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Lerchbaumer MH, Perschk M, Gwinner C. [Ultrasound in sports traumatology]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:89-99. [PMID: 38781978 DOI: 10.1055/a-2267-1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Ultrasound (US) has numerous applications in sports traumatology. The technical progress of mobile US devices has led to increasing use of ultrasound as a primary diagnostic tool. New applications such as elastography and 3 D vascularization are used for special indications.The purpose of this review is to present the current status of ultrasound in the diagnosis of sports injuries and sport traumatology including established applications and new technical advances. US is presented both in its comparison to other imaging modalities and as a sole diagnostic tool.US can be used for initial diagnosis to improve the clinical examination and for intensive shortterm follow-up imaging. The main areas of application are currently the diagnosis of acute muscle and tendon injuries as well as overuse injuries. In particular, the exclusion of structural muscle injuries can be adequately ensured with US in the majority of anatomical regions. The recently published guideline on fracture ultrasound has strengthened the clinical evidence in this area, especially in comparison to conventional radiography and in the development of algorithms and standards. The increasing use of mobile ultrasound equipment with adequate image quality makes US a location-independent modality that can also be used at training sites or during road games.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Clemens Gwinner
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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Providência R, Aali G, Zhu F, Katairo T, Ahmad M, Bray JJH, Pelone F, Khanji MY, Marijon E, Cassandra M, Celermajer DS, Shokraneh F. Handheld echocardiography for the screening and diagnosis of rheumatic heart disease: a systematic review to inform WHO guidelines. Lancet Glob Health 2024; 12:e983-e994. [PMID: 38762298 DOI: 10.1016/s2214-109x(24)00127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic role. Standard echocardiography might not be feasible in high-prevalence regions due to its high cost, complexity, and time requirement. Handheld echocardiography might be an easy-to-use, low-cost alternative, but its performance in screening for and diagnosing acute rheumatic fever and rheumatic heart disease needs further investigation. METHODS In this systematic review and meta-analysis, we searched Embase, MEDLINE, LILACS, and Conference Proceedings Citation Index-Science up to Feb 9, 2024, for studies on the screening and diagnosis of acute rheumatic fever and rheumatic heart disease using handheld echocardiography (index test) or standard echocardiography or auscultation (reference tests) in high-prevalence areas. We included all studies with useable data in which the diagnostic performance of the index test was assessed against a reference test. Data on test accuracy in diagnosing rheumatic heart disease, acute rheumatic fever, or carditis with acute rheumatic fever (primary outcomes) were extracted from published articles or calculated, with authors contacted as necessary. Quality of evidence was appraised using GRADE and QUADAS-2 criteria. We summarised diagnostic accuracy statistics (including sensitivity and specificity) and estimated 95% CIs using a bivariate random-effects model (or univariate random-effects models for analyses including three or fewer studies). Area under the curve (AUC) was calculated from summary receiver operating characteristic curves. Heterogeneity was assessed by visual inspection of plots. This study was registered with PROSPERO (CRD42022344081). FINDINGS Out of 4868 records we identified 11 studies, and two additional reports, comprising 15 578 unique participants. Pooled data showed that handheld echocardiography had high sensitivity (0·87 [95% CI 0·76-0·93]), specificity (0·98 [0·71-1·00]), and overall high accuracy (AUC 0·94 [0·84-1·00]) for diagnosing rheumatic heart disease when compared with standard echocardiography (two studies; moderate certainty of evidence), with better performance for diagnosing definite compared with borderline rheumatic heart disease. High sensitivity (0·79 [0·73-0·84]), specificity (0·85 [0·80-0·89]), and overall accuracy (AUC 0·90 [0·85-0·94]) for screening rheumatic heart disease was observed when pooling data of handheld echocardiography versus standard echocardiography (seven studies; high certainty of evidence). Most studies had a low risk of bias overall. Some heterogeneity was observed for sensitivity and specificity across studies, possibly driven by differences in the prevalence and severity of rheumatic heart disease, and level of training or expertise of non-expert operators. INTERPRETATION Handheld echocardiography has a high accuracy and diagnostic performance when compared with standard echocardiography for diagnosing and screening of rheumatic heart disease in high-prevalence areas. FUNDING World Health Organization. TRANSLATIONS For the Chinese, French, Italian, Persian, Portuguese, Spanish and Urdu translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Rui Providência
- Genes Health and Social Care Evidence Synthesis Unit, Institute of Health Informatics, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Ghazaleh Aali
- Cochrane Heart, Institute of Health Informatics, University College London, London, UK
| | - Fang Zhu
- Systematic Review Consultants, Nottingham, UK
| | | | - Mahmood Ahmad
- Genes Health and Social Care Evidence Synthesis Unit, Institute of Health Informatics, University College London, London, UK; Cardiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Jonathan J H Bray
- Genes Health and Social Care Evidence Synthesis Unit, Institute of Health Informatics, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ferruccio Pelone
- Genes Health and Social Care Evidence Synthesis Unit, Institute of Health Informatics, University College London, London, UK
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Eloi Marijon
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Miryan Cassandra
- Cardiology Department, Hospital Dr Ayres de Menezes, São Tomé, São Tomé and Príncipe
| | - David S Celermajer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Farhad Shokraneh
- Genes Health and Social Care Evidence Synthesis Unit, Institute of Health Informatics, University College London, London, UK; Systematic Review Consultants, Nottingham, UK
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Healy J, Tzeng CFT, Wolfshohl J, Shedd A, Lin J, Patel C, Chou EH. Point-of-Care Ultrasound in the Emergency Department: Training, Perceptions, Applications, and Barriers from Different Healthcare Professionals. J Acute Med 2024; 14:74-89. [PMID: 38859928 PMCID: PMC11163417 DOI: 10.6705/j.jacme.202406_14(2).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 06/12/2024]
Abstract
Background Point-of-care ultrasound (POCUS) is a valuable tool that assists in diagnosis and management of patients in the emergency department (ED) while being cost-efficient and without the use of ionizing radiation. To discern the opinions and perceptions of ED staff about POCUS applications and barriers, we conducted a cross-sectional survey of employees of 12 EDs in North Texas. Methods Participants completed a 20-item online survey about POCUS with questions pertaining to four domains: (1) employee and training information, (2) perceived benefits, (3) common applications, and (4) barriers to use. Out of 805 eligible ED employees, 103 completed the survey (16.1% response rate). Results The results indicated a generally positive perception of POCUS among all employee types. Physician had significant exposure and training of POCUS than non-physician group ( p < 0.001). Physicians tend to find cardiac assessments more useful for clinical management than non-physicians (47% vs. 23%, p = 0.01), while non-physicians find soft tissue/abscess assessments more useful (27% vs. 9%, p = 0.01). Conclusion The most significant barriers to POCUS use were time constraints for physicians and a lack of training for non-physician employees. Our study provides valuable insights into the perceptions of multiple ED professionals, serving as a foundation for promoting POCUS use in the ED.
