Ultrasound-guided Interventional Procedures Research Articles

Resident training in interventional pathology: Ultrasound-guided fine-needle aspiration and rapid on site evaluation-5 years of teaching experience in a single university hospital.

Despite the established role of the interventional pathologist, their diagnostic performance is difficult to establish. At least in Spain training of pathology residents in ultrasound-guided interventional procedures for specimen collection is limited or absent in most institutions. We present our teaching experience in the instruction of ultrasound-guided fine-needle aspiration (FNA) to pathology residents in a tertiary-level hospital. The training of pathology residents who rotated through the interventional unit of the pathology department and the application of ultrasound-guided FNA and rapid on-site evaluation (U-ROSE) was documented over 5 years. The training period was broken down into learning phases and included the number of ultrasound-guided FNA performed, anatomical location, and their diagnostic performance, among other aspects. Nineteen (19) pathology residents were trained in U-ROSE, and performed a total of 4003 procedures, with a mean of 211 per resident. In 53% of cases only one pass was required for an adequated sample. The specimen was diagnostic in more than 97% of cases. The most frequently sampled anatomical sites were the thyroid gland (n = 2347), followed by lymph node (n = 667), soft tissues (n = 663) and salivary glands (n = 322). The results support the training programme followed by pathology residents in learning U-ROSE, which is essential to lay the foundations for the future interventional pathologist.

Musculoskeletal Radiology Education: A National Survey by the Italian College of Musculoskeletal Radiology.

Our aim was to understand how musculoskeletal training is structured in Italian residency programmes and the needs of young trainees. We sent out an online questionnaire (17 questions) to Italian Society of Radiology residents and board-certified radiologists aged up to 39 years. A total of 1144 out of 4210 (27.2%) members participated in the survey; 64.7% were residents and 35.3% were board-certified radiologists. Just 26.6% of participants had dedicated rotations for musculoskeletal training during their residency, although this percentage substantially increased in replies from northern Italy. One-fourth of residents had a scheduled period of musculoskeletal ultrasound. Most participants (76.3%) had <20 h per year of musculoskeletal lessons. The majority considered their musculoskeletal education poor (57.7%) or average (21.9%). According to 84.8% of replies, no dedicated training period about interventional musculoskeletal procedures was scheduled. Further, just 12.8% of residents took active part in such interventions. Nearly all participants believed that the musculoskeletal programme during residency needs to be improved, particularly concerning practices in ultrasound (92.8%), MRI cases interpretation/reporting (78.9%), and practice in ultrasound-guided interventional procedures (64.3%). Despite some differences in the structure of musculoskeletal education provided by different regions, there is a shared demand for improvement in musculoskeletal training.

Tips and tricks in ultrasound-guided musculoskeletal interventional procedures.

Ultrasound visualization affords proceduralists versatile and accurate guidance for a variety of percutaneous, minimally invasive procedures in the musculoskeletal system including joint (intra-articular) injections or aspirations, intra-bursal injections, peritendinous, and perineural injections. A variety of percutaneous procedures are traditionally performed blindly, but may be more easily or more accurately performed with the real-time assistance of ultrasound guidance. Other procedures are only possible utilizing image-guidance, due to the required precision of the injection because of delicate local anatomy or depth of the injection; ultrasound is a safe, portable, and widespread modality that can be used to assist the proceduralist in localizing the needle tip in such cases, to ensure safe and accurate delivery of the medication, most frequently a solution of steroid and anesthetic. This review aims to provide a foundational approach to ultrasound-guided procedures in the musculoskeletal system, offering tips and tricks that can be employed in many different procedures including intra-articular, juxta-articular, and perineural injections for a multitude of clinical scenarios. Technical considerations regarding ultrasound transducer selection, sonographic technique, as well as common indications, contraindications, and complications of these procedures, are presented. Additionally, a variety of pharmacologic considerations for proceduralists contemplating ultrasound-guided injections are discussed.

Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain.

In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

Ultrasound-guided interventional procedures in the musculoskeletal system

Ultrasound-guided interventional procedures in the musculoskeletal system

Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain.

In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

Ultrasound-guided Musculoskeletal Interventional Procedures Around the Hip: A Practical Guide.

Several studies have shown that ultrasound guidance may contribute to improved safety, effectiveness and accuracy of musculoskeletal interventional procedures performed around the hip if compared to those performed with a landmark-guided technique. Different approaches and injectates can be used for treating hip musculoskeletal disorders. These procedures may involve injections in the hip joint, periarticular bursae, tendons, and peripheral nerves. Intra-articular hip injections are mostly used as a conservative approach for treating patients affected by hip osteoarthritis. Ultrasound-guided injection of the iliopsoas bursa is performed in patients with bursitis and/or tendinopathy, to treat those with painful prosthesis due to iliopsoas impingement, or when the lidocaine test is indicated to identify the iliopsoas as a source of pain. Ultrasound-guided interventions are routinely used in patients with greater trochanteric pain syndrome having as target the gluteus medius/minimus tendons and/or the trochanteric bursae. Ultrasound-guided fenestration and platelet-rich plasma injection are applied in patients with hamstring tendinopathy with good clinical outcomes. Last but not least, ultrasound-guided perineural injections can be used for peripheral neuropathies or blocks of the sciatic, lateral femoral cutaneous, and pudendal nerves. In this paper, we discuss the evidence and technical tips for musculoskeletal interventional procedures performed around the hip, highlighting the added value of ultrasound as an imaging guidance modality.

