The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

Abstract

The miniaturization of ultrasound equipment in the form of tablet- or smartphone-sized ultrasound equipment is a result of the rapid evolution of technology and handheld ultrasound devices (HHUSD). This position paper of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of HHUSD in abdominal ultrasound, pediatric ultrasound, targeted echocardiography and heart ultrasound, and we will report position comments on the most common clinical applications. Also included is a SWOT (Strength – Weaknesses – Opportunities – Threats) analysis, the use for handheld devices for medical students, educational & training aspects, documentation, storage and safety considerations.

Zusammenfassung

Die Verkleinerung von handlichen zu handgeführten Ultraschallgeräten mit einer Größe und Form von Tablets bzw. Smartphones ist das Ergebnis einer rasanten Technologieentwicklung. Dieses Positionspapier der Europäischen Ultraschallgesellschaft (EFSUMB, European Federation of Societies in Ultrasound and Medicine) beschreibt aktuelle Anwendungen von kleinen und kleinsten Ultraschallgeräten am Thorax und Abdomen. Häufige angewandte Applikationen werden beschrieben. Das Positionspapier beinhaltet auch eine SWOT-Analyse (Strength – Weaknesses – Opportunities – Threats). Anwendungen durch Medizinstudenten sowie Ausbildungs- und Trainingsaspekte, Dokumentation, Speicherung von Daten sowie Sicherheitsaspekte werden beleuchtet.