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Affiliation(s)
- Jack Healy
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
- Texas Christian University Burnett School of Medicine Fort Worth USA
| | | | - Jon Wolfshohl
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Andrew Shedd
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Judy Lin
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Chinmay Patel
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Eric H Chou
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
- Baylor University Medical Center Department of Emergency Medicine Dallas USA
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Moran CM, McLeod C, Inglis S, Pye SD. An Assessment of the Imaging Performance of Hand-Held Ultrasound Scanners Using the Edinburgh Pipe Phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00174-1. [PMID: 38705784 DOI: 10.1016/j.ultrasmedbio.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Although hand-held ultrasound devices (HHUSDs) are currently used for a diverse range of diagnostic and interventional applications the imaging performance of such scanners is rarely considered. The aim of this study was to assess the imaging performance of a wide-range of HHUSDs and compare their imaging performance to cart-based systems utilized for the same clinical applications. METHODS The grayscale imaging performances of 19 HHUSDs from eight different manufacturers, manufactured between 2016 and 2021, were measured using a figure-of-merit known as the resolution integral. The imaging performance of the HHUSDs were compared to 142 cart-based ultrasound scanners. RESULTS The HHUSD with the overall highest resolution integral (66) was a Butterfly (Burlington, MA, USA) wired phased array for small parts applications, followed by a Philips (Bothell, WA, USA) Lumify wired curvilinear transducer (57) for abdominal applications, a Butterfly wired phased array (56) for abdominal applications, a GE (Freiburg, Baden-Wurttemberg, Germany) VScan Air wireless linear array (56) for small parts applications, and a Healcerion (Seoul, Korea) Sonon 300L wireless linear array (56) for small parts applications. A GE VScan Extend wired phased array had the highest resolution integral (44) for cardiac applications. CONCLUSIONS The Butterfly phased array had the highest resolution integral of all the 19 HHUSDs, although this value is still less than the majority of cart-based cardiac and abdominal ultrasound scanners manufactured from 2010 to 2017. Clinical users of HHUSDs should be mindful of the limitations in imaging performance of hand-held ultrasound devices.
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Affiliation(s)
- Carmel M Moran
- University-BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK.
| | | | | | - Stephen D Pye
- University-BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
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Firima E, Gonzalez L, Manthabiseng M, Bane M, Lukau B, Leigh B, Kaufmann BA, Weisser M, Amstutz A, Tromp J, Labhardt ND, Burkard T. Implementing focused echocardiography and AI-supported analysis in a population-based survey in Lesotho: implications for community-based cardiovascular disease care models. Hypertens Res 2024; 47:708-713. [PMID: 38228749 PMCID: PMC10912015 DOI: 10.1038/s41440-023-01559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
In settings where access to expert echocardiography is limited, focused echocardiography, combined with artificial intelligence (AI)-supported analysis, may improve diagnosis and monitoring of left ventricular hypertrophy (LVH). Sixteen nurses/nurse-assistants without prior experience in echocardiography underwent a 2-day hands-on intensive training to learn how to assess parasternal long axis views (PLAX) using an inexpensive hand-held ultrasound device in Lesotho, Southern Africa. Loops were stored on a cloud-drive, analyzed using deep learning algorithms at the University Hospital Basel, and afterwards confirmed by a board-certified cardiologist. The nurses/nurse-assistants obtained 756 echocardiograms. Of the 754 uploaded image files, 628 (83.3%) were evaluable by deep learning algorithms. Of those, results of 514/628 (81.9%) were confirmed by a cardiologist. Of the 126 not evaluable by the AI algorithm, 46 (36.5%) were manually evaluable. Overall, 660 (87.5%) uploaded files were evaluable and confirmed. Following short-term training of nursing cadres, a high proportion of obtained PLAX was evaluable using AI-supported analysis. This could be a basis for AI- and telemedical support in hard-to-reach areas with minimal resources.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Beat A Kaufmann
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
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Shekarriz P, Hosseini F, Shojaee P. Ultrasound assessment of the nose vasculature: A review of the common method of non-surgical filler-based rhinoplasty. J Cosmet Dermatol 2024; 23:731-736. [PMID: 37846655 DOI: 10.1111/jocd.16037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND With the increasing use of dermal injectable fillers in aesthetic medicine, the popularity of non-surgical filler-based rhinoplasty (NSR) is also growing. While performing this procedure might result in certain vascular complications, injecting deep into the midline of the nose is commonly considered the safest method for blind primary NSR. AIMS In this study, we challenged the common NSR method with a Doppler ultrasound study of the nose. PATIENTS/METHODS The vascular pattern of the common zones of the NSR procedure (radix and nasal tip) of 21 Iranian women were investigated by using a 14 MHz Doppler handheld ultrasound device (Silarious L14PS). Participants had never undergone any procedure on their nose. We focused on the depth of midline vessels in the radix and nasal tip. The radix was studied sagittally and horizontally, and the nasal tip was examined axially by ultrasound. RESULTS In the radix of eight cases (38%), at least one vessel was observed at midline, and all were superficial. In the nose tip of 18 cases (86%), at least one vessel was observed at midline, and 9 out of these 18 vessels (50%) were deep. As a result, conducting NSR by the common method in our study population was relatively safe in the radix, but there was an increased likelihood of vascular events in the tip. CONCLUSION Our research results show that while the common method of the NSR may carry a high risk of vascular events, the safety of this procedure could be enhanced by using ultrasound for planning and conducting a tailored treatment.
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Park KE, Mehta P, Tran C, Parikh AO, Zhou Q, Zhang-Nunes S. A comparison of five point-of-care ultrasound devices for use in ophthalmology and facial aesthetics. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:28-35. [PMID: 38314019 PMCID: PMC10836224 DOI: 10.1177/1742271x231166895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 02/06/2024]
Abstract
Introduction Point-of-care ultrasound is becoming increasingly popular, and we sought to examine its role in evaluating ocular and periocular structures and facial vasculature. With the large number of point-of-care ultrasound devices available, it is difficult to determine which devices may be best suited for ophthalmic and facial aesthetic applications. This study compares five popular handheld point-of-care ultrasound devices to help guide clinicians in choosing the device best suited for their needs. Methods We compared five point-of-care ultrasound devices: Butterfly IQ+ (Butterfly, Burlington, MA), L15 (Clarius Mobile Health, Vancouver, British Columbia, Canada), L20 (Clarius Mobile Health, Vancouver, British Columbia, Canada), Lumify (Philips, Amsterdam, Netherlands) and Vscan Air (GE, Boston, MA). Three ophthalmologists obtained the following views on three volunteers: eight arteries, four ocular and periocular structures and areas of filler injections. The image quality of each view was graded on a four-point Likert-type scale. In addition, graders filled out a survey. The data were analysed using analysis of variance tests with the significance level set to p < 0.05. Results In terms of overall image quality, the L20 received the highest mean rating, followed by the L15, Vscan Air, Butterfly IQ+ and the Lumify (p < 0.05). With further stratification for structure type, the L20 was ranked first for filler, artery and orbital imaging (p < 0.05). Conclusions The L20 received the highest image quality rankings. While image quality is an important aspect of point-of-care ultrasound device selection, other factors such as cost, wireless capabilities, range of presets and battery life should also be considered.
