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Dinges HC, Hoeft J, Cornelius VM, Steinfeldt T, Wiesmann T, Wulf H, Schubert AK. Nominal logistic regression analysis of variables determining needle visibility in ultrasound images - a full factorial cadaver study. BMC Anesthesiol 2023; 23:369. [PMID: 37950214 PMCID: PMC10636954 DOI: 10.1186/s12871-023-02339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Needle visualization is essential to avoid vascular puncture and nerve injury in ultrasound-guided regional anesthesia. Several factors that statistically influence needle visibility have been described but the dimensions of their individual impact remain unclear. This study aimed to quantify the impact of various independent factors on ultrasound needle visibility. METHODS A total of 1500 ultrasound videos of in-plane needle insertions were obtained in embalmed cadavers with ten different commercially available echogenic and non-echogenic needles at different insertion angles and bevel orientations in a full factorial study design. The visibility of needle tip and shaft were rated as "good" or "poor" visibility. Nominal logistic regression analyses were calculated for the visibility of the needle tip and shaft. RESULTS SonoPlex Stim Sprotte, SonoTAP Facet (needle tip and shaft) and Spinostar PencilPoint (needle tip)), insertion angle and bevel orientation were associated with good ultrasound visibility, reaching statistical significance (p < 0.05). The range of the effect on the log-odds scale for needle tip visibility was largest for the insertion angle with 6.33, followed by the tissue condition (3.76), bevel orientation (1.45) and the needle types (1.25). Regarding the needle shaft visibility, the largest effect range was observed with the insertion angle (7.36), followed by the tissue conditions with 3.96, needle type (1.86) and bevel orientation (0.95). CONCLUSION In-plane needle visibility in ultrasound images depends mainly on the insertion angle, as expected. This is closely followed by the tissue condition, which is a factor related to the patient, thus cannot be altered to improve needle visibility. In the dimensions of the log-odds scale, the choice of a specific needle is far less important towards achieving a good visualization, whereas optimizing the bevel orientation can have a larger impact than the needle choice. Concluding from the relative dimensions of factors that determine needle visibility in this model, the importance of needles with echogenic features may be overrated.
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Affiliation(s)
- Hanns-Christian Dinges
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany.
| | - Julia Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
| | - Valér Michael Cornelius
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thorsten Steinfeldt
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum Schwäbisch-Hall, Schwäbisch- Hall, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
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Antipova V, Niedermair JF, Siwetz M, Fellner FA, Löffler S, Manhal S, Ondruschka B, Pietras SM, Poilliot AJ, Pretterklieber ML, Wree A, Hammer N. Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues. ANATOMICAL SCIENCES EDUCATION 2023; 16:1144-1157. [PMID: 37337999 DOI: 10.1002/ase.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023]
Abstract
Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.
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Affiliation(s)
- Veronica Antipova
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julian F Niedermair
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
| | - Martin Siwetz
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Franz A Fellner
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
- Division of Virtual Morphology, Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Sabine Löffler
- Department of Anatomy, University of Leipzig, Leipzig, Germany
| | - Simone Manhal
- Office of the Vice-Rector for Studies and Teaching, Medical University of Graz, Graz, Austria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra M Pietras
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | - Michael L Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Wree
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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Formalin-free soft embalming of human cadavers using N-vinyl-2-pyrrolidone: perspectives for cadaver surgical training and medical device development. Anat Sci Int 2022; 97:273-282. [PMID: 35460067 DOI: 10.1007/s12565-022-00664-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023]
Abstract
The traditional apprenticeship approach to surgical skill education for young surgeons has drastically changed to more systematic surgical training using cadavers. Cadavers fixed with formalin are not suitable for surgical training because of their associated health hazards and overhardening. Recently, we established a formalin-free soft preservation method for human cadavers using N-vinyl-2-pyrrolidone. Since 2012, 61 cadavers have been embalmed with pyrrolidone in our institution. Tissues of pyrrolidone-embalmed cadavers are soft and pliable, and their bodies can be preserved for as long as 37 months without any signs of corruption. In this review, we introduce our recent attempts to apply pyrrolidone-embalmed cadavers in surgical and medical procedure training, including endotracheal intubation, motion physiology of the vocal folds, laparoscopic surgery, endoscopic skull base surgery, and development of novel medical devices. Future research perspectives on pyrrolidone embalming are discussed.
