From the RSNA. pp The skifis needed to perform ultrasonographic (US)-guided interventional procedures

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "From the RSNA. pp The skifis needed to perform ultrasonographic (US)-guided interventional procedures"

Transcription

1 From the RSNA m u Refresher Courses This article meets the Freehand Interventional Sonography in criteriafor 1.0 credit the Breast: Basic Principles and Clinical hourincategorylof #{149} theama Physician s Applications Recognition Award. To obtain credit, see Dianne Georgian-Smith, MD #{149}William E. Shiels II, DO the questionnaire on pp The skifis needed to perform ultrasonographic (US)-guided interventional procedures in the breast can be learned by practicing the key maneuvers on a tissue phantom. Use of a tissue phantom rather than a synthetic phantom provides the tactile feedback from transducer movement against tissue and from needle insertion into tissue, which more closely simulates the performance of the procedure in a real breast. There are three key transducer motionssweeping, rocking, and rotating-that are used to achieve three important goals in US-guided procedures: finding the needle, maximally visualizing the needle, and correctly aligning the needle shaft and ultrasound beam. For each transducer maneuver, there is a corollary needle motion that can be used to achieve the same goal. Either the transducer or the needle should be moved. during a procedure, not both simultaneously. Longitudinal alignment of the needle shaft with the ultrasound beam is best achieved with the perpendicular. approach. The perpendicular approach is preferred because it allows superior needle visualization, orientation parallel to the chest wall, and location of the needle shaft at the focal zone. With use of a tissue phantom, the radiologist-intraining can practice the key procedures and tailor them to his or her mdividual preferences... INTRODUCTION In the past few years, ultrasonography (US)-guided interventional procedures have become an established diagnostic tool in the work-up of breast masses. Radiologists-intraining have successfully learned these skills by using a variety of tissue phantoms. In 1989, two homemade phantoms containing gelatin were introduced (1,2). Commercially produced synthetic phantoms are now also available. Index terms: Breast, biopsy, , #{149}Breast neoplasms. diagnosis, #{149} Breast neoplasms, US, #{149} Phantoms, #{149}Ultrasound (US), guidance, RadioGraphics 1996; 16: I From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St. Cincinnati, OH (D.G.S.) and the Departments of Radiology, Cincinnati Children s Hospital Medical Center, and Walter Reed Army Medical Center (W.E.S.). Presented as a refresher course at the 1993 RSNA scientific assembly. Received February ; revision requested October 10 and received October 24: accepted October 24. Address reprint requests to D.G.S. RSNA,

2 a. 3b. Figures 1-3. (1) Phantom preparation. Blunt dissection of the thawed turkey breast from the lateral side creates a cavity between the muscles and rib cage. Musdc fibers remain attached to the sternum. (2) Implantation of the targets (eg, olives) is performed under water to prevent the introduction of air. (3) US images of partially thawed (a) and completely thawed (b) tissue phantoms demonstrate relatively increased echogenicity in the former caused by ice crystals. This article describes a tissue phantom, first introduced in 1990 for learning foreign body removal (3), which can be used to practice the skills of freehand interventional sonography. The basic mechanics of freehand interventional sonography, including the relationships between the needle and ultrasound beam, hand and transducer, and transducer and tissue, are illustrated. These basic principles are then applied to the clinical setting. U PRACTICE LABORATORY The materials needed for practicing US-guided interventional procedures of the breast include a thawed turkey breast split in half with the bone in place, pimento-filled olives or pearl onions used for simulating masses, rubber gloves filled with water to simulate cysts, a water basin, and various needles and syringes. The turkey breast is prepared for use as a phantom by dissecting the pectoral muscles so as to leave a pocket between the muscles and the rib cage (Fig 1). The sternal or medial side is left intact to prevent the implanted targets (eg, olives) from escaping. Targets are implanted while the turkey breast is submerged under water to prevent the formation of air pockets (Fig 2). The tissue must be completely thawed before scanning; otherwise, ice crystals attenuate the sound beam (Fig 3). Care must be taken to prevent bacterial contamination when working with raw poultry. If handled properly, the phantom can be returned to the freezer and reused, with the frequency of reuse limited by eventual spoilage. 150 U Continuing Education Volume 16 Number 1

3 a. b. Figure 4. Needle-ultrasound beam relationship in the longitudinal alignment. US images with superimposed diagrams of the needle and transducer positions demonstrate the shallow oblique approach (a) and perpendicular approach (b). The depth of the target (circle) is determined from the sonogram. The site of the needle puncture on the skin is estimated from this depth. Although eventual spoilage is a disadvantage, the turkey breast phantom is better than synthetic phantoms because it is composed of real tissue. The tactile feedback from transducer movement against tissue and from needle insertion into tissue more closely simulates the performance of the procedure in a real breast. Multiple passes with the needle could cause air bubbles to form in the needle tracts; however, this artifact develops only rarely, unlike its common occurrence in agar phantoms.. BASIC PRINCIPLES. Needle-Ultrasound Beam Relationship The key aspect to needle visualization during intcrventional sonography is longitudinal alignment of the needle shaft with the ultrasound beam. This alignment can be achieved with the needle placed either oblique (Fig 4a) or perpendicular (Fig 4b) to the sound beam (4-7). The latter placement is preferred because it allows superior needle visualization, orientation parallel to the chest wall, and location of the needle shaft at the focal zone. Because the shape of the ultrasound beam is biconcave, the narrowest portion of the beam is at the focal zone. Thus, needle alignment to the mass is less affected by volume averaging when the perpendicular approach is used than when the oblique longitudinal approach is used. In using the perpendicular approach to place the needle, one should use the curvature of the breast to determine the depth for the needle insertion. The depth of insertion is estimated from the US image, which shows the depth of the mass from the skin surface in centimeters. Because most masses lie at a depth of less than or equal to 2 cm from the skin surface, most needle insertions are made 1-2 cm from the short axis of the transducer (Fig 4); greater distances are rarely needed. Deep lesions, such as those 4 cm posterior to the skin surface, can be accessed from a distance of 2 cm from the transducer by using additional techniques to visualize the needle better. Vertical needle insertion in an antcroposterior direction (5) has been used as an alternative to the longitudinal approach. In this method, the needle is inserted just lateral to the midpoint of the transducer and angled obliquely toward the target. The needle shaft and ultrasound beam arc nearly parallel. The angle of insertion is adjusted to the depth of the lesion. The needle is advanced blindly until it reaches the ultrasound beam, and it appears as an echo- January 1996 Georgian-Smith and Shiels U RadioGrapbics U 151

4 a. b. FlgurC 6. Transducer-tissue relationship. (a) The transducer is positioned perpendicular to the tabletop, which is the preferred position for performing interventional sonography. (b) In contrast, when the transducer is positioned perpendicular to the skin surface, as shown, the ultrasound beam is obliquely projected. genic dot. This approach allows use of a shorter skin-to-lesion distance; however, as noted by several authors (5,8), the triangulation of the needle tip and the ultrasound beam to the correct depth to hit the target can be frustrating because needle advancement is blind. Moreover, if the needle tip is advanced through the plane of the ultrasound beam, the needle shaft (as well as the tip of the needle) wifi appear as an echogenic dot. Thus, the radiologist may not appreciate that the needle tip has been advanced beyond the mass. This is a serious disadvantage, since needle tip placement must be controlled to avoid pectoral muscle puncture and possible pneumothorax. Because visualization of the needle passage through the tissues is superior when the longitudinal approach is used, this approach is advocated. The advantage of the tissue phantom is that one can experiment with both techniques to adopt a preference. Figure 5. Hand-transducer relationship. The nondominant hand is used for scanning, and the third, fourth, and fifth fingers brace the transducer against the tissue phantom. The thumb and index fingers, and occasionally the third fmger, are free to move the transducer.. Hand-Transducer Relationship Radiologists often scan with the dominant hand. To perform freehand interventional sonography, one must choose to develop the dcxterity of the nondominant hand for either necdlc insertion or scanning. Either skifi can be learned with practice. The transducer must be braced on the soft tissues of the breast by using the ulnar aspect of the hand and the third, fourth, and fifth fmgcrs (Fig 5). This hand position is essential for continuous visualization of the target in soft, ma!- leable tissue. Moreover, these fingers are used to establish resistive pressure against the forward advancement of the needle. The first, 5ccond, and sometimes the third fmgers, with occasional assistance from the opposite hand, are used to manipulate the transducer.. Transducer-Tissue Relationship To facilitate the intersection of the ultrasound beam and needle in the longitudinal plane, the transducer should be held perpendicular to the tabletop (Fig 6a) and not to the skin surface. if the transducer follows the curved surface of the breast and thus is angled (Fig 6b), the ultrasound beam wifi be projected obliquely; therefore, it will be difficult to intersect the beam with the needle. 152 U Continuing Education Volume 16 Number 1

