Ultrasound-guided Needle Placement Research Articles

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study.

Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface. We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle. A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted (safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed. The ultrasound-guided technique was associated with a significantly higher accuracy (p < 0.001) but without differences in safety (p = 0.249) as compared to the palpation-guided procedure. Our results suggest that ultrasound-guided insertion exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis.

Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Patellar Tendon: A Cadaveric Study.

For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa's fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended.

Robot-assisted Laparoscopic Excision of Abdominal Wall Endometrioma Utilizing Intraoperative Ultrasound and Transabdominal Needle Placement

In patients with endometriosis, extra pelvic endometriosis is estimated to have an incidence of 11% and a rare subset of extra pelvic lesions include abdominal wall endometriosis with an incidence of 0.03-3.5%1,3. Evaluation for and surgical management of abdominal wall endometriosis is an essential skillset for the advanced gynecologic surgeon. In this video, we demonstrate a surgical technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intraoperative ultrasound-guided needle placement. Description and demonstration of surgical technique. Patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain. Tertiary care, academic center INTERVENTIONS: Intraoperative ultrasound-guided needle placement to map location and boundaries of the lesion followed by minimally invasive resection of the lesion with the intermittent advancement and withdrawal of needles to confirm clear margins. Minimally invasive resection of abdominal wall endometriosis using intraoperative ultrasound guided needle placement is an effective technique to guide surgical dissection and allow for clear surgical margins and successful treatment of this rare condition.

Precision of Ultrasound-Guided versus Anatomical Palpation-Guided Needle Placement of the Ulnar Nerve at the Cubital Tunnel: A Cadaveric Study.

Percutaneous electrical stimulation has been performed for years with only the assistance of anatomical landmarks. The development of real-time ultrasonography guidance has improved the precision and safety of these percutaneous interventions. Despite ultrasound-guided and palpation-guided procedures being performed routinely for targeting nerve tissues in the upper extremity, the precision and safety of these techniques are unknown. The aim of this cadaveric study was to determine and compare the precision and safety of ultrasound-guided versus palpation-guided needling procedure with and without the handpiece of the ulnar nerve on a cadaveric model. Five physical therapists performed a series of 20 needle insertion tasks each (n = 100), 10 palpation-guided (n = 50) and 10 ultrasound-guided (n = 50) on cryopreserved specimens. The purpose of the procedure was to place the needle in proximity to the ulnar nerve at the cubital tunnel. The distance to target, time performance, accurate rate, number of passes, and unintentional puncture of surrounding structures were compared. The ultrasound-guided procedure was associated with higher accuracy (66% vs. 96%), lower distance from needle to the target (0.48 ± 1.37 vs. 2.01 ± 2.41 mm), and a lower frequency of perineurium puncture (0% vs. 20%) when compared with the palpation-guided procedure. However, the ultrasound-guided procedure required more time (38.33 ± 23.19 vs. 24.57 ± 17.84 s) than the palpation-guided procedure (all, p < 0.001). Our results support the assumption that ultrasound guidance improves the accuracy of needling procedures on the ulnar nerve at the cubital tunnel when compared with palpation guidance.

Accuracy of Ultrasound-Guided Needle Placement on the L5 Lumbar Nerve Root: A Cadaveric Study.

The aims of the study are to analyze and describe the accuracy of an ultrasound-guided approach to target the L5 root in cadaveric specimens and evaluate whether gender differences exist. A cross-anatomical study on 40 cadaver L5 nerve roots was performed. A needle was introduced until contacting the L5 nerve root using ultrasound guidance. After that, specimens were frozen and studied by a cross-anatomical view to see the needle's path. The angulation, length, distance from the vertebral spine, the relevant ultrasound anatomical references, and the accuracy of the procedure were evaluated. The needle tip reached the L5 root at a 72.5% rate. The mean angulation degrees of the needle relative to the skin surface were 75.53 ± 10.17 degrees, the length of the needle inserted was 5.83 ± 0.82 cm, and the distance from the vertebral spine to the point of entry of the needle was 5.39 ± 1.44 cm. An ultrasound-guided technique can potentially be an accurate technique to perform invasive procedures on the L5 root. There were statistically significant differences between males and females in the length of the needle introduced. If the L5 root is not clearly visualized, ultrasound will not be the technique of choice.

