Ultrasound-guided Procedures Research Articles

Gender differences in self-reported participation in ultrasound-guided procedures: a retrospective analysis.

Across multiple procedural specialties, female trainees tend to perform fewer procedures and receive less autonomy than their male counterparts. However, there is currently no data on procedure contribution levels for radiology trainees. To evaluate whether there was a difference in the degree of reported participation in ultrasound-guided procedures between male and female trainees at our institution. This retrospective study assessed for differences in the reported level of participation between male and female trainees in ultrasound (US) guided paracentesis and thoracentesis. We performed a radiology information system (RIS) search of US guided procedures performed on adult patients from 7/1/2018 to 2/29/2024. Trainee participation levels in the procedures were determined per available reports and classified into independently performed, assisted, or observed. We evaluated the differential reporting of procedure contributions for male and female trainees based on observed vs. expected frequencies, as well as the effect of the trainees' and supervising physicians' gender and experience level on these contributions. A total of 189 trainees (52 female, 137 male) and 58 supervising physicians (18 female and 40 male) were included. The study evaluated 4156 reports, which showed no difference in the percentage of independently completed procedures (females 80.9% vs. 81.9%, X2 (1, N = 4156) = 0.494, p = 0.48) except when supervised by junior physicians less than 2 years out of training (females 81.0% vs. 86.5%, X2 (1, N = 1908) = 8.19, p = 0.0042). However, female trainees were more likely than male trainees to report observing procedures (females 9.2% vs. 5.2%, X2 (1, N = 4156) = 21.1, p < 0.00001) rather than actively participating in procedures despite a similar training level; this difference was not observed when supervising physicians were females. Female radiology trainees report a similar percentage of independently performed procedures but a lower rate of active participation than male trainees.

Radial nerve at Fhrose's arcade: a new technique of release under total ultrasound guidance. First experience.

Radial nerve compression at the arcade of Frohse is a rare but significant condition that typically presents with pain primarily after exertion and at night on the dorsal side of the forearm, more distally than tennis elbow pain, and weakness of the wrist extensors and the long fingers and thumb extensors. Traditional treatment often involves open surgery, resulting in significant scarring. This study introduces a novel percutaneous radial nerve release technique under complete ultrasound guidance and highlights its efficacy and safety. The procedure involves identifying the entry point, lateral of the radial nerve, allowing for targeted release of the superficial fascia surrounding the supinator muscle without damaging nearby vascular or nerve structures. A cadaveric study was performed on ten fresh-frozen specimens to validate the entry point and route, which successfully demonstrated complete fascial release without complications. Preliminary clinical results from five patients showed complete resolution of symptoms associated with radial tunnel syndrome with no reported complications. The technique results in a significantly smaller incision (<1 cm) compared to traditional methods (up to 10 cm) and can be performed under WALANT anesthesia, making it suitable for the outpatient setting. This approach offers a minimally invasive alternative for patients with isolated posterior interosseous nerve compression and highlights the importance of ultrasound guidance in achieving optimal results. Because the technique requires a learning curve, it is recommended for surgeons with experience in ultrasound-guided procedures.

Assessing Physician Assistant Students' Ability to Accurately Identify the Regional Landmarks of the Fascia Iliaca Compartment With Point of Care Ultrasound After a Brief Training Session.

Regional anesthesia, specifically fascia iliaca compartment blocks (FICB), is highly effective in managing pain, especially in military settings. However, a significant barrier to its implementation is the lack of provider confidence in performing ultrasound-guided procedures. This study evaluates the ability of physician assistant (PA) students, who are often first-line providers in austere locations, to identify the fascia iliaca compartment (FIC) using point-of-care ultrasound (POCUS) after a brief training session and assesses their retention of this skill over a 60- to 90-day period. We conducted this prospective observational study involving 10 PA students at an Air Force hospital. Participants underwent a brief training course on FIC identification using POCUS. Their ability to identify 4 anatomical landmarks (fascia iliaca, fascia lata, iliopsoas muscle, and femoral artery) was assessed immediately post-training and again after 60 to 90 days. Initially, participants demonstrated a high success rate in identifying the FIC, with 47 out of 60 attempts (78%) correctly identified. However, follow-up evaluations showed a significant decline, with only 7 out of 54 attempts (13%) correctly identified after 60 to 90 days (P < .001). Identification rates for specific landmarks also declined significantly, except for the femoral artery, which remained the most accurately identified landmark. This study demonstrates that PA students can accurately identify the FIC using POCUS after a brief training session. However, there was a significant decline in skill retention over a 60- to 90-day period, underscoring the need for continuous education and practice to sustain proficiency. Further research with larger sample sizes and diverse settings is needed to develop effective training protocols and ensure long-term retention of U.S.-guided procedural skills.

