How to Improve Accuracy of Ultrasound-Guided Procedures

1. Introduction
Ultrasound guidance has traditionally been used to obtain biopsies of masses or abdominal organs,^1,2  but more recently, it has gained increased recognition for musculoskeletal use, including injection of cervical articular facets,^3–5  navicular bursa,⁶  coxofemoral joints,⁷  and sacroiliac joints.⁸  All of these structures are otherwise challenging to access using blind techniques. Although these reports illustrate the benefits of ultrasound guidance and describe the approach to these structures, the basic principles of ultrasound-guided procedures are frequently challenging. The expanding use of intralesional therapeutics for tendon and ligament injuries has also created a greater need for practitioners skilled in its use. Ultrasound guidance ensures that these products are deposited directly into the injured portion of the tendon or ligament.⁹  The relative expense of intralesional therapeutics to horse owners should encourage practitioners to use ultrasound guidance to maximize any potential beneficial effect. Other benefits of ultrasound guidance include accurate needle placement and increased diagnostic yield when faced with a focal lesion in a large structure such as the spleen or liver (Fig. 1). Ultrasound guidance also prevents inadvertent entry into vital structures such as adjacent bowel or blood vessels that can occur with blind procedures. Lastly, ultrasound guidance can be used for multiple purposes during intra-operative procedures including localization of fracture fragments, masses, or foreign bodies.^10–14 [...]