Sauter 2010 - Ultrasound

A. R. Sauter Rikshospitalet University Hospital

Ultrasound Theoretical and practical background

SOund Navigation And Ranging

Technical principles

Ultrasound image generation and device operations

Infra- Audible sound sound 20Hz 20kHz

Ultrasound 200MHz 1-17MHz Medica ultrasound

Piezoelectric effect

Technical principles
Velocity (depending on the density):

electrical energy

air water fat 1450 muscle bone

330 m/s 1450 m/s 1462-1473 m/s 1580 m/s 4080 m/s

electrical energy

Impedance: product of density and velocity

Sauter 2010 - Ultrasound

Technical principles
Differences in impedance (interface) give reflections

Acoustic coupling medium

Strong differences in impedance

give strong reflections hyperechoic

Small differences in impedance give

transmission of the US beam hypoechoic

Transducers

Transducers
! Frequeny " Frequeny ! Resolution " Penetration " Resolution ! Penetration

Transducers

Axial resolution

Resolution

Axial resolution Lateral resolution Spatial resolution

Sauter 2010 - Ultrasound

Lateral resolution

TGC - Time Gain Compensation

ENERGY Reflection DISTANCE

ATTENUATION

Scatter

Refraction

Absorption

TGC - Time Gain Compensation

TGC - Time Gain Compensation

ENERGY

Amplified signal

ATTENUATION
Near Far Overall

TGC - Time Gain Compensation

Time gain control

DISTANCE

Focus and Depth

Sites 2008

Sauter 2010 - Ultrasound

Doppler sonography

Doppler sonography

increased frequency

decreased frequency

Practical aspects

Ultrasound imaging

pressure alignment rotation tilting

Sauter 2010 - Ultrasound

Ultrasound imaging

Short axis

Long axis

Ultrasound imaging
In-plane needle insertion In-plane Out-of-plane

Ultrasound imaging
Out-of-plane needle insertion

short axis / in-plane short axis / out-of-plane long axis / in-plane long axis / out-of-plane

Sauter 2010 - Ultrasound

Ultrasound imaging
Visualization of nerves:

Visualization of nerves:
-honeycomb structure - hypoechoic or anechoic

Bigeleisen 2006

Ultrasound imaging
Visualization of local anesthetics:

Pitfalls and artifacts

Sauter 2010 - Ultrasound

Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia.
Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Reg Anesth Pain Med 2007;32:107-15.

Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia.
Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Reg Anesth Pain Med 2007;32:107-15.

Video documentation of USG nerve blocks

performed by 6 anesthesia residents

1) failure to recognize the maldistribution of local anesthesia 2) failure to recognize the location of the needle tip before injection 3) fatigue 4) failure to correctly correlate the sidedness of the patient with the sidedness of the ultrasound image 5) poor choice of needle-insertion site and angle with respect to the probe preventing accurate needle visualization.

398 committed errors in 520 blocks

Intravascular needle placement

Intraneural needle placement

Pneumothorax

Ultrasound-guided PNB

Koscielniak-Nielsen 2008

Sauter 2010 - Ultrasound