The article presents standards for performing and reporting of transrectal prostate ultrasound in adults. The document consists of ultrasound protocol, which describes the methodology of ultrasound examination performing, and ultrasound report, describing the examination results with final conclusion. The ultrasound protocol and ultrasound report comply with current national and international guidelines.

A standard protocol for superficial lymph node (LN) ultrasound is presented. The document consists of a technological (1) and descriptive (2) protocols. The technological protocol describes the technique of superficial LN ultrasound. The descriptive protocol contains a detailed report of the results of superficial LN ultrasound, which ends with a conclusion. Modern domestic and foreign clinical and diagnostic recommendations that determine the indications for superficial LN ultrasound are analyzed.The presented standard protocol for superficial LN ultrasound fully complies with current Russian clinical recommendations and does not contradict foreign clinical and diagnostic recommendations.

The article presents the most informative ultrasound (US) signs of unchanged, "reactive," lymphoproliferative and metastatic lymph nodes (LN). A literature analysis was conducted on the stratification of US-signs of malignancy of the LN, on the basis of which it was concluded that at present time there is no single classification of US-signs of pathological changes in the LN, existing classifications have been developed to assess the LN in some regions, include from 3 to 5 categories and are not used everywhere. Due to certain difficulties in interpreting the nature of the LN lesions associated with their localization, size, number, severity of response to the infectious process and presence of oncological history of the patient, it is justified to create a unified classification of US signs of the LN changes employing 6 categories that is similar to previously accepted classifications of radiation diagnostics TI-RADS, BI-RADS. For a wide discussion by experts, it is proposed a draft classification Node-RADS for stratification US-signs of surface LN.

BACKGROUND : the main reason for postoperative vocal folds paresis is the variable anatomy of the recurrent laryngeal nerve. An example of such an “extreme form of embryonal development» is the non-recurrent laryngeal nerve. However, many surgeons consider this structure to be a rare anomaly with prevalence less than 0.5%. This opinion is associated with a six to seven-fold increase in the number of vocal folds paresis when a surgeon encounters with a non-recurrent laryngeal nerve. Meanwhile, in cadaveric studies a significantly higher prevalence of non-recurrent laryngeal nerve was demonstrated — 2.2%. The right aberrant subclavian artery was diagnosed during CT in 3.1% patients. AIM : the aim of the study is to determine the effectiveness of preoperative ultrasound in detecting the right aberrant subclavian artery and non-recurrent laryngeal nerve. MATERIALS AND METHODS : patients underwent thyroid and parathyroid surgery with identification of a right inferior laryngeal nerve. The preoperative neck ultrasound was performed on all patients with visualization of a brachiocephalic trunk (Y-sign) or a right aberrant subclavian artery (AL-sign). CT-angiography was performed in the postoperative period on patients who had a non-recurrent laryngeal nerve. RESULTS : the study included 1476 patients. The Y-sign was determined among 1338 (90.7%) patients. In these cases a typical anatomy of the recurrent laryngeal nerve was observed. In 138 (9.3%) cases, the Y-sign was not detected. In this subgroup of patients, in 20 (1.4%) cases, a non-recurrent laryngeal nerve and a right aberrant subclavian artery were noted. Thus, the sensitivity of the Y-sign in confirming the normal anatomy of the recurrent laryngeal nerve was 100%, specificity — 91.9%, positive prognostic value — 14.5%, negative prognostic value — 100%. On the contrary, AL-sign was notedall 20 (1.4%) patients with non-recurrent laryngeal nerve and right aberrant subclavian artery. False positive and false negative results were not observed. Three variants of the non-recurrent laryngeal nerve were identified: type I (superior type) — located behind the upper third of the thyroid lobe, has a direct descending way and forms an angle to the larynx of 30–50°; type III (inferior type) — has a direct ascending way (simulates the course of the recurrent laryngeal nerve) and forms an angle to trachea in 30–50°; type II (middle type) — all variants of the non-recurrent laryngeal nerve located between types I and III. CONCLUSION : the preoperative ultrasound detection of brachiocephalic trunk (Y-sign) confirms the presence of a recurrent laryngeal nerve (sensitivity 100%), and visualization of the right aberrant subclavian artery (AL-sign) determines a non-recurrent laryngeal nerve (sensitivity and specificity 100%).

