Twenty-five years have passed since the reports on upper abdominal screening using ultrasonography were published for the first time in 1982. However, the upper abdominal screening using ultrasonography has been performed without having evaluation and is far from evidence-based healthcare. It is necessary to analyze the data of the screening immediately before loosing confidence, and to establish the evidence. In order to evaluate the upper abdominal screening using ultrasonography and to have the evidence, the Japan Society of Ultrasonics in Medicine should take the initiative in conducting the study which should be performed jointly with other medical societies that use the ultrasonography in the medical screening.

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The Toranomon Hospital Health Management Center has been carrying out more than 10,000 abdominal ultrasound screening tests a year as part of its routine comprehensive medical checkups ever since it was established in 1984. We describe the types and frequencies of an array of findings obtained from these comprehensive medical checkups and present data on malignant tumors detected on ultrasound examination during our first 5 years of operation. The overall frequency of malignant tumors was 0.12%, and renal cancer was the most common (0.08%) type of tumor encountered. Invasive pancreatic ductal carcinoma and bile duct carcinoma were rarely observed (≤0.01%). We recognize the importance of focusing on the ability of ultrasound to detect such tumors at an early stage as well as of following the number and frequency of tumors detected. This will require both improving levels of diagnostic skill of sonographers in order to ensure appropriate management by ultrasound specialists after screening, and enhancing the quality of detailed examinations conducted after comprehensive medical checkups.

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We began screening by the abdominal ultrasonic method in 1984 in Kagoshima Prefecture. In the early years, it was performed only by the Kagoshima Prefecture Association of Prevention for Adult Disease. During these years, the number of examinees was less than 20,000 anually. In 1994, KAGOSHIMA KOHSEIREN Medical Health Care Centre began circuit screening by the abdominal ultrasonic method with circuit total health examination. Since then, the number of examinees has rapidly increased to 66,943 (in 2005) anually in all of Kagoshima Prefecture. In the last several years, KAGOSHIMA KOHSEIREN Medical Health Care Centre has performed about 30,000 circuit examinations and over 10,000 examinations at the Centre. We have detected cancers at a rate above 0.06% and many other diseases needing treatment. Requirements for cancer screening are safety, convenience, economy, efficiency, and effectiveness. Screening by the abdominal ultrasonic method meets the requirements for safety and convenience, but there has been an extreme lack of studies on economy, efficiency, and effectiveness. Many researchers have studied only the accuracy of screening with abdominal ultrasonic. Moreover, screening by the abdominal ultrasonic method can be used not only for cancer screening but also for health examinations. Therefore, we should discuss its usefulness, efficiency, and effectiveness in primary prevention of lifestyle diseases. In order to study these, consequency management needs to be improved and the accuracy of all screening systems examined. Accordingly, all persons engaged in screening by the ultrasonic method must recognize these qualities and must have a strong intention to improve its usefulness and accuracy.

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Abdominal ultrasound has been used in general screening in Japan for the past 20 years, during which medical ultrasound instrumentation has rarely benefited from advanced ultrasound technology: Moderate or low-priced systems have always been used. We now need to be more aware of the operational principles of our ultrasound equipment in order to improve diagnostic confidence. We discuss technologies that show promise for this purpose. 1) Acoustic velocity adjustment: All actual ultrasound systems reconstruct ultrasound images on the assumption that ultrasound propagates through the body at a fixed velocity of 1530 to 1540 m/sec, and the discordance between actual propagation velocity in tissue and the assumed propagation velocity makes ultrasound images ambiguous. An acoustic velocity adjustment system can present many images simultaneously in a variety of ways by changing the back-ground acoustic velocity. There are two types of systems: a) one using conventional line-by-line sonography, which is expected to improve distal resolution, and b) one employing zone sonography, which is designed to increase lateral resolution. 2) Trapezoid scanning: This system widens the scanning plane. The probe is operated by applying voltage pulses to all elements in the assembly as a complete group, but with small time differences. The same time differences are used in each scan and the process is repeated. Beam direction is adjusted by slight angulation from scan to scan. Advances in computer technology have expanded the possibilities for generating uniform beamforming. Trapezoid scanning provides certain advantages, especially the ability to facilitate anatomical orientation. 3) Small devices: Advances in computer technology will expand the possibilities for minimizing instrument size without degrading image quality or image display capabilities. 4) 3D: A series of 2D images are recorded rapidly while the conventional probe is manipulated over the area of interest. 2D ultrasound images are generated while the probe is moved, and are integrated at predefined positional intervals to avoid geometric distortion. 3D ultrasound offers definite benefits, and integrated views obtained with 3D ultrasound may permit better and faster understanding of the whole structure of the abdomen and thus facilitate a more accurate diagnosis. Navigating the abdominal vessels in three orthogonal planes of a section enables the operator to facilitate correct determination of multiple planes and standardize evaluation and measurement. Conclusion. These new technologies promise to further expand the dimension and confidence of abdominal ultrasound in mass-screening.

