Is Bigger Really Better? Comparison of Ultraportable Handheld Ultrasound with Standard Point-of-Care Ultrasound for Evaluating Safe Site Identification and Image Quality prior to Pleurocentesis

Abstract Background: Point-of-care ultrasound (PoCUS) can serve as a valuable adjunct for patient care. This study aimed to investigate the clinical integration of PoCUS of the first post-graduate year (PGY-1) residents after a PoCUS curriculum.Methods: The prospective study was conducted at the emergency department (ED) of the National Taiwan University Hospital between July 2015 and October 2017. Every PGY-1 resident had one-month ED training and a PoCUS curriculum was implemented during the first week. The post-training objective structured clinical examination global ratings were obtained, as well as the sonographic examinations the residents performed on shifts. Four groups could be identified: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations.Results: 239 residents participated. The median global rating was 4 (interquartile ranges, 4-5). After the curriculum, an increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality. No differences existed in the global ratings between 4 groups, however, nearly 30% of residents did not use PoCUS during their shifts. Group 1 performed more cases with better image quality and using ≥2 US applications (8/100 vs. 82/359, p=0.0009), compared with those before the curriculum. Comparing with those in groups 1 and 2, group 1 performed more cases (p<0.0001) with better image quality (p=0.03). “No suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks in groups 3 and 4.Conclusions: A short focused US training had an immediate positive impact on OSCE global ratings and integration of PoCUS of PGY-1 residents in the ED. The global ratings could not predict whether to use PoCUS in the ED practice. Although the working climate was designated to be friendly for utilizing US, a substantial percentage of residents did not use PoCUS. Further longitudinal studies would be needed for the sustained effects of the curriculum.Trial registration: NCT03738033.

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Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0889-8070 ◽

2019 ◽

Vol 41 (03) ◽

pp. 308-316 ◽

Cited By ~ 2

Author(s):

Eckhart Fröhlich ◽

Katharina Beller ◽

Reinhold Muller ◽

Maria Herrmann ◽

Ines Debove ◽

...

Keyword(s):

Decision Making ◽

Geriatric Patients ◽

Clinical Decision Making ◽

Point Of Care ◽

False Negative ◽

Clinical Decision ◽

Point Of Care Ultrasound ◽

Handheld Device ◽

Ultrasound Device ◽

Handheld Ultrasound

Abstract Purpose The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard. Materials and Methods Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications. Results The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an “overall sensitivity” of 89.5 %. The respective “overall specificity” was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed. Conclusion The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.

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The Role of a Handheld Ultrasound Device to Facilitate Remote Learning for a Point-of-Care Ultrasound Certificate Program

Advances in Medical Education and Practice ◽

10.2147/amep.s328625 ◽

2021 ◽

Vol Volume 12 ◽

pp. 1043-1048

Author(s):

Alok Moharir ◽

Joseph D Tobias

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Certificate Program ◽

Ultrasound Device ◽

Handheld Ultrasound ◽

Remote Learning

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Evaluation of a novel handheld point-of-care ultrasound device in an African emergency department

The Ultrasound Journal ◽

10.1186/s13089-020-00200-8 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Samuel L. Burleson ◽

Jonathan F. Swanson ◽

Erin F. Shufflebarger ◽

Douglas W. Wallace ◽

Matthew A. Heimann ◽

...

Keyword(s):

Emergency Department ◽

Image Quality ◽

Point Of Care ◽

Low Cost ◽

Clinical Care ◽

Point Of Care Ultrasound ◽

Emergency Setting ◽

Low Resource ◽

Ultrasound Device ◽

High Acuity

Abstract Background Many point-of-care ultrasound devices are now “pocket-sized” or handheld, allowing easy transport during travel and facilitating use in crowded spaces or in austere low-resource settings. Concerns remain about their durability, image quality, and clinical utility in those environments. Method Five emergency physicians with training in point-of-care ultrasound employed the Butterfly iQ, a novel handheld ultrasound device, in routine clinical care in a busy, high-acuity African emergency department over a period of 10 weeks. We retrospectively evaluated the performance of the Butterfly iQ from the perspectives of both the clinicians using the device and expert ultrasound faculty reviewing the images. Results We found advantages of the Butterfly iQ in a high-acuity African emergency department include its use of a single probe for multiple functions, small size, ease of transport, relatively low cost, and good image quality in most functions. Disadvantages include large probe footprint, lower, though still adequate, cardiac imaging quality, frequent overheating, and reliance on internet-based cloud storage, but these were surmountable. We also report a wide variety of patient presentations, pathology, and procedures to which the device was used. Conclusion We conclude the Butterfly iQ is an effective, though imperfect, point-of-care ultrasound device in a low-resource emergency setting. We will continue to employ the device in clinical emergency care and teaching in this setting.

