For athletes in any discipline it is really important to manage body composition and weight. The main objective of this paper is to evaluate the accuracy of body fat by using portable ultra sound device which results are reliable and authentic. Its design is based on Cross validation study. The paper deals on a set of individuals of total 93 athletes. The composition of these athletes is as follows: There were 24 women and 69 men), aged between 23.5 ± 3.7 years, their body mass lies between 24.0 ± 4.2 and body fat = 9.41 ± 8.1.All participants committed with a broad range of weight-category sports.
Methods
Author used two methods for conducting the whole research
Data collection Procedures
Statistical analysis
Data Collection Procedures
From the set of individuals, DEXA device is used for measuring total body composition. Test was taken after breakfast and all athletics had assimilated 296 ml of water before DEXA measurement. Hologic device was used to obtain BF% measurements. DEXA method usually uses X-Ray tube with filter to generate low energy and high energy photons. Hologic software is also used in the test in order to obtain accurate and fast results.
Ultra Sound device was used to obtain ultra sound measurements. A sonographic approach was frequently used in the whole process. The ultra sound technique is widely used to measure the fat between the skin and the muscle. Using a highly reliable technique, the intraclass correlation co efficient was found above 0.98.Bf and FFM model were used for all athletes. Height was also measured without shoes in order to obtain accurate results.
Statistical analysis
DEXA and UT were examined via paired sample tests to find out the relationship between BF%. Coefficient of determination is used to find out the accuracy of BF prediction.
Results
The derived results showed by the author are highly based on accuracy and BF% bias measurement. Results shows that 46 participants. BF% determined by UT showed a minor difference Mean difference according to the results, BF% estimates on the scale of fatness (r=0.12 p> 41). It can be cleared form the following table:
Discussion
Bland and Altman methods are used to examine the level of UT and DEXA BF % estimates. UT Gem device used in this whole process is good enough for providing best and accurate results. According to estimated results using DEXA, there were 43 trained males. The device is really good and gives accurate range of body composition. Characterizing body composition is beneficial in order to obtain high quality and reliable results and it is important for athletes physical and mental. Diets and excessive diet usually create a problem and it doesn’t sound good. BF content helps in increasing BF% estimate which overall add life to your bones. Integrating body indicators with body composition via different methods add life to your daily routine. In a nut shell, accurate body composition is really beneficial for athletes. Device used in this research allows identification of body composition within a particular sport. Health and performing status is necessary for better achievement in sports. According to the results UT versus DEXA was perfect and they both want the same hours of attention.
Application
Weight fluctuations and its effect on body composition are very important for athletes in sports. As many athletes need to loose weight before competitions, it’s necessary to know their ideal body composition for best performance. Determination of BF and FFM is important to optimize body composition. Non-invasive technique of measuring BF would be a good alternative to obtain quick results. Portable non-invasive ultrasound device can measure subcutaneous fat and give accurate results. These researches will definitely help athletic and science professionals in finding accurate results.
Ultrasound is a widely used imaging technique in medicine either as a therapeutic or as a diagnostic tool. Ultrasound imaging technique is used in almost every form of medicine ranging from cardiology, internal medicine, anesthesia, dentistry, hypothermia, physical therapy, surgery etc. Millions of ultrasound scans are done every year, and ultrasound remains one of the fastest growing imaging techniques in medicine. The popularity of ultrasound imaging in medicine is due to the facts that it is a low cost, real time and less risky technique. The wide usage of ultrasound in medical imaging elicits the question of the biological effects of ultrasound examination on living tissues.
This paper evaluates the basic physics behind the use of ultrasound imaging technique with an emphasis on the medical ultrasound imaging. The paper also evaluates the physical mechanisms for the biological effects of ultrasound and the effects of ultrasound on living tissues in vivo and vitriol. Several effects of ultrasound on tissues are then reviewed to provide an insight on the range of the effects of ultrasound on tissues.
This report also explores the significance of the biological effects of ultrasound on the safe use of ultrasound techniques in medical practice. Concerning the exposure of humans to ultrasound, the paper covers the applications of ultrasound on the human medicine. This report is intended to cover the biological effects of ultrasound with peculiar interest in clinical applications. This report, therefore, be considered a valuable resource for those interested in the use of ultrasound imaging and its effects.
Introduction
Ultrasound involves the use of sound waves of high intensity to create images of body organs and the body systems. An ultra sound machine produces various images that allow the organs and systems in the body to be visualized. The ultrasound machine sends out sound waves of high frequency that reflect off the body structures. A computer then receives the waves reflected and uses them to create a picture of the body tissues. There is no ionizing radiation used in ultrasound imaging. The use of ultrasound in medical diagnosis is called ultrasonography (NCRP, 2006).
An ultrasound technician can use information from an ultrasound image to answer questions about a medical condition. A transducer also called prove is used to project and then receive the reflected sound waves. A gel is normally applied on the patient’s skin so as not to distort the waves as they are crossing the skin. Ultrasound scans can answer questions about a medical condition using an understanding of human anatomy and the picture of the reflected waves (Andreassi, 2004).
The widespread use of ultrasound imaging in medicine and diagnostics raised concerns over the effects of the use of this technique on the body. Concerns have been raised in the past over whether there are any adverse effects of the sound waves in the body. Experiments carried out on animals have provided a link to ultrasound in cancers, internal bleeding, schizophrenia and autism (Nelson & Pretorus, 2008).
However, although there are some biological effects of ultrasound on tissues, no adverse affects have been reported to date over the use of ultrasound in medical imaging. Some of the biological effects of ultrasound on tissues are transient and not well understood. It is also difficult to perform valid experimental procedures on the effects of ultrasound on tissues and, therefore, the use of ultrasound technique has been limited to the use of as low as reasonably active (ALARA) principle (Guy van, Steven, & Cozy, 2007).
