A whole body scan, which usually is made from mid-thighs to the top of the head, takes from 5 minutes to 40 minutes depending on the acquisition protocol and technology of the equipment used. FDG imaging protocols acquires slices with a thickness of 2 to 3 mm. Hypermetabolic lesions are shown as false color -coded pixels or voxels onto the gray-value coded CT images. Standardized Uptake Values are calculated by the software for each hypermetabolic region detected in the image. It provides a quantification of size of the lesion, since functional imaging does not provide a precise anatomical estimate of its extent. The CT can be used for that, when the lesion is also visualized in its images (this is not always the case when hypermetabolic lesions are not accompanied by anatomical changes).
The supraclavicular approach to ultrasound-guided SCV cannulation may be ideal in certain scenarios and safer than the landmark-based SCV central line placement. 2,3,11 We recommend this access site as an alternative for providers comfortable in procedures requiring in-plane needle visualization. Using a pragmatic ultrasound-based approach to central venous cannulation that relies on visualized patient anatomy, operator skill, and the clinical scenario allows emergency physicians to become adept at an often challenging aspect of emergency care.
Complementary and Alternative Medical Treatments . Other nonpharmacologic treatment modalities that have been studied during pregnancy include acupuncture, manual therapy, water therapy, transcutaneous nerve stimulation, stabilization belts, yoga, and other complementary and alternative medical treatments. Acupuncture is generally considered safe during pregnancy [ 9 , 10 ]. It is believed that acupuncture works by stimulating the body’s own pain relieving opioid mechanisms [ 9 ]. No significant adverse effects have been found [ 5 , 6 ], although it is recommended to avoid acupuncture points that can stimulate the cervix and uterus, as they can induce labor [ 9 , 10 ]. Studies have compared the efficacy of acupuncture compared to physical therapy for the treatment of low back pain, and the results highlight the superiority of acupuncture for relieving pain and decreasing disability [ 9 ]. Manual therapy is also important for decreasing pain as it influences the spinal “gating” mechanism as well as the pain suppression system [ 9 ]. One form of manual therapy is osteopathic manipulative treatment (OMT), which is offered by osteopathic physicians. One randomized controlled trial studied low back pain and related symptoms in the third trimester of pregnancy by comparing OMT and standard obstetric care, standard obstetric care and sham ultrasound treatment, and standard obstetric care alone. The results showed that, during the third trimester of pregnancy, OMT reduces or stops the deterioration of back pain related functioning [ 11 ]. Another notable treatment modality is water therapy, which involves physical exercises in a pool. Studies have shown the benefits that water therapy has to ameliorate pain and to lessen the demand for sick leave in women with pregnancy-related low back pain [ 5 , 6 , 12 ]. On the other hand, there is limited data that transcutaneous electrical nerve stimulation (TENS) is an efficacious and innocuous treatment modality for low back pain during pregnancy. One study compared TENS to exercise and acetaminophen and found that TENS improved low back pain more effectively; however, Keskin and colleagues suggested that further studies are needed before generalizing these results [ 13 ]. The TENS unit is used for labor analgesia in many countries and often used for pain management during pregnancy. It is recommended to keep the current density low and avoid certain acupressure points [ 14 ]. Please refer to Table 3 for more information on complementary and alternative medicine options.