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Hernandez Torres SI, Ruiz A, Holland L, Ortiz R, Snider EJ. Evaluation of Deep Learning Model Architectures for Point-of-Care Ultrasound Diagnostics. Bioengineering (Basel) 2024; 11:392. [PMID: 38671813 PMCID: PMC11048259 DOI: 10.3390/bioengineering11040392] [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: 03/22/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Point-of-care ultrasound imaging is a critical tool for patient triage during trauma for diagnosing injuries and prioritizing limited medical evacuation resources. Specifically, an eFAST exam evaluates if there are free fluids in the chest or abdomen but this is only possible if ultrasound scans can be accurately interpreted, a challenge in the pre-hospital setting. In this effort, we evaluated the use of artificial intelligent eFAST image interpretation models. Widely used deep learning model architectures were evaluated as well as Bayesian models optimized for six different diagnostic models: pneumothorax (i) B- or (ii) M-mode, hemothorax (iii) B- or (iv) M-mode, (v) pelvic or bladder abdominal hemorrhage and (vi) right upper quadrant abdominal hemorrhage. Models were trained using images captured in 27 swine. Using a leave-one-subject-out training approach, the MobileNetV2 and DarkNet53 models surpassed 85% accuracy for each M-mode scan site. The different B-mode models performed worse with accuracies between 68% and 74% except for the pelvic hemorrhage model, which only reached 62% accuracy for all model architectures. These results highlight which eFAST scan sites can be easily automated with image interpretation models, while other scan sites, such as the bladder hemorrhage model, will require more robust model development or data augmentation to improve performance. With these additional improvements, the skill threshold for ultrasound-based triage can be reduced, thus expanding its utility in the pre-hospital setting.
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Affiliation(s)
| | | | | | | | - Eric J. Snider
- Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX 78234, USA; (S.I.H.T.); (A.R.); (L.H.); (R.O.)
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Inchingolo R, Zanforlin A, Buonsenso D, Perrone T, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Marchetti G, Carlucci P, Radovanovic D, Lohmeyer FM, Smargiassi A. Lung Ultrasound Signs: The Beginning. Part 3-An Accademia di Ecografia Toracica Comprehensive Review on Ultrasonographic Signs and Real Needs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:629-641. [PMID: 38168739 DOI: 10.1002/jum.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | | | - Paolo Carlucci
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | | | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Rapid Ultrasound for Shock and Hypotension: A Clinical Update for the Advanced Practice Provider: Part 1. Adv Emerg Nurs J 2020; 42:270-283. [PMID: 33105180 DOI: 10.1097/tme.0000000000000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.
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Pérez JM, Alessi C, Grzech-Wojciechowska M. Diagnostic methods for the canine idiopathic dilated cardiomyopathy: A narrative evidence-based rapid review. Res Vet Sci 2019; 128:205-216. [PMID: 31821959 DOI: 10.1016/j.rvsc.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/19/2019] [Accepted: 12/01/2019] [Indexed: 11/24/2022]
Abstract
Idiopathic dilated cardiomyopathy (DCM) is an important etiology of mortality and morbidity in dogs and its diagnosis relies on systolic dysfunction, chambers dilation, electrical instability and congestion. During the last decades veterinary cardiologists have been joining efforts to obtain diagnostic resources to correctly identify canine DCM in the preclinical stage. Unfortunately, most diagnostic resources have been used with the support of research with weak evidence, without high quality methodologies such as systematic reviews or meta-analysis. Therefore, the support of evidence-based medicine is tailored by empiricism and diagnostic criteria lose'out the ability to properly classify dogs suffering DCM. The presentation of the evidence in medicine is established by multiple sources and the most reliable source has been the presentation of evidence-based medicine from systematic reviews and meta-analysis. Rapid reviews can be interpreted as a pragmatic approach to systematic reviews and although a rapid review follows most of the critical steps of a systematic review to provide timely evidence, some components of a systematic review process are either simplified or omitted. The objective of this narrative evidence-based rapid review is twofold. First: To recognize and to stratify the level of evidence offered by rigorous selected papers about the diagnosis of DCM. Second: To classify the degree of clinical recommendation of the diagnostic resources available.
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Affiliation(s)
- Jeff M Pérez
- Advanced Veterinary Centre- المستوصف البيطرى المتقدمة, Doha Expy, Amr Bin Alass St. Madynat Khalefa South, PO.BOX: 1234, Doha, Qatar.
| | - Chiara Alessi
- Faculty of Agricultural Science, Universidad de Caldas, PO.BOX: 170004, Street 65, 26-10 Manizales, Colombia
| | - Magdalena Grzech-Wojciechowska
- Wydział Medycyny Weterynaryjnej, Uniwersytet Warmiński-Mazurszki w Olsztynie ul, Michała Oczapowskiego, PO.BOX. 2 10-719, Olsztyn, Poland; Cor-Vet Kardiologia Weterynaryjna, PO.BOX 76-200, Słupsk, Poland
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Raheja R, Brahmavar M, Joshi D, Raman D. Application of Lung Ultrasound in Critical Care Setting: A Review. Cureus 2019; 11:e5233. [PMID: 31565634 PMCID: PMC6758979 DOI: 10.7759/cureus.5233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This article reviews the use of thoracic ultrasound in the intensive care unit (ICU). The focus of this article is to review the basic terminology and clinical applications of thoracic ultrasound. The diagnostic approach to a breathless patient, the blue protocol, is presented in a simplified flow chart. The diagnostic application of thoracic ultrasound in lung parenchymal and pleural diseases, role in bedside procedures, diaphragmatic assessment, and lung recruitment are described. Recent updates discussed in this review help support its increasingly indispensable role in the emergent and critical care setting.