5 FigurC 7. US images with superimposed diagrams of the needle and transducer positions demonstrate how to find the needle with the perpendicular approach. By sliding the transducer toward the needle, there is earlier detection of the needle tip. Distance of the needle tip to the target (circle) is maintamed, yet more of the needle is seen in the right image IcLIDk==IcEIN Figure 8. Diagrams depict the motions of the transducer. These motions can be described by six coordinates, three of which are rotations (1, 2, 3) and three are translations (4, 5, 6). One of the translational motions (4) was referred to in Figure 7 for early needle detection. Early detection of the needle tip is important for control. Early detection can be achieved by sliding the transducer along its longitudinal axis toward the needle (Fig 7). To visualize the necdlc tip during this action, the target should appear on the screen opposite the side of needle entry.. MECHANICS OF TRANSDUCER AND NEEDLE MOVEMENT The three-dimensional movement of the linear array transducer can be dcfmed by six coordinates, three of which arc translations and three are rotations (Fig 8) (9). One must learn how to apply the three rotational movements- sweeping, rocking, and rotating -of the transducer to attain three goals, respectively: finding the needle, maximally visualizing the needle, and achieving perfect longitudinal alignment. For each transducer maneuver, there is a corollary needle motion that can be used to achieve the same goal. Therefore, it is important that cither the transducer or the needle be moved during a procedure, not both simultaneously. The needle should never be advanced through the tissues unless the tip is well visualized. January 1996 Georgian-Smith and Shiels U RadioGrapbics U 153

6 Figure 9. Diagrams illustrate the transducer and corollary needle movements that can be used to find the needle. (a) The transducer sweeps the ultrasound beam to look for the needle. The needle is in a plane to the right side of the target (circle). From this motion, the relationship of the needle to the target can be determined. (b) The needle is moved in and out on an arc to look for the ultrasound beam. The ultrasound beam stays fixed in the plane of the target (circle). a. b. In addition, accessing deep lesions and volume averaging artifacts are special problems that the radiologist-in-training must learn how to address before using freehand interventional sonography procedures in a clinical setting.. Finding the Needle Finding the needle is the first objective in the performance of freehand interventional sonography. This can be accomplished by either moving the transducer in a sweeping motion while the needle is held still or moving the needle while the transducer is stationary. In the first method, the sweeping of the transducer, which is analogous to the motion of a broom, is used to sweep the ultrasound beam through the tissues to localize the needle. First, one must visually align the needle with the midpoint of the short side of the transducer and insert the needle into the breast for 1-3 cm, a length long enough for the needle tip to enter the ultrasound beam. If the needle is not seen immediately, the transducer must be moved to sweep the ultrasound beam through the tissues to look for the needle (Fig 9a). Once the needle is found, its relationship to the mass can be determined from this sweeping motion. First, the transducer is moved to relocalize the mass. By using the newly deduced relationship of the needle to the mass, the needle can be redirected to the mass. An alternate method for finding the needle is the corollary needle maneuver. In this mancuver, the needle tip is used to find the ultrasound beam while the transducer is held stationary over the lesion. After the needle is inserted for a distance of approximately 1-3 cm, it is gently moved in and out in an ardlike fashion (Fig 9b). One must refrain from advancing the needle blindly beyond 3 cm in the hope of seeing it because this may lead to unsuspected tissue trauma. Once the needle tip intersects the beam, the needle can be advanced to the target. Both maneuvers accomplish the goal of fmding the needle tip. The latter, in which the needle intersects the ultrasound beam, is the easier of the two maneuvers to perform because the target remains in view. Care must be taken to avoid excessive trauma to the tissues caused by the needle motion. The transducer and the needle should never be moved simultaneously during either maneuver, since this eliminates feedback gained from the positioning of each hand.. Maximally Visualizing the Needle The second objective in the performance of freehand interventional sonography is to visualize the needle maximally. Visualization of the needle shaft is decreased if the needle intersects the ultrasound beam at any angle less than 90#{176} (Fig 10). Maximal visualization of the necdle can be accomplished by either moving the transducer in a rocking motion while the necdle is stationary or moving the needle while the transducer is held still. If the needle intersects the ultrasound beam obliquely, the transducer can be rocked (since breast tissues are soft) to produce a perpendicular alignment of the needle shaft to the ultrasound beam (Fig 1 la). The needle shaft and transducer face are parallel to one another. 154 U Continuing Education Volume 16 Number 1

7 a. b. Figure 11. Diagrams illustrate the transducer and corollary needle movements that can be used to visualize the needle maximally. Circle = target. (a) The transducer is rocked so that the ultrasound beam intersects the needle at 90#{176}. (b) The needle shaft is depressed so that the shaft and transducer face become parallel (needle puncture site is maintained). a. b. H: Figure 10. Needle visualization depends on the angle at which the needle shaft intersects with the ultrasound beam. Sonograms demonstrate the depiction of the needle (arrowheads) at 58#{176} (a), 80#{176} (b), and 90#{176} (C). Visualization improves as the angle increases to 90#{176}, the angle of maximal visualization. C. The corollary needle motion is the depression of the needle shaft while the transducer is held motionless (Fig 1 ib). The index fmger should be placed on the needle near the skin puncture site to prevent the needle from bending. Of these two maneuvers, rocking the transducer is easier to perform because the breast is an external organ and its tissues are compressible. January 1996 Georgian-Smith and Shiels U RadioGraphics U 155

8 Figures 12, 13. (12) US images of a needle shaft and ultrasound beam in (a) and out (b) of longitudinal alignment. Both images show an echogenic white line representing the needle shaft, but only the first shows the correct location of the needle tip. (13) Diagrams illustrate the transducer and corollary needle movements that can be used to achieve perfect longitudinal alignment of the needle shaft and ultrasound beam. Circle = target. (a) The transducer is rotated around its axis to align the needle tip and shaft. (b) The needle is rotated to achieve longitudinal alignment (needle puncture site is maintamed). ;;. -,., IY,. s, f_..-.: -: I : ; #{149} 1 #{149} ; ;-.-;.- #{149}.-..:.- ;:::;, #{149} se #{149}4., ;.... T: r.:, 12a. 12b. 13b. 13a.. Achieving Perfect Longitudinal Alignment The third goal is to achieve perfect longitudinal alignment of the ultrasound beam and needle shaft (Fig 1 2). This will result in control of the needle tip and shaft during needle advancement. Perfect longitudinal alignment can be accomplished by rotating the transducer while the needle is held still. The transducer is rotated around its axis to align the longitudinal axis of the ultrasound beam and the needle shaft (Fig 1 3a). Although there is a corollary needle maneuver in which the needle is rotated and the transducer is stationary (Fig 1 3b), this method is not recommended because the needle shaft will bend and its motion may traumatize the breast tissues.. Accessing Deep Lesions When one is using the curve of the breast to determine the depth of the needle insertion for a perpendicular approach, it is important to not traverse through too much breast tissue that is not in the ultrasound beam (Fig 14) to avoid unsuspected tissue trauma. In addition, blind needle advancement through several centimeters of tissue may make it difficult to fmd the needle and to achieve longitudinal alignment of the needle and ultrasound beam. The following approach, which uses rocking of the transducer and its corollary needle ma- 156 U Continuing Education Volume 16 Number 1