Physics background of ultrasound
Sound is a form of mechanical energy and propagates longitudinally in elastic media in alternating zones of rarefaction and compression. Ultrasound imaging uses short pulses of sound, and the energy is reflected in impulses. The basic properties of sound waves used in medical imaging are of frequency 1 to 15 MHz, pulse length of 3 to five cycles, the wavelength is 05mm, and attenuation is one db the speed of sound in tissue is 1540m/s. The pulses reflected in moving interfaces like blood vessels exhibit a shift in phase that can be used to measure the velocity of the movement along the sound beam. These are called the Doppler Effect and are in the range of 10 to 1000 Hz (Barry, 2011).
There are two types of Doppler. The velocity Doppler computes the velocity of each pixel and displays color schemes whose direction and saturation depends on the component measured. The power Doppler computes the entire velocity distribution and displays the magnitude as either color or brightness (Dalecki, 2004).
Diagram showing the functioning of an ultrasound machine
Ultrasound also uses contrast materials such as gas filled micro bubbles for better visualization of tissues and vessels. These contrast agents help in enhancing the masses, visualizing blood flow and delivering drugs and genetic agents to sites. The sound beam used in ultrasound propagates in two directions, the Fresnel field and the far flied. The scan lines sweeping in different directions are used to create a dimensional image of the tissue under analysis (Collins, 2008). The potential of an ultrasound beam to cause bio effects is indicated by the formula:
ISPPA=ISATA/duty cycle
An Ipa=ita/duty cycle, is the indicator of the potential, thermal, effect of ultrasound.
Ispta=Isata (Isp/Isa) duty cycle
This is the indicator of the potential mechanical bio effects and the cavitations of ultrasound.
The potential bio effects of ultrasound are also influenced by the power output and the acoustic power of the ultrasound machine i.e. the rate of production of energy, flow and absorption. Different tissues of the body have different attenuation coefficients for sound waves. For example, the lung has an attenuation coefficient of 40, while the blood has an attenuation coefficient of 0.18. This different attenuation coefficient of tissues determines the frequency and the intensity of ultrasound scan that is used in different tissues of the body (Collins, 2008).
Mechanism of interaction of ultrasound with body tissues and the potential bio effects
Ultrasound is a form of mechanical energy where pressurized sound waves travel through tissues. Reflected and scattered waves are then used to form an image of the object under scan (Nelson & Pretorius, 2008). The major effects, of ultrasound are characterized into:
Thermal effects
As the ultrasound sound waves travel through tissue, their energy is converted into heat in tissues. Tissues with high absorption coefficient like bone have highest absorption and record high thermal effects than tissues with low absorption coefficients like amniotic fluids. The Energy conversion of sound waves in tissues is also dependent on tissue thermal characteristics, the intensity of ultrasound and the period of exposure. The intensity of ultrasound is in turn dependent on power output, the mode of ultrasound, the depth of scanning and area of imaging. There are so many variables involved in thermal effects of sound waves on tissues that it is difficult to model temperature rises in tissue. The transducer phase of ultrasound can also heat in an ultrasound examination (NCRP, 2006).
Cavitations
Cavitations’ is the development of stable or temporal gas bubbles in tissues. Inertial (transient cavitations have the most damage on tissue because when the gas filled cavity grows, then during pressure rarefaction of the ultrasound pulse and contraction during the compression phase the collapse of the bubble can generate high pressure and high temperatures. This has been hypothesized to be the cause of hemorrhage in lungs and intestines of experimental animals. The use of contrast agents in ultrasound leads to the formation of micro bubbles that in a way provide nuclei for cavitations to form (Dalecki, 2004).
Other mechanical effects
Passage of ultrasound waves on tissues causes a low form of radiation force on tissue. However, the pressure that result from ultrasound waves and the pressure gradient that develops across the beam of sound even at high intensities of the diagnostic range are exceptionally low. The effect of this radiation force manifest itself best in fluid volumes where streaming can develop within the fluid. However, the fluid velocities that may develop are unlikely to cause any damage in tissues (Nyborg, 2011).
The effect of ultrasound on fetus
No evidence of cavitations on fetal scanning but hyperthermia has been thought to be tetranogenic. However, the results are not particularly clear and valid to indicate any adverse effect of ultrasound on fetus. The guidelines for use of ultrasound in pregnancy are that ultrasound scans that results in temperature rise, in tissue of 1.5degres centigrade, may be used without reservations and those above 4 degrees centigrade are potentially hazardous to tissue (Colins, 2008).
Chemical effects
Experimental ultrasound can lead to depolymerisation of DNA, polysaccharide and polypeptides. Oxidation and reduction reactions can also occur although these processes have not been reported in vivo, in diagnostic procedures. High intensity and high frequency ultrasound have been shown to result in chromosomal; damage, genetic mutations and tissue necrosis and teratogenic effects (Barry, 2011).
Applications in medicine and biology
Ultrasound has been used in many clinical settings for medical imaging. The main advantage of ultrasound over other diagnosis and therapeutic procedures is that certain structures of the body can be visualized without using radiation. Ultrasound is also faster than x-rays or other radiographic techniques (NCRP, 2006).
The Use of ultra sound in diagnosis
Obstetrics
Ultrasound imaging is routinely used in examining the progression of pregnancy, and observation of tumors in ovary, uterus and fallopian tubes. Ultrasound is the most common procedure used in measuring the size of the fetus, the position of the fetus in the uterus and checking the position of the placenta to assess whether it is developing properly over the opening of the cervix (Nelson & Pretorius, 2008).
In cardiology, ultrasound imaging is used to examine the heart function and blood flow motion in a procedure called echocardiography. Ultrasound is also used to assess the functioning of many body organs in orthopedics and blood vessel diseases (Barry, 2011). Ultrasound is also used in therapeutics. It may help physicians insert needles into the body. In urology ultrasound, imaging is used in measuring blood flow in kidneys, visualization of kidney stones and detection of prostrate cancer. Ultrasound is also finding uses as a diagnostic tool in emergency rooms (Dalecki, 2004).
