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van de Voort JC, Stark PW, van Dongen TT, Borger van der Burg BL, Hoencamp R. Ultrasound guided arterial access for combat medics: A blinded proof-of-concept study using echogenic needles. J Vasc Access 2024:11297298241256171. [PMID: 38825786 DOI: 10.1177/11297298241256171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Obtaining percutaneous vascular access in hemodynamically unstable patients with constricted vessels can be challenging. Training combat medics in this procedure is necessary for administration of fluid and blood products and introducing endovascular bleeding control tools in pre-hospital settings. Echogenic coated needles might provide better ultrasound visibility in invasive procedures and hereby lower complications. The primary aim was to evaluate the efficacy of a microteaching program for obtaining ultrasound-guided femoral artery access for ultrasound inexperienced combat medics. The secondary aim was to assess the additional value of innovative echogenic coated needles in ultrasound-guided vascular access. METHODS Combat medics participated in a four-step microteaching program. The program consisted of a theoretical and step-by-step practical part with three different models including live and dead tissue & a REBOA Access Task Trainer. During the final test, all participants had to obtain femoral artery access on a pressurized post-mortem human specimen model with both echogenic coated and conventional needles. Self-perceived and observed performance as well as procedure times were scored. RESULTS All nine participants succeeded in blood vessel visualization and obtaining vascular access in the two models within 3 minutes and were significantly faster during the second attempt on the pressurized post-mortem human specimen model. Scoring comparison and usability preference by ultrasound inexperienced personnel showed a significant difference in favor of the echogenic coated needles. CONCLUSION Microteaching may be an effective approach to train combat medics in obtaining ultrasound-guided percutaneous femoral artery access. The use of echogenic coatings on needles could be a valuable adjunct and provide advantage in obtaining vascular access. Future research should focus on realistic simulation of austere situations and further evaluation of the use of echogenic coated instruments for vascular access in these pre-hospital settings.
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Affiliation(s)
- Jan C van de Voort
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter W Stark
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Defense Healthcare Organisation, Ministry of Defense, Utrecht, The Netherlands
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2
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Chen S, Zhang Y, Ma B, Chen J, Hao J, Zhang F, Cui C, Chen M. Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging. ACS Biomater Sci Eng 2023; 9:5824-5831. [PMID: 37651609 DOI: 10.1021/acsbiomaterials.3c00807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Ultrasound-guided needle interventions play a pivotal role in the diagnosis and treatment processes in clinical practice. However, existing echogenic needles face challenges in achieving a balance between effectiveness, ease of manufacturing, and inexpensiveness. In this study, we developed an echogenic needle that encompassed the aforementioned advantages through the use of the electrolysis technology. The overall contour of the needle after electrolysis was observed using bright-field microscopy, while scanning electron microscopy (SEM) was employed to examine the micro-variations on the needle's surface. Subsequently, we validated the enhanced visualization effects in vitro (pork) and in vivo (anesthetized rabbit's thigh) puncture phantoms. To ensure the safety of the needles after the puncture procedure, we conducted Vickers hardness tests, SEM detection, bright-field microscopy, and DAPI staining. The results demonstrated that the surface roughness of the needle increased with the duration of electrolysis. Taking into account the comprehensive safety tests, the needle, subjected to 40 s of electrolysis, demonstrated a safe and effective enhancement of ultrasound visualization.
