Advanced Thyroid and Parathyroid Ultrasound 1st Edition by Mira Milas, Susan J. Mandel, Jill E. Langer 3319441009 9783319441009

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ISBN-10 :  3319441009 

ISBN-13 :  9783319441009

Author:  Mira Milas, Susan J. Mandel, Jill E. Langer 

This text provides a comprehensive review of ultrasound in thyroid and parathyroid diseases. These topics are presented from a vantage point of complex decision-making encountered in real clinical scenarios. The sections are organized according to a logical structure covering benign and malignant thyroid conditions, parathyroid disease, and ultrasound technology, ultrasound-guided interventions, and innovations. The style of the chapters provide practical, actionable information that is richly illustrated with figures and links to video cine-clips. The chapter topics aim to show how different specialists uniquely apply ultrasound in given clinical scenarios. The text illustrates the optimal incorporation of current practice guidelines, as this remains varied and inconsistent among clinicians. The content is written by invited experts who perform ultrasound in their daily clinical practices and participate in teaching ultrasound nationally and internationally. It conveys the most up-to-date scientific and clinical information in an interactive and visual format.       Advanced Thyroid and Parathyroid Ultrasound fills a gap in currently available resources by serving as a single resource unifying information relevant to multiple specialists interested in advanced thyroid and parathyroid ultrasound. It provides a practical, concise yet comprehensive summary of the current status of the field that will help guide patient management.

Advanced Thyroid and Parathyroid Ultrasound 1st Table of contents:

Part I: Ultrasound in Clinical Practice: Philosophy and Logistics
1: Thyroid and Parathyroid Ultrasound: Comprehensive and Problem-Focused Point-of-­Care Utilizati
1.1 Introduction
1.1.1 History of Sonography
1.1.2 What Is Point-of-Care Ultrasound?
1.2 Point-of-Care Ultrasound of the Thyroid and Parathyroid Glands
1.3 Why Perform Point-of-Care Neck Ultrasound
1.3.1 Nodules
1.3.2 Parathyroid
1.4 Expanding the Traditional Use of Thyroid and Parathyroid Ultrasound: Perils and Pitfalls
1.5 Radiologic Studies Complementing Thyroid/Parathyroid US
1.6 The Rationale for a Multidisciplinary Ultrasound Textbook
1.7 Summary
References
2: Key Components of a Comprehensive Thyroid and Parathyroid Ultrasound Report
2.1 Introduction
2.2 Recommendations for Thyroid Ultrasound Reporting
2.2.1 Recommendations for Ultrasound Reporting of Parathyroid Pathology
References
3: Pathways to Thyroid and Parathyroid Ultrasound Certification
3.1 Introduction
3.2 Background
3.3 Endocrine Certification in Neck Ultrasound (ECNU) Credential
3.4 American Institute of Ultrasound in Medicine (AIUM) Practice Accreditation
3.5 Conclusion
References
Part II: Ultrasound Technology
4: Selection and Setup of Ultrasound in Point-of-Care Medical Practice
4.1 Introduction
4.2 Space
4.3 Ultrasound Equipment
4.4 Outfitting the Room
