Needle Insertion Research Articles

Does Mini-Percutaneous Nephrolithotomy Cause Increased Intrarenal Pressure During Percutaneous Nephrolithotomy and is This Mitigated by a Suctioning Sheath? A Randomized Control Trial.

Introduction: Intrarenal pressure (IRP) generated during percutaneous nephrolithotomy (PCNL) may have the potential to cause renal damage and/or sepsis. It has been suggested that mini-PCNL (mPCNL) can further increase IRP but that a suctioning sheath may mitigate this elevation. We sought to measure IRP throughout the PCNL process, randomizing patients getting mPCNL to receiving two different mPCNL sheaths, one suctioning and the other nonsuctioning, and then comparing them with patients undergoing standard PCNL (sPCNL) using a 24F sheath. Patients and Methods: Twenty patients meeting the eligibility criteria for mPCNL were randomized into two groups: suctioning mPCNL (s-mPCNL) with a single-step dilator and continuous suction sheath (ClearPetra™, 18F, n = 10) and nonsuctioning mPCNL (ns-mPCNL) with a metallic dilator and sheath (Storz MIP-M™, 17.5F, n = 10). A group of 10 patients undergoing sPCNL using a balloon dilator with a Polytetrafluoroethylene (PTFE) sheath (NephroMax™, 24F, n = 10) were included as a control. IRP was measured with a 0.014″ COMET™ II Pressure guidewire retrogradely positioned in the renal pelvis. Gravity irrigation was utilized. Pressure data captured include baseline IRPs, retrograde pyelogram (RPG), needle entry, fascial dilation, tract dilation, sheath insertion, nephroscopy, and lithotripsy. The primary outcome was differences in mean and peak IRP during each stage. Categorical data were compared using chi-square or Fisher's exact tests. Continuous variables were analyzed using one-way analysis of variance. Results: Peak and mean IRPs (millimeters of mercury or mm Hg) were similar at baseline and during RPG, needle insertion, and fascial dilation in the two experimental groups and in the control group. During tract dilation and sheath placement, both the mPCNL sheaths generated much higher peak IRP compared with the 24F balloon dilation control group but similar to each other (dilation: 36.6 and 38.6 vs 6.9, p < 0.001; sheath placement: 36.6 and 35.3 vs 13.8, p = 0.039). During nephroscopy, ns-mPCNL generated greater peak IRP compared with s-mPCNL and the control group (41.8 vs 19.09 and 24.15; p = 0.019). The highest peak IRP for each group occurred during RPG and when a nephroscope was placed through a narrow infundibulum. Conclusions: Compared with balloon dilation, coaxial dilation with mPCNL sheaths generates significantly higher IRP. During nephroscopy, ns-mPCNL sheaths generate higher IRP compared with standard and suctioning sheaths. Highest IRPs are generated during RPG and when a nephroscope goes through a narrow infundibulum. These findings can inform improved sheath and nephroscope design. Further research assessing the effect of high IRP on postoperative pain, sepsis, and renal injury is needed.

Comparative Evaluation of Functional Outcomes in High Condylar Fractures Treated with Closed Methods with and without Temporomandibular Joint Arthrocentesis: A Research Protocol for a Randomised Controlled Trial

Introduction: Temporomandibular Disorders (TMD) encompass a range of conditions affecting the joint and surrounding structures, often resulting in pain, restricted movement, and dysfunction. Arthrocentesis involves the insertion of a single needle into the joint space, allowing for irrigation, lavage, and aspiration of the joint. The present procedure aims to alleviate symptoms, improve joint function, and promote healing by removing inflammatory mediators, debris, and adhesions from the joint space. Need of the study: Arthrocentesis offers several advantages over traditional techniques, including reduced trauma, quicker recovery times, and a decreased risk of complications. It has emerged as a valuable tool in the multidisciplinary approach to managing TMDs, offering patients a minimally invasive option to relieve their symptoms and restore jaw function. Hence, the present study will present the utility of arthrocentesis as an adjunct procedure to closed reduction in high condylar fractures, improving the functionality of the condyle, providing pain relief, increasing mouth opening and bite force, stabilising bilateral occlusion, and normalising excursive movements. Aim: To compare and evaluate the efficacy of closed reduction with or without arthrocentesis in patients with high condylar fractures regarding functional outcomes. Materials and Methods: A randomised controlled trial will be conducted at Siddharth Gupta Memorial Cancer Hospital, Sawangi, Wardha, Maharashtra, India, from September 2024 to May 2026, involving 10 patients. The protocol includes examining patients with suspected high condylar fractures, taking detailed case histories, performing clinical examinations focusing on the Temporomandibular Joint (TMJ), and recording preoperative measurements of mouth opening and pain levels using a Visual Analogue Scale (VAS). Patients with suspected fractures will undergo radiographic examinations, and those meeting the inclusion criteria will be included in the study after providing informed consent. Arthrocentesis will be performed using a specialised needle with two lumens, inlet and outlet bevels, and a silicone stopper for maximal insertion depth. Statistical analysis will be conducted using descriptive and inferential statistics, specifically the Chi-square test and Student’s paired and Unpaired t-tests, with p-value&lt;0.05 considered significant.

