Modern clinical software medicine it outputs the following parameters ultrasonic testing research various bodies on the leading companies positions and taps to him, sometimes, the dominant one role in the integrated during the survey patients with explicit manifest pathology. High information content this method allows you to recently use it more and more often ultrasonic cleaning visualization and for diagnostics many diseases on preclinical tests (latent) stages. More moreover, large scientific research justified possibility and proved practical application value Ultrasound for screening some of them common ones internal diseases bodies, Central administration the nervous system and bony skeleton (in children), somatic diseases anomalies (y embryo and of the fetus), genitals organs, endocrine systems changes during mass production and selective ones dispensary-preventive measures population health checks.
Unquestionable feature professional activity preparation domestic doctor of phonographers is that, what is teaching nosological ultrasonic diagnostics it is constructed as rule b compliance with the with organ-descriptive content the principle. Like this compositional adheres to the plan and absolute most of them authors at the same time printed publication works on ultrasonic diagnostics diagnostics. Unfortunately doctors in the General hospital practice, significantly less common works that have been built on nosological sites criteria, when it is selected the principle of ” from diseases of the K visualizations organ”, and not on the contrary — ” from ultrasonic anatomy (normal and pathological) to the diagnosis.”
Especially sharp lack of practical skills knowledge gained and verified ones according to modern standards, that’s enough strict laws evidence-based (Evidence based) medicine, it is felt in the recent years in the future diagnostics diseases endocrine system systems. Multi-year plan teaching experience clinical endocrinology in the system postgraduate education educational institutions different doctors specialties, medical and Advisory services works in real time (at the reception and in the hospital) and the virtual one space (Internet*) allows you to regret it obvious the gap between available features ultrasonic visualizations (huge scientific potential, accumulated abroad and in our country; an abundance of special information theme-based references; advanced features tools technologies; powerful multi-functional hardware) and their application in practice healthcare during the survey adult patients and especially children with pathology iron secretions. K unconditional “costs production” in many regions The Russian Federation should assign mass events ultrasonic cases overdiagnoses syndrome polycystic kidney disease ovaries, inflammatory diseases diseases, tumors and hypoplasia thyroid gland and parathyroid glands glands, adrenal glands along with not less rare situations rough diagnostic tests errors leading to to skip expressed anomalies and severe diseases endocrine systems bodies.
Real ones critical features notes are dedicated to, perhaps the most topical and widespread problem — ultrasound errors during diagnostics, dynamic observation and monitoring treatment of thyroiditis pathologies in children children and teenagers and adults. Specifically for thyroid gland glands today typical sad disparity meanwhile, ” how it can do a lot!” Ultrasound of the thyroid gland the glands (and this really so) and dissatisfaction clinicians its results due to lack of data literate the Protocol research at the highest level level of knowledge in the region ultrasonic visualizations thyroid gland the glands that make up the body in the 90s of the XX century V.
In modern conditions algorithms diagnostic tool search results for thyroid problems diseases are large it matters Ultrasound of the thyroid gland the glands. Attention! Today at the suspected on any pathology thyroid gland as in any case age of the Clinician after the inspection the patient objectively and not by accident selects first this particular one highly informative method. And with that assigns to get the function one of the main ones and reference criteria primary diagnostics, from the results which one will be used depend necessity and the choice is not only follow-up surveys (hormonal analysis, immunological tests tests, morphological research materials punctuation biopsies), but also treatment. Exactly Ultrasound is eligible elected endocrinologist as a presenter dynamic search method status assessments thyroid gland on different stages of therapeutic treatment after operational and radiation interventions if life dispensary observation (in catamnesis) for early identify the threat of relapse disease after his cure.
Main goal the real one publications — working out common approaches, which should be used strictly be guided, and universal ones requirements, submitted documents endocrinologists and doctors paraclinic services that are mandatory on a modern level development stage thyroidology technical conditions of the event Ultrasound of the thyroid gland glands and clinical interpretations information, received information when it is routine visualizations.
