Name: point-of-care kidney and genitourinary ultrasound in adults: image acquisition
Uploaded: 2024-06-21T14:35:00.000+00:00
Duration: 3 min 19 s
Description: A range of conditions involving the kidneys and urinary bladder can cause organ-threatening complications that are preventable if diagnosed promptly with ...

本研究中涉及人类参与者的所有程序均符合杜克大学卫生系统机构研究委员会的道德标准以及 1964 年赫尔辛基宣言及其后来的修正案或类似的道德标准。根据机构标准，事先征得同意，纳入的图像是在作者自己身上进行的，以获得正常图像，并作为常规教育超声扫描的一部分进行，用于正面图像的教学目的。根据以下标准纳入患者： 任何急性肾损伤、尿量减少或任何其他怀疑肾功能异常原因的患者。排除标准包括腹部开放的患者。疼痛是超声检查的相对禁忌证，尤其是当疼痛严重到无法放置探针时（例如，腹内高压）。使用的试剂和设备列在 材料表中。
术语：身体的三个平面称为冠状面、矢状面和横向 这可能会令人困惑，因为后一个术语（“横向”）也可以用来指代单个器官的短轴，同时使用术语“纵向”来指代器官的长轴。为了尽量减少混淆，该协议将专门使用冠状、矢状和横向来指代人体的平面，并将使用长轴和短轴来指代肾脏的平面。此外，由于气囊的动态形状使其无法具有永久的长轴或短轴，因此气囊的两个视图将仅根据视图与物体平面对齐的两个视图之一来命名：矢状或横向。
1. 传感器选择
<ol><li>选择低频换能器：最好是曲线换能器 （2-5 MHz）。如果没有曲线探头，可以使用扇形阵列（又名“相控阵”，1-5 MHz）作为替代。 注：曲线换能器是通过单一视图可视化肾脏的最佳选择，因为它的足迹创造了一个大的视野，并且其低频压电晶体允许深入人体。然而，在通过肋骨观察肾脏时，曲线探头可能很难使用。</li>
</ol>2. 机器设置
<ol><li>设置深度，使肾脏出现在超声筛查的中间三分之一（典型设置在 16 厘米到 20 厘米之间）。</li>
	<li>设置增益，使肾髓质金字塔显示为无回声（黑色），肾窦复合体显示为高回声（明亮），肾皮层出现在这些极端之间。</li>
</ol>3. 模式和预设
<ol><li>选择二维 （2D） 模式，也称为亮度模式（B 模式）。这是一种二维灰度超声模式。</li>
	<li>激活 2D 模式后，选择腹部预设。</li>
</ol>4. 患者定位
<ol><li>在检查的大部分时间里，患者仰卧位。 注意：在对右肾进行成像时，可能需要将患者重新定位在左侧卧位，以便更好地观察右肾。在对左肾进行成像时，可能需要将患者重新定位在右侧卧位，以便更好地观察左肾。</li>
	<li>扫描前，暴露患者的下胸部和腹部。</li>
	<li>放置超声机的位置，使超声医师的惯用手可以握住超声探头。这允许对超声探头进行更精细的操作，并解放非惯用手来操作超声机。 注意：右撇子超声医师应将自己置于患者的右侧，反之亦然。</li>
</ol>5. 右肾成像
<ol><li>凝胶应用<ol><li>在采集每张图像之前，将凝胶直接涂抹在超声探头上，以最大限度地提高扫描效率。</li>
	</ol></li>
	<li>冠状视图<ol><li>将探针放在右侧，沿腋中线，第 5-7肋 间隙，指示器指向颅骨（图 1）。</li>
		<li>调整探头位置（向上/向下滑动，前后倾斜），直到在其最大纵向范围内看到右肾（见 图2）。</li>
		<li>从前向后扇形，以筛查肾积水和其他严重异常（视频 1）。</li>
		<li>电影剪辑采集：对于配置为回顾性图像采集的计算机，请在步骤 5.2.4 之前单击 采集 。对于配置为预期图像采集的计算机，请在步骤 5.2.4 后单击 acquire 。</li>
	</ol></li>
	<li>肾脏长轴直径测量<ol><li>将肾脏在图像中居中，单击 “冻结”，然后测量肾脏的高度（图 3）。</li>
		<li>单击 Save （或等效按钮）。</li>
	</ol></li>
	<li>横视图<ol><li>以右肾为中心后，将探针顺时针旋转 90 度，直到探针标记朝前，在横向视图中露出肾脏（图 4）。</li>
		<li>调整探针位置（向上/向下滑动，前后倾斜），直到在这个横向平面上看到右肾的最大尺寸（图 5）。</li>
		<li>从颅侧到尾部扇形，以筛查肾积水和其他严重异常（视频 2）。重复该步骤。</li>
	</ol></li>
</ol>6. 左肾成像
<ol><li>对左肾重复步骤 5.1-5.3。</li>
</ol>7. 膀胱成像
<ol><li>凝胶应用：重复步骤 5.1.1。</li>
	<li>横视图<ol><li>探头位置：将探头放置在耻骨联合的颅骨上，探头指示器指向患者的右侧（图6）。</li>
		<li>将超声束向尾部倾斜到骨盆中，直到可以看到膀胱的最大尺寸。</li>
		<li>图像优化<ol><li>调整深度，直到在屏幕的中间三分之一处可以看到气囊。</li>
			<li>调整增益，直到膀胱腔严重无声（黑色）并且膀胱正后方的组织平面略微高回声（明亮）。</li>
		</ol></li>
		<li>Cine 剪辑采集<ol><li>从颅骨到尾部扇形穿过膀胱，以可视化整个结构。重复步骤 5.2.3。</li>
		</ol></li>
		<li>横向膀胱尺寸测量<ol><li>将视图以膀胱的最大尺寸为中心，单击 “冻结 ”并测量膀胱的前后和横向到内侧直径（图 7，左图）。</li>
			<li>单击 Save （或等效按钮）。</li>
		</ol></li>
	</ol></li>
	<li>矢状视图<ol><li>保持横向视图，将视图置于膀胱的中心，并将探针顺时针旋转 90 度，直到探针标记面向颅骨，在矢状面上露出肾脏（图8）。</li>
		<li>Cine 剪辑采集<ol><li>从一侧到另一侧扇形穿过气囊，以观察整个结构。重复步骤 5.2.3。</li>
		</ol></li>
		<li>横向膀胱尺寸测量<ol><li>将视图置于膀胱最大尺寸的中心，单击 “冻结 ”并测量膀胱的颅侧到尾部直径（图 7，右图）。</li>
			<li>单击 Save （或等效按钮）。</li>
		</ol></li>
	</ol></li>
</ol>