Teaching Accuracy through Repeated Gamified Echography Training (TARGET): Assessment of an Ultrasound Skill Simulator in Teaching Ultrasound-Guided Needle Placement, a Prospective Observational Study.

The increasing use of ultrasound in veterinary private practice and demand for skilled operators upon graduation has placed an increased burden on the ever-dwindling number of academic radiologists. Simulation-based medical education can help prepare for and consequently reduce this burden, allowing for the acquisition of clinical skills through deliberate practice in a safe, controlled, and low-stakes environment. Ultrasound-guided fine needle placement is the foundation for more advanced interventions such as ultrasound-guided fine needle aspirates and centeses. A reusable novel ultrasound skill simulator consisting of metal targets wired to a circuit and suspended in ballistics gel was created to teach ultrasound-guided fine needle placement. Forty-seven second-year veterinary students watched an instructional video and performed two ultrasound-guided fine needle placement skill tests on the simulator with a period of practice between. Significant improvement in time to task completion (p = .0021) was noted after the period of practice. The majority of student feedback was positive with 89% (42/47) indicating they would use the simulator again to practice and that it should be incorporated into the curriculum, 74% (35/47) indicating their basic skills, knowledge, and confidence using ultrasound improved using the simulator, and 55% (26/47) indicating they could now teach this skill to a peer. The authors suggest further development of this model for ease of manufacture and increased variation in difficulty, and veterinary curriculum incorporation for basic ultrasound-guided fine needle placement training.

Needle Placement for Robot-assisted 3D-guided Ultrasound Breast Biopsy: A Preliminary Study

This work describes a new robot-assisted three-dimensional ultrasound-guided needle placement for breast biopsy to improve cancer diagnosis by automating needle trajectory, simplifying manual insertion and alleviating radiologist fatigue. In this way, basic robot requirements were first determined based on linking a free-hand ultrasound-guided breast biopsy with a whole-breast volumetric reconstruction system as part of a clinical workflow for breast cancer diagnosis. For modeling, a five-degree-of-freedom open-chain robot was proposed by considering the womans breast volume and a radial ultrasound scanning approach as workspace. The forward and inverse kinematics were calculated using the screw axis-based theory and a geometric-algebraic formulation, respectively. For trajectories, a collision-free path algorithm was computed to assess target reachability. For simulating, a dedicated biopsy environment was implemented in MATLAB-Simulink to perform multiple simulations by modifying some radiologist manipulability variables in accordance with a factorial-method research design. The results showed a numerical and graphical verification of the equations and even a visual one of the needle placement during two stages: before a biopsy and after it. In conclusion, it was computationally explored the use of a novel robot-assisted needle placement in breast biopsy for women in a prone position.

The median effective volume of ultrasound-guided thoracic paravertebral nerve block with 0.3% ropivacaine in radical thoracoscopic surgery for lung cancer.

Ultrasound-guided needle placement has revolutionized the thoracic paravertebral block technique and can be applied in thoracoscopic surgery. This study investigated the median effective volume (EV50) of an ultrasound-guided single shot of 0.3% ropivacaine used as a thoracic paravertebral nerve block for the radical thoracoscopic resection of lung cancer. A total of 27 patients who received a single shot of ultrasound-guided thoracic paravertebral nerve block and underwent radical thoracoscopic resection of lung cancer were enrolled in this study between February 10 and August 13, 2018. All patients were rated as ASA grades I or II. Using ultrasound as a guide, the block needle was gradually pushed through the lateral costotransverse ligaments to the thoracic paravertebral space by the in-plane technique. After confirming the absence of blood or cerebrospinal fluid, 1-2ml of 0.3% ropivacaine hydrochloride was injected to confirm that the position of the needle was appropriate, and a pre-determined volume of 0.3% ropivacaine hydrochloride was then administered to the patients. Sensory testing by pinprick was performed every 5minutes for 30minutes following the thoracic paravertebral block injection to identify the time segments during which the loss of sensation to the pinprick and its blocking effect occurred. All patients completed the study and 14 (51.8%) had a successful block. The EV50 of 0.3% ropivacaine was 18.46ml (95% CI 17.09-19.95ml) and the EV95 was 20.89ml.

