Knowledge

Ultrasound Devices

Handheld vs Cart-based Ultrasound

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The lower costs and increased portability of handheld or pocket-sized ultrasound devices can have potential to improve the accessibility of medical imaging for all - especially at the point-of-care. Pocket-sized ultrasound has shown promise for reducing time to diagnosis, for validating working diagnoses, and for facilitating procedures while reducing exposure to radiation. While growing evidence generally supports the idea that pocket-sized ultrasound devices are "comparable" or in "good overall agreement" with traditional, cart-based ultrasound devices, more work could be done to develop guidelines for use and validate use in clinical and educational settings.


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Potential Impacts: B-lines

Publication

Platz, E., Pivetta, E., Merz, A.A., Peck, J., Rivero, J., & Cheng, S. (2015). Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure. The American Journal of Emergency Medicine, 33(11), 1552-1556.

Key Findings

  • Neither the 4-zone or 8-zone protocols demonstrated a significant difference in number of B-lines detected between pocket ultrasound and high-end ultrasound (mean difference of 0.3 B-lines and 0.6 B-lines for 4-zone and 8-zone, respectively) in 2 second clips
  • B-line counts tended to increase with clip duration (from 2-, 4- and 6- second clips) on high-end ultrasound machines

Paper Implications

  • Clip duration may have a greater impact on ability to count B-lines than image quality between pocket-sized ultrasound device and high-end ultrasound device
  • It is likely that the longer the clip duration, the greater the number of B-lines detected


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Potential Impacts: Diagnostic Practice

Publication

Dalen, H., Gunderson, G.H., skjetne, K., Haug, H.H., Kleinau, J.O., Norekval, T.M., & Graven, T. (2015). Feasibility and reliability of pocket-size ultrasound examinations of the pleural cavities and vena cava inferior performed by nurses in an outpatient heart failure clinic. European Journal of Cardiovascular Nursing, 14(4), 286–293.

Key Findings

  • Using diagnosis from a cardiologist with a high-end cart-based ultrasound as a baseline, two specialized nurses using pocket-sized ultrasound devices demonstrated sensitivity and specificity of 92% and 99%, respectively, for any pleural effusion and sensitivity and specificity of 93% and 100%, respectively, for significant pleural effusion in patients with heart failure 
  • The correlation between findings of both nurses for pleural effusion in both cavities was 0.96

Paper Implications

  • Pocket-sized ultrasound devices can be a reasonable adjunct to physical exam by trained individuals in an outpatient clinic

Publication

Torbjørn Graven, Alexander Wahba, Anne Marie Hammer, Ove Sagen, Øystein Olsen, Kyrre Skjetne, Jens Olaf Kleinau & Havard Dalen. (2015). Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery. Scandinavian Cardiovascular Journal, 49:1, 56-63.

Key Findings

  • Findings using a pocket-sized ultrasound device showed a 0.81 correlation to diagnosis made by a high-end cart-based ultrasound for pleural effusion (formal diagnosis)
  • Findings using chest x-ray showed a 0.21 correlation to diagnosis made by a high-end cart-based ultrasound for pleural effusion (formal diagnosis)

Paper Implications

  • Despite the suboptimal image quality in images obtained from patients soon after cardiac surgery, pocket-sized ultrasound has potential for detecting potential complications post-surgery
  • Pocket-sized ultrasound performs better than chest x-ray for detecting pleural effusion in patients soon after cardiac surgery