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Watanabe K, Tokumine J, Lefor AK, Nakazawa H, Yamamoto K, Karasawa H, Nagase M, Yorozu T. Photoacoustic needle improves needle tip visibility during deep peripheral nerve block. Sci Rep 2021; 11:8432. [PMID: 33875687 PMCID: PMC8055898 DOI: 10.1038/s41598-021-87777-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Abstract
We developed a novel technology using the photoacoustic effect that improve needle tip visibility. We evaluated whether this technology improves needle tip visibility when performing a deep peripheral nerve block in a cadaver model. A photoacoustic needle was developed using a conventional echogenic needle with an intraluminal optical fiber. A pulsed laser sends light from a source through the fiber, which is converted to ultrasound at the needle tip using the photoacoustic effect. A nerve block expert performed deep nerve blocks using the photoacoustic needle and the ultrasound views recorded, with or without photoacoustic ultrasound at the needle tip. Needle tip visibility was evaluated by questionnaire (Likert scale 1: very poor, 5: very good) completed by anesthesiologists evaluating recorded images. The score was presented as median [first quartile, third quartile]. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test. The scores of needle tip visibility with photoacoustic ultrasound from the needle tip (4.3 [4.0, 4.5]) was significantly higher than that without photoacoustic ultrasound (3.5 [3.2, 3.8]) (p < 0.01). Ultrasound emitted at the needle tip using the photoacoustic effect improves needle tip visibility during deep peripheral nerve blocks. Clinical trial number University Hospital Medical Information Network Center Clinical Trials Registration System (UMIN000036974).
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Affiliation(s)
- Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Katsuya Yamamoto
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Hiroyuki Karasawa
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Miki Nagase
- Department of Anatomy, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
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Jiang T, Zhu X, Jiao Y, Li X, Shen Z, Cui Y. Localization Accuracy of Ultrasound-Actuated Needle with Color Doppler Imaging. Diagnostics (Basel) 2020; 10:diagnostics10121020. [PMID: 33260712 PMCID: PMC7761225 DOI: 10.3390/diagnostics10121020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
An ultrasonic needle-actuating device for tissue biopsy and regional anaesthesia offers enhanced needle visibility with color Doppler imaging. However, its specific performance is not yet fully determined. This work investigated the influence on needle visibility of the insertion angle and drive voltage, as well as determined the accuracy and agreement of needle tip localization by comparing color Doppler measurements with paired photographic and B-mode ultrasound measurements. Needle tip accuracy measurements in a gelatin phantom gave a regression trend, where the slope of trend is 0.8808; coefficient of determination (R2) is 0.8877; bias is −0.50 mm; and the 95% limits of agreement are from −1.31 to 0.31 mm when comparing color Doppler with photographic measurements. When comparing the color Doppler with B-mode ultrasound measurements, the slope of the regression trend is 1.0179; R2 is 0.9651; bias is −0.16 mm; and the 95% limits of agreement are from −1.935 to 1.605 mm. The results demonstrate the accuracy of this technique and its potential for application to biopsy and ultrasound guided regional anaesthesia.
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Affiliation(s)
- Tingyi Jiang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Correspondence: (T.J.); (Y.C.)
| | - Xinle Zhu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
| | - Yang Jiao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xinze Li
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
| | - Zhitian Shen
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei 230031, China
| | - Yaoyao Cui
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215010, China; (X.Z.); (Y.J.); (X.L.); (Z.S.)
- Correspondence: (T.J.); (Y.C.)
