Changes in Ultrasonographic Echogenicity and Visibility of Needles with Changes in Angles of Insonation

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PURPOSE

To objectively compare the echogenicity of several types of needles at clinically important angles of insonation.

MATERIALS AND METHODS

Four commercial needles (Echotip, Mini-Stick, Echo-Coat, Surflo) and a prototype dimpled needle were tested in a liver phantom at angles of insonation ranging from 90° to 15°. Photodensity measurement determined echogenicity levels in arbitrary echogenicity units (EU).

RESULTS

At 90° angles of insonation all needles were easily seen (60–76 EU) and echogenic levels were similar (P < .264). All values decreased with angulation. From the 35° to 15° angles, the prototype and Echotip needles were superior (P < .05). At 15° the values were 43 EU for the prototype needle, 40 EU for the Echotip needle, 9.0 EU for the Echo-Coat needle, and 5.0 EU for the Surflo needle.

CONCLUSION

With angulation, all needles drop in echogenicity, with prototype dimpled and Echotip best maintaining visibility at clinically important angles.

Section snippets

Devices

Commercial 21or 22-gauge needles with a dimpled distal shaft (Echotip; Cook, Bloomington, IN), a prototype needle with more dimples (Cook), an echogenic textured needle (Mini-Stick; Meditech, Boston, MA), a polymeric coated needle (Echo-Coat, STS Biopolymers, Henrietta, NY), and a non–echo-enhanced plasticsheathed needle (Surflo; Terumo, Tokyo, Japan) were tested. The Echotip needle (Cook) had 54 dimples per low power microscopic field and the prototype needle (Cook) had 70 dimples per low

RESULTS

At 90° angles of insonation, all needle types were easily seen and had similar echogenic values ranging from 60.8 to 75.8 EU (Fig 3). At all angles of insonation less than 90°, the prototype needle (Cook) had the highest average echogenicity. Needle echogenicity decreased as the angle of insonation decreased in all cases, but the magnitude of this decrease varied with each needle. The sheathed needle, Surflo (Terumo), demonstrated the steepest slope (had the greatest drop in visibility) across

DISCUSSION

US guidance for invasive procedures is a well-established technique that continues to gain in popularity. In most situations it is used with high success rates; however, needle visibility remains a limitation in many situations. Good needle visibility is expected in tissues that are relatively sonolucent and when angles of insonation approach 90°. Needle visualization is a problem with targets of increased depth or tissue echogenicity and when targets require small angles of insonation. Factors

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Presented at SIR 2003 annual meeting.

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None of the authors have identified a potential conflict of interest.

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