Interpersonal Assignment

On May 9th, 2016 I attended an SDMS society meeting. Brian McDaniel

with Siemens came to Methodist Germantown Hospital to speak about

elastography. I have been very interested in this topic since I learned about it

in class. He spoke about several different types of elastography and how it

has been updated throughout the years.

Elastography is a way of using compression to tell how hard or soft

tissue is and use that information to classify different types of pathology. The

old types of elastography were not quantitative and were dependent upon

the user. The user had to compress with the probe so results were hard to

reproduce from person to person.

He then introduced the newest form of elastography called ARFI,

Acoustic Radiation Force Impulse. This type works like a pebble when

dropped in water. As the pebble moves through the water, the water moves

outward from the pebble. With elastography, as the sound waves move

vertically through the tissue from the probe, shear waves travel horizontally

from the sound waves and through the tissue. The shear waves calculate a

velocity in meters per second that helps determine the stiffness of the tissue.

The thicker the tissue is, the faster the waves move. The velocity is used to

determine disease by comparing it to a scale of F0-F4. This is similar to what

Radiologists use when determining a breast mass so it is a familiar

technique. Also, with his updated form of elastography, ARFI has created a
way to virtually palpate tissue meaning the user no longer has to manually

compress on the probe. ARFI also has quantitative data which helps improve

specificity. This can be helpful in determining metastatic lesions from benign

lesions since we are learning that fine needle aspirations are becoming less

accurate. ARFI could replace most biopsies and prevent patients from having

to undergo high levels of stress and worry. Also, when combined with

ultrasound it can penetrate even further and help find and characterize deep

lesions.

Elastography can be found helpful for so many things. The usual things

are when trying to characterize a breast or liver mass or lesion. It determines

the benign or malignant qualities within seconds. Cancer is most patients

biggest concern; imagine the relief of finding out what that lump was the

same day rather than having to be stuck with a needle and wait for results.

Brian began to speak about how some people began to explore what else

elastography can do other than just characterizing masses and lesions. It

was used on a cervix of a pregnant female to find out if there would be any

preterm labor. It was used during surgery to remove portions of bowel by

determining which portions were good and bad so that they could take all the

bad instead of accidently taking some of what was actually good. It has even

been used on the pancreas to help determine pancreatitis. The pancreas is

an organ that can develop pathology and be easily missed. For example,

pancreatic cancer has a poor prognosis since it is found so late; however, by

using elastography as a screening tool maybe we could raise the probability

of early detection. Also, some pathologies do not show up on ultrasound

because they simply blend in with normal tissue. With elastography, it can

find those abnormal areas and help categorize them so they are not missed

or continue to grow.

I found this meeting extremely helpful and resourceful. Brian

broadened my horizon on the field of ultrasound and what I could someday

be capable of accomplishing. I hope people get as excited as I am about all

of the possibilities for elastography.