Mandatory fields components ultrasound Protocol thyroid
Thyroid volume. Equipment measurements sizes of the thyroid gland the gland should provide next one minimum of important ones elements. How and for others surface-located bodies, you need linear sensor with frequency 7.5-12 MHz, but not less 5 MHz. Position sensor on the neck the subject must be accompanied by minimal pressure on the skin (avoid contact with eyes flattenings shares that distort result in the side of the possible overestimations — especially at the children). Measuring linear dimensions you should only on such cross-sections and longitudinal ones cross sections of shares, which reflect maximum value their value (random or any other custom selecting cross sections this will lead to false underestimation actual value values). Choosing cross section a cross section that follows navigate on the true one (anatomical) cross section plane cross sections (horizontally – not at an angle), whereas longitudinal size (length or height shares) in reality defined by on an axis that deviates from the vertical. Optimal is such a thing non-vertical position sensor, when it is oriented in parallel outer edge nodding (sternoclavicular-mastoid) the muscles.
When measuring sizes thyroid gland extremely it is important to remember what spatial the amount of on characterizes only the total the amount of ferrous tissue and separated define linear parameters (thickness, width and the length of the lobes; including their area section live or cross slices) no semantic load not bear (!). In order and measured at least three linear dimensions each share (in cm) to their basis according to the formula J. Brunn (1981) calculate the amount of thyroiditis volume (in ml or in cm3) equal to sum of works three sizes to the right and left, multiplied for correction purposes coefficient 0.479. Other methods, formulas or amendments to the other indexes they are deprecated and they don’t match to the who standard. Separate calculating the volume shares are not held, because only their total amount the value reflects quantity synthesizing system tissue hormones. Symmetry estimation share values devoid of clinical significance meaning and not needed, since normally, as follows at least three four quarters of healthy people people have physiological skewness sizes of all paired organs. Acceptable for clinical use practices and adequate for endocrinologists unified information system classifications magnification levels thyroid disease volume (as opposed to from the palpatory-visual system who scales, 1994) not in the world. For the Clinician important question – different thyroid the volume of the person being examined patient from normal standard? Degree of deviation from the top normal limits (at increase thyroid gland a gland that is referred to as endocrinologists goiter, and in echography thyromegaly) or from the bottom limit (when hypoplasia thyroid gland glands) when if it can be expressed only as a percentage. The last one information (+%or -%) has secondary value and required to the doctor only for dynamic comparisons changes absolute volume on the background treatment for evaluate it efficiency for correction dosage of medicinal products drugs.
The question of whether who are the doctors (specialist by UZD or endocrinologist) must give evaluation of the calculated value as a result volumetrics thyroid disease volume, rather in total, you should solve depending on depending on your age the patient. In children’s and teenage girl practice interpretation volume values conducted by only by a Clinician, because rationing takes into account surface area the child’s body (m2), for calculation which you need “recent” information about his height and weight body weight (Who, 1997). Decision similar questions for adults (including u pregnant women women) can be conducted a specialist by UZD. Although in recently and they appeared reasons for callouts standards for persons older 18 years old, however currently time for now used previous international agreements standards: for women — 4.4-18 ml (for pregnant women at any time gestations are not allowed more than 20), for men — 7,7-25 ml.
Description of a typical application regulations thyroid gland glands, as well as forms of its shares for absolute most sick and healthy people it doesn’t have any people principle values. Partially zagrudinnaya street localization lower poles or any other abnormal condition location organ meets extremely rare. Only in these cases cases and important attract attention the Clinician in the conclusion Ultrasound, in other cases the same cases when making a list the Protocol — neglect (for the following reasons save time and funds).
Echogenicity thyroid function fabrics. Reduction conductive properties of the parenchyma thyroid gland the gland is “cornerstone with a stone ” in diagnostics diffuse and focal options its pathologies, a assessment of this vo parameter depends a lot from settings instruments and a doctor’s experience. Therefore, when routine RCD we offer simple way, as much as possible leveling tool subjective data disadvantages, inherent to the previous ones recommendations – compare density thyroid function non-muscle tissues fabrics of any kind localizations (neck, tongue, shoulder biceps) and not with other authorities (spleen), and only with this one individual standard of the norm, which it serves easily visualized the same as thyroid iron, sensor parotid tissue the salivary gland the subject.
Echostructure thyroid function fabrics. Extremely important to avoid when describing it any, though common, but very much so subjective ones descriptive ones characteristics and epithets,
Ah stick to it standard and understandable to all echographic system terminology (diagram).
Normal (uniform) it should be recognized only this one small-cell structure ferruginous fabric, point hypoechoic grain size which does not exceeds V diameter of 1 mm. When visualizing against this background different ones by echogenicity land plots it is stated heterogeneous (heterogeneous) character echographic system structures, which depends on from the prevalence these changes can match diffuse (non-node) or focal (nodal) pathologies thyroid.
