Philippine Journal of Science

150 (2): 391-396, April 2021

ISSN 0031 - 7683
Date Received: 27 Jul 2020

Okra (Abelmoschus esculentus L. Moench)

Pod Gel as a Low-cost Alternative
to Commercial Acoustic Gel

Mark M. Alipio*

College of Radiologic Technology, Iligan Medical Center College

Iligan City, Region X 9200 Philippines

Ultrasound is an essential diagnostic tool in medicine. However, a commercial acoustic gel is

cost-prohibitive, especially in low-resource settings. In this study, okra (Abelmoschus esculentus
L. Moench) pod gel was evaluated as a low-cost alternative to commercial acoustic gel by
comparing the sonographic image quality, organoleptic characteristics, spreadability, pH,
viscosity, and ease of use of commercial gel and formulated okra pod gel (OPG). Fresh okra
pods were harvested from a local plant nursery. OPG was prepared by mixing okra pods with
water and cooking the mixture on medium heat. OPG and commercial gel were physically
evaluated and randomly swabbed to different surfaces of a human tissue-mimicking phantom
to obtain sonographic images. Five experienced sonologists rated the sonographic images based
on image quality parameters. OPG had optimal appearance, texture, homogeneity, and pH
value. OPG had higher spreadability but lower viscosity compared to commercial acoustic gel.
No significant difference was reported in the image quality parameters between the gels used.
Acceptability of OPG in terms of ease of use was the same as that of commercial gel. However,
the sonologists reported that compared to commercial gel, OPG did not evaporate easily during
the sonographic procedure. Based on the evaluation, OPG is feasible as a low-cost alternative
to commercial acoustic gel. Further clinical trials employing actual patients are recommended
to increase the validity of the study results.

Keywords: low-resource setting, natural products, okra pod, ultrasound gel

INTRODUCTION inaccurately (Bradley 2019). This gel is produced

commercially by mixing propylene glycol, trolamine,
Ultrasound is a valuable tool in the imaging of soft-tissue EDTA (ethylenediaminetetraacetic acid), distilled water,
organs in the body. In practice, an ultrasound machine’s and carbomer at an appropriate mix proportion set by
probe sends high-frequency waves towards the body organ, the World Health Organization (Cabrelli et al. 2016).
receives the reflected waves, and transforms them into Despite its diagnostic value, the use of ultrasound is
information critical to diagnosis (Enriquez and Wu 2014). currently challenged especially in less-economically
To aid the transmission of sound waves, a mucilaginous developed settings due to the unavailability and high cost
acoustic gel is placed on the skin surface (Abo 2014). of consumable ultrasound products, specifically acoustic gel
Without this gel, the produced images would have poor (Binkowski et al. 2014; Salmon et al. 2015; Monti 2017).
quality and diagnostic information may be interpreted
Few published studies examined alternatives to commercial
*Corresponding Author: markmalipio@gmail.com acoustic gel. Cornstarch, glucomannan powder, cassava

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Philippine Journal of Science Alipio: Okra Pod Gel as a Low-cost
Vol. 150 No. 2, April 2021 Commercial Gel Alternative