Outcomes of Percutaneous Ultrasound-guided Splenic Procedures: A Retrospective Observational Study from a Tertiary Care Centre in Southern India

Introduction: Data on image-guided percutaneous procedures of the spleen are limited, particularly for infectious lesions. Aim: To evaluate the complication rate of percutaneous ultrasound-guided splenic procedures. Materials and Methods: A retrospective observational study was conducted in a tertiary care centre in Southern India. Data from all consecutive patients who underwent ultrasound-guided splenic procedures from January 2008 to October 2023 were analysed. Information was extracted from digital radiology reports, images, inpatient records, outpatient records and blood investigation reports. Complications were categorised according to standardised guidelines. Descriptive statistics for categorical data were reported. Pearson Chi-square test were used to assess associations between categorical variables. Statistical Package for the Social Sciences (SPSS) software version 21.0 was used. Results: A total of 312 patients were included, with mean age of 42.2±15.8 years. Of these, 212 (68%) were males and 100 (32%) were females. There were 259 diagnostic procedures: 125 (40.1%) Fine Needle Aspiration Cytology (FNACs), 18 (5.8%) biopsies and 116 (37.2%) aspirations. Fifty-three procedures were therapeutic: 52 (16.7%) drainages, and 1 (0.3%) percutaneous injection of sclerosant. The overall complication rate was 22 in 312 patients (7.1%, with 95% CI of 4.7% to 10.4%). As per the Society of Interventional Radiology (SIR) Clinical Practice Guidelines classification, six patients (27.3%) had Category-A complications with small perisplenic haematomas, three patients (13.6%) had Category-B complications, 10 patients (45.5%) had Category-C complications and two patients (9.1%) had Category-D complications. One patient (4.5%) died during the postoperative period (Category-F complication). No patients had SIR Category-E complications. Conclusion: Percutaneous ultrasound-guided procedures were safe and efficacious in this patient cohort, which predominantly consisted of individuals with infectious diseases and exhibited a low mortality rate.

Topographic Analysis of the Periorbital Region Including Orbicularis Oculi Muscle Based on Ultrasonography Interpretation.

Ultrasonographic examination is easy, fast, safe, and used in various fields; however, its application to the facial area has been limited. Complex anatomical structures are mixed within thin, soft tissues in the facial region; therefore, understanding their structural characteristics is crucial. This study aimed to use ultrasonography to obtain information on the layered structure and soft tissue thickness of the eye area around the orbicularis oculi muscle and provide guidance for clinical practice. Healthy volunteers (33 men and 19 women; mean age: 28.4 years) underwent ultrasonography with nine reference points. The soft tissue thickness, including the orbicularis oculi muscle, was measured on monochromatic images. Ultrasonographic scans were performed at facial landmarks using linear transducers (IO8-17, E-CUBE15, Alpinion Medical System, Seoul, Korea), with images scanned transversely. The thickness was measured using ImageJ (National Institutes of Health, Bethesda, MD, USA). The mean thickness of the orbicularis oculi muscle was 1.56 ± 0.45 mm (range 1.03-2.31 mm). The highest thickness was measured at the points VII (2.31 ± 0.68 mm) and VI (2.15 ± 0.48 mm). The mean depth of the orbicularis oculi muscle was 1.63 ± 0.62 mm (range 0.88-2.80 mm), and the most superficial point was 0.88 ± 0.99, at point VII. This study provides critical anatomical data that can enhance the precision of ultrasound-guided procedures in the periorbital area, allowing clinicians to accurately target the muscle layer and soft tissue structures. By utilizing these findings, practitioners can optimize treatment effectiveness, reduce complications, and improve outcomes in cosmetic procedures such as botulinum toxin injections, filler placements, and other non-invasive facial treatments. The detailed anatomical insights gained from this study will help bridge the gap between anatomical understanding and clinical application, promoting safer and more efficient aesthetic interventions.

From diagnosis to rehabilitation of trigger finger: a narrative review.