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Beger O, Karagül Mİ, Koç T, Kayan G, Cengiz A, Yılmaz ŞN, Olgunus ZK. Effects of different cadaver preservation methods on muscles and tendons: a morphometric, biomechanical and histological study. Anat Sci Int 2019; 95:174-189. [DOI: 10.1007/s12565-019-00508-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
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7
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Tang L, Yishake M, Ye C, Hade H, Li Z, He R. Safe zone for lateral pin placement for external fixation of the distal humerus. Clin Anat 2019; 33:637-642. [PMID: 31573096 DOI: 10.1002/ca.23471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/07/2019] [Accepted: 09/15/2019] [Indexed: 11/07/2022]
Abstract
External fixation is a common, efficient technique used for humeral shaft stabilization and elbow fractures. There are reports of radial nerve injuries associated with this procedure. In this study, we investigated the course and variability of the radial nerve along the lateral humerus in relation to the elbow joint to determine a relatively safe zone for lateral pin placement in external fixation. Twenty upper extremities from 10 cadavers were studied. The nerve branches and course of the radial nerve along the lateral humerus were carefully dissected. Straight lines (a, b, and c) were made connecting three landmarks (the acromion, coracoid process, and anterior wall of the axilla) in the proximal upper extremity to the lateral condyle (LC) of the humerus; their intersections with the radial nerve (A, B, and C) were marked. We analyzed whether the intersection positions were correlated with the connecting line lengths. The mean lengths of the connecting lines were (a) 27.24 ± 2.57, (b) 26.18 ± 2.79, and (c) 20.95 ± 1.44 cm; the distance between the intersection points and the LC of the humerus were (Aa) 7.56 ± 1.31, (Bb) 6.90 ± 2.27, and (Cc) 5.01 ± 0.83 cm; and the measured intersection points of the radial nerve in the lateral aspect of the humerus were (A) 18.48%-34.82%, (B) 13.48%-40.00%, and (C) 19.27%-28.05% of the lengths of lines a, b, and c, respectively. Our data provide a more reliable reference to predict the course of the radial nerve on the lateral humerus and define a safe zone for pin placement. Clin. Anat., 33:637-642, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lan Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mumingjiang Yishake
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chenyi Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haisaier Hade
- Department of Orthopedic Surgery, Xinhua Hospiatal, Ili Kazakh Autonomous Prefecture, Xinjiang, China
| | - Zhanchun Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongxin He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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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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Prabhakar C, Uppal V, Sondekoppam RV. Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40°, 50°, and 60° Needle Insertion Angles. Anesth Analg 2018; 126:1926-1929. [PMID: 29116966 DOI: 10.1213/ane.0000000000002618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0-10. The effect of different levels of beam steer was also explored. At 40°, steep beam steering improves visualization of both nonechogenic and echogenic needles to an equal, satisfactory level. At 50° and 60°, visualization of nonechogenic needles is poor, whereas visibility of an echogenic needle was adequate and may be improved with steep beam steering.
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Affiliation(s)
- Christopher Prabhakar
- From the Department of Anesthesiology, Pharmacology and Therapeutics, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wu KW, Wang YA, Li PC. Laser Generated Leaky Acoustic Waves for Needle Visualization. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:546-556. [PMID: 29610085 DOI: 10.1109/tuffc.2018.2799725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound (US)-guided needle operation is usually used to visualize both tissue and needle position such as tissue biopsy and localized drug delivery. However, the transducer-needle orientation is limited due to reflection of the acoustic waves. We proposed a leaky acoustic wave method to visualize the needle position and orientation. Laser pulses are emitted on top of the needle to generate acoustic waves; then, these acoustic waves propagate along the needle surface. Leaky wave signals are detected by the US array transducer. The needle position can be calculated by phase velocities of two different wave modes and their corresponding emission angles. In our experiments, a series of needles was inserted into a tissue mimicking phantom and porcine tissue to evaluate the accuracy of the proposed method. The results show that the detection depth is up to 51 mm and the insertion angle is up to 40° with needles of different diameters. It is demonstrated that the proposed approach outperforms the conventional B-mode US-guided needle operation in terms of the detection range while achieving similar accuracy. The proposed method reveals the potentials for further clinical applications.