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Wireless point-of-care ultrasound: First experiences with a new generation handheld device

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211197 ◽

2021 ◽

pp. 1-12

Author(s):

E.M. Jung ◽

J. Dinkel ◽

N. Verloh ◽

M. Brandenstein ◽

C. Stroszczynski ◽

...

Keyword(s):

Image Quality ◽

Mobile Device ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Imaging Method ◽

Diagnostic Reliability ◽

Handheld Device ◽

Ultrasound Device ◽

Linear Probe ◽

New Generation

AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 –80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2–5 MHz (convex probe) and 3–12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0–4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions. Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD –0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD –0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.

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Handheld ultrasound; point-of-care examinations by intensive care nurses in a cardiac intensive care unit. An interrater agreement study

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.091 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

M Jorgensen ◽

K Oterhals ◽

V Ponitz ◽

I Morken

Keyword(s):

Intensive Care ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Cardiac Intensive Care Unit ◽

Intensive Care Nurses ◽

Brief Training ◽

Conventional Ultrasound ◽

Handheld Ultrasound ◽

Cardiac Intensive Care ◽

Agreement Study

Abstract Background Adding point-of-care ultrasound to the physical examination of patients to assess early signs of decompensation and fluid overload has been proven to add information and improve quality of care, also when performed by nurses. Few studies have examined intensive care nurses’ point-of-care ultrasound examinations in acute cardiac settings. Purpose To evaluate if the findings of intensive care nurses ultrasound examinations, after brief training, were in agreement with conventional ultrasound examination performed by physicians. Methods This comparative cross sectional interrater agreement study included 50 patients admitted with signs and symptoms of dyspnoea and suspected cardiac disease to a cardiac intensive care unit. After brief training, the study nurses performed standardized examinations of the patients’ inferior vena cava (IVC) and the pleural- and pericardial cavities using a handheld ultrasound device. A physician repeated the same examinations using conventional ultrasound, blinded of the nurses’ findings. Results Analysis using Gwets agreement coefficient (AC2) with quadratic weights showed moderate agreement for the IVC respiration variation 0.60 (95% CI 0.38-0.82), and substantial agreement for the IVC diameter 0.70 (95% CI 0.50- 0.90) and right-sided pleural effusion 0.70 (95% CI 0.52-0.88). For left-sided pleural effusion 0.85 (95% CI 0.75-0.95) and for pericardial effusion 0.95 (95% CI 0.90-1.01) the agreement was almost perfect. Conclusion This study indicates that intensive care nurses, after brief training in point-of- care ultrasound, can perform reliable examinations of the IVC and pleural- and pericardial cavities compared to a physicians conventional ultrasound examination.

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Relationship between Evaluations of Tracheal Tube Position Using Ultrasound and Fluoroscopy in an Infant and Pediatric Population

Journal of Clinical Medicine ◽

10.3390/jcm9061707 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1707

Author(s):

Davinder Ramsingh ◽

Elizabeth Ghazal ◽

Brent Gordon ◽

Philip Ross ◽

Darren Goltiao ◽

...

Keyword(s):

Image Quality ◽

Tracheal Tube ◽

Strong Correlation ◽

Point Of Care ◽

Pediatric Population ◽

Cricoid Cartilage ◽

Pediatric Care ◽

Point Of Care Ultrasound ◽

Linear Probe ◽

Age Range

Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects’ height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location. Methods: Perioperative pediatric patients (<10 years) requiring a cuffed TT were enrolled. After routine TT placement, ultrasound and fluoroscopy images were obtained. Measurements from the TT cuff to the cricoid cartilage were obtained from the POCUS examination. Chest fluoroscopy was reviewed to measure the TT’s distance from the carina. Both measurements were then compared after scaling for patient height. The duration of the ultrasound examination and image quality scores were also recorded. Results: Forty-one patients were enrolled, with a median age of 3 (25th/75th percentile: 1.50/7.00) years. The POCUS examination identified the TT cuff in all cases with the highest image quality score. The median POCUS exam time was 112 (25th/75th percentile: 80.00/156.00) seconds. There was a strong correlation between the POCUS measurements and the fluoroscopy measurements, r = −0.7575, 95% CI [−0.8638, −0.5866 ], p < 0.001). Conclusions: Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.

