Fetal Hydrothorax

Ultrasound

Fetal Hydrothorax | Johns Hopkins Medicine

The subspecialty-trained radiologists in body imaging use various cross-sectional imaging methods, such as computed tomography (CT or CAT scan), magnetic resonance imaging (MRI) and ultrasound, to diagnose disease and conditions found in the major organs of the chest, abdomen and pelvis. These organs include the heart, lungs, stomach, intestines, liver, pancreas, kidneys, bladder and all other organs found in the body. Organ-specific protocols for each imaging technique allow for targeted, highly detailed examinations.

Body imaging radiologists also perform image-guided diagnostic biopsies and aspirations.

The radiologists in this discipline work closely with primary care physicians, surgeons, pulmonologists, gastroenterologists, chiropractors near me, urologists and other specialists. Our body imaging experts help to diagnose diseases and provide consultation to ensure optimal treatment options are explored.

Computed Tomography (CT scan)

Mission

To provide state-of-the-art patient services in thoracic, abdominal and pelvic computed tomography (CT scan) and to be a leading resource for education and research world-class CT imaging.

Special Services

More than 90,000 CT examinations are performed each year. Our clinical service includes CT imaging of the chest abdomen and pelvis, including CT angiography and 3D imaging. We have the latest in 3D software and currently complete more than 1,000 3D CT cases a month.

The section has nine state-of-the-art Siemens multidetector CT (MDCT) scanners (two scanners at MDCT 64 slice and seven flash dual source scanners). High temporal resolution results from the use of dual X-ray and detector systems. In flash mode an examination of the chest, abdomen and pelvis can be completed in 10-12 seconds.

The flash scanner is especially beneficial for patients who may experience low back pain or shortness of breath when lying down or patients who may have high or irregular heart rates.

Research

  • 3D Medical Visualization
  • Web-based Education and Training
  • Oncologic Imaging
  • Cardiac Imaging
  • MDCT/CTA Development and Design

Magnetic Resonance Imaging (MRI)

The Division of Magnetic Resonance Imaging (MRI) is committed to upholding the tripartite mission of the Johns Hopkins Medical Institutions, which is to offer its patients the highest quality patient care, research and education available. The department’s world-renowned faculty focuses on blending the latest in magnetic resonance technology with the highest possible standard of patient care.

The Division of MRI provides outpatient and inpatient diagnostic MRI exams and image-guided therapy procedures. Referrals are welcome from physicians who do not have privileges at Hopkins, as well as Hopkins medical staff.

Outside MRI examinations from other facilities are also interpreted. Please call 410-955-4567 for details.

The Division of MRI is very active in performing teleradiology services related to diagnosis and treatment evaluation with MR imaging.

If you are the owner or director of an outpatient MRI center and you are interested in having radiologists at Johns Hopkins read your body MR examinations, please contact us below.

We currently perform teleradiology services for both domestic and international customers. The services we can provide include DICOM transfer of MR images and electronic transfer of reports. Evaluation of images and report issuance is completed by the next business day. Emergency requests can be accommodated with preliminary verbal reports.

In some cases, additional arrangements can be made to assist in the training of your MR technologists on the performance of body MR examinations, including cardiovascular MRI.

Our faculty is available to consult with you regarding your teleradiology cases, and the teleradiology coordinator is readily available to assist you with all of your customer service needs.

Special Services

  • Cardiovascular MRI
  • Breast MRI
  • Functional MRI
  • Liver/hepatobiliary MRI
  • Abdominal MRI
  • Prostate MRI/spectroscopy
  • Pelvic MRI

Mission

To provide state-of-the-art patient services in ultrasound and to be a leading resource for education and research ultrasound imaging.

  • The ultrasound section of The Johns Hopkins Hospital performs more than 24,000 examinations each year, including abdominal and gynecologic ultrasound, thyroid and neck, obstetrics, organ transplants, ultrasound of all joints, muscles, tendons and nerves, carotid duplex, abdominal doppler, and peripheral vascular doppler examinations.
  • Our 15 rooms are equipped with state-of-the-art ultrasound units including Philips Epiq and IU22, Siemens S3000 Helix and S2000 and GE Logiq E9. Most of our units have 3D and fusion capabilities. We currently store all images electronically on a picture archiving and communicating system.
  • Our sonographers are registered by the American Registry of Diagnostic Sonographers (ARDMS) and our facilities are accredited in abdominal, obstetrical, gynecological and vascular sonography by the American College of Radiology (ACR).

