<p begin="00:00:07.639" end="00:00:09.351" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.351" end="00:00:11.510" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.510" end="00:00:14.415" style="s2">is used to perform an<br />ultrasound guided aspiration</p>
<p begin="00:00:14.415" end="00:00:16.039" style="s2">of a Baker's cyst.</p>
<p begin="00:00:16.039" end="00:00:18.528" style="s2">The patient is in a supine position.</p>
<p begin="00:00:18.528" end="00:00:20.870" style="s2">The transducer is placed transversely</p>
<p begin="00:00:20.870" end="00:00:22.752" style="s2">over the popliteal fossa,</p>
<p begin="00:00:22.752" end="00:00:26.088" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:26.088" end="00:00:28.820" style="s2">The most common location<br />for a Baker's cyst</p>
<p begin="00:00:28.820" end="00:00:31.767" style="s2">is at the crossing of the<br />semimembranosus muscle</p>
<p begin="00:00:31.767" end="00:00:32.839" style="s2">and the medial head</p>
<p begin="00:00:32.839" end="00:00:36.367" style="s2">of the gastrocnemius muscle<br />above the femoral condyle.</p>
<p begin="00:00:36.367" end="00:00:38.343" style="s2">The femoral condyle is seen as a</p>
<p begin="00:00:38.343" end="00:00:41.719" style="s2">bright hyperechoic structure<br />on the left of the screen.</p>
<p begin="00:00:41.719" end="00:00:43.494" style="s2">The speckled pattern of the tendon</p>
<p begin="00:00:43.494" end="00:00:45.454" style="s2">of the semimembranosus muscle,</p>
<p begin="00:00:45.454" end="00:00:47.718" style="s2">and the starry night<br />appearance of the medial head</p>
<p begin="00:00:47.718" end="00:00:50.591" style="s2">of the gastrocnemius can<br />be seen as the transducer</p>
<p begin="00:00:50.591" end="00:00:52.535" style="s2">is moved more distally.</p>
<p begin="00:00:52.535" end="00:00:54.071" style="s2">A Baker's cyst appears as a</p>
<p begin="00:00:54.071" end="00:00:58.903" style="s2">C-shaped, darker hypoechoic<br />or anechoic cystic structure,</p>
<p begin="00:00:58.903" end="00:01:01.746" style="s2">with a superficial and deep component.</p>
<p begin="00:01:01.746" end="00:01:04.871" style="s2">The transducer is rotated<br />90-degrees clockwise,</p>
<p begin="00:01:04.871" end="00:01:06.143" style="s2">with the orientation marker</p>
<p begin="00:01:06.143" end="00:01:08.472" style="s2">directed toward the patient's head.</p>
<p begin="00:01:08.472" end="00:01:11.095" style="s2">The extent and depth of the Baker's cyst</p>
<p begin="00:01:11.095" end="00:01:12.946" style="s2">should be confirmed by scanning</p>
<p begin="00:01:12.946" end="00:01:15.839" style="s2">the cyst proximally and distally.</p>
<p begin="00:01:15.839" end="00:01:17.806" style="s2">The needle is inserted in the skin</p>
<p begin="00:01:17.806" end="00:01:20.287" style="s2">just proximal to the transducer.</p>
<p begin="00:01:20.287" end="00:01:22.913" style="s2">The needle is slowly<br />advanced to lie in plane</p>
<p begin="00:01:22.913" end="00:01:24.358" style="s2">to the transducer beam,</p>
<p begin="00:01:24.358" end="00:01:28.447" style="s2">and is seen as a bright,<br />hyperechoic linear structure.</p>
<p begin="00:01:28.447" end="00:01:30.041" style="s2">The needle is slowly advanced</p>
<p begin="00:01:30.041" end="00:01:32.262" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:32.262" end="00:01:33.623" style="s2">until the tip is seen to lie</p>
<p begin="00:01:33.623" end="00:01:35.022" style="s2">within the Baker's cyst,</p>
<p begin="00:01:35.022" end="00:01:37.647" style="s2">where an aspiration can be done.</p>
<p begin="00:01:37.647" end="00:01:39.415" style="s2">After the procedure is finished,</p>
<p begin="00:01:39.415" end="00:01:40.700" style="s2">the area should be scanned</p>
<p begin="00:01:40.700" end="00:01:42.782" style="s2">to ensure that there is<br />no evidence of bleeding</p>
<p begin="00:01:42.782" end="00:01:43.865" style="s2">in this area.</p>

<p begin="00:00:02.881" end="00:00:04.710" style="s2">- Soon as we turn on the function of the</p>
<p begin="00:00:04.710" end="00:00:09.042" style="s2">advanced neo visualization, the<br />image quality stays the same</p>
<p begin="00:00:09.042" end="00:00:13.209" style="s2">and we just see greater echos<br />when we insert the needle.</p>
<p begin="00:00:19.386" end="00:00:21.172" style="s2">So I haven't noted any decrement to the</p>
<p begin="00:00:21.172" end="00:00:23.864" style="s2">image resolution and quality.</p>
<p begin="00:00:23.864" end="00:00:26.957" style="s2">In my practice it's really<br />added increased speed.</p>
<p begin="00:00:26.957" end="00:00:30.492" style="s2">I'm getting to the target<br />more directly with less time.</p>
<p begin="00:00:30.492" end="00:00:33.267" style="s2">Getting in and out, which<br />always makes the patient happier</p>
<p begin="00:00:33.267" end="00:00:35.589" style="s2">and certainly it reduces<br />the amount of pain</p>
<p begin="00:00:35.589" end="00:00:38.063" style="s2">that might be involved in a procedure.</p>
<p begin="00:00:38.063" end="00:00:40.614" style="s2">- So the ability to see the<br />needle going through tissue</p>