Effects of virtual reality application on pain, anxiety, and vital signs due to port catheter needle insertion: Randomized controlled study.

This study aims to examine the effects of virtual reality applications on pain, anxiety, and vital signs during port catheter needle insertion in adult cancer patients. The research followed a randomized controlled design as intervention and control groups. In the intervention group, patients received virtual reality sessions with five images in addition to routine procedures during the port catheter needle insertion. We measured the pain, anxiety, and vital parameters resulting from the port catheter needle insertion. Assessments were measured twice: at baseline (before port catheter needle insertion, T0) and at the end of the proceduce (after port catheter needle insertion, T1). The virtual reality application significantly reduced the levels of pain (p=0.45) and anxiety (p<0.001) at T1 in the intervention group compared to the control group. The virtual reality application showed no difference between T0 and T1 in the vital parameters of the intervention group. Virtual reality application during the port catheter needle insertion procedure reduced pain levels and anxiety levels in cancer patients. The virtual reality applications to reduce pain and anxiety levels during the port catheter needle insertion procedure can be recommended.

Multiple needle insertion attempts: insights from a US survey of patients and nurses.

Needle insertion, for example for venepuncture or intravenous (IV) cannulation, is a common intervention experienced by patients. However, up to half of venepuncture and IV cannulation procedures fail on the first attempt, resulting in further attempts. Multiple needle insertion attempts can lead to pain and other complications for patients and can take up staff time and increase equipment costs for hospitals, so it is important to ensure that needle insertion practices and outcomes are optimised. This article reports the results of a US survey that aimed to provide an insight into patients' and nurses' perspectives on and experiences of needle insertion. The results show that multiple needle insertion attempts are common and that associated complications have a detrimental effect on patients' satisfaction with the procedure. The results also suggest that patients and nurses are interested in alternatives to needle insertion, such as ultrasound guided IV cannulation or needle-free blood collection. Nurse leaders should be aware of these technologies and consider the implementation of sustainable initiatives to evolve practice.

Measurement of mandibular anatomy associated with inferior alveolar nerve block anesthesia using 3D mandible models reconstructed by CBCT.

The objective was to evaluate the anatomical relationship between the mandibular foramen and surrounding structures using CBCT and to investigate the potential causes of inferior alveolar nerve block (IANB) failure. In this retrospective study, CBCT images of 222 mandibular sides from 111 patients (55 men, 56 women; aged 18-45 years) who underwent CBCT examination at the Shenzhen University General Hospital between January 2018 and December 2020 were analyzed. Three-dimensional models were reconstructed, and measurements of angles and distances related to the mandibular foramen were performed. The presence of a bony protuberance on the medial side of the mandibular ramus was evaluated. Differences between sexes were assessed using paired t tests or Wilcoxon rank-sum tests (α = .05). The angle between the anterior-posterior line of the mandibular ramus and the line connecting the innermost point to the mandibular foramen (angle AP-IF) was significantly greater than zero (P .05), indicating the presence of a bony protuberance. The angle between the midline and the line connecting the mandibular premolar contact point to the mandibular foramen (angle F45MnLP-ML) was 49.69 ± 2.17 degrees in men and 48.19 ± 2.20 degrees in women (P .001). The distance from the occlusal plane to the mandibular foramen was 9.45 ± 3.40 mm in men and 8.28 ± 3.41 mm in women (P = .011). The presence of a bony protuberance on the medial side of the mandibular ramus may contribute to IANB failure. Adjusting the needle insertion angle and height/vertical distance according to the reported measurements may improve IANB success rates. These findings may help clinicians optimize IANB techniques and improve success rates by adjusting needle insertion angles and heights/vertical distances based on individual patient anatomy.