推进床边护理：肾脏泌尿生殖系统 POCUS 多学科指南

<ol>
	<li>Rewa, O., Bagshaw, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+kidney+injury+-+epidemiology,+outcomes+and+economics.">Acute kidney injury - epidemiology, outcomes and economics.</a> Nat Rev Nephrol. 10 (4), 193-207 (2014).</li><li>National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Renal+Data+System.+2023+USRDS+annual+data+report:+Epidemiology+of+kidney+disease+in+the+United+States.">Renal Data System. 2023 USRDS annual data report: Epidemiology of kidney disease in the United States.</a> National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. , (2023).</li><li>Susantitaphong, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=World+incidence+of+AKI:+A+meta-analysis.">World incidence of AKI: A meta-analysis.</a> Clin J Am Soc Nephrol. 8 (9), 1482-1493 (2013).</li><li>Kellum, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Classifying+AKI+by+urine+output+versus+serum+creatinine+level.">Classifying AKI by urine output versus serum creatinine level.</a> J Am Soc Nephrol. 26 (9), 2231-2238 (2015).</li><li>Khaled Shawwa, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heterogeneity+in+acute+kidney+injury+management+in+critically+ill+patients:+National+survey.">Heterogeneity in acute kidney injury management in critically ill patients: National survey.</a> J Nurse Pract. 19 (10), 104776 (2023).</li><li>Diaz-Gomez, J. L., Mayo, P. H., Koenig, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasonography.">Point-of-care ultrasonography.</a> N Engl J Med. 385 (17), 1593-1602 (2021).</li><li>Koratala, A., Bhattacharya, D., Kazory, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point+of+care+renal+ultrasonography+for+the+busy+nephrologist:+A+pictorial+review.">Point of care renal ultrasonography for the busy nephrologist: A pictorial review.</a> World J Nephrol. 8 (3), 44-58 (2019).</li><li>Fischer, E. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hospitalist-operated+compression+ultrasonography:+A+point-of-care+ultrasound+study+(hocus-pocus).">Hospitalist-operated compression ultrasonography: A point-of-care ultrasound study (hocus-pocus).</a> J Gen Intern Med. 34 (10), 2062-2067 (2019).</li><li>Sibley, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasound+for+the+detection+of+hydronephrosis+in+emergency+department+patients+with+suspected+renal+colic.">Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic.</a> Ultrasound J. 12 (1), 31 (2020).</li><li>Yaxley, J., Yaxley, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Obstructive+uropathy+-+acute+and+chronic+medical+management.">Obstructive uropathy - acute and chronic medical management.</a> World J Nephrol. 12 (1), 1-9 (2023).</li><li>Rahbari-Oskoui, F., O'Neill, W. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+management+of+acquired+cystic+kidney+disease+and+renal+tumors+in+ESRD+patients.">Diagnosis and management of acquired cystic kidney disease and renal tumors in ESRD patients.</a> Semin Dial. 30 (4), 373-379 (2017).</li><li>Bhutani, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+ultrasound+and+magnetic+resonance+imaging+shows+that+kidney+length+predicts+chronic+kidney+disease+in+autosomal+dominant+polycystic+kidney+disease.">A comparison of ultrasound and magnetic resonance imaging shows that kidney length predicts chronic kidney disease in autosomal dominant polycystic kidney disease.</a> Kidney Int. 88 (1), 146-151 (2015).</li><li>Liu, C., Wang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+utility+of+ultrasonographic+evaluation+in+acute+kidney+injury.">Clinical utility of ultrasonographic evaluation in acute kidney injury.</a> Transl Androl Urol. 9 (3), 1345-1355 (2020).</li><li>Wong, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Barriers+to+learning+and+using+point-of-care+ultrasound:+A+survey+of+practicing+internists+in+six+north+American+institutions.">Barriers to learning and using point-of-care ultrasound: A survey of practicing internists in six north American institutions.