scholarly journals The Role and Challenges of Clinical Imaging During COVID-19 Outbreak

2021 ◽  
pp. 875647932110569
Author(s):  
Mustafa Alhasan ◽  
Mohamed Hasaneen
Keyword(s):  
Infection Control ◽  
Imaging Modality ◽  
Point Of Care ◽  
Limiting Factors ◽  
Disease Stage ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Signal Loss ◽  
Clinical Utilization ◽  
Precautionary Measures

Objective: The Radiology department played a crucial role in detecting and following up with the COVID-19 disease during the pandemic. The purpose of this review was to highlight and discuss the role of each imaging modality, in the radiology department, that can help in the current pandemic and to determine the challenges faced by staff and how to overcome them. Materials and Methods: A literature search was performed using different databases, including PubMed, Google scholar, and the college electronic library to access 2020 published related articles. Results: A chest computed tomogram (CT) was found to be superior to a chest radiograph, with regards to the early detection of COVID-19. Utilizing lung point of care ultrasound (POCUS) with pediatric patients, demonstrated excellent sensitivity and specificity, compared to a chest radiography. In addition, lung ultrasound (LUS) showed a high correlation with the disease severity assessed with CT. However, magnetic resonance imaging (MRI) has some limiting factors with regard to its clinical utilization, due to signal loss. The reported challenges that the radiology department faced were mainly related to infection control, staff workload, and the training of students. Conclusion: The choice of an imaging modality to provide a COVID-19 diagnosis is debatable. It depends on several factors that should be carefully considered, such as disease stage, mobility of the patient, and ease of applying infection control procedures. The pros and cons of each imaging modality were highlighted, as part of this review. To control the spread of the infection, precautionary measures such as the use of portable radiographic equipment and the use of personal protective equipment (PPE) must be implemented.

scholarly journals The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Pourmand ◽  
U. Dimbil ◽  
A. Drake ◽  
H. Shokoohi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Imaging Modality ◽  
Point Of Care ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Short Term ◽  
Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

Point-of-care ultrasound in a multiplace hyperbaric chamber

2021 ◽  
pp. 221-226
Author(s):  
Kirsten Hornbeak ◽  
◽  
Jay Duchnick ◽  
Anthony Medak ◽  
Peter Lindholm ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Electronic Devices ◽  
Point Of Care Ultrasound ◽  
Clinical Settings ◽  
Proof Of Concept ◽  
Safety Standards ◽  
Patient Assessments ◽  
Hyperbaric Environment ◽  
Hbo2 Therapy

Historically, electronic devices have been generally prohibited during hyperbaric oxygen (HBO2) therapy due to risk of fire in a pressurized, oxygen-rich environment. Point-of-care ultrasound (POCUS), however, has emerged as a useful imaging modality in diverse clinical settings. Hyperbaric chambers treating critically ill patients would benefit from the application of POCUS at pressure to make real-time patient assessments. Thus far, POCUS during HBO2 therapy has been limited due to required equipment modifications to meet safety standards. Here we demonstrate proof of concept, safety, and successful performance of an off-the-shelf handheld POCUS system (SonoSite iViz) in a clinical hyperbaric environment without need for modification.

Paediatric ultrasound

2019 ◽  
pp. 217-224
Author(s):  
Jason Fischer ◽  
Lianne McLean
Keyword(s):  
Critical Care ◽  
Abdominal Pain ◽  
Pyloric Stenosis ◽  
Imaging Modality ◽  
Point Of Care ◽  
Adult Patients ◽  
Point Of Care Ultrasound ◽  
Lung Pathology ◽  
Skull Fractures ◽  
Body Habitus

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.

scholarly journals MP035: Point-of-care-ultrasound to diagnose appendicitis in a Canadian emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S78-S78
Author(s):  
S. Sharif ◽  
S. Skitch ◽  
D. Vlahaki ◽  
A. Healey
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Fellowship Training ◽  
Point Of Care Ultrasound ◽  
Suspected Appendicitis ◽  
Test Characteristics ◽  
Resident Physicians ◽  
Definitive Management ◽  
Surgical Condition

Introduction: Appendicitis is a common surgical condition that frequently requires patients to undergo diagnostic imaging. Abdominal computed tomography is the gold standard imaging technique for the diagnosis of appendicitis, but exposes patients to radiation. Ultrasound offers an alternate radiation-free imaging modality for appendicitis. However, the availability of ultrasound during off-hours is limited in many Emergency departments (EDs). Clinician performed point-of-care ultrasound (POCUS) is increasingly used by emergency physicians as a bedside tool to evaluate suspected appendicitis. The purpose of this study is to evaluate the test characteristics of emergency physician performed POCUS to diagnose appendicitis in a Canadian ED. Methods: A pragmatic, retrospective chart review was performed on all patients for whom a POCUS was performed to diagnose appendicitis at St. Joseph’s Healthcare Hamilton in Ontario from December 1, 2010 to December 4, 2015. All POCUS scans were performed by physicians with Registered Diagnostic Medical Sonographer (RDMS) credentials or resident physicians undergoing POCUS fellowship training. All scans were over-read by RDMS credentialed faculty and subject to a rigorous quality assurance (QA) process. POCUS findings and patient outcomes were reported. Results: A total of 90 patients were included in the study. 24 patients were diagnosed with appendicitis on POCUS. Ultimately, 18 were diagnosed with appendicitis through formal imaging, laparoscopy, and pathology. The sensitivity and specificity for POCUS to diagnose appendicitis was found to be 69.2% (95% CI, 48.1%-84.9%) and 90.6% (95% CI, 80.0%-96.1%) respectively. Conclusion: Bedside ultrasound is a reliable imaging modality for ruling in acute appendicitis. In cases where POCUS is negative or indeterminate for appendicitis, further imaging should be obtained as clinical suspicion warrants. The use of POCUS has the potential to reduce patient exposure to ionizing radiation and decrease the costs of obtaining CT scans, while hastening the process of achieving definitive management through earlier surgical consultation.

