J Korean Orthop Assoc.  2013 Oct;48(5):342-349. 10.4055/jkoa.2013.48.5.342.

Intervention Using Ultrasonography

• Song HS
• Kim DY
• Yoon KS

• KMID: 1494146
• DOI: http://doi.org/10.4055/jkoa.2013.48.5.342

Abstract

Intervention using ultrasonography includes injection, aspiration, needling (barbotage), nerve block, tumor biopsy, and removal of the foreign body. The principles of disinfection during skin preparation, as well as handling of the transducer and needle should be maintained. The needle could be visualized on the ultrasonographic image, and could be tracked during the intervention. Factors affecting visualization of the needle on ultrasonography include the diameter and the incidence angle of the needle. Ultrasonography can be classified as an indirect technique or a real-time technique according to constant use. According to the angle between the transducer and needle, it can be classified as a lateral approach or a coaxial approach.

Keyword

ultrasonography; intervention; angle of incidence; approach

MeSH Terms

Biopsy
Disinfection
Foreign Bodies
Handling (Psychology)
Incidence
Needles
Nerve Block
Skin
Track and Field
Transducers
Ultrasonography*

Figure

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  Figure 1 Sterile envelope for the transducer: (A) sterile-packed and (B) wrapped and rubber-banded.

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  Figure 2 Ultrasonography shows the reverberation by the needle (arrow). Dotted arrows indicate the comet-tail artifact behind the needle.

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  Figure 3 Long needle with a stylet.

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  Figure 4 Ultrasonography of the posterior approach to the shoulder joint shows no reverberation by the needle. Arrows indicate the needle.

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  Figure 5 Incidence angle of the needle can be increased by change of the puncture site apart from the transducer: (A) near the transducer, (B) apart from the transducer.

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  Figure 6 Incidence angle of the needle can be increased by pressing on the opposite side of the transducer: (A) before, (B) after the heel-toe maneuver.

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  Figure 7 The indirect technique. Two perpendicular lines crossing the center of the lesion are marked with dotted lines.

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  Figure 8 Lateral approach (in-plane technique) for injection into the aromioclavicular joint. The needle is aligned with the small side of the transducer.

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  Figure 9 Coaxial approach (out-of-plane technique) for injection into the aromioclavicular joint. The needle is aligned with the broad side of the transducer.

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