Ngokusasazwa okuqhubekayo kwezixhobo ze-ultrasound, ngakumbi nangakumbi abasebenzi bezonyango banokusebenzisa i-ultrasound ukwenza umsebenzi wokubonwayo.Ngaphantsi kokubonwa kwetekhnoloji ye-ultrasound, i-wave ye-ultrasound puncture ngamaza emva kwamaza.Ngokomzekelo, kungekhona kuphela i-ultrasound ye-GE, i-Philips, i-Siemens, i-Esaote, i-Chison, kunye ne-Sonoscape zithandwa kakhulu, kodwa i-stents yabo ye-puncture ehambelana nayo iyaziwa kwimarike.Inkampani yethu ibonelela ngokuizinti zesikhokelo sokugqobhozayeempawu ezinkulu
Nangona kunjalo, ngokwemiqathango ethile yokusetyenziswa kweklinikhi ebonwa ngumbhali, ukuthandwa kwezixhobo ze-ultrasound kunye nokuthandwa kwe-ultrasound visualization ayikwazi ukulingana ngokuthe ngqo.Thatha i-ultrasound-guided puncture kwintsimi yokufikelela kwi-vascular njengomzekelo, abantu abaninzi basesekwimeko yokungazi nto, enokubangela ukuba kube lula kwiingozi zonyango.Ngenxa yokuba nangona kwakukho i-ultrasound, kwakungenakwenzeka ukubona apho inaliti yokuhlatywa iye phi.Indlela yokwenyani yokugqobhoza ekhokelwa yi-ultrasound kuqala kufuneka iqinisekise ukuba indawo yenaliti okanye incam yenaliti inokubonwa phantsi kwe-ultrasound, kunokuba wenze uqikelelo olurhabaxa, kwaye emva koko "i-puncture eyimfama" phantsi kwesikhokelo se-ultrasound.Ngokubanzi, ibandakanya ezi meko zilandelayo:
I-Ultrasound-guided puncture ihlulwe ngokubanzi kwiindlela ezimbini: i-in-plane puncture kunye ne-out-of-plane puncture.Zomibini iindlela zokubhoboza zineemeko ezisebenzayo kwintsimi yokufikelela kwi-vascular, kwaye kungcono ukuba ube nobuchule kuzo.(Lo mhlathi ulandelayo ucatshulwe kwi-American Society of Ultrasound Medicine's practice guideline on ultrasound-guided vascular access surgery.)
Kwinqwelomoya (i-axis ende) Vs.Ngaphandle kwenqwelomoya (i-axi emfutshane)
I-in-plane/out-of-plane imele ubudlelwane obunxulumene nenaliti, inaliti ihambelana nenqwelomoya yokucinga ye-ultrasound ikwi-plane, kwaye inaliti i-perpendicular kwi-ultrasound imaging plane iphumile kwinqwelomoya.
Ngaphantsi kweemeko eziqhelekileyo, i-in-plane puncture ibonisa i-axis ende okanye i-longitudinal icandelo legazi;ukugqabhuka ngaphandle kwenqwelo-moya kubonisa i-axis emfutshane okanye i-cross-section yomthambo wegazi
Ke ngoko, ukufikelela kwemithambo ye-ultrasound kungagqibekanga ukuya ngaphandle-kwenqwelomoya/kwi-axis emfutshane, kunye nenqwelomoya/i-axis ende zizithethantonye.
Inaliti inokufakwa ukusuka phezulu kumbindi wesitya segazi ngaphandle kwenqwelomoya, kodwa incam yenaliti kufuneka ilandelelwe kwaye ibekwe ngokujikeleza iprobe ukunqanda ukubujongela phantsi ubunzulu bencapha yenaliti.
Isikhundla somnxeba wenaliti sinokuqwalaselwa kwi-statically kwindiza, kodwa kulula "ukutshitshisa" indiza apho inaliti ikhona okanye / kunye nendiza yeziko lomkhumbi wegazi;i-puncture kwi-plane ifaneleke ngakumbi kwiinqanawa ezinkulu
In-plane/out-of-plane indlela edityanisiweyo: out-of-plane/short-axis scan ukuqinisekisa ukuba incam yenaliti yokuhlatywa ifikelela embindini wenqanawa, jikelisa iprobe kwi-plane/long-axis yokufakwa inaliti.