</a> Ultrasound J. 12 (1), 19 (2020).</li><li>Ozmen, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+as+a+diagnostic+tool+to+differentiate+acute+from+chronic+renal+failure.">Ultrasound as a diagnostic tool to differentiate acute from chronic renal failure.</a> Clin Nephrol. 74 (1), 46-52 (2010).</li><li>Soni, N. J., Arntfield, R., Kory, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Point-of-care ultrasound. Second edition. , 229-230 (2020).</li><li>O'Neill, W. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+evaluation+of+renal+failure.">Sonographic evaluation of renal failure.</a> Am J Kidney Dis. 35 (6), 1021-1038 (2000).</li><li>Koratala, A., Bhattacharya, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extra-renal+pelvis+mimicking+hydronephrosis:+A+case+for+caution.">Extra-renal pelvis mimicking hydronephrosis: A case for caution.</a> Clin Case Rep. 5 (10), 1720-1721 (2017).</li><li>Muglia, V. F., Westphalen, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bosniak+classification+for+complex+renal+cysts:+History+and+critical+analysis.">Bosniak classification for complex renal cysts: History and critical analysis.</a> Radiol Bras. 47 (6), 368-373 (2014).</li><li>Silverman, S. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bosniak+classification+of+cystic+renal+masses,+version+2019:+An+update+proposal+and+needs+assessment.">Bosniak classification of cystic renal masses, version 2019: An update proposal and needs assessment.</a> Radiology. 292 (2), 475-488 (2019).</li><li>Burgan, C. M., Sanyal, R., Lockhart, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+of+renal+masses.">Ultrasound of renal masses.</a> Radiol Clin North Am. 57 (3), 585-600 (2019).</li><li>Weber, T. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonography+of+benign+renal+cystic+disease.">Sonography of benign renal cystic disease.</a> Radiol Clin North Am. 44 (6), 777-786 (2006).</li><li>Pei, Y., Watnick, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+screening+of+autosomal+dominant+polycystic+kidney+disease.">Diagnosis and screening of autosomal dominant polycystic kidney disease.</a> Adv Chronic Kidney Dis. 17 (2), 140-152 (2010).</li><li>Hines, J. J., Eacobacci, K., Goyal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidental+renal+mass-+update+on+characterization+and+management.">The incidental renal mass- update on characterization and management.</a> Radiol Clin North Am. 59 (4), 631-646 (2021).</li><li>Baldini, G., Bagry, H., Aprikian, A., Carli, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postoperative+urinary+retention:+Anesthetic+and+perioperative+considerations.">Postoperative urinary retention: Anesthetic and perioperative considerations.</a> Anesthesiology. 110 (5), 1139-1157 (2009).</li><li>Bih, L. I., Ho, C. C., Tsai, S. J., Lai, Y. C., Chow, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bladder+shape+impact+on+the+accuracy+of+ultrasonic+estimation+of+bladder+volume.">Bladder shape impact on the accuracy of ultrasonic estimation of bladder volume.</a> Arch Phys Med Rehabil. 79 (12), 1553-1556 (1998).</li><li>Goertz, J. K., Lotterman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+the+degree+of+hydronephrosis+on+ultrasound+predict+kidney+stone+size.">Can the degree of hydronephrosis on ultrasound predict kidney stone size.</a> Am J Emerg Med. 28 (7), 813-816 (2010).</li><li>Noble, V. E., Brown, D. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Renal+ultrasound.">Renal ultrasound.</a> Emerg Med Clin North Am. 22 (3), 641-659 (2004).</li><li>Onen, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grading+of+hydronephrosis:+An+ongoing+challenge.">Grading of hydronephrosis: An ongoing challenge.</a> Frontiers in Pediatrics. 8, 458 (2020).</li><li>Koratala, A., Reisinger, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasound+training+in+nephrology:+A+leap+forward,+not+merely+a+check+mark.">Point-of-care ultrasound training in nephrology: A leap forward, not merely a check mark.</a> Kidney Med. 6 (1), 100752 (2024).</li></ol>