9 C. Figure 15. US images with superimposed diagrams of the needle and transducer positions demonstrate how to access deep lesions with the perpendicular approach. In all these maneuvers, needle puncture site is maintamed. Circle = target. (a) Initial needle trajectory at (1) is too shallow from a standard skin puncture site of 1-2 cm from the transducer. The needle enters the ultrasound beam at 1 cm below the skin surface. The needle shaft is redirected deeper to position (2) for a very short distance of approximately 1 cm. (b) The needle shaft is depressed to position (3) to produce an oblique approach. The needle enters the ultrasound beam at 2 cm below the skin surface. (c) The transducer is rocked to convert a shallow oblique approach to a perpendicular approach for maximal needle visualization. The needle enters the ultrasound beam at 3 cm below the skin surface, yet the site of needle puncture has not changed. Figure 14. A standard perpendicular approach is not advised for accessing deep lesions (greater than 2 cm) because of the large amount of tissue that is not included in the US image. In the diagram, the shaded area represents the portion of tissue through which the needle passes that would not be monitored on the US screen. Circle = target. neuver, needle depression, allows access to deep lesions and optimal needle visualization, even though a skin puncture site normally used to reach shallow lesions (<2 cm) is utilized. if the initial needle trajectory is too shallow, the needle can be redirected deeper without repuncturing the skin. First, the needle shaft is elevated and the needle advanced more steeply toward the chest wall for a very short distance (approximately 1 cm) (Fig 1 5a). The needle shaft is then depressed downward to produce an oblique approach (Fig 15b). This maneuver should be reserved for deep lesions in largebreasted women because the downward necdlc insertion may need to be performed blindly. The same maneuver performed in smallbreasted women may be more liable to cause January 1996 Georgian-Smith and Shiels U RadioGrapbics U 157

10 - ::. - - % ,# FlgurC 16. Volume averaging artifact. (a) On the US image, the needle appears to be in the cyst. (b, c) However, when the transducer is rotated 90#{176} (b), the true relationship of the needle tip to the cyst can be seen on the sonogram (c). The needle tip is adjacent to the cyst (arrow).!, I a. b. pectoral muscle puncture. In addition, this maneuver, although well tolerated in the breast without incurring trauma, may not be suitable in other tissues. The oblique approach is then converted to a perpendicular approach by rocking the transducer for maximal visualization of the needle (Fig 1 Sc).. Volume Averaging Artifact An important pitfall in performing freehand interventional sonography with the longitudinal approach is volume or beam width averaging. The needle appears to be within the mass when in fact it is adjacent to the mass (Fig 16a). This artifact results from volume averaging of the needle and the adjacent mass in the width of the ultrasound beam (4,6). The true relationship of the needle tip to the mass can be determined by rotating the transducer 90#{176} (Fig 16b, 16c). Minor redirection of the needle can be performed if the needle is not within the mass.. CLINICAL SETflNG Proficiency at performing freehand interventional sonography should be attained with practice on a tissue phantom before clinical application is attempted (1,2,6). One should become familiar with the basic principles previously illustrated. A number of successful approaches have been described (4-8,10-12), and the method suggested in this article is only one of many. The radiologist is encouraged to develop his or her own style by using a phantom for predlinical trials. 158 U Continuing Education Volume 16 Number 1

11 a. b. Figure 17. Diagrams illustrate suggested scanning planes. Arrows = needle directions. (a) Right breast. The radiologist is standing on the patient s right side, with the right hand holding the needle and the left hand holding the transducer. A transverse plane is suggested to access most lesions, with the curve of the breast being used to achieve depth alignment. The longitudinal plane, with the needle direction from inferior to superior, can be used to access the medial aspect of either the right breast without passing through the nipple or the left breast without needle obstruction from the opposite breast. (b) Left breast. The radiologist is standing on the patient s left side. The transverse plane is again preferred to ascertain depth. Oblique approaches for the medial side of the left breast can be used to avoid the nipple as well as the patient s face and neck.. The Approach The number of scan planes, and hence potential approaches to a lesion, are unlimited in the breast because it is an external organ. During initial training in freehand interventional sonography, there is a tendency to scan in only the transverse or longitudinal planes of the body. Oblique planes should also be considered to avoid the nipple, opposite breast, and abdomen for patient comfort and safety. The transverse plane is the best scanning approach for guiding a perpendicular needle insertion, with the needle direction from lateral to medial. The curve of the breast can then be used to ascertain the depth for needle alignment to the mass (Fig 4). Masses located in the superior, lateral, and inferior areas of the breast can be accessed from the transverse plane (Fig 17). This approach is unobstructed by the abdomen or opposite breast. Masses located in the medial side may be best approached in the parasagittal or oblique plane (Fig 17). For performing US-guided interventional procedures on lesions in the left breast, we suggest that the radiologist stand on the patient s left side. In fact, routine scanning of the left breast can be performed in this manner by facing the patient in the opposite direction. The standard orientation of the patient s right side on the left of the image is maintained by correct orientation of the transducer. Although this setup is unconventional and may seem unnecessary at first, it places the target closest to the radiologist and facilitates use of a perpendicular approach, since the lateral aspect of the breast is easily accessible. Of all the parameters so far discussed, the approach has been the most difficult to teach radiologists-in-training because the number of scan planes is unlimited and because experience often determines which of these is easier to use.. Patient Positioning To perform a procedure on a lesion from the lateral side, the patient is rolled onto the contralateral side and the ipsilateral arm is raised above the head. This maneuver flattens the breast, makes the lesion less deep, and firms the tissues to facilitate needle advancement. Moreover, perpendicular alignment of the transducer to the tabletop is easier to maintain. If the patient is turned steeply onto the contralateral side, the radiologist must avoid passing through pectoral muscle while advancing January 1996 Georgian-Smith and Shiels U RadioGraphics U 159