4.5 Interventional Endocrinology
4.6 FNA and On-Site Adequacy
4.7 FNA for Needle Wash
4.8 Thyroid Nodule and Lymph Node Ablation
4.9 Summary
Reference
5: Principles of Ultrasound and Applied Ultrasound Physics Relevant for Advanced Sonographers
5.1 Principles of Sound Waves
5.2 How Medical Ultrasound Devices Work
5.3 Physics of Common Artifacts
References
6: Principles of Color and Power Doppler in Neck Ultrasound Imaging
6.1 Introduction
6.2 The Doppler Effect
6.3 Duplex/Spectral Doppler Mode
6.4 Overview of the Color Doppler Image
6.5 Color Doppler Image Acquisition
6.6 Color Doppler Limitations and Artifacts
6.7 Power Mode Doppler Imaging
References
7: 3D Ultrasound
7.1 Introduction
7.2 Technical Aspects of Three-­Dimensional (3D) Ultrasound
7.3 Risk Assessment of Thyroid Nodules for Malignancy
7.4 Preoperative Assessment of Extrathyroidal Extension of Thyroid Cancers
7.5 Thyroid Volume Calculations
7.6 Summary
References
8: Elastography: Applications and Limitations of a New Technology
8.1 Introduction
8.2 Strain Elastography
8.3 Shear Wave Elastography
8.4 The Application of Elastography for Thyroid Nodules
8.5 Limitations of Elastography in the Evaluation of Thyroid Nodules
8.5.1 Operator Dependence
8.5.2 Thyroid Inflammation
8.5.3 Cyst Fluid and Calcifications
8.6 Conclusions
References
Part III: Thyroid Ultrasound: Anatomy and Fundamental Features
9: Normal Thyroid Appearance and Anatomic Landmarks in Neck Ultrasound
10: Feature Illustration: Echogenicity, Composition, and Shape
10.1 Echogenicity
10.1.1 Composition
10.2 Taller-Than-Wide Shape
10.3 Conclusions
References
11: Feature Illustration: Thyroid Nodule Margins and Extrathyroidal Extension and Invasion
11.1 Overview
11.2 Nodule Margins and Contour
11.2.1 Completely Smooth and Well-­Defined Margins
11.2.2 Lobulated Margins
11.2.3 Irregular Margins
11.2.4 Indistinct or Poorly Defined Margins
11.2.5 Infiltrative Margins
11.2.6 Halo
11.2.7 Artifacts and Challenging Scenarios of Contour Evaluation
11.3 Extrathyroidal Extension
11.3.1 Absence of Extrathyroidal Extension
11.3.2 Suspected Extrathyroidal Extension
11.4 Extrathyroidal Invasion
11.5 Conclusions
References
12: Feature Illustration: Hyperechoic Foci and Calcifications
12.1 Introduction
12.2 Punctate Foci with No Posterior Artifact
12.3 Echogenic Foci with Small Comet-Tail Artifacts (≤1 mm Long)
12.4 Echogenic Foci with Large Comet-Tail Artifact (>1 mm)
12.5 Internal Echogenic Foci with Posterior Acoustic Shadowing
12.6 Peripheral Echogenic Foci with Posterior Acoustic Shadowing
12.7 Nodules Possessing More than One Type of Echogenic Foci
12.7.1 Pitfalls
12.8 Conclusion
References
13: Feature Illustration: Vascularity
13.1 Nodular Lesions
13.2 Hyperthyroidism
References
Part IV: Pattern Recognition of Thyroid Disease Sonographic Presentations
14: The Application of Sonographic Patterns to Risk Stratification of Thyroid Nodules
14.1 Introduction
14.2 Classification Systems of Sonographic Patterns
14.3 Application of Sonographic Patterns
14.4 Conclusion
References
15: Challenges in Pattern Recognition: Navigating Assessment of Thyroid Features and the Subject