flour, and olive oil were potential alternatives. However, peduncles, and other unnecessary parts, the collected okra
these materials have low spreadability on the skin pods were washed with distilled water. The okra pods
surface and require a tedious process of production, were weighed and 1 kg of the plant sample was collected.
specifically in the monitoring of temperature to attain The pods were then mixed with 500 mL of water and the
optimal consistency (Luewan et al. 2007; Binkowski mixture was cooked on medium heat (162–189 ⁰C) by
et al. 2014; Aziz et al. 2018; Milton et al. 2018). In means of an electric stove. The mixture was thoroughly
addition, physiochemical properties needed to assess gel stirred for 20 min and transferred to a beaker of 1000
consistency and improve acceptability by the performing mL to allow it to cool for 10 min. The mixture was then
healthcare professionals were not reported previously. In filtered using a fine mesh strainer to remove pods and
general, there is still a need to find practical alternatives other debris. The OPG obtained was then placed in empty
to commercial acoustic gel. acoustic gel containers. AquaSonic 100 Sterile Ultrasound
Transmission Gel (Parker Laboratories, Fairfield, New
Okra (Abelmoschus esculentus L. Moench) is one of the Jersey, USA) with a light green color has been used as a
most widely known vegetable crops in tropical and sub- commercial gel.
tropical countries, such as Taiwan, Thailand, and India
(Singh et al. 2014). In the Philippines, it is considered
a priority crop owing to its commercial and industrial Physical Evaluation of Acoustic Gels
potentials (Mina et al. 2015). Hence, local sources are Organoleptic characteristics. OPG and commercial
abundant and accessible. Mucilage, a soluble and viscous gel were tested for color, homogeneity, immediate
dietary fiber and a primary feature of an ideal acoustic skin feel, physical appearance, and texture. Color and
gel, could be extracted from the pods of okra and has an physical appearance were based on visual observation,
intrinsic viscosity value of about 30% when dissolved in while immediate skin feel was assessed by evaluating
water (Habtamu et al. 2015). With this, okra differs from the greasiness, grittiness, and stiffness of the gels.
other common vegetables in having high mucilage content Homogeneity and texture were determined by pressing
(Gemede et al. 2018). Thus, it encompasses various food the gels between the index finger and thumb and
applications as a thickener, emulsifying agent, gelling assessing the consistency of and presence of coarse
agent, stabilizer, and whipping agent for plant-based particles in the gels.
adhesives (Tyagi et al. 2015; Farhana et al. 2017; Durazzo
Spreadability. A 1-g sample of each gel was placed
et al. 2019).
between two glass plates (10 cm x 20 cm) that are
Using okra pods and water, which are both inexpensive horizontally mounted from each other. A 100-g weight
and within easy reach, the study aimed to evaluate the board was placed on the upper glass plate to compress
potential of OPG as a low-cost alternative to commercial the sample. The spreadability of the gels was measured
acoustic gel by comparing the sonographic image quality, by calculating the spreading diameter after 1 min. Each
organoleptic characteristics, spreadability, pH, and gel was tested three times.
viscosity using OPG and commercial gel. Furthermore,
pH values. A 1-g sample of each gel was dispersed in
the study evaluated the sonologists’ subjective assessment
20 mL of deionized water, and a pH meter was used to
of the gel’s ease of use during the procedure.
measure the pH value of each gel. Measurements were
repeated three times.
Viscosity. A Brookefield Viscometer with a cylinder
MATERIALS AND METHODS spindle number 7 was utilized to measure the viscosity
of the acoustic gels. The spindle was rotated at 0–100
Collection of Materials rpm values at a temperature of 25 ⁰C, and viscosity was
Fresh okra pods were harvested at the edible maturity calculated in centiPoise (cP). Viscosity at 50 rpm value
stage from a local plant nursery in Davao City, Philippines. was considered. Measurements were done in triplicates.
This nursery propagates and grows non-genetically
modified plants in an organic method. The plants used Analysis of Sonographic Images
were specified and verified by a botanist employed in a Ultrasound examinations were performed in a human
higher education institution in Davao City, Philippines. tissue-mimicking phantom using a GE Healthcare
Ultrasound Machine. The scanning protocols and
Preparation of OPG techniques were adapted from those of Tempkin (2014).
The method used in the preparation of acoustic gel was The phantom was positioned supine, and 10 mL of
adapted and improved from previous studies (Binkowski acoustic gels were randomly swabbed into the 15 different
et al. 2014; Alipio et al. 2019). After the removal of seeds, surfaces of the phantom.

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Vol. 150 No. 2, March 2021 Commercial Gel Alternative