12 the needle to the target. The breast should be palpated at the point of estimated needle insertion to ensure that muscle is not immediately under the skin. For procedures on lesions located medially in the breast, the patient may need to be fully supine. In very small breasted women, the arm may be placed alongside the body so that there is greater depth to the tissue to lessen the chance of pectoral muscle puncture. Needles that arc etched, are scored, or have multiple side holes arc highlighted (ie, echogenic) when the needle is in an oblique approach because of the portions of these markings that remain oriented perpendicular to the ultrasound beam. However, these markings increase the drag of the needle during advancement because of increased friction. In some clinical settings, tissue density can thwart the success of the procedure.. Needle Characteristics Needle choice depends on the type of procedure and preference of the radiologist. The mechanics of needle guidance under sonographic control are the same, regardless of the procedure type, whether an aspiration, needle localization, or core biopsy. Needles of gauge are easier to use with the longitudinal approach than smaller gauge needles because the larger needles are stiff enough to maintain a straight trajectory within the longitudinal axis of the ultrasound beam. Needles of 20 and 22 gauge can be visualized if oriented perpendicularly to the ultrasound beam. This principle is illustrated daily in scans of cysts, whose anterior and posterior walls arc microscopically thin and yet sharply demarcated. As shown in Figure 10, however, the portions of the walls obliquely oriented to the beam arc progressively less well visualized as the angle increases to the point at which the lateral margins are not seen. However, the smaller the gauge of needle, the easier it is deflected by the tissues during advancement. For similar reasons, a longer needle of the same gauge is more difficult to manage than a shorter needle. Most lesions can be accessed with a 6- cm or shorter needle.. The Procedure After initial preparation, the needle is inserted with direct sonographic guidance. There are three steps for completing this procedure: (a) localizing the needle, (b) advancement of the needle toward the target, and (c) three-dimensional confirmation of the needle in the mass (Fig 16). The needle is localized by aligning its tip with the target in the longitudinal axis of the ultrasound beam. The needle is then advanced toward the mass. During this portion of the procedure, one may lose sight of the needle or the target because of tissue malleability and needle deflection by fibrous tissues. When the needle tip is not seen, needle advancement should be stopped; otherwise, unsuspected tissue trauma, as well as incorrect alignment of the needle tip and mass, may result. Maneuvers to find the needle-sweeping the transducer or moving the needle-must be performed before needle advancement can proceed. When needle advancement is difficult in dense tissue, a spiral rotation of the needle along with the forward motion may be helpful. This motion may also be useful to counteract deflection of the needle tip (Fig 18). Once the needle tip is at the perimeter of the mass, its wall can be punctured by using a quick, jabbing motion. Because cyst walls may be exceedingly elastic and fibrotic, the puncturd may be made more readily by applying resistant pressure from fmgcrs three, four, and five of the hand holding the transducer. 160 U Continuing Education Volume 16 Number 1

13 Figure 18. Drawings show a spiral rotation of the biopsy needle. When this motion is used as the needle is advanced forward, it facilitates advancement of the needle in dense breast tissue and prevention of needle tip deflection. Noting the feel of the needle tip within the mass may be helpful in determining its nature. The inner contents of breast cysts, even when highly viscous, feel vacuous. Some solid masses, such as fibroadenomas, may feel rock hard, making needle advancement exceedingly difficult. Breast cancers may feel gritty like a pear, and lymphoma may feel soft like butter. U SUMMARY In summary, basic principles of freehand interventional sonography and suggestions relevant to performing these US-guided procedures in the clinical setting have been presented. Tailoring these principles to one s individual preferences can be practiced on the tissue phantom. Acknowledgments: The authors thank Jan Warren, MA, for the medical illustrations and Edward S. Grood, PhD, from the Department of Aerospace and Engineering and Engineering Mechanics for his assistance in the preparation of the manuscript. U REFERENCES 1. Fornage BD. A simple phantom for training in ultrasound-guided needle biopsy using the freehand technique. J tjltrasound Med 1989; 8: McNamara MP Jr, McNamara ME. Preparation of a homemade ultrasound biopsy phantom. J Clin Ultrasound 1989; 17: Shiels WE II, Babcock DS, Wilson JL, et al. Localization and guided removal of soft-tissue foreign bodies with sonography. AJR 1990: 155: Fornage BD. US examination of the breast. UItrasoundQ 1993; 11: Fornage BD, Coan JD, David CL. Ultrasoundguided needle biopsy of the breast and other interventional procedures. Radiol Clin North Am 1992; 30: Matalon TAS, Silver B. US guidance of interventional procedures. Radiology 1990; 174: Charboneau JW, Reading CC, Welch TJ. CT and sonographically guided needle biopsy: current techniques and new innovations. AJR 1990; 154: D Orsi CJ, Mendelson EB Interventional breast ultrasonography. Semin Ultrasound CT MR 1989; 10: Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 1983; 105: Parker SH, Jobe WE, Dennis MA, et al. USguided automated large-core breast biopsy. Radiology 1993; 187: Karstrup 5, Nolsoe C, Brabrand K, Nielsen KR. Ultrasonically guided percutaneous drainage of breast abscesses. Acta Radiol 1990; 31: Kopans DB, MeyerJE, Lindfors KK, Buccianeri SS. Breast sonography to guide cyst aspiration and wire localization of occult solid lesions. AJR 1984; 143: This article meets the criteriafor 1. 0 credit hour in Category I of the AMA Physician s Recognition Award. To obtain credit, see the questionnaire on pp January 1996 Georgian-Smith and Shiels U RadioGraphics U 161

Ultrasound Guidance Needle Techniques

Ultrasound Guidance Needle Techniques Ultrasound Guidance Needle Techniques Dr TANG Ho-ming AED/UCH USG Guidance Needle Techniques Commonly used in EM 1. Vessel cannulation-peripheral & central 2. Foreign body removal 3. Peripheral nerve/plexus

More information

Needle visualization with ZONARE ultrasound systems

Needle visualization with ZONARE ultrasound systems Needle visualization with ZONARE ultrasound systems This material provides a general overview of ultrasound guided needle imaging and techniques and is not intended to replace formal training or education

More information

Terminology Tissue Appearance

Terminology Tissue Appearance By Marc Nielsen, MD Advantages/Disadvantages Generation of Image Ultrasound Machine/Transducer selection Modes of Ultrasound Terminology Tissue Appearance Scanning Technique Real-time Portable No ionizing

More information

Principles of Ultrasound. Cara C. Prideaux, M.D. University of Utah PM&R Sports Medicine Fellow March 14, 2012

Principles of Ultrasound. Cara C. Prideaux, M.D. University of Utah PM&R Sports Medicine Fellow March 14, 2012 Principles of Ultrasound Cara C. Prideaux, M.D. University of Utah PM&R Sports Medicine Fellow March 14, 2012 None Disclosures Outline Introduction Benefits and Limitations of US Ultrasound (US) Physics

More information

Preamble (disclaimer)

Preamble (disclaimer) Preamble (disclaimer) PHYSICS AND PRINCIPLES OF HEAD/NECK ULTRASOUND Joseph C. Sniezek, MD FACS LTC, MC, USA Otolaryngology/H&N Surgery Tripler Army Medical Center 1. I am not a physicist 2. ACS has recommended

More information

Ultrasound Physics & Terminology

Ultrasound Physics & Terminology Ultrasound Physics & Terminology This module includes the following: Basic physics terms Basic principles of ultrasound Ultrasound terminology and terms Common artifacts seen Doppler principles Terms for

More information

CONTENTS. Test Number cpd Tanya Reynolds (Nat. Dip. Diag. Rad., B. Tech. Diag. Rad., B. Tech. Ultrasound)

CONTENTS. Test Number cpd Tanya Reynolds (Nat. Dip. Diag. Rad., B. Tech. Diag. Rad., B. Tech. Ultrasound) CONTENTS page 1-15 page 16 BASIC 2-DIMENSIONAL ULTRASOUND PRINCIPLES Multiple Choice Test Test Number cpd 41640 Tanya Reynolds (Nat. Dip. Diag. Rad., B. Tech. Diag. Rad., B. Tech. Ultrasound) Tanya is

More information

Soft tissue biopsy needles

Soft tissue biopsy needles Soft tissue biopsy needles Automated Achieve programmable biopsy systems 2 Semi-automated CareFusion offers a wide range of soft tissue biopsy needles that you can rely on for precise samples every time.

More information

Chest Ultrasound: Pneumothorax

Chest Ultrasound: Pneumothorax WINFOCUS BASIC ECHO (WBE) Chest Ultrasound: Pneumothorax Mark Hamlin, MD, MS Associate Professor of Anesthesiology and Surgery University of Vermont College of Medicine Co-Director of Surgical Critical

More information

Ultrasonography of the Neck as an Adjunct to FNA. Nicole Massoll M.D.