15.1 Introduction
15.2 Challenge #1: Wide Spectrum of Practitioners Performing Thyroid Ultrasound
15.3 Challenge #2: Training in Pattern Recognition
15.4 Challenge #3: Recognizing the Pattern of Benign Nodules
15.5 Challenge #4: Pattern Recognition in Inflammatory Conditions
15.6 Challenge #5: Recognizing Anatomic, Structural, and Mental Pitfalls in Pattern Recognition
15.7 Challenge #6: Keeping Up with Advancements in the Field of Pattern Recognition
References
16: Pattern Recognition: Diffuse Thyroid Disease
16.1 Introduction
16.2 Chronic Lymphocytic (Hashimoto’s) Thyroiditis (CLT)
16.3 Patterns of Heterogeneity Seen in Chronic Lymphocytic Thyroiditis
16.3.1 Pattern 1: Hypoechoic and Heterogeneous
16.3.2 Pattern 2: Pseudomicronodular
16.3.3 Pattern 3: Pseudomacronodular Pattern
16.3.4 Pattern 4: Profoundly Hypoechoic
16.3.5 Pattern 5: Developing Fibrosis
16.3.6 Pattern 6: Hyperechoic and Heterogeneous
16.3.7 Pattern 7: Speckled
16.4 Thyroid Nodules in Chronic Lymphocytic Thyroiditis
16.5 Lymph Nodes in CLT
16.5.1 Atrophic Thyroiditis
16.5.2 Graves’ Disease
16.5.3 Painless Thyroiditis
16.5.4 Drug-Induced Thyroiditis
16.6 Summary
References
17: Pattern Recognition: Uncommon Clinical Scenarios
17.1 Case Vignette 1: Hypoechoic Enlarging Thyroid Mass
17.2 Case Vignette 2: Large Mass with Microcalcifications in the Central Neck
17.3 Case Vignette 3: Anaplastic Thyroid Carcinoma
17.4 Conclusions
References
18: Pattern Recognition of Benign and Malignant Thyroid Nodules: Ultrasound Characteristics and Ultr
18.1 Introduction
18.2 Sonographic Evaluation of Thyroid Disease
18.3 Sonographic Evaluation of Diffuse Thyroid Disease
18.3.1 Case 1: Diffuse Thyroid Disease (Thyroiditis)
18.3.2 Case 2: Diffuse Thyroid Disease (Nodular Thyroiditis)
18.3.3 Case 3: Diffuse Thyroid Disease (Thyroiditis)
18.3.4 Case 4: Diffuse Thyroid Disease (Thyroiditis vs. Leukemia)
18.3.5 Case 5: Lymphoma
18.3.6 Case 6: Prostate Cancer
18.3.7 Case 7: Diffuse Papillary Thyroid Carcinoma
18.4 Sonographic Features of Thyroid Nodules: Benign
18.4.1 Case 8: Thyroid Cyst
18.4.2 Case 9: Crystalline Colloid
18.4.3 Case 10: Complex Avascular Thyroid Nodule
18.5 Sonographic Features of Thyroid Nodules: Malignant
18.5.1 Case 11: Vascular Complex Thyroid Nodule
18.5.2 Case 12: Malignant Thyroid Nodule (Punctate Calcifications)
18.5.3 Case 13: Colloid Nodule Mimicking Malignant Nodule
18.5.4 Case 14: Solitary Nodule Is of Concern Independent of Appearance
18.5.5 Case 15: Malignant Thyroid Nodule Mimicking a Colloid Thyroid Nodule
18.5.6 Case 16: Malignant Thyroid Nodule Mimicking a Benign Appearance (FDG-Avid, Small Thyroid No
18.5.7 Case 17: Thyroid Isthmus Nodule
18.5.8 Case 18: Isthmus Nodule with Benign Appearance
18.6 Ultrasound-Guided FNA of the Thyroid
18.7 Conclusion
References
Part V: Evaluation of Cervical Lymph Nodes and Thyroid Cancer Metastases
19: Rationale for the Evaluation of Cervical Lymph Nodes in the Setting of Thyroid Cancer
19.1 Introduction
19.2 Preoperative Identification of Metastatic Lymph Nodes
19.2.1 Frequency of Lymph Node Metastases
19.2.2 Clinical Impact of Lymph Node Metastases