An Ultrasound-Guided Miniature Hand-Eye Integrated Robot for Percutaneous Needle Placement

Abstract Ultrasound-guided percutaneous puncture technology has advantages such as intra-operative real-time imaging, noninvasive operation, high targeting accuracy, nonionizing radiation, and low cost. However, traditional percutaneous puncture surgery requires doctors to hold ultrasound probes or puncture needles, which causes complex operations. In this article, by integrating ultrasound and needle insertion mechanisms, an ultrasound-guided miniature puncture robot is proposed. This robot can work without an external navigation or industrial or cooperative manipulator after hand-eye calibration and acknowledge the coordinate relationship between the ultrasound image and the robot tip. A three degrees-of-freedom (DoFs) of in-plane mechanism using linear actuators is designed so that the puncture needle can always be scanned by ultrasound during the operation, ensuring real-time monitoring. The method of planning puncture path, modeling the robot kinematics, and ultrasound hand-eye calibration are proposed. To track a needle in an ultrasound image, the image recognition and filter algorithm for the needle tip are presented. The accuracy of the robot puncture operation is verified by point targeting and path tracking experiments in the water tank and phantom, and the puncture error of the robot is 1.5 ± 0.5 mm in the water tank, 1.98 mm in the abdominal phantom, and 1.41 mm in the breast phantom. Finally, the work of this article effectively improves the availability and effectiveness of the ultrasound-guided puncture robot.

Xyla-P Cream vs. Lidocaine Spray: Impact on Patient Satisfaction, Anxiety, Cooperation, and Pain in Spinal Anesthesia for Cesarean Section

Background: One of the fundamental principles of medical interventions is to avoid causing pain to patients, and childbirth is no exception. With the rising prevalence of cesarean sections, addressing factors that may diminish maternal satisfaction is crucial. Spinal anesthesia, the most common method for cesarean sections, faces challenges such as patient anxiety. To mitigate pain associated with needle insertion, various methods, including lidocaine spray and Xyla-P cream, have been recommended. Objectives: This study aimed to evaluate the effectiveness of lidocaine spray and Xyla-P cream in reducing pain during needle insertion for spinal anesthesia in cesarean sections. Methods: This randomized, placebo-controlled interventional study included 263 pregnant women at 37 weeks or more of gestational age who were candidates for elective cesarean sections. Participants were randomly assigned to intervention and control groups using a block permutation technique. In intervention group 1, 10 g of Xyla-P cream was applied 30 minutes before spinal anesthesia. In intervention group 2, three puffs of 10% lidocaine spray were used. The control group received three puffs of water spray ten minutes before anesthesia. Pain intensity and anxiety were assessed using the Visual Analog Scale (VAS), and maternal cooperation was scored by the anesthesiologist. Results: The mean age of the participants was 30 years, and 21% had no prior history of cesarean section. There was no significant difference in pain, anxiety, satisfaction, and cooperation between the Xyla-P and lidocaine groups. However, in the group receiving lidocaine, satisfaction (P-value: 0.001) and cooperation (P-value: 0.019) improved significantly compared to the placebo group, whereas anxiety increased significantly compared to the placebo group (P-value: 0.045). Conclusions: Lidocaine had a positive effect on maternal satisfaction with spinal anesthesia and, compared to the placebo, led to significant improvements in maternal satisfaction and cooperation. In light of these findings, lidocaine emerges as a more appropriate choice than Xyla-P cream.

Clinical Application of Deep Learning-Assisted Needles Reconstruction in Prostate Ultrasound Brachytherapy.

High dose rate (HDR) prostate brachytherapy (BT) procedure requires image-guided needle insertion. Given that general anesthesia is often employed during the procedure, minimizing overall planning time is crucial. In this study, we explore the clinical feasibility and time-saving potential of artificial intelligence (AI)-driven auto-reconstruction of transperineal needles in the context of ultrasound (US)-guided prostate BT planning. This study included a total of 102 US-planned BT images from a single institution and split into 3 groups: 50 for model training and validation, 11 to evaluate reconstruction accuracy (test set), and 41 to evaluate the AI tool in a clinical implementation (clinical set). Reconstruction accuracy for the test set was evaluated by comparing the performance of AI-derived and manually reconstructed needles from 5 medical physicists on the 3D-US scans after treatment. The needle total reconstruction time for the clinical set was defined as the timestamp difference from scan acquisition to the start of dose calculations and was compared with values recorded before the clinical implementation of the AI-assisted tool. A mean error of (0.44 ± 0.32) mm was found between the AI-reconstructed and the human consensus needle positions in the test set, with 95.0% of AI needle points falling below 1 mm from their human-made counterparts. Post-hoc analysis showed that only one of the human observers' reconstructions were significantly different from the others including the AIs. In the clinical set, the AI algorithm achieved a true positive reconstruction rate of 93.4% with only 4.5% of these needles requiring manual corrections from the planner before dosimetry. Total time required to perform AI-assisted catheter reconstruction on clinical cases was on average 15.2 min lower (P < .01) compared with procedure without AI assistance. This study demonstrates the feasibility of an AI-assisted needle reconstructing tool for 3D-US-based HDR prostate BT. This is a step toward treatment planning automation and increased efficiency in HDR prostate BT.

