Abstracts SESSION 5B: POCUS Right heart in critical illness Li Huey Tan Intensive Care Specialist, Supervisor Critical Care Echocardiography & Ultrasonography, Alfred Health, Melbourne, VIC, Australia The right ventricle can often be neglected during the clinical and echocardiographic assessment of critically unwell patients. Its complex shape and close proximity to other vital structures, makes it vulnerable to injury in many disease states such as pulmonary embolism, cardiomyopathies, valvulopathies and ARDS. The RV is viewed as the "forgotten ventricle" but recognising a struggling RV, should form part of an integrated clinical and echo assessment to drive patient management. A series of case studies will be presented to highlight the pitfalls and challenges in assessing the RV in critical illness. SESSION 5C: VASCULAR Con or Common Sense? A review of asymptomatic carotid artery screening Matt Adams Camperdown Vascular Lab, Camperdown, NSW, Australia Stroke is the second highest cause of death and third leading cause of disability worldwide. Ischaemic strokes are caused by embolism and cerebrovascular disease, the latter of which can be detected at high rates of sensitivity and specificity with duplex ultrasound. Screening for asymptomatic carotid artery stenosis (ACAS) remains highly controversial. Partly to blame is the prevalence of for-profit organisations encouraging the public to have ‘check-up’ style imaging that may detect ACAS. This is one of the reasons for numerous healthcare boards, most notably the US Preventive Task Board in 2014, issuing recommendations against asymptomatic carotid artery screening, citing that it would yield too many false positives and may actually do more harm than good. There are contrasting opinions on the screening of ACAS in Australia however there is no official position on this topic. A properly designed program that selects asymptomatic patients based on risk factors with scans performed by accredited vascular laboratories can provide for the assessment of overall cardiovascular health. This has been demonstrated by The Atherosclerosis Risk in Communities study. We propose a multidisciplinary program for these select patients that may improve outcomes, at risk patient awareness and empower long term lifestyle modification. References: 1. World Health Organisation. [Internet]. WHO: 2016. Stroke: a global response is needed.[cited 15/02/2019]. Available at - https:// www.who.int/bulletin/volumes/94/9/16-181636/en/. 2. LeFevre, M. Screening for Asymptomatic Carotid Artery Stenosis: U.S Preventive Task Force Recommendation Statement. Annals of Internal Medicine (2014). 161 (5). P365-363. 3. Wright, J. The Atherosclerosis Risk in Communities Study, National Heart, Lung and Blood Institute (1985-2016).
The novel technique of using superb microvascular imaging to determine carotid intima-media thickness Fatima M. Hasan, Musarrat Hasan Institute of Ultrasound Imaging, Karachi, Sind, Pakistan Objective: The objective of this study was to investigate the interobserver reliability when measuring the carotid intima media thickness (IMT) using superb microvascular imaging (SMI) and B-mode ultrasonography. Methods: Two sonologists were selected to scan the left common carotid artery and measure IMT first with B-mode and then with SMI
on 20 patients. They were blinded to each other results. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability using both the modes of scanning. Results: Interobserver agreement when using SMI, for both near wall and far wall, was almost perfect (ICC, 0.870; 95% confidence interval [CI], 0.700 0.946). Interobserver agreement when using B-mode was poor for near wall (ICC, 0.396; 95% CI, ?0.048 0.708) and moderate for far wall (ICC, 0.474, 95% CI, 0.070 0.749). Conclusions: SMI proved to be a greatly reliable tool in the measurement of carotid IMT. SESSION 5D: BREAST Comparison of ‘fat-to-lesion strain ratio’ to ‘gland-tolesion strain ratio’ with controlled precompression in characterising sonographically indeterminate and suspicious breast lesions Rameysh Danovani Mahmood,1 Charlyn Chee,1 Paul Lombardo,2 Michael Schneider2 1 Changi General Hospital, Singapore, Singapore, 2 Monash University, Melbourne, VIC, Australia Objective: The purpose of this study was to compare the diagnostic performance of Fat-to-lesion strain ratio (FLR) and Gland-to-lesion strain ratio (GLR) for patients with indeterminate or suspicious breast lesions under controlled precompression technique and to see if the technique improves the reproducibility of FLR and GLR measurement. Methods: 53 lesions in 39 consecutive patients who had scheduled core biopsy or excision surgery based on sonographic findings were examined by sonoelastography. Each lesion was acquired under controlled precompression by two sonographers independently. Both the FLR and GLR of the lesion were calculated. For diagnostic performance, the sensitivity, specificity, negative predictive value, positive predictive value and accuracy were obtained. Inter-observer reliability between different sonographers will be assessed with intraclass correlation (ICC). Results: 40 lesions were benign and 13 lesions were malignant. Both FLR and GLR were significantly higher in malignant than benign lesion (P=0.003 and P=0.03 respectively). FLR has yielded higher accuracy and specificity when compared to GLR (Accuracy: 79.2% vs. 78.4% and Specificity: 87.5% vs. 72.5%). With the controlled precompression at less than 25% applied during elastography, the inter-observer agreement was excellent, (ICC value 0.853, 95% CI: 0.738-0.920) for FLR measurements and (ICC value 0.779, 95% CI: 0.619-0.87) for GLR measurements. Conclusion: FLR performed better than GLR in the detection of breast malignancy, thus fatty tissue was a better reference tissue for calculating strain ratio in malignant breast tumourelastography. Keeping precompression to less than 25% will enable different operators to acquire similar elastograms with reproducible FLR and GLR readings. Breast elastography early experiences Natalie Clements, Sandra O’Hara SKG Radiology, Bunbury, WA, Australia Introduction: Breast elastography improves the diagnostic performance of B mode ultrasound to characterise lesions. There are many methods to use shear wave values to assess breast lesions. The aim was to assess elastography of the breast to characterise breast lesions. Assessment of the breast lesion including histological profile, tumour grade and molecular subtype. Method: A prospective study, the patients were self selected into the study. The patients were routine visits to the ultrasound department and any lesions were assessed with measurements, colour doppler, vocal fremitis and elastography. The treatment pathway was not altered by this study. If they required a biopsy and were in agreeance for the pathology results