19.3 Postoperative Surveillance
19.3.1 Risk of Recurrent Disease
19.3.2 Staging Systems
19.3.3 Initial Ultrasound Surveillance
19.3.4 Long-Term Ultrasound Surveillance
19.4 Observation of Small Nodal Disease
19.5 Limitations of Ultrasound Imaging for Cervical Lymph Nodes
19.6 Summary
References
20: Normal Cervical Lymph Node Appearance and Anatomic Landmarks in Neck Ultrasound
20.1 Introduction
20.2 Level I: Submandibular
20.3 Level II: Upper Jugular
20.4 Level III: Middle Jugular
20.5 Level IV: Lower Jugular
20.6 Level V: Posterior Triangle
20.7 Level VI: Central Neck
20.8 Scanning Lymph Nodes
References
21: Sonographic Appearance of Abnormal Cervical Lymph Nodes in the Preoperative and Reoperative/
21.1 Introduction
21.2 Ultrasound Technique and Reporting
21.3 Normal Morphology
21.4 Abnormal Cervical Lymph Nodes
21.5 Ultrasound Abnormalities
21.5.1 Shape
21.5.2 Echogenic Pattern
21.5.3 Size
21.5.4 Cystic Degeneration
21.5.5 Microcalcifications
21.5.6 Vascularity
21.6 The Technique of Preoperative and Surveillance Ultrasound
21.7 Conclusion
References
22: Ultrasound Characteristics and Ultrasound-Guided Fine-­Needle Aspiration of Lymph Nodes in t
22.1 Introduction
22.2 Technique: Routine US Evaluation of Cervical Lymph Nodes
22.2.1 Case 1: Sonographic Evaluation of Benign Cervical Lymph Nodes in the Lower and Mid-Jugula
22.2.2 Case 2: The Importance of Assessing for Symmetry of Cervical Lymph Nodes in the Superior Jugu
22.2.3 Case 3: The Importance of Assessing for Symmetry of Cervical Lymph Nodes in the Superior Jug
22.2.4 Clinical Case 4: Distorted Hilum in a Metastatic Lymph Node
22.2.5 Case 5: Absent Hilum in a Metastatic Lymph Node
22.2.6 Case 6: Disorganized Vascular Flow in a Metastatic Lymph Node
22.2.7 Case 7: Calcification in Metastatic Lymph Nodes
22.2.8 Case 8: Metastatic Lymph Nodes with Cystic Change
22.2.9 Case 9: Diagnosis of Early Metastatic Lymph Node Involvement
22.2.10 Case 10: Diagnosis of Early Metastatic Lymph Node Involvement
22.2.11 Case 11: Do Not Touch Me Cervical Soft Tissue Nodules and Lymph Nodes
22.2.12 Case 12: Do Not Touch Me Cervical Soft Tissue Nodules and Lymph Nodes
22.3 Ultrasound-Guided FNA of Lymph Nodes
22.4 Conclusion
References
23: Ultrasound Characteristics of Non-­endocrine Cervical Pathology
23.1 Introduction
23.2 Congenital Lesions
23.2.1 Thyroglossal Duct Cysts
23.2.2 Dermoid and Epidermoid Cysts and Teratomas
23.2.3 Branchial Cleft Abnormalities
23.3 Neoplastic Lesions
23.3.1 Benign Neoplastic Lesions
23.3.1.1 Lipoma
23.3.1.2 Paraganglioma
23.3.1.3 Schwannoma and Neurofibroma
23.3.1.4 Hemangioma
23.3.1.5 Lymphangioma
23.3.2 Malignant Neoplastic Lesions
23.3.2.1 Lymphoma
23.3.2.2 Non-thyroid Metastatic Lesions
23.4 Reactive Lymph Nodes
23.5 Sarcoidosis
23.6 Ranula
23.7 Laryngocele
23.8 Transverse Processes of Cervical Spine
23.9 Salivary Gland Pathology
23.10 Benign Tumors
23.11 Malignant Tumors
23.12 Inflammatory and Other Diseases
23.13 Conclusion
References
Part VI: Parathyroid Ultrasound: Anatomy and Fundamental Features
24: Ultrasound and FNA in Parathyroid Disease: Fundamentals of Appearance and Evaluation of Abn
