Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters
Technical Report,29 Sep 2008,28 Sep 2015
Research Institute at Nationwide Childrens Hospital Columbus Columbus United States
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Purpose To demonstrate that 1 ultrasound guided foreign body removal USFBR is superior to conventional surgery in the cadaver model, 2 USFBR can be taught to radiologists and generate competency, and 3 radiologists can apply the technique in the patient setting to remove foreign bodies. Materials and Methods Radiologist and surgeon removed nine 1-cm foreign bodies using the USFBR method P and traditional surgery S with and without wire guidance W on the cadaver model. Technique was evaluated by removal success, time, incision size, and wound closure. Analysis of variance was applied to the data. USFBR was taught to 48 radiologists at 4 hospitals. Instruction and evaluation covered instrument alignment, handtransducer position, forceps use, foreign body definition, forceps grasp, recognition of volume averaging, and oblique cross cut artifact. Pre-training testing included single tooth pick removal over 15 minutes. Training included didactic and hands-on instruction. Post-training evaluation consisted of 5 toothpick removals of 15 minutes each. Data were evaluated using chi squared and Fishers exact tests. Clinical implementation of USFBR included foreign body removal under ultrasound guidance by a trained radiologist. Parameters including age of patient, radiologist, removal success, type and size of foreign bodyies, incision size, foreign body retention time, reason for removal, symptoms, modalities used in detection, wound closure, and sedation are recorded in an online database.