Objective, Noninvasive Wound Assessment Using B-Mode Ultrasonography
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Disclosures: Dr. Wendelken is a consultant for Biosound Ultrasound Co., part owner of Hudson Diagnostic Imaging, and owner and inventor of the ultrasound device used in this study.
Developments in advanced wound care have concentrated on wound treatments and therapies. There has been little progress in the field of wound assessment and diagnostics. Clinicians have had to rely on clinical expertise and invasive methods to inspect pathology before making decisions about wound etiology and wound complications. Using diagnostic ultrasound, a novel technique has been developed to evaluate wounds objectively and noninvasively. This technique, called Wound-Mapping® (Hudson Diagnostic Imaging LLC, Elmwood Park, New Jersey) is a significant advance in the field of wound assessment and offers a sophisticated way to measure wound size, depth, undermining, edema, and abnormalities in dermis, muscle, fat, and bone surface.
The purpose of this paper is twofold. First, the authors will introduce diagnostic ultrasound as a tool for noninvasive wound assessment. Second, the authors will share their experiences using ultrasound in the examination of chronic wounds of varying etiologies.
Overview of Diagnostic Ultrasound
Ultrasonography has been an integral part of medicine for more than 30 years. It is best known for its use in the area of obstetrics and gynecology, cardiology, radiology, internal medicine, and vascular surgery. Today, sophisticated ultrasound machines can produce three-dimensional images. Ultrasound systems use relatively high-frequency sound waves that are pulsed at a specific time interval through a transducer. This same transducer listens for echoes that are produced by various tissues. After capturing these echoes, a central processing unit compiles the echoes into an image that is sent to a display (cathode ray tube or solid state display). Today’s high-speed electronics have made it possible to package a high-resolution, cost-effective imaging tool that provides accurate and reproducible ultrasound scans. Some portable ultrasound scanners can be worn on physicians’ wrists while maintaining a reasonable degree of performance.
The increased diagnostic capabilities of ultrasound technology are directly related to the availability of advanced microprocessors, which have also lowered the cost of ultrasound scanners. Practical transducers now have a frequency range from 3.0Mhz to 20Mhz with axial and spatial resolution in the hundreds of millimeters (transducer and scanner dependent). Unlike magnetic resonance imaging (MRI), a benefit of these advances is that clinicians have the option to scan soft tissue via musculoskeletal ultrasound in the office or clinic setting. This modality is readily available for physicians to scan wounds during typical patient office visits, thereby avoiding potential MRI scheduling delays and follow-up consultations. Less obvious to the patient but more important to the physician is the capability of real-time imaging of structures for immediate diagnoses or to rule out diagnoses with no delay in final report generation. Radiographs (x-rays) often are the first type of diagnostic imaging performed on wounds to rule out infection of bone and soft-tissue involvement. However, radiographic images can be misleading because pathologic changes may not appear for two weeks following the x-ray. Computerized tomography (CT) scans, like MRI, may have scheduling delays, which consume valuable time before results are obtained; this may lead to increased morbidity for patients. Of the four imaging modalities, only diagnostic ultrasound is totally noninvasive and has no contraindications, such as harmful x-rays, injected dyes, magnetic fields, or potential patient clostrophobia.
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