AIM: To assess the developing competence of two trainees learning groin and shoulder ultrasound when compared to an expert practitioner. MATERIALS AND METHODS: Specific pro formal were used to record ultrasound trainee performance in each scan region and their diagnosis was compared to the opinion of the expert. The data derived were reviewed using kappa analysis and training end points were defined as a minimum 80% trainee agreement with the expert. Retrospectively, cumulative sum analysis was applied to the data to assess case-by-case performance. RESULTS: For groin hernias, reporting an average of 70 examinations was required to become competent and inguinal hernias required higher numbers of examinations than femoral hernias. For shoulders, an average of 80 examinations was required and the supraspinatus and infraspinatus tendons proved the most challenging structures. CONCLUSIONS: Kappa analysis demonstrated a differential in the learning curves for individual structures within each examination region. Sequential kappa scores are consistent with a sigmoid learning curve. The numbers required to achieve satisfactory agreement are suggested as required minima for ultrasound training curricula. Cumulative sum analysis provided a sensitive indicator of trainee performance, quickly highlighting individual learning difficulties when they arose. Its prospective use can ensure extra training support is instigated quickly and appropriately. Crown Copyright (C) 2019 Published by Elsevier Ltd on behalf of The Royal College of Radiologists. All rights reserved.

Sir — We read the article by Gray et al. 1. Gray R.A. Williams P.A. Dubbins P.A. et al. Decontamination of transvaginal ultrasound probes: review of national practice and need for national guidelines. Clin Radiol. 2012; 67: 1069-1077 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar with interest; however, we were surprised to note that an article on ultrasound probe decontamination by ourselves 2. Mullaney P.J. Munthali P. Vlachou P. et al. How clean is your probe? Microbiological assessment of ultrasound transducers in routine clinical use, and cost effective ways to reduce contamination. Clin Radiol. 2007; 62: 694-698 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar has not been included in the literature review. This article, which assessed all ultrasound probes, including transvaginal probes, across a single trust for bacterial contamination, is relevant for several reasons. The authors describe that some centres only dry wipe probes with a paper towel and then speculate that this method of cleaning is inadequate. We were able to demonstrate in the in vitro arm of our study that this method does not remove all bacterial contamination off the transducer head. Our initial clinical sampling run — where this was the baseline cleaning technique — confirmed this. The clinical significance was discussed and we suggested that additional air drying of the resting transducer head between patients may contribute to asepsis. Decontamination of transvaginal ultrasound probes: Review of national practice and need for national guidelinesClinical RadiologyVol. 67Issue 11PreviewTo determine the national practice of transvaginal ultrasound (TVUS) probe decontamination in English hospitals and to develop recommendations for guidance. Full-Text PDF

Ultrasound is a proven technique that has been available in clinical practice for over three decades and is used in the management of patients across almost all medical and surgical disciplines. It is safe, quick, and allows real-time imaging for both diagnosis and for therapeutic interventions. The contact required with the patient to gain images can potentially contaminate the transducer, which can then act as a source for cross-infection, especially with patients with broken skin.

Tumors of sweat gland origin are rare in the hand but should be considered in the differential diagnosis when certain imaging features are present. We present a case of nodular hidradenoma of the hand, with previously unreported magnetic resonance imaging features, and a further case in the thigh, both with ultrasound and histopathological correlation. The imaging literature of this tumor is reviewed, and its significance is discussed with respect to the current understanding of its malignant potential.

Posterior or lateral dislocation of the long head of biceps is a rare complication of shoulder dislocation that can result in inability to relocate the humerus. The diagnosis should be suspected when certain radiographic features are present at the initial presentation. Other imaging modalities can aid diagnosis when clinical management is unsuccessful or protracted. We present a case of surgically proven posterior dislocation of the biceps tendon with conventional radiographic, computed tomography and magnetic resonance imaging assessment. The literature on this subject is reviewed, and imaging features associated with the diagnosis are described.

These results reflect the need for improved N staging across the region to aid the appropriate multimodal treatment of patients.

Background: In the surgical management of gastric carcinoma, regional lymphatic spread is of prognostic importance. The fifth edition of the Union Internacional Contra la Cancrum classification has been shown to be reproducible, practical and of significant prognostic use. The tumour node metastasis (TNM) system requires at least 15 lymph nodes to be acquired and examined for staging to be accurate. This has raised concern over the consistency with which the requisite numbers of nodes would be acquired. This study was performed to assess how consistently surgically managed cases of gastric cancer in the West Midlands fulfilled this requirement to allow accurate staging.Methods: Data from the West Midlands Cancer Intelligence Unit on all cases of gastric cancer registered from 1998 to 1999 were obtained and the number of lymph nodes documented for each surgically managed case was assessed.Results: Overall, only 31.0 per cent of surgically resected cases could be assessed accurately according to the TNM system. The proportion staged accurately varied widely across hospitals from 10.9 to 76.0 per cent.Conclusion: These results reflect the need for improved N staging across the region to aid the appropriate multimodal treatment of patients.