Robot-Assisted Excision of Abdominal Wall Endometrioma Utilizing Intra-Operative Ultrasound and Transabdominal Needle Placement

Study Objective Demonstrate technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intra-operative ultrasound-guided needle placement. Design Description and demonstration of surgical technique. Setting Tertiary care, academic center. Patients or Participants Patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain. Interventions Intra-operative ultrasound-guided needle placement to map location of the lesion. Minimally invasive resection of the lesion with the advancement of needles to confirm clear margins. Measurements and Main Results Complete resection via a minimally invasive approach. Conclusion Minimally invasive resection of abdominal wall endometriosis using intra-operative ultrasound guided needle placement to guide surgical dissection accomplishes clear surgical margins as well as successful treatment. Demonstrate technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intra-operative ultrasound-guided needle placement. Description and demonstration of surgical technique. Tertiary care, academic center. Patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain. Intra-operative ultrasound-guided needle placement to map location of the lesion. Minimally invasive resection of the lesion with the advancement of needles to confirm clear margins. Complete resection via a minimally invasive approach. Minimally invasive resection of abdominal wall endometriosis using intra-operative ultrasound guided needle placement to guide surgical dissection accomplishes clear surgical margins as well as successful treatment.

Ultrasound-guided needle placement for bone marrow aspiration of the anterior iliac crest

IntroductionBone marrow aspirate concentrate (BMAC) use has increased for both primary treatment and as a surgical adjunct of several other musculoskeletal conditions such as degenerative joint disease and rotator cuff tears. Bone marrow harvest, when performed as part of musculoskeletal treatment or in conjunction with orthopedic surgery is commonly performed at the anterior iliac crest. No technique for ultrasound guidance has been validated at the anterior iliac crest. ObjectivesHere we describe a novel approach for bone marrow aspiration at the anterior iliac crest utilizing ultrasound guidance to facilitate safe needle placement using a human cadaveric model. MethodsUsing cadaver hemipelvises, needle placements were attempted along the anterior iliac crest via ultrasound guidance and latex dye was used to mark the site of cortical penetration. ResultsA total of 39 cortical penetrations were attempted on 8 iliac crests. Needle placements were accurately placed on the crest under ultrasound guidance as confirmed by dissection of the relevant anatomy and confirmation of colored dye within the cortical penetration. ConclusionUltrasound can be used as a valuable tool for image guidance during bone marrow needle placement along the anterior iliac crest. This technique for initial needle placement at the anterior iliac crest is safe and feasible for providers with skill in ultrasound guided needle placement to assist with localization along safe zones for quality bone marrow cellular harvest.

Enhancement of needle visualization and localization in ultrasound.

This scoping review covers needle visualization and localization techniques in ultrasound, where localization-based approaches mostly aim to compute the needle shaft (and tip) location while potentially enhancing its visibility too. A literature review is conducted on the state-of-the-art techniques, which could be divided into five categories: (1) signal and image processing-based techniques to augment the needle, (2) modifications to the needle and insertion to help with needle-transducer alignment and visibility, (3) changes to ultrasound image formation, (4) motion-based analysis and (5) machine learning. Advantages, limitations and challenges of representative examples in each of the categories are discussed. Evaluation techniques performed in ex vivo, phantom and in vivo studies are discussed and summarized. Greatest limitation of the majority of the literature is that they rely on original visibility of the needle in the static image. Need for additional/improved apparatus is the greatest limitation toward clinical utility in practice. Ultrasound-guided needle placement is performed in many clinical applications, including biopsies, treatment injections and anesthesia. Despite the wide range and long history of this technique, an ongoing challenge is needle visibility in ultrasound. A robust technique to enhance ultrasonic needle visibility, especially for steeply inserted hand-held needles, and while maintaining clinical utility requirements is needed.

