1
|
Merkel D, Lueders C, Schneider C, Yousefzada M, Ruppert J, Weimer A, Herzog M, Lorenz LA, Vieth T, Buggenhagen H, Weinmann-Menke J, Weimer JM. Prospective Comparison of Nine Different Handheld Ultrasound (HHUS) Devices by Ultrasound Experts with Regard to B-Scan Quality, Device Handling and Software in Abdominal Sonography. Diagnostics (Basel) 2024; 14:1913. [PMID: 39272698 DOI: 10.3390/diagnostics14171913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The HHUS market is very complex due to a multitude of equipment variants and several different device manufacturers. Only a few studies have compared different HHUS devices under clinical conditions. We conducted a comprehensive prospective observer study with a direct comparison of nine different HHUS devices in terms of B-scan quality, device handling, and software features under abdominal imaging conditions. METHODS Nine different HHUS devices (Butterfly iQ+, Clarius C3HD3, D5CL Microvue, Philips Lumify, SonoEye Chison, SonoSite iViz, Mindray TE Air, GE Vscan Air, and Youkey Q7) were used in a prospective setting by a total of 12 experienced examiners on the same subjects in each case and then assessed using a detailed questionnaire regarding B-scan quality, handling, and usability of the software. The evaluation was carried out using a point scale (5 points: very good; 1 point: insufficient). RESULTS In the overall evaluation, Vscan Air and SonoEye Chison achieved the best ratings. They achieved nominal ratings between "good" (4 points) and "very good" (5 points). Both devices differed significantly (p < 0.01) from the other seven devices tested. Among the HHUS devices, Clarius C3HD3 and Vscan Air achieved the best results for B-mode quality, D5CL Microvue achieved the best results for device handling, and SonoEye Chison and Vscan Air achieved the best results for software. CONCLUSIONS This is the first comprehensive study to directly compare different HHUS devices in a head-to-head manner. While the majority of the tested devices demonstrated satisfactory performance, notable discrepancies were observed between them. In particular, the B-scan quality exhibited considerable variation, which may have implications for the clinical application of HHUS. The findings of this study can assist in the selection of an appropriate HHUS device for specific applications, considering the clinical objectives and acknowledging the inherent limitations.
Collapse
Affiliation(s)
- Daniel Merkel
- BIKUS-Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
| | - Christian Lueders
- Klinik am See, Rehabilitation Center for Internal Medicine, 15562 Rüdersdorf bei Berlin, Germany
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
| | - Johannes Ruppert
- Department of Medicine, Justus Liebig University Giessen, 35385 Giessen, Germany
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Moritz Herzog
- Else Kröner Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, 01307 Dresden, Germany
| | - Liv Annebritt Lorenz
- Department of Radiooncology and Radiotherapy, Mainz University Hospital, 55131 Mainz, Germany
| | - Thomas Vieth
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| |
Collapse
|
2
|
Lorentzen MJ, Kristensen AH, Kaldan FP, Cartuliares MB, Hertz MA, Specht JJ, Posth S, Lindberg MJH, Skaarup SH, Hansen MR, Spile CS, Andersen MB, Graumann O, Mogensen CB, Skjøt-Arkil H, Laursen CB. Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study. Diagnostics (Basel) 2024; 14:1921. [PMID: 39272706 DOI: 10.3390/diagnostics14171921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.