Ultrasonography of the Neck as an Adjunct to FNA. Nicole Massoll M.D. Ultrasonography of the Neck as an Adjunct to FNA Nicole Massoll M.D. Basic Features of Head and Neck Ultrasound and Anatomy Nicole Massoll M.D. University of Arkansas for Medical Sciences, Little Rock

More information

Conventus CAGE PH Surgical Techniques

Conventus CAGE PH Surgical Techniques Conventus CAGE PH Surgical Techniques Conventus Orthopaedics The Conventus CAGE PH (PH Cage) is a permanent implant comprised of an expandable scaffold, made from nitinol and titanium, which is deployed

More information

Artifacts and Pitfalls in Sonographic Imaging of the Breast

Artifacts and Pitfalls in Sonographic Imaging of the Breast Downloaded from www.ajronline.org by 80.243.135.192 on 02/26/18 from IP address 80.243.135.192. Copyright RRS. For personal use only; all rights reserved rtifacts and Pitfalls in Sonographic Imaging of

More information

Knee Surgical Technique

Knee Surgical Technique Knee Surgical Technique COMPASS Universal Hinge by Jimmy Tucker, M.D. Orthopaedic Surgeon Director, Arkansas Sports Medicine, P.A. Little Rock, Arkansas Table of contents Design features 3 Indications

More information

RibFix Blu. Thoracic Fixation System

RibFix Blu. Thoracic Fixation System RibFix Blu RibFix Blu Thoracic Fixation System The New Era of Rib Fixation Begins Now Designed by Trauma Surgeons for Trauma Surgeons Your work matters and so do your patients. We are continually engineering

More information

P R O X I M A L H U M E R U S. Surgical Techniques

P R O X I M A L H U M E R U S. Surgical Techniques P R O X I M A L H U M E R U S Surgical Techniques Table of Contents Introduction Conventus Cage TM PH... 3 AO Principles... 4 Indications... 5 OR Set-Up... 6 Surgical Techniques Retrograde Direct Access...

More information

Zimmer Small Fragment Universal Locking System. Surgical Technique

Zimmer Small Fragment Universal Locking System. Surgical Technique Zimmer Small Fragment Universal Locking System Surgical Technique Zimmer Small Fragment Universal Locking System 1 Zimmer Small Fragment Universal Locking System Surgical Technique Table of Contents Introduction

More information

Basics of US Regional Anaesthesia. November 2008

Basics of US Regional Anaesthesia. November 2008 Basics of US Regional Anaesthesia November 2008 Essential Physics HIGH frequency = great resolution but poor penetration LOW frequency = poor resolution but great penetration Potential Advantages of US

More information

What is Ultrasound? What is Ultrasound? B A. Basic Principles of Ultrasound. Basic Principles of Ultrasound. Basic Principles of Ultrasound

What is Ultrasound? What is Ultrasound? B A. Basic Principles of Ultrasound. Basic Principles of Ultrasound. Basic Principles of Ultrasound Introduction to Ultrasound Principles Mani Montazemi, RDMS Baylor College of Medicine Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology Manager, Maternal Fetal Center Imaging

More information

Chapter 14. Imaging Artifacts

Chapter 14. Imaging Artifacts Chapter 14 Image Artifacts The complex physical interactions that occur between an ultrasound beam and human anatomy and the intricate and sophisticated technological components of a sonographic imaging

More information

POSTERIOR 1. situated behind: situated at or toward the hind part of the body :

POSTERIOR 1. situated behind: situated at or toward the hind part of the body : ANATOMICAL LOCATION Anatomy is a difficult subject with a large component of memorization. There is just no way around that, but we have made every effort to make this course diverse and fun. The first

More information

Biomet Large Cannulated Screw System

Biomet Large Cannulated Screw System Biomet Large Cannulated Screw System s u r g i c a l t e c h n i q u e A Complete System for Simplified Fracture Fixation 6.5mm & 7.3mm The Titanium, Self-drilling, Self-tapping Large Cannulated Screw

More information

The Language of Anatomy. (Anatomical Terminology)

The Language of Anatomy. (Anatomical Terminology) The Language of Anatomy (Anatomical Terminology) Terms of Position The anatomical position is a fixed position of the body (cadaver) taken as if the body is standing (erect) looking forward with the upper

More information

3. PATIENT POSITIONING & FRACTURE REDUCTION 3 8. DISTAL GUIDED LOCKING FOR PROXIMAL NAIL PROXIMAL LOCKING FOR LONG NAIL 13

3. PATIENT POSITIONING & FRACTURE REDUCTION 3 8. DISTAL GUIDED LOCKING FOR PROXIMAL NAIL PROXIMAL LOCKING FOR LONG NAIL 13 Contents IMPLANT FEATURES 2 1. INDICATIONS 3 2. PRE-OPERATIVE PLANNING 3 3. PATIENT POSITIONING & FRACTURE REDUCTION 3 4. INCISION 4 5. ENTRY POINT 4-6 6. PROXIMAL NAIL INSERTION 6-7 7. PROXIMAL LOCKING

More information

Children's (Pediatric) Ultrasound - Abdomen

Children's (Pediatric) Ultrasound - Abdomen Scan for mobile link. Children's (Pediatric) Ultrasound - Abdomen Children s (pediatric) ultrasound imaging of the abdomen is a safe, noninvasive test that uses sound waves to produce a clear picture of

More information

3.5 MM VA-LCP PROXIMAL TIBIA PLATE SYSTEM

3.5 MM VA-LCP PROXIMAL TIBIA PLATE SYSTEM 3.5 MM VA-LCP PROXIMAL TIBIA PLATE SYSTEM Part of the DePuy Synthes Variable Angle Periarticular Plating System SURGICAL TECHNIQUE TABLE OF CONTENTS INTRODUCTION 3.5 mm VA-LCP Proximal Tibial Plate 2 AO

More information

Objectives. Hepatobiliary Ultrasound: Anatomy, Technique, Pathology. RUQ: Normal Anatomy. Emergency Ultrasound: Gallbladder Location

Objectives. Hepatobiliary Ultrasound: Anatomy, Technique, Pathology. RUQ: Normal Anatomy. Emergency Ultrasound: Gallbladder Location Hepatobiliary Ultrasound: Anatomy, Technique, Pathology Laleh Gharahbaghian, MD FAAEM Associate Director, EM Ultrasound Co-Director, EM Ultrasound Fellowship Stanford University Medical Center Seric Cusick,

More information

System. Humeral Nail. Surgical Technique

System. Humeral Nail. Surgical Technique System Humeral Nail Surgical Technique Contents IMPLANT FEATURES 2 1. INDICATIONS 3 2. PRE-OPERATIVE PLANNING 3 3. PATIENT POSITIONING & FRACTURE REDUCTION 3 4. INCISION 4 5. ENTRY POINT 4-6 6. PROXIMAL

More information

Improving Methods for Breast Cancer Detection and Diagnosis. The National Cancer Institute (NCI) is funding numerous research projects to improve

Improving Methods for Breast Cancer Detection and Diagnosis. The National Cancer Institute (NCI) is funding numerous research projects to improve CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Improving Methods for

More information

Locking Radial Head Plates

Locking Radial Head Plates Locking Radial Head Plates Locking Radial Head Plates Since 1988, Acumed has been designing solutions to the demanding situations facing orthopaedic surgeons, hospitals and their patients. Our strategy

More information

PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique

PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique Surgical Technique Contour Femur Plate The technique description herein is made available to the healthcare professional to illustrate the

More information

QUICK REFERENCE GUIDE. The PreFix Fixator (92000 Series) ALWAYS INNOVATING

QUICK REFERENCE GUIDE. The PreFix Fixator (92000 Series) ALWAYS INNOVATING 21 The PreFix Fixator (92000 Series) ALWAYS INNOVATING INTRODUCTION The PreFix fixator is designed to provide temporary external fixation. This may be needed when local facilities or the condition of the

More information

Subclavian - Central Venous Catheterization

Subclavian - Central Venous Catheterization Subclavian - Central Venous Catheterization INTRODUCTION: Central lines are commonly placed in the ED for rapid infusion of fluids, placement of transvenous pacemakers, and administration of medications

More information

The Focused Assessment with Sonography for Trauma, (FAST) procedure.

