Development of an ultrasound-imaging procedure and acquisition of ultrasound images of acupuncture points for safety and accuracy of needle insertion

Clinical study on improving the function of female bladder in controlling urine by acupuncture Zhibian (BL54) under ultrasound guidance

OBJECTIVE

To observe the effect of acupuncture Zhibian (BL54) on the function of the bladder in controlling urine in women under ultrasound.

METHOD

74 healthy subjects were randomly divided into deep acupuncture group of 37 cases and shallow acupuncture group of 37 cases. Under the guidance of ultrasound, the two groups of subjects were acupunctured at bilateral BL54. The deep acupuncture group was acupunctured to the pudendal nerve, and the shallow acupuncture group was acupunctured to the superficial fascia. Ultrasound was used to observe the peak systolic velocity (PSV), time average maximum velocity (TAMX), end diastolic velocity (EDV), pulsation index (PI), resistance index (RI) of the pudendal arteries, and bladder volume of two groups of subjects before and after acupuncture. The anatomical hierarchical structure of bilateral BL54 and score of Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) of all subjects was measured.

RESULT

After acupuncture, the PSV, TMAX of the pudendal artery, bladder volume, and the Score of C-MASS Scale in the deep acupuncture group were higher than in the shallow acupuncture group (P < 0.05). The RI of the pudendal arteries in the shallow acupuncture group decreased compared to before acupuncture (P < 0.05).

CONCLUSION

Acupuncture at the BL54 can increase the blood flow velocity of the pudendal artery, improve the function of the bladder in controlling urine in women, and different depths of acupuncture will have different therapeutic effects.

Survey on the current usage of ultrasound-guided procedures in Korean Medicine Clinics and Hospitals

Ultrasound-guidance is applied during the administration of Korean medicine (KM) interventions to improve the safety and effectiveness of the interventions. Although many case series and reports on the use of ultrasound-guided KM interventions have been reported, no study has investigated the current use of ultrasound-guidance in clinical practice by doctors of Korean medicine (KMDs). An online survey was conducted with questions examining the status of ultrasound-guidance usage among KMDs practicing in various KM clinical settings. Survey responses from 335 KMDs were collected. Ultrasound started to be widely used in the clinical practice of KM since 2022. The primary objective of using ultrasound-guidance was "To improve the accuracy and efficacy" by 54.6%. Ultrasound-guidance was most frequently applied for shoulder joint diseases, and pharmacopuncture was the most frequently used intervention (76.1% and 90.4%, respectively). The respondents reported that effectiveness could be enhanced the most in nerve entrapment syndromes and especially when used in shoulder joints. Over 90% of KMDs responded that the safety and efficacy of treatment, specialty, and patients' satisfaction were improved after adopting ultrasound-guidance. Moreover, 94.9% of KMDs agreed with the necessity for reimbursement of ultrasound-guidance in KM under national health insurance coverage. Most KMDs responded that they had positive perceptions regarding the clinical use of ultrasound-guidance in KM in terms of treatment effects, safety, and patient satisfaction, and the need for national health insurance coverage of the service. Our findings may provide practice-based evidence for conducting clinical studies.

An Observational Study Using Ultrasound to Assess Allowable Needle Insertion Range of Acupoint CV12

Background: Abdominal organ injuries are a rarely reported complication when deep acupuncture needling is applied to the abdomen. In order to ascertain the allowable needle insertion range (ANIR) of the abdomen region, we selected acupoint CV12, which is commonly used for treating gastric disease, and ANIR was measured with an ultrasound device. Method: Eighty-five healthy volunteers were recruited, of which 83 cases of ultrasound images were obtained. To investigate the prediction factor of ANIR, we also measured several anthropometric factors. Results: The average ANIR was 25.3 ± 10.2; generally, the ANIRs of females were thicker than those of males; and the liver was observed in 62.7% subjects’ ultrasound images. The non-observed group showed thicker ANIR and higher BMI than the liver-observed group. Conclusion: There are reliable variables that make it possible to predict the ANIR. It is advised to refer to anthropometric factors in needling acupoint CV12 to avoid complications with the acupuncture treatment. However, individual differences are not negligible when applying deep needling. Thus, if the risk is not judged before or during the procedure, practitioners could consider the patient’s ANIR on CV12 when applying acupuncture by examining the individual anatomical structures using ultrasound and considering internal organ positions to prevent adverse events due to acupuncture.

Implementation of Objective Structured Clinical Examination on Diagnostic Musculoskeletal Ultrasonography Training in Undergraduate Traditional Korean Medicine Education: An Action Research

This study aimed to report the specific methods and investigate the educational effects of diagnostic musculoskeletal ultrasound training and the Objective Structured Clinical Examination (OSCE) for traditional medicine students. Scanning volar wrist and diagnosing carpal tunnel syndrome were selected for musculoskeletal ultrasound to train students to use the basic functions of the ultrasound device and scan various structures including tendons, nerves, and arteries. The students were divided into two groups: one group had 8 weeks of training with mock OSCE experience and received feedback about their scan images, and the other group had 3 weeks of training with flipped learning. The OSCE was implemented on the last day of the training. The subjective learning outcomes were analyzed as students’ evaluation with a 5-point scale, and the objective learning outcomes were analyzed using OSCE scores evaluated with a pre-validated checklist. Of the 111 students, 60 (54.1%) responded to the questionnaire. Overall satisfaction with this ultrasound training was high (4.5 ± 0.60). The average OSCE score in the 8-week group was significantly higher than that in the 3-week group. The students’ self-assessment showed no significant differences between the two groups. Proficiency in using ultrasound is affected by the practice time and feedback. Ultrasound training should be further expanded as a required curriculum to meet students’ needs and achieve learning objectives in the clinical skills education of Korean medicine colleges. Further studies are needed on ultrasound education, especially guided interventions for traditional medicine students.

