Various ultrasound probe stand-offs available …

There are three main types of "stand-off" for your ultrasound probe:

  1. The kind that actually attaches to your probe.
  2. The kind that looks like a clear gel hockey puck or gel pouch.
  3. The kind that is more like a disposable, individually-wrapped wound-dressing.

Unfortunately, I have not yet assembled a library of sample images showing each of these in use. I am in the process of collecting additional images, particularly of wound ultrasounds. If you come up with a good one, I would love to be able to include it in our collection. Just email me with the image or images, and even better, if you could email me the images along with a short write-up concerning the procedure [you can write me at my usual address: shawn (at)].

I am going to be building up additional material and procedure tips on this over the coming weeks. I’ll send out an update on this soon.


The Stand-Off Probe Attachment with Gel Inserts

The stand-off attachment comes in two varieties. One is a gel block that you fit on the end of the probe, the other a plastic attachment in a little baggie inside of a small Tupperware container (which is itself usually inside of another baggie), equipped initially with three small gel inserts, each in its own little plastic container.

If you have the gel block variety, you simply stick it on the end of your probe (with gel on the probe first, to make sure the probe surface and the gel block are connected). And that’s it. I cover this one in the section below this one.

If you have the attachment-with-gel-insert variety, it’s a little more complicated, but not much (see the image below).

The way you will use these inserts is like this: Put gel on the probe itself, then put the gel insert into the probe stand-off attachment, and put the attachment onto the end of the probe — usually you want to push it on far enough to where the little gel insert protrudes a bit from the attachment — and then add more gel to the surface. (Basically you are making a gel sandwich: probe surface – ultrasound gel – gel insert – attachment to hold insert in place – then more ultrasound gel.)

As long as you rinse these little inserts off in warm soapy water and store them WET in the Tupperware container and keep that somewhere they won’t dry out or be exposed to the sun, you should get 3 to 4 weeks of use from each gel insert before having to toss it or before it rips. Then just pull out the next one.

For the first week or so the attachment may want to pop off the probe unless you hold it there. If this happens with yours, rest assured, after a while it will conform to the probe and stay on much better. But initially it may prove a rather slippery affair, and if so, I recommend holding the probe like a big fat marker, where your first finger is on the end with the bump and your thumb and middle finger hold the attachment in place on the probe. This gets easier after about a week. It can just take a little bit for the stand-off attachment to adapt to the probe. Stay with it.

(And don’t lose the stand-off attachment. Believe it or not, that little piece of custom plastic recently went up in price and costs $185 to replace, even at dealer cost.)

Definitely practice with this and try it across various applications. Remember, though: the stand-off moves your image down a little on the screen, so you may need to tweak your focus pointers and lower your frequency to compensate.

If you need more gel inserts you can either print out the PDF order form available here, or just have someone at your office give us a call and we can get some more out to you. The little gel inserts are $20 for a pack of three (each should last you about a month of solid use, with good care).

standoff attachment


Rubber Stand-Off Attachment (without inserts)

Many doctors prefer the single-piece rubber block stand-off rather than the stand-off clip and gel inserts. For one, you have fewer parts to mess with, making it faster to work with and easier to clean. For another, you never have to buy little gel inserts for it.

If you would like to try out one of these, download the PDF order form available here, or just have someone at your office give us a call and we can get one of these out to you. They’re rather pricey, but with care they should last for many years to come.

Using one is simple enough: You put gel on your probe, then stick the stand-off gel block on the end of it, then add more gel to the surface of the block that will go against the patient’s skin. And that’s it.

You can see a short tutorial on the use of this kind of stand-off (and an example of an Achilles image with and without stand-off), by clicking here.

When you are finished using the stand-off, be sure to wash it off with soapy water, rinse it, and then store it wet in a Tupperware container or zip-lock baggie. If you need to sterilize it, wipe it off with alcohol, but then be sure to rinse off the alcohol with water before storing it. If you let it sit with alcohol, it will eventually dry out and crack. (Same with your probe: if you need to, you can wipe it off with an acohol pad, but then be sure to rinse off the acohol with water and dry it with a paper towel. Ideally use "T-Spray" disinfectant spray to clean the probe. And remember: the probe you want to store DRY, the stand-off you want to store WET.)

standoff attachment


The Disposable "Hockey-Puck" and Reusable "Gel Bag" Varieties

The larger 1.5cm hockey-puck-style pads do not attach to your probe, and therefore can sometimes require two hands to manipulate; but they are definitely more sturdy and you should get a lot more use out of them (assuming you store them wet). They can certainly be much easier to use on some procedures, particularly around the ankle or over a wound.

"Wound-mapping" is a fancy name given to simply using your ultrasound to take an image of a wound, either when you first see the patient (and again, later, when you check on them during a follow-up), or immediately pre- and/or post- surgery.

Putting the probe head directly onto an open wound probably isn’t the best idea. So using a sterile gel pad as a buffer makes sense. It also moves the image down on the screen by about one and a half to two centimeters, which will improve the image you are able to capture — the idea being to capture an image of the wound and measure ("map") its depth and width at various points, and possibly even its perimeter and area (using your "Area" measurement mode). Note: I will be compiling a great deal more material on this application over the coming weeks. Stay tuned!

We can get you these gel hockey pucks at $10 apiece with free shipping. Simply download and fax in the order form available here.

stand-off puck

A variation of this type of gel stand-off would be the "gel bag" variety. Where the "hockey-puck" variety will eventually need to be replaced, the "bag" variety should last forever — which accounts for its $75 price tag. These acoustic stand-offs come in two thicknesses and are definitely larger than the hockey-puck. Civco has 4" x 6" gel bag acoustic stand-offs in both .4" and .8" thicknesses. You can try these out if you like by downloading our PDF order form here.

gel bag


The Ultrasound-Transparent Sterile Disposable Wound Dressing

The absolute best solution for ultrasounding wounds is surely the Sterile HydroScan Couplant Sheet: a sterile, disposable wound-dressing, transparent to ultrasound waves. You don’t really get the "step-off" you would with a reusable gel pad, but the couplant sheets are certainly going to be the most sterile during and after surgeries — which is something your patients will doubtless appreciate.

Civco has 4" x 6" sterile couplant sheets, five sheets to a pack. We can get you packs of these if you simply fill out and send in our order sheet available here.

couplant sheet

And particularly where it comes to these disposable sheets, I would love to see some of your results. If you send me a few really nice images of wounds you have imaged using these sheets, maybe with a few lines of commentary, I will happily send you some more of the sheets for free.

We have the exciting situation of having dozens and dozens of podiatrists around the country all using the CTS-5500+ and CTS-7700+ (and becoming increasingly effective at using them). It makes sense to bring the group of you together to share the things you particularly are getting great results at. You might be great at plantar fascia injections, but not so comfortable yet with neuromas — but someone else might be great at neuromas while having a challenge with the Achilles tendon. My hope is to help everyone get better, across the board, in a dozen different applications. This site should help make that possible, and all the more so if a number of our clients contribute an image or two (and possibly allow me to record them over the phone delivering a short commentary on the images).