The Focused Assessment with Sonography for Trauma, (FAST) procedure. The Focused Assessment with Sonography for Trauma, (FAST) procedure. ROBERT H. WRIGLEY Professor Veterinary Diagnostic Imaging University of Sydney Veterinary Teaching Hospital Professor Emeritus Colorado

More information

Valencia Pedicle Screw Surgical Technique

Valencia Pedicle Screw Surgical Technique Valencia Pedicle Screw Surgical Technique VALENCIA CIRCUIT TABLE OF CONTENTS Design Rationale Indications for Use Surgical Technique 1. Pedicle Preparation 2. Screw Insertion 3. Rod Placement 4. Locking

More information

relieve pressure on the lungs treat symptoms such as shortness of breath and pain determine the cause of excess fluid in the pleural space.

relieve pressure on the lungs treat symptoms such as shortness of breath and pain determine the cause of excess fluid in the pleural space. Scan for mobile link. Chest Interventions What are Chest Interventions? Chest interventions are minimally invasive procedures used to diagnose and treat pleural effusions, a condition in which there is

More information

NONGYNECOLOGICAL CYTOLOGY FINE NEEDLE ASPIRATION SPECIMENS

NONGYNECOLOGICAL CYTOLOGY FINE NEEDLE ASPIRATION SPECIMENS NONGYNECOLOGICAL CYTOLOGY FINE NEEDLE ASPIRATION SPECIMENS I. Purpose Fine needle aspiration of mass lesions is commonly utilized in the detection and characterization of a variety of malignant diseases.

More information

A Phantom Study Comparing Ultrasound-Guided Liver Tumor Puncture Using New Real-Time 3D Ultrasound and Conventional 2D Ultrasound

A Phantom Study Comparing Ultrasound-Guided Liver Tumor Puncture Using New Real-Time 3D Ultrasound and Conventional 2D Ultrasound Gastrointestinal Imaging Original Research Sugimoto et al. 4D Ultrasound Guided Puncture for Focal Hepatic Lesions Gastrointestinal Imaging Original Research Katsutoshi Sugimoto 1 Fuminori Moriyasu 1 Junji

More information

NCB Proximal Humerus Plating System

NCB Proximal Humerus Plating System NCB Proximal Humerus Plating System Surgical Technique The right locking option for tough fractures Disclaimer This document is intended exclusively for experts in the field, i.e. physicians in particular,

More information

PART ONE. Belly Dance Fitness Technique

PART ONE. Belly Dance Fitness Technique PART ONE Belly Dance Fitness Technique OVERVIEW Understanding belly dance movement The gentle, symmetrical, rhythmic undulations that we practice in Belly dance can help to revitalize almost every part

More information

Certification Review. Module 28. Medical Coding. Radiology

Certification Review. Module 28. Medical Coding. Radiology Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases. Vocabulary Barium enema (BE): lower gastrointestinal

More information

The Technical Model: an Overview Explanation of the Technical Model

The Technical Model: an Overview Explanation of the Technical Model A Technical Model for Pole Vault Success Michael A. Young Louisiana State University ****************This is a modified version of an article published in Track Coach Pole vaulting is perhaps the most

More information

BME 400 Capstone Design. Steerable Core Biopsy Needle

BME 400 Capstone Design. Steerable Core Biopsy Needle BME 400 Capstone Design Steerable Core Biopsy Needle Team Members : Tyler Allee Betsy Appel Evan Rogers Kristen Sipsma Advisor : Prof. Willis J. Tompkins, Ph. D. Client : Dr. Frederick Kelcz, M.D. Ph.

More information

Breast Cancer Screening

Breast Cancer Screening Scan for mobile link. Breast Cancer Screening What is breast cancer screening? Screening examinations are tests performed to find disease before symptoms begin. The goal of screening is to detect disease

More information

Physical Principles of Ultrasound

Physical Principles of Ultrasound Physical Principles of Ultrasound Grateful appreciation to Richard A. Lopchinsky, MD, FACS and Nancy H. Van Name, RDMS, RTR, and MarleneKattaron, RDMS 2000 UIC All Rights Reserved. Course Objectives Identify

More information

OMT FOR CONCUSSIONS KIMBERLY WOLF, D.O. FEBRUARY 17, 2017

OMT FOR CONCUSSIONS KIMBERLY WOLF, D.O. FEBRUARY 17, 2017 OMT FOR CONCUSSIONS KIMBERLY WOLF, D.O. FEBRUARY 17, 2017 POTENTIAL SEQUENCE Address lymphatics including all transition zones/diaphragms Address somatic dysfunction in spine Focus on upper cervical spine

More information

Introduction. The Inner Core Muscles. Why Train The Inner Core? How Do You Train The Inner Core?

Introduction. The Inner Core Muscles. Why Train The Inner Core? How Do You Train The Inner Core? Introduction Pilates focuses on the deep postural muscles, including the pelvic floor, the transversus abdominis (TA) and the multifidus. These deep postural muscles are also referred to as the core. Improving

More information

ARROW EZ-IO Intraosseous Vascular Access System Procedure Template

ARROW EZ-IO Intraosseous Vascular Access System Procedure Template ARROW EZ-IO Intraosseous Vascular Access System Procedure Template PURPOSE To provide procedural guidance for establishment of intraosseous vascular access using the ARROW EZ-IO Intraosseous Vascular Access

More information

Introduction to Ultrasound Examination of the Hand and upper

Introduction to Ultrasound Examination of the Hand and upper Introduction to Ultrasound Examination of the Hand and upper Emil Dionysian, M.D. Ultrasound of upper ext. Upside Convenient Opens another exam dimension Can be like a stethoscope Helps 3-D D visualization

More information

Basic Physics of Ultrasound and Knobology

Basic Physics of Ultrasound and Knobology WELCOME TO UTMB Basic Physics of Ultrasound and Knobology By Daneshvari Solanki, FRCA Laura B. McDaniel Distinguished Professor Anesthesiology and Pain Medicine University of Texas Medical Branch Galveston,

More information

Starting a Strength Training Program

Starting a Strength Training Program MINTO PREVENTION & REHABILITATION CENTRE CENTRE DE PREVENTION ET DE READAPTATION MINTO Starting a Strength Training Program About This Kit The key to improving strength is applying resistance to the muscle

More information

Breast Cancer. What is breast cancer?

Breast Cancer. What is breast cancer? Scan for mobile link. Breast Cancer Breast cancer is a malignant tumor in or around breast tissue. It usually begins as a lump or calcium deposit that develops from abnormal cell growth. Most breast lumps

More information

THE FIBULAR SESAMOID ELEVATOR: A New Instrument to Aid the Lateral Release in Hallux Valgus Surgery

THE FIBULAR SESAMOID ELEVATOR: A New Instrument to Aid the Lateral Release in Hallux Valgus Surgery C H A P T E R 1 4 THE FIBULAR SESAMOID ELEVATOR: A New Instrument to Aid the Lateral Release in Hallux Valgus Surgery Thomas F. Smith, DPM Lopa Dalmia, DPM INTRODUCTION Hallux valgus surgery is a complex

More information

Visualisation of needle position using ultrasonography

Visualisation of needle position using ultrasonography doi:10.1111/j.1365-2044.2005.04475.x REVIEW ARTICLE Visualisation of needle position using ultrasonography G. A. Chapman, 1 D. Johnson 2 and A. R. Bodenham 3 1 Research fellow in Anaesthesia and Intensive

More information

Anatomy is the branch of science that deals with the structural organization of living things how they are built and what they consist of.