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Affiliation(s)
- Shaojie Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yanjuan Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Biao Ma
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Jiuzhou Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jingzhe Hao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Feng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Shi M, Bodian S, West SJ, Sathasivam S, Gordon RJ, Collier P, Vercauteren T, Desjardins AE, Noimark S, Xia W. Enhanced Photoacoustic Visualisation of Clinical Needles by Combining Interstitial and Extracorporeal Illumination of Elastomeric Nanocomposite Coatings. SENSORS (BASEL, SWITZERLAND) 2022; 22:6417. [PMID: 36080876 PMCID: PMC9460224 DOI: 10.3390/s22176417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Ultrasound (US) image guidance is widely used for minimally invasive procedures, but the invasive medical devices (such as metallic needles), especially their tips, can be poorly visualised in US images, leading to significant complications. Photoacoustic (PA) imaging is promising for visualising invasive devices and peripheral tissue targets. Light-emitting diodes (LEDs) acting as PA excitation sources facilitate the clinical translation of PA imaging, but the image quality is degraded due to the low pulse energy leading to insufficient contrast with needles at deep locations. In this paper, photoacoustic visualisation of clinical needles was enhanced by elastomeric nanocomposite coatings with superficial and interstitial illumination. Candle soot nanoparticle-polydimethylsiloxane (CSNP-PDMS) composites with high optical absorption and large thermal expansion coefficients were applied onto the needle exterior and the end-face of an optical fibre placed in the needle lumen. The excitation light was delivered at the surface by LED arrays and through the embedded optical fibre by a pulsed diode laser to improve the visibility of the needle tip. The performance was validated using an ex-vivo tissue model. An LED-based PA/US imaging system was used for imaging the needle out-of-plane and in-plane insertions over approach angles of 20 deg to 55 deg. The CSNP-PDMS composite conferred substantial visual enhancements on both the needle shaft and the tip, with an average of 1.7- and 1.6-fold improvements in signal-to-noise ratios (SNRs), respectively. With the extended light field involving extracorporeal and interstitial illumination and the highly absorbing coatings, enhanced visualisation of the needle shaft and needle tip was achieved with PA imaging, which could be helpful in current US-guided minimally invasive surgeries.
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Affiliation(s)
- Mengjie Shi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Semyon Bodian
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Simeon J. West
- Department of Anaesthesia, University College Hospital, London NW1 2BU, UK
| | - Sanjayan Sathasivam
- Department of Chemistry, University College London, London WC1H 0AJ, UK or
- School of Engineering, London South Bank University, London SE1 0AA, UK
| | | | - Paul Collier
- Johnson Matthey Technology Centre, Reading RG4 9NH, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Adrien E. Desjardins
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Sacha Noimark
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Wenfeng Xia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
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4
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Daoud MI, Abu-Hani AF, Shtaiyat A, Ali MZ, Alazrai R. Needle detection using ultrasound B-mode and power Doppler analyses. Med Phys 2022; 49:4999-5013. [PMID: 35608237 DOI: 10.1002/mp.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ultrasound is employed in needle interventions to visualize the anatomical structures and track the needle. Nevertheless, needle detection in ultrasound images is a difficult task, specifically at steep insertion angles. PURPOSE A new method is presented to enable effective needle detection using ultrasound B-mode and power Doppler analyses. METHODS A small buzzer is used to excite the needle and an ultrasound system is utilized to acquire B-mode and power Doppler images for the needle. The B-mode and power Doppler images are processed using Radon transform and local phase analysis to initially detect the axis of the needle. The detection of the needle axis is improved by processing the power Doppler image using alpha shape analysis to define a region of interest (ROI) that contains the needle. Also, a set of feature maps are extracted from the ROI in the B-mode image. The feature maps are processed using a machine learning classifier to construct a likelihood image that visualizes the posterior needle likelihoods of the pixels. Radon transform is applied to the likelihood image to achieve an improved needle axis detection. Additionally, the region in the B-mode image surrounding the needle axis is analyzed to identify the needle tip using a custom-made probabilistic approach. Our method was utilized to detect needles inserted in ex vivo animal tissues at shallow [20° -40°), moderate [40° -60°), and steep [60° -85°] angles. RESULTS Our method detected the needles with failure rates equal to 0% and mean angle, axis, and tip errors less than or equal to 0.7°, 0.6 mm, and 0.7 mm, respectively. Additionally, our method achieved favorable results compared to two recently introduced needle detection methods. CONCLUSIONS The results indicate the potential of applying our method to achieve effective needle detection in ultrasound images. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohammad I Daoud
