Name: troubleshooting focus image acquisition: patient positioning, transducer manipulation, and image optimization
Uploaded: 2023-03-03T14:25:00
Description: Watch this Scientific Journal Video about Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization at JoVE.com

我们要感谢密歇根大学麻醉系、Max Harry Weil 重症监护研究与创新研究所以及 Katelyn Murphy 的行政和平面设计支持。

本材料是作者的原创作品，以前未在其他地方发表过。所描述的方案用于临床用途，而不是研究目的。去识别化的图像是从非临床环境中的志愿者模型获得的。作者没有根据机构政策向IRB寻求正式的“不受监管”决定，因为该活动超出了共同规则和FDA对人类受试者研究的定义。
1. 换能器
<ol><li>使用相控阵探头。这是一个 4-12 MHz 的换能器，由于与其他超声换能器...

<ol>
	<li>Birch, M. S., Marin, J. R., Liu, R. B., Hall, J., Hall, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trends+in+diagnostic+point-of-care+ultrasonography+reimbursement+for+medicare+beneficiaries+among+the+US+emergency+medicine+workforce,+2012+to+2016.">Trends in diagnostic point-of-care ultrasonography reimbursement for medicare beneficiaries among the US emergency medicine workforce, 2012 to 2016.</a> Annals of Emergency Medicine. 76 (5), 609-614 (2020).</li><li>Moore, C. L., Copel, J. 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+ultrasonography.">Point-of-care ultrasonography.</a> The New England Journal of Medicine. 364 (8), 749-757 (2011).</li><li>Su, E., Dalesio, N., Pustavoitau, 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+ultrasound+in+pediatric+anesthesiology+and+critical+care+medicine.">Point-of-care ultrasound in pediatric anesthesiology and critical care medicine.</a> Canadian Journal of Anaesthesiology. 65 (4), 485-498 (2008).</li><li>Niblock, F., Byun, H., Jabbarpour, Y. <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+use+by+primary+care+physicians.">Point-of-care ultrasound use by primary care physicians.</a> The Journal of the American Board of Family Medicine. 34 (4), 859-860 (2021).</li><li>Coritsidis, G. N., 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+assessing+arteriovenous+fistula+maturity+in+outpatient+hemodialysis.">Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis.</a> The Journal of Vascular Access. 21 (6), 923-930 (2020).</li><li>Gundersen, G. 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=Adding+point+of+care+ultrasound+to+assess+volume+status+in+heart+failure+patients+in+a+nurse-led+outpatient+clinic.+A+randomised+study.">Adding point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study.</a> Heart. 102 (1), 29-34 (2016).</li><li>Kirkpatrick, J. N., 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=Recommendations+for+echocardiography+laboratories+participating+in+cardiac+point+of+care+cardiac+ultrasound+(POCUS)+and+critical+care+echocardiography+training:+report+from+the+American+Society+of+Echocardiography.">Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: report from the American Society of Echocardiography.</a> Journal of the American Society of Echocardiography. 33 (4), 409-422 (2020).</li><li>Annals of Emergency Medicine. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+Guidelines:+Emergency,+point-of-care+and+clinical+ultrasound+guidelines+in+medicine.">Ultrasound Guidelines: Emergency, point-of-care and clinical ultrasound guidelines in medicine.</a> Annals of Emergency Medicine. 69 (5), 27-54 (2017).</li><li>Levitov, 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=Guidelines+for+the+appropriate+use+of+bedside+general+and+cardiac+ultrasonography+in+the+evaluation+of+critically+ill+patients-part+II:+cardiac+ultrasonography.">Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: cardiac ultrasonography.</a> Critical Care Medicine. 44 (6), 1206-1227 (2016).</li><li>Neskovic, A. N., 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=Focus+cardiac+ultrasound+core+curriculum+and+core+syllabus+of+the+European+Association+of+Cardiovascular+Imaging.">Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging.</a> European Heart Journal. Cardiovascular Imaging. 19 (5), 475-481 (2018).</li><li>Mitchell, C., 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=Guidelines+for+Performing+a+Comprehensive+Transthoracic+Echocardiographic+Examination+in+Adults:+Recommendations+from+the+American+Society+of+Echocardiography.">Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography.</a> Journal of the American Society of Echocardiography. 32 (1), 1-64 (2019).</li><li>Dinh, V. 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=Measuring+cardiac+index+with+a+focused+cardiac+ultrasound+examination+in+the+ED.">Measuring cardiac index with a focused cardiac ultrasound examination in the ED.</a> The American Journal of Emergency Medicine. 30 (9), 1845-1851 (2012).</li><li>Expert Round Table on Echocardiography in ICU. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+consensus+statement+on+training+standards+for+advanced+critical+care+echocardiography.">International consensus statement on training standards for advanced critical care echocardiography.</a> Intensive Care Medicine. 40 (5), 654-666 (2014).</li><li>Expert Round Table on Echocardiography in ICU. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+expert+statement+on+training+standards+for+critical+care+ultrasonography.">International expert statement on training standards for critical care ultrasonography.</a> Intensive Care Medicine. 37 (7), 1077-1083 (2011).</li><li>Spencer, K. T., 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=Focused+cardiac+ultrasound:+recommendations+from+the+American+Society+of+Echocardiography.">Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.</a> Journal of the American Society of Echocardiography. 26 (6), 567-581 (2013).</li><li>Nelson, B. P., Sanghvi, 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+cardiac+ultrasound:+feasibility+of+performance+by+noncardiologists.">Point-of-care cardiac ultrasound: feasibility of performance by noncardiologists.</a> Global Heart. 8 (4), 293-297 (2013).</li></ol>

