Bladder Scanner Vitacon Confidential April 2012 VitaScan LT An - - PowerPoint PPT Presentation

VitaScan LT Bladder Scanner

Vitacon Confidential – April 2012

VitaScan LT

• An ultrasound probe
• In a carrying case
• Connects to any PC*
• Result easily stored,

shared or printed

• Optional cart
• Calibration on-line

*meeting requirements, see suggestions

A versatile solution

• The VitaScan LT can be

used with a large choice

• f control units
• 1. A lightweight slate
• 2. A 10’ netbook
• 3. A medical grade tablet
• r panel PC
• 4. Your current laptop/PC
• 5. Your current

urodynamic system PC

  

Real Time Ultrasound benefits

• You can see

where the probe is aiming

• You make sure

the entire bladder is inside the ultrasound cone.

• One single scan

should be enough for an accurate measurement

The VitaScan Real-Time ultrasound image shown during a Pre-Scan

Advantages: • Real-Time Prescan for a better

visualization of the organs:

– During the PreScan phase

• Automatic measurement in 12

planes:

– No need for sonographic skills

• Image can be stored with the

volume measurement

– Making sure about what is measured…

• Affordable repair and calibration

service contract

Automatic measurement

• The VitaScan measures

in multiple planes and displays the result automatically

• The default 12 planes

setting should be enough

     

Automatic measurement

• Some Bladder scanners are not really

automatic

• In a video, from a competitor, you see :

– The measurement can be made from

• ne single plane

– The operator must press the « Sagittal Scan » button to add a 2nd plane – A stylus is to be used to draw the bladder edge

Two echographic images benefit

• The result screen includes 2 images (=2 planes)
• It may allow to code the exam as an echography

Transverse plane Sagittal plane

Transverse plane Sagittal Plane

How to perform a successful measurement with the VitaScan LT and other tips.

12.12.2011 9

Probe positioning

Positioning the probe is key for a good measurement. The purpose

• f this presentation is to explain

how to proceed:

• 1. Find the midline position on the

patient’s lower abdomen

• 2. Palpate the pubis bone
• 3. Apply gel on the probe head or
• n the patient’s abdomen
• 4. Place the probe head 2-3cm

above the pubis bone on the midline

April 2012 10

Pubis bone 2-3 cm Bladder

Probe positioning (Cont.)

• Press the Pre-Scan button to find

the bladder.

• Angle the probe so that:

– the green line is in the middle of the bladder shape – The bladder takes the largest area on the screen

• Keep this angle and press the Scan

button to make the measurement

• Don’t move while the

measurement is going-on.

– Note: You know that the measurement is over when the motor is not heard and 2 images appear on the screen.

April 2012 11

Watch the video…

Note: Internet connection required

April 2012 12

Tips

• Ultrasound gel quantity:

Too little ultrasound gel will result in a poor image. If the exam is repeated several time, you may have to put some more gel. A walnut volume is a minimum.

• Patient’s position:

The patient should be in supine position, not sitting, not standing.

• Pressure to apply:

A good pressure is to be applied on the probe to obtain a clear Black & White image of the bladder.

• Validate (or reject) the measurement:

The operator should be able to validate or reject measurements. See the examples in the next slides for more explanations.

• Pathologies and abnormalities:

Internal structures like hematoma, abdominal fluid/acids, liquids in bowel, cysts, bladder diverticula, scars may affect also the measurement. Patients with known urologic pathology may have abnormal bladders affecting the accuracy of the measurement.

April 2012 13

Case 1: Validated measurement

• This measurement can

be validated because:

• 1. Both ultrasound images

are showing a bladder with a closed structure.

• 2. The bladder is well

seen in the center of the ultrasound cone.

• 3. The yellow icon is well

centered inside the target.

• This measurement proved

to be very accurate:

• It reads 145 ml when the

voided volume was 150 ml.

Case 2: Validated measurement for a larger bladder

• As you can see the

images are meeting all requirements:

1. Both ultrasound images are showing a bladder with a closed structure. 2. The bladder is well seen in the center of the ultrasound cone. 3. The yellow icon is well centered inside the target.

• Compared to the voided

volume, this measurement proved to be very accurate.

Case 3: Validated measurement for an empty bladder

• Many patients

successfully empty their bladder completely.

• There is nothing for the

VitaScan LT to capture.

• The resulting images

beside are obviously not showing the bladder.

• The bladder is empty
• The VitaScan LT

correctly measured a 0 ml volume.

Case 4: Validated measurement for an almost empty bladder

• In the images beside, the

bladder is seen but was not detected in all planes.

• This can result in the

messages “ReScan please”.

• In the case beside, the

message “ReScan please” should be considered as an insignificant volume.

• In this case, the message

“ReScan please” should be considered as an insignificant volume.

Case 5: Rejected measurement

• As you can see, the

sagittal plane is not showing an image of the bladder with a closed shape

• The yellow icon is not

centered in the target.

• In these circumstances,

the operator should reject the measurement, re-aim and rescan using a different position or angle as explained above

• In the result below, you

read 418 ml.

• It was an overestimated

result compared to the voided volume.

Transverse plane Sagittal plane

Case 6: Rejected measurement

• As you can see both images

are showing open edges on the upper right of the ultrasound cone (marked with yellow line and arrow).

• The yellow icon is not well

enough centered.

• This measurement is to be

rejected

• Re-aim and angle the probe

below the pubic bone towards the patient’s lower pelvis.

