title: Ultrasonography of the cervical spine: an in vitro anatomical validation model.
abstract: BACKGROUND
  Anatomical validation studies of cervical ultrasound images are sparse. Validation is crucial to ensure accurate interpretation of cervical ultrasound images and to develop standardized reliable ultrasound procedures to identify cervical anatomical structures. The aim of this study was to acquire validated ultrasound images of cervical bony structures and to develop a reliable method to detect and count the cervical segmental levels.
  
  
  METHODS
  An anatomical model of a cervical spine, embedded in gelatin, was inserted in a specially developed measurement device. This provided ultrasound images of cervical bony structures. Anatomical validation was achieved by laser light beams projecting the center of the ultrasound image on the cervical bony structures through a transparent gelatin.
  
  
  RESULTS
  Anatomically validated ultrasound images of different cervical bony structures were taken from dorsal, ventral, and lateral perspectives. Potentially relevant anatomical landmarks were defined and validated. Test/retest analysis for positioning showed a reproducibility with an intraclass correlation coefficient for single measures of 0.99. Besides providing validated ultrasound images of bony structures, this model helped to develop a method to detect and count the cervical segmental levels in vivo at long-axis position, in a dorsolateral (paramedian) view at the level of the laminae, starting from the base of the skull and sliding the ultrasound probe caudally.
  
  
  CONCLUSIONS
  Ultrasound bony images of the cervical vertebrae were validated with an in vitro model. Anatomical bony landmarks are the mastoid process, the transverse process of C1, the tubercles of C6 and C7, and the cervical laminae. Especially, the cervical dorsal laminae serve best as anatomical bony landmarks to reliably detect the cervical segmental levels in vivo.
authors.affiliation: From the Department of Anesthesiology and Pain Management (M.v.E., J.P., M.S., M.v.K., J.V.Z.), University Medical Center Maastricht, Maastricht, The Netherlands; Department of Anesthesiology and Pain Management (M.v.E.), Amphia Hospital, Breda, The Netherlands; Department of Anatomy and Embryology (J.M.S., A.L.), Maastricht University, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care ( J.M.S., A.L.), Maastricht, The Netherlands; Department of Anesthesiology and Multidisciplinary Pain Center ( J.V.Z.), Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Eerd
authors.forename: Jacob
authors.initials: J
authors.lastname: Patijn
authors.forename: Judith M
authors.initials: JM
authors.lastname: Sieben
authors.forename: Mischa
authors.initials: M
authors.lastname: Sommer
authors.forename: Jan
authors.initials: J
authors.lastname: Van Zundert
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.forename: Arno
authors.initials: A
authors.lastname: Lataster
mesh_terms: D059925:Anatomic Landmarks; D002102:Cadaver; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003625:Data Collection; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D008953:Models, Anatomic; D010969:Plastics; D015203:Reproducibility of Results; D019291:Skull Base / Q000033:anatomy & histology; D013116:Spinal Cord / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000295:instrumentation
chemical_list: D010969:Plastics