Basic requirements to the Protocol Ultrasound in case of diffuse pathologies thyroid
Previously the norm it was considered not only fine-grained, but also average- and large-cell drawing (multiple small, multi-sized items hypoechoic enabling features diameter from 2 to 4 mm). When describing it you should specify not just the diameter magic tricks, but also prevalence (in one or more languages both shares) and localization (throughout the entire thickness or mostly in the region front/rear polygons. upper/lower level poles). This one echographic system pattern is wide common when forming a report diffuse endemic species goiter and even in the not yet exaggerated thyroid problems glands in the population iodine deficient territories, which include almost all regions Of Russia. Naming similar changes “polycystic kidney disease thyroid gland but ” incorrect, such a “diagnosis” it doesn’t exist.
From the point of view of morphology and clinical endocrinology, this instrumental the phenomenon serves a feature tissue reconstruction organ in response on the pathological level iodine deficiency or on impact other strumogens (food grade or ecopathogens). Morphological substrate similar changes, obviously not peculiar healthy thyroid glands, is colloidnokistoznaya degeneration fabrics with extensions clearances and overexpression follicle walls at the expense of excess savings their secret — the colloid. Sometimes in the center of such follicles with a sharply hypoechoic effect with a clear opening or pericentral appears individual placemark hyperechogenic bright signal, the non-giver is behind you self-shadow-so this happens in the following cases especially thick consistencies colloid on unchanged otherwise background. This is a physical and optical method phenomenon, on the actually in lumen of bubbles nothing but thickening of the secret, no, not really. However more than once I had to collide with the wrong one interpretation these signals in the form of conclusions about availability “microcalcinates”, “petrifikatov” and even ” psammoms Taurus”. All three the latest ones the term have, usually, oncological surgery color and applicable only to such people situations, when they meet in the nodes of the thyroid gland glands and give at the same time light (thin) acoustic the shadow, especially well-captured high frequency sensor with change directions ULTRASONIC waves when dynamic inspection.
But similarly in hypoechoic inclusions in thyroid gland can rendered and not related with iodine deficiency inflammatory focuses on the initial stages of formation autoimmune process: their substrate serve pockets lymphoplasmacytic infiltration and swelling of thyroid tissue. Comparatively rarely (in any case in this case, significantly less often than this meets in the protocols Ultrasound) such changes arise in the result virusinduced rupture of the follicles in subacute thyroiditis de quervain of Krila.
Classic ones signs autoimmune diseases thyroiditis defined by with ultrasound at the stage of expanded clinical patterns of the disease when it appears even palpatorally captured data changes consistencies glands and symptoms violations of it hormonal therapy functions. Such late ULTRASONIC signs form the following diagnostic triad: thyromegaly (more often) or hypoplasia thyroid gland glands (significantly less frequently); echogenicity thyroid function fabrics in General, not sharp — moderate or slightly – diffuse reduced by on this background in different ratios and with different intensity, depending from the previous date and activity process, detected sections of incorrect information forms with blurred lines uneven polygons. modifying its own direction and contrast ratio when making a change regulations sensor and direction UZ-beam in the under study areas, and having some — more sharp decline densities (maximum value severity auto-aggression), others are isoechogenic to salivary tissue iron (not yet involved in inflammation), the rest — hyperechogenic conditions rounded tricks or linear connecting strands fabric (substitute fibrosis). Such changes correspond to heterogeneous thyroid tissue clearly and explicitly heterogeneous its character echographic system structures.
Other signs diseases you should describe, giving them optional only value (bumpy share outlines, blurry uneven and intermittent character thickened and edematous capsules). Various word forms visual-imaginative like, often mentioned as signs autoimmune diseases thyroiditis (“bee products combs”, ” shreds cotton wool on wet asphalt”, “plowed field”, ” cobblestone Mostovaya”, “polar radiance”, ” black hole”), unacceptable because of subjectivism and non-reproducibility even if it is repeated review the same thing a specialist.