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Affiliation(s)
| | - Preeya Mehta
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Charlene Tran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alomi O Parikh
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Qifa Zhou
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sandy Zhang-Nunes
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Johnson JI, Beasley H, Southwick D, Lords AM, Kessler R, Vrablik ME, Baker RT. Development of a hybrid point-of-care ultrasound curriculum for first year medical students in a rural medical education program: a pilot study. BMC MEDICAL EDUCATION 2024; 24:16. [PMID: 38172848 PMCID: PMC10765644 DOI: 10.1186/s12909-023-05005-6] [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: 08/25/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The field of point-of-care ultrasound (POCUS) has advanced in recent decades due to the benefits it holds for medical providers. However, aspiring POCUS practitioners require adequate training. Unfortunately, there remains a paucity of resources to deliver this training, particularly in rural and underserved areas. Despite these barriers, calls for POCUS training in undergraduate medical education are growing, and many medical schools now deliver some form of POCUS education. Our program lacked POCUS training; therefore, we developed and implemented a POCUS curriculum for our first-year medical students. METHODS We developed a POCUS curriculum for first year medical students in a rural medically underserved region of the United States. To evaluate our course, we measured learning outcomes, self-reported confidence in a variety of POCUS domains, and gathered feedback on the course with a multi-modal approach: an original written pre- and post-test, survey tool, and semi-structured interview protocol, respectively. RESULTS Student (n=24) knowledge of POCUS significantly increased (pre-test average score = 55%, post-test average score = 79%, P<0.0001), and the course was well received based on student survey and interview feedback. In addition, students reported increased confidence toward a variety of knowledge and proficiency domains in POCUS use and their future clinical education and practice. CONCLUSIONS Despite a lack of consensus in POCUS education, existing literature describes many curricular designs across institutions. We leveraged a combination of student initiatives, online resources, remote collaborations, local volunteers, and faculty development to bring POCUS to our institution in a rural and medically underserved region. Moreover, we demonstrate positive learning and experiential outcomes that may translate to improved outcomes in students' clinical education and practice. Further research is needed to evaluate the psychomotor skills, broader learning outcomes, and clinical performance of students who take part in our POCUS course.
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Affiliation(s)
- Joshua I Johnson
- WWAMI Medical Education Program, University of Idaho, Moscow, Idaho, USA.
- University of Washington School of Medicine, Seattle, Washington, USA.
| | - Heather Beasley
- WWAMI Medical Education Program, University of Idaho, Moscow, Idaho, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Derek Southwick
- WWAMI Medical Education Program, University of Idaho, Moscow, Idaho, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Allie M Lords
- WWAMI Medical Education Program, University of Idaho, Moscow, Idaho, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Ross Kessler
- University of Washington School of Medicine, Seattle, Washington, USA
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Michael E Vrablik
- University of Washington School of Medicine, Seattle, Washington, USA
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Russell T Baker
- WWAMI Medical Education Program, University of Idaho, Moscow, Idaho, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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Teira Calderón A, Levine M, Ruisánchez C, Serrano D, Catoya S, Llano M, Lerena P, Cuesta JM, Fernández-Valls M, González Vilchez F, de la Torre Hernández JM, García-García HM, Vazquez de Prada JA. Clinical comparison of a handheld cardiac ultrasound device for the assessment of left ventricular function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:55-64. [PMID: 37882957 DOI: 10.1007/s10554-023-02979-8] [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: 04/26/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assessed by a moderately experienced sonographer using an HHUD compared to the routine LVEF assessment performed at the Echocardiography Laboratory. METHODS This was a prospective single center study which enrolled 120 adult inpatients and outpatients referred for a comprehensive Echocardiography (EC). RESULTS The mean age of the patients was 69.9 ± 12.5 years. There were 47 females (39.2%). The R-squared was r 0.94 (p < 0.0001) and the ICC was 0.93 (IC 95% 0.91-0.95, p ≤ 0.0001). The Bland-Altman plot showed limits of agreement (LOA): Upper LOA 10.61 and Lower LOA - 8.95. The overall agreement on the LVEF assessment when it was stratified as "normal" or "reduced" was 89.1%, with a kappa of 0.77 (p < 0.0001). When the LVEF was classified as "normal", "mildly reduced", "moderately reduced", or "severely reduced," the kappa was 0.77 (p < 0.0001). The kappa between the HHUD EC and the comprehensive EC for the detection of RWMAs in the territories supplied by the LAD, LCX and RCA was 0.85, 0.73 and 0.85, respectively. CONCLUSION With current HHUD, an averagely experienced operator can accurately bedside visual estimate the LVEF. This may facilitate the incorporation of this technology in daily clinical practice improving the management of patients.
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Affiliation(s)
- Andrea Teira Calderón
- Hospital Universitari i Politécnic La Fe, Valencia (Valencia), España.
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España.
| | - Molly Levine
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Cristina Ruisánchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - David Serrano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Santiago Catoya
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Miguel Llano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Piedad Lerena
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - José María Cuesta
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Mónica Fernández-Valls
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Francisco González Vilchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Jose María de la Torre Hernández
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Héctor M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jose Antonio Vazquez de Prada
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
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11
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Greiner B, Kaiser U, Hammer S, Platz Batista da Silva N, Stroszczynski C, Jung EM. Comparison of wireless handheld ultrasound and high-end ultrasound in pediatric patients with venous malformations - First results. Clin Hemorheol Microcirc 2024; 86:121-131. [PMID: 37638426 DOI: 10.3233/ch-238106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
AIM To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs). MATERIAL AND METHODS 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus. RESULTS 10 patients (4-17 years; 10.0±4.32 years; female n = 6, male n = 4) with 10 VMs (4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality. CONCLUSION Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs.