24.1 Introduction
24.2 Historical Perspectives
24.3 Surgical Anatomy and Embryologic Development of Parathyroid Glands
24.4 Epidemiology of Primary Hyperparathyroidism
24.5 Imaging Features of Parathyroid Adenomas, Atypical Adenomas and Parathyroid Carcinomas
24.6 Location of Parathyroid Adenomas
24.7 Fine Needle Aspiration (FNA) of Parathyroid Glands or Adenomas
24.8 Procedure of Parathyroid FNA
24.9 A Protocol for Specimen Processing, Handling, and Smear Preparation of Parathyroid FNA (See
24.10 Indications and Procedure of ETOH Ablation
24.11 Special Considerations: Multigland Disease, Atypical Adenomas, and Parathyroid Carcinomas
24.12 Parathyroid Incidentalomas and Confounders
24.13 Summary
References
25: Ultrasound as a Localization Technique in Hyperparathyroidism
25.1 Introduction
25.2 Education of Surgeons in Parathyroid Ultrasound
25.3 Ultrasound in Patients with Primary Hyperparathyroidism: Why Not?
25.3.1 Concomitant Thyroid Disease
25.3.2 US to Localize the Parathyroid and Help with Operative Planning
25.3.3 Cost-Effectiveness of Ultrasound
25.4 Parathyroid Embryology and Anatomy as It Relates to Parathyroid Ultrasound Interpretation
25.4.1 Typical Ultrasound Appearance and Location of Parathyroid Adenomas
25.4.2 Superior Parathyroid Anatomic and Imaging Location
25.4.3 Inferior Parathyroid Anatomic and Imaging Location
25.5 A Suggested Algorithm for the Use of Ultrasound as a Localization Technique in Hyperpara
25.6 Ultrasound in the Reoperative Setting
25.7 Clinical Scenarios and Lessons Learned
25.7.1 Case 1: Ultrasound to Avoid Radiation Exposure
25.7.2 Case 2: Is It a Thyroid Nodule or a Parathyroid?
25.7.3 Case 3: Parathyroid Cancer Confused with a Goiter: Avoid FNA When Not Absolutely Necessary
25.7.4 Lessons Learned
25.7.5 Case 4: Thinking Outside the Box: Case of a Missing Parathyroid
25.7.6 Lesson Learned
25.8 Parathyroid Ultrasound Pearls
References
26: Ultrasound Case Vignettes: Multigland Parathyroid Disease
26.1 Introduction
26.2 Case Vignette 1: Hypercalcemic Crisis
26.3 Case Vignette 2: Tertiary Hyperparathyroidism and Thyroid Cancer
26.4 Case Vignette 3: Double Superior Parathyroid Adenomas Versus 4-Gland Hyperplasia
26.5 Case Vignette 4: Primary Hyperparathyroidism in Pregnancy
26.6 Case Vignette 5: Multiple Endocrine Neoplasia Type 1 (MEN-1)
26.7 Conclusions
References
27: Parathyroid Ultrasound Imaging: Pearls, Pitfalls, and Tips
27.1 Typical Appearance on US
27.2 Elusive Adenoma
27.3 Atypical Findings
27.4 Abnormal Location
27.5 Parathyroid Carcinoma
27.6 Imaging Pitfalls
27.7 Optimizing Scanning Technique
27.8 Conclusion
References
Part VII: Interventional Ultrasound
28: The Procedure of Ultrasound-­Guided Percutaneous Biopsy of Thyroid and Cervical Lymph Nodes:
28.1 Introduction
28.2 Preparation of the Patient
28.3 The Biopsy-Planning Ultrasound and the “Time Out”
28.4 Performing the FNA: Technical Aspects
28.5 Imaging for FNA
28.6 Special Situations
28.7 Complications: Prevention and Treatment
28.8 Slide Preparation
28.9 Cervical Lymph Node FNA
28.10 Top 10 Pearls Regarding Biopsy
References
29: The Preparation of Biopsy Specimens for Routine and Molecular Cytology: Technical Steps, Pear