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Kennel L, Martin DMA, Shaw H, Wilkinson T. Learning anatomy through Thiel- vs. formalin-embalmed cadavers: Student perceptions of embalming methods and effect on functional anatomy knowledge. ANATOMICAL SCIENCES EDUCATION 2018; 11:166-174. [PMID: 28719722 DOI: 10.1002/ase.1715] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 05/01/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
Thiel-embalmed cadavers, which have been adopted for use in anatomy teaching in relatively few universities, show greater flexibility and color retention compared to formalin-embalmed cadavers, properties which might be considered advantageous for anatomy teaching. This study aimed to investigate student attitudes toward the dissection experience with Thiel- compared to formalin/ethanol-embalmed cadavers. It also aimed to determine if one embalming method is more advantageous in terms of learning functional anatomy through the comparison of student anterior forearm functional anatomy knowledge. Student opinions and functional anatomy knowledge were obtained through use of a questionnaire from students at two medical schools, one using Thiel-, and one using more traditional formalin/ethanol-embalmed cadavers. Both the Thiel group and the formalin group of students were surveyed shortly after completing an anterior forearm dissection session. Significant differences (P-values <0.01) in some attitudes were found toward the dissection experience between cohorts using Thiel- vs. formalin-embalmed cadavers. The Thiel group of students felt more confident about recognizing anatomy in the living individual, found it easier to identify and dissect anatomical structures, and indicated more active exploration of functional anatomy due to the retained flexibility of the cadaver. However, on testing, no significant difference in functional anatomy knowledge was found between the two cohorts. Overall, although Thiel embalming may provide an advantageous learning experience in some investigated areas, more research needs to be carried out, especially to establish whether student perception is based on reality, at least in terms of structure identification. Anat Sci Educ 11: 166-174. © 2017 American Association of Anatomists.
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Affiliation(s)
- Larissa Kennel
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
| | - David M A Martin
- School of Life Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Hannah Shaw
- School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
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Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement. Eur J Anaesthesiol 2017; 34:135-140. [DOI: 10.1097/eja.0000000000000584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sawhney C, Lalwani S, Ray BR, Sinha S, Kumar A. Benefits and Pitfalls of Cadavers as Learning Tool for Ultrasound-guided Regional Anesthesia. Anesth Essays Res 2017; 11:3-6. [PMID: 28298747 PMCID: PMC5341665 DOI: 10.4103/0259-1162.186607] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound-guided regional anesthesia (UGRA), like other basic skills, should be learnt in a simulation laboratory before performing on the patient. Cadavers provide an ideal tool for learning sonoanatomy and skills required for performing UGRA. On the basis of preservation technique used, the cadavers can be formalin embalmed cadavers, Thiel cadavers (soft cadavers), and fresh frozen cadavers. We compared three types of cadavers for performing ultrasound-guided upper and lower limb blocks. We observed that fresh frozen and Thiel cadavers were less smelling and had more realistic appearance as compared to formalin embalmed cadavers. It was seen that Thiel cadavers were more flexible and hence, rotation of neck, shoulder and knee was easier. Although images seen in most cadavers were comparable with live subjects but, Thiel cadavers provided more realistic model.
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Affiliation(s)
- Chhavi Sawhney
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Department of Forensic Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Sinha
- Department of Neurosugery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhyuday Kumar
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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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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Park JW, Cheon MW, Lee MH. Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices. Ann Rehabil Med 2016; 40:575-82. [PMID: 27606263 PMCID: PMC5012968 DOI: 10.5535/arm.2016.40.4.575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/30/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.