Extended Reality Interventions for Health and Procedural Anxiety: Panoramic Meta-Analysis Based on Overviews of Reviews.

Extended reality (XR) technologies are increasingly being used to reduce health and procedural anxieties. The global effectiveness of these interventions is uncertain, and there is a lack of understanding of how patient outcomes might vary between different contexts and modalities. This research used panoramic meta-analysis to synthesize evidence across the diverse clinical contexts in which XR is used to address common outcomes of health and procedural anxiety. Review-level evidence was obtained from 4 databases (MEDLINE, Embase, APA PsycINFO, and Epistemonikos) from the beginning of 2013 until May 30, 2023. Reviews that performed meta-analysis of randomized controlled trials relating to patient-directed XR interventions for health and procedural anxiety were included. Studies that analyzed physiological measures, or focused on technologies that did not include meaningful immersive components, were excluded. Furthermore, data were only included from studies that compared intervention outcomes against no-treatment or treatment-as-usual controls. Analyses followed a preregistered, publicly available protocol. Trial effect sizes were extracted from reviews and expressed as standardized mean differences, which were entered into a 3-level generalized linear model. Here, outcomes were estimated for patients (level 1), studies (level 2), and anxiety indications (level 3), while meta-regressions explored possible influences of age, immersion, and different mechanisms of action. Where relevant, the quality of reviews was appraised using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, Revised Instrument) tool. Data from 83 individual trials were extracted from 18 eligible meta-analyses. Most studies involved pediatric patient groups and focused on procedural, as opposed to general, health anxieties (eg, relating to needle insertion, dental operations, and acute surgery contexts). Interventions targeted distraction-, education-, and exposure-based mechanisms, and were provided via a range of immersive and nonimmersive systems. These interventions proved broadly effective in reducing patient anxiety, with models revealing significant but heterogeneous effects for both procedural (d=-0.75, 95% CI -0.95 to -0.54) and general health (d=-0.82, 95% CI -1.20 to -0.45) indications (when compared with nontreatment or usual-care control conditions). For procedural anxieties, effects may be influenced by publication bias and appear more pronounced for children (vs adults) and nonimmersive (vs immersive) technology interventions, but they were not different by indication. Results demonstrate that XR interventions have successfully reduced patient anxiety across diverse clinical contexts. However, significant uncertainty remains about the generalizability of effects within various unexplored indications, and existing evidence is limited in methodological quality. Although current research is broadly positive in this area, it is premature to assert that XR interventions are effective for any given health or procedural anxiety indication.

Designing and clinical application of a 3D-printed personalized model of a radiofrequency needle guide with a maxillary fixator for puncture of the gasserian ganglion for trigeminal neuralgia treatment.

The purpose of this study was to present a newly designed 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixation for gasserian ganglion (GG) puncture. Implementation of 3D CT-guided radiofrequency therapy of the GG with and without use of 3D PPM was analyzed. The following parameters were assessed: radiation time, dose area product, air kerma reference point, pain severity during the puncture needle insertion, prosopalgia regression degree (according to visual analog scale) and the severity of facial numbness (according to the Barrow Neurological Institute scale) in the early postoperative period, and postpuncture complications. Pain severity reduction was equivalent in both groups, and postoperative facial numbness was not observed. A statistically significant difference in radiation exposure parameters was revealed: radiation time was 181.67 ± 2.99 and 310.50 ± 18.46 seconds (p < 0.001); dose area product was 950.97 ± 115.41 and 1545.48 ± 135.04 µGy*m2 (p < 0.005); and the air kerma reference point was 114.53 ± 16.81 and 190.88 ± 17.48 mGy (p < 0.005) in groups 1 and 2, respectively. The severity of pain during a puncture needle insertion was assessed as mild in 62.5% and 25%, moderate in 37.5% and 41.6%, and severe in 0% and 33.3% of patients in groups 1 and 2, respectively. No serious perioperative complications were observed. The use of 3D PPM allows for controlled needle insertion, reducing the radiation dose to the patient and medical staff, reducing pain during a puncture needle insertion into the area of the foramen ovale, and minimizing the risk of postoperative complications.