Summary and recommendations
The use of ultrasound in diagnosis and therapeutics has provided a wealth of knowledge in medicine, and there is a need to appreciate the impact that the technique has had on medicine. Millions of ultrasound examinations are done every year, and ultra sonography is one of the fastest growing imaging techniques. The growth of ultrasound technique in imaging is partly, because of this it is a low cost real time image display, and largely the few bio effects it has on body tissues.
Although animal studies have shown that the ultrasound procedure has some potential bio effects on tissue, the regulatory processes that control the use of ultrasound devices has set a safety margin for the safe use of ultrasound in clinical settings since high intensity high frequency sound waves are damaging to the body. These guidelines have restricted the patient exposure to ultrasound procedures to be restricted to levels that produce little or no bio effects (Nyborg, 2011). The regulations stipulating the use of ultrasound devices are set by bodies like the International Electro Technical Association, the USA food and drugs administration and the federation of societies of ultrasound in Medicine and biology (EFSUMB) (Nyborg, 2011).
The field of ultrasound imaging is rapidly changing. Therefore, a physician or an Ultrasonographer is needed to play a leading role in adhering to the accepted exposure limits of ultrasound to limit the potential effects of ultrasound on tissues. This calls for prudent adherence to the standards of safe use of ultrasound by the physician and the ultrasound technicians.
References
Andreassi, M. (2004). The biological effects of diagnostic cardiac imaging on chronically Exposed Physicians. The importance of being none ionizing. Pisa: Institute of Clinical Physiology.
Barry, G. (2011). Ultrasound bio effects for the perinatologist. Web.
Collin, D. (2008). Safety of diagnostic ultrasound in fetal scanning. London: Centrus.
Dalecki, D. (2004). Mechanical bioEffects of ultrasound. Annual review of biomedical Engineering. Volume 6, 229-248.
George, L. (2011). The physics of ultrasound. Sydney: BAT Research group.
Guy van, C., Steven, D., Cosyn, B. (2007). Bio effects of ultrasound contrast Agents in Daily Clinical practice: fact or fiction. European heart journal. vol. 102, 224-254.
Nelson, T., & Pretorius, D. (2008). Ultrasound bio effects. Web.
NCRP, (2006). Biological effects of ultrasound mechanisms and clinical implications. Milan: NCRP.
Nyborg, W. (2011). The biological effects of ultrasound: development of safety Guidelines. Part ii General Review. Burlington: University of Vermont.
Evident from previous research and casual empiricism, application of 3D ultrasound technology across many healthcare centers demonstrate much promise. This shift in philosophy has forced researchers to keep an eye on current technological changes. 3D ultrasound application in the modern medical world is inevitable and may be considered to possess both positive and negative impacts. The methodology in this research utilizes 3D technology of capturing multiple-dimension images on pregnant women while focusing on the progressive development of the fetus in its entire gestation.
Introduction
Technology has improved the way medical specialists diagnose diseases. The newly introduced technology such as 3D ultrasound has increased the likelihood that tissue abnormities can be detected with no much effort. Evidently, modern 3D surfaces have demonstrated clinical utility. Ultrasound is an emerging modality and research argues that its application to have improved diagnosis in human organ soft tissues that would have otherwise missed by standards MRI procedures. An extrapolation from 2D ultrasound technology, 3D imaging has undoubtedly increased the evaluation of standardization of ultrasound evaluation. As 3D ultrasound continues to mature, this research will investigate specific 3D ultrasound application to clinical set ups.
Evidence-based practice is the basis of work for most practitioners, in which the same evidence is used but is being applied for different purposes. 3D modeling technology has provided avenues for a variety of technological development, especially in the medical field. The technology has been embraced by a wide variety of ultrasound laboratories as a useful diagnostic tool. Widely applied in management of pregnancy, 3D technology non-invasive procedures have made is easy for parents to know the sex of the baby as well as rule out any anomalies. 3D models imaging technology works by transferring media images into health and diagnostic procedures enabling parents view video of their child prior to delivery.
This study is aimed at identifying both positive and negative influences of computer technologies as important diagnostic tool. The methodology is based on secondary data, statistics were provided as well as primary data in form of a questionnaire that will be given out to several participants in order to form a qualitative empirical analysis on this topic. The survey will be measured in a Likert scale that will enable patients’ rate their opinions regarding use and application of 3D ultrasound technology
After gathering the replied surveys, the aim of the study is to compare and contrast the results between hybrid pregnant women and real expectant mothers as well as with the literature review in order to make clear to the reader how innovative technologies in the modern world, how it is changing with evolving healthcare and finally examine if such applications have positively influenced activities of sonographers.
Literature Review
Applied as a medical ultrasound technique, three-dimension (3D) imaging is used as a diagnostic tool in determining fetal development at various stages. It provides a three dimensional image that shows features of a fetus including movement and the sex of the baby. Ultrasound technology has for the past years experienced dramatic improvement as quoted by Lazebnik and Desser (2007) in “ultrasound image quality, resolution, availability and a range of indications” (p.1). Evidence-based practice is the basis of work for most practitioners, in which the same evidence is used but is being applied for different purposes. This is coherent to the 3D planar imaging are improved technology previously applied in the 2D ultrasound technology. The essay will record experiences in research (i.e., approach, methodology, critical thinking) may be considered evidence of practice in themselves since the concepts about how they are done are being applied practically. These advances accelerated the explosion of various medical applications whetting appetite for more advanced volumetric CT and MRI technologies. The rigidity of tasks undertaken in the previous 2D imaging stimulated sonographer’s appetite to provide a comparable volumetric technology that is more advanced.
Physics of 3D Ultrasound
As an extrapolation from 3D technology, 3D ultrasound is applied as a medical diagnostic technique that utilizes waves within the ultrasound machines. The beams reflected from the scanned image are transmitted back to the transducer projecting an image onto the screen in form of a video. Different scanning models exist in obstetric ultrasound, but 3D ultrasound features are specifically designed to pick sound waves being sent to different angles. Sound waves sent back and forth return with echoes which are processed by a computer program projecting in three dimensional images of internal organs. 3D ultrasound uses the same technology but clearly defines width, heights and depth of images for proper diagnostic analysis.