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Affiliation(s)
| | - Min Woo Cheon
- Department of Hospital Biomedical Engineering, Dongshin University, Gwangju, Korea
| | - Min Hong Lee
- Department of Rehabilitation Medicine, Chosun University Hospital, Gwangju, Korea
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16
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[Improvement of sonographic visualization of cannula needle tips by alignment of the needle lumen : In vitro investigation of established needle tip forms]. Anaesthesist 2015; 64:937-942. [PMID: 26464322 DOI: 10.1007/s00101-015-0098-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the context of ultrasound-guided peripheral nerve blocks (regional anesthesia), clear visualization of the needle tip and the target structure are mandatory for the performance of a safe puncture and injection. The purpose of this in vitro study was to analyze the visualization of different forms of needle tips and calibers of cannulas in a phantom simulating human tissue, with the help of a standardized image analysis system. Different depths and angles of the puncture needle in relation to the ultrasound probe were tested. MATERIAL AND METHODS Cannula needles established for use in regional anesthesia with different surfaces, diameters and needle tip form in 23 different combinations were analyzed. A gelatine-based phantom was used to simulate human tissue. The standardized visualization of the needle tip with the ultrasound probe was performed in plane at different angles (30°, 45° and 60°), depths of penetration (1 cm, 2 cm and 3 cm) and two different alignments of the cannula needle lumen to the ultrasound probe (0° and 180°). The screenshots of the ultrasound pictures were analyzed by quantifying the pixel brightness around the needle tip (region of interest) with a standardized software (score 0-255). RESULTS In this study 1104 ultrasound images of cannula needles were analyzed. Diminished scores (reduced pixel brightness) of the needle tips were documented with increasing distance from the ultrasound probe. Comparison of punctures at angles of 30° and 45° showed no differences in needle tip visibility (same scores) but punctures at an angle of 60° were poorly visualized compared with 30° and 45° (mean scores 87.90 ± 11.60 vs. 78.40 ± 12.07, p < 0.001 and 81.85 ± 11.79 vs. 78.40 ± 12.07, p < 0.001, respectively). The direct alignment of the cannula lumen towards the ultrasound probe (0°) was significantly more easily visualized when compared with the reverse alignment of 180° (mean scores 86.90 ± 12.74 vs. 84.80 ± 11.66, p = 0.003, respectively). No differences in visibility were detected between the different cannula needle diameters examined. The Sprotte cannula showed the best visibility score with respect to the cut of the needle tip (mean score 89.40 ± 11.72). CONCLUSION The visibility of cannulas in ultrasound scans depends on the ultrasound frequency, angle of the puncture in relation to the ultrasound probe and the depth of penetration. The results of this study showed that direct alignment of the cannula needle lumen towards the ultrasound probe (0°) independently improved needle tip visualization. This simple measure allows a significant improvement in the safe performance of ultrasound-guided peripheral nerve blocks.