Indawo yexesha lokwenyani lencam yenaliti okanye umzimba wonke wenaliti unokujongwa ngokwezibalo kwinqwelomoya, nto leyo eluncedo kakhulu!Nangona kunjalo, ngaphandle kwenkxaso yezixhobo ezincedisayo ezifana nee-rocks zokubhoboza, ngokwenene kuthatha amakhulukhulu oqheliselo ukugcina inaliti kwinqwelo-moya yomfanekiso we-ultrasound ukuze iphumelele izakhono.Kwiimeko ezininzi, ngenxa yokuba i-angle ye-puncture inkulu kakhulu, inaliti yokuhlatywa ngokucacileyo kwi-ultrasound imaging plane, kodwa inaliti ayikabonakali.Kutheni kunje?
Ii-angles zokufakwa kweenaliti zenaliti yokuhlatywa kumfanekiso ongezantsi ziyi-17 ° kunye ne-13 ° ngokulandelanayo.Xa i-engile ingu-13 °, umzimba wonke wenaliti yenaliti yokuhlatywa ubonakaliswe ngokucacileyo.Xa i-angle i-17 °, umzimba wenaliti unokubonwa ngokucacileyo.Kancinci, kwaye inkulu i-engile, kokukhona uya kuba yimfama.Kutheni ke kukho umahluko we-engile ye-4 ° kuphela, kwaye kutheni kukho umahluko omkhulu kangaka ekusebenzeni kwenaliti yokuhlatywa?
Oku kufuneka kuqale ngokukhutshwa kwe-ultrasonic kunye nokugxila ekufumaneni.Njengolawulo lokuvula kugxininiso lweefoto, inqaku ngalinye kwifoto lisiphumo esidityanisiweyo sokugxila kuko konke ukukhanya okudlula kwi-aperture, kwaye inqaku ngalinye kumfanekiso we-ultrasonic yimpembelelo edibeneyo yokugxila kuzo zonke ii-transducers ze-ultrasound ngaphakathi kokuhambisa kunye ukufumana imingxuma.Njengoko kuboniswe kumzobo ongezantsi, uluhlu oluphawulwe ngumgca obomvu luluhlu lweskimu sokugxilwa kwe-ultrasonic transmission, kwaye umgca oluhlaza luluhlu lweskimu (umda wasekunene) wokufumana ukugxila.Ngenxa yokuba inaliti ikhanya ngokwaneleyo, ukubonakaliswa okukhethekileyo kuya kwenzeka, kwaye umgca omhlophe uphawula ulwalathiso oluqhelekileyo lokubonakaliswa okukhethekileyo.Ukucinga ukuba uluhlu lokugxilwa kokukhutshwa oluphawulwe ngumgca obomvu lufana "nezibane" ezimbini, emva kokubetha isibuko sobuso benaliti, "izibane" ezibonakalisiweyo zifana nemigca emibini ye-orange emfanekisweni.Ekubeni "ukukhanya" kwicala lasekunene lomgca oluhlaza kudlula uluhlu lwe-aperture yokufumana kwaye alukwazi ukufunyanwa yi-probe, "ukukhanya" okunokufunyanwa kuboniswe kwindawo ye-orange kumfanekiso.Ingabonwa ukuba kwi-17 °, i-probe isenokufumana i-echoes ezimbalwa kakhulu ze-ultrasonic, ngoko umfanekiso ohambelanayo ngumfanekiso otyhafileyo, kwaye kwi-13 °, i-echoes enokufunyanwa ingaphezulu kwe-17 °.Ixesha landa kakhulu, ngoko ke umfanekiso ucacile.Njengoko i-angle ye-puncture iyancipha, inaliti iya isiba ngakumbi nangakumbi "i-flat", kwaye i-echoes ebonakaliswa ngakumbi evela kumzimba wenaliti inokufunyanwa ngokufanelekileyo, ngoko ukubonwa kweenaliti kuba ngcono kwaye kube ngcono.