Created by Olaf von Ramm and Stephen Smith at Duke University in 1987, it was though that 3D ultrasound imaging technology would ease clinical diagnosis especially in fetal anomaly scanning, breast and pelvic imaging. Deeply embedded in 3D technology, picture display in 3D ultrasound is completely real time and eliminates lag problems associated with delayed computer constructed images common in traditional MRI ultrasounds.
Benefits and Limitations of the 3D ultrasound Technology
It is indicated that radiologists dependent on a series of non-continuous and often uniform imaging organ as a prediction of the whole human anatomy. This therefore requires repeat examination of sampling in developmental which is often challenging and time consuming since fixing of the imaging plane and reconstruction of other cross section are required. Second limitation is that no spatial relationship is indicated in the images submitted for review, forcing a radiologist to depend on image labels trusting the labels have minimal sonographer variability. To verify this, a sonographer is forced to perform a comparison analysis for the acquisition technique used, which proves challenging in an event where serial exams were performed since no exact corresponding planes will be acquired. Third, volume measurements such as ellipsoid are defined by length and width and do not depict the true 3D shape. Finally, transformation from 2D to 3D technology does not exploit volume rendering techniques.
Therefore, 3D ultrasound approaches were developed to allow the acquisition of a sonographic volume. It also argued that personal experience of the sonographer in the 2D post-processing cine clips study is also one that may be categorized to be similar to offline workstation acquired by freehand scanning into 3D volumes. Such post-processing scanning are what Lazebnik and Desser (2007) categorizes as “easy to implement and less accurate than volumetric acquisition” (p.1). The 3D technology intensifies data into a 2D image to obtain a true 3D sonographic volume then uses these rays to visualize 3D ultrasound data. In This case, options such as 2D transducer arrays, mechanical scanners and freehand techniques with automated localization are utilized to acquire acquiring sensors of a convectional 2D diagnostic ultrasound machine. This is an advantage because the technique does not involve use of ionizing radiation since it acquires volume information directly a series of continuous or non-continuous 2D images which retains scanning flexibility. Being an extrapolation from 2D technology, 3D ultrasound o acquires sensors of a convectional 2D diagnostic ultrasound machine.
Another benefit of 3D ultrasound is that its sonographic features are universally applicable. First, in 3D ultrasound setting, a sonographer scans the region of interest with a linear-array transducer contrary to the CT scan that requires multiple sweeps. Also, in applications such as bedside neonatal 3D neoro-sonography, 3D ultrasound has greatly reduced time performed on scanning since it eliminates sedation techniques such as the ones performed in MRI modalities (Fritz et al, 2005, p.299). Similar to volumetric CT data, 3D ultrasound volumes are performed prior to the set acquisition in order to rule out any technical problems that may be encountered during a scan analysis. Pretorius and his colleagues (2005) also state that “ an evaluation of multindodular thyroid glands or fibroid uteri, for example, may become much easier when the organ is viewed in multiple planes simultaneously on tomographic display workstations” (p.941). In this sense, Pretorious et al (2009) provides that “post-processing allows remote interpretation and teleradiology for sonography, as the reader has necessary information in the scanned volume” (p.942). This enables easy comparison of serial imaging over a period of time since numerous corresponding anatomic landmarks are displayed in all data sets. Conclusively, this experimental learning is experienced by the sonographer in his engagement with the various learning tasks. Lazebnik and Desser (2007) add that measurement of organ volumes with 3D surface visualization are directly computed by manual/ automatic segmentation that comes along with data set-which does not require interpretation of any specific geometry to analyze scanned images.
Abdomen and Pelvis Application
3D ultrasound benefits are numerous. For example, examining the abdomen with 3D ultrasound requires what Lazebnik and Desser (2007) quote as “estimating volumes of liver masses, gallbladder, or gallstones and other size measurements i.e. kidney long axis, have traditionally relied on the sonographer’s accurate imaging of this plane” (p.3).
Accessibility and Feasibility of 3D Ultrarsound
3D ultrasound already demonstrates clinical utility as evidenced from obstertric applications mentioned throughout this essay. Given that several limitations persist in 2D imaging, the unmatched benefits of 3D imaging are overwhelming. 3D ultrasound also show potential benefits in obstetric imaging (Benacerraf et al, 2005) and when exploring gynecological applications, 3D imaging is regarded as a more efficient clinical approach. 3D is also beneficial in what Benacerraf et al (2005) states as “evaluation of congenital uterine anomalies, where post-processing into the coronal plane permits visualization of the uterine fundal contour” (p.1249). Images obtained here can be used in comparing two volumetric techniques for estimating the nature of fibroid uterus growth. Lazebnik and Desser (2007) also mention 3D imaging application services to include “endometrial polyps, corneal ectopic pregnancies, intrauterine devices, and adnexal lesions and other interventions including abscess drainage of the pelvis and abdomen as well as fertility procedure” (p.3). They mention these medical interventions to have been made easier by 3D technology by enabling viewing of multiple planes at once. 3D imaging also offers benefits in urologic sonography when applied in both urodynamic imaging and anatomic survey. In pediatric application, Mitterberger et al (2006) quotes “3D ultrasound is intrinsically superior to 2D in documentary congenital renal anomalies and ureter configuration (in context of reflux), as these 3D structures cannot be completely visualized in a single plane” (p.11). When further comparing with 2D sonography, Mitterberger et al (2006) also add that 3D ultrasound is superior for evaluation of hematuria with regard to identifying bladder cancer, bladder wall hypertrophy, bladder diverticula, mucosal bladder folds, and re-growth of the prostate, as validated by cystoscopy and/or bladder biopsy” (p.11).
