Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study.

AIMS: To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone. MATERIALS AND METHODS: Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard. RESULTS: The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements CONCLUSIONS: Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.

The response of buildings to tunnelling: A case study

A case study of the response of two buildings to the construction of a 12 m diameter tunnel excavated by conventional method, in Italy, is studied. The 12 m diameter tunnel was constructed carrying out reinforcement of the tunnel face and around the crown prior to excavation and installation of the temporary sprayed concrete lining and the permanent reinforced concrete lining. Reflective prisms, placed at first floor level around the perimeter of the building facades, allowed building settlements to be measured. Ground settlements between the two buildings were measured using BRE type settlement studs. Extensive protective measures were adopted to maintain stability of the tunnel excavation and to reduce ground movements. The number of horizontal jet grout columns installed into the tunnel face was reduced over the course of the project. Results from CPT tests indicate that the undrained shear strength at the tunnel axis is around 120 kPa. SPT and undrained unconsolidated (UU) triaxial tests indicate lower strengths of around 80 kPa, although this may be due to sample disturbance.

Winglets for Improved Aerothermal Performance of High Pressure Turbines

This paper investigates the design of winglet tips for unshrouded high pressure turbine rotors, considering aerodynamic and thermal performance simultaneously. A novel parameterization method has been developed to alter the tip geometry of a rotor blade. A design survey of un-cooled, flat-tipped winglets is performed using RANS calculations for a single rotor at engine representative operating conditions. Compared to a plain tip, large efficiency gains can be realized by employing an overhang around the full perimeter of the blade, but the overall heat load rises significantly. By employing an overhang on only the early suction surface, significant efficiency improvements can be obtained without increasing the overall heat transfer to the blade. The flow physics are explored in detail to explain the results. For a plain tip, the leakage and passage vortices interact to create a three-dimensional impingement onto the blade suction surface, causing high heat transfer. The addition of an overhang on the early suction surface displaces the tip leakage vortex away from the blade, weakening the impingement effect and reducing the heat transfer on the blade. The winglets reduce the aerodynamic losses by unloading the tip section, reducing the leakage flow rate, turning the leakage flow in a more streamwise direction and reducing the interaction between the leakage fluid and endwall flows. Generally these effects are most effective close to the leading edge of the tip, where the leakage flow is subsonic.