Special Services

We perform ultrasound-guided biopsies and procedures of various organs and masses including the liver, thyroid, lymph nodes, kidney, pancreas, mediastinum, pleural based lung and retroperitoneal pelvic masses. We are also a recognized leader in MRI fusion biopsies of the prostate.

Source: https://hopkinsradiology.org/

Fetal balloon treatment for lung-damaging birth defect works best when fetal and maternal care are highly coordinated

Fetal Hydrothorax | Johns Hopkins Medicine

Researchers from The Johns Hopkins Center for Fetal Therapy report new evidence that fetuses with severe congenital diaphragmatic hernia (CDH), a rare but life-threatening, lung-damaging condition, experience a significantly high rate of success for the fetal treatment known as FETO, if they and their mothers receive coordinated and highly experienced care in the same expert setting.

A report on the findings was published online, on Feb. 6, in the journal Obstetrics & Gynecology.

FETO — fetoscopic tracheal balloon occlusion — is a minimally invasive procedure in which a fetoscope is inserted through the abdominal wall into the uterus and then into the mouth of the fetus to place an inflatable balloon, to temporarily block the fetal trachea. The blockage allows lung fluids to build up behind the balloon, encouraging expansion of the airways and lung growth. The procedure improves the odds that fetuses with severe CDH acquire sufficient lung function after birth to lead a normal life.

“The primary cause of death in babies with CDH is that the lungs do not develop properly, and they cannot breathe outside the womb,” says Ahmet Baschat, M.D., director of The Johns Hopkins Center for Fetal Therapy and professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.

Usually detected through a routine prenatal ultrasound, CDH is a rare condition that impairs lung development, affecting one in 3,000 live births. It is characterized by the partial or complete absence of the diaphragm — the muscle that separates the chest from the abdomen — resulting in a hole.

The gap may permit organs that are usually in the abdomen, such as the bowel, the stomach and the liver, to push into the chest. This causes a hernia or bulge, a displacement that leaves too little space for fetal lungs to develop normally. The degree of lung damage is greatest for large hernias, where the liver herniates into the chest.

After birth, surgical closure of the hole is possible, but the lung damage that has occurred before birth can make this condition fatal.

To assess the feasibility and impact on the health of mothers and babies after FETO therapy, Johns Hopkins researchers enrolled 14 women, all patients at The Johns Hopkins Center for Fetal Therapy, between May 2015 and June 2019. The women were an average of 28 weeks pregnant and an average of 33 years old.

For the study, Baschat and his team performed successful FETO balloon blockages on all 14 fetuses between 26 and 29 weeks of gestation. No procedure-related fetal or maternal complications occurred. The team removed the balloons at about 33 weeks of gestation, after a median 34 days of blockage.

The researchers say that FETO therapy produced favorable outcomes in the 14 infants born to the mothers in the study when performed in a single center setting, where prenatal and postnatal monitoring and care were highly coordinated.

“This is most ly due to prenatal management by a team with experience in fetal interventions, as well as maternal-fetal care in one single institution,” says Baschat.

“From the time of balloon insertion, we had a multidisciplinary team of fetal therapists, neonatologists, pediatric surgeons, pediatric ENTs and obstetric and pediatric anesthesiologists available for any emergency balloon removals and to make sure the fetuses' airways weren't obstructed in case of unplanned birth.”

“FETO has been studied in the past, in the United States and abroad, in a randomized trial, a large feasibility study and several smaller studies, and while the overall approach was comparable to our study, we employed a deliberate strategy to minimize potential contributors to preterm birth associated with premature rupture of membranes,” adds Baschat. Some of these strategies included treating the mothers with vaginal progesterone, avoiding the lower part of the uterus when inserting the fetoscope and aggressive treatment of preterm contractions.

A striking difference in the Johns Hopkins study, Baschat notes, is that delivery of the babies was at an average of 37 weeks of gestation, with no deliveries prior to 32 weeks; 7% of deliveries before 34 weeks and 43% prior to 37 weeks of gestation. This allowed all the infants to be candidates for extracorporeal membrane oxygenation (ECMO) — an advanced life-support technique — which may have been an important contributor to the survival of the infants.

Overall, babies were born about 30 days after balloon removal. All cases experienced a sustained increase in lung size, from 23.2% before blockage to 46.6% prior to birth.