Abanye abantu abacokisekileyo baya kufumana isenzeko ukuba xa i-engile ingaphantsi kwexabiso elithile (inaliti ayifuni ukuba ngokupheleleyo "i-flat"), uphuhliso lomzimba wenaliti ngokusisiseko lugcina iqondo elifanayo lokucaca.yintoni ngale?Kutheni le nto uluhlu lokugxilwa kokuhanjiswa (umgca obomvu) uzotywe umncinci kunoluhlu lokufumana ugxininiso (umgca oluhlaza) kumfanekiso ongentla?Oku kungenxa yokuba kwi-imaging system ye-ultrasound, ugxininiso lokukhutshwa lungajoliswa kuphela kubunzulu obunye.Nangona singakwazi ukuhlengahlengisa ubunzulu bojoliso olukhutshwayo ukwenza umfanekiso okufutshane nobunzulu bengqwalasela yethu icace, asifuni ukuba indawo engaphaya kojoliso ibe mfiliba kakhulu..Oku kwahluke kakhulu kwisidingo sethu sokuthatha iifoto zeshukela-zamanzi zabasetyhini abahle.Ifilimu yamanzi eswekile ifuna ukuba imvelaphi kunye nephambili eziswe yi-aperture enkulu kunye nobunzulu obuncinci bentsimi yonke imnyama.Kumfanekiso we-ultrasound, sinethemba lokuba imifanekiso ekuluhlu ngaphambi nasemva kobunzulu bogqaliselo bucace ngokwaneleyo, ngoko ke sinokusebenzisa i-aperture encinci yokukhutshwa ukuze sifumane ubunzulu bentsimi, ukuze sigcine ukufana komfanekiso.Ngokubhekiselele ekufumaneni ugxininiso, ngenxa yokuba iinkqubo zangoku ze-imaging ze-ultrasonic ziye zenziwa idijithali ngokupheleleyo, i-ultrasonic echoes ye-transducer nganye / i-array element ingagcinwa, kwaye ke zonke iinzulu ze-imaging zinokucutshungulwa ngamandla ngeendlela zedijithali.Ugxininiso oluqhubekayo, ngoko ngeli xesha, zama ukuvula i-aperture yokufumana kangangoko kunokwenzeka, ngokude nje izinto ezinokuthi zifumane umqondiso we-echo zisetyenzisiwe, ukwenzela ukuba kuqinisekiswe ukuba ugxininiso olungcono kunye nesisombululo esingcono sinokufumaneka.Buyela kwisihloko ngoku, xa i-angle yokubhoboza incinci ukuya kumlinganiselo othile, amaza e-ultrasonic akhutshwa yi-aperture encinci inokufunyanwa yi-aperture enkulu yokufumana emva kokubonakaliswa ngumzimba wenaliti, ngoko umphumo wokuphuhliswa komzimba wenaliti. iya kuhlala ngokwendalo ingatshintshanga..
Kuphando olungentla, kufuneka ndenze ntoni ukuba inaliti yokuhlatywa ayinakubonwa emva kokuba i-angle ye-puncture kwinqwelomoya idlula i-17 °?
Ukuba isixokelelwano siyayixhasa, ungazama umsebenzi wokuphucula inaliti yokuhlatywa ngeli xesha.Itekhnoloji ebizwa ngokuba yitekhnoloji yokuphucula inaliti yokuhlatywa kukufakela isakhelo somfanekiso wokuskena ojikisiweyo kuthumelo kunye nolwamkelo emva kokuba isakhelo sesiqhelo sesiskeni.Isalathiso sokuphambuka sisalathiso somzimba wenaliti, ukwenzela ukuba ukubonakaliswa kwenaliti yomzimba kunokubuyiselwa I-wave iwela kwindawo yokuvula yokufumana ugxininiso kangangoko kunokwenzeka, kwaye umfanekiso wenaliti eyomeleleyo kumfanekiso wokuphambuka uyakhutshwa kwaye iboniswe emva kokudityaniswa nomfanekiso wethishu eqhelekileyo.Ngokuxhomekeke kubungakanani kunye nokuphindaphinda kweprobe yesiqalelo soluhlu, i-engile yophambuko yeprobe yoluhlu oluphezulu lwefrikhwensi ayibikho ngaphezulu kwe-30 °, ngoko ke i-engile yokugqobhoza ingaphezulu kwe-30 °.Ayikaqhubeli phambili ukuya kweli nqanaba)