Lazebnik and Desser (2007) mentions that 3D ultrasound imaging in the scrotum provides better 3D visualization of the AUS complex geometry of the epididymis and other extratesticular structures, substantially improving diagnostic confidence and proper medication. For patients with suspected prostate cancer,
Sauvain at el (2007) mentions 3D application in Doppler sonography to “improve diagnostic and staging accuracy of anatomic imaging through improved depiction of prostate vascular structures” (p.30). Finally, utilization of 3D imaging in biopsy site selection has helped greatly in identifying areas of abnormal blood flow. Boggers et al (2008) concludes by adding “extracapsular involvement is evaluated by detecting the presence of vessels perforating capsule and use of microbubble-based contrast agents further increases the sensitivity of 3D ultrasound for prostate malignancy” (p.97).
Breast Imaging
In breast imaging, Cho et al (2006) embraces the 3D technique in its ability to identify breast masses. In stressing their point, Cho et al (2006) state “multiplanar capability of 3D has introduced to the imaging palette the coronal plane, which some investigators suggest improves depiction of tumor margins and of the orientation of tumor relative to ductal structures” (p.31).
Cardiovascular Application
In cardiovascular application, 3D ultrasound has proven beneficial in vascular imaging by providing detailed anatomic structures that includes color, spectral visualization and quantification of blood flow. On the contrary though, Kripfgans and his colleagues (2006) mention the inherent 2D ultrasound contradictions to include inaccurate estimation of flow volume since cross-sections areas are unknown. Recent research by Kripfgans and his colleagues (2006) suggests that “3D techniques provide true volumetric flow estimates that are angle-independent and allows direct visualization and quantification of plaque volume unlike 2D ultrasound that allow detection of arterial atherosclerosis primarily through velocity measurements” (p.1305). AbuRahma et al (2007) further add “the addition of 3D color toDoppler information may provide benefits in the grading of stenotic lesions with respect to flow dynamic” (293). Busek et al (2005) and Klotzsch et al (2008) argue that the ability to reformat 2D volumetric data to fit 3 dimensions enable greater visualization of data flow in a plane resulting to low interobserver. Also 3D provides a single plane that displays all the related vasculature (for example, the hepatic arterial system) enabling the viewer to view the entire anatomy. the viewer can observe the entire tree in 3D. Since the heart’s contraction motion is depicted in a three-dimensional image, the evaluation of cardiac anatomy alongside its function through 3D technology provides accurate measurement of chamber volume and ejection fraction. Ota et al (2007) summarizes that “while 2D echocardiography requires assumption of a simplified geometric mode of the ventricular shape, the 3D approach allows for direct ventricle segmentation” (p.93). They conclude by adding that visualization of an entire valve has been made possible by 3D technology by improving septal defects and analysis of anatomic relationships in congenital heart disease (Houck et al, 2006, p.1092).
Impacts of 3D ultrasound to Professionals
3D ultrasound has been beneficial in real time visualization by guiding of both invasive and operative interventional procedures. Application of 3D ultrasound to neurosurgical procedures has greatly benefited surgical specialists in cases of resection of intracranial tumors. Lindner (2006) provides that 3D information “allows surgeon to modify preoperative planning maps to account for warping and tissue removal” (p.1975) as the applied Doppler imaging provides improved visualization of vasculature of interest. Unsgaard et al (2006) and Woydt et al (2005) further mentions 3D beneficial features to include “biopsy guidance, resection guidance, arteriovenous malformation localization (and involved in vessel identification, localization of peripheral ancurysms, and declination of cavernous hemangiomas in both brain parenchyma and the brain stem” (p.235, 28). For gliomas resection, Unsgaard et al (2005) mentions that “3D ultrasound volumes provide delineation of metastases and solid component at least as reliability as navigated 3D MRI” (p.1269). In summary, 3D ultrasounds does no require data pre-set unlike the MRI application that may be affected navigational accuracy.
Materials and Methods
The methods utilized for analyzing research question were survey questionnaire distributed to each e pregnant woman participating in the research study. The questionnaires were given a study format with a thorough explanation of what was required from them. This strategy was used in anticipation that extensive data will be collected on how each member perceived changes and developments of their fetus rather than forcing themselves into YES and NO replies on pre-existing scales designed around the authors beliefs. Questionnaire method of data collection applied by the research assistants to record raw information and report the findings on the sensitive issues of information technology was reliable and improved the credibility of data collected. In determining the validity the results obtained, generated 3D hybrid models were compared with real expectant mothers with the supervision of obstetricians and radiologists.
Lazebnik and Desser (2007) intensive research into 3D ultrasound technology confirmed that “the study of interactions between radio frequency waves and biological tissues requires precise models of the human body at various stages” (p.1). To this, the research identifies a hybrid human head models based on magnetic resonance image (MRI) data, as a sample for studying impacts of 3D technology to pregnant mothers. Participants were informed on the procedure to be followed and professionals were exposure magnetic fields prior to the research to check if the machines were set correctly. Lazebnik and Desser (2007) define dosimetry as “numerical simulations computing the dose absorbed by body tissues resulting from the exposure to some specified radiations” (p.1). Dosimetry will therefore use a standard method of anatomical model to calculate the absorbed radiations by pregnant women. To do this, detailed information of the tissue including tissue localization, anatomic details of the utero-fatal unit and the organ shapes will be required. The hybrid models of pregnant women were pre-selected on the basis of dosimetry simulations.
Sample
The samples consisted of 15 participant and only 13 responded were responded were assumed to have used 3D ultrasound at least once a month. Three hybrid pregnant women were also used. The response rate was rated at 70% since 10 participants applied 3D ultrasound in one way or another. The responded included a 23 woman, a secretary at department store and a 30 year old housewife woman. The questions were carefully drawn to avoid misrepresentation and where technical terms were used, were followed by simple explanations to ensure higher response rate.