Anatomy is the branch of science that deals with the structural organization of living things how they are built and what they consist of. Principles and Terminology Anatomy is the branch of science that deals with the structural organization of living things how they are built and what they consist of. Anatomy Plant Anatomy Animal Anatomy

More information

Thyroid and Parathyroid Ultrasound Protocol

Thyroid and Parathyroid Ultrasound Protocol Thyroid and Parathyroid Ultrasound Protocol Reviewed By: Anna Ellermeier, MD Last Reviewed: December 2017 Contact: (866) 761-4200, Option 1 **NOTE for all examinations: 1. If documenting possible flow

More information

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CAROTID ULTRASOUND What is Carotid Ultrasound Imaging? Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to highfrequency sound waves to produce pictures

More information

Alternative Approach To Needle Placement In Cervical Spinal Cord Stimulator Insertion

Alternative Approach To Needle Placement In Cervical Spinal Cord Stimulator Insertion Pain Physician 2011; 14:195-210 ISSN 1533-3159 Technical Report Alternative Approach To Needle Placement In Cervical Spinal Cord Stimulator Insertion Jie Zhu, MD 1,2, Frank J. E. Falco, MD 1, 2, C. Obi

More information

DISTAL ELBOW SET. proximal ulna plate SURGICAL TECHNIQUE GUIDE

DISTAL ELBOW SET. proximal ulna plate SURGICAL TECHNIQUE GUIDE SURGICAL TECHNIQUE GUIDE DISTAL ELBOW SET proximal ulna plate As described by: Jorge L. Orbay, M.D. Miami Hand & Upper Extremity Institute Miami, Florida DISTAL ELBOW SET proximal ulna plate Indications

More information

CT Body Stereotaxis: An Aid

CT Body Stereotaxis: An Aid 163 CT Body Stereotaxis: An Aid for CT-Guided Biopsies Gary Onik1 Philip Costelld Eric Cosman2 Tren Wells, Jr.3 Henry Goldberg4 Albert Moss5 Robert Kane1 Melvin E. Clouse1 William Hoddick4 Sheila Moore4

More information

CURRENT METHODS IN IMAGE GUIDED BREAST BIOPSY

CURRENT METHODS IN IMAGE GUIDED BREAST BIOPSY CURRENT METHODS IN IMAGE GUIDED BREAST BIOPSY Stuart Silver April 24, 2004 OBJECTIVES Review development of current techniques Discuss stereotactic breast biopsy Discuss US guided breast biopsy 1 OBJECTIVES

More information

WINSTA-C. Clavicle Plating System

WINSTA-C. Clavicle Plating System Clavicle Plating System Clinical Advisor Michael Kurer FRCS FRCS (Orth) Consultant Orthopaedic and Shoulder Surgeon North Middlesex University Hospital NHS Trust Table of Contents Introduction Indication

More information

Method & Sites for Intra-osseous Needle Insertion. Main Insertion Sites suggested for paediatric use are:

Method & Sites for Intra-osseous Needle Insertion. Main Insertion Sites suggested for paediatric use are: Method & Sites for Intra-osseous Needle Insertion There are 8 potential sites for the insertion of an intraosseous needle using the EZ-IO device or standard intraosseous needle, these include proximal

More information

Resurfacing Patellar Preparation

Resurfacing Patellar Preparation Surgical Technique Resurfacing Patellar Preparation Primary Total Knee Arthroplasty LEGION Total Knee System Resurfacing Patellar preparation Contents Introduction...2 Instrument assembly...3 Resurfacing

More information

Active-Assisted Stretches

Active-Assisted Stretches 1 Active-Assisted Stretches Adequate flexibility is fundamental to a functional musculoskeletal system which represents the foundation of movement efficiency. Therefore a commitment toward appropriate

More information

Surgical Technique. Forearm Fracture Solutions

Surgical Technique. Forearm Fracture Solutions Surgical Technique Forearm Fracture Solutions Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that improve

More information

WINSTA-R. Distal Radius System

WINSTA-R. Distal Radius System Distal Radius System Table of Contents Introduction WINSTA-R System 2 Indication 2 Surgical Technique Palmar Access for Radius Plate 3 Dorsal Access for Radius Plate 3 Positioning of the Radius Plate

More information

Zimmer Natural Nail System

Zimmer Natural Nail System Zimmer Natural Nail System Antegrade Femoral Nail Surgical Technique (Piriformis Fossa & Greater Trochanteric Approaches) Zimmer Natural Nail System Antegrade Femoral Surgical Technique 1 Zimmer Natural

More information

operative technique Universal Application

operative technique Universal Application operative technique Universal Application Introduction Introduction Building upon the design rationale of the Xia Spinal System, the new Xia Spinal System represents the latest advancement in spinal implant

More information

Clinical Principles to Successful Intraosseous Vascular Access. Explore. Discover. Examine. 05/11/2016. T-522, Rev A. Explore. Discover. Examine.

Clinical Principles to Successful Intraosseous Vascular Access. Explore. Discover. Examine. 05/11/2016. T-522, Rev A. Explore. Discover. Examine. Explore. Discover. Examine. www.vidacare.com Explore. Discover. Examine. Clinical Principles to Successful Intraosseous Vascular Access Expand Your Skills. Develop Your Practice 1 For adult and pediatric

More information

Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman

Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman Breast anatomy: Breast conserving surgery: The aim of wide local excision is to remove all invasive and in situ

More information

Common Applications for Sonography and Guided Intervention: Shoulder

Common Applications for Sonography and Guided Intervention: Shoulder Common Applications for Sonography and Guided Intervention: Shoulder Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Disclosures: Consultant:

More information

The Thoracic Cage. OpenStax College

The Thoracic Cage. OpenStax College OpenStax-CNX module: m46350 1 The Thoracic Cage OpenStax College This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0 By the end of this section, you will

More information

Bendigo Emergency Department Spinal Management and Collar Care Package

Bendigo Emergency Department Spinal Management and Collar Care Package Bendigo Emergency Department Spinal Management and Collar Care Package Bonnie Lusher Associate Nurse Unit Manager Bendigo Emergency Department (2011) 1 All major trauma patients are considered to have

More information

Procedure for Measuring Back Motion with the BROM II

Procedure for Measuring Back Motion with the BROM II BROM II Procedure Manual Procedure for Measuring Back Motion with the BROM II BROM (Back Range of Motion Instrument) is a product of: Performance Attainment Associates www.spineproducts.com 1-800-835-2766

More information

Lower Extremity Physical Performance Testing. Return to Function (Level I): Core Stability

Lower Extremity Physical Performance Testing. Return to Function (Level I): Core Stability Physical performance testing is completed with patients in order to collect data and make observations regarding the overall function of the limb integrated into the entire functional unit of the body,

More information

Ultrasound Applied Physics

Ultrasound Applied Physics Ultrasound Applied Physics University of Toronto Department of Medical Imaging Applied Physics Mini-Course #3 2016 Ultrasound Laboratory Manual and Examination Booklet 1/21/2016 Ultrasound Applied Physics

More information

Rotator Cuff and Shoulder Conditioning Program

Rotator Cuff and Shoulder Conditioning Program Rotator Cuff and Shoulder Conditioning Program Purpose of Program After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy

More information

LESSON ASSIGNMENT. After completing this lesson, you should be able to: 3-1. Identify body part terminology.

LESSON ASSIGNMENT. After completing this lesson, you should be able to: 3-1. Identify body part terminology. LESSON ASSIGNMENT LESSON 3 Positioning Terminology. LESSON ASSIGNMENT Paragraphs 3-1 through 3-23. LESSON OBJECTIVES After completing this lesson, you should be able to: 3-1. Identify body part terminology.

