Interventional ultrasound beyond the classical abdominal applications. Are guidelines for other applications urgent needed?

Abstract

Interventional ultrasound (INVUS) has gained wide acceptance in the field of interventional radiology over the last years. The following advantages made US a very attractive guidance method in several applications: easy to use, possibility to perform and assess outcome and complications in real time, lack of radiation, repeatability, the possibility to perform at the bed side [1].Abdominal ultrasound is a very popular imaging method being adopted by several medical and surgical specialties: internal medicine, gastroenterology, urology, nephrology, and oncology. Many applications both with diagnostic and therapeutic aims have been discovered and implemented in clinical practice over the last years [2]. For example in the last 10 years the number of papers with INVUS topics indexed in PubMed has dramatically increased (10652 vs.5011 before 2005).Facing such a high number of interventions and clinical applications there are some concerns that have risen regarding its proper use, the knowledge of complication, availability and training.Based on huge amount of knowledge and experience a group of physicians from Europe under the auspicion of European Society of Ultrasound in Medicine in Biology (EFSUMB) have recently elaborated Guidelines for INVUS. The guidelines will include recommendations regarding the general aspects of INVUS, diagnostic and therapeutic procedures using the transcutaneous and endoscopic ultrasound approaches and vascular access. However, the above-mentioned recommendations are addressed mainly to abdominal applications (using both the transabdominal and endoscopic ultrasound approach).Interventional ultrasound has extensively widening its applications over the last years in many other fields (thyroid and other head and neck lesions like salivary glands tumors, soft tissue tumors, thorax lesions, musculoskeletal -MSK interventions, breast, obstetrics and gynecology, cardiology, anesthesiology, or intensive care medicine) [3][4][5][6][7][8][9][10]. A part of these interventions are performed by the interventional US physicians, mainly those with internal medicine specialty or by interventional radiologists (IRs) trained to perform INVUS [11].Some of the non-abdominal applications of INVUS may be considered specialty-oriented interventions like MSK interventions in rheumatology and sports medicine, diagnostic and therapeutic procedures in obstetrics&gynecology, cardiology and specific interventions in anesthesiology&intensiv care medicine [6,7,[9][10][11]. Regarding education, the training in INVUS in those fields should be part of a more complex US formation (usually with 3 levels of expertise) and may be included in the residency/fellowship programs. Experts from these fields should elaborate their own guidelines. However, the experience gained by other physicians, especially IRs is extremely helpful in the training process and also for guidelines publications.In other fields (like thorax lesions, thyroid lesions and head&neck tumors) although "interventional" US physicians and IRs perform many in...

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