Likert scale enabled participants to indicate their degree of agreement with the statement using a five point scale that indicates;
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Results
3 generic hybrid models series were created to represent pregnant women at a different gestation stages and placed the fetus in different positions. For proper dosimetry scanning, the models were acquired during regular clinical follow-ups and detailed tissues of the fetus and the utero-fetal unit, were displayed. Adequate time was allocated to validate the accuracy of the 3D ultrasound machine with the approval of clinical obstetricians and radiologists.
A total of 13 respondents were used for the analysis after filling and returning the questionnaire for their completeness and consistency. The participant profiles were presented per the following demographic criteria
58% of the corresponds were aged more than 23 years
59% of the respondents had stable jobs and their able to afford 3D ultrasound
24.8% of the responded said heathcare did not cover 3D, so they could not afford.
The age ranged from 20 to 35 years
Age Group
Age
Response Rate
Response Rate in %
20-23
5
6
24-27
11
13.5
28-31
18
22
32-35
9
11
The age ranged from 20 to 35 years
The maximum respondents lied between ages 25 through 30 years whereas minimum respondents were represented by ages 31 through 35. With regards to employment status, only 26.8% of the respondents were permanently employed while the minimum groups of 6% were either jobless or were housewives. The frequency use of 3D ultrasound was measured in monthly basis, and 26.8% argued the technology improved the bonding with child.
Limitation of 3D ultrasound
First; as sonographers would make us believe, 3D image acquisition is not different from the 2D ultrasound since they both use the same contrast-acoustic impedances. Also in obstetrics applications, 3D renderings have been effective in identifying amniotic fluids since they provide high contrasts between the background and the fetal surface but fails to provide the same contrasts in other organ systems. Secondly; 3D platforms does not provide standard display convection making it complex and hard to master or even interpret the reconstructed images. Also, the scientific characterization that uses medical techniques such as posterior enhancement is difficult to understand in an event where multiple simultaneous transducer orientation is applied. Third; 3D ultrasound technology impresses the methodology that does not use present data acquisition, which is a standard methodology employed by 2D for easy interpretation. Fourth; Lazebnik and Desser (2007) quote “rendering of data in 3D using volume or surface rendering techniques introduces an additional layer of potential artifacts and lack of standardized review” (p.4). Fifth; since 3D images are more accurate that the traditional 2D sections, literature that support clinical benefits of 3D ultrasound imaging are insufficient, particularly in comparing their benefits and indications.
Elective 3D ultrasound
Elective 3D ultrasound refers to what Michailidis and his colleagues (2006) states as “ultrasounds performed on pregnant women for the reason of a woman wanting to see her unborn baby including the sex of the child” (p.215). Although there is no conclusive evidence to show the benefits of 3D ultrasound to a mother and the unborn baby, medical literature mentions 3D rays to be harmful when the duration of ultrasound exposure, intensity of the waves and frequency of ultrasound the sessions are uncontrolled.
Duration
Incases of malfunction, As Michailidis et al (2006) states that “3D ultrasound machines should be preset to send signals warning or shut off in cases of breakdown if any of the built-in barriers fail to control the limit of the ultrasound waves as provided by the FDA standard” (p.216). As Michailidis and his colleagues (2006) succinctly concludes, “a higher intensity of ultrasound waves are used to detect the baby’s heartbeat, and as the waves are directed and focused onto a single organ in the fetus, it is advised to use ultrasound machine to detect and play baby’s heartbeat after two weeks of gestation” (p.216).
Frequency
It is however advised use ultrasound at least once a month since studies claim that frequency use may pose potential risk to a patient and should not be substituted with routine prenatal care. Michailidis et al (2006) extensive research also provide that neither of the participants (mother and the child) can feel the heat produced by the machine however higher intensities create slight warmth and may be dangerous to the baby.
Medical effects
There are currently no found reports on the mental defects of ultrasound usage to both the mother and the child.
Other risks
Some potential risks inherent in 3D ultrasound technology are miscalculations that may display false positives which can cause panic to the mother. Inexperienced technician can also misdiagnose certain conditions by using 3D ultrasound machine since some artifacts can be easily translated as duplicates or even missing. It is also advised not to perform ultrasound on fetus less than 17 weeks of gestation as the waves may cause harm to the mother.
For risk reduction, FDA requires that qualified ultrasound technologists with ARDMS-certificates allowed in performing ultrasound scans. Since there is no law requiring 3D ultrasound to be conducted by certified ultrasound technologists, healthcare centers should make an effort to employ qualified medical directors and provide the needed training to perform ultrasound scans. Pregnant mothers on the other hand to produce pre-natal care before 3D ultrasounds are performed. For clear images patients may be advised to drink plenty of water prior to the appointment for adequate amniotic.
Future Developments and Conclusion
Benefits of 3D ultrasound to pregnant mothers are overwhelming, and to this we recommend that 3D ultrasound to be part of routine care, and prenatal clinics should provide them as courtesy. Medical researchers are constantly faced with the task of innovating new technological tools but insurance companies’ serves as a barrier to this, especially if it delivers predictable returns in the short term. In this case, insurance companies should start accepting 3D ultrasound as part of health cover. Medical companies should invest in creating awareness on benefits of elective 3D ultrasounds as it has proven very useful in detecting fetal anomalies which can help diagnosis.
Since the application of innovation technologies relies heavily on medical practices, the selection of suitable computer programs and qualified technological sonographers is required to be able to cope with the technological changes as success or failure of a diagnosis relies on them. This study should also be conducted in several hospitals to compare the results and use large samples from different
States to improve results achieved. The study covered the application of 3D ultrasound innovative technology in the modern healthcare and even considered elective 3D imaging a effective in early anomaly detections; hence researchers may consider studying reasonable limits to which pregnant women should be allowed to take 3d Ultrasounds. Insurance companies should therefore welcome this technology by including it in medical covers.
