European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 9, pp 2697–2705 | Cite as

Comparison of in-plane and out-of-plane needle insertion with vs. without needle guidance

  • Verena Constanze Meiser
  • Helene Kreysa
  • Orlando Guntinas-Lichius
  • Gerd Fabian VolkEmail author
Head and Neck



First comparison of two methods of needle insertion: long axis (“in-plane”) versus short axis (“out-of-plane”) approach, each with and without a prototype needle guidance system (NGS).

Materials and methods

24 medical students without prior experience punctured an ultrasound phantom (transparent except for the decklayer) in four conditions, with the goal of achieving as many accurate punctures as possible within a fixed time.


Out-of-plane with NGS led to substantially more hits at first attempt than punctures without NGS (p < 0.001), as well as to a greater total number of hits (p = 0.004), and participants were faster to hit the target the first time (p = 0.009).


Thus, navigation increases accuracy as well as efficiency of ultrasound guided punctures on the phantom. It could prove advantageous in clinical applications for fine needle biopsies, musculoskeletal injections, vascular access, and in regional anesthesia.


Needle guidance Fine needle biopsy In-plane Out-of-plane Comparison of short and long axis Ultrasound 


Compliance with ethical standards


The Company eZono AG Jena (Spitzweidenweg 30, D-07743 Jena, Germany) provided the ultrasound scanner with the prototype needle guidance system for the time the trial was running. No further funding was secured for this study.

Conflict of interest

eZono provided a prototype of the ultrasound machine for the time of the study and was otherwise not involved in study design, execution, and analysis. VCM has received a travel grant from the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery to present parts of this study on the 84th annual meeting 2013 in Nürnberg, Germany. GFV has received a research grant from the Interdisziplinäres Zentrum für Klinische Forschung (IZKF) of the Jena University Hospital, Jena, Germany.

Supplementary material

405_2015_3806_MOESM1_ESM.ppt (1 mb)
Supplementary material 1 (PPT 1062 kb)
405_2015_3806_MOESM2_ESM.ppt (622 kb)
Supplementary material 2 (PPT 622 kb)
405_2015_3806_MOESM3_ESM.ppt (888 kb)
Supplementary material 3 (PPT 887 kb)
405_2015_3806_MOESM4_ESM.ppt (676 kb)
Supplementary material 4 (PPT 676 kb)

Supplementary material 5 (AVI 3584 kb)

Supplementary material 6 (AVI 2960 kb)

405_2015_3806_MOESM7_ESM.pdf (173 kb)
Supplementary material 7 (PDF 173 kb)

Supplementary material 8 (AVI 3019 kb)

Supplementary material 9 (AVI 2364 kb)