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Affiliation(s)
- Barbara Greiner
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Simone Hammer
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | | | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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12
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Greiner B, Kaiser U, Maurer K, Stroszczynski C, Jung EM. Wireless handheld ultrasound for internal jugular vein assessment in pediatric patients. Clin Hemorheol Microcirc 2024; 86:441-449. [PMID: 37980654 DOI: 10.3233/ch-231981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Rapid evolution of ultrasound technology has allowed widespread use of handheld ultrasound devices (HHUDs) for many possible applications. Along with the adult population, the use of HHUDs for Point of Care Ultrasound (POCUS) in pediatric medicine has been increasing over the last few years. However, pediatric-specific literature is still scarce on mobile vascular ultrasound. OBJECTIVE To evaluate diagnostic capabilities of Vscan Air™ in comparison with high-end ultrasound for the assessment of the internal jugular vein in children and adolescents. METHODS 42 Internal Jugular Veins (IJVs) of 21 pediatric patients were scanned by an experienced examiner using a WLAN-supported handheld ultrasound device (Vscan Air™) and high-end cart-based ultrasound (LOGIQ E9) as reference. B-Mode and Color-coded Doppler (CCDS) were performed and compared. Image quality was assessed using a score of 0 to 5 and statistically analyzed. Results were interpreted independently by two readers in consensus. RESULTS 21 patients (2-17 years; mean 11,00±4,5 years; female n = 11, male n = 10) were examined. The rating score never dropped below 3 for both devices. The median score evaluation of B-Mode and CCDS for the high-end device was 5.00, of Vscan Air™ 5.00 for B-Mode and 4.00 for CCDS. A significant difference was shown between the two devices in the evaluation of CCDS. CONCLUSIONS Vscan Air™ ultrasound device allows sufficient assessability of the IJV in pediatric patients, opening up new possibilities for fast and mobile POCUS of cervical veins and potential guidance of central venous catheter placement.
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Affiliation(s)
- Barbara Greiner
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Maurer
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Gómez-Álvarez U, de la Fuente-Mancera JC, Antonio-Villa NE, Álvarez-Sangabriel A, Guizar-Sánchez CA, Tenorio-Bautista F. Experience with the Kosmos ultrasonographic tool in the approach and treatment of ambulatory patients of a heart failure clinic: a single-center cross-sectional study. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:79-85. [PMID: 38507324 PMCID: PMC11160521 DOI: 10.24875/acm.22000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/29/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND In Mexico, the epidemiology of heart failure is still not well understood. However, it is known that the primary cause of hospital admissions in patients with heart failure is pulmonary and systemic congestion. OBJECTIVE To estimate congestion status and assess cardiac function using portable ultrasound in patients with heart failure. METHOD A cross-sectional observational study was conducted. Patients who attended the Heart Failure Clinic at the Ignacio Chávez National Cardiology Institute in Mexico City between May and August 2022 were selected. They underwent ultrasonographic evaluation using a portable device to assess pulmonary and systemic congestion, as well as cardiac function and structure. RESULTS One-hundred patients diagnosed with heart failure were prospectively included during the study period; 76% were male, with an average age of 59 years (range: 50-68 years). The recorded LVEF median was 34% (IQR: 27-43.5%). When evaluating pulmonary congestion, 78% of the patients showed a pattern A and 22% a pattern B. Following the VExUS protocol, 92% of the patients were at grade 0, 2% at grade 1, and 6% at grade 2. CONCLUSIONS The use of the portable ultrasound facilitated the quantitative characterization of the echocardiographic features of the studied population. This device could provide better clinical characterization which, in turn, might allow for optimized drug prescription for heart failure and dose adjustments of diuretics based on echocardiographic congestion findings.
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Affiliation(s)
- Ulises Gómez-Álvarez
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan C. de la Fuente-Mancera
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Neftali E. Antonio-Villa
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Amada Álvarez-Sangabriel
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Carlos A. Guizar-Sánchez
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Fernando Tenorio-Bautista
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Jung EM, Jung F, Dong Y, Kaiser U. Initial description of the novel handheld wireless ultrasound device TE Air with Doppler and Color Duplex imaging. Clin Hemorheol Microcirc 2024; 86:89-97. [PMID: 37574725 PMCID: PMC10894582 DOI: 10.3233/ch-238100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To test and initially describe a new handheld wireless ultrasound technique (TE Air) for clinical use. METHODS In this pilot study, the new ultrasound device TE Air from Mindray was used to examine the hepatic and renal vessels of healthy volunteers for first impressions. The probe has a sector transducer with a frequency range of 1.8-4.5 MHz. The B-mode and color-coded doppler sonography (CCDS) scanning methods were used. A high-end device from the same company (Resona 9, Mindray) was used as a reference. The results were evaluated using an image rating scale ranging from 0 to 5, with 0 indicating not assessable and 5 indicating without limitations. RESULTS Altogether, 61 participants (n = 34 female [55.7%], n = 27 male [44.3%]), age range 18-83 years, mean age 37.9±16.5 years) could be adequately studied using TE AIR and the high-end device. With one exception, the image quality score for TE Air never fell below 3 and had a mean/median scored of 4.97/5.00 for the B-mode, 4.92/5.00 for the color flow (CF) mode, and 4.89/5.00 for the pulse wave (PW) mode of the hepatic vein, 4.90/5.00 for the portal vein, 4.11/4.00 for the hepatic artery, and 4.57/5.00 for the renal segmental artery. A significant difference in the assessment of flow measurement of the hepatic artery and renal segmental arteries was found between TE AIR and the high-end device. CONCLUSIONS TE Air represents a new dimension in point-of-care ultrasound via wireless handheld devices. Especially, its flow measurement ability offers a relevant advantage over other available handheld models. TE Air provides a formally sufficient image quality in terms of diagnostic significance.
