Feasibility of freehand ultrasound to measure anatomical features associated with deep tissue injury risk

Deep tissue injuries (DTI) are severe forms of pressure ulcers that start internally and are difficult to diagnose. Magnetic resonance imaging (MRI) is the currently preferred imaging modality to measure anatomical features associated with DTI, but is not a clinically feasible risk assessment tool. B-mode ultrasound (US) is proposed as a practical, alternative technology suitable for bedside or outpatient clinic use. The goal of this research was to confirm US as an imaging modality for acquiring measurements of anatomical features associated with DTI. Tissue thickness measurements using US were reliable (ICC = .948) and highly correlated with MRI measurements (muscle r = .988, p ≤.001; adipose r = .894, p ≤.001; total r = .919; p ≤.001). US measures of muscle tissue thickness were 5.4 mm (34.1%) higher than MRI, adipose tissue thickness measures were 1.6 mm (11.9%) lower, and total tissue thickness measures were 3.8 mm (12.8%) higher. Given the reliability and ability to identify high-risk anatomies, as well as the cost effectiveness and availability, US measurements show promise for use in future development of a patient-specific, bedside, biomechanical risk assessment tool to guide clinicians in appropriate interventions to prevent DTI.