In vivo Safety and Feasibility of a Computed Tomography-Guided Robotic Device for Percutaneous Needle Placement in Bone.

To evaluate the feasibility and accuracy of a robotic device used clinically in soft tissues (abdomen and lung), modified in design and workflow, to perform needle insertion in percutaneous bone procedures. The primary objective was safety (severe complications) of robotic-assisted insertion in this new application. Secondary objectives were feasibility (placement technical success), performance (acceptable insertions rate), accuracy (lateral deviation), number of intermediate CT-scans and tolerance (minor/moderate complications). Robotic-assisted insertions were performed by six interventional radiologists on three male pigs under general anaesthesia. Needle trajectory was planned on the device software, then needles were inserted with robotic guidance to reach the cortical bone; an intermediate CT-scan was then performed to verify needle direction; if needed, the trajectory was modified, and robotic-assisted modified insertion to target was performed. As many intermediate CT scans and trajectory modifications as needed by the operator were allowed. 28 needles were inserted (10 spine, 18 pelvis). No complication was reported. Technical success rate was 96.4% (27/28). One insertion was not feasible after several robotic attempts. The placement success rate was 100% (27/27). After the planned intermediate CT-scan, 13/27 (48.1%) trajectories did not require any modification, and 11/27 trajectories (40.7%) required a single modification. One needle was removed and replaced to achieve correct placement. Placement accuracy was similar for spinal and pelvic insertions, with a mean lateral deviation of 2.1 mm (±1.3). Pre-clinical robotic-assisted needle insertions in bone were safe and feasible, with satisfactory accuracy. A multicentre first-in-human study is on-going to evaluate feasibility and safety for percutaneous bone ablation and consolidation procedures.

Robot-Assisted CT-guided Biopsy with an Artificial Intelligence-Based Needle-Path Generator: An Experimental Evaluation Using a Phantom Model.

To investigate the feasibility of a robotic system with artificial intelligence-based lesion detection and path planning for CT-guided biopsy, compared to the conventional freehand technique. Eight nodules within an abdominal phantom, incorporating the simulated vertebrae and ribs, were designated as targets. A robotic system was used for lesion detection, trajectory generation, and needle-holder positioning. Four interventional radiologists with over 5 years of experience and four with 5 years or less performed 96 robot-assisted insertions encompassing both in-plane and out-of-plane trajectories. Additionally, 32 CT fluoroscopy-guided freehand needle insertions were performed along the in-plane trajectories. The three-dimensional (3D), lateral, depth deviations, and insertion time were quantified using post-needle insertion CT scans. Statistical analysis was performed using the unpaired t-test or one-way analysis of variance, with a significance level of P<0.05. The system detected all the target lesions and generated appropriate needle paths. Robot-assisted insertions exhibited significantly smaller 3D and depth deviations than freehand insertions (3.8 ± 1.3 vs. 4.7 ± 1.6 mm, P = 0.001 and 1.8 ± 1.2 vs. 2.6 ± 1.8 mm, P = 0.005, respectively). No significant difference was observed in lateral deviations (3.0 ± 1.5 vs. 3.5 ± 1.5 mm, P = 0.118). Robotic assistance significantly reduced insertion time compared to freehand insertion (17.3 ± 7.8 vs. 78.6 ± 38.1 sec, P < 0.001). The same trends were observed between the two groups of radiologists. The robotic system has the potential to shorten puncture time while maintaining sufficient accuracy in CT-guided procedures.

Pilot Study of a Modified DOPS Scale for Insulin Pump and CGM Installation Training in Chinese Medical Students During Endocrinology Rotations.