Key words

abdomen - chest - gynecology - obstetrics

• References

• 1 Nielsen MB. Handheld Ultrasound devices (HHUSD): A short review of the equipment available on the market as of September 2017. Ultraschall in Med 2017; 38: 668-668
• 2 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43: 49-58
• 3 Birth of „Echoscopy“ – The EFSUMB Point of View. Ultraschall in Med 2013 34. 92
• 4 Dietrich CF, Rudd L, Saftiou A. et al. The EFSUMB website, a great source for ultrasound information and education. Med Ultrason 2017; 19: 102-110
• 5 Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason 2013; 15: 215-223
• 6 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364: 749-757
• 7 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
• 8 Kjesbu IE, Laursen CB, Graven T. et al. Feasibility and Diagnostic Accuracy of Point-of-Care Abdominal Sonography by Pocket-Sized Imaging Devices, Performed by Medical Residents. J Ultrasound Med 2017; 36: 1195-1202
• 9 Mjolstad OC, Dalen H, Graven T. et al. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med 2012; 23: 185-191
• 10 Hall MK, Hall J, Gross CP. et al. Use of Point-of-Care Ultrasound in the Emergency Department: Insights From the 2012 Medicare National Payment Data Set. J Ultrasound Med 2016; 35: 2467-2474
• 11 Ojeda JC, Colbert JA, Lin X. et al. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30: 199-206
• 12 Coşkun F, Akıncı E, Ceyhan MA. et al. Our new stethoscope in the emergency department: handheld ultrasound. Ulus Travma Ve Acil Cerrahi Derg 2011; 17: 488-492
• 13 Stock KF, Klein B, Steubl D. et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: diagnostic value and time required in bedside ultrasound examination. Abdom Imaging 2015; 40: 2861-2866
• 14 Keil-Ríos D, Terrazas-Solís H, González-Garay A. et al. Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis. Intern Emerg Med 2016; 11: 461-466
• 15 Landers A, Ryan B. The use of bedside ultrasound and community-based paracentesis in a palliative care service. J Prim Health Care 2014; 6: 148-151
• 16 Dijos M, Pucheux Y, Lafitte M. et al. Fast track echo of abdominal aortic aneurysm using a real pocket-ultrasound device at bedside. Echocardiography 2012; 29: 285-290
• 17 Andersen GN, Graven T, Skjetne K. et al. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med 2015 2015; 34: 627-636
• 18 Colli A, Prati D, Fraquelli M. et al. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PloS One 2015; 10: e0122181
• 19 Alnaif B, Drutz HP. The accuracy of portable abdominal ultrasound equipment in measuring postvoid residual volume. Int Urogynecol J Pelvic Dysfunct 1999; 10: 215-218
• 20 Lavi A, Tzemah S, Hussein A. et al. A urologic stethoscope? Urologist performed sonography using a pocket-size ultrasound device in the point-of-care setting. Int Urol Nephrol 2017; 49: 1513-1518
• 21 Kameda T, Uebayashi K, Wagai K. et al. Assessment of the renal collecting system using a pocket‐sized ultrasound device. J Med Ultrason 2018; 45: 577-581
• 22 Chen Y, Zheng H, Zang Z. et al. Real-Time Ultrasound-Guided Percutaneous Nephrolithotomy Using Newly Developed Wireless Portable Ultrasound: A Single-Center Experience. Surg Innov 2018; 25: 333-338
• 23 Bruns RF, Menegatti CM, Martins WP. et al. Applicability of pocket ultrasound during the first trimester of pregnancy. Med Ultrason 2015; 17: 284-288
• 24 Sayasneh A, Preisler J, Smith A. et al. Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology?. Ultrasound Obstet Gynecol 2012; 40: 145-150
• 25 Galjaard S, Baeck S, Ameye L. et al. Use of a pocket-sized ultrasound machine (PUM) for routine examinations in the third trimester of pregnancy. Ultrasound Obstet Gynecol 2014; 44: 64-68
• 26 Troyano Luque JM, Ferrer-Roca O, Barco-Marcellán MJ. et al. Modification of the hand-held Vscan ultrasound and verification of its performance for transvaginal applications. Ultrasonics 2013; 53: 17-22
• 27 Mirabel M, Celermajer D, Beraud A-S. et al. Pocket-sized focused cardiac ultrasound: strengths and limitations. Arch Cardiovasc Dis 2015; 108: 197-205
• 28 Testuz A, Müller H, Keller P-F. et al. Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting. Eur Heart J Cardiovasc Imaging 2013; 14: 38-42
• 29 Cullen MW, Geske JB, Anavekar NS. et al. Handheld echocardiography during hospitalization for acute myocardial infarction. Clin Cardiol 2017; 40: 993-999
• 30 Andersen GN, Haugen BO, Graven T. et al. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011; 12: 665-670
• 31 Abe Y, Ito M, Tanaka C. et al. A novel and simple method using pocket-sized echocardiography to screen for aortic stenosis. J Am Soc Echocardiogr 2013; 26: 589-596
• 32 Prinz C, Dohrmann J, van Buuren F. et al. Diagnostic performance of handheld echocardiography for the assessment of basic cardiac morphology and function: a validation study in routine cardiac patients. Echocardiography 2012; 29: 887-894
• 33 Sicari R, Galderisi M, Voigt J-U. et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. Eur J Echocardiogr 2011; 12: 85-87
• 34 Tsai BT, Dahms EB, Waalen J. et al. Actual use of pocket-sized ultrasound devices for cardiovascular examination by trained physicians during a hospitalist rotation. J Community Hosp Intern Med Perspect 2016; 6: 33358
• 35 Mai TV, Shaw DJ, Amundson SA. et al. Learning to apply the pocket ultrasound device on the critically ill: comparing six “quick-look” signs for quality and prognostic values during initial use by novices. Crit Care 2013; 17: 448
• 36 Platz E, Lewis EF, Uno H. et al. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. Eur Heart J 2016; 37: 1244-1251
• 37 Platz E, Pivetta E, Merz AA. et al. Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure. Am J Emerg Med 2015; 33: 1552-1556
• 38 Cogliati C, Antivalle M, Torzillo D. et al. Standard and pocket-size lung ultrasound devices can detect interstitial lung disease in rheumatoid arthritis patients. Rheumatology 2014; 53: 1497-1503
• 39 Filopei J, Siedenburg H, Rattner P. et al. Impact of pocket ultrasound use by internal medicine housestaff in the diagnosis of dyspnea. J Hosp Med 2014; 9: 594-597
• 40 Lisi M, Cameli M, Mondillo S. et al. Incremental value of pocket-sized imaging device for bedside diagnosis of unilateral pleural effusions and ultrasound-guided thoracentesis. Interact Cardiovasc Thorac Surg 2012; 15: 596-601