<p begin="00:00:40.614" end="00:00:43.197" style="s2">makes their clinical procedures safer,</p>
<p begin="00:00:43.197" end="00:00:46.169" style="s2">makes it faster, obviously<br />better for the patient.</p>
<p begin="00:00:46.169" end="00:00:49.649" style="s2">- It appears maybe two,<br />three, four times brighter.</p>
<p begin="00:00:49.649" end="00:00:52.315" style="s2">Seems to have a better echo<br />during the entire procedure.</p>
<p begin="00:00:52.315" end="00:00:55.471" style="s2">- Basically, the enhanced<br />visualization technology</p>
<p begin="00:00:55.471" end="00:00:58.939" style="s2">is a softer grade, and<br />it's very easy to use.</p>
<p begin="00:00:58.939" end="00:01:01.561" style="s2">There's no extra equipment<br />or specialty needles</p>
<p begin="00:01:01.561" end="00:01:04.168" style="s2">that have to be part of the procedure.</p>
<p begin="00:01:04.168" end="00:01:06.587" style="s2">Hard to close, it works<br />with any needle out there,</p>
<p begin="00:01:06.587" end="00:01:09.099" style="s2">and it's basically available<br />at the push of a button.</p>
<p begin="00:01:09.099" end="00:01:11.309" style="s2">- The beauty of it is that<br />there really is no setup time.</p>
<p begin="00:01:11.309" end="00:01:12.997" style="s2">It actually speeds up the procedure</p>
<p begin="00:01:12.997" end="00:01:14.621" style="s2">'cause it's easier to see the needle.</p>
<p begin="00:01:14.621" end="00:01:17.660" style="s2">So if anything it's a<br />time saving technique.</p>
<p begin="00:01:17.660" end="00:01:20.502" style="s2">I think it really can enhance learning</p>
<p begin="00:01:20.502" end="00:01:23.453" style="s2">and becoming competent<br />in performing aspirations</p>
<p begin="00:01:23.453" end="00:01:24.979" style="s2">and biopsies and a variety of different</p>
<p begin="00:01:24.979" end="00:01:26.977" style="s2">needle localization techniques</p>
<p begin="00:01:26.977" end="00:01:29.690" style="s2">in a much quicker, safer fashion.</p>
<p begin="00:01:29.690" end="00:01:31.370" style="s2">- There's really no<br />other competitor that has</p>
<p begin="00:01:31.370" end="00:01:33.840" style="s2">anything quite like what we're doing.</p>
<p begin="00:01:33.840" end="00:01:35.199" style="s2">There's a few technologies out there</p>
<p begin="00:01:35.199" end="00:01:37.569" style="s2">that try to help see the needle tip.</p>
<p begin="00:01:37.569" end="00:01:39.070" style="s2">The bigger issue I see with those</p>
<p begin="00:01:39.070" end="00:01:41.149" style="s2">is that they take a long time to set up,</p>
<p begin="00:01:41.149" end="00:01:42.569" style="s2">and they're also expensive.</p>
<p begin="00:01:42.569" end="00:01:44.094" style="s2">There's hardware involved.</p>
<p begin="00:01:44.094" end="00:01:46.232" style="s2">This was a proprietary software algorithm</p>
<p begin="00:01:46.232" end="00:01:49.735" style="s2">that we can upgrade any turbo<br />or S system on the market.</p>
<p begin="00:01:49.735" end="00:01:51.977" style="s2">- You get all the visualization<br />that you really need</p>
<p begin="00:01:51.977" end="00:01:53.971" style="s2">and you don't need to<br />use any special needles,</p>
<p begin="00:01:53.971" end="00:01:56.041" style="s2">you don't need to use a larger needle.</p>
<p begin="00:01:56.041" end="00:01:57.848" style="s2">The larger the caliber of the needle,</p>
<p begin="00:01:57.848" end="00:02:00.593" style="s2">the more painful and the more<br />potential for complications</p>
<p begin="00:02:00.593" end="00:02:04.488" style="s2">so I get great visualization<br />with a 25 gauge needle.</p>
<p begin="00:02:04.488" end="00:02:07.485" style="s2">- The reason we're excited<br />is because now we can</p>
<p begin="00:02:07.485" end="00:02:10.264" style="s2">for the first time say<br />that stick needle angles</p>
<p begin="00:02:10.264" end="00:02:13.201" style="s2">are no longer a problem<br />for ultrasound imaging.</p>
<p begin="00:02:13.201" end="00:02:14.587" style="s2">- I think it's one of our biggest</p>
<p begin="00:02:14.587" end="00:02:16.362" style="s2">breakthroughs in a long time,</p>
<p begin="00:02:16.362" end="00:02:17.843" style="s2">and again it meets the criteria.</p>
<p begin="00:02:17.843" end="00:02:19.925" style="s2">It addresses a real<br />problem that our customers</p>
<p begin="00:02:19.925" end="00:02:22.706" style="s2">and our clinicians are<br />dealing with every day.</p>
<p begin="00:02:22.706" end="00:02:26.026" style="s2">It's inexpensive, it's<br />simple, and it works.</p>
<p begin="00:02:26.026" end="00:02:28.350" style="s2">- It is a game changer in the market</p>
<p begin="00:02:28.350" end="00:02:31.017" style="s2">of ultrasound guided procedures.</p>
<p begin="00:02:31.886" end="00:02:34.553" style="s2">It's the speed, the ease of use,</p>
<p begin="00:02:35.700" end="00:02:39.602" style="s2">the reduction of time to<br />completion of the procedure,</p>
<p begin="00:02:39.602" end="00:02:42.084" style="s2">the safety features, all of those are</p>
<p begin="00:02:42.084" end="00:02:46.167" style="s2">a win-win situation for<br />doctor and patient alike.</p>