Collapse
Affiliation(s)
- Morten Jongshøj Lorentzen
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne Heltborg Kristensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Frida Poppius Kaldan
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Mariana Bichuette Cartuliares
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Mathias Amdi Hertz
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Juel Specht
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Stefan Posth
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, 5000 Odense, Denmark
| | | | - Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8000 Aarhus, Denmark
| | | | | | - Michael Brun Andersen
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, 2200 København, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, 8000 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| |
Collapse
|
3
|
Azapoglu Kaymak B, Eksioglu M. Rapid Ultrasonography for Shock and Hypotension Protocol Performed using Handheld Ultrasound Devices by Paramedics in a Moving Ambulance: Evaluation of Image Accuracy and Time in Motion. Prehosp Disaster Med 2024:1-6. [PMID: 38757178 DOI: 10.1017/s1049023x24000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Handheld ultrasound (US) devices have become increasingly popular since the early 2000s due to their portability and affordability compared to conventional devices. The Rapid Ultrasonography for Shock and Hypotension (RUSH) protocol, introduced in 2009, has shown promising accuracy rates when performed with handheld devices. However, there are limited data on the accuracy of such examinations performed in a moving ambulance. This study aimed to assess the feasibility and accuracy of the RUSH protocol performed by paramedics using handheld US devices in a moving ambulance. OBJECTIVES The study aimed to examine the performability of the RUSH protocol with handheld US devices in a moving ambulance and to evaluate the accuracy of diagnostic views obtained within an appropriate time frame. METHODS A prospective study was conducted with paramedics who underwent theoretical and practical training in the RUSH protocol. The participants performed the protocol using a handheld US device in both stationary and moving ambulances. Various cardiac and abdominal views were obtained and evaluated for accuracy. The duration of the protocol performance was recorded for each participant. RESULTS Nine paramedics completed the study, with 18 performances each in both stationary and moving ambulance groups. The accuracy of diagnostic views obtained during the RUSH protocol did not significantly differ between the stationary and moving groups. However, the duration of protocol performance was significantly shorter in the moving group compared to the stationary group. CONCLUSION Paramedics demonstrated the ability to perform the RUSH protocol effectively using handheld US devices in both stationary and moving ambulances following standard theoretical and practical training. The findings suggest that ambulance movement does not significantly affect the accuracy of diagnostic views obtained during the protocol. Further studies with larger sample sizes are warranted to validate these findings and explore the potential benefits of prehospital US in dynamic environments.
Collapse
Affiliation(s)
- Burcu Azapoglu Kaymak
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Merve Eksioglu
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Thomas JO, To JK, Vu AN, Horton D, Dzihic E, Browne AW. Imaging performance of portable and conventional ultrasound imaging technologies for ophthalmic applications. PLoS One 2024; 19:e0300451. [PMID: 38739643 PMCID: PMC11090327 DOI: 10.1371/journal.pone.0300451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the imaging capabilities of Butterfly iQ with conventional ophthalmic (piezoelectric) ultrasound (COU) for ophthalmic imaging. METHODS Custom phantom molds were designed and imaged with Butterfly iQ and COU to compare spatial resolution capabilities. To evaluate the clinical imaging performance of Butterfly iQ and COU, a survey containing pathological conditions from human subjects, imaged with both Butterfly iQ and COU probes, was given to three retina specialists and graded on image detail, resolution, quality, and diagnostic confidence on a ten-point Likert scale. Kruskal-Wallis analysis was performed for survey responses. RESULTS Butterfly iQ and COU had comparable capabilities for imaging small axial and lateral phantom features (down to 0.1 mm) of high and low acoustic reflectivity. One of three retina specialists demonstrated a statistically significant preference for COU related to resolution, detail, and diagnostic confidence, but the remaining graders showed no significant preference for Butterfly iQ or COU across all sample images presented. CONCLUSION The emergence of portable ultrasound probes offers an affordable alternative to COU technologies with comparable qualitative imaging resolution down to 0.1 mm. These findings suggest the value to further study the use of portable ultrasound systems and their utility in routine eye care.
Collapse
Affiliation(s)
- Jack O. Thomas
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California, United States of America
- School of Medicine, California University of Science and Medicine, Colton, California, United States of America
| | - Josiah K. To
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California, United States of America
| | - Anderson N. Vu
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California, United States of America
| | - David Horton
- School of Medicine, University of California Irvine, Irvine, California, United States of America
| | - Ermin Dzihic
- School of Medicine, University of California Irvine, Irvine, California, United States of America
| | - Andrew W. Browne
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California, United States of America
- Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California Irvine, Irvine, California, United States of America
- Institute for Clinical and Translational Science, University of California Irvine, Irvine, California, United States of America
| |
Collapse
|
5
|
Acuña J, Situ-LaCasse E, Yarnish AA, McNinch NL, Adhikari S. Does Size Matter? A Prospective Study on the Feasibility of Using a Handheld Ultrasound Device in Place of a Cart-Based System in the Evaluation of Trauma Patients. J Emerg Med 2024; 66:e483-e491. [PMID: 38429215 DOI: 10.1016/j.jemermed.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. OBJECTIVE We aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during the evaluation of trauma patients using the Focused Assessment with Sonography for Trauma (FAST) examination. METHODS This was a prospective study of adult trauma patients who received a FAST examination as part of their evaluation. A FAST examination was performed using a cart-based machine and a handheld device. The results of the examinations were compared with computed tomography imaging. Images obtained from both ultrasound devices were reviewed by an expert for image quality. RESULTS A total of 62 patients were enrolled in the study. The mean (SD) time to perform a FAST examination using the handheld device was 307.3 (65.3) s, which was significantly less (p = 0.002) than the 336.1 (86.8) s with the cart-based machine. There was strong agreement between the examination results of the handheld and cart-based devices and between the handheld and computed tomography. Image quality scores obtained with the handheld device were lower than those from the cart-based system. Most operators and reviewers agreed that the images obtained from the handheld were adequate for medical decision making. CONCLUSIONS Data support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system.
