Needle Guidance Adds Safety and Accuracy to US-Guided Procedures
Physician: Knut Brabrand, MD
Facility: Oslo University Hospital, Oslo, Norway
Featured Product: General Purpose Needle Guide
Q. How did you become interested in the ultrasound field and how did it lead you to this career choice?
A. I became fascinated by ultrasound technology early in my career, in particular by the possibility to be able to improve the quality of the exam based on my own effort. I also liked the art of ultrasound, you create the images with the machine and can make important diagnoses bedside. I found it very challenging to learn how operator dependent ultrasound imaging can be. Additionally, I found it particularly fascinating to work directly close to patients with a real-time technology which did not expose the patient or doctor to any ionizing radiation.
Q. How did you become interested in needle guidance?
A. The use of needle guidance was part of my initial training. The reason for my continued use of needle guidance technology is that I think it adds safety and accuracy to most ultrasound-guided punctures. I have been working with various biopsy guides over the years, and for the last 10 years I have been working with the Ultra-Pro II™ needle guide. In my opinion anything that can make an interventional procedure more accurate and safer should be implemented.
Q. What procedures do you most commonly perform when using needle guidance?
A. In our department, most ultrasound-guided procedures are performed with needle guidance. Only very easy procedures are performed without the use of a needle guide including drainage of large volumes of pleural fluid and ascites in the abdomen.
Q. Describe your current role at your facility. How do you use the role to educate and advance the field of ultrasound?
A. I am the head of ultrasound in the department of radiology at Oslo University Hospital, Rikshospitalet, meaning I am responsible for ultrasound diagnostics in the adult patients, excluding musculoskeletal ultrasound procedures. I teach my colleagues doing diagnostic (B-mode, Doppler and Contrast Enhanced Ultrasound) and interventional ultrasound. We perform approximately 1,500-2,000 ultrasound-guided procedures per year, mostly biopsies of renal and liver transplants in addition to drainages and radiofrequency ablation procedures.
Q. Describe a time when needle guidance helped you avoid or reduce challenges or complications.
A. I recently performed a radiofrequency ablation as an open procedure to treat a 1cm metastatic tumor located cranially in the liver (previous right hemihepatectomy) between the middle and left hepatic veins, some not far from the confluence to IVC in a 35-year-old woman. Due to massive adhesions from previous surgery, the tumor could not be surgically resected. We placed two radiofrequency needles in parallel to each other using the Ultra-Pro II™ needle guide. The needle trajectory was long and quite challenging as we had to avoid both the hepatic artery, portal vein and hepatic veins. We managed to avoid the vessels and the treatment was successful. I would not have dared to do that as a freehand procedure.
Q. In regards to needle guidance technology, what advice would you offer those just entering ultrasound?
A. I would strongly recommend doctors who are entering the profession of radiology to use needle guidance for the majority of punctures in order to reduce the complication rate. In my opinion, needle guidance is of great help to keep the needle in the scan plane and to make the needle follow a planned trajectory. It should not be forgotten however, that a needle guidance system also has a learning curve, but once the basic skills are learned, one may proceed to perform more challenging and difficult punctures with greater safety.
Q. What do you expect of ultrasound in the future?
A. The future of ultrasound will depend on various factors including technological developments, economy and training. I believe ultrasound technology will become utilized by more physicians in specialties other than radiology, a trend that is already a reality in many countries. As ultrasound machines are getting less expensive, the technology will be more available and widespread. Many doctors will perform basic ultrasound in various clinical departments as a kind of modern stethoscope. There will likely be more sub-specialties within the field of ultrasound, and also more levels of sophistication within the various fields.