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Intravenous Fluid Bag as a Substitute for Gel Standoff Pad in Musculoskeletal Point-of-care Ultrasound

Military Medicine ◽

10.1093/milmed/usab422 ◽

2021 ◽

Author(s):

Cristin Mount ◽

David Taylor ◽

Carl Skinner ◽

Scott Grogan

Keyword(s):

Foreign Body ◽

Soft Tissue ◽

Image Quality ◽

Point Of Care ◽

Image Acquisition ◽

Intravenous Fluid ◽

P Value ◽

Point Of Care Ultrasound ◽

Body Model ◽

Significant Difference

ABSTRACT Introduction Point-of-care ultrasound (POCUS) is a tool undergoing expanding use in military medicine, including routine inpatient, outpatient, and operational environments. Specific musculoskeletal POCUS examinations require additional equipment in the form of a standoff assist device to maximize image acquisition. These devices may not be readily available to POCUS users in more austere or resource-constrained environments. We devised a study to determine if intravenous fluid bags of various volumes could be substituted for standard standoff devices in musculoskeletal POCUS. Materials and Methods Sequential images of a soft tissue foreign body model, an interphalangeal joint, and a chest wall were taken using a gel standoff pad or water bath and compared to images acquired using three different sizes of intravenous fluid bags after removing excess air from the bags. Images were de-identified and scored for quality using a visual analog scale. We used a two-factor analysis of variance without replication to analyze the differences in image quality between standoff devices, with a P-value less than.05 considered statistically significant. Results We performed 13 POCUS studies and had a group of eight POCUS-trained physicians and physician assistants score these studies, resulting in 104 total quality scores. There was no significant difference in image quality between standoff devices for chest (P-value.280) and hand (P-value 0.947) images. We found a significant difference in image quality between standoff devices for the soft tissue foreign body model (P-value 0.039), favoring larger intravenous fluid bag standoff over standard devices. Conclusions In the absence of a standard commercial gel standoff device or water bath, intravenous fluid bags of 50, 100, and 250 mL can facilitate quality image acquisition for musculoskeletal POCUS.

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Handheld Ultrasound Device Usage and Image Acquisition Ability Among Internal Medicine Trainees: A Randomized Trial

Journal of Graduate Medical Education ◽

10.4300/jgme-d-20-00355.1 ◽

2021 ◽

Vol 13 (1) ◽

pp. 76-82

Author(s):

Jessica Buesing ◽

Yingjie Weng ◽

John Kugler ◽

Libo Wang ◽

Ondrej Blaha ◽

...

Keyword(s):

Internal Medicine ◽

Point Of Care ◽

Rapid Assessment ◽

Point Of Care Ultrasound ◽

Self Directed Learning ◽

Post Intervention ◽

Assessment Scores ◽

Lecture Series ◽

Handheld Ultrasound ◽

Thoracic And Abdominal

ABSTRACT Background There is insufficient knowledge about how personal access to handheld ultrasound devices (HUDs) improves trainee learning with point-of-care ultrasound (POCUS). Objective To assess whether HUDs, alongside a yearlong lecture series, improved trainee POCUS usage and ability to acquire images. Methods Internal medicine intern physicians (n = 47) at a single institution from 2017 to 2018 were randomized 1:1 to receive personal HUDs (n = 24) for patient care/self-directed learning vs no-HUDs (n = 23). All interns received a repeated lecture series on cardiac, thoracic, and abdominal POCUS. Main outcome measures included self-reported HUD usage rates and post-intervention assessment scores using the Rapid Assessment of Competency in Echocardiography (RACE) scale between HUD and no-HUD groups. Results HUD interns reported performing POCUS assessments on patients a mean 6.8 (SD 2.2) times per week vs 6.4 (SD 2.9) times per week in non-HUD arm (P = .66). There was no relationship between the number of self-reported examinations per week and a trainee's post-intervention RACE score (rho = 0.022, P = .95). HUD interns did not have significantly higher post-intervention RACE scores (median HUD score 17.0 vs no-HUD score 17.8; P = .72). Trainee confidence with cardiac POCUS did not correlate with RACE scores. Conclusions Personal HUDs without direct supervision did not increase the amount of POCUS usage or improve interns' acquisition abilities. Interns who reported performing more examinations per week did not have higher RACE scores. Improved HUD access and lectures without additional feedback may not improve POCUS mastery.

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