Direct Observation of Procedural Skills (DOPS) is a clinical assessment tool that enables trainers to observe medical students' procedural abilities in real-time clinical settings. It assesses students' knowledge application, decision-making, and skill proficiency during clinical tasks. This study modifies the DOPS to evaluate the operation of insulin pumps (PUMP) and continuous glucose monitoring systems (CGMS) in diabetes management. Key elements of the modified DOPS include 1) Knowledge Assessment: Evaluating understanding of PUMP and CGMS, including interpreting CGMS data for insulin adjustments; 2) Operational Skills: Assessing correct PUMP needle insertion, programming, and adjustments; 3) Patient Safety: Ensuring safe and aseptic procedures; 4) Feedback: Providing constructive feedback to help students improve their skills. Training through DOPS led to significant improvements in all domains, overall performance scores, and reduced execution time for each domain. Correlations between domains showed that PUMP indication scores were linked to all other domains and execution times, including re-evaluation. Communication skills and seeking assistance were crucial factors influencing other domains. Multilinear regression analysis revealed that while DOPS-CGMS (R square 1.0) fully explained performance scores, DOPS-PUMP (R square 0.984) indicated that additional personal qualities significantly impacted students' PUMP operation performance. This customized DOPS form offers insights into students' abilities in managing diabetes with PUMP and CGMS, while emphasizing the need for training on both technical skills and interpersonal skills in future educational models.

Ultrasonographic Measurement of Skin to Lumbar Epidural Space Depth in Pregnant Women Undergoing Elective Cesarean Section: An Observational Study

Introduction: Neuraxial anesthesia is commonly used during cesarean delivery and is preferred for its effectiveness and minimal risks. Accurate identification of the depth of the lumbar epidural space is crucial to ensure successful block and minimize complications. However, this can be challenging in pregnant women due to physiological changes that affect the anatomy of the lumbar spine. Ultrasound is a helpful device for providing real-time visualization of the relevant anatomical structures and facilitating accurate needle insertion. In this study, we evaluated the utility of ultrasound in determining the depth from the skin to the lumbar epidural space in pregnant women undergoing elective caesarean section.Methods: This is an observational cross-section study performed after approval from Institutional Review Committee (Reference number:09062023/03). Using a curvilinear ultrasound probe, imaging of spine at lumbar third and fourth intervertebral space was performed. The measurements were performed in the sitting position with the patients' backs flexed in the parasagittal oblique and transverse median view to determine the distance from the skin to the lumbar epidural space. Results: The mean depth from the skin to the lumbar epidural space/posterior complex in the parasagittal oblique view was 46.84±7.18 mm (95% CI: 45.48-48.20), and transverse median view was 45.27±8.16mm (95% CI: 43.73-46.81). Conclusions: The skin-to-lumbar epidural space depth in pregnant women undergoing elective cesarean section was comparable to other studies conducted in similar settings.

Accurate Needle Localization in the Image Frames of Ultrasound Videos

Ultrasound imaging provides real-time guidance during needle interventions, but localizing the needle in ultrasound videos remains a challenging task. This paper introduces a novel machine learning-based method to localize the needle in ultrasound videos. The method comprises three phases for analyzing the image frames of the ultrasound video and localizing the needle in each image frame. The first phase aims to extract features that quantify the speckle variations associated with needle insertion, the edges that match the needle orientation, and the pixel intensity statistics of the ultrasound image. The features are analyzed using a machine learning classifier to generate a quantitative image that characterizes the pixels associated with the needle. In the second phase, the quantitative image is processed to identify the region of interest (ROI) that contains the needle. In the third phase, the ROI is processed using a custom-made Ranklet transform to accurately estimate the needle trajectory. Moreover, the needle tip is identified using a sliding window approach that analyzes the speckle variations along the needle trajectory. The performance of the proposed method was evaluated by localizing the needle in ex vivo and in vivo ultrasound videos. The results show that the proposed method was able to localize the needle with failure rates of 0%. The angular, axis, and tip errors computed for the ex vivo ultrasound videos are within the ranges of 0.3–0.7°, 0.2–0.7 mm, and 0.4–0.8 mm, respectively. Additionally, the angular, axis, and tip errors computed for the in vivo ultrasound videos are within the ranges of 0.2–1.0°, 0.3–1.0 mm, and 0.3–1.1 mm, respectively. A key advantage of the proposed method is the ability to achieve accurate localization of the needle without altering the clinical workflow of the intervention.