本出版物的目的是提供实用的建议和最佳实践，以在具有挑战性的临床环境中获得最佳FoCUS图像。正式的超声研讨会、临床经验和实践教学中对学习者的观察已经深入了解了陷阱和不太理想的趋势。因此，影响立体定向和精神运动技能的许多因素变得明显。虽然本材料是针对FoCUS检查描述的，但许多原则可以应用于其他护理点超声检查和超声换能器类型。除了影响学习者之外，教师还可以将这些概...

聚焦心脏超声 （FoCUS） 是一种有限的、由临床医生执行的超声心动图应用，可为患者护理提供即时的解剖、生理和功能信息。这些检查由五个经典视图组成，以问题为导向，在床边实时进行，不能取代全面的超声心动图检查1，2。鉴于这些检查的重点性质，当临床状态改变或需要连续监测时，通常会重复进行。在可能的情况下，进行标准化培训并获得所有五个视图的足够图像非常重要，因为某些视图可能提供有限的信息，具体取决于个体患者和病理。
FoCUS的使用正在迅速扩大。许多临床领域，如围手术期麻醉学、重症监护和急诊医学1、2、3，现在常规使用 FoCUS。住院病房和门诊临床护理机构也正在采用此工具来加强临床实践4，5，6。因此，一些社会机构，如美国超声心动图学会、重症监护医学学会和美国急诊医师学会，已经发布了关于 FoCUS 能力和实践范围的指南和建议7，8，9。虽然这些指南和建议没有编纂成文，但大部分内容是一致的，并影响了FoCUS培训课程10。
除了教学和图像解释之外，FoCUS的能力还包括掌握立体定向和精神运动技能。立体定向技能是指根据三维解剖特征将超声换能器准确定位在身体上。精神运动技能描述了认知功能与影响协调、灵巧和操作的身体运动之间的关系。扩大对这些技能的知识和认识支持FoCUS学员的发展。
本文介绍了在FoCUS中进行高质量图像采集的概念，既有实用的考虑，也有对立体定向和精神运动技能的关注。具体而言，本文讨论了最佳患者定位、探头操作，并提出了优化相控阵探头使用的技巧。最后，它研究了二维（B模式或2D模式）和运动模式（M模式）的图像优化。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Aquasonic ultrasound gel</td>
			<td>Parker</td>
			<td>30592052</td>
			<td>https://dr.graphiccontrols.com/en/catalog/ultrasound-gel/parker-laboratories-01-50-aquasonic-100-gel-5l-1332e66e/</td>
		</tr>
		<tr>
			<td>Philips Sparq ultrasound machine</td>
			<td>Phillips</td>
			<td></td>
			<td>https://www.usa.philips.com/healthcare/product/HC795090CC/sparq-ultrasound-system#documents</td>
		</tr>
	</tbody>
</table>

troubleshooting focus image acquisition: patient positioning, transducer manipulation, and image optimization

聚焦心脏超声 （FoCUS） 是一种有限的、由临床医生执行的超声心动图应用，用于为患者护理添加实时信息。这些床旁检查以问题为导向，快速且反复进行，并且在很大程度上是定性的。FoCUS的能力包括掌握换能器操作和图像采集所需的立体定向和精神运动技能。能力还需要能够优化设置、排除图像采集故障以及了解由于复杂的临床环境和患者病理学而导致的超声限制。本文介绍了在FoCUS中成功进行高质量二维（B模式）图像采集的概念。
高质量图像采集的概念可应用于 FoCUS 检查的所有已建立的超声窗口：胸骨旁长轴 （PLAX）、胸骨旁短轴 （PSAX）、心尖四腔 （A4C）、肋下四腔 （SC4C） 和下腔静脉 （IVC）。提到了顶端五腔 （A5C） 和肋下短轴 （SCSA） 视图，但未深入讨论。本文还提供了一个实用的图，说明了相控阵探头的运动，作为FoCUS图像采集过程中的认知辅助工具。

从上述聚焦心脏超声方案获得的代表性图像如图2、图3、图4、图5和图6所示，证明了所述技术的可行性。 这些图像是用相控阵5-1 MHz探头捕获的。从协议部分7获得的胸骨旁长轴（PLAX）图像如图2所示。从协议部分8获得的胸骨旁短轴（PSAX）图像如图...