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Affiliation(s)
- Ronak Raheja
- Internal Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, IND
| | - Megha Brahmavar
- Internal Medicine, Cloudphysician Healthcare, Bengaluru, IND
| | - Dhruv Joshi
- Internal Medicine, Cloudphysician Healthcare, Bengaluru, IND
| | - Dileep Raman
- Internal Medicine, Cloudphysician Healthcare, Bengaluru, IND
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The Use of M-Mode Ultrasonography to Differentiate the Causes of B Lines. Chest 2018; 153:689-696. [DOI: 10.1016/j.chest.2017.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/16/2017] [Accepted: 10/19/2017] [Indexed: 12/21/2022] Open
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Cox M, Soudack M, Podberesky DJ, Epelman M. Pediatric chest ultrasound: a practical approach. Pediatr Radiol 2017; 47:1058-1068. [PMID: 28779186 DOI: 10.1007/s00247-017-3896-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/08/2017] [Accepted: 05/04/2017] [Indexed: 02/04/2023]
Abstract
Chest ultrasonography is an important imaging adjunct for diagnosing and managing disease in children. Compared with CT and MRI, ultrasound is cheaper, portable and provides vascular or flow-related information that cannot otherwise be obtained noninvasively. The spatial and temporal resolution of ultrasound is excellent, particularly for superficial structures. In cases where a suspicious abnormality is found, tissue sampling can be performed percutaneously with US guidance. Ultrasound also excels at demonstrating and characterizing pleural fluid collections. As concerns about radiation exposure increase among laypersons and doctors alike, there is a compelling argument for making ultrasonography the initial imaging study of choice for many thoracic abnormalities in a child. In this review the authors discuss and illustrate the US findings of some of the more common chest complaints in children.
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Affiliation(s)
- Mougnyan Cox
- Department of Medical Imaging, Nemours Children's Health System, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michalle Soudack
- Pediatric Imaging Unit, Sackler School of Medicine, Tel-Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel J Podberesky
- Department of Medical Imaging/Radiology, Nemours Children's Health System, Nemours Children's Hospital, University of Central Florida, 13535 Nemours Parkway, Orlando, FL, 32827, USA
| | - Monica Epelman
- Department of Medical Imaging/Radiology, Nemours Children's Health System, Nemours Children's Hospital, University of Central Florida, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
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Kolinsky DC, Kim AJ, Ablordeppey EA. Sub-acute Tamponade and the Value of Point-of-Care Ultrasound for Rapid Diagnosis: A Case Report. Clin Pract Cases Emerg Med 2017; 1:232-237. [PMID: 29849315 PMCID: PMC5965178 DOI: 10.5811/cpcem.2017.3.33413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 11/16/2022] Open
Abstract
Minoxidil is a strong oral vasodilator that is used to treat patients with hypertension refractory to first-line medications. We report a case of minoxidil-associated subacute cardiac tamponade diagnosed by point-of-care ultrasound (POCUS) in a hypertensive patient. A 30-year-old male with a past medical history of poorly controlled hypertension (treated with minoxidil) and chronic kidney disease presented with 2–3 days of chest pain and shortness of breath with markedly elevated blood pressures. A point-of-care transthoracic echocardiogram revealed a massive pericardial effusion with sonographic tamponade physiology. We review the risk factors for developing pericardial effusions that progress to cardiac tamponade, the utility of diagnosing these patients by POCUS, and the incidence of patients who present with sonographic signs of cardiac tamponade without hypotension.
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Affiliation(s)
- Daniel C Kolinsky
- Washington University School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Albert J Kim
- Washington University School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Enyo A Ablordeppey
- Washington University School of Medicine, Department of Emergency Medicine, St. Louis, Missouri.,Washington University School of Medicine, Department of Anesthesiology, Division of Critical Care, St. Louis, Missouri
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Blanco P, Socransky S, Hall G. M-Mode in the Emergency Department: Is it Really Necessary? J Emerg Med 2016; 51:330-331. [PMID: 27431870 DOI: 10.1016/j.jemermed.2015.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/13/2015] [Indexed: 06/06/2023]
Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Hospital "Dr. Emilio Ferreyra", Necochea, Argentina
| | - Steve Socransky
- ED Ultrasound Fellowship Director, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Greg Hall
- Director of ED Ultrasound, Brantford General Hospital, McMaster University, Brantford, Ontario, Canada
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Saul T, Siadecki S, Berkowitz R, Rose G, Matilsky D, Sauler A. Reply. J Emerg Med 2016; 51:331-332. [PMID: 27372374 DOI: 10.1016/j.jemermed.2016.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/06/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Turandot Saul
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Sebastian Siadecki
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Rachel Berkowitz
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Gabriel Rose
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Danielle Matilsky
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Allison Sauler
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
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