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Balta JY, Cronin M, Cryan JF, O'Mahony SM. Human preservation techniques in anatomy: A 21st century medical education perspective. Clin Anat 2015; 28:725-34. [PMID: 26118424 DOI: 10.1002/ca.22585] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/06/2022]
Abstract
Anatomy is the cornerstone of education for healthcare professionals with the use of human material providing an excellent teaching tool in the modern curricula. The ability and quality of preservation of human remains has enabled such use. The introduction of formaldehyde as a preservative in 1893 was an important step in the history of preservation. With the European Union directive on the use of formaldehyde and its expected banning, anatomists are trying to find a more convenient and safe substitute. In this review, we compare the different techniques used based on the need for embalming, fixative used, period of preservation and the features of the embalmed specimen. The fact that embalming is used in different disciplines, multiple purposes and described in different languages has led to the development of ambiguous interchangeable terminology. Overall, there is a lack of information specifically classifying, listing and comparing different embalming techniques, and this may be due to the fact that no internationally recognized experimental standards are adhered to in this field. Anatomists strive to find an embalming technique that allows the preserved specimen to accurately resemble the living tissue, preserve the body for a long period of time and reduces health risk concerns related to working with cadavers. There is a need for embalming to shift to an independent modern day science with well-founded research at the heart of it. While this may take time and agreement across nations, we feel that this review adds to the literature to provide a variety of different methods that can be employed for human tissue preservation depending on the desired outcome.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Michael Cronin
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhain M O'Mahony
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
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18
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Hassan S, Eisma R, Malhas A, Soames R, Harry L. Surgical simulation flexor tendon repair using Thiel cadavers: a comparison with formalin embalmed cadavers and porcine models. J Hand Surg Eur Vol 2015; 40:246-9. [PMID: 24436356 DOI: 10.1177/1753193413520281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to compare Thiel-embalmed cadavers with formalin-embalmed cadavers and porcine models in the surgical simulation repair of a Zone II flexor tendon division. Nine participants were recruited to the study. The models were assessed using a five-point scale. Assessment was divided into tissue quality, surgical approach and identification of structures. Thiel cadavers rated consistently higher compared with the formalin and porcine models (mean 37 SD 2, 22 SD 6 and 23 SD 5, respectively). Thiel cadavers recorded an average tendon glide of 21 mm SD 5, formalin cadavers 2 mm SD 2 and the porcine model 6 mm SD 2. We have demonstrated the benefit of Thiel embalming, with flexibility of tissues allowing testing of the repair of a flexor tendon in a realistic anatomical model. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- S Hassan
- Department for Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - R Eisma
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - A Malhas
- Department of Orthopaedics and Trauma Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - R Soames
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - L Harry
- Department for Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, Dundee, UK
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19
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Nakagawa K, Kamiya T, Arakawa K, Akiyama S, Sakai K. Objective and subjective comparison of the visibility of three echogenic needles and a nonechogenic needle on older ultrasound devices. ACTA ACUST UNITED AC 2015; 53:1-6. [DOI: 10.1016/j.aat.2014.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/29/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
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20
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Balta JY, Lamb C, Soames RW. A pilot study comparing the use of Thiel- and formalin-embalmed cadavers in the teaching of human anatomy. ANATOMICAL SCIENCES EDUCATION 2015; 8:86-91. [PMID: 24996059 DOI: 10.1002/ase.1470] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/27/2014] [Accepted: 05/25/2014] [Indexed: 06/03/2023]
Abstract
Formalin had traditionally been used to preserve human material to teach gross anatomy. In 2008 the Centre for Anatomy and Human Identification (CAHID) at the University of Dundee embarked on the use of the Thiel method of embalming. The aim of this pilot study was to assess the difference between formalin-embalmed cadavers (FEC) and Thiel-embalmed cadavers (TEC) used for teaching and surgical training. Three different questionnaires were prepared for data collection from undergraduate and postgraduate students and clinical staff. All undergraduate and postgraduate students as well as clinical staff commented on the appearance of the TEC. There was no overall consensus concerning the use of TEC, some respondents preferred TEC for the entire dissection, some only for certain areas such as the musculoskeletal system. On a technical level TEC were considered less hazardous then FEC by one-third of participants with fewer than 10% regarding TEC as more irritating than FEC. Psychologically, 32.7% of undergraduate students expressed the view that TEC made them feel more uncomfortable compared with FEC because of their life-like appearance. However, 57.1% of undergraduate students encountered the same uncomfortable feelings when viewing both TEC and FEC. The use of Thiel-embalmed cadavers to teach anatomy has an added value, though further research is required over longer periods of time to identify its best usage.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland; Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
