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

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          Abstract

          Background

          Acupuncture is a relatively safe, commonly used “alternative” medical treatment for various symptoms. However, adverse effects can occur, including trauma, pneumothorax, and central-nervous-system injury. Our objective was to develop a reliable and practical procedure for ultrasound imaging of acupuncture points to improve safety during needling, and to acquire ultrasound images of several (44) acupuncture points, especially those in high-risk areas, according to an in-house standard operating procedure.

          Methods

          We created the standard operating procedure for ultrasound imaging for acupuncture, and collected ultrasound images of acupuncture points in clinical trials.

          Results

          Ultrasound images for 44 acupuncture points considered as high-risk points were collected from 85 healthy people who were classified by body-mass index, and high-quality, clear representative images of all 44 points were obtained.

          Conclusion

          These baseline images could be helpful for understanding the anatomy under the skin at acupuncture points, which would allow for an enhanced safety and more accurate needling.

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          Most cited references24

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          A cumulative review of the range and incidence of significant adverse events associated with acupuncture.

          To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice. Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events. A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients. The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.
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            Tissue displacements during acupuncture using ultrasound elastography techniques.

            Acupuncture needle manipulation has been previously shown to result in measurable changes in connective tissue architecture in animal experiments. In this study, we used a novel in vivo ultrasound (US)-based technique to quantify tissue displacement during acupuncture manipulation in humans. B-scan ultrasonic imaging was performed on the thighs of 12 human subjects at different stages of needle motion, including varying amounts of rotation, downward and upward movement performed with a computer-controlled acupuncture needling instrument. Tissue displacements, estimated using cross-correlation techniques, provided successful mapping and quantitative analysis of spatial and temporal tissue behavior during acupuncture needle manipulation. Increasing amounts of rotation had a significant linear effect on tissue displacement during downward and upward needle motion, as well as on rebound tissue displacement after downward needle movement. In addition to being a valuable tool for studies of acupuncture's mechanism of action, this technique may have applications to other types of needling including biopsies.
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              Acupuncture sensation during ultrasound guided acupuncture needling.

              Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation+rotation. In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation+rotation and oscillation alone did not significantly differ between acupuncture and control points. The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.
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                Author and article information

                Contributors
                Journal
                Integr Med Res
                Integr Med Res
                Integrative Medicine Research
                Elsevier
                2213-4220
                2213-4239
                19 September 2017
                December 2017
                19 September 2017
                : 6
                : 4
                : 427-433
                Affiliations
                [a ]Research & Development, Korea Institute of Oriental Medicine, Daejeon, Korea
                [b ]Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan, Korea
                [c ]Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Korea
                [d ]Department of Meridian & Acupoint, College of Korean Medicine, Wonkwang University, Iksan, Korea
                [e ]Department of Medical Non-Commissioned Officer, Wonkwang Health Science, Iksan, Korea
                Author notes
                [* ] Corresponding authors. Department of Meridian & Acupoint, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, South Korea; Research & Development, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, South Korea.Department of Meridian & AcupointCollege of Korean MedicineWonkwang UniversityIksanKorea medicdog@ 123456wku.ac.kr jyj92@ 123456kiom.re.kr
                Article
                S2213-4220(17)30141-5
                10.1016/j.imr.2017.09.003
                5741397
                29296570
                f2d73eea-9ba0-4a98-a9a6-76ed6513714c
                © 2017 Korea Institute of Oriental Medicine. Published by Elsevier.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 4 August 2017
                : 29 August 2017
                : 1 September 2017
                Categories
                Original Article

                acupuncture methods,trauma,ultrasonography
                acupuncture methods, trauma, ultrasonography

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