Intrauterine transfusion: an international review of practice and policy

BackgroundIntrauterine transfusion (IUT) is a treatment for fetal anemia. This technique involves ultrasound guided needle placement followed by transfusion of a specially prepared blood component. The most common indications include hemolytic disease of the fetus and newborn (HDFN) and prenatal infection.MethodsThe literature was reviewed, and blood component characteristics and preparatory techniques identified. An international survey of IUT was conducted.ResultsComponent preparation for IUT differs from preparation for other transfusions. Differences relate to unique characteristics of the fetus including a small blood volume, invasive access for transfusion and immune deficiency. The techniques for preparation of red blood cells (RBC) are variable with limited evidence. Most use fresh concentrated RBC. Irradiation is uniformly recommended. RBC that are antigen negative for the maternal alloantibody are provided, and the product is selected or modified to minimize risk for cytomegalovirus transmission. Selection of ABO group and the degree of additional prophylactic phenotype matching are variable. While maternal RBC transfusion may be used, compatible allogeneic RBC are more common. For maternal antibodies to high prevalence antigens rare phenotype deglycerolized RBC may be used. There are challenges in providing RBC for IUT. Pre and post transfusion blood samples must be correctly managed in the medical record. Hemovigilance requires that both the fetus and the mother be documented as recipients. Preparation may be urgent, and sterile technique is required. Records of IUT must be conveyed to neonatal care providers as the transfused blood may mask the true blood group for weeks to months post transfusion, and component modifications may be required for any postnatal transfusion in neonates who were treated with IUT.

Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections.

Mezian, Kamal MD, PhD; Sobotová, Karolína MD; Angerová, Yvona MD, PhD Author Information

Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections.

The aim of the study was to assess the accuracy of ultrasound-guided needle placement for sacroiliac joint injections. Institutional review board approval was gained for a prospective cohort study of 50 patients (N = 50). Study patients who were referred for sacroiliac joint injections for sacroiliac joint mediate pain and met inclusion/exclusion criteria were enrolled in the study. Each patient underwent needle placement with ultrasound guidance in the procedure suite. After the needle was placed with the ultrasound guidance, fluoroscopy was used to confirm correct placement via contrast injection confirming a sacroiliac joint arthrogram. The arthrogram was confirmed via the performing physician and radiologist. The placement of the needle with ultrasound guidance into the sacroiliac joint was confirmed successful in 96% (48/50) patients by fluoroscopic arthrogram. The two patients with unsuccessful arthrograms after initial placement of the needle with ultrasound were morbidly obese. There was intravascular uptake during the arthrogram of one patient who had a successful arthrogram. Ultrasound-guided injection of the sacroiliac joint is successful and accurate upon confirmation of fluoroscopic arthrogram and should be used as an imaging modality for needle guidance.

Tools for Simulation; Low Budget and No Budget

Interventional Radiology (IR) incorporates a unique set of technical skills such as ultrasound-guided needle placement, inferior vena cava filter placement, and wire/catheter exchange, which are not easily attained in other aspects of medical training. Simple, low cost models can allow medical students and residents to attain these skills in a low risk setting. These simulated tasks will ultimately combine to improve preparedness of trainees during patient procedures allowing them to advance more quickly through the training paradigm without patient risk. Many commercially available devices may be cost prohibitive, so low cost solutions are presented.

New Ultrasound Technology Is a Useful Training Adjunct for Invasive Procedures.

The use of ultrasound for procedural guidance is an essential skill in emergency medicine (EM) and a required Accreditation Council for Graduate Medical Education (ACGME) competency for residents. Resident learners develop their skill set through hands-on training and may benefit from an intervention that encourages proper technique, bolsters confidence, and improves procedural success. Clear Guide ONE, a Food and Drug Administration-approved technology, overlays real-time virtual instrument navigation onto ultrasound displays to allow visualization of expected instrument trajectory prior to needle puncture, ensuring alignment with the target. This study investigated computer-assisted instrument guidance as an educational tool for residents in a simulation environment. Primarily, the study evaluated residents' procedural speed and accuracy using ultrasound with and without the guidance device. A total of 34 residents were observed performing ultrasound-guided needle placement in ballistic gel models with and without computer assistance in a simulation-based observational crossover study. Scan time before needle insertion, time to target, total procedure time, number of needle redirections, and procedural accuracy were measured. A total of 104 observations were recorded with 52 in each group. Paired-sample t-test analysis was used to compare group performance. Secondary outcomes were derived from survey data assessing resident opinions about the device. The computer-guidance group significantly outperformed the ultrasound-alone group in mean time to target, number of needle redirections, and procedural accuracy. There was no significant difference in mean scan time before needle insertion or total procedure time. Fifty percent of residents preferred the guidance system. Most residents (67%, n=23) reported that the device increased confidence and the majority (94%, n=32) reported perceived improvement in speed, accuracy, or both. Use of computer assistance technology for sonographic instrument guidance was successful in improving procedural accuracy, number of needle redirections, and time to target performance metrics and was well received by residents. This educational study suggests that this technology may emerge as a valuable tool in training EM residents to utilize ultrasound for procedures.