Watch this Scientific Journal Video about Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization at JoVE.com

Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization

在这里，我们提出了一种协议，允许提供者在临床环境中进行聚焦心脏超声（FoCUS）。我们将介绍探头操作方法，回顾探头移动的常见陷阱，并提出优化相控阵探头使用的技巧。

FoCUS 图像采集故障排除：患者定位、换能器操作和图像优化

Focused cardiac ultrasound (FoCUS) is a limited, clinician-performed application of echocardiography to add real-time information to patient care. These ...

聚焦心脏超声允许临床医生在床边进行以问题为导向的超声检查，以回答实时临床问题。该过程在临床环境中快速、务实且可重复。该检查的含义适用于各种危重疾病，因为它提供的信息有助于临床评估心脏功能、体液状态和其他血流动力学特征。演示这一程序的将是医生Adam Gottula和Suhas Devangam，我的机构的教职医生Jessica Koehler博士。首先将患者置于仰卧位。如果难以获得胸骨旁长轴图像，请将患者放在左侧，并将手臂伸过头顶。将换能器斜放在胸骨旁区域第三和第五肋间隙之间的斜角处，换能器标记指向患者的右肩。可视化右心室、左心室、左心房、二尖瓣、左心室流出道、主动脉瓣和降胸主动脉。然后可视化二尖瓣和主动脉瓣同时打开和关闭，以确保图像不会缩短。现在从大约 15 到 20 厘米的初始深度开始，并调整深度，使二尖瓣的尖端位于图像的中心，并且可以看到下降的胸主动脉。调整增益以最大化心肌和二尖瓣的可见性，并将最集中的感兴趣区域的焦点移动到二尖瓣深度。要获得此图像，请将患者置于先前显示的位置或仰卧位。将换能器相对于换能器放置在胸骨旁长轴上约 90 度。然后倾斜换能器，直到看到状中部肌肉以进行焦点评估。将换能器向心脏底部倾斜。从更深的图像开始，以识别任何胸腔积液。调整深度以包括左心室和弥漫性厘米的全深度，以确保心包积液完全可见。调整增益以最大限度地提高鼻中隔和肌的可视化效果。之后，将焦点调整到肌。将患者放在左侧，左臂伸过头顶。如果存在明显的伪影，让患者呼气并屏住呼吸，以尽量减少肺伪影。将换能器沿左前辅助线放置在第四至第六肋间隙，换能器标记指向左腋窝。横向、内侧或侧向移动换能器以获得最佳的顶端四腔视图。如有必要，提起乳房组织以允许探头进入。如果左心室心尖未完全可见，则在将换能器朝向右肩的同时将换能器向外侧移动。在正常心脏中，左心室的顶端位于扇区的顶部和中心，右心室呈三角形且较小，心肌从心尖到心室瓣应均匀。现在捕获一个顶端四腔视图，包括心房、心室间隔以及三尖瓣和二尖瓣环的外侧部分。主动脉瓣和左心室流出道应仅存在于心尖五腔视图中。要改善瓣膜的图像，请将换能器向上或向下滑动肋条空间，然后向下倾斜换能器的底座。如果换能器的底部向下倾斜得太远，则会出现包括主动脉瓣在内的根尖五腔视图，并且换能器应向上倾斜以优化心尖四腔视图。将换能器的底座朝患者的中线旋转，以优化心室间隔位置，该位置应垂直位于图像中心。对两个心房进行成像并增加深度以包括图像最深处的两个心房，并容纳左心室和右心室游离壁。调整增益以最大限度地提高可见度，通常会导致心肌、二尖瓣环和三尖瓣环的回声增加。将焦点调整到瓣环的深度。显示聚焦心脏超声胸骨旁长轴、胸骨旁短轴、根尖四腔、肋下四腔和下腔静脉图像。聚焦心脏超声的立体定向和精神运动方面需要重复、时间和经验才能掌握。经验应包括在各种临床环境中对具有不同体型的患者进行检查。在某些临床情况下，限制是无法克服的。熟练的提供者将识别不应进行聚焦心脏超声的情况，并寻求其他检查，例如经食管或经胸超声心动图。

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