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Ahmed M.,Kings College London | Abdullah N.,University of Kuala Lumpur | Cawthorn S.,Frenchay Hospital North Bristol NHS Trust | Usiskin S.I.,St. Bartholomews Hospital | Douek M.,Kings College London
Breast Cancer Research and Treatment

Portable ultrasound is now used in a variety of clinical settings by specialties outside of radiology. Despite increased accessibility to ultrasound, the overall performance of ultrasound by breast surgeons is consistently low. We discuss the reasons why this is unacceptable for future patient care and answer the question, 'Why should breast surgeons use ultrasound?' We reviewed the literature for evidence assessing the outcomes of breast surgeon-performed ultrasound both intra-operatively and in the outpatient department. Intra-operative ultrasound performed by surgeons reduces re-excision rates in breast-conserving surgery. Outpatient-based ultrasound performed by surgeons frees up the resources of radiology departments, allowing them to focus upon patients requiring more complex diagnostic and interventional procedures. For surgeons to competently perform intra-operative and outpatient-based ultrasound, a period of formal ultrasound training is necessary to acquire knowledge of ultrasound skills and techniques. This should be followed by a period of mentorship and supervised training with an experienced breast radiologist. Breast surgeon-performed ultrasound is beneficial to the multi-disciplinary care of breast cancer patients. To further improve multidisciplinary care, breast surgeons and radiologists should work more collaboratively to optimise imaging applications both in the operating theatre and outpatient department. Current advances in therapeutic percutaneous techniques are of interest to both surgeons and radiologists. In future, a hybrid specialisation should be considered to incorporate accreditation in both specialties for breast interventional procedures. © 2014 Springer Science+Business Media New York. Source

Harding J.,Frenchay Hospital North Bristol NHS Trust | Chesser T.J.S.,Frenchay Hospital North Bristol NHS Trust | Bradley M.,Frenchay Hospital North Bristol NHS Trust
The Scientific World Journal

Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection). Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay. © 2013 J. Harding et al. Source

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