Biopsy using Real-time Ultrasound
localization(1)
Occasionally, after conventional ultrasound
localization of the kidney, the operating physician
finds it difficult to determine whether the biopsy
needle has been positioned correctly, that is, with
the tip of the needle at or near the capsular
surface of the kidney.
In this circumstance, I have frequently seen
attempts made to try to visualize the relationship
of the inserted needle tip to the capsular surface
for the kidney by positioning the transducer on the
patient's flank, lateral to the inserted biopsy
needle, and surveying the ultrasound image to
direct the final proper positioning of the
needle.
It is my experience that this above described
maneuver is rarely, if ever, helpful. The
procedure seems logical and appropriate, and I have
no idea why the maneuver seems almost uniformly
non-productive.
On the other hand I wish to contrast the
ineffectiveness of the above described approach,
which is at least an approximately "real-time"
method of localization, with the following real-time
procedure which I will now describe, an approach
which I have observed to be almost uniformly highly
efficient and extremely productive.
The following method, which I will describe
and illustrate, I have observed on multiple
occasions in but one institution, in a mid-size
regional community hospital about one hour south of
Nashville. I have unsuccessfully suggested to other
medical imaging services that they investigate this
technique, and it is my impression that the
availability of the imaging technique may be
restricted to certain instrumentation and/or
software. The procedures illustrated below were
imaged on a "Siemens Sonoline Elegra".