The review presents the most common diagnostic models, algorithms and stratification systems developed for the purpose of optimal differential diagnosis of benign and malignant ovarian tumors from 1990 to the present. Four variants of the RMI 1–4 malignancy risk index with their comparative characteristics are described. A proprietary comprehensive ultrasound scoring scale for ovarian tumors is described. Algorithms for the integrated use of echography and tumor markers (CA-125, HE4, ROMA), including the Risk Ovarian Cancer computer system, are presented. All existing IOTA diagnostic models are described: Simple IOTA rules, Simple IOTA rules with quantitative calculation of the risk of malignancy, Logistic regression analysis IOTA LR1 & LR2, Easy IOTA descriptors, IOTA ADNEX. The main algorithms for the integrated use of IOTA models are presented. The principles of using the diagnostic stratification systems GI-RADS and O-RADS are outlined. Clinical examples of the use of diagnostic models are given. The review concludes by presenting the ESGO/ISUOG/IOTA/ESGE consensus on the preoperative diagnosis of ovarian tumors.

Background: Salivary gland tumors account for up to 5% of all head and neck neoplasms. Ultrasonography is one of the main diagnostic modalities for the salivary gland pathology; however, its diagnostic potential is under scrutiny. Fine needle aspiration cytology is considered the main diagnostic method, although its role in the differential diagnosis is disputable.Objective: To identify, based on morphology results, the effectiveness of the main ultrasonographic signs indicating major salivary gland neoplasms in the differential diagnosis and study these signs, to evaluate the effectiveness of fine needle aspiration in the diagnosis of benign and malignant major salivary gland neoplasms.Materials and methods: This retrospective study evaluated a group of 220 patients. We calculated sensitivity, specificity, and accuracy of qualitative ultrasonographic signs of salivary gland neoplasms, analyzed the fine needle aspiration effectiveness, and compared results accuracy by calculating Pearson’s empirical χ-square.Results: Common ultrasonographic signs of benign salivary gland neoplasms included a clear contour (97.5%) and decreased echogenicity (72.7%). Malignant tumors frequently presented with a clear contour (76.7%), uneven contour (72.1%), and decreased echogenicity (69.8%). Fine needle aspiration sensitivity and specificity in the diagnosis of benign neoplasms were 75.5% and 53.6%, respectively. Fine needle aspiration sensitivity and specificity in respect of malignant tumors were 50% and 94%, respectively. Pearson’s χ-square value for the clear contour had significant differences in favor of benign neoplasms.Discussion: Benign and malignant salivary gland neoplasms often have a similar ultrasonographic pattern. A significant diagnostic sign of malignant tumors is the uneven contour. We compared the effectiveness of cytological differentiation between benign and malignant neoplasms and found high rates of specificity and accuracy for malignant tumor diagnosis.Conclusions: Clear contour and decreased echogenicity are significant ultrasonographic signs in the differentiation of benign neoplasms. Uneven contour is a significant differentiating factor for malignant neoplasms. Cytology can be used for initial morphology in diagnosing major salivary gland neoplasms, but in half of the cases it fails to identify the nature and type of the tumor.

