Best Practice Recommendations for the Safe use of Lung Ultrasound

Abstract

The safety of ultrasound is of particular importance when examining the lungs, due to specific bioeffects occurring at the alveolar air-tissue interface. Lung is significantly more sensitive than solid tissue to mechanical stress. The causal biological effects due to the total reflection of sound waves have also not been investigated comprehensively.

On the other hand, the clinical benefit of lung ultrasound is outstanding. It has gained considerable importance during the pandemic, showing comparable diagnostic value with other radiological imaging modalities.

Therefore, based on currently available literature, this work aims to determine possible effects caused by ultrasound on the lung parenchyma and evaluate existing recommendations for acoustic output power limits when performing lung sonography.

This work recommends a stepwise approach to obtain clinically relevant images while ensuring lung ultrasound safety. A special focus was set on the safety of new ultrasound modalities, which had not yet been introduced at the time of previous recommendations.

Finally, necessary research and training steps are recommended in order to close knowledge gaps in the field of lung ultrasound safety in the future.

These recommendations for practice were prepared by ECMUS, the safety committee of the EFSUMB, with participation of international experts in the field of lung sonography and ultrasound bioeffects.

Zusammenfassung

Die Sicherheit des Ultraschalls ist bei der Untersuchung der Lunge von besonderer Bedeutung, da spezifische Wechselwirkungsmechanismen an der alveolaren Luft-Gewebe-Grenze auftreten. Lungengewebe ist dabei deutlich empfindlicher gegenüber mechanischen Kräften als solides Gewebe. Die ursächlichen biologischen Effekte, basierend auf Totalreflektion von Schallwellen, sind zudem nur unzureichend untersucht.

Andererseits ist der klinische Nutzen des Lungenultraschalls beträchtlich und hat aufgrund der Pandemiesituation einen erheblichen Stellenwert dazugewonnen. Dabei erweist sich dieser bisweilen dem anderer radiologischer Bildgebungsverfahren als ebenbürtig.

Deshalb widmet sich diese Arbeit, basierend auf derzeit verfügbaren Literaturquellen, dem Einfluss von Schalleffekten auf das Lungenparenchym und evaluiert bestehende Empfehlungen zur Schalldruckreduzierung bei der Durchführung der Lungensonografie.

Es wird ein Vorgehen empfohlen, um klinisch relevante Bilder zu erhalten und gleichzeitig die Ultraschallsicherheit zu gewährleisten. Ein besonderes Augenmerk liegt auf der Sicherheit neuer Ultraschall-Modalitäten, welche zum Zeitpunkt früherer Empfehlungen noch nicht berücksichtigt waren.

Abschließend werden notwendige Forschungs- und Ausbildungsschritte empfohlen, um Wissenslücken auf dem Gebiet des Lungenultraschalls in Zukunft schließen zu können.

Diese Empfehlungen für die Praxis wurden von ECMUS, dem Sicherheitskomitee der EFSUMB, unter Mitwirkung von internationalen Experten auf dem Gebiet der Lungensonografie und biologischer Ultraschallwechselwirkung, erstellt.

Key words

lung ultrasound - bio effects - pulmonary hemorrhage - safety - chest

Publikationsverlauf

Eingereicht: 21. Juli 2022

Angenommen: 14. November 2022

Accepted Manuscript online:
14. November 2022

Artikel online veröffentlicht:
03. März 2023

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