A linear probe was then placed in the phantom’s surface, Table 1. Organoleptic characteristics of the acoustic gels.
and an ultrasound image was captured and saved. The scan Parameters Commercial OPG
was repeated three times per acoustic gel per surface of the Color Light green Light green
phantom, resulting in 90 saved images (3 repetitions x 2
Homogeneity Homogeneous Homogeneous
acoustic gels x 15 surfaces). An 80-kB size of information
was allocated per image, and all of the ultrasound machine Immediate skin feel Not greasy, not Not greasy, not
gritty, not stiff gritty, not stiff
knobology were set the same for each scan.
Physical appearance Transparent Transparent
Five experienced sonologists, with more than ten years of
Texture Smooth Smooth
experience in the clinical practice, separately evaluated
the images based on the four image quality parameters
– namely, the level of acceptability, visibility of detail,
Table 2. Spreadability, pH, and viscosity values of the acoustic gels
amount of recorded detail, and distortion. Each image
(n = 9, results depicted as mean ± SD) and t-test.
quality parameter was rated on a five-point Likert scale
Parameters Commercial OPG p-value
with “5” as “very high” and “1” as “very low.” All of the
selected evaluators obtained a board-certified license to Spreadability (mm) 20.07 ± 0.05 27.13 ± 0.09 < 0.001
practice sonology and attended a post-graduate ultrasound pH 5.62 ± 0.01 4.60 ± 0.02 < 0.001
training program. The evaluators were blinded with the Viscosity (cP) 18651.00 ± 0.82 8812.00 ± 0.82 < 0.001
type of acoustic gel used in the image. The same laptop,
screen, and room lighting were utilized during the conduct
of image evaluation.
Analysis of Sonographic Images
The analysis of sonographic images indicated that OPG
Subjective Assessment of Acoustic Gels had a comparable level of acceptability, visibility of
The sonologists’ subjective assessment on the acceptability detail, amount of recorded detail, and distortion to that
of gel in terms of ease of use was undergone through the of commercial product (Table 3; Figure 1). The results
completion of a three-question survey after each scan. also reported that the image quality parameters were
Each question in the survey was rated on a five-point statistically the same for both gels tested (p > 0.05).
Likert scale with “5” as “strongly agree” and “1” as
“strongly disagree.” Several questions were adopted from
those of Aziz and colleagues (2018). Table 3. Image quality values of the sonograms scanned using
the acoustic gels (n = 45, results depicted as mean ± SD)
and t-test.
Data Collection and Analysis Image quality
Descriptive statistics (mean and standard deviation) were parameters Commercial OPG p-value
used to describe the average value of the four image quality Level of
parameters, spreadability, pH, viscosity, and subjective acceptability 3.96 ± 0.38 3.99 ± 0.37 0.70
assessment of the tested acoustic gels. The independent Visibility of
t-test was utilized to compare the acceptability and detail 4.03 ± 0.33 3.94 ± 0.35 0.25
quality of images obtained using the tested acoustic gels. Amount of
A p-value of less than 0.05 was considered significant. recorded detail 3.96 ± 0.36 3.93 ± 0.41 0.70
Distortion 1.50 ± 0.19 1.53 ± 0.17 0.42

RESULTS Subjective Assessment of Acoustic Gels

Most of the subjective assessment scores of the sonologists
Physical Evaluation of Acoustic Gels were similar in both OPG and commercial gel (Table
OPG and commercial gel were characterized as light 4). Acceptability of OPG in terms of ease of use was
green, homogeneous, not greasy, not gritty, not stiff, and comparable to that of commercial gel. However, the
smooth (Table 1). OPG had higher spreadability, but lower sonologists reported that compared to commercial gel,
viscosity compared to commercial acoustic gel (Table 2). OPG did not evaporate easily during the sonographic
The pH of both gels was slightly acidic. The spreadability, procedure.
pH, and viscosity values were statistically different in both
gels used (p < 0.05).

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Vol. 150 No. 2, April 2021 Commercial Gel Alternative

Figure 1. Human thyroid phantom imaged using commercial gel and OPG.

Table 4. Subjective assessment of acoustic gels (n = 45, results this parameter plays a significant role in the application
depicted as mean ± SD) and t-test. of gel for medical purposes. However, in ultrasound
Items Commercial OPG p-value examinations, the acoustic gel is not used as a therapeutic
1. The gel used in the
agent but is primarily used to enhance the transmission
scan was messy. 1.20 ± 0.45 1.40 ± 0.55 0.55 of sound waves from the probe to the organ of interest
2. The gel used in
(Chaudhary and Verma 2014).
the scan was easy to
remove. 4.60 ± 0.55 4.40 ± 0.55 0.58
On the other hand, the viscosity of the formulation refers
to its thickness due to internal friction. This parameter
3. The gel did not
evaporate easily during 1.80 ± 0.45 4.20 ± 0.84 < 0.001
is one of the most important factors to consider when
the scan. developing acoustic gel (Dimic-Misic et al. 2014). Highly
viscous fluids contain molecules that are arranged close
together compared to low viscosity fluids (Dimic-Misic
et al. 2014). Sound waves travel faster in molecules that
DISCUSSION are packed together than in loosely packed molecules.
OPG was formulated in this study from low-cost and Previous studies have shown that the mucilage substance
highly accessible materials. The formulation used a simple found in the water-storing tissues of the okra pods
heating method, and the obtained gel was physically accounted for the viscosity of the plant extract (Habtamu
evaluated on the basis of its organoleptic characteristics, et al. 2015; Gemede et al. 2018).
spreadability, pH, viscosity, and ease of use. Five
Based on their pH values, both gels were slightly acidic.
evaluators analyzed the sonographic images obtained after
The pH of the formulation to be used should match the
a series of ultrasound scans based on four parameters of
pH of the skin to avoid skin irritation and other reactions
image quality – namely, the level of acceptability, visibility
(Tamayol et al. 2016). The pH of the skin varies from
of detail, amount of detail recorded, and distortion.
4–7 (Tamayol et al. 2016). The acoustic gels tested were
The physical analysis revealed that both OPG and optimal in terms of pH as the results matched the normal
commercial gels had an optimum appearance, texture, pH range of the skin. Previous gel alternatives have not
and homogeneity. The OPG had a light green color. In addressed the issue of skin sensitivity of the produced gel
the study, the plant sample used contains water-storing (Luewan et al. 2007; Binkowski et al. 2014; Salmon et al.
tissues composed of simple parenchymal cells containing 2015; Monti 2017; Aziz et al. 2018; Milton et al. 2018;
chlorophyll, giving OPG a light green color (Vernon and Alipio et al. 2019). This study offers significant novelty
Seely 2014). in that it first reports the pH of the tested alternative
and considers this factor in the formulation to avoid
The spreadability and viscosity tests revealed that the OPG skin allergies that could occur during any ultrasound
had a higher spreadability but lower viscosity compared to examination.
the commercial gel. The spreadability of the formulation
is the ability to spread evenly on the surface of the skin The analysis of the image quality parameters showed
(Andrade et al. 2014). Previous studies have reported that that OPG was comparable to the commercial gel in

