ELSEVLER

l Book Review

Ultrasound in Med. & Biol., Vol. 22, No. 6, p. 767. 1996 Copyright 0 I996 World Federation for Ultrasound in Medicine & Biology

Printed in the USA. All rights reserved 0301.5629/96 $15.00 + .OO

MANUAL OF DIAGNOSTIC ULTRASOUND

Edited by P. E. S. Palmer, WHO/WFUMB, Geneva, 1995, 334 pp.

This manual is a truly international collaboration on a practi- cal guide to basic ultrasound techniques, directed particularly toward inexperienced operators who may not have expert advice available on site. The intended readership is wide- ranging, including those in developing countries, GPs, medi- cal students, physicians, sonographers, and midwives, mak- ing it a difficult and somewhat controversial task.

As the authors point out, 334 pages cannot hope to inform the user in any great depth, but aim to introduce the concept of ultrasound and to demonstrate some of the pathology that may be encountered. The authors state that the book is meant to be a supplement to proper training and other existing texts and not a substitute for them.

The book addresses physics, instrumentation, tech- niques, and ultrasound appearances of the normal and patho- logical abdomen and pelvis, pregnancy, neonates, and others, including ultrasound-guided needle puncture.

The text is clear and I like the idea of duplicating the images-the second, reference image having a clearly superimposed diagram with labeling. Some of the primary images, however, have not been reproduced particularly well and seem to have lost some acoustic information. A variety of equipment has been used to produce the images, from static B scanners to high resolution machines.

The instructions on technique are prescriptive and sim- ple to follow; however, it is doubtful that they would result in a particularly successful scan on most patients in real life. The concept of teaching ultrasound from its most basic level,

as the book attempts to do, seems at odds with the rapid transition to the advanced techniques required for some of the included pathological processes, i.e., the prenatal diagno- sis of cleft palate.

For the benefit of operators in developing countries there is, quite reasonably, considerable attention toward pa- thology not commonly encountered in the UK. Because the intended readership is so wide-ranging, it has obviously been a very difficult task to decide what to include and exclude and inevitably a compromise has been made.

A few of the statements made are incorrect (internal debris and a floating membrane in a well-defined liver cyst is ’ ‘pathognomonic” of a hydatid cyst) or misleading (Doppler measures blood flow). The labeling, in the obstetric chapter, of lateral ventricle walls as “cerebral veins” will also give rise to confusion.

Although the pitfalls and dangers of “dabbling” in ultrasound unsupervised are recognized by the authors, this does not lessen the problem. Plainly there is a need for reference texts when expert help is unavailable, particularly in developing countries, but the use of a basic how-to-do-it manual such as this treads a fine line between helping the inexperienced operator and encouraging or perpetuating un- reliable practice.

Despite stressing the need for proper training, this di- lemma has not been solved, which makes it difficult to wholeheartedly recommend such a book.

Leeds, UK JANE BATES

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