Development of an Objective Structured Clinical Examination Checklist and a Post-Education Questionnaire for Musculoskeletal Ultrasound Training Focusing on Volar Wrist and Carpal Tunnel Syndrome

Background: The objective structured clinical examination (OSCE) is used in the colleges of Korean Medicine, but few studies have validated the OSCE evaluation criteria or post-education questionnaires. Diagnostic ultrasound is used in Korean medicine treatment including acupuncture, acupotomy, and pharmacopuncture to increase the safety and efficacy of treatment. We aimed to develop and validate a OSCE checklist and questionnaire for diagnostic musculoskeletal ultrasound training.Methods: A OSCE checklist and rubric for diagnostic ultrasound training, and questionnaire was developed using literature research. Eight expert panelists verified each draft item in a single-round survey. Items with a content validity ratio (CVR) < 0.75 were excluded or modified to reflect the experts’ opinions.Results: The OSCE checklist and rubric for diagnostic ultrasound training focusing on volar wrist and carpal tunnel syndrome included: 15 items revised according to CVR and expert opinions, the pre-examination procedure, structures to be identified by ultrasound, scans with 2 diagnostic criteria for carpal tunnel syndrome, an explanation of the exam results, and the post exam procedure. The questionnaire consisted of 15 items, including the overall evaluation of training, the effect of the OSCE, and the perception of the ultrasound. All 6 self-evaluation items were not revised, as they had a CVR of ≥ 0.75.Conclusion: An ultrasound OSCE for scanning the volar wrist and diagnosing carpal tunnel syndrome was developed using 15 validated tasks, 15 survey questions about ultrasound training, and 6 questions for selfevaluation. These results may be used in the future for education in diagnostic ultrasound.

Interpretation of acupoint location in traditional Chinese medicine teaching: Implications for acupuncture in research and clinical practice

Acupuncture is a therapeutic intervention of traditional Chinese medicine, characterized by the insertion of a fine metal needle through the human body's skin at an acupuncture point (acupoint). Acupuncture has become from cultural curiosity to fast-growing complementary and alternative medicine therapy worldwide, including in the United States. The ability to locate acupoints on the body surface precisely is critical for the acupuncture treatment. However, the location of acupoints varies frequently among practitioners. Therefore, in the present study, the author will address the application of acupoint in traditional Chinese medicine (including the anatomical location of acupoint) to draw attention to the issues about the acupoint location in acupuncture research and clinical practice. Moreover, further studies are needed to determine whether acupoint location with specificity could be validated by employing reliable tools. In the future, the incongruity among acupuncturists regarding acupoint location should be resolved, and the acupoint location methods with more accuracy should be developed.

Development and Evaluation of Inexpensive Ultrasound Using A-Mode and M-Mode Signals to Identify Lung Depth and Avoid Risk of Pneumothorax in Acupuncture

Purpose

To increase patient safety, ultrasound detection acupuncture (UDA) has been developed, which can detect a safe depth for acupuncturists to avoid causing pneumothorax. This study aims to develop and evaluate a single-transducer ultrasound for acupuncture (UFA) to promote UDA.

Methods

Special A-mode and M-mode signals were analyzed to identify the depth of the lung. Six subjects were recruited to test the reliability and validity of UFA on GB21, LV14 and BL43 acupuncture points.

Results

The result showed UFA’s coefficient of variation was less than 0.2 and no difference in age, gender, and BMI of the subjects statistically, demonstrating excellent reliability. However, the content validity index of 0.51 did not meet expectations. UFA has good reliability, but it cannot reach the level of medical ultrasound. UFA uses A-mode and the seashore sign of M-mode to make a good identification of the lung, and it would be useful in the promotion of UDA.

Neuroanatomical relationship between Jingbi and the brachial plexus

BACKGROUND

This study examined the stratified anatomy of the traditional acupuncture point Jingbi and the neuroanatomical relationship between Jingbi and the brachial plexus, and investigated neural pathways that could be affected by acupuncture stimulation at Jingbi.

METHODS

Twelve dissected specimens were used to study the pathway of an acupuncture needle inserted at Jingbi. The stratified anatomy and the neuroanatomical relationship between Jingbi and the brachial plexus were studied. Our samples were grouped by gender and cause of death for comparative analysis.

RESULTS

All needles (n = 24, on both sides of a total of 12 cadavers) punctured the anterior scalene muscle medial to the brachial plexus and external jugular vein, lateral to the phrenic nerve and internal jugular vein, and superior to the clavicle and subclavian artery/vein. The depth of needle insertion at Jingbi on the right side of male samples was 28.0 (interquartile range (IQR), 22.5-30.8) mm, which was approximately 8 mm deeper than for female subjects (p < 0.05). The needle was 3.0 (IQR, 2.0-5.0) mm and 7.0 (IQR, 5.5-8.0) mm medial to the brachial plexus on the left and right sides, respectively.

CONCLUSION

Deep needle insertion at Jingbi can puncture the anterior scalene muscle. The mechanism of action of acupuncture stimulation at Jingbi might be related to its close relationship with the brachial plexus. Significant differences in needling depth were observed when our samples were grouped by gender. More studies are needed.