Ultrasound-guided medical procedures: a growing field with new opportunities

Navigate biopsy with ultrasound under augmented reality device: Towards higher system performance

PURPOSE

Biopsies play a crucial role in determining the classification and staging of tumors. Ultrasound is frequently used in this procedure to provide real-time anatomical information. Using augmented reality (AR), surgeons can visualize ultrasound data and spatial navigation information seamlessly integrated with real tissues. This innovation facilitates faster and more precise biopsy operations.

METHODS

We have developed an augmented reality biopsy navigation system characterized by low display latency and high accuracy. Ultrasound data is initially read by an image capture card and streamed to Unity via net communication. In Unity, navigation information is rendered and transmitted to the HoloLens 2 device using holographic remoting. Concurrently, a retro-reflective tool tracking method is implemented on the HoloLens 2, enabling the simultaneous tracking of the ultrasound probe and biopsy needle. Distinct navigation information is provided during in-plane and out-of-plane punctuation. To evaluate the effectiveness of our system, we conducted a study involving ten participants, assessing puncture accuracy and biopsy time in comparison to traditional methods.

RESULTS

Ultrasound image was streamed from the ultrasound device to augmented reality headset with 122.49±11.61ms latency, while only 16.22±11.25ms was taken after data acquisition from image capture card. Navigation accuracy reached 1.23±0.68mm in the image plane and 0.95±0.70mm outside the image plane, within a depth range of 200 millimeters. Remarkably, the utilization of our system led to 98% and 95% success rate in out-of-plane and in-plane biopsy, among ten participants with little ultrasound experience.

CONCLUSION

To sum up, this paper introduces an AR-based ultrasound biopsy navigation system characterized by high navigation accuracy and minimal latency. The system provides distinct visualization contents during in-plane and out-of-plane operations according to their different characteristics. Use case study in this paper proved that our system can help young surgeons perform biopsy faster and more accurately.

Lightweight Force-Controlled Device for Freehand Ultrasound Acquisition

This study investigates a force-controlled auxiliary device for freehand ultrasound (US) examinations. The designed device allows sonographers to maintain a steady target pressure on the US probe, thereby improving the US image quality and reproducibility. The use of a screw motor to power the device and a Raspberry Pi as the system controller results in a lightweight and portable device, while a screen enhances user-interactivity. Using gravity compensation, error compensation, an adaptive proportional-integral-derivative algorithm, and low-pass signal filtering, the designed device provides highly accurate force control. Several experiments using the developed device, including clinical trials relating to the jugular and superficial femoral veins, validate its utility in ensuring the desired pressure in response to varying environments and prolonged US examinations, enabling low or high pressures to be maintained and lowering the threshold of clinical experience. Moreover, the experimental results show that the designed device effectively relieves the stress on the sonographer's hand joints during US examinations and enables rapid assessment of the tissue elasticity characteristics. With automatic pressure tracking between probe and patient, the proposed device offers potentially significant benefits for the reproducibility and stability of US images and the health of sonographers.

A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance

BACKGROUND

The use of point of care ultrasound (PoCUS) in the management of musculoskeletal (MSK) disorders is a diverse area of PoCUS practice. Its use by clinicians, such as physiotherapists, can occur across a wide range of roles and care pathway configurations; however, professional, educational and regulatory uncertainties can leave clinicians, managers and patients at risk.

MAIN BODY

A PoCUS framework approach (previously applied to support PoCUS consolidation and expansion) is used to frame these proposals. Central to this is the defining of (clinical and sonographic) scope of practice (ScoP). A number of indicative ScoPs are described to both (i) illustrate application of the principles and (ii) provide templates for ScoP derivations for individual services or clinicians. Image-guided MSK interventions are increasingly an aspect of MSK physiotherapy PoCUS. Given the utility of physiotherapists drawing upon their imaging to fully inform the selection (and performance) of such techniques, we present a rationale for competency in undertaking sonographic differentials as a pre-cursor to performing ultrasound image-guided MSK interventions. Alignment of ScoP with the relevant education and formal competency assessments are a cornerstone of the PoCUS framework approach; as such, key aspects of MSK PoCUS education and competency assessment are outlined. Strategies for addressing such requirements in healthcare settings where formal provision is not accessible, are also presented. Governance considerations are aligned with the regulatory environment, including those pertaining to professional guidance and insurance considerations. In addition, generic quality assurance elements are emphasised, as core aspects of high-quality service provision. Whilst the paper clarifies the situation for MSK physiotherapists using PoCUS in the UK, prompts are provided to support other professional groups working in MSK services in the United Kingdom (UK) and MSK physiotherapists/physical therapists in other countries-to facilitate their application of the principles.

CONCLUSION

Acknowledging the breadth of MSK physiotherapy PoCUS practice, this paper draws upon a framework approach to provide integrated ScoP, education/competency and governance solutions, along with mechanisms for other professions working with MSK PoCUS-and physiotherapists/physical therapists outside of the UK-to consolidate and expand their practice.