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Affiliation(s)
- Ernst Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Friedrich Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - Yi Dong
- Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
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Weimer JM, Beer D, Schneider C, Yousefzada M, Gottwald M, Züllich TF, Weimer A, Jonck C, Buggenhagen H, Kloeckner R, Merkel D. Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices-A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive Care. Diagnostics (Basel) 2023; 14:54. [PMID: 38201363 PMCID: PMC10795594 DOI: 10.3390/diagnostics14010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the use of handheld ultrasonography (HHUS) devices is well established in prehospital emergency diagnostics, as well as in intensive care settings. This is based on several studies in which HHUS devices were compared to conventional high-end ultrasonography (HEUS) devices. Nonetheless, there is limited evidence regarding potential variations in B-scan quality among HHUS devices from various manufacturers, and regarding whether any such differences hold clinical significance in intensive care medicine settings. METHODS this study included the evaluation of eight HHUS devices sourced from diverse manufacturers. Ultrasound videos of five previously defined sonographic questions (volume status/inferior vena cava, pleural effusion, pulmonary B-lines, gallbladder, and needle tracking in situ) were recorded with all devices. The analogue recording of the same pathologies with a HEUS device served as gold standard. The corresponding findings (HHUS and HEUS) were then played side by side and evaluated by sixteen intensive care physicians experienced in sonography. The B-scan quality and the clinical significance of the HHUS were assessed using a five-point Likert scale (5 points = very good; 1 point = insufficient). RESULTS both in assessing the quality of B-scans and in their ability to answer clinical questions, the HHUS achieved convincing results-regardless of the manufacturer. For example, only 8.6% (B-scan quality) and 9.8% (clinical question) of all submitted assessments received an "insufficient" rating. One HHUS device showed a significantly higher (p < 0.01) average points score in the assessment of B-scan quality (3.9 ± 0.65 points) and in the evaluation of clinical significance (4.03 ± 0.73 points), compared to the other devices. CONCLUSIONS HHUS systems are able to reliably answer various clinical intensive care questions and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS devices. Irrespective of this, the present study was able to demonstrate relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Michael Gottwald
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Christopher Jonck
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Daniel Merkel
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany
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Wubben BM, Yun HI. The Performance Characteristics of Handheld, Non-Piezoelectric Point-of-Care Ultrasound (POCUS) in the Emergency Department. Diagnostics (Basel) 2023; 14:17. [PMID: 38201326 PMCID: PMC10795712 DOI: 10.3390/diagnostics14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The use of handheld point-of-care ultrasound (HH-POCUS) platforms is rapidly increasing, but the diagnostic performance of HH-POCUS in the emergency department (ED) has not been well-studied. For a period of one year, only a HH-POCUS system that uses a non-piezoelectric array (Butterfly iQ+™) was available for clinical POCUS examinations in our ED. We performed a retrospective observational study of patients who underwent cardiac, thoracic, renal, biliary, or lower extremity venous (DVT) examinations from November 2021-November 2022 and calculated performance characteristics of HH-POCUS relative to radiology imaging. A total of 381 HH-POCUS studies were evaluated. Cardiac image quality was significantly lower than lung (p = 0.002). Over half of the studies (213/381) had imaging available for comparison, and HH-POCUS identified 86.5% (32/37, (95%CI) 70.4-94.9) of prespecified emergent diagnoses, including acute cholecystitis, severely reduced left ventricular ejection fraction, pericardial effusion or tamponade, moderate or larger pleural effusion, pneumothorax, moderate or larger hydronephrosis, and DVT. For less emergent diagnoses, 84.3% (43/51, (95%CI) 70.9-92.5) were identified. Overall, HH-POCUS using a non-piezoelectric array showed modest real-world performance in the ED for cardiac, thoracic, renal, biliary, and DVT examinations. HH-POCUS may be inadequate to rule out some common ED diagnoses, but had good specificity for certain conditions such as pericardial effusion.
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Affiliation(s)
- Brandon Michael Wubben
- Department of Emergency Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Hae In Yun
- Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA 52242, USA;
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Haji-Hassan M, Capraș RD, Bolboacă SD. Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis. Diagnostics (Basel) 2023; 13:3665. [PMID: 38132248 PMCID: PMC10742630 DOI: 10.3390/diagnostics13243665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Miniaturization has made ultrasound (US) technology ultraportable and, in association with their relatively low cost, made handheld devices attractive for medical education training programs. However, performing an ultrasound requires complex skills, and it is unclear whether handheld devices are suitable for the training of novices. Our study aimed to identify to what extent handheld US devices can be employed in medical undergraduates' and residents' education. We selected studies that evaluate the results obtained by students and/or residents who have participated in ultrasound training programs using handheld devices. The studies were included if they reported post-test (pre-test optional) achievements or a comparison with a control group (a group of experts or novices who underwent a different intervention). Twenty-six studies were selected, and their characteristics were summarized. Handheld ultrasound devices were used in training programs to learn echocardiography, abdominal, and/or musculoskeletal ultrasound. Statistically significant progress was noted in the ability of naïve participants to capture and interpret ultrasound images, but training duration influenced the outcomes. While ultrasound training using handheld devices has proven to be feasible for various body regions and purposes (e.g., better understanding of anatomy, clinical applications, etc.), the long-term impacts of handheld education interventions must be considered in addition to the short-term results to outline guidelines for targeted educational needs.
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Affiliation(s)
- Mariam Haji-Hassan
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania; (M.H.-H.); (S.D.B.)
| | - Roxana-Denisa Capraș
- Department of Anatomy and Embryology, Iuliu Hațieganu University of Medicine and Pharmacy, Clinicilor Str., No. 3–5, 400006 Cluj-Napoca, Romania
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania; (M.H.-H.); (S.D.B.)
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Chato L, Regentova E. Survey of Transfer Learning Approaches in the Machine Learning of Digital Health Sensing Data. J Pers Med 2023; 13:1703. [PMID: 38138930 PMCID: PMC10744730 DOI: 10.3390/jpm13121703] [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: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Machine learning and digital health sensing data have led to numerous research achievements aimed at improving digital health technology. However, using machine learning in digital health poses challenges related to data availability, such as incomplete, unstructured, and fragmented data, as well as issues related to data privacy, security, and data format standardization. Furthermore, there is a risk of bias and discrimination in machine learning models. Thus, developing an accurate prediction model from scratch can be an expensive and complicated task that often requires extensive experiments and complex computations. Transfer learning methods have emerged as a feasible solution to address these issues by transferring knowledge from a previously trained task to develop high-performance prediction models for a new task. This survey paper provides a comprehensive study of the effectiveness of transfer learning for digital health applications to enhance the accuracy and efficiency of diagnoses and prognoses, as well as to improve healthcare services. The first part of this survey paper presents and discusses the most common digital health sensing technologies as valuable data resources for machine learning applications, including transfer learning. The second part discusses the meaning of transfer learning, clarifying the categories and types of knowledge transfer. It also explains transfer learning methods and strategies, and their role in addressing the challenges in developing accurate machine learning models, specifically on digital health sensing data. These methods include feature extraction, fine-tuning, domain adaptation, multitask learning, federated learning, and few-/single-/zero-shot learning. This survey paper highlights the key features of each transfer learning method and strategy, and discusses the limitations and challenges of using transfer learning for digital health applications. Overall, this paper is a comprehensive survey of transfer learning methods on digital health sensing data which aims to inspire researchers to gain knowledge of transfer learning approaches and their applications in digital health, enhance the current transfer learning approaches in digital health, develop new transfer learning strategies to overcome the current limitations, and apply them to a variety of digital health technologies.