MAS 报告收到 Elsevier-Nephrology Secrets 的酬金;担任美国内科肾脏病学委员会的成员;因在 NephMadness 执行委员会任职而获得 NKF 的酬金;获得 Medscape 的 CKD 播客系列酬金;因担任 ASN Journals Portfolio（JASN、CJASN、Kidney360）的通信编辑而获得酬金。YSB 报告称，美国麻醉医师协会 （American Society of Anesthesilogists） 因编辑委员会在床旁超声方面的工作而获得酬金，并因创建与 POCUS 相关的教育内容而获得 OpenAnesthesia.org 酬金。其余作者没有披露。

AKI 常见于危重住院患者，增加了死亡风险。为了熟练执行上述步骤并区分正常和病理结果，必须全面了解正常解剖结构和超声表现，并严格遵守方案的具体步骤。
方案中的关键解剖学/步骤 肾脏 - 肾脏是位于体内斜冠状平面的腹膜后器官，需要将换能器倾斜定位才能进行准确成像。为了帮助可视化左肾和右肾，临床医生可以将脾脏和肝脏分别用作声学窗...

急性肾损伤 （AKI） 由多种病因引起，是住院患者中常见的医学诊断。AKI 导致肾功能突然下降，导致细胞外液、尿素和其他含氮废物的积累，以及电解质失调。此外，AKI 的诊断预示着更差的短期和长期结果，并且与消耗更多的医疗保健资源有关1。根据美国肾脏数据系统 （USRDS） 的数据，在 2020 年医疗保险按服务收费受益人中，AKI 住院率为每 1000 名患者年 62 例2。此外，对采用肾脏病改善全球结局 （KDIGO） AKI 诊断标准的 154 项研究的系统评价发现，在这些试验的 3,585,911 人中，主要来自北美、北欧和东亚，不同住院环境中的 AKI 发病率为 20%-32%3。在住院环境中，AKI 通常在重症监护病房中被发现，并且与死亡率增加有关4。床旁超声 （POCUS） 机器在 ICU 等环境中很容易获得，但尽管诊断性肾 GU 超声能够快速评估 AKI5 的几种病因，但往往未得到充分利用。
与会诊超声相比，在会诊超声中，患者的主要提供者要求放射技师进行正式的超声检查并由放射科医生读取，而诊断性 POCUS 则由患者的主要提供者在护理点进行和解释6。越来越多的证据表明，非放射科医生可以有效和准确地将诊断 POCUS 用于各种疾病7。例如，2019 年住院医师手术加压超声检查：床旁超声研究 （HOCUS-POCUS） 前瞻性队列研究将住院医师进行的深静脉血栓形成 （DVT） 压迫 POCUS 与会诊技术人员/放射科医生进行的血管 DVT 超声检查进行了比较。该研究表明，住院医师进行的 POCUS 与技术员/放射科医生进行的会诊血管超声的准确性相似，敏感性为 100%，特异性为 96%8。同样，2020 年的一项研究发现，与计算机断层扫描扫描相比，由具有不同经验的急诊科提供者进行的肾 GU POCUS 在检测肾积水方面具有中等准确性（特异性为 72%，敏感性为 77%）9。重要的是，与技术人员/放射科医生成像相比，初级提供者执行的 POCUS 可以更及时地进行诊断和干预。
AKI 的病因可分为肾前性（血流动力学介导的损伤）、肾内（肾小球或间质病变）和肾后性（泌尿系统病因，最常见的是梗阻性尿路病）。尤其是后者，可以被诊断为 POCUS。梗阻性尿路病的年发病率为每 1000 人 1.7 例，估计约占急性和慢性肾病的 10%10。从前列腺增生到肾结石，尿路梗阻的原因有很多。这些病症在肾脏水平的主要病理表现是肾积水。这在 POCUS 上很容易可视化，并且诊断速度对于治疗急性肾衰竭患者至关重要。 
除了 AKI，POCUS 仍然是评估慢性肾病的一种经济高效且安全的方式。POCUS 可用于识别指示肾细胞癌的病变，因为它能够可视化大于或等于 3 cm 的囊肿，并区分被认为与恶性肿瘤有关的特征11。POCUS 允许快速评估常染色体显性遗传性多囊肾病 （ADPKD），避免不必要的肾活检安排和昂贵的实验室工作。此外，与金标准基于磁共振的身高调整总肾体积测量 （htTKV） 相比，肾长的超声测量显示可预后早期 ADPKD 的进展风险 （htTKV）12。 
虽然计算机断层扫描在检测肿瘤、结石和钙化方面具有优势，但尚未证实计算机断层扫描在诊断 AKI 病因方面优于超声检查13。此外，一些患者可能病得太重而无法走出他们的房间，从而无法运送到 CT 扫描仪甚至放射科套房，以便技术人员/放射科医生进行会诊超声检查。在这些情况下，POCUS 提供了一种安全可靠的诊断替代方案。尽管如此，诊断肾 GU POCUS 仍然是一种未得到充分利用的工具，可能是由于一线临床医生缺乏培训14。为了解决这一知识差距，本叙述性综述汇集了多个专业（医院医学、重症监护、麻醉学和肾病学）的专业知识，提出了一种循证肾脏 GU POCUS 图像采集方案，包括适应症/禁忌症、患者定位、换能器选择、采集顺序和检查限制。最后，我们描述了肾脏 GU 超声图像解释的基本概念，包括每个执行这种方式的床边临床医生都应该知道的关键异常发现。