- Department of Computer Engineering, German Jordanian University, Amman, 11180, Jordan
| | - Ayah F Abu-Hani
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, 80333, Germany
| | - Ahmad Shtaiyat
- Department of Computer Engineering, German Jordanian University, Amman, 11180, Jordan
| | - Mostafa Z Ali
- Department of Computer Information Systems, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Rami Alazrai
- Department of Computer Engineering, German Jordanian University, Amman, 11180, Jordan
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5
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Hovgesen CH, Wilhjelm JE, Vilmann P, Kalaitzakis E. Echogenic Surface Enhancements for Improving Needle Visualization in Ultrasound: A PRISMA Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:311-325. [PMID: 33870532 DOI: 10.1002/jum.15713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 05/12/2023]
Abstract
Optimal visualization of needles in clinical ultrasound imaging is important and challenging, especially at steep angles. Improvement of visualization has been attempted with various techniques, for example, coatings and dimples. This systematic review summarizes enhancement techniques and identifies superior echogenic surface enhancements. Twenty-four papers were identified providing visibility measures for 33 different echogenic needles. These were grouped according to surface characteristics and ranked. Echogenic needles ranked higher than standard needles especially at steeper angles. Among the echogenic needles, coated needles were seemingly better visualized "in vivo" than noncoated needles, despite heterogeneity in study conditions. No unambiguous comparison revealed which needle was best visualized.
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Affiliation(s)
- Caroline Harder Hovgesen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jens E Wilhjelm
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Peter Vilmann
- Gastrounit, Herlev University Hospital, Herlev, Denmark
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Sánchez-Margallo JA, Tas L, Moelker A, van den Dobbelsteen JJ, Sánchez-Margallo FM, Langø T, van Walsum T, van de Berg NJ. Block-matching-based registration to evaluate ultrasound visibility of percutaneous needles in liver-mimicking phantoms. Med Phys 2021; 48:7602-7612. [PMID: 34665885 PMCID: PMC9298012 DOI: 10.1002/mp.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To present a novel methodical approach to compare visibility of percutaneous needles in ultrasound images. Methods A motor‐driven rotation platform was used to gradually change the needle angle while capturing image data. Data analysis was automated using block‐matching‐based registration, with a tracking and refinement step. Every 25 frames, a Hough transform was used to improve needle alignments after large rotations. The method was demonstrated by comparing three commercial needles (14G radiofrequency ablation, RFA; 18G Trocar; 22G Chiba) and six prototype needles with different sizes, materials, and surface conditions (polished, sand‐blasted, and kerfed), within polyvinyl alcohol phantom tissue and ex vivo bovine liver models. For each needle and angle, a contrast‐to‐noise ratio (CNR) was determined to quantify visibility. CNR values are presented as a function of needle type and insertion angle. In addition, the normalized area under the (CNR‐angle) curve was used as a summary metric to compare needles. Results In phantom tissue, the first kerfed needle design had the largest normalized area of visibility and the polished 1 mm diameter stainless steel needle the smallest (0.704 ± 0.199 vs. 0.154 ± 0.027, p < 0.01). In the ex vivo model, the second kerfed needle design had the largest normalized area of visibility, and the sand‐blasted stainless steel needle the smallest (0.470 ± 0.190 vs. 0.127 ± 0.047, p < 0.001). As expected, the analysis showed needle visibility peaks at orthogonal insertion angles. For acute or obtuse angles, needle visibility was similar or reduced. Overall, the variability in needle visibility was considerably higher in livers. Conclusion The best overall visibility was found with kerfed needles and the commercial RFA needle. The presented methodical approach to quantify ultrasound visibility allows comparisons of (echogenic) needles, as well as other technological innovations aiming to improve ultrasound visibility of percutaneous needles, such as coatings, material treatments, and beam steering approaches.