Recent trends in chronic pain medicine.

Chronic pain presents as an unequalled challenge for physicians, owing to the complexity of biochemical and biological pathways involved in pain transmission and high variability of pain perception among individuals. Often, there is an inadequate response to conservative treatment, and opioid treatment has its own drawbacks, such as side effects and opioid dependence. Hence, novel strategies have evolved for the effective and safe management of chronic pain. Radiofrequency technique, regenerative biomaterial, platelet-rich plasma, mesenchymal stem cells, reactive oxygen species scavenger nanomaterial, ultrasound-guided interventional pain management procedures, endoscopic spinal procedures, vertebral augmentation therapy, and neuromodulation are some of the promising and upcoming modalities in the armamentarium of pain physicians.

Ultrasound-Guided Intervention for Breast Lesions

The role of ultrasound-guided interventions in the diagnosis and treatment of breast lesions is gaining importance and prevalence, particularly as the instances of non-palpable breast lesion detection, breast-conserving surgery, and neoadjuvant chemotherapy are increasing. This review attempts to summarize the types and techniques of breast ultrasound-guided interventional procedures, such as biopsy, tissue marker insertion, and preoperative localization, and their indications. Furthermore, we highlight the pro and cons of the most commonly used procedures with the intention of promoting their use in clinical practice.

Longitudinal Ultrasound-Guided Injection Curriculum for Physical Medicine and Rehabilitation Residents.

Physiatrists are increasingly using musculoskeletal ultrasound for both diagnostic and therapeutic purposes. However, a standardized longitudinal curriculum for instructing physical medicine and rehabilitation residents in performing ultrasound-guided interventional procedures has yet to be established. The purpose of this study is to develop and assess the effectiveness of a longitudinal curriculum in training residents to perform common ultrasound-guided musculoskeletal injections using fresh-frozen cadaveric specimens. The course included six weekly hands-on educational sessions, divided by anatomical region, integrated into an established anatomy and physical examination curriculum. After completion of the curriculum, residents reported improved comfort and confidence and displayed improved competence in performing these injections. Other physiatry residency programs should consider implementing longitudinal, hands-on cadaveric training courses to better prepare trainees to perform ultrasound-guided injections as part of their future clinical practice.

Current concepts in the diagnosis and treatment of adhesive capsulitis: role of diagnostic imaging and ultrasound-guided interventional procedures.

Adhesive capsulitis is a common cause of painful shoulder, characterized by pain and restricted range of motion of the glenohumeral joint. With a well-known clinical presentation, and an increasing understanding of its clinical and radiologic features, early diagnosis of adhesive capsulitis is becoming a reality. Although often treated conservatively, for refractory cases arthroscopic release and open capsulotomy have been the only therapeutic option for a long time. Therefore, in the last years, a particular effort was put into the development of novel minimal-invasive techniques capable of pain relief and functional range improvement of the glenohumeral joint. The purpose of this literature review is to report the main updates on diagnosis and treatment for adhesive capsulitis with a focus on imaging diagnosis techniques and novel minimally invasive ultrasound-guided treatments. Results showed that ultrasound-guided procedures come with a high success rate in terms of pain reduction and improved range of motion, thus making the ultrasound a unique tool capable of giving the operator real-time diagnostic information confirming the clinical suspicion, and subsequently performing an interventional procedure.

Role of ultrasound-guided technique in the treatment of gynecologic diseases: A systematic review and meta-analysis.

The efficacy and safety of ultrasound-guided interventional procedures for gynecologic diseases have not been evaluated comprehensively. Therefore, we aimed to provide an evidence-based medical reference for clinical treatment in this meta-analysis. The literature searches were conducted in databases of PubMed, Embase, and Web of Science for eligible studies published from 2002 to May 2022. All literature was searched, screened, and reviewed by 2 researchers separately. RevMan 5.3.0 was used to analyze the relevant data. A total of 12 articles consisting of 2854 patients were included. Compared with the control group, meta-analysis showed that ultrasound-guided technique in the experimental group was associated with a higher effective rate [risk ratio = 0.84, 95% confidence interval (CI) (0.84, 0.84)], a lower probability of recurrence [odds ratio = 0.13, 95% CI (0.13, 0.13), P < .00001], and a greater effective reintervention rate [odds ratio = 3.39, 95% CI (1.29, 8.86), P = .01]. However, it was not significantly associated with fewer adverse reactions. Ultrasound-guided technique in treating gynecologic diseases exerted a positive effect and had fewer adverse reactions, which could be popularized and applied in clinical practice.