29.1 Introduction
29.2 Collection
29.3 Preparation
29.3.1 Classic Smear Technique
29.3.2 Bookend Smear Technique
29.4 Fixation
29.5 Staining
29.6 Ancillary Studies
References
30: Cytomorphology of Fine Needle Aspiration of Thyroid
30.1 Introduction and General Considerations
30.2 Cytomorphology of Thyroid Lesions
30.2.1 Benign Lesions
30.2.1.1 Nodular Goiter
30.2.2 Diffuse Toxic Goiter (Graves’ disease)
30.2.3 Autoimmune Thyroiditis/Chronic Lymphocytic Thyroiditis
30.2.4 Follicular Neoplasm/Suspicious for Follicular Neoplasm
30.2.5 Oncocytic Follicular (AKA Hürthle Cell) Neoplasm/Suspicious for Oncocytic Follicular (AKA
30.2.6 Malignant Neoplasms
30.2.6.1 Papillary Thyroid Carcinoma and Its Variants
30.2.7 Diffuse Sclerosis Variant of PTC
30.2.8 Medullary Thyroid Carcinoma
30.2.9 Poorly Differentiated Carcinoma
30.2.10 Anaplastic Carcinoma
30.3 Rare Tumors of Thyroid Gland
30.4 Conclusions
References
31: Transcutaneous Laryngeal Ultrasonography: Clinical Variables
31.1 Background
31.2 How Does TLUSG Work?
31.3 Steps and Tips in Carrying Out a TLUSG of the VCs
31.4 Factors Leading to Non-­visualization of VCs
31.5 Ventral vs. Lateral Approach
31.6 Conclusions
References
32: Transcutaneous Laryngeal Ultrasonography: Technical Performance and Interpretation
32.1 Introduction
32.2 Larynx Anatomy
32.3 Technique and Material
32.4 Pearls and Pitfalls of Vocal Cord Ultrasound
32.5 Conclusion
References
33: The Role of Ultrasound in Determining Eligibility for Remote Access/Robotic Surgery and Cosm
33.1 Introduction
33.2 Ultrasound for Incision Planning
33.2.1 Thyroid
33.2.2 Parathyroid
33.3 Ultrasound for Remote Access Approaches
33.4 Conclusion
References
34: Intraoperative Use of Ultrasound in Thyroid, Parathyroid, and Cervical Lymph Node Surgery