  1. 1.
    Moore CL, Copel JA (2011) Point-of-care ultrasonography. New Engl J Med 364(8):749–757. doi: 10.1056/NEJMra0909487 CrossRefPubMedGoogle Scholar
  2. 2.
    Nicolaou S, Talsky A, Khashoggi K, Venu V (2007) Ultrasound-guided interventional radiology in critical care. Crit Care Med 35(5 Suppl):S186–S197. doi: 10.1097/01.CCM.0000260630.68855.DF CrossRefPubMedGoogle Scholar
  3. 3.
    Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, Samonis G, Tsoutsos DA, Konstadoulakis MM, Karabinis A (2006) Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 10(6):R162. doi: 10.1186/cc5101 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Miller AH, Roth BA, Mills TJ, Woody JR, Longmoor CE, Foster B (2002) Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med 9(8):800–805CrossRefGoogle Scholar
  5. 5.
    Kopac DS, Chen J, Tang R, Sawka A, Vaghadia H (2013) Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model. J Vasc Surg 58(3):735–741. doi: 10.1016/j.jvs.2013.03.007 CrossRefPubMedGoogle Scholar
  6. 6.
    Ewertsen C, Nielsen KR, Nielsen MB (2011) Freehand biopsy guided by electromagnetic needle tracking: a phantom study. Ultraschall Med 32(6):614–618. doi: 10.1055/s-0031-1281852 CrossRefPubMedGoogle Scholar
  7. 7.
    Collins GB, Fanou EM, Young J, Bhogal P (2013) A comparison of free-hand vs laser-guided long-axis ultrasound techniques in novice users. Br J Radiol 86(1029):20130026. doi: 10.1259/bjr.20130026 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wallach D, Toporek G, Weber S, Bale R, Widmann G (2013) Comparison of freehand-navigated and aiming device-navigated targeting of liver lesions. The international journal of medical robotics+computer assisted surgery MRCAS. doi: 10.1002/rcs.1505
  9. 9.
    Hakime A, Deschamps F, De Carvalho EG, Barah A, Auperin A, De Baere T (2012) Electromagnetic-tracked biopsy under ultrasound guidance: preliminary results. Cardiovasc Intervent Radiol 35(4):898–905. doi: 10.1007/s00270-011-0278-8 CrossRefPubMedGoogle Scholar
  10. 10.
    Levine DM LM, Gadsden J (2014) Training with on-screen needle-probe alignment cues improves skill acquisition in novice trainees performing ultrasound-guided nerve blocks. Abstract Presented at the 39th Annual Regional Anesthesiology and Acute Pain Meeting, Chicago, IL, 3–6 April 2014Google Scholar
  11. 11.
    Crum T, Adhikari S, Lander L, Blaivas M (2014) Do echo-enhanced needles make a difference in sonographically guided vascular access? J Ultrasound Med Off J Am Inst Ultrasound Med 33(4):623–628. doi: 10.7863/ultra.33.4.623 Google Scholar
  12. 12.
    Shi J, Schwaiger J, Lueth TC (2011) Nerve block using a navigation system and ultrasound imaging for regional anesthesia. Conf Proc Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Conf 2011:1153–1156. doi: 10.1109/IEMBS.2011.6090270 Google Scholar
  13. 13.
    Auyong DB, Yuan SC, Rymer AN, Green CL, Hanson NA (2015) A randomized crossover study comparing a novel needle guidance technology for simulated internal jugular vein cannulation. Anesthesiology 123(3):535–541. doi: 10.1097/ALN.0000000000000759 CrossRefPubMedGoogle Scholar
  14. 14.
    Brinkmann S, Vaghadia H, Sawka A, Tang R (2013) Methodological considerations of ultrasound-guided spinal anesthesia using the Ultrasonix GPS needle tracking system. Can J Anaesth J Canadien d’anesthesie 60(4):407–408. doi: 10.1007/s12630-013-9884-z CrossRefGoogle Scholar
  15. 15.
    Wong SW, Niazi AU, Chin KJ, Chan VW (2013) Real-time ultrasound-guided spinal anesthesia using the SonixGPS(R) needle tracking system: a case report. Can J Anaesth J Canadien d’anesthesie 60(1):50–53. doi: 10.1007/s12630-012-9809-2 CrossRefGoogle Scholar
  16. 16.
    Moon CH, Blehar D, Shear MA, Uyehara P, Gaspari RJ, Arnold J, Cukor J (2010) Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model. Acad Emerg Med Off J Soc Acad Emerg Med 17(10):1138–1141CrossRefGoogle Scholar
  17. 17.
    Blaivas M, Brannam L, Fernandez E (2003) Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med Off J Soc Acad Emerg Med 10(12):1307–1311CrossRefGoogle Scholar
  18. 18.
    Berk D, Gurkan Y, Kus A, Ulugol H, Solak M, Toker K (2013) Ultrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches? J Clin Monit Comput 27(3):319–324. doi: 10.1007/s10877-013-9437-6 CrossRefPubMedGoogle Scholar
  19. 19.
    Mahler SA, Wang H, Lester C, Skinner J, Arnold TC, Conrad SA (2011) Short- vs long-axis approach to ultrasound-guided peripheral intravenous access: a prospective randomized study. Am J Emerg Med 29(9):1194–1197. doi: 10.1016/j.ajem.2010.07.015 CrossRefPubMedGoogle Scholar
  20. 20.
    Shiloh AL, Savel RH, Paulin LM, Eisen LA (2011) Ultrasound-guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controlled trials. Chest 139(3):524–529. doi: 10.1378/chest.10-0919 CrossRefPubMedGoogle Scholar
  21. 21.
    Gadsden J, Latmore M, Levine DM (2015) Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures. Expert Rev Med Devices 12(3):251–261. doi: 10.1586/17434440.2015.995095 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Verena Constanze Meiser
    • 1
  • Helene Kreysa
    • 2
  • Orlando Guntinas-Lichius
    • 1
  • Gerd Fabian Volk
    • 1
    Email author
  1. 1.Department of OtorhinolaryngologyJena University HospitalJenaGermany
  2. 2.Department of General PsychologyFriedrich Schiller University JenaJenaGermany

Personalised recommendations