Trigger finger (TF), also known as stenosing flexor tenosynovitis, is a common pathology of the fingers causing functional deficit of the hand. In recent years, new therapeutic approaches such as extracorporeal shock wave therapy (ESWT) and ultrasound-guided (USG) procedures have joined the most traditional conservative treatments as the adaptation of daily activities involving the affected hand and the orthosis. Likewise, the ultrasound (US) examination of the affected finger using modern high-frequency probes has progressively become part of the comprehensive assessment of patients with TF coupled with the medical history, the physical examination, and the functional scales. In this sense, considering the technological advances in both diagnostic and therapeutic fields, the non-surgical strategies have progressively grown defining a rehabilitation panel more complex than in the past. The present manuscript aims to provide an updated practical guide for clinicians and surgeons reviewing the state-of-art of both the assessment and the treatments of patients with TF to plan tailored rehabilitation management taking advantage of the matching of traditional and novel techniques.

How to enhance the novices’ learning in ultrasound-guided procedures utilizing handmade phantoms?

IntroductionThis prospective study aims to evaluate the learning effect of US-guided thoracocentesis and pericardiocentesis in novices through simulation training using handmade phantoms.MethodsThe novices included undergraduate-year (UGY) students and first postgraduate-year (PGY-1) residents. Handmade phantoms were utilized for training and immediate assessment. Novices were re-evaluated using high-fidelity phantoms three months after training, while experienced PGY-3 emergency medicine residents were recruited and evaluated with high-fidelity phantoms simultaneously. Data on their performance, puncture time, and number of attempts were collected.ResultsThirty-six novices (18 PGY-1 and 18 UGYs) and 12 PGY-3 emergency medicine residents were recruited. Alongside clinical observation, novices demonstrated improved skill retention and performance at the 3-month assessment compared to the immediate assessment [5 (4–5) vs. 3.5 (3–4), p = 0.0005] in thoracocentesis, achieving a comparable level of proficiency with the PGY-3 emergency medicine residents [5 (4–5) vs. 5 (5), p = 0.105]. Without clinical observation, novices exhibited a decline in skill proficiency in pericardiocentesis at the 3-month assessment [3 (3–4) vs. 4 (4–4.5), p = 0.015]. The puncture time was comparable between novices and PGY-3 emergency medicine residents for both thoracocentesis and pericardiocentesis. However, novices required a greater number of puncture attempts for pericardiocentesis.ConclusionsNovices showed superior performance in thoracocentesis but experienced skill decay in pericardiocentesis at the 3-month assessment following training with handmade phantoms. This decline may be attributed to the very low frequency of pericardiocentesis cases encountered by novices after training, as well as the higher-stakes nature of the procedure. Further investigation is needed to evaluate the long-term effects of training, skill retention, and transfer of skills to actual patient care. Additionally, research should focus on determining optimal retraining intervals for pericardiocentesis and evaluating the use of standardized pericardiocentesis videos as an alternative to clinical observation.Trial registrationRegistered at ClinicalTrials.gov (NCT04792203) on March 7, 2021.

Inadvertent Wire Shearing During Endoscopic Ultrasound-Guided Rendezvous Procedure.

Inadvertent Wire Shearing During Endoscopic Ultrasound-Guided Rendezvous Procedure.

Ultrasound-Guided Venous Catheter Placement in Prone Position.

The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position.

Ultrasound guided procedures in the musculoskeletal system: a narrative review with illustrative examples.

Ultrasound guidance plays a pivotal role in percutaneous procedures for diagnosing and managing musculoskeletal disorders. Such procedures encompass biopsies for tumor, diagnostic aspiration and therapeutic drainage of abscesses, hematomas, cysts and fluid collections, therapeutic injections into joints, nerves, and tendons, as well as aspirations of calcium deposits and extraction of foreign bodies. This review aims to compile the most frequent ultrasound-guided procedures in the musculoskeletal system and present the state-of-the-art in current advances and evidence. We performed a literature review on interventional ultrasound in the musculoskeletal system, and included reviews, systematic reviews, meta-analysis, and clinical trials published during the last 10 years. Articles related to imaging techniques different from ultrasound, or spinal, thoracoabdominal and facial procedures were excluded. A total of 120 articles were selected and included in this review. We qualitatively synthesized the main findings and complemented the review with illustrative images from our daily practice. Most of the reviewed studies found superiority of ultrasound-guided versus landmark-guided procedures. Ultrasound was generally considered as a valuable tool for many specialists in diagnosing and treating many musculoskeletal pathologies, but some disparities in needle approaches, techniques, medication, and doses make it difficult to draw strong evidence in different clinical scenarios. Advances in ultrasound-guided procedures in the musculoskeletal system have enabled radiologists and other specialists to achieve high accuracy in diagnosing and treating various musculoskeletal conditions, including tumors, inflammatory and degenerative arthritis, tendinopathies, and bursal pathologies.