It should be especially noted underline, what are all the intermediate ones types of UZ patterns thyroid,
not meet description as fully uniform structure isoechoic thyroid tissue and classic triad of autoimmune process, i.e. diffuse change of the type of “incomplete the norm, but implicit autoimmune thyroiditis” there are visual reflection the most diverse thyroid pathology (not only “thyroiditis”!), which the basis only analysis eyes even an experienced specialist to distinguish impossible. So everything intermediate ones options are subject to careful monitoring standard without a description utterances categorical ones judgments about their origin and especially about final diagnosis. This very important and with the deontological points of view when communicating with patients and from the point of view of justification endocrinologist if necessary further reading surveys by other methods for the final version verifications nature of the disease thyroid. Convincing we recommend it formulate only preliminary ones conclusions probabilistic approach plan (“changes by type…”, ” similar the picture can match…”, “what meets when…”, ” so it might look…”, “we can assume availability… ” and etc.).
Basic requirements to the Protocol Ultrasound in nodal surgery pathologies thyroid
Precise ultrasonic cleaning visualization nodes of the thyroid gland how to use this tool modern instruments available in solid cases land plots — focal formations, having dimensions more than 4-5 mm. Availability smaller ones tricks, especially when they are at the this is not palpable, reflected in the Protocol without application the term “node”.
In clinical practice practice has to collide with cases diagnostic tools errors when only on the basis of cross-section scanning options per node false accepted normal ones anatomical features structures, lying behind left or right the rear polygon lower division right lobe thyroid gland the glands. In the first case if there is an error conditioned by syntopia (location next door) esophagus, echogenicity which cross section close to the thyroid fabrics. In the second – option normal, although not often observed vascularization in the pool the lower thyroid arteries when its main one the trunk disintegrates on small branches not immediately on penetration level to the lower pole left lobe thyroid gland glands, and continues be tracked and in the thickness of the lobe, as if cutting it off on the cross section small cross section rounded section healthy tissue and imitating nonexistent node. Important remember that in both cases specialist guaranteed from an error when when using it classic the following rules apply to SDCs: conclusion about volumetric education possible when its visualizations at least in both perpendicular lines projections (cross-section and longitudinal). Then the image esophagus and vascular system shadows succeed, in contrast to true node, “expand» in non-vertical mode cross-section into longitudinal tubular structures. The esophagus easily to differentiate from the host with posteromedial localization in the left lobe thyroid gland glands and others in this way-when dynamic visualizations on the background of swallowing.
When describing it the size of the focal point educational institutions necessary specify no less than three of them sizes. Only then the Clinician it can detect relative node volume and with high accuracy rely on its dynamics in progress therapeutic treatment that in recent years the years are getting wider practiced abroad and in our country with benign prostatic hyperplasia nodal pathology thyroid gland glands (levothyroxine in the suppressive state in this mode). Information only about the maximum type of education or even two its parameters (especially without instructions to use what cross section and what kind of sensor they are measured) significantly reduces accuracy evolution estimates node in the background hormonal therapy therapy.
Characteristic echographic devices node properties thyroid gland the glands can include a set the most diverse UZ attributes, which is accepted describe and any others volume formations other bodies. But at the same time we must not forget those that instructions for the Clinician the most important one information, essentially considered if suspected for malignant growth in progress differential diagnosis diagnostics nodal pathology thyroid gland glands (see diagram). To such probabilistic parameters (suspicious, suspensive) echosimptomam for routine use Ultrasound of the thyroid gland the glands include information:
about the structure intranodular fabric (i.e. content rating: solid nodes more than suspicious, than complex ones, with heterogeneous structure);
about its echogenicity (thyroid cancer the glands are more frequent submitted by hypoechoic fabric).
about polygons nodes (blurred intermittent events node outline they are inherent in non-encapsulated systems malignant thyroid tumors glands or tumors. sprouting my own capsule; suspicion on germination share capsules thyroid gland the glands can occur when contact information node outline with the share outline or during localization educational institutions in the isthmus “the so — called ‘I’. the “studious” symptom»);
on the presence in the lumen node microcalcifications (see above);
on condition regional lymph nodes (cervical nodes with increasing more than 5 mm, especially careful a description of those of them that palpable, have a ratio of the longitudinal axis to the diameter less than 1.5, the ratio of the thickness of the cortical layer to the brain less than 1). Statement States peripheral devices lymph nodes for a specialist,
who identified it education in the thyroid iron during ultrasound, it should be the same mandatory one procedure, like palpation lymph nodes with an endocrinologist, which node I felt in it. This component software protocols assigned to the right to ” gold standard ultrasound” when nodal pathologies thyroid.