The main advantages of vocal folds ultrasound are noninvasiveness, wide technical availability, the possibility of application by different specialists, and that it takes a short time to exam. These properties determine the method as a screening method for diagnosing paresis and paralysis of the larynx. However, the method has not been widely used due to its low sensitivity and is mainly used in patients before and after thyroid surgery. The low accuracy of the ultrasonography for the assessment of vocal fold mobility is mainly due to the lack of universal ultrasound anatomical landmarks, the presence of which would increase the possibilities of ultrasound. Thus, most specialists choose vocal cords as a main sonographic marker which do not have clear image and are not visualized in all patients. The work carried out the correlation of anatomical structures identified during autopsy, endoscopic and ultrasound studies. The arytenoid cartilages, identified in all the subjects, were distinguished by the constancy of the ultrasound pattern and active mobility in accordance with breathing cycles and phonation. Therefore, these structures are proposed as the main ultrasound landmarks for assessing the mobility of the vocal cords. Additional structures reflecting the motor function of the larynx are the vocal cords and vestibular folds, the ventricles, and the muscular-ligamentous apparatus of the larynx. They did not have precise patterns, are not identified in all patients, and their movements could not be quantified. Thus, the proposed ultrasound anatomical landmarks and the creation of a unified ultrasound protocol for the ultrasonography assessment of vocal cords mobility in the future can increase the effectiveness of the method and expand the scope of its application in medicine.

Цель: оценить возможность применения кардио-торакального индекса (КТИ) как второго критерия, наряду с пиковой систолической скоростью в средней мозговой артерии (ПСС в СМА), для более точной диагностики умеренно тяжелой и тяжелой анемии плода. Материал и методы: определены значения КТИ плода в контрольной группе (группа 1, 368 плодов, 367 беременных) (беременности без риска развития анемии, врожденных аномалий развития у плода и с известным катамнезом, которые завершились рождением новорожденных с нормальным уровнем гемоглобина) и группе плодов с умеренно тяжелой и тяжелой анемией (группа 2, 20 плодов, 20 беременных) (забор крови плода при кордоцентезе: гемоглобин плодов соответствовал критериям умеренно тяжелой (6/20, 30,0%) и тяжелой (14/20, 70,0%) анемии). Эти группы составили обучающую выборку. Для тестирования диагностического алгоритма сформирована группа сравнения (группа 3, 61 плод, 60 беременных), в которую включены беременные с высоким риском анемии у плода. Гемоглобин у 15 (15/61, 24,6%) плодов (подгруппа 3а) соответствовал критериям умеренно тяжелой и тяжелой анемии, у остальных (46/61, 75,4%) (подгруппа 3b) - анемии легкой степени или норме. Статистическая обработка количественных параметров проведена с помощью языка Python и открытой библиотеки scikit-learn. Результаты: значения КТИ увеличиваются со сроком беременности и достоверно отличаются в подгруппах (четыре подгруппы соответственно сроку беременности) здоровых плодов (группы 1) и плодов с умеренной и тяжелой анемией (группа 2) (P 0,01 для всех сравнений). Методом логистической регрессии получена дискриминантная функция и построена модель, позволяющая выделять плодов с умеренной и тяжелой анемией с величиной ошибки 0,5%. Для диагностики умеренно тяжелой и тяжелой анемии плода необходимо оценить ПСС в СМА, а в случае превышения верхней границы 95%-го доверительного интервала оценить КТИ (два параметра). Проведен сравнительный ROC-анализ предлагаемого подхода и подхода G. Mary et al. (2000) (один параметр - ПСС в СМА) в группе 3, не принимавшей участия в оценивании модели. Предлагаемый подход характеризуется чувствительностью 93,3%, специфичностью 100,0%, предсказательной ценностью положительного теста 100,0%, предсказательной ценностью отрицательного теста 97,9%, ложно-положительной фракцией 0,0%, ложноотрицательной фракцией 6,7%, AUC (area under the curve) 0,966; методика G. Mary et al. (2000) - 100,0%, 84,8%, 68,2%, 100,0%, 15,2%, 0,0%, 0,920 соответственно. Выводы: предлагаемый метод диагностики умеренно тяжелой и тяжелой анемии имеет более высокую специфичность и предсказательную ценность положительного теста. Это позволит избежать необоснованных вмешательств, что особенно важно в ранние сроки беременности в связи с высоким риском осложнений. Ключевые слова: ультразвуковое исследование с допплерометрией, средняя мозговая артерия, пиковая систолическая скорость кровотока, множитель медианы, анемия плода, анемия умеренно тяжелой степени, анемия тяжелой степени, кардиоторакальный индекс, гемолитическая болезнь,