Ultrasound-guided minimally invasive removal of deep contraceptive implants: outcomes and challenges.

Contraceptive arm implants, such as Implanon NXT®/Nexplanon®, are reversible methods of birth control that have gained global popularity, with over 20 million worldwide users. While palpable implants can be easily removed, deep or non-palpable implants pose complications during extraction, often requiring open surgery. This ultrasound-guided removal technique offers a minimally invasive, safe, and effective alternative, providing real-time control over the implant and neurovascular structures. Our study aims to evaluate the effectiveness and challenges of this implant removal method. In this retrospective observational study, all cases referred to our institution for ultrasound-guided removal of contraceptive implants, from June 2022 to December 2023, were reviewed. Our facility serves as a referral center for handling challenging implants. Twenty-nine women with contraceptive implants were referred for implant removal in this period of time. Thirty implants were sent for removal in total (one patient had a double implant). Data specific to the patients were collected: age and body mass index (BMI). Data specific to the implant were also collected: time since implant insertion (months), history of a previous removal attempt, type of implant (single or double rod), implant palpability, laterality of the implant, supra or subfascial location, success or failure of the ultrasound-guided removal procedure and presence of complications in the post-procedure. Statistical analysis was conducted to determine the relationship between the procedure success rate and these variables, and also between these variables and the supra or subfascial location of the implant. Twenty-six of the 30 implants (86.67%) were successfully removed with this fully ultrasound-guided technique. In cases where the implant could not be removed, there was a higher rate of subfascial implant location (75%), while in cases where the removal was successful, the rate of subfascial implant location was significantly lower at 19.23% (P=0.048). Patients whose implants could be removed had a median BMI of 23.71 kg/m2, which was higher than the BMI of patients whose implants could not be removed (20.82 kg/m2), with a P=0.022. No complications were registered. Percutaneous real-time ultrasound-guided implant removal is effective, safe and offers a minimally-invasive alternative to open surgery. The removal of subfascial implants is also feasible but more challenging, leading to a reduction of success rate in this group. These positive outcomes suggest its potential as a standard initial approach for deep contraceptive implant removal.

The clinical value of integrated pulmonary index monitoring during an endobronchial ultrasound-guided transbronchial needle aspiration procedure under sedoanalgesia: A prospective study.

To evaluate the clinical relevance of Integrated Pulmonary Index (IPI) monitoring during transbronchial needle aspiration (EBUS-TBNA) under sedation and determine whether it reduces hypoxic events compared to standard monitoring. This prospective observational research was carried out at Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey, between July 2022 and July 2023. A total of 50 patients, aged 18-80 years with American Society of Anesthesiologists scores of I-III, undergoing EBUS-TBNA with deep sedation for diagnostic purposes were included. The IPI values were measured at 6 time points: baseline, induction, 3, 5, 10 minutes, and at the end of the procedure. Patients were categorized based on whether their IPI scores were above 7 (group 1) or below 7 (group 2). A total of 43 patients completed the study. Group 1 had higher end-tidal carbon dioxide and respiratory rate at multiple time points, including induction and at 3, 5, and 10 minutes post-induction (p<0.05). Group 2 experienced a higher rate of apnea at these times (p<0.05). Those with lower IPI scores (namely, IPI=3 and IPI=4) showed significantly higher apnea rates, while those with higher scores (namely, IPI=7 and IPI=8) were less likely to have apneic episodes. The IPI monitoring during EBUS-TBNA under sedation demonstrated improved detection of apnea episodes and enhanced respiratory safety compared to standard monitoring techniques. Additional research involving more varied populations is necessary to confirm these results.

The Transformation of Acupuncture Practice Using Ultrasonography: Expert Opinions.