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21
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Fuzier R, Casalprim J, Bataille B, Harper I, Magues JP. The echogenicity of nerve blockade needles. Anaesthesia 2014; 70:462-6. [DOI: 10.1111/anae.12977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. Fuzier
- Department of Anaesthesiology; Institut Claudius Regaud; IUCT-O; Toulouse France
- Pharmacoepidemiology Research Unit; INSERM 1027; University of Toulouse; Toulouse France
| | - J. Casalprim
- Department of Anaesthesiology; CHU Purpan; Toulouse France
| | - B. Bataille
- Department of Anaesthesiology and Critical Care; CH Hotel Dieu; Narbonne France
| | - I. Harper
- Department of Anaesthesiology; Wansbeck General Hospital; Ashington UK
| | - J. P. Magues
- Department of Anaesthesiology; CHU Purpan; Toulouse France
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22
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Wiesmann T, Steinfeldt T, Volk T, Schwemmer U, Kessler P, Wulf H. [Seeing more : Technical innovations in regional anesthesia]. Anaesthesist 2014; 63:875-82. [PMID: 25398422 DOI: 10.1007/s00101-014-2381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Visualization and verification are key factors since the implementation of ultrasound-guided regional anesthesia. This article reviews and discusses newer technical innovations in regional anesthesia with regard to optimization of needle guidance, improvements in needle visibility, technical improvements in ultrasound techniques and innovative technologies in regional anesthesia. Clinically available applications are presented as well as experimental tools and techniques with a potential for clinical implementation in the future. Mechanical needle guides are used to improve alignment of needle axis and ultrasound beam axis. Compound imaging technology improves needle visibility in steep needle insertion angles and is already implemented in daily clinical practice. Sonoelastography improves tissue discrimination and detection of small amounts of fluids. Benefits of 3D and 4D ultrasound in regional anesthesia are discussed as well as experimental tools for tissue discrimination, such as optical reflection spectrophotometry.
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Affiliation(s)
- T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität, Baldinger Str., 35033, Marburg, Deutschland,
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23
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Munirama S, Joy J, Columb M, Habershaw R, Eisma R, Corner G, Cochran S, McLeod G. A randomised, single-blind technical study comparing the ultrasonic visibility of smooth-surfaced and textured needles in a soft embalmed cadaver model. Anaesthesia 2014; 70:537-42. [DOI: 10.1111/anae.12925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Munirama
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
| | - J. Joy
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - M. Columb
- Departments of Anaesthesia & Intensive Care Medicine; Wythenshawe Hospital; Manchester UK
| | - R. Habershaw
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | | | - S. Cochran
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - G. McLeod
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
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Abstract
In this essay Roos Eisma and Tracey Wilkinson describe how the Thiel technique has expanded the range of applications in which embalmed human cadavers can be used. For decades, embalmed cadavers have played an important role in teaching anatomy to the scientists and doctors of the future. Most anatomy departments use a traditional formaldehyde-based embalming method, but formalin embalming makes the bodies very rigid, which limits their usefulness for procedures other than dissection. A more recent embalming method developed by W. Thiel has allowed these “silent teachers” to take on a further role in applied anatomy research and teaching: to act as models for surgical training and medical research.
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Affiliation(s)
- Roos Eisma
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, Scotland, United Kingdom
- * E-mail:
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, Scotland, United Kingdom
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25
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Effect of beam steering on the visibility of echogenic and non-echogenic needles: a laboratory study. Can J Anaesth 2014; 61:909-15. [DOI: 10.1007/s12630-014-0207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022] Open
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27
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Reusz G, Sarkany P, Gal J, Csomos A. Needle-related ultrasound artifacts and their importance in anaesthetic practice. Br J Anaesth 2014; 112:794-802. [DOI: 10.1093/bja/aet585] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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28
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29
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Kilicaslan A, Topal A, Tavlan A, Erol A, Otelcioglu S. Differences in tip visibility and nerve block parameters between two echogenic needles during a simulation study with inexperienced anesthesia trainees. J Anesth 2013; 28:460-2. [DOI: 10.1007/s00540-013-1720-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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30
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DUGER C, ISBIR AC, KAYGUSUZ K, KOL IOZDEMIR, GURSOY S, OZTURK H, MIMAROĞLU C. The importance of needle echogenity in ultrasound guided axillary brachial plexus block: a randomized controlled clinical study. Int J Med Sci 2013; 10:1108-12. [PMID: 23869186 PMCID: PMC3714386 DOI: 10.7150/ijms.6598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/18/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. METHODS 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. RESULTS Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. CONCLUSION We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.