Collapse
Affiliation(s)
- Josie Acuña
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Elaine Situ-LaCasse
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Adrienne A Yarnish
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | | | - Srikar Adhikari
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| |
Collapse
|
6
|
Gibbons RC, Jaeger DJ, Berger M, Magee M, Shaffer C, Costantino TG. Diagnostic Accuracy of a Handheld Ultrasound vs a Cart-based Model: A Randomized Clinical Trial. West J Emerg Med 2024; 25:268-274. [PMID: 38596929 PMCID: PMC11000544 DOI: 10.5811/westjem.17822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model. Methods This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system. Patients who required a cardiac, lung, renal, aorta, or biliary POCUS were randomized to a portable device or to a cart-based model. We hypothesized that the cart-based model would have a 90% diagnostic accuracy vs 70% for the handheld device. To detect a 20% difference, the sample size was calculated to be 98, with 49 patients randomized to each arm. We used standard 2x2 tables to calculate test characteristics with 95% confidence intervals (CI). Results A total of 110 patients were enrolled, with 56 patients randomized to the cart-based model and 54 to the handheld device. The sensitivity, specificity, and diagnostic accuracy of the cart-based vs handheld were 77.8% (40-97.2) vs 92.9% (66.1-99.8), 91.5% (79.6-97.6) vs 92.3% (79.1-98.4%), and 89.3% (78.1-96) vs 92.5% (81.8-97.9), respectively. Conclusion The diagnostic accuracy of a portable, handheld device is similar to that of a cart-based model.
Collapse
Affiliation(s)
- Ryan C. Gibbons
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Daniel J. Jaeger
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Matthew Berger
- Capital Health, Department of Emergency Medicine, Pennington, New Jersey
| | - Mark Magee
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Claire Shaffer
- University of Pittsburgh Medical Center Harrisburg, Department of Emergency Medicine, Harrisburg, Pennsylvania
| | - Thomas G. Costantino
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
Collapse
Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
| |
Collapse
|
8
|
Merkel D, Züllich TF, Schneider C, Yousefzada M, Beer D, Ludwig M, Weimer A, Künzel J, Kloeckner R, Weimer JM. Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions. Diagnostics (Basel) 2023; 13:3622. [PMID: 38132206 PMCID: PMC10742722 DOI: 10.3390/diagnostics13243622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. METHOD The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). RESULTS The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. CONCLUSION In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers.
Collapse
Affiliation(s)
- Daniel Merkel
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany;
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, 10115 Berlin, Germany;
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany;
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| |
Collapse
|
9
|
Ekambaram K, Hassan K. Establishing a Novel Diagnostic Framework Using Handheld Point-of-Care Focused-Echocardiography (HoPE) for Acute Left-Sided Cardiac Valve Emergencies: A Bayesian Approach for Emergency Physicians in Resource-Limited Settings. Diagnostics (Basel) 2023; 13:2581. [PMID: 37568944 PMCID: PMC10416975 DOI: 10.3390/diagnostics13152581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/23/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Acute severe cardiac valve emergencies, such as acute severe mitral regurgitation (AMR) and acute severe aortic regurgitation (AAR), present significant challenges in terms of diagnosis and management. Handheld point-of-care ultrasound devices have emerged as potentially pivotal tools in ensuring the prompt and accurate diagnosis of these left-sided valve emergencies by emergency physicians, particularly in resource-limited settings. Despite the increased utilisation of point-of-care ultrasound by emergency physicians for the management of patients in states of acute cardiorespiratory failure, current diagnostic protocols cannot perform sufficient quantitative assessments of the left-sided cardiac valves. This review elucidates and evaluates the diagnostic utility of handheld point-of-care focused-echocardiography (HoPE) in native AMR and AAR by reviewing the relevant literature and the use of clinical case examples from the Emergency Department at Port Shepstone Regional Hospital (PSRH-ED)-a rural, resource-limited hospital located in KwaZulu-Natal, South Africa. Combining the findings of the review and clinical case illustrations, this review proceeds to synthesise a novel, Bayesian-inspired, iterative diagnostic framework that integrates HoPE into the evaluation of patients with acute cardiorespiratory failure and suspected severe left-sided valve lesions.
