Competence in thoracic ultrasound

Thoracic Ultrasound in Others Scenarios: An Expanding Tool

Modern management of thoracic disease is dominated by ultrasound assessment with strong evidence supporting its use in many clinical settings, providing both diagnostic and procedural. Thoracic ultrasound is a pivotal step in the management of chronic lung disease and pulmonary vascular disease, in early assessment as in therapeutic monitoring. Development and validation of novel ultrasound biomarkers of activity and prognostic, especially those linked to advanced ultrasound techniques, are expected in the coming years. Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. To explore novel techniques, including imaging with ultrasound is important. Artificial intelligence (AI) excels at automatically recognizing complex patterns and providing quantitative assessment for imaging data, showing high potential to assist physicians in acquiring more accurate and reproducible results. Finally, a training system with structured proficiency and competency standards, about the use of TU is necessary. We offer our perspective on the challenges and opportunities for the clinical practice in other scenarios.

A Modern Diagnostic Procedure-The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians' Daily Routine

BACKGROUND

Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally.

METHODS

Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy.

RESULTS

The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings.

CONCLUSION

The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.

Role of Imaging in the Management of Patients with SARS-CoV-2 Lung Involvement Admitted to the Emergency Department: A Systematic Review

During the waves of the coronavirus disease (COVID-19) pandemic, emergency departments were overflowing with patients suffering with suspected medical or surgical issues. In these settings, healthcare staff should be able to deal with different medical and surgical scenarios while protecting themselves against the risk of contamination. Various strategies were used to overcome the most critical issues and guarantee quick and efficient diagnostic and therapeutic charts. The use of saliva and nasopharyngeal swab Nucleic Acid Amplification Tests (NAAT) in the diagnosis of COVID-19 was one of the most adopted worldwide. However, NAAT results were slow to report and could sometimes create significant delays in patient management, especially during pandemic peaks. On these bases, radiology has played and continues to play an essential role in detecting COVID-19 patients and solving differential diagnosis between different medical conditions. This systematic review aims to summarize the role of radiology in the management of COVID-19 patients admitted to emergency departments by using chest X-rays (CXR), computed tomography (CT), lung ultrasounds (LUS), and artificial intelligence (AI).

Ten Years of Pediatric Lung Ultrasound: A Narrative Review

Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.

Lung Ultrasound for Imaging of B-Lines in Dogs and Cats-A Prospective Study Investigating Agreement between Three Types of Transducers and the Accuracy in Diagnosing Cardiogenic Pulmonary Edema, Pneumonia and Lung Neoplasia

Transthoracic heart and lung ultrasound (LUS) was performed in 200 dogs and cats with dyspnea to evaluate the agreement between the results obtained using three types of transducers (microconvex, linear, and phased array) and to determine the accuracy of LUS in discriminating between three conditions commonly causing dyspnea in companion animals: cardiogenic pulmonary edema (CPE), pneumonia, and lung neoplasm. The agreement beyond chance was assessed using the weighted Cohen's kappa coefficient (κw). The highest values of κw (>0.9) were observed for the pair of microconvex and linear transducers. To quantify B-lines the lung ultrasound score (LUSscore) was developed as a sum of points describing the occurrence of B-lines for each of 8 standardized thoracic locations. The accuracy of LUSscore was determined using the area under ROC curve (AUROC). In dogs AUROC of LUSscore was 75.9% (CI 95%: 65.0% to 86.8%) for distinguishing between lung neoplasms and the two other causes of dyspnea. In cats AUROC of LUSscore was 83.6% (CI 95%: 75.2% to 92.0%) for distinguishing between CPE and the two other causes of dyspnea. The study shows that results obtained with microconvex and linear transducers are highly consistent and these two transducers can be used interchangeably. Moreover, the LUSscore may help identify dogs with lung neoplasms and cats with CPE, however its diagnostic accuracy is only fair to moderate.

Training in interventional pulmonology: What we have learned and a way forward

IP encompasses a complex list of procedures requiring knowledge, technical skills and competence. Modern, learner-centric educational philosophies and an explosion of multidimensional educational tools including manikins, simulators, online resources, social media and formal programs can foster learning in IP, promoting professionalism and a culture of lifelong learning. This paper provides background and guidance to a structured, multidimensional and learner-centric strategy for medical procedural education. Focusing on our experience in IP, we describe how competency-based measures, simulation technology and various teaching modalities contribute to a more uniform learning environment in which patients do not suffer the burdens of procedure-related training.

Intestinal ultrasonography in adults with Crohn's disease: a 2020 update

In the last years intestinal ultrasonography (IUS) has increased its role in the management of inflammatory bowel diseases (IBD), that include Crohn's disease (CD) and ulcerative colitis. This is due to the fact that IUS is a non-invasive, inexpensive, and well-tolerated examination technique. Furthermore, it allows a real-time diagnosis with no radiation exposure. Usually, convex and linear probes with frequency between 3.5 and 12 MHz are used, also with the Color- Power Doppler. Focusing on CD, the IUS images of clinical interest are: bowel wall thickening (greater than 3 mm), pseudostratification and the wall vascularization. Moreover, IUS demonstrates inflammatory mass, loss of colonic haustration and the complications of the disease, such as stenosis, abscesses, and fistulas as well as other extraintestinal manifestations, such as lymph node enlargement and changes in the appearance of the mesenteric adipose tissue (creeping fat). Oral and intravenous contrast are used to obtain a better visualization of the bowel wall and to increase the diagnostic accuracy of IUS. In particular, intravenous contrast, administered during the procedure, allows to differentiate between active disease (bowel wall enhancement) and the fibrostenotic complications. Contrast-enhanced ultrasonography (CEUS) was proven to be useful in the follow-up and the disease recurrence detection. Beyond the support in the initial diagnosis, IUS has an important role in the follow-up of patients with CD, to monitor the response to the medical therapy and to detect possible complications. Furthermore, it can predict the recurrences after surgery, with more accuracy if Color-Doppler is used.