S10 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

line on the monitor correspond with the needle canal on the guide,when attached to that particular transducer. Using a needle guideprovides safer control of the needle during insertion, but it is on the costof lesser flexibility of needle manipulation and limited degree offreedom regarding puncture direction. With the “free hand” techniquethere is no physical connection between needle and transducer and thusno limitations exist regarding point of needle insertion or angel ofpuncture. There is no punctureline on the monitor and the needle maybe inserted from any direction parallel or perpendicular to the scanningplane, which ever solution is most suitable according to the situation athand.Two factors have changed interventional ultrasound in recent years:Contrast ultrasound can distinguish malignant lesions from benignlesions (as haemangiomas) in the liver, thus reducing the amount ofbiopsies significantly. Fusion imaging (CT and US) can guide theinterventionalist for a safer and more accurate puncture procedure incases of poor US visibility.

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Technical Advances and Clinical Applications of MicrowaveAblationsPing Liang, Chinese PLA General Hospital, China

Objective: Microwave ablation (MWA) is an effective local thermalablation technique for treating solid malignant tumors. In recent years,this technique had undergone tremendous progress due to technicaladvances. The purpose of this article is to review the basic principles,equipment, current status and future trends of MWA in the treatment ofmalignant tumors.Methods: All articles published in English on MWA or MWA as atreatment for malignant tumors were identified with a PubMed searchfrom the 1990s through Dec 2008. Papers were reviewed about thetechnical advances of the MWA equipment, the clinical applications ofMWA including indications, techniques, therapeutic outcomes, andcomplications.Results: MWA has become one kind of minimally invasive treatmentmodalities in the treatment of solid malignant tumors. Many studieshave demonstrated that MWA has several advantages, including highthermal efficiency, higher capability of coagulating blood vessel, fasterablation time and so on. Clinically, MWA has been widely used fortreatment of hepatocelluar carcinoma and liver metastasis. Long-termsurvival rates can be comparable to that of surgical resection for tumorsmeasuring 4 cm or less and the complication rates appear to be low.This technique also has been adopted for treatment of renal carcinoma,lung cancer and other malignant tumors. Contrast enhanced ultrasoundand MRI play an important role in evaluation of therapeutic results.Conclusions: With the technical advances in the future, MWA maybecome an important therapeutic modality for treatment of solid ma-lignant tumors.

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Ultrasound Guided Ablative Techniques, Review and FutureAspectsChristian Nolsoe, Køge Hospital, University of Copenhagen,Denmark

Tissue ablation of localized cancer in a variety of organs by means ofradioactive seeds, alcohol, heat or frost guided by percutaneous, en-doluminal or endoscopic ultrasound has gained widespread use duringthe last two decades. These techniques are referred to as minimalinvasive therapies but differ with respect to invasiveness and complex-ity of the equipment, time and personnel needed and cost related to thetreatment. They range from a simple set-up with a needle and a syringe

containing few cc of ethanol used for ablation of parathyroid adenomas

to a highly sophisticated scenario where liquid nitrogen under highpressure and low temperature is circulated from big tanks into severaldedicated needleshaped probes meticulously positioned transperineallyin a prostate cancer. Each method has advantages of its own andcomparison of the results can only be done to a limited degree. Ingeneral ethanol has been used for ablation of hepatocellular carcinomaand parathyroid adenoma, brachytherapy mainly for prostate cancer bymeans of Iodine-125 seeds, cryotherapy for liver metastases, prostatecancer and renal carcinoma and finally, thermal ablation by heat withthe use of laser, radiofrequency (RF), microwave or high-intensityfocused ultrasound (HIFU) has been used in a range of organs on avariety of indications but, by far mostly in the treatment of colo-rectalliver metastases. Any new treatment has to be validated. For RFablation of colo-rectal liver metastases the published data confirm thata 5 years survival rate comparable to surgical treatment i.e. 30% to 40%can be achieved.

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Live Scanning Workshop: Elbow Collateral Ligaments, BicepsBrachii Apparatus and Joint Space AccessStephen Bird, Benson Radiology, Australia

This workshop will demonstrate the more challenging aspects of elbowsonographic assessment. The biceps brachii tendon insertion onto theradial tuberosity is an area which is traditionally difficult to assess withultrasound. A variety of factors including anisotropy, deep location andpoor quality acoustic window through muscle belly edges result in atechnical challenge. A method of sonographic assessment using thepronator teres muscle belly as an acoustic window will be demonstratedallowing high resolution assessment of the tendon insertion and mus-culotendinous junction. This technique allows the examination to beextended beyond intact / ruptured differentiation to include more subtlefindings such as tendonosis and partial tears and avulsions. The result-ing images are of high resolution and diagnostic quality allowingvisualization of the normal periosteal fibrocartilage at the tendon en-thesis. The bicipitoradial bursa is also easily assessed and injected /aspirated with application of the technique.Assessment of the elbow medial and lateral collateral ligament appa-ratus is an important extension to routine golfers or tennis elbowexaminations respectively. Sonographic technique for assessment ofthe collateral ligament structures will be demonstrated including diag-nostic clues and provocative tests which assist the diagnosis of liga-ment failure. The technique for assessment of the posterior interosseousnerve will also be demonstrated.The Elbow has many recesses which allow sonographic evaluation ofjoint effusion or identification of loose bodies. Sonographic techniquefor elbow joint access through a variety of windows will be demon-strated. These access points are all suitable for diagnostic joint aspira-tion or injection of therapeutic pharmaceuticals.

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Live Scanning Workshop: The 12 Week ScanVanessa Pincham, Sydney Ultrasound for Womenv, Australia

Ultrasound evaluation during the first trimester has many advantages,including accurate pregnancy dating, detection of early fetal demise(3% of first trimester examinations), aneuploidy screening ,exclusion ofectopic pregnancy and identification and characterization of twin preg-nancies (2% of first trimester examinations).Nuchal translucency (NT) measurement with the addition of maternalage and maternal serum biochemistry is now a well established screen-ing method which can detect approximately 90% of trisomy 21 fetuses

at a 5% false positive rate.