ANGIOGRAPHYANDINTERVENTION.COM
What about Ultrasound Intervention?
What training is involved?
How are ultrasound images interpreted?
The use of ultrasound in Angiography & Intervention is part of cross-modality training and upskilling of interventional radiographers. The training involved is primarily "on the job" and can be taught by supervising senior interventional radiographers and learning from asking questions to interventional radiologists.
The use of ultrasound is part of the role and does not qualify you as a sonographer (this requires further study and training). However, a sound understanding and skillset in acquiring and interpretating ultrasound images are important when supporting and performing these procedures. Knowledge of anatomy and thinking in "3-Dimensions" is beneficial for improving practice in this area. Expertise can progress to scanning and marking the patient as part of the preparation.
PREPARATION
Patient preparation is important before starting any procedure.
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Have pathology and bloods been collected?
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Is the patient on any blood thinning medication (anti-coagulants)?
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Check for International Nationalised Ratio (INR) results? Should be <1.5 for any interventional procedure.
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Any allergies or previous iodinated contrast media reactions?
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Monitoring for patients under sedation.
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Prepare the interventional equipment needed such as biopsy needles, embolization (e.g. GelFoam, FloSeal), pathology containers.
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Some interventions can benefit from using both ultrasound and CT guidance.
PATIENT POSITIONING
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Speak to the interventional radiologist to ensure that the correct patient position is used.
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Check the request form and review previous imaging, such as ultrasounds, CT, MRI, and SPECT.
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Always check and consider patient comfort and mobility.
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Patients can be supine, prone, or even decubitus.
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Use of pillows, sponges, and support straps to stabilize and minimize patient movement during the scan and procedure.
SCANNING
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Check and review the previous imaging to see the region of interest (ROI).
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Perform a pre-scan of the ROI before sterilising and draping.
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The patient is scanned prior to the procedure using the appropriate probe (linear for superficial and vascular access, and curved array for deep organs/tissue).
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Ensure that the ultrasound gel is warmed before use.
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Always check patient comfort and positioning of any lines, tubing, and monitoring.
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Scan and mark the area with a marking pen. The interventional radiologist will clean, sterilize, and drape the ROI, followed by administering local anaesthetic. The interventional radiographer controls the ultrasound after the probe is covered.
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Make sure the correct depth and gain are used. Activate colour if requested. Freeze and save images for documentation.
IMAGE INTERPRETATION
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Correlate ultrasound images with previous scans done to determine size and location, and any changes since the last imaging.
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Become familiar with the anatomy that you are imaging.
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Various body tissues conduct sound differently - as some tissues absorb sound waves while others reflect them. The density of the tissue dictates the speed at which the echoes return.
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FLUID is always BLACK and TISSUE is GRAY. Dense tissue will appear a brighter white (i.e. bone).
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The interventional radiographer ensures that the image quality is optimal for the interventional radiologist while performing the intervention.