The rapidly growing use of ultrasound in South Korea has revolutionized the real-world application of acupuncture, making it a safer, more accurate treatment. However, little is known about the challenges Korean medicine doctors (KMDs) encounter, as well as the procedures and resources necessary for hygienic, safe ultrasound-guided acupuncture. This study aimed to investigate the purpose, indications, and procedure for ultrasound-guided acupuncture in Korean medicine (KM) practice and the challenges KMDs encounter in using ultrasonography. Eleven KMDs with expertise in practicing or teaching ultrasonography were consulted in detail. The purpose of ultrasonography in real-world practice, the overall process, resources utilized in ultrasound-guided procedures, and the unaddressed needs of KMDs were investigated. Ultrasound guidance, employed for various diseases in KM practice, is crucial for pharmacopuncture and acupotomy to increase accuracy and safety. Ultrasoundguided acupuncture involves covering the probe, putting on sterile gloves, and scanning with disinfectants, though the exact steps vary among experts. They also suggested that a lack of insurance coverage was a common obstacle for KMDs utilizing ultrasonography. Acupuncture with ultrasound guidance has become a prevalent procedure in South Korea. Standard procedure guidelines and insurance coverage for ultrasonography used for acupuncture procedures are essential to ensure safe, accurate procedures.

Perfectly Imperfect: A Novel Hydrogel for Ultrasound-guided Procedure Training

Perfectly Imperfect: A Novel Hydrogel for Ultrasound-guided Procedure Training

American Thyroid Association Policy Statement: Impact of Changes in Fine Needle Aspiration Biopsy Reimbursement on Clinical Care of Patients with Thyroid Nodules in the United States.

Introduction: The Clinical Affairs Committee of the American Thyroid Association has developed this statement to describe recent changes in the billing and coding of ultrasound-guided fine needle aspiration procedures of thyroid nodules, and to raise awareness of the adverse consequences that have arisen as a result. Review: A reduction in payment of ultrasound-guided fine needle aspiration procedures was enacted by the Centers for Medicare and Medicaid Services in 2019. The Clinical Affairs Committee has sought to examine the effects of the change in reimbursement on the care of patients with thyroid diseases. Summary: The historical background of the changes in payment structure for ultrasound-guided fine needle aspiration of thyroid nodules is discussed. The years 2019 and 2020 saw a significant decline in claims for ultrasound-guided fine needle aspiration procedures, concomitant with a shift in the performance of these procedures away from non-facility outpatient settings and a rise in costs to the health care system. Conclusion: Several negative consequences of the decrease in reimbursement for ultrasound-guided fine needle aspiration of thyroid nodules have arisen. This has led to significant concern among clinicians who care for patients with thyroid diseases regarding delays in patient access to care and diagnosis, and a diminished pool of qualified thyroid specialists to perform these procedures in the future.

Clinical Evaluation of a Novel Compression Device For Ultrasound-Guided Repair of Femoral Artery Pseudoaneurysms: A Double-Blind Clinical Trial

Background: Femoral artery pseudoaneurysm is a well-known complication after conventional angiography. Today, the treatment of choice for this condition is noninvasive repair using manual ultrasound-guided compression. Objectives: This study aimed to evaluate the efficacy of a novel compression device in improving angiography-induced pseudoaneurysm treatment compared to manual ultrasound-guided compression repair. Patients and Method: A double-blind, randomized clinical trial was performed on patients with femoral angiography-induced pseudoaneurysm in the Radiology Department of Ghaem Hospital, Mashhad, Iran. Based on color Doppler ultrasound exams, patients diagnosed with a pseudoaneurysm within 72 hours of angiography were included in the study. Patients were excluded if they had complete blockage, complete pseudoaneurysm thrombosis, abscess, surface tissue infection, or open wound in the area. The patients were allocated to a manual ultrasound-guided compression group or a device-assisted compression group using simple randomization with a sealed envelope method. After collecting demographic data, the patients underwent an ultrasound exam of the groin to determine and record the size of the pseudoaneurysm and the ratio of thrombosis to open lumen. The therapeutic success rate was defined as complete lumen thrombosis after conducting the compression procedure one to three times. Also, the pain score was measured during compression using the Visual Analog Scale based on a scale of 0 - 10. The duration of successful procedures was also documented. The patients were monitored for 6 hours for any side effects. The level of statistical significance was set at P &lt; 0.05 for all tests. Results: The study was performed on 22 patients (13 males/9 females) with a mean age of 65.5 ± 3.5 years divided into two groups of device-assisted (n = 11) and manual ultrasound-guided (n = 11) compression repair. The two groups did not differ significantly in terms of demographic variables or initial ultrasound variables associated with the pseudoaneurysm. The device-assisted compression group was found to have lower pain intensity (5.0 ± 1.0 vs. 6.0 ± 0.8; P = 0.024) and a significantly higher success rate (100% vs. 45.5%; P = 0.004) compared to the manual compression group. None of the patients showed any side effects. Conclusion: This preliminary study showed that the proposed device is completely safe and may improve the success rate while decreasing pain scores during ultrasound-guided compression procedures. Using a large multicenter study design, evaluating the efficacy of the novel device for hemostasis during sheath removal and adding new equipment to the device, such as manometers to apply controlled pressure, are suggested for future studies.