Collapse
Affiliation(s)
- Kamlin Ekambaram
- Port Shepstone Regional Hospital, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Karim Hassan
- Life Bay View Private Hospital, Mossel Bay 6506, South Africa;
| |
Collapse
|
10
|
Utility of hand-held ultrasound for image acquisition and interpretation by trained Kenyan providers. Ultrasound J 2023; 15:12. [PMID: 36884093 PMCID: PMC9995612 DOI: 10.1186/s13089-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) plays a prominent role in the timely recognition and management of multiple medical, surgical, and obstetric conditions. A POCUS training program for primary healthcare providers in rural Kenya was developed in 2013. A significant challenge to this program is the acquisition of reasonably priced ultrasound machines with adequate image quality and the ability to transmit images for remote review. The goal of this study is to compare the utility of a smartphone-connected, hand-held ultrasound with a traditional ultrasound device for image acquisition and interpretation by trained healthcare providers in Kenya. METHODS This study took place during a routine re-training and testing session for healthcare providers who had already received POCUS training. The testing session involved a locally validated Observed Structured Clinical Exam (OSCE) that assessed trainees' skills in performing the Extended Focused Assessment with Sonography for Trauma (E-FAST) and focused obstetric exams. Each trainee performed the OSCE twice, once using a smartphone-connected hand-held ultrasound and once using their notebook ultrasound model. RESULTS Five trainees obtained a total of 120 images and were scored on image quality and interpretation. Overall E-FAST imaging quality scores were significantly higher for the notebook ultrasound compared to the hand-held ultrasound but there was no significant difference in image interpretation. Overall focused obstetric image quality and image interpretation scores were the same for both ultrasound systems. When separated into individual E-FAST and focused obstetric views, there were no statistically significant differences in the image quality or image interpretation scores between the two ultrasound systems. Images obtained using the hand-held ultrasound were uploaded to the associated cloud storage using a local 3G-cell phone network. Upload times were 2-3 min. CONCLUSION Among POCUS trainees in rural Kenya, the hand-held ultrasound was found to be non-inferior to the traditional notebook ultrasound for focused obstetric image quality, focused obstetric image interpretation, and E-FAST image interpretation. However, hand-held ultrasound use was found to be inferior for E-FAST image quality. These differences were not observed when evaluating each E-FAST and focused obstetric views separately. The hand-held ultrasound allowed for rapid image transmission for remote review.
Collapse
|
11
|
Abstract
BACKGROUND Ultrasound (US) for the detection of pneumothorax shows excellent sensitivity in the hands of skilled providers. Artificial intelligence may facilitate the movement of US for pneumothorax into the prehospital setting. The large amount of training data required for conventional neural network methodologies has limited their use in US so far. METHODS A limited training database was supplied by Defense Advanced Research Projects Agency of 30 patients, 15 cases with pneumothorax and 15 cases without. There were two US videos per patient, of which we were allowed to choose one to train on, so that a limited set of 30 videos were used. Images were annotated for ribs and pleural interface. The software performed anatomic reconstruction to identify the region of interest bounding the pleura. Three neural networks were created to analyze images on a pixel-by-pixel fashion with direct voting determining the outcome. Independent verification and validation was performed on a data set gathered by the Department of Defense. RESULTS Anatomic reconstruction with the identification of ribs and pleura was able to be accomplished on all images. On independent verification and validation against the Department of Defense testing data, our program concurred with the SME 80% of the time and achieved a 86% sensitivity (18/21) for pneumothorax and a 75% specificity for the absence of pneumothorax (18/24). Some of the mistakes by our artificial intelligence can be explained by chest wall motion, hepatization of the underlying lung, or being equivocal cases. CONCLUSION Using learning with limited labeling techniques, pneumothorax was identified on US with an accuracy of 80%. Several potential improvements are controlling for chest wall motion and the use of longer videos. LEVEL OF EVIDENCE Diagnostic Tests; Level III.
