A water cushion improved needle visualization by artificial beam steering during ultrasound-guided in-plane technique: an in vitro simulation study

Excellent needle visualization is critical for the safety and success of ultrasound-guided puncture procedures. However, optimal visualization is often challenging when a needle is inserted at a steep angle via in-plane technique. We hypothesized that a water cushion filled under the probe would result in better needle visualization via artificial beam steering during the ultrasound-guided in-plane technique. We simulated human soft tissue with pork and two targets with rigid needles. A water cushion was also made beforehand: a surgical glove was filled with an appropriate amount of water. Ultrasound-guided in-plane puncture procedures for the two targets were performed without and with the water cushion under the ultrasound probe. Clear ultrasound images of the needles were captured for objective visualization analysis. The angles between the ultrasound beam and the puncture needle were measured. The visualization of the needle was significantly better at shallow angles than at steep angles. After using A water cushion, the needle was clearly displayed again at a steep insertion angle. During the ultrasound-guided in-plane technique, needle visualization at a steep insertion angle can be improved by artificial beam steering generated with a water cushion.