Comparison of Thoracolumbar Interfascial Plane-to-Skin Distances at Different Lumbar Levels and Positions Under Ultrasonography

Background: This study aimed to determine the optimal lumbar level and patient position for performing the thoracolumbar interfascial plane (TLIP) block by evaluating the distance between the thoracolumbar interfascial plane and the skin using ultrasound guidance. Additionally, we explored the influence of body mass index (BMI) on this distance. Materials and Methods: Eighty patients aged 18 to 65 years undergoing upper lumbar region surgery were evaluated. The thoracolumbar interfascial plane-to-skin distance was measured at L1 and L3 levels in three po-sitions: sitting, lateral, and prone, using a high-frequency ultrasound probe. Measurements were conducted without needle insertion, ensuring clarity and accuracy. Patient demographics, including age and body mass index (BMI), were recorded and analyzed to assess their impact on these measurements. Results: The thoracolumbar interfascial plane was significantly closer to the skin at the L1 level compared to L3 across all positions (p&amp;lt;0.01). Among the positions, the prone position provided the closest plane-to-skin dis-tance and the clearest ultrasound image, allowing better visualization of anatomical landmarks. Conversely, the sitting position produced the poorest image quality and was the least comfortable for patients. Furthermore, a moderate positive correlation was found between BMI and the thoracolumbar plane-to-skin Conclusions: Our findings suggest that the L1 level and prone position are optimal for TLIP block application, offering clearer imaging and easier block administration. For obese patients, the prone position is particularly advantageous as it reduces the skin-to-plane distance, potentially minimizing procedural difficulty and compli-cation risks. These insights contribute to the optimization of TLIP block techniques, especially in patient popu-lations with higher BMI. Further studies are recommended to confirm these findings and expand clinical appli-cations.

Evaluating virtual reality anatomy training for novice anesthesiologists in performing ultrasound-guided brachial plexus blocks: a pilot study.

Developing proficiency in ultrasound-guided nerve block (UGNB) demands an intricate understanding of cross-sectional anatomy as well as spatial reasoning, which is a big challenge for beginners. The aim of this pilot study was to evaluate the feasibility of virtual reality (VR)-facilitated anatomy education in the first performance of ultrasound-guided interscalene brachial plexus blockade among novice anesthesiologists. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial. Twenty-one anesthesia trainees with no prior ultrasonography or nerve block training were included in this study. All participants underwent a training program encompassing theory and hands-on practice. Trainees were randomized into one of two groups: one received VR-assisted anatomy course while the other did not. Subsequently, both groups completed identical practical modules on ultrasound scanning and needle insertion. The primary end point was defined as the evaluation of trainees' performance during their initial ultrasound-guided interscalene brachial plexus block, assessed using both the Global Rating Scale (GRS) and a task-specific Checklist. The secondary end point included the improvement in scores for written multiple-choice questions (MCQs). In evaluating practical ultrasound-guided nerve block skills, the VR group significantly outperformed the control group on the task-specific Checklist (29.23 ± 3.91 vs. 24.85 ± 5.13; P < 0.05), while both groups showed comparable performance on the GRS. Additionally, post-theoretical course MCQ scores increased substantially, with post-test results significantly surpassing pre-test scores in both groups (P < 0.001). However, intergroup analysis indicated no significant difference in score improvements between the VR and control groups (21.82 ± 12.30 vs. 18.33 ± 9.68, P > 0.05). Overall, the findings of this pilot study suggest that immersive virtual reality training in anatomy may contribute to improving the proficiency of ultrasound-guided brachial plexus blocks among novice anesthesiologists. Incorporating VR into future anesthesia technique training programs should be considered. ClinicalTrials.gov identifier: ChiCTR2300067437. Date of Registration Jan 9, 2023.

Treatment of sudden sensorineural hearing loss with tinnitus with Fu subcutaneous needling: A case report.

Fu's subcutaneous needling (FSN) is a special acupuncture method that uses FSN to sweep the subcutaneous tissue around or adjacent to the limbs to disperse the pain. Sudden sensorineural hearing loss (SSHL) is a kind of otological emergency with sudden onset within 72 hours, with unilateral hearing loss, and hearing loss of ≥20 dB in 2 connected frequencies, and most of the patients have no obvious triggers. Most patients with SSHL are accompanied by tinnitus, vertigo, and nausea and vomiting. The patient suffered from hearing loss with tinnitus. Although received relevant treatment, the hearing loss and tinnitus did not improve significantly. SSHL with tinnitus. FSN treatment. A point 5 cm lateral to the point of tension and stiffness of the left trapezius muscle was selected on the affected back as the needle insertion point, and the condition of the neck muscles was improved through the FSN sweeping movement with neck reperfusion activities. The patient received treatment twice a week, and 4 weeks of treatment as a phase. At the end of each phase, a pure tone threshold audiometry, tinnitus evaluation scale Tinnitus Handicap Inventory assessment, and neck muscle palpation were performed. The patient's hearing improved and the Tinnitus Handicap Inventory score decreased. FSN has a good therapeutic effect on SSHL with tinnitus.