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Affiliation(s)
- Juan A Sánchez-Margallo
- Bioengineering and Health Technologies Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Lisette Tas
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Adriaan Moelker
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Nick J van de Berg
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Sonographic visibility of cannulas using convex ultrasound transducers. BIOMED ENG-BIOMED TE 2019; 64:691-698. [DOI: 10.1515/bmt-2018-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
The key for safe ultrasound (US)-guided punctures is a good visibility of the cannula. When using convex transducers for deep punctures, the incident angle between US beam and cannula varies along the cannula leading to a complex visibility pattern. Here, we present a method to systematically investigate the visibility throughout the US image. For this, different objective criteria were defined and applied to measurement series with varying puncture angles and depths of the cannula. It is shown that the visibility not only depends on the puncture angle but also on the location of the cannula in the US image when using convex transducers. In some image regions, an unexpected good visibility was observed even for steep puncture angles. The systematic evaluation of the cannula visibility is of fundamental interest to sensitise physicians to the handling of convex transducers and to evaluate new techniques for further improvement.
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8
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van de Berg NJ, Sánchez-Margallo JA, van Dijke AP, Langø T, van den Dobbelsteen JJ. A Methodical Quantification of Needle Visibility and Echogenicity in Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:998-1009. [PMID: 30655111 DOI: 10.1016/j.ultrasmedbio.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
During ultrasound-guided percutaneous interventions, needle localization can be a challenge. To increase needle visibility, enhancements of both the imaging methods and the needle surface properties have been investigated. However, a methodical approach to compare potential solutions is currently unavailable. The work described here involves automated image acquisition, analysis and reporting techniques to collect large amounts of data efficiently, delineate relevant factors and communicate effects. Data processing included filtering, line fitting and image intensity analysis steps. Foreground and background image samples were used to compute a contrast-to-noise ratio or a signal ratio. The approach was evaluated in a comparative study of commercially available and custom-made needles. Varied parameters included needle material, diameter and surface roughness. The shafts with kerfed patterns and the trocar and chiba tips performed best. The approach enabled an intuitive polar depiction of needle visibility in ultrasound images for a large range of insertion angles.
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Affiliation(s)
- Nick J van de Berg
- Department of BioMechanical Engineering Delft University of Technology, Delft, The Netherlands.
| | - Juan A Sánchez-Margallo
- Medical Technology, SINTEF, Norway; Computer Systems and Telematics, University of Extremadura, Extremadura, Spain
| | - Arjan P van Dijke
- Department of BioMechanical Engineering Delft University of Technology, Delft, The Netherlands
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Takahashi H, Horiuchi T. Laser-Scan Lithography and Electrolytic Etching for Fabricating Meshed Pipes of Stainless Steel. J PHOTOPOLYM SCI TEC 2018. [DOI: 10.2494/photopolymer.31.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Sassaroli E, Scorza A, Crake C, Sciuto SA, Park MA. Breast Ultrasound Technology and Performance Evaluation of Ultrasound Equipment: B-Mode. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:192-205. [PMID: 27831870 DOI: 10.1109/tuffc.2016.2619622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ultrasound (US) has become increasingly important in imaging and image-guided interventional procedures. In order to ensure that the imaging equipment performs to the highest level achievable and thus provides reliable clinical results, a number of quality control (QC) methods have been developed. Such QC is increasingly required by accrediting agencies and professional organizations; however, these requirements typically do not include detailed procedures for how the tests should be performed. In this paper, a detailed overview of QC methods for general and breast US imaging using computer-based objective methods is described. The application of QC is then discussed within the context of a common clinical application (US-guided needle biopsy) as well as for research applications, where QC may not be mandated, and thus is rarely discussed. The implementation of these methods will help in finding early stage equipment faults and in optimizing image quality, which could lead to better detection and classification of suspicious findings in clinical applications, as well as improving the robustness of research studies.
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