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Affiliation(s)
- Cevdet DUGER
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Ahmet Cemil ISBIR
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Kenan KAYGUSUZ
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Iclal OZDEMIR KOL
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Sinan GURSOY
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Hayati OZTURK
- 2. Department of Orthopedics, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Caner MIMAROĞLU
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
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Hocking G, Mitchell CH. Optimizing the safety and practice of ultrasound-guided regional anesthesia: the role of echogenic technology. Curr Opin Anaesthesiol 2013; 25:603-9. [PMID: 22825047 DOI: 10.1097/aco.0b013e328356b835] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Significant improvements have been made in the quality of ultrasound imaging, and it is now much easier to see nerves. However, the key to safe ultrasound-guided regional anesthesia is to be able to direct the needle to the target. This relies on good needle visibility. We review the recent advances that have been made in this crucial area. RECENT FINDINGS Echogenic needles can improve shaft and tip visibility independent of experience level, compensate for suboptimal scanning technique, allow steeper insertion angles, reduce technical difficulty, and increase both confidence and satisfaction by anesthesiologists. An echogenic needle encourages holding the probe in one place on the patient, only advancing the needle when it can be seen, hence reducing the likelihood of quality-compromising behaviors. The poor visibility of nonechogenic needles when inserted at steeper angles commonly causes the observer to underestimate the insertion depth of the needle. Significant differences in echogenicity are found when comparing the currently available needles. SUMMARY Good echogenic needles should increase safety, efficacy, and simplicity, and hopefully further drive the adoption of ultrasound-guided techniques, to the benefit of our patients.
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Affiliation(s)
- Graham Hocking
- School of Medicine and Pharmacology, The University of Western Australia, Western Australia, Australia.
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WIESMANN T, BORNTRÄGER A, NEFF M, WULF H, STEINFELDT T. Needle visibility in different tissue models for ultrasound-guided regional anaesthesia. Acta Anaesthesiol Scand 2012; 56:1152-5. [PMID: 22897671 DOI: 10.1111/j.1399-6576.2012.02758.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Models for ultrasound-guided regional anaesthesia (USGRA) are important for research and training. However, the limited data available show great differences in quality of needle and tissue visualisation with regard to the applied model. This study aims to compare common USGRA models and human tissue with regard to their influence on needle visibility. METHODS We conducted this study using four models (embalmed human cadaver, turkey breast, pork, and synthetic gel models) and a volunteer (human control) as well as two different needles [Stimuplex A (StA), conventional needle; Stimuplex D Plus (StD+), needle with improved echogenicity]. We obtained ultrasound videos of needle advancement and withdrawal using the in-plane approach at a 45° angle in all four models and the volunteer. Fifteen test persons were prospectively enrolled. Ultrasound videos were presented in a randomised, blinded manner. The test persons were asked to rate the visibility of the needle shaft (VS) and tip (VT) on a four-point scale (0-3). RESULTS VS and VT were comparable between the human control and cadaver model for both needle types. The pork, turkey, and synthetic gel models had significantly higher visibility scores than the human control for both needle types. VS of StD+ was significantly higher than that of StA in the pork and turkey models, but not in the synthetic model, cadaver model, or human control. CONCLUSION In this pilot study, needle visibility in embalmed cadaver is comparable with that in human control. Needle visibility was significantly higher in other tissue models (turkey breast, pork, synthetic gel models) than in the human control, which may limit their value in training environments.
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Affiliation(s)
- T. WIESMANN
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - A. BORNTRÄGER
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - M. NEFF
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - H. WULF
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - T. STEINFELDT
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
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