Okulandelayo, makhe sijonge imeko yokugqobhoza ngaphandle kwenqwelomoya.Emva kokuqonda umgaqo wophuhliso lwenaliti yokuhlatywa kwendiza, kuya kuba lula kakhulu ukuhlalutya uphuhliso lwenaliti yokuhlatywa ngaphandle kwenqwelomoya.Ukutshayela i-fan ejikelezayo ekhankanywe kwisikhokelo sokuziqhelanisa linyathelo elibalulekileyo lokubhoboza ngaphandle kwenqwelomoya, elingasebenziyo kuphela ekufumaneni indawo yencam yenaliti, kodwa nasekufumaneni umzimba wenaliti.Kuphela nje ukuba inaliti yokuhlatywa kunye ne-imaging ye-ultrasound ayikho kwindiza enye ngeli xesha.Kuphela xa inaliti yokubhoboza i-perpendicular kwindiza yokucinga inokuthi isiganeko samaza e-ultrasonic kwinaliti yokubhoboza ingabonakaliswa emva kwiprobe ye-ultrasonic.Kuba umkhombandlela wobungqingqwa weprobe ngokuqhelekileyo ujoliswa kwilensi yeacoustic, iindawo zokuvula kuzo zombini ezi zinto zigqithisayo kunye nokwamkela ziyafana kolu cala, kwaye ubungakanani bendawo bububanzi bewafer yetransducer.Ububanzi boluhlu lweprobe bumalunga ne-3.5mm kuphela (indawo yokuvula yokufumana umfanekiso ongaphakathi kwinqwelomoya idla ngokungaphezulu kwe-15mm, inkulu kakhulu kunobubanzi be-wafer).Ngoko ke, ukuba i-echo ebonakalisiweyo yenaliti yokuhlatywa ngaphandle kwendiza ibuyela kwiprobe, kuyimfuneko kuphela ukuqinisekisa ukuba inaliti yokuhlatywa kunye ne-angle phakathi kweendiza zokucinga isondele kwii-90 degrees.Uyigweba njani ke i-engile ethe nkqo?Eyona nto inomdla kakhulu yi "comet tail" ende erhuqa emva kwendawo eqaqambileyo eqaqambileyo.Oku kungenxa yokuba xa amaza e-ultrasonic eyenzeka kwinaliti yokubhoboza ngokuthe nkqo, ngaphezu kwee-echoes ezibonakaliswe ngokuthe ngqo kwi-probe ngenaliti yomhlaba, inani elincinci lamandla e-ultrasonic lingena kwinaliti.Ukubonakaliswa okuphindaphindiweyo ngasemva naphambili, kunye ne-echoes ezininzi zokubonisa ezibonakaliswe kwicala le-probe kwakhona, yiza kamva, ngoko ke "umsila we-comet" omde wenziwa.Emva kokuba inaliti ingekho i-perpendicular kwindiza ye-imaging, amaza omsindo abonakaliswe ngasemva naphambili aya kubonakaliswa kwezinye iindawo kwaye akakwazi ukubuyela kwi-probe, ngoko "umsila we-comet" awubonakali.I-phenomenon yomsila we-comet ayibonakali kuphela kwi-puncture yangaphandle, kodwa nakwi-in-plane puncture.Xa inaliti yokuhlatywa iphantse yangqamana nomphezulu weprobe, imiqolo yemigca ethe tye inokubonwa.Umsila weComet".
Ukuze ubonise ngokucacileyo i-in-plane kunye ne-out-of-plane "comet tail", sithatha ukusebenza kwe-out-of-plane kunye ne-in-plane scans kunye ne-staples emanzini, kwaye iziphumo ziboniswa kumfanekiso. ngezantsi.
Umfanekiso ongezantsi ubonisa ukusebenza komfanekiso wee-engile ezahlukeneyo xa umzimba wenaliti uphumile kwinqwelomoya kwaye ifeni ejikelezayo iskenwa.Xa i-probe i-perpendicular kwinaliti yokuhlatywa, oko kuthetha ukuba inaliti yokuhlatywa i-perpendicular kwi-plane yokucinga ye-ultrasound, ngoko unokubona ngokucacileyo "umsila we-comet" ocacileyo.
Gcina i-probe perpendicular kwinaliti yokuhlatywa kwaye uyihambise ecaleni komzimba wenaliti ukuya kwincam yenaliti.Xa "umsila we-comet" uphela, kuthetha ukuba icandelo lokuskena lisondele kwincam yenaliti, kwaye indawo eqaqambileyo iya kunyamalala phambili.Indawo phambi kokuba indawo eqaqambileyo inyamalale kulapho incam yenaliti ikhona.Indawo.Ukuba awukhululekanga, yenza i-engile encinci ejikelezayo ifeni kufutshane nale ndawo ukuze uqinisekise kwakhona.
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Ixesha lokuposa: Aug-17-2022