Ключевые слова: ультразвуковое исследование легких, консенсусное заявление, COVID-19, lung ultrasound, consensus statement, COVID-19

Ultrasound examinations (ultrasound) are one of the most popular methods of instrumental diagnostics. Like any medical intervention, ultrasound is associated with infection risks for patients who are clearly underestimated. The epidemiological safety system of ultrasound diagnostics in our country has not been developed, which is associated with the lack of sanitary regulation in the field of this medical technology. The article presents scientific literature data characterizing the main risks of infection of patients, the view of epidemiologists and ultrasound diagnostics specialists on the epidemiological safety problem.

Ключевые слова: ультразвуковое исследование легких, консенсусное заявление, COVID-19, lung ultrasound, consensus statement, COVID-19

Ultrasound examinations (ultrasound) are one of the most popular methods of instrumental diagnostics. Like any medical intervention, ultrasound is associated with infection risks for patients who are clearly underestimated. The epidemiological safety system of ultrasound diagnostics in our country has not been developed, which is associated with the lack of sanitary regulation in the field of this medical technology. The article presents scientific literature data characterizing the main risks of infection of patients, the view of epidemiologists and ultrasound diagnostics specialists on the epidemiological safety problem.

The authors performed a systematic review to summarize data on the approaches and methods of bowels preparation for radiography, radiology and ultrasound studies. The review included 15 articles on computed tomography (CT) and 30 articles on magnetic resonance imaging (MRI). Due to the limited evidence, researches on X-ray and ultrasound (US) studies are not included in the review; the authors just summarized the main provisions for these modalities. The bowels preparation must be completed before making the CT colonography (diet, bowel cleansing within max. 24 hours, marking the residual content). For purification, solutions of low-volume polyethylene glycol (PEG) 2 L with ascorbate complex and electrolytes, bisacodyl and other medications were used. The choice of a specific drug regimen of bowels cleansing should be based on a personalized approach to patient, balance, consideration of studies purpose and reasons. The bowels preparation must be completed before making the MRI (two ways: complete cleansing (most often with low-volume polyethylene glycol 2 L solutions with ascorbate complex and electrolytes or diet, followed by contrasting the residual content). There is no reliable information on the benefits of each particular approach. The insufficient evidence is due to the lack of comparative studies. When performing the MRI of men's small pelvic, doctors use antispasmodics, for women they prefer diet, mechanical cleansing, suppositories with bisacodyl or magnesia, followed by rehydration on the day of studies. There is currently no reliable data on the need in bowels preparation before making the following studies: CT of abdominal cavity and small pelvis (except for the large intestine), excretory urography, metro(hystero)salpingography, ultrasound of the large intestine. PEG solutions with electrolytes have relative advantages in preparing bowels for radiation studies (possibility of using in cases when the prescription of other laxatives is contraindicated).

Aim. To improve the results of treatment of patients with pancreatic diseases. Materials and Methods. For the period from 2010 to 2014 it was performed 59 robot-assisted pancreatic operations. There were distal pancreatectomy in 30 cases and pancreaticoduodenectomy in 12 cases including total pancreatoduodenectomy (1), central resection (5), tumor enucleations (12). The study included 48 (81.4%) females and 11 (19.6%) males. Median age was 48.4 ± 14.5 years. Results. Average operation time in case of ancreaticoduodenectomy, distal pancreatectomy, central resection and tumor enucleation was 463.1 ± 111.1, 218.0 ± 68.2, 253.0 ± 37.7 and 150.0 ± 49.0 minutes respectively. Postoperative complications arose in 24 (40.7%) cases including external pancreatic fistula in 19 patients, delayed gastric empty in 3 and arrosive hemorrhage in 2 cases. There was one death after robot-assisted pancreaticoduodenectomy. Conclusion. Indications for robot-assisted pancreatic surgery are malignant tumors T1–T2, neuroendocrine neoplasms and benign tumors with size not more than 5–6 cm. The use of robotic complex doesn’t prevent from specific postoperative complications definitive for pancreatic surgery.