Collapse
|
12
|
Dietrich CF, Bulla P, Dudwiesus H, Lo H, Hocke M, Hoffmann B, Horn R, Lehmann B, Morf S, Nuernberg D, Prosch H, Serra A, Spengler J, Blaskova A, Jenssen C. [Perspectives and Challenges of hand-held Ultrasound]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022. [PMID: 36170860 DOI: 10.1055/a-1901-9394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The use of handheld ultrasound devices from a technical and data protection point of view, device properties, functionality, documentation, indications, delegation of performance, applications by doctors, students and non-medical staff is examined and discussed.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Peter Bulla
- Medizinische Klinik I, Klinik für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Universitätsklinikum Tübingen, Deutschland, Tübingen, Germany
| | | | - Hendra Lo
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Michael Hocke
- Klinik für Innere Medizin II, HELIOS Klinikum Meiningen, Meiningen, Germany
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Boston MA, Boston, United States
| | - Rudolf Horn
- Center da sandà Val Müstair, Sta. Maria, Switzerland
| | - Beat Lehmann
- Universitäres Notfallzentrum, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Susanne Morf
- Center da sandà Val Müstair, Sta. Maria, Val Müstair, Switzerland
| | - Dieter Nuernberg
- Brandenburgisches Institut für Klinischen Ultraschall und Fakultät Gesundheitswissenschaften, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Helmut Prosch
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Austria
| | | | | | - Andrea Blaskova
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
| |
Collapse
|
13
|
Holbert SE, Fowler B, West M, Morris J, Turcotte J, King P. Pain After Preoperative Ultrasound Guided Hip Injections for Total Hip Arthroplasty: A Pilot Randomized Controlled Trial. Surg Innov 2022:15533506221124460. [DOI: 10.1177/15533506221124460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Hip replacement is a frequently performed and highly successful treatment for patients with end stage osteoarthritis. Advances in technique and pain management have allowed for rapid mobilization and early discharge after surgery. We hypothesize that pre-incision intra-articular injection of local anesthetic with epinephrine under image guidance combined with post incision peri-articular injection (PAI) may be more effective than PAI alone. Methods. A prospective, randomized, controlled, comparative investigation at a single institution of 41 patients undergoing THA who received standard 30 mL post-arthrotomy, PAI of ropivacaine with epinephrine under direct visualization after prosthesis implantation before closure or an equivalent dose divided into a 10 mL pre-incision, ultrasound guided intra-articular injection and a 20 mL post-arthrotomy PAI. Results. 42 patients were included in this study before its early conclusion with 22 patients in the treatment group and 20 in the control group. There were no significant differences in age, BMI or ASA scores. Additionally, there were no significant differences noted when comparing groups by postoperative outcome measures including OMME, EBL, OR time, PACU minutes, and first and last PACU pain score. Furthermore, there were no significant differences in the PROMs evaluated. Discussion. The addition of ultrasound guided pre-incision intra-articular injection to the standard PAI had no benefit when compared with standard PAI during a THA. Portable mobile phone based ultrasound devices provide a cost effective way to perform musculoskeletal blocks, and further studies on their use and comparative accuracy is warranted. A novel technique for confirmation of injection location is described.
Collapse
Affiliation(s)
| | | | | | | | | | - Paul King
- Anne Arundel Medical Center, Annapolis, MD, USA
| |
Collapse
|
14
|
Dewar ZE, Ko S, Rogers C, Oropallo A, Augustine A, Pamula A, Berry CL. Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study. Ultrasound J 2022; 14:23. [PMID: 35698007 PMCID: PMC9191400 DOI: 10.1186/s13089-022-00270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00270-w.
Collapse
Affiliation(s)
- Zachary E Dewar
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA.
| | - Stephanie Ko
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA.,Wilkes University, 84 West South Street, Wilkes-Barre, PA, 18766, USA
| | - Cameron Rogers
- Greater Valley EMS, 904 North Lehigh Ave, Sayre, PA, 18840, USA
| | - Alexis Oropallo
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Andrew Augustine
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Ankitha Pamula
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Christopher L Berry
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| |
Collapse
|
15
|
Malik AN, Rowland J, Haber BD, Thom S, Jackson B, Volk B, Ehrman RR. The Use of Handheld Ultrasound Devices in Emergency Medicine. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 9:73-81. [PMID: 33996272 PMCID: PMC8112245 DOI: 10.1007/s40138-021-00229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
Purpose of Review Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology. Recent Findings Images obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of "tele-ultrasound" and augmented reality scanning. Summary This review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.
Collapse
Affiliation(s)
- Adrienne N Malik
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Jonathan Rowland
- Department of Emergency Medicine, University of California-Irvine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Brian D Haber
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
| | - Stephanie Thom
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bradley Jackson
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bryce Volk
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
| |
Collapse
|