All 14 women delivered at The Johns Hopkins Hospital at a median gestational age of 39 weeks (range 33-39). Eight (57%) delivered at term (?37 weeks of gestation), after scheduled, induced labor.

The majority of mothers (71%) delivered their baby vaginally.

“We've been able to achieve a really good safety protocol — not only did the procedure result in lung expansion, but balloon removals were all scheduled; they were not emergency procedures,” says Baschat.

Infant survival on day 28 was 93%, and the overall survival to 6 months or hospital discharge was 86%.

All of the babies had absence of the diaphragm on the side of the hernia and required surgical repair of the CDH using a patch, which was performed within the first week of life. The primary complication after surgery in three of the 14 babies (36%) was recurrence of diaphragmatic herniation, due to areas of the patch detaching from the chest wall as the infants grew in size.

“The study had the highest survival rate ever reported for these types of patients, with the lowest complication rate of FETO in terms of procedure risks, obstetric risks and fetal risks,” says Baschat.

A randomized trial involving U.S. and European fetal therapy centers is underway; however, the researchers say they want to wait to see those results to decide on next steps. “Standardized prenatal and postnatal care appear to be complementary in achieving survival in these infants,” says Baschat.

“Anticipating possible obstetric complications and reactively providing prompt treatment may improve the chance for mothers to deliver at term.

” Meanwhile, the researchers are collaborating with other fetal therapy specialists to investigate how care-setting factors and management strategies can be optimized to apply them across other fetal therapy centers.

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Source: https://www.sciencedaily.com/releases/2020/02/200219113738.htm

Diagnostic Medical Sonography – Johns Hopkins Schools of Medical Imaging

Fetal Hydrothorax | Johns Hopkins Medicine

This 18-month, full-time program in Diagnostic Medical Sonography will provide you with first-hand clinical experience in a broad range of both routine and highly specialized ultrasound procedures — in one of the largest and most dynamic labs in the country.

Diagnostic Medical Sonography uses high frequency sound waves to create images of the human body.

Training includes a thorough familiarization with routine diagnostic exams as well as additional concentration in specific areas such as: high-risk obstetrics, abdominal, superficial structures imaging, gynecology, pediatrics, and neurosonology.

Specialties also include all aspects of spectral color, power color Doppler (peripheral, cerebral, and abdominal), endocavity imaging, intraoperative, and interventional ultrasound. This program will allow you to take the national certification examinations in several areas of Diagnostic Medical Sonography

You will obtain first-hand, clinical experience in sonographic procedures at several of our facilities, as well as other clinical facilities throughout the Baltimore-Washington metropolitan region: The Johns Hopkins Hospital, The Johns Hopkins Hospital Outpatient Center, Johns Hopkins Maternal Fetal Medicine, Johns Hopkins Avon Breast Center, Johns Hopkins Wilmer Eye Center, Johns Hopkins Bayview Medical Center, Johns Hopkins Howard County General, Johns Hopkins Sibley Memorial, Johns Hopkins Suburban Hospital, Anne Arundel Medical Center and Anne Arundel Diagnostics, Sinai Hospital of Baltimore, Mercy Medical Center, MedStar Franklin Square, MedStar Union Memorial and Greater Baltimore Medical Center.

To download the application, please click here.

For more information, please see our catalog.

Program Outcomes

View the program outcomes and effectiveness data.

Prerequisite Courses

  • The following prerequisite courses are required for all applicants and must be completed with a grade of C or better. In addition, the combined grade point average of all prerequisite coursework must average to 3.0 or better. Please use our spreadsheet to determine your eligibility for this program.
    • Human Anatomy & Physiology I (4 credit course with laboratory)
    • Human Anatomy & Physiology II (4 credit course with laboratory)
    • Physics for science/allied health majors (4 credit course with laboratory)
    • College Algebra or higher mathematics
    • Medical Terminology-This course must be taken at the college level, for credit
    • Speech and Communication or Public Speaking
    • Psychology
    • Statistics
  • Applicants must have a minimum of a two year Associate degree with an overall GPA of 2.5 or greater or be a graduate of a two year clinically related accredited school in Allied Health (RN, RT, RDMS, Respiratory Therapy, etc.) with appropriate certification in that clinical specialty.
  • At the time of the interview, the candidate will be required to complete a computer competency test consisting of basic word processing skills and an Internet search for information.