• In the result screen below,

the measurement was underestimated.

Validate or Reject measurements Validate when:

1. Both ultrasound images (in

Transverse and Sagittal planes)

are showing a bladder with a closed structure. 2. The bladder is well seen in the center of the ultrasound cone. 3. The yellow icon is well centered inside the target.

Reject when:

• 1. The bladder image is not a

closed structure, and/or

• 2. 1 or both of the images is

not showing the bladder well centered, and/or

• 3. The Yellow icon is not well

centered in the target, and/or

• 4. The Yellow icon has a

strange shape

Data logging (NB: advanced feature)

It is possible to store automatically all the images for further investigation

• How to do this?

– Go to the Setup menu – Enter the password 1234 – Check the box “Enable Data Logging” – 2 types of files are stored in 2 directories:

• Bitmap (*.bmp) files showing each

planes.

• A proprietary format (*.bmvi) used to

playback the measurement

• NB : Directory location: C:\Program Files

(x86)\VitaScanLT\INSTALL\LOG

– If you face a difficulty, you could send us the files for evaluation

• Warning:
• Data Logging should not

be enabled by default.

• Each measurement will

take 64 Mb of space

Accuracy discussion: Why do I measure a different volume with the VitaScan LT and the beaker? 1.

As you may know the bladder is some times not fully emptied. Both the beaker volume and the Post-Void Residual volume must be added to make-up the VitaScan LT « full bladder » volume. 2. The medical literature (see ref. in the appendix) shows that an error is possible with a mean error going from 15 to 80 ml 3. Yet, the authors of most studies “consider this degree of accuracy to be reasonable for routine clinical practice”, and recommend Portable Bladder Ultrasound for its quickness and convenience. 4. The reference for our accuracy statement are phantoms and are fully met. 5. VitaScan LT is able to measure Bladder volume as low as 5 ml! 6. Some medical problems may also explain the difference. An extreme case of falsely elevated postvoid residual volumes was documented by Kannayiram Alagiakrishnan (see next slide) due to renal and ovarian cystic lesions.

Medical problems affecting accuracy

• Some medical problems may also explain

the difference.

• An extreme case of “falsely elevated

postvoid residual volumes” was documented by K. Alagiakrishnan (see ref in the appendix) due to renal and ovarian cystic lesions.

• The article reads “Postvoid residual urine

volumes, measured on several different

• ccasions, ranged from 403 to 855 mL,

with only 75 to 200 mL drained by in-and-

• ut catheterization.”
• Which brings the author to conclude:

“Any difference or discrepancy between the results of the bladder scanner and the in-and-out catheter should alert the health care professional to look for cystic and pelvic pathology, which can present as falsely high PVR volumes.”

Large renal cyst, extending from the lower pole of the left kidney toward the bladder area

Medical article references

• Marks LS, Dorey FJ, macairan ML, Park C, DeKernion JB. Three-Dimensional Ultrasound Device for Rapid Determination of

Bladder Volume. Adult Urology 1997; 50(3):341-8.

• Goode PS, Locher JL, Bryant RL, Roth DL, BurgioKL. Measurement of POstvoid Residual Urine with POrtable Transabdominal

Bladder ltrasound Scanner with Urethral Catheterization. International Urogynecology Journal 2000; 11:296-300.

• Brouwer TA, Eindhoven BG, Epema AH, Henning RH. Validation of an ultrasound scanner for determing urinary volumes in

surgical patients and volunteers. Journal of Clinical Monitoring & Computing 1999; 15(6):379-385.

• Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with an ultrasound scanner. Acta

Anaesthesiologica Scandinavica 2002; 46(3):279-282.

• Borrie MJ, Campbell K, Arcese ZA, Bray J, Hart P, Labate T et al. Urinary retention in patients in a geriatric rehabilitation unit:

prevalence, risk factors, and validity of bladder scan evaluation. Rehabilitation Nursing 2001; 26(5):187-191.

• Moselhi M, Morgan M. Use of a portable bladder scanner to reduce the incidence of bladder catheterisation prior to
• laparoscopy. BJOG: An International Journal of Obstetrics & Gynaecology 2001; 108(4):423-424.
• Fakhri S, Ahmen MMH, Allam SH, Akbar M, Eyadeh AA. Advantages of Using a Portable Ultrasound Bladder Scanner to

Measure the Postvoid Residual Urine Volume in Spinal Cord Injury Patients. Kuwait Medical Journal 34[4], 286-8. 2002.

• Ding YY, Sahadevan S, Pang WS, Choo PW. Clinical utility of a portable ultrasound scanner in the measurement of residual

urine volume. Singapore Medical Journal 1996; 37(4):365-368.

• Cardenas DD, Kelly E, Krieger JN, Chapman WH. Residual urine volumes in patients with spinal cord injury: measurement

with a portable ultrasound instrument. Arch Phys Med Rehabil 1988; 69:514-6

• Revord JP, Opitz JL, Murtaugh P, Harrison J. Determining residual urine volumes using a portable ultrasound device. Arch

Phys Med Rehabil 1993; 74:457-62

• Kannayiram Alagiakrishnan. Ultrasound bladder scanner presents falsely elevated postvoid residual volumes. Can Fam
• Physician. 2009 February; 55(2): 163–164.
• Christopher E Kelly, MD. Evaluation of Voiding Dysfunction and Measurement of Bladder Volume. Rev Urol. 2004; 6(Suppl 1):

S32–S37.PMCID: PMC1472847