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Affiliation(s)
- Lina Chato
- Department of Electrical and Computer Engineering, University of Nevada, Las Vegas, NV 89154, USA;
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Merkel D, Züllich TF, Schneider C, Yousefzada M, Beer D, Ludwig M, Weimer A, Künzel J, Kloeckner R, Weimer JM. Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions. Diagnostics (Basel) 2023; 13:3622. [PMID: 38132206 PMCID: PMC10742722 DOI: 10.3390/diagnostics13243622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. METHOD The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). RESULTS The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. CONCLUSION In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Daniel Merkel
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany;
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, 10115 Berlin, Germany;
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany;
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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20
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Firima E, Gonzalez L, Khan MA, Manthabiseng M, Sematle MP, Bane M, Khomolishoele M, Leisa I, Retselisitsoe L, Burkard T, Seelig E, Lee T, Chammartin F, Gupta R, Leigh B, Weisser M, Amstutz A, Labhardt ND. High Rates of Undiagnosed Target Organ Damage Among Adults with Elevated Blood Pressure or Diabetes Mellitus in a Community-Based Survey in Lesotho. J Epidemiol Glob Health 2023; 13:857-869. [PMID: 37883005 PMCID: PMC10686968 DOI: 10.1007/s44197-023-00158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Prevalence of elevated blood pressure (BP) and diabetes mellitus (DM) is increasing in sub-Saharan Africa. Data on target organ damage such as retinopathy, left ventricular hypertrophy (LVH), renal impairment and peripheral neuropathy (PN) among persons with elevated BP and/or DM in sub-Saharan Africa remain scarce. AIM To determine at community-level the prevalence of retinopathy, LVH, renal impairment, and PN among adults with elevated BP and/or DM, and assess the association of elevated BP and/or DM with target organ damage in Lesotho. METHODS During a household-based survey, a sub-sample of adults with elevated BP (≥ 140/90 mmHg) and/or DM (glycosylated hemoglobin ≥ 6.5%), as well as comparators (BP < 140/90 mmHg, HbA1c < 6.5%) were screened for retinopathy, LVH, renal impairment, and PN. We used multivariable logistic regression for inferential analysis. RESULTS Out of 6108 participants screened during the survey, 420 with elevated BP only, 80 with DM only, 61 with elevated BP and DM, and 360 comparators were assessed for target organ damage. Among those with elevated BP, and among those with DM with or without elevated BP, prevalence of retinopathy was 34.6% (89/257) and 14.4% (15/104); renal impairment was 45.0% (156/347) and 42.4% (56/132), respectively. Among those with elevated BP, 2.3% (7/300) and 65.7% (224/341) had LVH and left ventricular concentric remodeling, respectively. PN, only assessed among those with DM, was present in 32.6% (42/129). Elevated BP was associated with increased odds of retinopathy (aOR, 19.13; 95% CI, 8.52-42.94; P < 0.001) and renal impairment (aOR, 1.80; 95% CI, 1.27-2.55; P = 0.001). Presence of both elevated BP and DM was associated with an increased odds of retinopathy (aOR, 16.30; 95%CI, 5.69-46.68; P < 0.001), renal impairment (aOR, 2.55; 95% CI, 1.35-4.81; P = 0.004), and PN (aOR, 2.13; 95% CI, 1.04-4.38; P = 0.040). CONCLUSION We found a high prevalence of undiagnosed target organ damage among adults with elevated BP and/or DM during community-based screening. These findings emphasize the importance of regular prevention and screening activities in this setting.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | | | | | | | | | - Thilo Burkard
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Eleonara Seelig
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Tristan Lee
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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Nunna B, Parihar P, Wanjari M, Shetty N, Bora N. High-Resolution Imaging Insights into Shoulder Joint Pain: A Comprehensive Review of Ultrasound and Magnetic Resonance Imaging (MRI). Cureus 2023; 15:e48974. [PMID: 38111406 PMCID: PMC10725840 DOI: 10.7759/cureus.48974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.
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Affiliation(s)
- Bhagyasri Nunna
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Shetty
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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22
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Lee JY, Conlon TW, Fraga MV, Bauer AJ, Soni NJ, Chen AE, Kaplan SL. Identifying commonalities in definition and governance of point-of-care ultrasound within statements from medical organizations in the United States: A scoping review for a shared understanding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1622-1630. [PMID: 37850556 DOI: 10.1002/jcu.23574] [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: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
This scoping review analyzed statements from 22 medical organizations in the United States to identify commonalities in the definition and governance of point-of-care ultrasound (POCUS). A total of 41 statements were included. The review found that the most commonly used elements in defining POCUS were "focused," "bedside," and "patient care." In terms of governance, consistent requirements included specific training programs, documentation in medical records, continuous quality assurance, and standards for credentialing and privileging. These findings suggest the existence of essential commonalities that could facilitate communication and the development of standardized POCUS programs in the future.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Fraga
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nilam J Soni
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Aaron E Chen
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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23
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Brown C, Bhatti Y, Harris M. Environmental sustainability in healthcare systems: role of frugal innovation. BMJ 2023; 383:e076381. [PMID: 37783474 DOI: 10.1136/bmj-2023-076381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Cyan Brown
- Department of Bioengineering, Biodesign, Stanford University, USA
| | - Yasser Bhatti
- MBS College of Business and Entrepreneurship, Saudi Arabia
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, UK
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24
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Winter SP, Kobes PK, Naiga J, Walumbembe J, Nassanga R, Dunn DP, Crawford AM. A Portable and Inexpensive Model for Ultrasound-Guided Procedure Training in Low- and Middle-Income Countries. J Am Coll Radiol 2023:S1546-1440(23)00707-X. [PMID: 37722465 DOI: 10.1016/j.jacr.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Stephen P Winter
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Patrick K Kobes
- Section Chief, Acute Care Imaging, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Joyce Naiga
- Makerere University, Department of Radiology, Kampala, Uganda
| | | | - Rita Nassanga
- Department Chair, Makerere University, Department of Radiology, Kampala, Uganda
| | - Dell P Dunn
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah.