Urgent ultrasound-guided interventional procedures

Interventional radiology procedures have become a fundamental part of radiology, resulting in faster diagnoses and in safer, more effective, and more precise treatments, all of which are important, and even more so when referring to urgent situations, where time is of the essence. In this context, the use of ultrasound to guide interventional procedures enables real-time viewing in multiple planes that can be done at the patient’s bedside, which is a great advantage in critical patients. We review the indications and technical aspects of the most common procedures related with radiological care of urgent patients.

Ultrasound-guided interventional radiology procedures on veins

Although ultrasound-guided interventional procedures have resulted in great advances in many fields of medicine, this approach has revolutionized endovascular procedures.This paper aims to review the basic principles to develop a strategy to follow in ultrasound-guided treatments of varices in the lower limbs, as well as to provide a brief overview of the main endovenous techniques available nowadays.We divide these techniques into those that use catheters to occlude straight saphenous axes (thermal / non-thermal ablation) and other options, such as foam sclerotherapy, which can be used in all types of varices, even in those originating in the pelvis.

Ultrasound-guided interventional procedures in breast imaging

Interventional procedures have become a routine part of breast imaging unit’s activity. Most interventional procedures in breast imaging are done under ultrasound guidance.The list of ultrasound-guided interventional procedures performed by breast imaging units is long. This chapter will review the different techniques, placing emphasis on the most cost-effective indications.

Intervencionismo ecográfico en imagen mamaria

Interventional procedures have become a routine part of breast imaging unit's activity. Most interventional procedures in breast imaging are done under ultrasound guidance.The list of ultrasound-guided interventional procedures performed by breast imaging units is long. This chapter will review the different techniques, placing emphasis on the most cost-effective indications.

Fabrication of Low-cost Realistic Three-dimensional Static Kidney Phantom for Ultrasound-guided Biopsy Applications.

Background:The rapid growth of using ultrasound-guided interventional procedures, including biopsy and drainage, which considered painful procedures, leads to improving the practice cycle of ultrasound-guided procedures. Fabrication of low-cost tissue-mimicking phantoms that serve as a training tool medium for kidney needle biopsy procedures has dramatically overcome the drawbacks associated with these practices, such as reducing the number of miss lesions, medical errors, and recurrence rate as well as these phantoms are widely available and considered a good substitute for cadavers which were not always available and relativity expensive. However, several drawbacks are associated with current kidney phantom models, mainly the short shelf life and the high fabrication cost.Methods:This study aims to fabricate a realistic three-dimensional static mature human kidney phantom from low cost and available material for training on ultrasound-guided interventional procedures mainly biopsy test; the material used to fabricate our model is the gelatin-agar mixture.Results:This model proved that it is a tissue-mimicking material by measuring their acoustic properties which nearly the same as real human kidney tissue.Conclusion:The results of practicing interventional procedures on our phantom model showed good and easy uses for interventional procedures training as well as make it a preferable and economically affordable model.

Ultrasound-guided interventional radiology procedures in the chest

Ultrasonography is a very good tool for guiding different interventional procedures in the chest. It is the ideal technique for managing conditions involving the pleural space, and it makes it possible to carry out procedures such as thoracocentesis, biopsies, or drainage. In the lungs, only lesions in contact with the costal pleura are accessible to ultrasound-guided interventions. In this type of lung lesions, ultrasound is as effective as computed tomography to guide interventional procedures, but the rate of complications and time required for the intervention are lower for ultrasound-guided procedures.

Ultrasound Guided Core Breast Biopsies

Core needle biopsies are common procedures performed in breast imaging centers. Utilizing ultrasound guidance for biopsy of suspicious findings within the breast and axilla is the standard of care when lesions are visible on ultrasound. Most ultrasound guided breast biopsies are performed by radiologists interpreting breast imaging who correlate findings across modalities including mammography, ultrasound and breast MRI, however interventional radiologists may perform in some practice settings. Appropriate knowledge of complete breast imaging is important not only for localization, but for determining radiologic-pathologic concordance. Proper localization, technique, and post biopsy management are essential to the success of the procedure and providing proper care for patients. This article discusses indications, strategies for accurate targeting, how-to biopsy techniques, post biopsy considerations and radiologic-pathologic concordance incorporating recommendations from the American College of Radiology Practice Parameter for the Performance of Ultrasound-guided Percutaneous Breast Interventional procedures.

New ultrasound-guided techniques in chronic pain management: an update.

The introduction of ultrasound guidance in interventional pain management leads to the development of new interventional pain management techniques. Ultrasound-guided (UG) interventional pain management is rapidly developing and increasingly more commonly used, due to its many advantages over traditional radiologic imaging modalities. This review will summarize recent literature around novel interventional pain techniques with ultrasound guidance published over the last 18 months. Many new interventional pain management methods have been described in the last few years in the literature. The use of ultrasonography in interventional pain management played a crucial role in these developments. This review includes newly described interventional methods in the literature. The review particularly focussed on the methods that are used to treat the pain in the hip, shoulder, knee, and lumbar area. These new techniques hold promise for significant improvements in the efficacy and safety of interventional pain management. There have been many innovations in UG interventional procedures, however, some of them require more rigorous validation before their widespread use.