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DOI: 10.1148/radiol.2413051595
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Vascular Access: Comparison of US Guidance with the Sonic Flashlight and Conventional US in Phantoms1

Wilson M. Chang, MD, PhD, Nikhil B. Amesur, MD, Roberta L. Klatzky, PhD, Albert B. Zajko, MD and George D. Stetten, MD, PhD

1 From the Department of Bioengineering, University of Pittsburgh, 749 Benedum Hall, Pittsburgh, PA 15261. From the 2004 RSNA Annual Meeting. Received September 27, 2005; revision requested November 14; revision received December 21; accepted January 24, 2006; final version accepted February 1. Supported by National Institutes of Health grants 1-R01-EB00860-1 and 1-R01-HL074285-01. Address correspondence to W.M.C. (e-mail: wmchang{at}gmail.com).


Figure 1
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  		Figure 1: Sonic flashlight, which incorporates a 10-MHz linear probe, a 54.8-mm (diagonal) organic light-emitting display (LED), and a 20 x 50-mm 30% reflective mirror.

 

Figure 2
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  		Figure 2: Diagram shows how the sonic flashlight functions. Half-silvered mirror bisects the angle between the US section within the patient and the flat-panel monitor. Angle {theta} is the angle between the flat-panel monitor and the half-silvered mirror, as well as the angle between the half-silvered mirror and the US section. Point P in the section and its corresponding location on the monitor are equidistant from the mirror along a line perpendicular to the mirror (distance = d). Because the angle of incidence equals the angle of reflectance (angle = {alpha}), the viewer (shown as an eye) sees each point in the reflection precisely at its corresponding physical three-dimensional location.

 

Figure 3
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  		Figure 3: Left: Overview of vascular access in phantom with sonic flashlight. Right: Operator's view through sonic flashlight. The operator sees the US image displayed exactly where it is being scanned, and the needle can be aimed directly at the vessel (arrow indicates needle within vessel lumen). Note that photographs cannot convey the very strong sense that the US image appears within the patient, as if emanating from its correct location.

 

Figure 4
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  		Figure 4: Diagrammatic representation of custom vascular access phantom used in studies 1 and 2. Vessel 1 was 5 mm in diameter and 9 mm deep, bifurcating; vessel 2, 3 mm in diameter and 20 mm deep, bifurcating; and vessel 3, 4 mm in diameter and 15 mm deep, straight. Task A was to access vessel 2 between the bifurcation of vessel 1, without penetrating vessel 1; task B, to access vessel 2 after the bifurcation; and task C, to access vessel 3.

 

Figure 5
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  		Figure 5: Study 1. Graphs depict mean vascular access time to perform tasks A (left), B (middle), and C (right) as a function of the number of trials with the sonic flashlight versus conventional US for US novices. With all tasks, the sonic flashlight showed an advantage, whereas learning rates were statistically equivalent. Error bars = 1 standard error of the mean.

 

Figure 6
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  		Figure 6: Study 2. Graph depicts mean vascular access time to perform tasks A, B, and C with the sonic flashlight versus conventional US for nurses proficient with conventional US. Performance was significantly faster with guidance from the sonic flashlight than from conventional US (P < .036). Error bars = 1 standard error of the mean.

 

Figure 7
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  		Figure 7: Study 3. Access of the left internal jugular vein in the cadaver. Arrow indicates needle tip within the vessel lumen.

 

Figure 8
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  		Figure 8: Study 3. Access of the right basilic vein in the cadaver. A flash in the needle hub indicated successful access. Arrow indicates needle tip within the vessel lumen.

 




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