<table><tbody><tr><td>Curvilinear Transducer</td><td>Philips</td><td>C5-2 USB</td><td>2-5 MHz, also called the abdominal probe</td></tr><tr><td>Curvilinear Transducer</td><td>SonoSite</td><td>C5-1</td><td>1-5 MHz, also called the abdominal probe</td></tr><tr><td>Edge 1 ultrasound machine</td><td>SonoSite</td><td></td><td>Used to obtain a subset of the Figures and Videos</td></tr><tr><td>Phased-Array Transducer</td><td>Philips</td><td></td><td>1-5 MHz, also called the cardiac probe</td></tr><tr><td>Phased-Array Transducer</td><td>SonoSite</td><td>P5-1</td><td>1-5 MHz, also called the cardiac probe</td></tr><tr><td>Ultrasound system</td><td>Philips</td><td>Affiniti30</td><td>Used to obtain a subset of the Figures and Videos</td></tr></tbody></table>

point-of-care kidney and genitourinary ultrasound in adults: image acquisition

涉及肾脏和膀胱的一系列疾病可能导致威胁器官的并发症，如果通过诊断性影像学检查及时诊断，这些并发症是可以预防的。常见的影像学检查方式包括计算机断层扫描或诊断性超声检查。传统上，肾脏泌尿生殖系统超声检查需要会诊团队，包括一名进行图像采集的超声医师和一名进行图像解读的放射科医生。然而，诊断性床旁超声 （POCUS） 最近已成为在床旁解决急性肾损伤的有用工具。研究表明，可以培训非放射科医生对一定数量的重要情况进行高精度的肾脏和膀胱诊断 POCUS。目前，肾脏泌尿生殖系统诊断性 POCUS 在实际临床实践中仍未得到充分利用。这可能是因为大多数临床医生在遇到急性肾损伤的专科中不熟悉该器官系统的图像采集，包括初级保健、急诊医学、重症监护、麻醉学、肾脏病学和泌尿学。为了解决这一多专业教育差距，本叙述性综述由一个多学科小组开发，旨在为肾脏泌尿生殖系统 POCUS 图像采集提供一个与专业无关的框架：适应症/禁忌症、患者定位、换能器选择、采集顺序和检查限制。最后，我们描述了肾脏泌尿生殖系统超声图像解释的基本概念，包括每个执行这种方式的床边临床医生都应该了解的关键异常发现。

超声检查正常
正常肾脏超声 肾包膜的回声性和有限的解剖变异性（除了偶尔的盆腔肾或更罕见的马蹄肾）使得床旁 POCUS 很容易识别肾脏。肾脏将具有典型的豆形外观，平均尺寸为 9-13 厘米，但大小随患者的身高和体重而变化（图 2， 视频 1）。外皮层相对于相邻的脾脏和肝脏通常为低回声。皮层内部是肾髓质，?...