• 41 Sforza A, Mancusi C, Carlino MV. et al. Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea. Cardiovasc Ultrasound 2017; 15: 16
• 42 Marin JR, Abo AM, Arroyo AC. et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8: 16
• 43 McLario DJ, Sivitz AB. Point-of-Care Ultrasound in Pediatric Clinical Care. JAMA Pediatr 2015; 169: 594-600
• 44 Burdjalov V, Srinivasan P, Baumgart S. et al. Handheld, portable ultrasound in the neonatal intensive care nursery: a new, inexpensive tool for the rapid diagnosis of common neonatal problems. J Perinatol 2002; 22: 478-483
• 45 Li X, Mack GK, Rusk RA. et al. Will a handheld ultrasound scanner be applicable for screening for heart abnormalities in newborns and children?. J Am Soc Echocardiogr 2003; 16: 1007-1014
• 46 Spurney CF, Sable CA, Berger JT. et al. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr 2005; 18: 313-319
• 47 Beaton A, Lu JC, Aliku T. et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. Eur Heart J Cardiovasc Imaging 2015; 16: 475-482
• 48 Mirabel M, Bacquelin R, Tafflet M. et al. Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach. Circ Cardiovasc Imaging 2015; 8: e002324
• 49 Beaton A, Aliku T, Okello E. et al. The utility of handheld echocardiography for early diagnosis of rheumatic heart disease. J Am Soc Echocardiogr 2014; 27: 42-49
• 50 Cramp G, Stonehouse M, Webb R. et al. Undetected rheumatic heart disease revealed using portable echocardiography in a population of school students in Tairawhiti, New Zealand. N Z Med J 2012; 125: 53-64
• 51 Lee HC, Silverman N, Hintz SR. Diagnosis of patent ductus arteriosus by a neonatologist with a compact, portable ultrasound machine. J Perinatol 2007; 27: 291-296
• 52 Torrazza RM, Chandran A, Co-Vu J. et al. Pocket echocardiography system for detection of patent ductus arteriosus in neonates. Echocardiogr 2015; 32: 319-324
• 53 Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration. Ann Emerg Med 1991; 20: 631-635
• 54 Chen L, Hsiao AL, Moore CL. et al. Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 2005; 115: 108-111
• 55 Tsung JW, Blaivas M, Cooper A. et al. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 2005; 21: 94-98
• 56 Mahmud N. Measurement of thyroid volume in children using a portable ultrasound machine: a technical note. Asia Pac J Public Health 2001; 13: 36-39
• 57 Fox JC, Schlang JR, Maldonado G. et al. Proactive medicine: the “UCI 30,” an ultrasound-based clinical initiative from the University of California, Irvine. Acad Med 2014; 89: 984-989
• 58 Cawthorn TR, Nickel C, O’Reilly M. et al. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J Am Soc Echocardiogr 2014; 27: 302-309
• 59 Wittich CM, Montgomery SC, Neben MA. et al. Teaching cardiovascular anatomy to medical students by using a handheld ultrasound device. JAMA 2002; 288: 1062-1063
• 60 Ho AM-H, Critchley LAH, Leung JYC. et al. Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation. Teach Learn Med 2015; 27: 307-313
• 61 Galusco V, Khanji MY, Bodger O. et al. Hand-held ultrasound scanners in medical education: A Systematic review. J Cardiovasc Ultrasound 2017; 25: 75-83
• 62 Ringsted C, Hodges B, Scherpbier A. “The research compass”: an introduction to research in medical education: AMEE Guide no. 56. Med Teach 2011; 33: 695-709
• 63 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2: E2-E7
• 64 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB statement on medical student education in ultrasound [short version]. Ultraschall in Med 2016; 37: 100-102
• 65 Dietrich CF. Ultrasound student education. Med Ultrason 2017; 19: 131-133
• 66 Seitz K. Who’s Doing Your Scan? The German Perspective on Ultrasound Services: Ultrasound is More Than a Technique, it’s a Medical Art. Ultraschall in Med 2017; 38: 661-663
• 67 American College of Radiology. Digest of Council Actions.pdf [Internet], page 54. Available from: https://www.acr.org/~/media/ACR/Documents/PDF/Membership/Governance/Digest-of-Council-Actions.pdf (August 2018)
• 68 American College of Emergency Physicians. ACEP emergency ultrasound guidelines-2001. Ann Emerg Med 2001; 38: 470-481
• 69 Mollenkopf M, Tait N. Is it time to include point-of-care ultrasound in general surgery training? A review to stimulate discussion. ANZ J Surg 2013; 83: 908-911
• 70 Mandavia DP, Aragona J, Chan L. et al. Ultrasound training for emergency physicians--a prospective study. Acad Emerg Med 2000; 7: 1008-1014
• 71 Blehar DJ, Barton B, Gaspari RJ. Learning curves in emergency ultrasound education. Acad Emerg Med 2015; 22: 574-582
• 72 Jang TB, Ruggeri W, Dyne P. et al. The learning curve of resident physicians using emergency ultrasonography for cholelithiasis and cholecystitis. Acad Emerg Med 2010; 17: 1247-1252
• 73 Dyre L, Nørgaard LN, Tabor A. et al. Collecting Validity Evidence for the Assessment of Mastery Learning in Simulation-Based Ultrasound Training. Ultraschall in Med 2016; 37: 386-392
• 74 Østergaard ML, Ewertsen C, Konge L. et al. Simulation-Based Abdominal Ultrasound Training – A Systematic Review. Ultraschall in Med 2016; 37: 253-261
• 75 Østergaard ML, Nielsen KR, Albrecht-Beste E. et al. Development of a reliable simulation-based test for diagnostic abdominal ultrasound with a pass/fail standard usable for mastery learning. Eur Radiol 2018; 28: 51-57
• 76 AIUM Practice Parameter for Documentation of an Ultrasound Examinationdocumentation.pdf [Internet]. [cited 2018 Aug]. Available from: http://www.aium.org/resources/guidelines/documentation.pdf
• 77 Becker DM, Tafoya CA, Becker SL. et al. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016; 21: 294-311
• 78 Shorter M, Macias DJ. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehospital Disaster Med 2012; 27: 172-177
• 79 Terry B, Polan D, Islam R. et al. Rapid Internet-based review of point-of-care ultrasound studies at a remote hospital in Uganda. Ann Glob Health 2014; 80: 222-223
• 80 Nielsen MB, Havre RF, Ewertsen C. et al. Ultrasound handheld devices – potential problems and possible solutions. Ultraschall in Med 2016; 37: 313-314
• 81 Expert RoundTable on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med 2011; 37: 1077-1083
• 82 Seward JB, Douglas PS, Erbel R. et al. Hand-carried cardiac ultrasound (HCU) device: recommendations regarding new technology. A report from the Echocardiography Task Force on New Technology of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 369-373