Evidence-based practice is the basis of work for most practitioners, in which the same evidence is used but is being applied for different purposes. In this regard, research in improving the current technologies should be embraced. 3D modeling technology has provided avenues for a variety of technological development, especially in the medical field. The technology has been embraced by a wide variety of ultrasound laboratories as a useful diagnostic tool. Widely applied in management of pregnancy, 3D technology non-invasive procedures have made is easy for parents to know the sex of the baby as well as rule out any anomalies. 3D models imaging technology works by transferring media images into health and diagnostic procedures enabling parents view video of their child prior to delivery. Since 3D images are more accurate that the traditional 2D sections, literature that s clinical benefits of 3D ultrasound imaging should be provided, particularly in comparing tits benefits and indications from other scanning machines. Although there is no conclusive evidence that shows benefits of 3D ultrasound to a mother and the unborn baby, duration of ultrasound exposure should be limited to only once a month.
References
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Bogers, H.A., Sedelaar, J.P., Beerlage, H.P (2008). Contrast enhanced three-dimensional power Doppler angiography of the human prostate: correlation with biopsy outcome. Urology, 54(1):97-104.
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Arterial puncture is a common procedure performed almost daily in most medical facilities including medical wards, and emergency departments. Despite how common it is, due to the traditional techniques of placing the artery, a variety of complications can occur, some of which can lead to prolonged discomfort, suffering and even death. The unit should be able to provide the best possible care for the patients, especially when the procedure is performed with high enough frequency to put a lot of people in danger. At the moment ultrasound equipment is starting to become common among emergency departments, but traditional methods of artery placement are still used. The unit fully supports the project due to the positive results shown by the studies. If ultrasound-guidance becomes the norm for this procedure, the unit, patients, and medicine, in general, would benefit from it.
Literature Review: Topic
The primary goal of this paper is to address the issues that arise from arterial puncture complications, as well as how to reduce or prevent these problems altogether. To provide an example of these problems a review of literature should be performed. This section of the paper will present two scientific articles about the arterial puncture complications.
The first article was created by an international team of physicians in 2014. It is titled “Incidence of Mechanical Complications of Central Venous Catheterization Using Landmark Technique: Do Not Try More Than Three Times.” Although the title singles out central venous catheterization, it concerns all types of mechanical complications including arterial puncture, pneumothorax, hemothorax, and subcutaneous hematoma. The purpose of this study was to determine how these complications occur and their potential risk factors. This study specifically concerns the traditional method of catheterization and was performed by a mixed group of practitioners (Calvache et al., 2016).
The introduction to the paper notes that mechanical complications are reported to happen in at least five percent of cases and depending on the study, this percentage can rise to 34%. It goes on to describe that mechanical complications are separated into four main categories. These include catheter-related factors, patient-related factors, site-related factors, and use- or care-related factors. Subsequently, the risk factors are defined as subclavian versus other sites, female gender, advanced age, extremes of body mass index, prior catheterization, surgery, radiotherapy, the number of punctures performed, time needed for placement of the artery or vein, and the overall experience of the operator. As the site of the research a university-affiliated ICU in Popayan, Columbia was chosen. As the title suggests, the authors focused their attention on the mechanical complications of central venous catheterization. This paper was selected due to similar complications being common during arterial puncture (Calvache et al., 2016).
This study was approved by an ethics committee board of the surgical ICU in La Estancial Clinic. The data of all patients over the age of 18 who were undergoing this procedure was collected. All the anthropometric and demographic variables were recorded, as well as the main diagnosis of admission, comorbidities, the placement of the central venous catheter, and the course of the procedure. The operator was responsible for choosing the site for the catheter. The operators were divided into three groups depending on their roles. The first group included house medical intensivists and specialist staff. The second included residents in anesthesiology, surgery, and internal medicine, with less than three years of experience of working in intensive care. The last group included general practitioners. The number of attempts and punctures was counted, with every subsequent one increasing the risk of mechanical complications. Successful application of the catheter was confirmed by the free flow of the fluid. Later, all patients were given an x-ray to confirm the results. Patients that suffered from the mechanical complications were observed for 24 hours after the application of the catheter. Overall, 300 patients participated in the trial (Calvache et al., 2016).
The results show that mechanical complications were strongly related to the number of punctures performed by the operator. This conclusion suggests that the accuracy of this type of procedure is essential to avoid the serious mechanical complications. Therefore, a more precise technique should be considered (Calvache et al., 2016).
Although the second study approaches the area of the literature review of possible solutions, it is chosen due to its attention to access site-related complications. This study was performed by the physicians from Boston, Massachusetts in 2015. The study is titled “Routine Use of Ultrasound-Guided Access Reduces Access Site-Related Complications after Lower Extremity Percutaneous Revascularization. While the methods are results of the study are important, this section will focus on how the paper defines these complications and their risk factors (Lo et al., 2015).
The study describes these complications as one of the main causes of perioperative mortality among patients who have to undergo percutaneous endovascular intervention. It approximates their rate of occurrence at one to nine percent. As the effects of access site-related complications, the study lists discomfort, prolonged hospital stay, increased costs of health care, and increased mortality rates even a year after the procedure. The study goes on to show how the occurrence of these complications can be reduced with routine ultrasound-guided access. Due to the severity of these complications and the positive results found during studies of ultrasound-guidance, it could be considered a possible solution to improve the procedure of arterial puncture for a variety of purposes (Lo et al., 2015).
Literature Review: Solution
A review of the literature on the topic of ultrasound use for arterial puncture and catheterization shows promising results. To show their results, it would be useful to showcase two recent studies on the subject.
The first of the two was done by a Chinese team of physicians in 2014 and was titled “Ultrasound Guidance for Radial Artery Catheterization: An Updated Meta-Analysis of Randomized Controlled Trials.” This meta-analysis has been done to update information about the use of ultrasound guidance in first-attempt cases. The first meta-analysis has shown a rise in success rate during catheterization of the radial artery, but since then some new randomized controlled trials have reported inconsistent results, leading to the need of a new meta-analysis. The authors utilized the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials. They searched for studies that involved randomized controlled trials while comparing ultrasound guidance with traditional palpation for radial artery catheterization. The authors used the Mantel-Haenszel method and the random effects model to create this meta-analysis (Tang et al., 2014).