Application Requirements

  • Be a citizen of the United States of America, or a permanent resident (hold a green card)
  • Be 18 years old at the time of matriculation
  • A non-refundable application fee of $40
  • Two letters of recommendation using the provided form in the applications*.
    • One from a college science or math instructor
    • One from your present employer
  • Statement of intent, in 200 words or less, stating why you are choosing a career in the health care profession and your specific career goals in medical imaging.
  • Transcripts documenting all post high school education. Foreign transcripts must be evaluated by one of the agencies in the United States that performs academic credential evaluations
  • If you are not completing a degree with one of our affiliated colleges or universities, you must have a minimum of an associates degree completed before the June start date of the program.

*Note: The applicants that are certified in a clinical health care specialty must request a recommendation from the Program Director of your specialty training course and a recommendation from your current employer.

Apply

  • Please complete the application with required documents by March 31, 2020 and submit to:
    • Johns Hopkins Schools of Medical Imaging111 Market PlaceSuite 830Baltimore, MD 21202

Program Accreditation

The Diagnostic Medical Sonography program is currently accredited by Maryland Higher Education and by The Commission on Accreditation of Allied Health Education Programs (CAAHEP) upon the recommendation of the Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS).

The CAAHEP can be contacted at 727-210-2350 or mail@caahep.org. Their offices are located at 25400 US Highway 19 North, Suite 158, Clearwater, FL 33763.

The JRC-DMS can be contacted at 443-973-3251 or mail@jrcdms.org. Their offices are located at 6021 University Boulevard, Suite 500, Ellicott City, MD 21043.

Additional Resources

Source: https://somi.jh.edu/programs/diagnostic-medical-sonography/

Registered Nurse 2: Outpatient Maternal and Fetal Medicine Center at Johns Hopkins Careers

Fetal Hydrothorax | Johns Hopkins Medicine

Requisition Number: 219788

Position Title:

External Description:

The Johns Hopkins Hospital

GYN-OB, Fetal Therapy, unit provides care to a wide variety of women including prenatal and postpartum care for High Risk patients, many with fetal anomalies.

In our clinic, you may participate in the following procedures:  Chorionic villi sampling, amniocentesis, fetal blood transfusion, laser coagulation for TTTS, and other types of fetoscopic procedures.

  The fetal nurse coordinator is responsible for coordinating care for an assigned group of patients to include arranging consults with pediatric specialty providers, acquiring insurance authorizations and providing fetal surveillance/assessment.  The ideal candidate will have an interest in fetal treatment for complex disease processes and anomalies.

Shifts:  8 Hour Day Shift

Qualifications:

  • BSN/MSN preferred. Must be from an accredited nursing program.
  • Applicants with an Associate’s degree in nursing from an accredited nursing program may be considered; provided they are enrolled in an accredited BSN/MSN program within 1 year of hire and complete the degree within 5 years of hire.
  • Active Maryland or Compact RN license is required
  • BLS CPR certification required: AHA, Red Cross, or Military Training Network accepted
  • RN work experience required
  • Ability to role model and support practices consistent with evidenced based care, guide others with plan of care, independently make clinical decisions in complex situations, and proactively assist others with patient assignment.

Join The Johns Hopkins Hospital Nursing team and become part of a patient centered collaborative work environment at a world renowned, Magnet designated, academic medical facility. Our nurses are committed to patient safety, clinical excellence, optimizing outcomes through evidenced based practice, and life-long learning.

City: Baltimore

State: Maryland

Community / Marketing Title: Registered Nurse 2: Outpatient Maternal and Fetal Medicine Center

Company Profile:

Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is an $8 billion integrated global health enterprise and one of the leading health care systems in the United States.

Johns Hopkins Medicine unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System.

Johns Hopkins Medicine's vision, “Together, we will deliver the promise of medicine,” is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, Johns Hopkins Medicine educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness.

Johns Hopkins Medicine operates six academic and community hospitals, four suburban health care and surgery centers, and 39 primary and specialty care outpatient sites.

 The Johns Hopkins Hospital, opened in 1889, has been ranked number one in the nation by U.S. News & World Report for 22 years, most recently in 2013.

For information about Johns Hopkins Medicine, its clinical programs or for help in choosing a personal physician, call 410-955-5000.

EEO Employer Verbiage:

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. Equal opportunity is the law — read more.