Silica Shells/Adhesive Composite Film for Color Doppler Ultrasound Guided Needle Placement.

Ultrasound (US) guided medical devices placement is a widely used clinical technology, yet many factors affect the visualization of these devices in the human body. In this research, an ultrasound-activated film was developed that can be coated on the surface of medical devices. The film contains 2 μm silica microshells and poly(methyl 2-cyanoacrylate) (PMCA) adhesive. The air sealed in the hollow space of the microshells acted as the US contrast agent. Ozone and perfluorooctyltriethoxysilane (PFO) were used to treat the surface of the film to enhance the US signals and provide durable antifouling properties for multiple passes through tissue, consistent with the dual oleophobic and hydrophobic nature of PFO. In vitro and in vivo tests showed that hypodermic needles and tumor marking wires coated with US activated film gave strong and persistent color Doppler signals. This technology can significantly improve the visibility of medical devices and the accuracy of US guided medical device placement.

Preliminary study of a teaching model for ultrasound-guided peripheral nerve blockade and effects on the learning curve in veterinary anesthesia residents

ObjectiveTo evaluate the use of an experimental colloid model for teaching veterinary anesthesia residents ultrasound-guided technique for nerve blockade. Study designProspective, blinded and randomized. MethodsColloid models were constructed for practice in ultrasound-guided needle location. Nine veterinary anesthesia residents with no prior experience of ultrasound-guided technique for nerve blocks were randomly divided into three groups. Each group received theoretical orientation. Two groups were assigned to practical training using the experimental model: group 1 (G1) received 2 hours of training and group 2 (G2) received 1 hour of training prior to testing with specific tasks. Group 3 (G3) received no practical training. During testing, the time required for task completion (e.g., display of structures and positioning a needle) and the number of failures were recorded. ResultsThe average times to completion of the tasks and the number of technical failures were: G1, 47 seconds and 1 failure; G2, 68 seconds and 2 failures; G3, 187 seconds and 7 failures. Conclusions and clinical relevanceIn residents with no prior experience of ultrasound-guided needle placement, using an experimental colloid model and a longer training period was associated with increased accuracy and decreased time to task completion. Based on the results of this study, training with an experimental model can be recommended to improve the speed and accuracy of needle manipulation using ultrasound in clinicians with no prior experience of ultrasound-guided technique.

Using an abdominal phantom to teach urology residentes ultrasound-guided percutaneous needle placement.

ABSTRACTIntroduction:To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement.Materials and methods:University of California, San Francisco (UCSF) urology residents completed a time trial, placing a needle into a phantom model target under ultrasound guidance. Participants were randomized into three educational exposure groups: Group 1's time trial occurred prior to any teaching intervention, group 2's after experiencing a hands-on training module, and group 3's after exposure to both the training module and one-on-one attending feedback. Needle placement speed and accuracy as well as trainees' perceived confidence in utilizing ultrasound were measured.Results:The study cohort consisted of 15 resident trainees. Seven were randomized to group 1, three to group 2, and five to group 3. All residents reported minimal prior ultrasound experience. Their confidence in using ultrasound improved significantly after completing the training module with the most significant improvement seen among junior residents. Time to needle placement was fastest after receiving attending feedback (46.6sec in group 3 vs. 82.7sec in groups 1 and 2, p<0.01). Accuracy also improved with attending feedback, though the number of repositioning attempts did not differ significantly between groups.Conclusions:A hands-on training module and use of an abdominal phantom trainer increased resident confidence and skill in their use of ultrasound to guide percutaneous needle positioning. Attending feedback is critical for improving accuracy in needle guidance toward a target. Ultrasound-guided needle positioning is a teachable skill and can be applicable to multiple urologic procedures.