Design and 3D printing of pelvis phantoms for cementoplasty.

Percutaneous image-guided cementoplasty is a medical procedure for strengthening bones structurally altered by disease, such as osteolytic metastasis. This procedure involves injecting biocompatible liquid bone cement, through one or more trocars into the damaged bone. Within a few minutes the bone cement hardens and restores the rigidity of the bony structure. The introduction of this technique in the case of large cancellous bones, such as the pelvis, raises some practical issues such as: how to manage the flow of cement with variable viscosity over time and how to inject a large amount of cement under fluoroscopy to effectively restore the patient's ability to bear weight? As a means of training for young practitioners to ensure maximal filling of a metastatic bone area, we have designed and manufactured a pelvic phantom capable of replicating cement diffusion in healthy and metastatic bone under fluoroscopic and computed tomographyguidance. The preliminary stage of the study consisted of an analysis of various lattice structures, with the objective of reproducing the haptic feedback experienced during the needle insertion and diffusion of cement within the trabecular bone. Cementoplasty tests were conducted by an experienced radiologist under fluoroscopy and CT guidance to evaluate the performance of the lattice structure. The initial analysis provided the groundwork for the design of the phantom pelvis, which was then evaluated against a patient case. The phantom was divided into two distinct components: a disposable sectionwith lattice structure, intended for the injection of cement, and a reusable part representing the pelvic bones. Two additive manufacturing methods were selected for the production of the phantom: Stereolithography (SLA) for the lattice structure and Fused Deposition Modeling (FDM) for the pelvic bones. The disposable component was composed of different lattice structures, selected to best match the anatomic conditions of both healthy and diseased areas visible on the patient images. Subsequently, the performance of the phantom was validated against patient images through a cementoplastytest. A total of 12 distinct lattice structures were subjected to three tests of cementoplasty. Stochastic lattices with 500 microns beam thickness and densities varying from 15% to 5% demonstrated the most effective replication of the needle haptic feedback, as well as the diffusion of the cement into healthy and osteolytic cancellous bone. These structures were then implanted in the phantom and validated against one patientcase. A methodology to design and manufacture a phantom dedicated to cementoplasty from patient images is proposed. Initially, a series of lattice structures, exhibiting diverse structure types, thicknesses, and densities, were evaluated to assess their capacity to accurately reproduce the haptic feedback of the needle and the diffusion of cement in the trabecular bone. Subsequent to the outcomes of these investigations, several structures were selected for the development of a phantom capable of accurately replicating a cementoplasty procedure under fluoroscopy and CT guidance. This phantom will enable the training of future practitioners on the procedure of cementoplasty in thepelvis.

Path planning for flexible needle based on both insertion mechanism kinematics and needle bending model.

Due to the limited operating space in the magnetic resonance (MR) environment, there is coupled motion in the insertion mechanism, which not only reduces the flexibility of the robot but also challenges the insertion path planning. Meanwhile, the path planning is also restricted by the bending rule of the flexible needle, thus the bending model of the needle is also essentially built. This paper proposes a path planner for the flexible needle based on both the coupled motion kinematics of the insertion robot and the bending model of the flexible needle. A kinematic analysis for the coupled motion of insertion robot is performed. And the bending model of flexible needle is established based on the needle-tissue interactions. The position and posture of the needle insertion at the entry point are obtained by the calculation of the target position and the analysis of the bending model. And the rotation or translation coordinates of each robot joint are calculated by the inverse kinematics of the insertion robot. Then the path planning based on the coupled kinematics and the bending model is realized. The insertion experiments were performed for each target of G1 and G2. The root mean square errors were 0.83 mm and 0.74 mm, and the maximum errors were 1.1 mm and 0.9 mm for G1 and G2, respectively. The experimental results show that the effectiveness and accuracy of the path planning can meet the requirements for a general minimally invasive surgery, so the proposed path planning algorithm is feasible. This study provides a new solution for the path planning of insertion robots for the minimally invasive surgery. This method can meet the insertion mechanism working within the limited operating space in the MR environment and has a high application value in future clinical medicine.