Fundamental Technical Skills In Interventional Radiology: Using Ultrasound

OVERVIEW

Properly using an ultrasound machine is a skill that is useful to many different fields of medicine. With this in mind, it is important to appreciate how critical the proper usage of ultrasound can be to performing interventional radiology procedures. It is a core skill, and it is important to master in order to ensure success in completing many different types of procedures, and is often times essential for basic components of procedures, such as gaining vascular access.

SELECTING YOUR EQUIPMENT

It is important to make sure that you are using the correct equipment before beginning an ultrasound guided procedure of any kind. An ultrasound machines that can give a good quality image should be utilized (if possible) and the correct type of ultrasound probe should also be selected (depending upon the nature of the procedure).

POSITIONING THE ULTRASOUND MACHINE

It is useful to appreciate that the location of the ultrasound machine can dictate the dynamics of how the procedure will be performed. The video below helps highlight some key consideration to keep in mind when deciding where you would like your ultrasound machine to be during your prospective procedure.

POSITIONING YOURSELF

It is critical to not only position the ultrasound machine, but for one to position their appropriately relative to the target surface that they will be working on. Associated with this is also making sure the height of the surface one is working on is appropriate relative to their height (avoid bending over if possible!)

ORIENTING YOUR PROBE

The ultrasound probe exhibits directionality in the sense that one end of the probe will transmit information to one end of the viewing screen. It is essential to make sure you know which end of the probe corresponds to the right and left sides of the screen.

HOLDING THE PROBE PROPERLY

A very commonly overlooked factor in performing ultrasound is how to hold the ultrasound probe properly. Multiple grips can be utilized (one is shown for each transverse and sagittal probe positions) however they must enable the operator to keep the probe stable and in a fixed position, preferably without causing one’s hand/arm to get overly fatigued!

ADJUSTING ULTRASOUND MACHINE SETTINGS

Understanding how to adjust the settings of an ultrasound machine can be a very useful endeavor. These settings can dramatically impact how the image on the machine will appear, and can contribute greatly to the difficulty of a procedure. While all the settings that can be adjusted on an ultrasound machine will not be covered here, the video below shows a few examples to keep in mind. This guide covers much more about adjusting ultrasound machine settings.

ACQUIRING AND POSITIONING YOUR TARGET

Not only is it important to be able to find your target, however it is useful to position the structure of interest in the center of your screen. This is because the center of the ultrasound screen corresponds to the center of the ultrasound probe, and this can be used as an important landmark during your procedure!

HOLDING YOUR NEEDLE/INSTRUMENT

Given that it is important to properly hold you ultrasound probe in one hand, it is equally important to properly hold the instrument that is in your other hand as well. The video below shows one technique for holding a micropuncture needle (which is a very common example of an instrument that will be used during various ultrasound procedures in order to gain vascular access).

PUNCTUIRNG A VESSEL (TRANSVERSE VIEW)

When holding your probe perpendicular to the length of a vessel you will see a transverse cross section of it on the ultrasound screen (this will be your target). This video helps bring together the ideas explained above to show you an example of how one can gain access to a vessel in this orientation using a micropuncture needle.

PUNCTURING A VESSEL (SAGITTAL VIEW)

When holding your probe parallel to the length of a vessel, you will see a sagittal cross section of it on the ultrasound screen (this will be your target). This video helps bring together the ideas explained above to show you an example of how one can gain access to a vessel in this orientation using a micropuncture needle.

EXTRA CONSIDERATIONS FOR TRACKING YOUR NEEDLE

This video below gives a few extra considerations to keep in mind when tracking your needle using ultrasound. It may be reserved for those who have more advanced skills with ultrasound. Briefly, it discusses a technique where the ultrasound probe is tilted during the insertion of a needle, in order to visualize the tip of the needle much sooner (and at a more shallow depth). As the needle is advanced toward the target, the tilt of the probe is simultaneously corrected (helping track the tip of the needle down to its target).

ACKNOWLEDGEMENTS

A very special thanks goes to Dr. Jeremy Schiller who made this page possible with his expertise and insight.

Page Updated: 08.24.2017