Untersuchungskonzepte und Untersuchungsabläufe in der Notfallsonographie

[Perspectives and Challenges of hand-held Ultrasound]

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.

Echoscopy in scanning cardiac diseases in critical care medicine

BACKGROUND AND AIMS

Targeted ultrasound examinations with a portable ultrasound device ("handheld ultrasound system"; HHUS) have been defined as "echoscopy" by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). Cardiac scanning with HHUS is feasible. Echoscopy could play a major role in emergency and intensive care medicine, but adequate data on its effectiveness are still lacking. Sonographic examinations in the field of emergency and intensive care medicine can often not be carried out under standardized examination conditions. Thus, the aim of this study is to show that the use of HHUS for echocardiography in emergency medicine is possible and that for this setting HHUS is not inferior to a high-end ultrasound system (HEUS) for detecting cardiac pathologies.

METHODS

The examinations were carried out with a Vscan™ (GE Medical Systems, Solingen, Germany) and a high-end ultrasound device (Acuson X‑300 or X‑700). The examinations were randomized and blinded to two examiners within 30 min. The examinations took place in the intensive care unit, the emergency room and the ambulance service. The results were recorded in an examination sheet.

RESULTS

In all, 93 patients (61 men and 32 women, age 69 ± 14.76 [33-95] years). In 32.6% (30/93) of examinations with HEUS the examination conditions were optimal and in 29.03% (27/93) when the HHUS was used. Of the examinations, 50.08% (31/61) were carried out by both examiners in the same patient position. Using HHUS, the following sensitivity and specificities (respectively) were found: pericardial effusion (73.68%; 96.97%), hemodynamically relevant effusion (50%; 97.67%), right heart strain (90,91%; 96,72%), arrest of the right ventricle (100%; 87,5%), limitation of left ventricular pump function (91.49%; 86.11%), wall movement disorders (WMD, 97.29%; 78.95%), aortic valve sclerosis (42.86%; 86.67%), aortic regurgitation (60%; 95%), mitral valve sclerosis (60%; 100%), mitral reguritation (66.67%; 82.86%), tricuspid valve regurgitation (48%; 81,48%). Measurements of the dimensions of pericardial effusion, the left ventricle, the left atrium and the left ventricular posterior wall each had a positive correlation between the examination with HHUS and HEUS (Κ = 0.45 to 0.91). The diameters determined by HHUS and HEUS for the septum and aortic root, however, correlated negatively (κ = -0.61 to -0.86).

CONCLUSIONS

The use of echoscopy in emergency and intensive care medicine is not inferior to HEUS for detecting defined cardiac pathologies.

Echoscopy in scanning abdominal diseases in a critical care setting

BACKGROUND AND AIMS

Targeted ultrasound examinations with portable ultrasound device (handheld ultrasound system [HHUS]) have been defined as "echoscopy" by the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB). For abdominal diseases it has been shown that echoscopy is sensitive and specific. The aim of this study is to show that the use of HHUS for abdominal ultrasonography is possible under the conditions prevailing in emergency and intensive care medicine and that it is not inferior to high-end devices (high-end ultrasound systems [HEUS]).

METHODS

Examinations were carried out with a first-generation Vscan™ (GE Medical Systems, Solingen, Germany) and HEUS device (Siemens Acuson X‑300 or X‑700, Siemens Healthcare, Erlangen, Germany). The HEUS device was seen as standard. The examinations were randomized and blinded and carried out by two examiners within 30 min in order to avoid falsifications due to time delay. They took place in the intensive care unit, the emergency room and the emergency medical service. The results had to be recorded in an examination sheet.

RESULTS

In all, 86 patients (54 men and 32 women, aged 73 ± 14.58 [28-95] years) were included. In 45.35% (39/86) of the ultrasound examinations using HEUS and in 41.86% (36/89) of the cases using HHUS the examination conditions were optimal. Furthermore, 76.19% of the examinations were carried out by both examiners in the same scanning position. For the detection of liver tumours, HHUS shows a sensitivity of 70% and specificity of 100%. With regard to identifying signs of cholecystitis, i.e., evidence of surrounding inflammation (a) or hydrops (b), HHUS shows a sensitivity of 66.67% (a) and 60% (b) and a specificity of 97.06% (a) and 96.86% (b). The diagnosis of an ileus is successful with a sensitivity of 87.5% and a specificity of 60%. The respiratory variability of the inferior vena cava has a sensitivity of 100% and a specificity of 40% using HHUS. Ascites and pleural effusions can be diagnosed with a sensitivity of 89% and a specificity of 93.1%. When using the FAST (Focused Assessment with Sonography for Trauma) protocol, HHUS has a sensitivity of 80% and a specificity of 90.9%. With the exception of kidney cysts and inferior vena cava, the measurement of the diameter has a positive correlation.