Ultrasound transducer disinfection for percutaneous procedures: A review of the evidence supporting guideline recommendations.

There are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high-level disinfection (HLD), others question the additional benefit this delivers over low-level disinfection (LLD). This narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024. No guidelines were supported by high-quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound-guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low. Without high-level evidence, using a risk-based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound-guided percutaneous procedures.

Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load

BackgroundAugmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings.MethodsThis randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1–4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration.ResultsWe found AR technology reduced the time required for critical steps in CVC placement, while minimizing users’ neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees’ effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees’ effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant.ConclusionsAR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education.Trial registrationThe trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT 06055400.

Augmented reality for point-of-care ultrasound-guided vascular access in pediatric patients using Microsoft HoloLens 2: a preliminary evaluation.

Conventional ultrasound-guided vascular access procedures are challenging due to the need for anatomical understanding, precise needle manipulation, and hand-eye coordination. Recently, augmented reality (AR)-based guidance has emerged as an aid to improve procedural efficiency and potential outcomes. However, its application in pediatric vascular access has not been comprehensively evaluated. We developed an AR ultrasound application, HoloUS, using the Microsoft HoloLens 2 to display live ultrasound images directly in the proceduralist's field of view. We presented our evaluation of the effect of using the Microsoft HoloLens 2 for point-of-care ultrasound (POCUS)-guided vascular access in 30 pediatric patients. A custom software module was developed on a tablet capable of capturing the moving ultrasound image from any ultrasound machine's screen. The captured image was compressed and sent to the HoloLens 2 via a hotspot without needing Internet access. On the HoloLens 2, we developed a custom software module to receive, decompress, and display the live ultrasound image. Hand gesture and voice command features were implemented for the user to reposition, resize, and change the gain and the contrast of the image. We evaluated 30 (15 successful control and 12 successful interventional) cases completed in a single-center, prospective, randomized study. The mean overall rendering latency and the rendering frame rate of the HoloUS application were 139.30ms and 30 frames per second, respectively. The average procedure completion time was 17.3% shorter using AR guidance. The numbers of puncture attempts and needle redirections were similar between the two groups, and the number of head adjustments was minimal in the interventional group. We presented our evaluation of the results from the first study using the Microsoft HoloLens 2 that investigates AR-based POCUS-guided vascular access in pediatric patients. Our evaluation confirmed clinical feasibility and potential improvement in procedural efficiency.

Advances in Ultrasound-Guided Surgery and Artificial Intelligence Applications in Musculoskeletal Diseases.

Ultrasound imaging is a vital imaging tool in musculoskeletal medicine, with the number of publications on ultrasound-guided surgery increasing in recent years, especially in minimally invasive procedures of sports, foot and ankle, and hand surgery. However, ultrasound imaging has drawbacks, such as operator dependency and image obscurity. Artificial intelligence (AI) and deep learning (DL), a subset of AI, can address these issues. AI/DL can enhance screening practices for hip dysplasia and osteochondritis dissecans (OCD) of the humeral capitellum, improve diagnostic accuracy for carpal tunnel syndrome (CTS), and provide physicians with better prognostic prediction tools for patients with knee osteoarthritis. Building on these advancements, DL methods, including segmentation, detection, and localization of target tissues and medical instruments, also have the potential to allow physicians and surgeons to perform ultrasound-guided procedures more accurately and efficiently. This review summarizes recent advances in ultrasound-guided procedures for musculoskeletal diseases and provides a comprehensive overview of the utilization of AI/DL in ultrasound for musculoskeletal medicine, particularly focusing on ultrasound-guided surgery.