Kochi, September 22, 23, 2018
5. Breast Imaging Workshop by MARK & Calicut Radiology Club
6. KREST Physics program at Kochi on August 11, 12 2018
7. Kochi IRIA public awareness programs at General Hospital & Girls School, Pachalam- Dr Amel Anthony, Dr Manjusha and Dr Anusha Varghese led the event
8. Celebrating the International Day of the Girl Child by National IRIA at Trivandrum organized by IRIA Kerala and Trivandrum City Chapter. Hon. Health Minister Shailaja Teacher Inaugurated. Govt Secretary Social Justice Biju Prabhakaran, IAS, SP of Police, Ms. Merlin Joseph, IPS gave messages. National President Dr Mohanan K Presided. RAKSHA National Coordinator Dr. Sona Pungaokar gave the RAKSHA message.
9. Dr. Gomathy, IRIA Kerala RAKSA State Co-ordinator has led the way commendably organizing state wide programs.
10. A special call out to the district coordinators of IRIA Kerala RAKSHA for leading the way in an exemplary manner: Dr Anusha Varghese, Dr. Manjusha, Dr. Sushama, Dr Judy Mary Kurian, Dr. Maggie Xavier, Dr. Rethika, Dr. Della, Dr Shiba, Dr. Usha and Dr. Sini
11. Reactivated the Journal Club on the IRIA Kerala Website: Two articles have been posted. We aim to post an article every fortnight covering all subspecialties of Radiology and Imaging.
This is a humble beginning. Together, with your support, participation and encouragement, we aim to make giant strides forward!

Dr. Rijo Mathew Choorakuttil
Member, Scientific Advisory Committee, IRIA
Member in Charge of Ultrasound, Career Assurance Program, IRIA
In Charge, National Fetal Radiology CME Programmes of IRIA
Fetal Radiology, Subspecialty Head, Indian College of Radiology & Imaging


Dear members,                                                                                                                                                                                                                  05/10/2018

The General Body Meeting of Indian Radiological & Imaging Association, Kerala State Branch is scheduled at 5 pm on 28th October, 2018 at IMA House after our midterm CME. All members are requested to attend the same. The agenda of the GBM will be informed soon.

Dr. Rijo Mathew, Secretary,
IRIA, Kerala State

X-ray phase contrast imaging of the breast-advances towards clinical implementation

Citation: Auweter SD, Herzen J, Willner M, Grandl S, Scherer K, Bamberg F, et al. X-ray phase-contrast imaging of the breast—advances towards clinical implementation. Br J Radiol 2014;87:20130606.

Breast cancer constitutes about one-quarter of all cancers and is the leading cause of cancer death in women. To reduce breast cancer mortality, mammographic screening programmes have been implemented in many Western countries. However, these programmes remain controversial because of the associated radiation exposure and the need for improvement in terms of diagnostic accuracy. Phase-contrast imaging is a new X-ray-based technology that has been shown to provide enhanced soft-tissue contrast and improved visualization of cancerous structures. Furthermore, there is some indication that these improvements of image quality can be maintained at reduced radiation doses. Thus, X-ray phase-contrast mammography may significantly contribute to advancements in early breast cancer diagnosis. Feasibility studies of X-ray phase-contrast breast CT have provided images that allow resolution of the fine structure of tissue that can otherwise only be obtained by histology. This implies that X-ray phase-contrast imaging may also lead to the development of entirely new (micro-) radiological applications. This review provides a brief overview of the physical characteristics of this new technology and describes recent developments towards clinical implementation of X-ray phase-contrast imaging of the breast.

Read the Complete Article: Breast Cancer Imaging

Placental Insufficiency in Fetuses That Slow in Growth but Are Born Appropriate for Gestational Age: A Prospective Longitudinal Study

Authors: Nadia Bardien1,5, Clare L. Whitehead1,3, Stephen Tong1,3, Antony Ugoni4, Susan McDonald5, Susan P. Walker1,2*

1 Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Australia, 2 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia, 3 Translational Obstetrics Group, University of Melbourne, Melbourne, Australia, 4 School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia, 5 La Trobe University, Mercy Hospital for Women, Melbourne, Australia



To determine whether fetuses that slow in growth but are then born appropriate for gestational age (AGA, birthweight >10th centile) demonstrate ultrasound and clinical evidence of placental insufficiency.


Prospective longitudinal study of 48 pregnancies reaching term and a birthweight >10th cen-tile. We estimated fetal weight by ultrasound at 28 and 36 weeks, and recorded birthweight to determine the relative change in customised weight across two time points: 28–36 weeks and 28 weeks-birth. The relative change in weight centiles were correlated with fetoplacental Doppler findings performed at 36 weeks. We also examined whether a decline in growth trajectory in fetuses born AGA was associated with operative deliveries performed for suspected intrapartum compromise.


The middle cerebral artery pulsatility index (MCA-PI) showed a linear association with fetal growth trajectory. Lower MCA-PI readings (reflecting greater diversion of blood supply to the brain) were significantly associated with a decline in fetal growth, both between 28–36 weeks (p = 0.02), and 28 weeks-birth (p = 0.0002). The MCA-PI at 36 weeks was significantly higher among those with a relative weight centile fall <20%, compared to those with a moderate centile fall of 20–30% (mean MCA-PI 1.94 vs 1.61; p<0.05), or severe centile fall of >30% (mean MCA-PI 1.94 vs 1.56; p<0.01). Of 43 who labored, operative delivery for suspected intrapartum fetal compromise was required in 12 cases; 9/18 (50%) cases where growth slowed, and 3/25 (12%) where growth trajectory was maintained (p = 0.01).


Slowing in growth across the third trimester among fetuses subsequently born AGA was associated with ultrasound and clinical features of placental insufficiency. Such fetuses may represent an under-recognised cohort at increased risk of stillbirth.

Published in PLOS One:  DOI:10.1371/journal.pone.0142788

READ THE COMPLETE ARTICLE:Placental Insufficiency in Fetuses That Slow in Growth but Are Born Appropriate for Gestational Age: A Prospective Longitudinal Study