Location_formattedLocationLong: Baltimore, Maryland US

Job Number: 19308

Source: https://hopkinsmedicine.gr8people.com/jobs/19308/registered-nurse-2-outpatient-maternal-and-fetal-medicine-center

ICTR in the News: Kickballs, Chicken and 3-D Models Help Johns Hopkins Surgeons Prepare for Complex Fetal Surgeries

Fetal Hydrothorax | Johns Hopkins Medicine

Kickball used to mimic womb Credit: Johns Hopkins Medicine

By combining high-tech 3-D printing technology with everyday items such as a kickball and pieces of chicken breast, surgeons at Johns Hopkins report they have devised an innovative way to “rehearse” a complex minimally invasive surgical repair of open lesions on fetal spinal cords inside the womb.

The procedure, called fetoscopic myelomeningocele repair, is performed by a maternal fetal medicine specialist and pediatric neurosurgeon working together to correct a particular form of spina bifida, a birth defect marked by failure of the spinal column to close normally during early fetal development. It occurs in about three to four of every 10,000 pregnancies and can result in permanent nerve damage if left untreated.

The standard of care for the condition is surgery to close the spine as soon after birth as possible, says Jena L. Miller, M.D., an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and member of the Johns Hopkins Center for Fetal Therapy.

For select patients, prenatal—or fetal—surgery is performed by making an incision on the mother’s abdomen and womb to expose the baby’s back, close the spinal opening, sew up the womb and maternal abdomen, and let the pregnancy continue.

Although that approach can successfully reduce the risk of spinal cord damage and disability, it carries risks for the mother’s health and her ability to sustain future pregnancies.

A handful of hospitals, including The Johns Hopkins Hospital, are performing the surgery minimally invasively through two small ports rather than through open, large incisions on the maternal womb.

But, the Johns Hopkins surgeons say, training to do it has been challenging. To address the difficulty, a Johns Hopkins team prepared for its first such procedure last year on the fetus of a 31-year-old woman 25 weeks pregnant by creating models on which to practice.

The work is described in a letter to the editor published online Aug. 29, 2017, in the journal Ultrasound in Obstetrics & Gynecology.

First, the surgeons report, they used ultrasound technology to obtain an accurate image of the fetal spine and lesion.

Then, they created mesh models of the region to be operated on and generated a 3-D print model of the area using flexible materials such as Tango (a material with rubber properties) and NinjaFlex (a filament with elasticity), adding a combination of silicones to produce a skin cover.

The surgeons also used a 10-inch diameter kickball secured to a Plexiglas base to mimic a uterus. “A kickball is about the size of a uterus at that time in pregnancy,” Miller says. “It holds its shape pretty well when sealed and un other trainers for laparoscopic surgery, it’s not see-through so it’s a more realistic model.”

For their practice sessions, the team cut two slits in the top of the kickball to serve as ports for surgical instruments. Then, inside the kickball, they placed the 3-D printed model with its silicone cover secured to a plastic fetus over a layer of marbles to mimic the intraoperative motion and instability of the fetus. Then they practiced the surgical steps in that environment.

Besides practicing on the 3-D printed model, they also practiced on a section of a skin-on chicken breast secured to a model of a fetus—placed inside the kickball—to get a better sense of touch for operating on multiple layers of tissue. This was helpful, Miller says, because chicken has more realistic properties than the 3-D printed model.

During their planning, the team members also used a variety of instruments, suture materials and techniques until they achieved consistent times and outcomes for the individual steps of the operation.

Their first live surgery went well, consistent with their practice on the 3-D model, and they were able to make a complete watertight closure without complications. The woman had a vaginal delivery at term and the newborn has not required any additional procedures.

The team has since used the technique to prepare for six additional cases.

“Repetitive practice by a dedicated surgical team in a patient-matched model lets us know exactly what to anticipate specific to each case,” Miller says.

The goal of such rehearsals, Miller adds, is to pre-identify potential obstacles, and decrease operating time and risks.

While the new procedure is promising, the surgeons caution that more study is needed to improve training, continue advancing the surgical technique, and reduce surgical time and potential risks of needing to convert to open fetal surgery.

Coauthors of the editorial were Edward Ahn, Juan R. Garcia, Andrew Satin and Ahmet A. Baschat of Johns Hopkins, and G T. Miller of the U.S. Army Medical Research and Materiel Command’s Medical Modeling and Simulation Innovation Center in Frederick, Maryland.

The work was supported by the Fetal Health Foundation.

For the Media

Source: https://ictr.johnshopkins.edu/news_announce/ictr-in-the-news-kickballs-chicken-and-3-d-models-help-johns-hopkins-surgeons-prepare-for-complex-fetal-surgeries/