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Philippine Journal of Science Alipio: Okra Pod Gel as a Low-cost
Vol. 150 No. 2, March 2021 Commercial Gel Alternative

terms of acceptability, visibility of detail, amount of The production of these gels requires strict temperature
detail recorded, and distortion. The level of acceptability controls in order to achieve optimum consistency. In
refers to the adequacy of the image for diagnostic the study, the okra pods were only subjected to simple
interpretation, while the visibility of detail refers to the heating and filtration methods and yield an image quality
clarity of the structure of the organ (Bushong 2013). The comparable to that of commercial acoustic gel. One
amount of detail recorded refers to the sharpness of the advantage identified by the OPG was its low volatility
structures of the relevant anatomy, and the distortion compared to the widely used commercial alcohol-based
refers to the degree of misrepresentation of the anatomy gel. Compared to OPG, an alcohol-based commercial gel
scanned in the image display (Bushong 2013). The levels readily evaporates, requiring more volume to complete a
of acceptability, visibility of detail, amount of detail single ultrasound test.
recorded, and distortion were robust indicators of image
quality in ultrasound practice. Similar to the previous
report, the parameters of image quality were statistically
identical between formulated and commercial acoustic CONCLUSION
gels (Binkowski et al. 2014). However, a previous
In conclusion, the study showed that OPG had an optimum
study using saluyot (Corchorus olitorius L.) gel showed
appearance, texture, homogeneity, and pH value. Although
statistically higher visibility of detail and amount of
there is a difference in spreadability, pH, and viscosity
recorded detail compared to commercial acoustic gel
between OPG and commercial gel, there was no significant
(Alipio et al. 2019). The differences in the results of
difference in the image quality parameters between the
previous research could be attributed to the number of
gels used in the study. The sonologists noted that one of
evaluators who rated the image quality of the sonographic
the significant advantages of OPG was its low volatility
images. The two studies employed only one sonologist
compared to the widely used commercial alcohol-based
and did not mention the clinical experience or prior
gel. Based on physical assessment, pH, spreadability, image
training received by the evaluator. The use of only one
quality, and subjective assessment, OPG is a cost-effective
sonologist with no clinical expertise as an image evaluator
alternative to commercial acoustic gel. Further clinical trials
could have yielded incorrect results and image quality
involving actual patients are recommended to increase the
interpretation, as the evaluator had no prior knowledge
validity of the results of the study.
of sonographic images. In order to control possible
variations in ratings, the present study recruited five Areas of further research may be undertaken. First, future
sonologists with more than ten years of experience in investigations may be conducted to optimize the viscosity
clinical practice. In comparison to the previous studies, of OPG. Second, the test of stability on organoleptic
all sonologists were blinded by the type of ultrasound gel characteristics, viscosity, pH, spreadability, and image
used during the assessment to avoid potential rating biases. quality parameters may be carried out over a period of time
In addition, the assessment was carried out in a separate to observe changes in the OPG properties. Third, in future
room using the same laptop, screen, and room lighting studies, actual patients in low-resource settings may be
to control possible external factors that might affect the scanned. Although other plant-based gel may be tested, this
rating. Using a highly controlled sonographic image study is the first to explore and demonstrate the feasibility of
evaluation, the SDs of the image quality parameters were OPG as a low-cost alternative to commercial acoustic gel.
less than 0.50, which represents the homogeneity of the
responses of the sonologists. Future studies may consider
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