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Background: Carotid arteries have been used as “windows” to or indicator sites for cerebral and coronary arteriosclerosis. However, there are many cases of cerebral or myocardial infarction without atherosclerosis in carotid arteries. Purpose: To find a new “window” and to determine whether subclavian and carotid arterial intima-media thickness (IMT) predicts cerebral infarction and coronary events. Subjects and Method: Maximal IMT of the right subclavian artery (S-max) and maximal IMT of carotid arteries (C-max) were measured by high-resolution (10 MHz) ultrasonography in 628 consecutive patients (26 patients with a history of cerebral infarction or coronary events and 602 patients without events) at Majima Digestive Organ Clinic. LDL, HDL, TG, taste in food, diabetes, and hypertension were examined in the patients without events. Taking the cases with events into consideration, the ultrasonographic findings in all cases were classified into five categories. Results: S-max was detected in 610 (97.1%) of 628 patients. The degree of thickening of S-max was correlated with LDL and TG levels, taste in food (meats, sweets, vegetables), and hypertension in the elderly (≥60 years old). The degree of thickening of C-max was correlated with LDL and HDL levels, taste in food (meats), and hypertension in the elderly (≥60 years old). The event history rate in the five categories was as follows: Level 0: 0.0% (0/182); Level 1: 1.2% (2/164); Level 2: 2.0% (2/100); Level 3: 11.4% (9/79); Level 4: 14.1% (12/85). Conclusions: S-max is a new clear “window” for the quantitation and follow-up of preclinical atherosclerosis. The categories employing the combination of S-max and C-max measurements are very useful for determining the risk levels of cerebral infarction and coronary events.

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Purpose: We compared the condition of coronary arteries rendered in ultrasonograms of the common carotid artery (CCA) and attempted to determine if ultrasonography of the common carotid artery was useful in predicting the properties of the coronary artery and in follow-up studies. We also studied the effect statin therapy on the common carotid and coronary arteries. Subjects and Methods: Subjects were those patients who had undergone coronary artery endoscopy during cardiac catheterization and ultrasonography of common carotid artery within the previous 3 days. We also used coronary artery endoscopy to compare ultrasonograms of the common carotid artery and presence of yellow plaques (YP) in the coronary arteries and compared changes associated with statin drug therapy. Results: Varying with plaque shape, the ratio of the high-echo plaque in the common carotid artery significantly increased with number of yellow plaques and plaque scores of the coronary arteries. However, there was no significant correlation between grade of yellow plaque and average intima-media thickness (IMT), nor between grade of yellow plaque and maximum plaque diameter. Average intima-media thickness and plaque size in the common carotid artery in the atrovastatin-treated group had decreased significantly by a mean of 6 months later, but did not decrease in the nonatrovastatin-treated group. The number of yellow plaques in the coronary arteries significantly increased in the nonatrovastatin-treated group but not in the atrovastatin-treated group. Conclusion: Ultrasonography of the common carotid artery was useful in predicting atherosclerosis of the coronary arteries, although the method of evaluation imposed certain limitations.

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Duodenal cancer is relatively rare. Many patients are diagnosed at an advanced stage and the prognoses are generally poor because patients often complain of non-specific symptoms and endoscopic diagnosis of the distal part of the duodenum is often difficult. We report a case of primary duodenal cancer detected by abdominal ultrasonography (US). A 68-year-old Japanese woman was admitted to our hospital for further examination of nausea, renal failure, and hypercalcemia. No abnormality was found with ordinal gastroduodenal endoscopy performed by a nearby doctor. Abdominal US revealed diffuse wall thickening with blurred wall stratification in the distal 3rd and 4th position of the duodenum. Contrast US with Levovist^® showed the hypovascular nature of the tumor. Left hydroureter with surrounding fat tissue thickening including lymph node swelling suggested broad tumor invasion into the retroperitoneal space. Barium contrast studies as well as endoscopy also showed luminal narrowing of the duodenum, suggestive of duodenal cancer. On operation, the tumor was not resectable due to broad invasion and dissemination. Histopathological examination of the resected seeding nodule confirmed the diagnosis of primary duodenal cancer, and gastrojejunostomy was performed as a palliative therapy. The patient, in whom chemotherapy was difficult to carry out because of renal failure, died two months after the operation. In this case, US was useful for not only detection but also assessment of invasion of duodenal cancer.

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