COMPARISON OF ULTRASOUND-GUIDED VS. STANDARD LANDMARK TECHNIQUES FOR TRAINING NOVICE OPERATORS IN PLACING NEEDLES INTO THE LUMBAR SUBARACHNOID SPACE OF CANINE CADAVERS.

Veterinary Radiology & UltrasoundVolume 57, Issue 4 p. 448-449 ADDENDUMFree Access COMPARISON OF ULTRASOUND-GUIDED VS. STANDARD LANDMARK TECHNIQUES FOR TRAINING NOVICE OPERATORS IN PLACING NEEDLES INTO THE LUMBAR SUBARACHNOID SPACE OF CANINE CADAVERS This article corrects the following: COMPARISON OF ULTRASOUND-GUIDED VS. STANDARD LANDMARK TECHNIQUES FOR TRAINING NOVICE OPERATORS IN PLACING NEEDLES INTO THE LUMBAR SUBARACHNOID SPACE OF CANINE CADAVERS Anne-Laure Etienne, Catherine Delguste, Valeria Busoni, Volume 57Issue 4Veterinary Radiology & Ultrasound pages: 441-447 First Published online: March 21, 2016 First published: 11 July 2016 https://doi.org/10.1111/vru.12382AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In Etienne et al.1 an omission was published on page 2 of early view; “Each operator performed both needle placement into the lumbar subarachnoid space techniques in close succession with an order previously defined.” After having received comments from a reader, the authors consider that the following sentences should have been included for clarification in the Materials and Methods section: …A total of 67 students performed both needle placement techniques in close succession. Forty-six students performed the blind landmark-guided technique first and then an additional group of 21 students was recruited after completion of this first study based on statistician recommendations for measuring and minimizing the effect of the order of the procedures on success rate. These 21 students started the procedure performing the ultrasound-guided technique first. Additional statistical analysis (chi-square test) was, therefore, performed to compare success rates of these two groups of students (those who started with the blind landmark-guided procedure and those who started with the ultrasound-guided procedure) … The authors consider that the following sentences should have been included in the Results section: …The success rate of the ultrasound-guided procedure was 72% for students who started with the blind landmark-guided method (group of 46 students) and 86% for students who started with the ultrasound-guided method (group of 21 students) with no statistical difference in success rate for the ultrasound-guided procedure between the two groups (P-value: 0.18). The success rate of the blind landmark-guided procedure was 35% for students who started with the blind landmark-guided method and 77% for students who started with the ultrasound-guided technique. This difference in success rate is statistically significant (P-value = 0.001) … The authors consider that the following sentences should have been included in the Discussion section: …One of the limitations of the study was that the number of students having performed the blind technique first is higher (46) compared to the number of students having performed the ultrasound-guided technique first (21), and that the order of procedures has not been randomized. Therefore, in order to avoid bias related to the experience potentially acquired while doing the procedure the first time and to the order of the procedures, the cofactor order was introduced in multinomial regression and the model has been adjusted for possible bias created by this variable. Results showed that the variable order was not significant in the multinomial regression (see Table 2 in the Results section). Moreover, success rate of ultrasound-guided needle placements was not statistically different between the two groups of students (72% vs. 86%) having performed the two techniques in a different order and it was higher in the groups of students having performed the ultrasound-guided procedure first. This result suggests that realization of a unique blind landmark-guided needle placement into the lumbar subarachnoid space does not provide a significant experience to increase the success rate of the ultrasound-guided procedure. In contrast, the success rate of blind landmark-guided needle placement was statistically higher in the group of 21 students having carried out the ultrasound-guided procedure first (35% vs. 77%) suggesting a potential significant impact of learning an ultrasound-guided needle placement into the lumbar subarachnoid space … The authors apologize for the omissions in the published manuscript and hope to have clarified with these additional information and data the rationale behind their conclusions. REFERENCE 1Etienne AL, Delguste C, Busoni V. Comparison of ultrasound-guided vs. standard landmark techniques for training novice operators in placing needles into the lumbar subarachnoid space of canine cadavers. Vet Radiol Ultrasound 2016; 57: 441– 447. Volume57, Issue4July/August 2016Pages 448-449 ReferencesRelatedInformation