More information

Abdominal Ultrasound

Abdominal Ultrasound Abdominal Ultrasound What is Ultrasound Imaging of the Abdomen? What are some common uses of the procedure? How should I prepare? What does the equipment look like? How does the procedure work? How is

More information

Translational Training Tools TM

Translational Training Tools TM Translational Training Tools TM The 3 Ts Serving the 3 Rs VOLUME 1 Recipes for Crafting Your Own Purpose-Specific Training Tools for Non-Surgical Procedures Wendy O. Williams, DVM, DACLAM David E. Mooneyhan,

More information

Principles of. By: Dr. Ahmad Rabah

Principles of. By: Dr. Ahmad Rabah Principles of By: Dr. Ahmad Rabah 1. Utilize what's present: Whenever possible, select a design that fits the teeth and soft tissues, rather than choosing one that requires tissue alteration. When minimal

More information

Fitball and Pilates Unite Filex 2017

Fitball and Pilates Unite Filex 2017 Fitball and Pilates Unite Filex 2017 Lisa Westlake www.physicalbest.com Pilates, fitball and physiotherapy blend perfectly to fine tune movement and postural awareness and provide a focus on technique,

More information

Scrotum Kacey Morrison Amanda Baxter Sabrina Tucker July 18, 2006 SCROTUM

Scrotum Kacey Morrison Amanda Baxter Sabrina Tucker July 18, 2006 SCROTUM Scrotum Kacey Morrison Amanda Baxter Sabrina Tucker July 18, 2006 SCROTUM 1) Other Names: Scrotum None Testicles Testes (Curry Tempkin, p. 236, 2/3/2) Ductus deferens spermatic cord (Tempkin, p. 279, Anatomy

More information

Types of Plates 1. New Dynamic Compression Plate: Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia

Types of Plates 1. New Dynamic Compression Plate: Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia Types of Plates 1. New Dynamic Compression Plate: DCP Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia 1. Undercut adjacent to the holes low contact: less stress shield 2. Undercut at the undersurface

More information

POSITIONING ACR REQUIREMENTS IMAGE REVIEW CATEGORIES DEFICIENCIES IN POSITIONING ACR REQUIREMENTS 3/28/2016 NUMBER 1 REASON FOR ACR FAILURE

POSITIONING ACR REQUIREMENTS IMAGE REVIEW CATEGORIES DEFICIENCIES IN POSITIONING ACR REQUIREMENTS 3/28/2016 NUMBER 1 REASON FOR ACR FAILURE CERTIFYING AGENCIES MAMMOGRAPHY CLINICAL IMAGE EVALUATION Pam Fulmer, BA RT (R)(M)(QM) FDA approved certifying states States can only certify facilities within their state borders Illinois Iowa South Carolina

More information

Obliques. Transverse Abdominous

Obliques. Transverse Abdominous The Muscles By Obliques It helps you rotate your waste Transverse Abdominous It helps you stabilize your back Muscle s Pictures Oblique Transverse Abdominus Muscles Origination and Insertion The origins

More information

Stand Tall with Osteoporosis thru Pilates

Stand Tall with Osteoporosis thru Pilates Stand Tall with Osteoporosis thru Pilates C A S S I T E R P E N I N G P T, D P T, C S C S, C P I C H R I S R I E G E R P T U P S T A T E U N I V E R S I T Y H O S P I T A L J U N E 1 9, 2 0 1 7 Content

More information

An abdominal ultrasound produces a picture of the organs and other structures in the upper abdomen.

An abdominal ultrasound produces a picture of the organs and other structures in the upper abdomen. Scan for mobile link. Ultrasound - Abdomen Ultrasound imaging of the abdomen uses sound waves to produce pictures of the structures within the upper abdomen. It is used to help diagnose pain or distention

More information

Lymphoscintigraphy is a special type of nuclear medicine imaging that provides pictures called scintigrams of the lymphatic system.

Lymphoscintigraphy is a special type of nuclear medicine imaging that provides pictures called scintigrams of the lymphatic system. Scan for mobile link. Lymphoscintigraphy Lymphoscintigraphy helps evaluate your body s lymphatic system for disease using small amounts of radioactive materials called radiotracers that are typically injected

More information

Chapter 2 Pitfalls in Musculoskeletal Ultrasound

Chapter 2 Pitfalls in Musculoskeletal Ultrasound Chapter 2 Pitfalls in Musculoskeletal Ultrasound Violeta Maria Vlad MD, PhD Introduction Taking a good ultrasound (US) picture is an art. Interpreting it is a science. This is in fact everything US is

More information

Application of Phased Array Radar Theory to Ultrasonic Linear Array Medical Imaging System

Application of Phased Array Radar Theory to Ultrasonic Linear Array Medical Imaging System Application of Phased Array Radar Theory to Ultrasonic Linear Array Medical Imaging System R. K. Saha, S. Karmakar, S. Saha, M. Roy, S. Sarkar and S.K. Sen Microelectronics Division, Saha Institute of

More information

Mobility sequencing!

Mobility sequencing! Mobility sequencing When practicing joint mobility drills we have the opportunity to improve our movement. The muscles associated with the joint being mobilised as well as the joint itself will improve

More information

COR. Precision Targeting Cartilage Repair System. Arthroscopic Technique for Repair of Osteochondral Defects

COR. Precision Targeting Cartilage Repair System. Arthroscopic Technique for Repair of Osteochondral Defects COR Precision Targeting Cartilage Repair System Arthroscopic Technique for Repair of Osteochondral Defects Planning the Procedure An 18-gauge spinal needle is initially used to plan a perpendicular approach

More information

Ultrasound - Musculoskeletal

Ultrasound - Musculoskeletal Ultrasound - Musculoskeletal What is Ultrasound Imaging of the Musculoskeletal System? Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency

More information

SHOULDER PATIENTS. Diagnostic Shoulder Arthroscopy Technique Guide

SHOULDER PATIENTS. Diagnostic Shoulder Arthroscopy Technique Guide SHOULDER PATIENTS Diagnostic Shoulder Arthroscopy Technique Guide mi-eye 2 Indications for Use The mi-eye 2 system is indicated for use in diagnostic and operative arthroscopic and endoscopic procedures

More information

Flexi-Flange Fiber. Instruction Book for Flexi-Flange Fiber Posts IMPORTANT: Read pages 7 through 12 for Technique first. ESSENTIAL DENTAL SYSTEMS

Flexi-Flange Fiber. Instruction Book for Flexi-Flange Fiber Posts IMPORTANT: Read pages 7 through 12 for Technique first. ESSENTIAL DENTAL SYSTEMS ESSENTIAL DENTAL SYSTEMS IMPORTANT: Read pages 7 through 12 for Technique first. Caution: Federal law restricts this device to sale by or on the order of a licensed dentist. Flexi-Flange Fiber Instruction

More information

Outline. Chapter 12 Treatment Planning Combination of Beams. Opposing pairs of beams. Combination of beams. Opposing pairs of beams

Outline. Chapter 12 Treatment Planning Combination of Beams. Opposing pairs of beams. Combination of beams. Opposing pairs of beams Chapter 12 Treatment Planning Combination of Beams Radiation Dosimetry I Text: H.E Johns and J.R. Cunningham, The physics of radiology, 4 th ed. http://www.utoledo.edu/med/depts/radther Outline Combination

More information

The posterolateral thoracotomy is still probably the

The posterolateral thoracotomy is still probably the Posterolateral Thoracotomy Jean Deslauriers and Reza John Mehran The posterolateral thoracotomy is still probably the most commonly used incision in general thoracic surgery. It provides not only excellent

More information

"Anatomy is the foundation of medicine and should be based on the form of the human body." Hippocrates

Anatomy is the foundation of medicine and should be based on the form of the human body. Hippocrates HASPI Medical Anatomy & Physiology 01a Internet Activity Name(s): Period: Date: "Anatomy is the foundation of medicine and should be based on the form of the human body." Hippocrates http://www.skyscanner.net/news/x_ray_full.jpg

More information