34.1 Introduction
34.2 Thyroid
34.3 Parathyroid
34.4 Lymph Nodes
34.5 Conclusions
References
35: Alcohol Ablation of Thyroid and Parathyroid Lesions and Lymph Nodes
35.1 Background/Introduction
35.2 Alcohol Ablation of Thyroid Cystic Lesions
35.2.1 US-Guided Percutaneous Alcohol Injection: The Technique (See Also Video 35.1)
35.2.1.1 Needle Insertion
35.2.1.2 Drainage of the Fluid Content
35.2.1.3 Ethanol Instillation
35.2.1.4 Needle Extraction
35.2.2 Clinical Outcomes
35.2.3 Side Effects
35.3 Alcohol Ablation of Thyroid Solid Nodules
35.3.1 Autonomously Functioning Thyroid Nodules
35.3.2 “Cold” Thyroid Nodules
35.4 Alcohol Ablation in Other Neck Lesions
35.4.1 Parathyroid Lesions
35.4.2 Alcohol Ablation of Metastatic Lymph Nodes
References
36: HIFU and RFA Ablation for Thyroid and Parathyroid Disease
36.1 Introduction
36.2 Radiofrequency Ablation
36.2.1 Principles
36.2.2 Devices
36.2.3 Technique (See Video 36.1)
36.2.4 Indications
36.2.5 Clinical Results in Benign Cold Thyroid Nodules
36.2.6 Clinical Results in Benign Autonomous Functioning Thyroid Nodules
36.2.7 Clinical Results in Recurrent Thyroid Cancer
36.2.8 Complications of Thyroid Radiofrequency Ablation
36.2.9 Comparison Between RFA and Other Nonsurgical Techniques for Benign Thyroid Nodules
36.3 High-Intensity Focus Ultrasound
36.3.1 Device and Technique
36.4 Clinical Results
References
37: Ultrasound-Guided Laser Ablation
37.1 Introduction
37.2 Why Ultrasound-Guided Laser Ablation for Thyroid Nodules?
37.3 Minimally Invasive Techniques
37.4 Basic Principles
37.5 Technique and Devices
37.6 Indications for Laser Treatment
37.7 Clinical Results
37.7.1 Hypo- or Iso-functioning Thyroid Nodules
37.7.2 Hyper-Functioning Thyroid Nodules
37.7.3 Cystic Lesions
37.8 Complications and Side Effects
37.9 Costs
37.10 Conclusions for Clinical Practice
References
Part VIII: Ultrasound in Advanced and Novel Applications
38: Ultrasound for Surgeons: What I Learned from Lifetime Practice
38.1 Introduction
38.2 Adaptation of Ultrasound into Surgical Practice
38.3 Overall Philosophy of Surgeon-Performed Ultrasound
38.4 Know How to Use Your Equipment
38.5 Optimizing the Use of Ultrasound in the Office
38.6 Optimizing Fine Needle Aspiration Results
38.7 Use of Ultrasound in the Operating Room
38.8 Conclusion
39: Ultrasound for Otolaryngologists and Head and Neck Surgeons: What I Learned from Lifetime P
39.1 Pro
39.1.1 Convenience and Efficiency of Patient Care
39.1.2 Comprehensive Attention to Relevant Details
39.1.3 Use in Operating Room
39.1.4 Continuity of Care
39.1.5 Comfort with Use of Invasive Procedures
39.1.6 Low-Resource Settings
39.2 Con
39.2.1 Ongoing Education Needs
39.2.2 Time Challenges
39.3 Conclusions
40: Ultrasound for Endocrinologists: What I Learned from Lifetime Practice
40.1 Exhilaration
40.1.1 What You Can See
40.1.2 What You Can Do
40.1.3 Whom You Can Work With
40.2 Humility—So Much Still to Learn
40.2.1 What You See May Not Be What It Is
40.2.2 Not Everything You See Merits a Needle
References
41: Ultrasound for Radiologists: What I Learned from Lifetime Practice
41.1 The Art of Sonography
41.2 The Role of the Radiologist
41.3 Radiologist as Gate Keeper
References
42: Ultrasound for Primary Care Practitioners and Emergency Medicine Physicians
42.1 “Top 10” Favorite Ultrasound Pearls
42.2 “Top 10” Lexicon Terms
42.3 Background
42.4 Technique
42.5 Thyroid Ultrasound in the Non-acute Care Setting
42.5.1 Case 1: Why Is Her Heart Racing?
42.5.2 Case 2: Does She Have a Thyroid Nodule?
42.5.3 Case 3: What Is the Etiology of His Throat Pain?
42.6 Thyroid Ultrasound in the Acute or Emergent Setting
42.6.1 Case 4: Fever, Palpitations, and Diaphoresis
42.7 Conclusion
References
43: Ultrasound as a Component of Medical School Curriculum/Simulation Training
43.1 Introduction
43.2 Ultrasound in Undergraduate Medical Education
43.3 Gross Anatomy
43.4 Physical Diagnosis
43.5 Ultrasound Guided Procedures
43.6 Ultrasound Curriculum for Undergraduate Medical Education
43.7 The Future of Ultrasound Training in Undergraduate and Graduate Medical Education
43.8 Conclusion
References
Part IX: Resources, Tools, and Tips for the Sonographer
44: The Ultrasound Lexicon: Common Terminology for Thyroid and Parathyroid Sonography
44.1 Pattern Recognition and Risk Stratification
44.2 Knobology
44.3 Delphian Lymph Node
44.4 Tubercle of Zuckerkandl
44.5 White Knight
44.6 Starry Starry Night
44.7 Comet Tail Artifact
44.8 Giraffe Pattern
44.9 Three Circle Sign
44.10 Pseudonodules and Cobblestones
44.11 Spongiform/Honeycomb Nodule
References
45: Educational Resources for Training in Thyroid and Parathyroid Ultrasound
45.1 Introduction to the History of Ultrasound and Ultrasound Training
45.1.1 Expansion of Ultrasound Use Outside the Radiology Department into Specialty Practices
45.2 Current Resources for Ultrasound Education and Training
45.2.1 Available Training Courses from Professional Societies
45.2.2 Ultrasound Training During Medical School, Residency, Fellowship, Clinical Practice
45.2.3 Remote Distance Learning Opportunities
45.2.4 Learning Curve
45.2.5 Adjuncts for Training
45.3 Certification and Accreditation
45.3.1 What Does Certification Mean?
45.3.2 The Role of AIUM in and Beyond Radiology Based Practices
45.3.3 Variations in Performance of Diagnostic Ultrasound and Reporting Practices Based on Clin
45.3.4 Safe Incorporation of New Ultrasound Techniques into Practice
45.4 Summary

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