作者聚焦：制定肾脏和泌尿生殖系统超声检查的床边方案

肾脏和泌尿生殖系统（肾-GU）的床旁超声（POCUS）可以帮助筛查肾功能障碍的某些原因。然而，尽管具有临床实用性，但由于临床医生缺乏培训，肾 GU POCUS 仍然未得到充分利用。为了解决这一差距，本文介绍了肾脏 GU 图像采集和解释。

成人床旁肾脏和泌尿生殖系统超声：图像采集

A range of conditions involving the kidneys and urinary bladder can cause organ-threatening complications that are preventable if diagnosed promptly with ...

急性肾损伤和/或低尿量的病情检查通常需要使用肾生殖器泌尿系统超声检查。虽然肾 GU 超声传统上由速记员和放射科医生作为咨询服务进行，但我们的论文定义了一种基于证据的床旁肾 GU 超声图像采集方案。我们的多学科小组开发了一种专业不可知的肾 GU 床旁超声图像采集方案。该协议包括适应症、限制、患者定位、换能器选择和图像优化。我们的方案简化了床旁肾脏和 GU 超声的入路并实现了标准化，减少了对会诊超声检查的需求并加快了诊断速度。

point-care-kidney-genitourinary-ultrasound-adults-image

Research

Education

JoVE Journal

JoVE Core

Anatomy and Physiology

Medicine

Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

Unit 1

The Urinary System

SCIENTISTS IN ACTION

903 次观看.  Duke University School of Medicine. 急性肾损伤和/或低尿量的病情检查通常需要使用肾生殖器泌尿系统超声检查。虽然肾 GU 超声传统上由速记员和放射科医生作为咨询服务进行，但我们的论文定义了一种基于证据的床旁肾 GU 超声图像采集方案。我们的多学科小组开发了一种专业不可知的肾 GU 床旁超声图像采集方案。该协议包括适应症、限制、患者定位、换能器选择和图像优化。我们的方案简化了床旁肾...

视频: 作者聚焦：制定肾脏和泌尿生殖系统超声检查的床边方案

Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is estimated to contribute to 19- 25% of all clinical cases of acute kidney injury (AKI) in critically ill patients. AKI detection has historically relied on metrics such as serum creatinine (sCr) or blood urea nitrogen (BUN) which are demonstrably inadequate in full assessment of nephrotoxicity in the early phase of renal dysfunction. Currently, there is no robust diagnostic method to accurately detect hemodynamic alteration in the early phase of AKI while such alterations might actually precede the rise in serum biomarker levels. Such early detection can help clinicians make an accurate diagnosis and help in in decision making for therapeutic strategy. Rats were treated with Cisplatin to induce AKI. Nephrotoxicity was assessed for six days using high-frequency sonography, sCr measurement and upon histopathology of kidney. Hemodynamic evaluation using 2D and Color-Doppler images were used to serially study nephrotoxicity in rats, using the sonography. Our data showed successful drug-induced kidney injury in adult rats by histological examination. Color-Doppler based sonographic assessment of AKI indicated that resistive-index (RI) and pulsatile-index (PI) were increased in the treatment group; and peak-systolic velocity (mm/s), end-diastolic velocity (mm/s) and velocity-time integral (VTI, mm) were decreased in renal arteries in the same group. Importantly, these hemodynamic changes evaluated by sonography preceded the rise of sCr levels. Sonography-based indices such as RI or PI can thus be useful predictive markers of declining renal function in rodents. From our sonography-based observations in the kidneys of rats that underwent AKI, we showed that these noninvasive hemodynamic measurements may consider as an accurate, sensitive and robust method in detecting early stage kidney dysfunction. This study also underscores the importance of ethical issues associated with animal use in research.

Early stage hemodynamic dysfunction is critical to the development of kidney disease. Yet, detection methodologies are limited. Recent advances in sonography provide a noninvasive, accurate option for early detection of kidney injury. This study outlines a step-by-step, sonographic methodology for detecting kidney dysfunction using a drug-induced nephrotoxicity rat model.