The study begins with an introduction to the concept of arterial catheterization. It defines its main purpose as continuous hemodynamic monitoring in critically ill patients, as well as blood gas sampling in a variety of other situations. The radial artery has a superficial blood course. This makes it the most common choice for catheterization. Then it talks about how despite the relative safety of the procedure, the traditional palpation method can require multiple attempts due to its reliance on the technical skill of the physician. Multiple attempts at artery puncture can lead to pain and suffering of the patient, especially in pediatric patients and patients with edema, obesity, and hypotension. Worse cases can lead to hematoma and infections which the study estimates at being about 5%. This frequency shows why ultrasound guidance is such an important tool for arterial puncture. The study covers how such machines as SonoSite 180 plus, the GE Vivid S6, and the Flex-Focus 400 can visually distinguish between arteries, veins, and surrounding structures, as well as assess the patency of a target vessel, and predict variant anatomies. These features make these machines highly effective when vascular access is required. Finally, the introduction provides a brief overview of the available techniques for vascular visualization. The main two include the long axis in-plane approach which shortens to LA-IP and the short axis out-of-plane approach known as SA-OOP. A newer modification of SA-OOP approach called dynamic needle tip positioning (DNTP) is tested to be more effective than the LA-IP in a gelatin phantom (Tang et al., 2014).
The initial search for studies uncovered 803 publications on this topic, but only seven RCTs were eligible for this study. These seven studies included a total of 482 patients. The covered studies took place from 2003 to 2014. Four of them were conducted in Europe, two in the United States and one in Asia. The primary outcome of the meta-analysis was the first-attempt success rate, with mean-attempts, mean-time, and the occurrence of hematoma being the secondary outcomes. This study shows that traditional methods provide worse effects than the ultrasound approach. These effects are demonstrated by a higher first-attempt success rate, reduced occurrence of hematoma, shorter mean-time to success, and fewer mean-attempts to success. As a possible explanation for these benefits, the authors cite the ultrasonic clarification of the relative position of the needle and the radial artery, among its surroundings. However, the authors point out that these results depend on the operator’s ability to use the ultrasound guidance (Tang et al., 2014).
The second paper is an example of a randomized controlled trial performed by a French team of physicians. The study is titled “Ultrasound Guidance for Radial Arterial Puncture: a Randomized Controlled Trial.” This study compares the method of ultrasound guidance with the conventional method of arterial puncture. This study specifically notes the process of arterial puncture can be difficult in the case of emergency, even though it is a common procedure. Anybody who needs arterial blood gas at admission in the emergency unit is included in the study, except for those who are Hallen test positive, have a local sepsis, local trauma, those who do not provide consent, and those suffering from cardiac arrest. Patients were assembled into two randomized groups. The first would experience arterial puncture with the ultrasound guidance, and the second would go through the conventional method. The primary objective of this study is to measure the number of attempts after enrollment. Secondary objectives include time to success, patient satisfaction, pain, and physician satisfaction. These groups were compared with nonparametric analysis (Bobbia et al., 2013).
The introduction to this study focuses on arterial puncture for blood gas analysis. It talks about how this procedure is very common in the medicine ward, intensive care units, and emergency departments. It points how the emergency department of the authors has 8% to 12% of patients benefiting from arterial blood gas. However, less invasive procedures have gained popularity in the recent years. They describe how blood gas analysis is necessary for precise diagnosis and monitoring of such diseases as respiratory disease in decompensation, thromboembolism disease, carbon monoxide poisoning and a multitude of other diseases. This technique was first developed in the 19th century and received numerous revisions and developments in the following years. It stresses how Ultrasonography could be a valuable tool for insertion of venous catheters and how the results provided so far are encouraging. The investigation was done over a one-month period in the emergency ward (Bobbia et al., 2013).
The patients participating in the study had to be at least 18 years old, required a radial artery sample, and had to give consent to the procedure. 13 physicians participated in the study. They were graduates of accredited French Society of Emergency Medicine and were all trained in both theory and practice of the procedure. For safety, three hours of simulator training were given before the start of the study. For the ultrasonic group, a GE Vivid S6 machine with a 10-MHz linear transducer was used. 74 patients participated in the study, with two of them being later excluded. 72 patients were divided into groups of 37 in the first and 35 being assigned to the second group. Surprisingly, the study found that the use of ultrasonic guidance did not result in the lower number of attempts when taking blood gas samples making it an outlier among research concerning ultrasound guidance. However, the authors point out that it has proven to be an effective technique for the majority of procedures concerning arterial puncture, and that during the study all radial arteries were seen while using ultrasonography (Bobbia et al., 2013).
Implementation
Ultimately, the solution to the artery puncture complications lies in the implementation of ultrasound guidance during the majority of procedures concerning access to arteries and veins. Although ultrasound-guidance is not yet the norm, the equipment for it is common in emergency departments. Therefore implementation would mostly concern training of the staff. Studies show that this type of training significantly improves the ability of emergency department technicians to perform arterial procedures. The course of training would be brief but comprehensive (Duran-Gehring et al., 2016).
The majority of the studies covered in this paper, as well as others, point to the increased safety of ultrasound-guidance (Powell et al., 2014). With the reduction of adverse effects, more patients would pass this common procedure without complications, leading to increased satisfaction of both patients and physicians. Due to the relatively short training process, even a less experienced registered nurse would be able to provide a safe procedure, which would otherwise require a more experienced physician to guarantee the same result. With the complete implementation of the ultrasound-guidance policy, the unit is expected to see better results which in turn should lead to increased interest in this technology. In the future, ultrasonography is expected to become even more advanced, which should lead to an even higher level of patient care. Such common procedures should become almost completely safe for the patients, and physicians with any amount of experience should be able to perform them.