| | - Amanda M Crawford
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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25
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Hamoudi C, Martins A, Debordes PA, Goetsch T, Liverneaux P, Facca S. A Cadaveric Study Examining the Accuracy of Wireless Hand-Held Guided Ultrasound Injections Versus Blind Injections in the Flexor Tendon Sheath. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:650-654. [PMID: 37790827 PMCID: PMC10543784 DOI: 10.1016/j.jhsg.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/22/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Hand-held ultrasound (HHUS) is gaining popularity among clinicians. Although its use for procedural guidance could have several advantages in hand surgery, other surgeons may wonder about its added benefits. This cadaveric study aimed to examine the hypothesis of increased accuracy of wireless HHUS-guided injections versus that of blind injections into the flexor sheath. Methods Our series included 20 fresh cadaveric hands with 80 fingers randomly assigned to 2 groups. In group A, 10 hands were randomly assigned to receive a landmark injection and then received a blinded injection to the flexor tendon sheath (FTS). In group B, 10 hands were blinded in the same manner and received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomic dissection was performed to evaluate the injection accuracy based on the dye's filling pattern in the FTS as stage I (no filling), stage II (<50% filling), and stage III (>50% filling). Statistical analysis was performed, and P <.05 indicated a significant difference. Results One finger was excluded because of severe Dupuytren contracture. In group A, 39 blind injections of the FTS were performed, with 82% (32/39) fingers achieving stage III filling. In group B, 40 ultrasound-guided FTS injections were performed, with 90% (36/40) of fingers achieving stage III filing. Our study did not reveal any superiority in accuracy when ultrasound guidance was used (P = .35). Conclusions Hand-held ultrasound-guided FTS injections were not more accurate than blind injections performed by an experienced hand surgeon. These findings suggest that blind injections can be used as routine practice when performed by experienced operators to treat trigger finger. However, the use of HHUS may offer other advantages in hand surgery practice. Clinical relevance Ultimately, choosing to perform HHUS-guided injection versus blind injection to treat trigger finger depends on the surgeon's experience and preference for a particular technique.
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Affiliation(s)
- Ceyran Hamoudi
- Department of Hand Surgery, SOS main, University hospital of Strasbourg, Strasbourg, France
| | - Antoine Martins
- Department of Hand Surgery, SOS main, University hospital of Strasbourg, Strasbourg, France
| | | | - Thibaut Goetsch
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, SOS main, University hospital of Strasbourg, Strasbourg, France
- UMR7357, ICube CNRS, Strasbourg University, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, SOS main, University hospital of Strasbourg, Strasbourg, France
- UMR7357, ICube CNRS, Strasbourg University, Strasbourg, France
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26
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Corroenne R, Chesnais M, Khawand C, Attali I, Boucherie AS, Defrance M, Morgan R, Maurey L, Ville Y, Salomon LJ. Physicians' perceptions of the daily use of a handheld ultrasound device in the labor room. J Gynecol Obstet Hum Reprod 2023; 52:102618. [PMID: 37290728 DOI: 10.1016/j.jogoh.2023.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of our study was to describe the perception of physicians who use a handheld ultrasound (US) device in an intensive perinatal care unit. METHODS We conducted a prospective observational study in the labor ward of an intensive perinatal care unit between November 2021 and May 2022. Obstetrics & Gynecology residents in rotation in our department during this time were recruited as participants in this study. All the participants were provided with a handheld US device Vscan Air™ (GE Healthcare, Zipf, Austria) to use during their normal days and nights practice in labor ward. At the end of their 6 months rotation, participants completed an anonymous surveys about their perceptions of the handheld US device. The survey included questions about the ease of use in clinical situations, the amount of time of initial diagnosis, performances of the device, feasibility to use, and patient's satisfaction with the use of the device. RESULTS 6 residents in their last year of residency were included. All the participants were satisfied with the device and would like to use it in their future practice. They all agreed that the probe was easy to handle and that the mobile application was easy to use. Image quality was always considered good by the participants and 5/6 of them declared that the handheld US device was always sufficient and did not require any confirmation with a conventional US machine. 5/6 of the participants considered that the handheld US device allowed them to gain time for clinical decision but half of them did not estimate that the use of the handheld US device improved their ability to make a clinical diagnosis. CONCLUSION Our study suggests that the Vscan Air™ is easy to use, with a good quality image and reduces the amount of time to make a clinical diagnosis. Handheld US device could be useful in the daily practice in maternity hospital.
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Affiliation(s)
- Romain Corroenne
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Marion Chesnais
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Chelsea Khawand
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Isabelle Attali
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Anne Sophie Boucherie
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Manon Defrance
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Rosemary Morgan
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Louise Maurey
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Yves Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France.
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27
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Jeong J, Chao CJ, Arsanjani R, Kim K, Pelkey MN, Chen YC, Ramzan RN, Elbahnasawy M, Sleem M, Ayoub C, Farina JMM, Grogan M, Kane GC, Patel BN, Oh JK, Banerjee I. Challenges and solutions of echocardiography generalization for deep learning: a study in patients with constrictive pericarditis. J Med Imaging (Bellingham) 2023; 10:054502. [PMID: 37840850 PMCID: PMC10569796 DOI: 10.1117/1.jmi.10.5.054502] [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: 02/28/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose The inherent characteristics of transthoracic echocardiography (TTE) images such as low signal-to-noise ratio and acquisition variations can limit the direct use of TTE images in the development and generalization of deep learning models. As such, we propose an innovative automated framework to address the common challenges in the process of echocardiography deep learning model generalization on the challenging task of constrictive pericarditis (CP) and cardiac amyloidosis (CA) differentiation. Approach Patients with a confirmed diagnosis of CP or CA and normal cases from Mayo Clinic Rochester and Arizona were identified to extract baseline demographics and the apical 4 chamber view from TTE studies. We proposed an innovative preprocessing and image generalization framework to process the images for training the ResNet50, ResNeXt101, and EfficientNetB2 models. Ablation studies were conducted to justify the effect of each proposed processing step in the final classification performance. Results The models were initially trained and validated on 720 unique TTE studies from Mayo Rochester and further validated on 225 studies from Mayo Arizona. With our proposed generalization framework, EfficientNetB2 generalized the best with an average area under the curve (AUC) of 0.96 (± 0.01 ) and 0.83 (± 0.03 ) on the Rochester and Arizona test sets, respectively. Conclusions Leveraging the proposed generalization techniques, we successfully developed an echocardiography-based deep learning model that can accurately differentiate CP from CA and normal cases and applied the model to images from two sites. The proposed framework can be further extended for the development of echocardiography-based deep learning models.