大鼠使用超声技术药物引起的肾血流动力学障碍的早期检测

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is ...

科研

医学

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Use of 3D Robotic Ultrasound for In Vivo Analysis of Mouse Kidneys

Common modalities for in vivo imaging of rodents include positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). Each method has limitations and advantages, including availability, ease of use, cost, size, and the use of ionizing radiation or magnetic fields. This protocol describes the use of 3D robotic US for in vivo imaging of rodent kidneys and heart, subsequent data analysis, and possible research applications. Practical applications of robotic US are the quantification of total kidney volume (TKV), as well as the measurement of cysts, tumors, and vasculature. Although the resolution is not as high as other modalities, robotic US allows for more practical high throughput data collection. Furthermore, using US M-mode imaging, cardiac function may be quantified. Since the kidneys receive 20%-25% of the cardiac output, assessing cardiac function is critical to the understanding of kidney physiology and pathophysiology.

Use of 3D Robotic Ultrasound for In Vivo Analysis of Mouse Kidneys

This protocol demonstrates robotic ultrasound (US) as a practical, cost-effective, and quick alternative to traditional non-invasive image modalities.

使用3D机器人超 声进行小鼠 肾脏体内分析

Common modalities for in vivo imaging of rodents include positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient&#39;s bedside.

Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally prevents direct visualization of the lung parenchyma. When showing the lung parenchyma, ultrasound typically generates a number of non-anatomic artifacts. However, over the past several decades, these artifacts have been studied by diagnostic point-of-care ultrasound (POCUS) practitioners, who have identified findings that have value in narrowing the differential diagnoses of cardiopulmonary dysfunction. For instance, in patients presenting with dyspnea, lung POCUS is superior to chest radiography (CXR) for the diagnosis of pneumothorax, pulmonary edema, lung consolidations, and pleural effusions. Despite its known diagnostic value, the utilization of lung POCUS in clinical medicine remains variable, in part because training in this modality across hospitals remains inconsistent. To address this educational gap, this narrative review describes lung POCUS image acquisition in adults, including patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization.

Point-of-care ultrasound (POCUS) of the lungs provides quick answers in rapidly changing clinical scenarios. We present an efficient and informative protocol for image acquisition for use in acute care settings.

成人床旁肺部超声:图像采集

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON method, which looks for and evaluates the Mallampati classification, signs of obstruction, and neck mobility. Clinical findings help predict a higher likelihood of difficult tracheal intubation, but no clinical result reliably excludes difficult intubation. Ultrasound as an adjunct to clinical examination can provide the clinician with a dynamic anatomical airway assessment, which is impossible with clinical examination alone. In the hands of anesthesiologists, ultrasound is becoming more popular in the perioperative period. This method is particularly applicable for identifying proper endotracheal tube positioning in specific patient populations, such as those who are morbidly obese and patients with head and neck cancer or trauma. The focus is on identifying the normal anatomy, correctly positioning the endotracheal tube, and refining the parameters that predict difficult intubation. Several ultrasound measurements are clinical indicators of difficult direct laryngoscopy in the literature. A meta-analysis revealed that the distance from the skin to the epiglottis (DSE) is most associated with a difficult laryngoscopy. An ultrasound of the airway could be applied in routine practice as an adjunct to the clinical examination. A full stomach, rapid sequence intubation, gross visual anatomical abnormalities, and restricted neck flexibility prevent using ultrasound to assess the airway. The airway evaluation is performed with a linear array transducer of 12-4 MHz, with the patient in the supine position, with no pillow, and with the head and neck in a neutral position. The central axis of the neck is where the ultrasound parameters are measured. These image acquisitions guide the standard ultrasound examination of the airway.

A point-of-care ultrasound (POCUS) is a simple, non-invasive, and portable tool that enables dynamic airway assessment. Several studies have attempted to determine the role of ultrasound parameters as an adjunct to clinical examination in predicting difficult laryngoscopies.

