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A deeper displacement with a particular applied force would allow for more shear force to be applied to the gelatin as the user tries to manipulate the probe across the surface.
The mentor therefore guided the nurse to manipulate the probe to demonstrate the 'bat sign of Lichtenstein' (Figure 1) representing the pleural interface of the visceral and the parietal pleura beneath two contiguous rib shadows [8, 9].
The advantage is that one does not need a transesophageal probe (which causes discomfort for the patient) and an extra operator to manipulate the probe.
Another limitation of allowing the volunteer to manipulate the probe is that the pressure applied was subjective and each volunteer may interpret 'gentle' and 'firm' differently.
Because we do not have any inanimate models, the residents learned on patients how to manipulate the probe to correctly visualize the different vessels, and then performed a four-hands procedure with the attending physician.
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Transesophageal echocardiography was not conducted because of difficulty in manipulating the probe due to the patient's position and surgical setting.
The meter and probe were connected by a ∼2 m cord, which allowed one diver to hold the meter and record data while another manipulated the probe.
One limitation to this study is that the volunteer manipulated the probe during measurements.
These other factors are related to the evaluator, the instruments and the measurement technique, including locating the landmarks, measuring arm position in elevation and manipulating the probe.
For all measurements, the volunteer manipulated the probe to ensure contact with the lip tissue while a technician acquired the data.
First, the surgeon searched the target inferior mock cancer by manipulating the US probe attached to the needle insertion manipulator.
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