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Affiliation(s)
- Jiwoong Jeong
- Arizona State University, School of Computing and Augmented Intelligence, Tempe, Arizona, United States
| | - Chieh-Ju Chao
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Reza Arsanjani
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | - Kihong Kim
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Melissa N. Pelkey
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Yi-Chieh Chen
- Mayo Clinic Health System Austin, Department of Pharmacy, Austin, Minnesota, United States
| | - Raheel N. Ramzan
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | | | - Mohamed Sleem
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | - Chadi Ayoub
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | | | - Martha Grogan
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Garvan C. Kane
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Bhavik N. Patel
- Mayo Clinic, Department of Radiology, Scottsdale, Arizona, United States
| | - Jae K. Oh
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Imon Banerjee
- Arizona State University, School of Computing and Augmented Intelligence, Tempe, Arizona, United States
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Money DB, Mehio M, Scoma C, Gupta S. Cardiac Point-of-Care Ultrasound (P.O.C.U.S.) Utilization for Hospitalists in the Assessment of Patients with Cardiac Complaints: An Educational Overview. J Community Hosp Intern Med Perspect 2023; 13:1-8. [PMID: 37868243 PMCID: PMC10589009 DOI: 10.55729/2000-9666.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 10/24/2023] Open
Abstract
The use of cardiac point-of-care ultrasound (P.O.C.U.S.) is underutilized in the field of internal medicine for the assessment of patients with cardiac complaints. Numerous studies in emergency medicine, anesthesia, and critical care have demonstrated the successful application of cardiac P.O.C.U.S. in resident and attending physicians with limited prior exposure. This article review overviews the practical implementation of cardiac P.O.C.U.S. for hospitalists by discussing proper technique and assessment for common pathology seen in the medical ward setting. We describe how to assess for left ventricular (LV) systolic function, right ventricular (RV) systolic function, suspected acute coronary syndrome (ACS), post-myocardial infarction (MI) complications, suspected pulmonary embolus, and assessment of intravascular volume status. In each section, we overview the pertinent literature to show how cardiac P.O.C.U.S. has been used to directly impact patient care.
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Affiliation(s)
- David B. Money
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
| | - Mohammad Mehio
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
| | - Christopher Scoma
- Division of Cardiovascular Sciences, University of South Florida, Tampa, FL,
USA
| | - Shanu Gupta
- Department of Internal Medicine, University of South Florida, Tampa, FL,
USA
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Bacariza J, Gonzalez FA, Varudo R, Leote J, Martins C, Fernandes A, Michard F. Smartphone-based automatic assessment of left ventricular ejection fraction with a silicon chip ultrasound probe: a prospective comparison study in critically ill patients. Br J Anaesth 2023; 130:e485-e487. [PMID: 37031022 DOI: 10.1016/j.bja.2023.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/25/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- Jacobo Bacariza
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal
| | - Filipe A Gonzalez
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Rita Varudo
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal
| | - João Leote
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Martins
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal
| | - Antero Fernandes
- Intensive Care Department, Hospital Garcia de Orta, Almada, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Faculdade de Ciencias da Saude da Universidade da Beira Interior, Covilha, Portugal
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Istrail L. Instant Endocarditis Diagnosis Using Point-of-Care Ultrasound (POCUS) in a Patient Diagnosed With Pneumonia. Cureus 2023; 15:e36043. [PMID: 37056558 PMCID: PMC10089372 DOI: 10.7759/cureus.36043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/13/2023] Open
Abstract
Acute bacterial endocarditis is an acute febrile illness that spreads hematogenously and can be fatal if it is not treated in a timely fashion. A traditional physical examination has very limited sensitivity and specificity when diagnosing bacterial endocarditis. Point-of-care ultrasound (POCUS) during the physical exam can assist with the diagnosis by evaluating for valvular regurgitation or visible vegetation. In this case, a patient presented to the hospital with a cough and shortness of breath and was diagnosed with pneumonia. She did not improve with intravenous antibiotics and a POCUS exam revealed the diagnosis was in fact bacterial endocarditis and not pneumonia. This led to further imaging, which revealed an abdominal abscess. This highlights the importance of incorporating POCUS into the physical exam of any patient presenting with cardiopulmonary symptoms.
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Handheld Echocardiography Measurements Concordance and Findings Agreement: An Exploratory Study. Diagnostics (Basel) 2023; 13:diagnostics13050853. [PMID: 36899997 PMCID: PMC10000668 DOI: 10.3390/diagnostics13050853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the 'stethoscope of the future' to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.
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Kaiser U, Herr W, Greiner B, Stroszczynski C, Jung EM. Mobile handheld ultrasound with VScan Air for the diagnosis of deep vein thrombosis. Clin Hemorheol Microcirc 2023; 83:149-161. [PMID: 36278343 DOI: 10.3233/ch-221598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate a new W-Lan-supported ultrasound mobile technology for the diagnosis of vascular peripheral thrombosis. MATERIAL AND METHODS Fifty patients were examined by an experienced reference sonographer using high-end technology and a W-Lan supported device (VScan Air) to evaluate its diagnostic capabilities for peripheral thrombosis. RESULTS Fifty patients were examined (age, 25-88 years; male, n = 27, female n = 23). Thromboses were diagnosed in the neck (n = 1), upper leg (n = 7), lower leg (n = 49), and muscle veins (n = 25). VScan Air technique also allows the diagnosis of circumscribed deep vein thrombosis with a sufficient diagnostic certainty. Moreover, for superficial thrombi that can be well-delineated, a maximum image quality is possible compared to high-end technology. CONCLUSION The mobile VScan technology opens up new possibilities for near-patient and location-independent imaging in cases of deep vein thrombosis.
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Affiliation(s)
- Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Greiner
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Kaiser U, Dropco I, Reuthner K, Ertl M, Schlitt HJ, Herr W, Stroszczynski C, Jung EM. Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic: Initial results of a pilot study1. Clin Hemorheol Microcirc 2023; 85:297-305. [PMID: 36502312 DOI: 10.3233/ch-229104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aim was to investigate the use of a novel device, the Vscan Air™, for rapidly and effectively performing ultrasound in student teaching during the COVID-19 pandemic. MATERIAL AND METHODS As part of the ultrasound practical course with integrated hands-on activity required by the regular medical curriculum, 100 medical students were instructed in the use of the Vscan Air™, including duplex mode. They then evaluated the quality of the ultrasound images obtained by the Vscan Air™ from previously selected organs. RESULTS 100 students were interviewed (female n = 68, male n = 32; age >18 years n = 100). The rated image quality never fell below a mean of 3 for the examined organs and portal vein flow (liver 4,58; spleen 3,99; kidneys 4,29; aorta 4,16; Douglas/rectovesical space 4,14; portal vein 4,43; pancreas 3,53; Focused Assessment with Sonography for Trauma 4,38). Scores below 3 were found sporadically in ultrasounds of the spleen (n = 4), kidneys (n = 3), Douglas/rectovesical space (n = 2), and pancreas (n = 15). The liver was rated the lowest for 59 ratings. The portal vein was evaluated in 68 cases. The hepatic artery and hepatic veins could be also visualized in all 68 examinations. The aorta was evaluated in 62 cases. CONCLUSION The Vscan Air™ technology offered adequate image quality and provided a new, fast and patient-oriented technique to support continuous ultrasound examinations and education of students, especially during a pandemic. Particularly noteworthy is the uncomplicated compliance with the required high level of hygiene.
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Affiliation(s)
- Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Ivor Dropco
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Reuthner
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Michael Ertl
- Department of Medical Technology, University Hospital Regensburg, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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