scholarly journals Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 42-44
Author(s):  
Sara Urquhart ◽  
Kendall Stevens ◽  
Mariah Barnes ◽  
Matthew Flannigan
Keyword(s):  
Emergency Department ◽  
Random Sample ◽  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Tertiary Care Medical Center ◽  
Time To Diagnosis ◽  
Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

scholarly journals Canadian Internal Medicine Ultrasound (CIMUS) Recommendations Regarding Internal Medicine Point-of-Care Ultrasound (POCUS) use during Coronavirus (COVID-19) Pandemic

2020 ◽  
Vol 15 (2) ◽  
pp. 8-11 ◽  
Author(s):  
Irene WY Ma ◽  
Ranjani Somayaji ◽  
Elissa Rennert-May ◽  
Joseph Minardi ◽  
Michael H Walsh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infection Control ◽  
Point Of Care ◽  
Contextual Factors ◽  
Point Of Care Ultrasound ◽  
Clinical Environment ◽  
High Level ◽  
Infection Control Guidelines ◽  
Cleaning And Disinfection ◽  
Do So

With the COVID-19 pandemic, we are in unprecedented times - our clinical environment is changing rapidly and may continue to do so in the future. Over the last decade there has been an increased support for the use of internal medicine point-of-care ultrasound (POCUS) across the country and worldwide. While standard infection control guidelines are available on device and tranducer cleaning and disinfection, these recommendations may not apply during the COVID-19 pandemic. While we anticipate that the experience and need for POCUS deployment will differ across the country depending on several contextual factors, similar principles will likely emerge across multiple settings. To that end, to enable POCUS readiness, we recommend that each program/ practice site consider undertaking the following steps and recommendations on a semi-urgent basis if POCUS use is anticipated. The objective of this article to provide internists who currently use POCUS with the interim recommendations on processes that need to be in place prior to its use. This document refers primarily to the non-critical use of ultrasound devices based on the Spaulding classification6 (see Appendix for definitions) and does not apply to the setting of critical use where sterilization is required, nor semi-critical use, where high-level disinfection is required. Each institution must have its own policy in place on the cleaning and disinfection procedures for POCUS. This doucument is meant to serve as an adjunct to existing protocols.

scholarly journals Point of care ultrasound in disaster triage

2017 ◽  
Vol 86 (1) ◽  
pp. 38-39
Author(s):  
Brandon Chau ◽  
Gayathri Sivakumar
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Accurate Method ◽  
Point Of Care Ultrasound ◽  
Life Threatening ◽  
Intraperitoneal Bleeding ◽  
Ultrasound Technology ◽  
Fast Exam ◽  
Disaster Scenario ◽  
The Military

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.

Training Requirements for Point of Care Ultrasound in Acute Medicine

2010 ◽  
Vol 9 (2) ◽  
pp. 87-90
Author(s):  
S M Ismaeel ◽  
◽  
N J Day ◽  
D Earnshaw ◽  
J W Lorains ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Predictive Value ◽  
Point Of Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Acute Medicine ◽  
Training Requirements ◽  
The Mean ◽  
High Level

The aim of the study was to explore the ultrasound training requirements in acute medicine by comparing the ultrasound skill of an acute medicine trainee (AMT) with that of the radiology department following short ultrasound training. Results: 43 participants (34 males and 9 females).The mean age was 58 (range 20-93 years). Liver: AMT reported 15/17 as normal (Specificity 88%) and diagnosed ascites in 100% (NPV 93%). Gallbladder: There was 100% sensitivity and NPV for excluding gallstone. CBD: Sensitivity and specificity of 83 and 95% for dilated CBD (NPV 95%). Kidneys: AMT identified 100% of normal kidneys. Spleen: Splenomegaly diagnosed with 95% specifity and NPV. Conclusion: The AMT achieved a high level of accuracy in diagnosing and excluding gallstone, dilated CBD, ascites and splenomegaly. CBD = Common Bile Duct, NPV=Negative Predictive Value.

scholarly journals Identification of Hollow Viscus Injury with FAST Examination in Kurdistan, Iraq

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ruj Al-Sindy ◽  
Heleen Alaqrawy ◽  
Mahmood Sh. Hafdullah ◽  
Christine Butts
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Organ Injury ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
Solid Organ ◽  
Hollow Viscus ◽  
Northern Iraq ◽  
Hollow Viscus Injury ◽  
Fast Exam

Point-of-care ultrasound has become indispensable in the evaluation of trauma, particularly in low resource areas, where it may be the only rapidly available imaging modality. The FAST (Focused Assessment with Sonography in Trauma) in particular can be lifesaving, by rapidly detecting signs of intra-abdominal hemorrhage. However, the FAST is primarily designed to identify free fluid associated with solid organ injury and is thought to have less sensitivity and power in identifying evidence of hollow viscus injury. We present a case of an unidentified man that presented to a hospital in the Kurdistan region of northern Iraq, a region of low resources, surrounded by war. The FAST exam proved to be the key to identifying this patient’s injuries.

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