CONCLUSION

Echoscopy of the abdomen in emergency and intensive care medicine is possible despite restrictive circumstances. The inferior vena cava can only be assessed to a limited extent with the first generation of Vscan™. In order to use sonography in emergency and intensive care medicine, a standardized procedure is to be aimed for and training in emergency sonography is necessary.

[Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine and critical care (CEUS Acute) : Consensus statement of DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM and DEGUM]

The present document describes the possible applications of contrast-enhanced ultrasound (CEUS) in emergency examinations. Guidelines on contrast medium ultrasound in acute and emergency care and intensive care medicine have not yet been published. Evidence-based CEUS guidelines were first provided by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB). The presented recommendations describe the possible applications and protocols of CEUS in acute care.

[Ultrasound in Student Education]

Ultrasound in Student Education Abstract. The subject 'Ultrasound in Medicine', already introduced during the studies increases the motivation of students by its practical character and combines basic medical knowledge (anatomy, physiology) and imaging with clinical applications in a unique way. This is done on the one hand as a point of care method (POCUS) at the point of decision-making, and on the other hand as a 'radiological' method with intervention options. POCUS is the use of ultrasound by physicians to correctly identify problems and implement solutions at the point of action. Both the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB) have published position papers on the targeted application of ultrasound technology (point of care), the status of which is reported here.

[Current status of teaching in lung ultrasound : Query of knowledge, utilization, need, and preferred teaching method]

BACKGROUND

Lung ultrasound (LUS) is a point-of-care technique which can quickly identify or rule out pathological findings. To date, it is unclear if knowledge about the use of LUS is readily available.

OBJECTIVES

We aimed to identify how much knowledge about the use of LUS is present, if there is a need for teaching in LUS, as well as the preferred teaching method in LUS.

MATERIALS AND METHODS

A total of 54 participants from two university departments of anesthesiology were randomized into the groups Online, Classroom, and Control. The Online group was taught by videos, the Classroom group by a traditional lecture with hands-on training, and the Control group was not taught at all. We conducted a pre- and posttest as well as a retention test 4 weeks after the end of the study by means of a survey (comparison with Mann-Whitney U test or t‑test, respectively, with p < 0.05 considered to be significant).

RESULTS

LUS is used "rarely" or "never", and mainly if there is a suspicion for pleural effusion (41.3%). There is a need for LUS (Online: 21.7%; Classroom: 60.9%; Control: 62.5%, p < 0.05). Hybrid teaching consisting of classroom-based and online-based teaching is preferred by the users (Online: 52.2%; Classroom: 56.5%; Control: 62.5%). At the end of the study, 32.6% of the participants of the intervention groups had used LUS in the diagnosis of a pneumothorax. Of the participants, 93.5% planned to use LUS more often in the future.

CONCLUSIONS

LUS is rarely used. There is a considerable need for teaching of LUS. Internet-based teaching and traditional lectures are considered equal. Both teaching methods improve the knowledge about LUS and lead to increased use of LUS in daily practice. The participants prefer hybrid teaching incorporating both teaching methods.

WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice

Gastrointestinal ultrasound (GIUS) is an ultrasound application that has been practiced for more than 30 years. Recently, GIUS has enjoyed a resurgence of interest, and there is now strong evidence of its utility and accuracy as a diagnostic tool for multiple indications. The method of learning GIUS is not standardised and may incorporate mentorship, didactic teaching and e-learning. Simulation, using either low- or high-fidelity models, can also play a key role in practicing and honing novice GIUS skills. A course for training as well as establishing and evaluating competency in GIUS is proposed in the manuscript, based on established learning theory practice. We describe the broad utility of GIUS in clinical medicine, including a review of the literature and existing meta-analyses. Further, the manuscript calls for agreement on international standards regarding education, training and indications.