床旁超声:预测困难气道的超声参数综述

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h equipment availability. In 2018, the sonographic algorithm for life-threatening emergencies (SAFE) protocol was published, which allows the assessment of neonates with sudden decompensation to identify abnormal contractility, tamponade, pneumothorax, and pleural effusion. In the study unit (with a consulting neonatal hemodynamics and POCUS service), the algorithm was adapted by including consolidated core steps to support at-risk newborns, aiding clinicians in managing cardiac arrest, and adding views to verify correct intubation. This paper presents a protocol that can be applied in the NICU and the delivery room (DR) in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. 
This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; the image acquisition protocol is carefully detailed. This method was designed to be learned as a general competence to obtain the timely diagnosis of life-threatening scenarios; the method aims to save time but does not represent a substitute for comprehensive and standardized hemodynamic and radiological analyses by a multidisciplinary team, which might not universally be on call but needs to be involved in the process. From January 2019 to July 2022, in our center, 1,045 hemodynamic consultation/POCUS consults were performed with 25 patients requiring the modified SAFE protocol (2.3%), and a total of 19 procedures were performed. In five cases, trained fellows on call resolved life-threatening situations. Clinical examples are provided that show the importance of including this technique in the care of critical newborns.

Here, we present a protocol that can be applied in the neonatal intensive care unit and the delivery room in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; an image acquisition protocol is carefully detailed.

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h ...

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter (ONSD). Diagnostic ultrasound of the ONSD to detect intracranial hypertension has traditionally faced many problems because of methodologic discrepancies. Due to inconsistencies in the measuring techniques, the potential for ONSD to become a non-invasive bedside monitoring tool for ICP has been hampered. However, establishing a transparent, consistent methodology for measuring the ONSD would support its use as a valid and reliable method of identifying intracranial hypertension. This is important as it has both high sensitivity and specificity in acute care settings. This narrative review describes ONSD POCUS image acquisition, including patient positioning, transducer selection, probe placement, the acquisition sequence, and image optimization. Further, visual aids are provided to assist in real-time during image acquisition. This method should be considered for patients for whom there are concerns regarding intracranial hypertension but who do not have an intracranial monitor in place.

Point-of-care ultrasound (POCUS) of the optic nerve sheath diameter (ONSD) has been shown to be useful in identifying patients with increased intracranial pressure (ICP). However, the non-standardized technique for this POCUS has hampered its use. We present a standardized image acquisition protocol for use in the acute care setting.

视神经鞘床旁超声:图像采集

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter ...

胃超声技术减轻围手术期误吸风险

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical inquiries related to gastric content. One emerging concern pertains to patients about to undergo sedation and/or endotracheal intubation: the elevated risk of aspiration from the patient&#39;s stomach contents. Aspiration of gastric contents into the lungs poses a serious and potentially life-threatening complication. This occurs more frequently when the stomach is considered &#34;full&#34; and can be affected by the techniques employed for airway management, making it potentially preventable. To mitigate the risk of peri-procedural aspiration, two distinct medical specialties (anesthesiology and critical care medicine) have independently developed techniques to utilize ultrasonography for identifying patients requiring &#34;full stomach&#34; precautions. Due to these separate specialties, the work of each group remains relatively unfamiliar outside its respective field. This article presents descriptions of both techniques for gastric ultrasound. Furthermore, it explains how these approaches can complement each other when one of them falls short. Regarding image acquisition, the article covers the following topics: indications and contraindications, selection of the appropriate probe, patient positioning, and troubleshooting. The article also delves into image interpretation, complete with example images. Additionally, it demonstrates how one of the two techniques can be employed to estimate gastric fluid volume. Lastly, the article briefly discusses medical decision-making based on the findings of this examination.

作者聚焦：用于围手术期护理中胃内容物评估和风险分层的床旁超声 

This protocol introduces two methods for image acquisition in gastric ultrasonography. Additionally, tips are provided for interpreting this information to assist in medical decision-making.

成人胃旁超声：图像采集和解释

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...

成人床旁肾脏和泌尿生殖系统超声：图像采集

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大鼠使用超声技术药物引起的肾血流动力学障碍的早期检测

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

使用3D机器人超声进行小鼠肾脏体内分析

下肢近端深静脉血栓形成的即时超声筛查

成人床旁肺部超声:图像采集

床旁超声:预测困难气道的超声参数综述

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

视神经鞘床旁超声:图像采集

成人胃旁超声：图像采集和解释

成人胃旁超声：图像采集和解释

成人床旁肾脏和泌尿生殖系统超声：图像采集

副本

摘要

探索更多视频

此视频中的章节

大鼠使用超声技术药物引起的肾血流动力学障碍的早期检测

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

使用3D机器人超 声进行小鼠 肾脏体内分析

下肢近端深静脉血栓形成的即时超声筛查

成人床旁肺部超声:图像采集

床旁超声:预测困难气道的超声参数综述

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

视神经鞘床旁超声:图像采集

成人胃旁超声：图像采集和解释

成人胃旁超声：图像采集和解释

使用3D机器人超声进行小鼠肾脏体内分析