title: Preferred view and transducer in lumbar ultrasound in overweight and obese patients.
abstract: BACKGROUND
  Ultrasound can be used to facilitate lumbar puncture, especially in obese patients.
  
  
  METHODS
  In this study, midline and paramedian approaches with curved and linear transducers were compared in patients with Body Mass Index (BMI) above 25 kg/m2for the identification of spinal landmarks. In each view, six major landmarks, including spinous process, ligamentum flavum, laminae, epidural space, subarachnoid space and posterior longitudinal ligament, were detected by emergency medicine residents and were then reviewed by radiologists.
  
  
  RESULTS
  Sixty patients with a mean BMI of 29.18 enrolled in the study. This study showed that a curved transducer detected major landmarks more accurately compared to a linear transducer. There was also a poor kappa correlation between these transducers in the midline and paramedian approaches.
  
  
  CONCLUSIONS
  This study showed that ultrasound can detect lumbar landmarks in overweight and obese patients, with the paramedian approach and a curved transducer being superior to the midline approach and a linear transducer in detecting these landmarks.
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shervin
authors.initials: S
authors.lastname: Farahmand
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Safavi
authors.affiliation: Radiology Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Shahriarian
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Arbab
authors.affiliation: Emergency Department of Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Basirghafoori
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Bagheri-Hariri
keywords: Ultrasound; lumbar puncture