Background.Question about the quality and format of postgraduate education of doctors raises increasingly in recent years. Development of professional standards and transition to a system of continuing professional education have allowed professional communities to raise issues of the quality of modern education but there is no clear evidence of the dependence of the level of education and the quality of medical care in the accessible literature. Experts of Research and Practical Center of Medical Radiology carried out the identification of dependence of post-graduate education length for radiologists and the quality of their work that can serve as a rationale for amending the system of doctors training.Patients and methods.The data on education and actual work of 85 radiologists of out-patient and in-patient units of medical organizations of the Moscow Healthcare Department have been analyzed. According to the results of the audit of diagnostic studies, carried out in the “Unified Radiological Information Service” system by the specialists of the Research and Practical Center of Medical Radiology, the final assessment of the work of each radiologist was formed, which reflects the presence or absence of diagnostic discrepancies.Results.Parameters of diagnostic errors depending on the age of doctors, the general length of service and the length of service as radiologist, the duration of postgraduate education in the clinical specialty and the specialty “radiology” have been compared.As a result of the analysis, it was found that the increase in the proportion of diagnostic differences is directly related to the increase in the age of the doctor and does not depend on either the length of service or the time of work in the specialty. Differences between the groups of physicians with the largest (professional retraining after clinical residency) and the smallest (clinical education + radiology) percentage of clinically significant discrepancies are statistically significant (p = 0.05, at the normative value of the Student's test score of 2.16).Conclusion.The inverse relationship between the duration of training of the radiologist in the specialty and the proportion of diagnostic errors, which can serve as a significant justification for making proposals for the exclusion of professional retraining within 576 hours for admission to professional activities of radiologists.

The use of the contrast agent SonoVue has been allowed in Russia since June 2014. Since then, russian experts have been accumulating their own experience in the contrast agent application for various diseases. The analysis of the obtained data showed that, besides the typical characteristics of the lesions enhancement, described in the literature, there can be atypical cases due to various causes (longterm course of the disease, co-morbidity). We present a clinical case of pancreas cystic lesion in female patient, that was misunderstood as a cystic tumor preoperatively. Considering the epithelial lining nature, absence of the accurate signs of the presence of an ovarian-like stroma, and also the significant secondary changes in the cystic wall such as hyalinosis, cholesterol deposits and macrophage accumulations, the lesion was interpreted as a long-standing pancreatic retention cyst with secondary changes by a morphological study. The features of the enhancement patterns of this lesion can be explained by the presence of significant secondary changes in the wall of cyst, that was first diagnosed in this patient 10 years ago.

Objective:a comparative “blind” assessment of the thyroid nodules identified by ultrasound, according to the TI-RADS scale in various modifications.Materials and methods.Retrospective analysis of 149 echograms of thyroid nodules by three independent experts was performed (the experience of ultrasound of thyroid ultrasound for more than 7 years).Results. In solid nodules, high-specific large (more than 94%) and small (more than 90%) ultrasound signs of thyroid cancer have been identified. The nodes are stratified according to the TI-RADS system: 1 – in the modification J.Y. Kwak et al. (2011), 2 – according to the proposed system, taking into account small ultrasound signs of thyroid cancer. High reproducibility of both systems are obtained. In the first system 13.7% of cancer nodes fell into the category of TI- RADS 3 (benign formations), in the second system only 5% of cancers fell into the category of TI-RADS 3, which is important for biopsy selection. The sensitivity of the first system was TI-RADS 82.05%, of the second system – 94.87%.Conclusions.Classification of TI-RADS can be used to interpret the ultrasound results of thyroid nodules, taking into account both the main large and small ultrasound signs of cancer. For its validation in our country, it is necessary to further broad discussion of the proposed TI-RADS system.