Part 5 of a 5-part series on the advantages of a freehand technique over a needle-guide system for ultrasound-guided biopsies. If you haven't read the rest of this post, please start at part 1.
Why “Do No Harm” is easier with a freehand technique
One of the observations that persuaded me not to use the guide is watching what happens to the needle when someone else is using the needle guide. If there is some difficulty seeing the needle or lesion, there is a strong tendency to want to move the transducer to see better while looking at the screen to find the needle. But the needle is already inside the patient! So if you are looking at the screen while you are moving the transducer, the needle may be bending and torquing while you aren’t watching. I have squirmed while seeing needles bend over 30-45 degrees! How could that not be traumatic to the tissues? It can even causing laceration at the organ surface or even internally, with significant lateral pressure on the end of the needle. That virtually can’t happen with a freehand technique. If you have to reposition with freehand, you partially withdraw and reinsert at a different angle, but I believe that is considerably less traumatic than the bending and angling that may occur with the needle guide.
Time and cost
All of the trickiness of setting up to use the guide takes time — sometimes a lot. I believe that I routinely have been able to perform procedures about 30-50% faster than someone using the guide (which is one big reason the technologists and nursers looked forward to my procedures days). The added cost of the device is obvious. However, there are additional costs of increased room time are real. I have also seen biopsies unnecessarily delayed because not all of the components needed were in stock or in the room or the device that attaches to the transducer actually broke and someone goes to find a replacement. Sometimes the device perforates the sheath and the user feels obligated to re-sterilize and start over… all totally avoidable problems if you don’t use this device.
If you believe that you cannot “walk” (biopsy) without a “crutch” (guide), then you don’t want to try to “walk” and do not develop and maintain the muscles and skills you need. I believe that no one would argue that doing biopsies requires fine eye-hand coordination and other visual and motor skills whether or not you use the guide. However, I believe that using the guide limits those skills from being thoroughly and frequently exercised, without you consciously realizing it. This may limit both your desire and ability to manage ultrasound-guided biopsies, particularly in challenging situations.
So, I recommend that if you have been accustomed to using the guide, try to toss the crutch aside from time to time, first in easier cases until you feel comfortable with your newly developing level of skill and I think that you, your technologists and patients will all be better off for the effort.
We have conducted a survey to get some insight into use of ultrasound biopsy guides and the results are now available! Read on...
In this series:
- part 1 - introduction
- part 2 - planning and preparation
- part 3 - approach and visualization
- part 4 - the biopsy
- part 5 - additional benefits & conclusion
- survey results
Lincoln L. Berland, MD is Professor Emeritus of the Abdominal Imaging Section of University of Alabama at Birmingham.
NB: Opinions expressed are those of the author alone, and are not those of his employer nor of Radiopaedia.org.