Technical assessment of resolution of handheld ultrasound devices and clinical implications

Abstract

Purpose Since handheld ultrasound devices are becoming increasingly ubiquitous, objective criteria to determine image quality are needed. We therefore conducted a comparison of objective quality measures and clinical performance.

Material and Methods A comparison of handheld devices (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) and workstations (GE Logiq E10, Toshiba Aplio 500) was performed using a phantom. As a comparison, clinical investigations were performed by two experienced ultrasonographers by measuring the resolution of anatomical structures in the liver, pancreas, and intestine in ten subjects.

Results Axial full width at half maximum resolution (FWHM) of 100µm phantom pins at depths between one and twelve cm ranged from 0.6–1.9mm without correlation to pin depth. Lateral FWHM resolution ranged from 1.3–8.7mm and was positively correlated with depth (r=0.6). Axial and lateral resolution differed between devices (p<0.001) with the lowest median lateral resolution observed in the E10 (5.4mm) and the lowest axial resolution (1.6mm) for the IQ+ device. Although devices showed no significant differences in most clinical applications, ultrasonographers were able to differentiate a median of two additional layers in the wall of the sigmoid colon and one additional structure in segmental portal fields (p<0.05) using cartwheel devices.

Conclusion While handheld devices showed superior or similar performance in the phantom and routine measurements, workstations still provided superior clinical imaging and resolution of anatomical substructures, indicating a lack of objective measurements to evaluate clinical ultrasound devices.

Zusammenfassung

Ziel Da tragbare Ultraschallgeräte zunehmend allgegenwärtig sind, sind objektive Kriterien zur Bestimmung der Bildqualität nötig. Wir haben daher einen Vergleich objektiver Qualitätsmessungen und klinischer Leistungen durchgeführt.

Material und Methoden Es wurde ein Vergleich von Handgeräten (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) und Workstations (GE Logiq E10, Toshiba Aplio 500) unter Verwendung eines Phantoms durchgeführt. Zum Vergleich wurden klinische Untersuchungen durchgeführt, bei denen die Auflösung anatomischer Strukturen in Leber, Pankreas und Darm von 2 erfahrenen Ultraschalldiagnostikern bei 10 Probanden gemessen wurde.

Ergebnis Die axiale volle Breite bei halber maximaler Auflösung (FWHM) von 100-µm-Phantomfäden in Tiefen zwischen 1–12cm lag zwischen 0,6 und 1,9 mm, ohne dass eine Korrelation zur Fadenhöhe bestand. Die laterale FWHM-Auflösung reichte von 1,3–8,7mm und zeigte eine positive Korrelation mit der Tiefe (r=0,6). Die axiale und laterale Auflösung unterschied sich zwischen den Geräten (p<0,001), wobei die niedrigste mediane laterale Auflösung beim Gerät E10 (5,4mm) und die niedrigste axiale Auflösung (1,6mm) beim Gerät IQ+ beobachtet wurde. Obwohl die Geräte bei den meisten klinischen Anwendungen keine signifikanten Unterschiede aufwiesen, konnten die Ultraschalldiagnostiker mit den Cartwheel-Geräten im Median 2 zusätzliche Schichten in der Wand des Colon sigmoideum sowie eine zusätzliche Struktur in segmentalen Portalfeldern unterscheiden (p<0,05).

Schlussfolgerung Während Handgeräte bei Phantom- und Routinemessungen eine überlegene oder ähnliche Leistung zeigten, lieferten Workstations immer noch eine überlegene klinische Bildgebung und Auflösung anatomischer Substrukturen, was auf den Mangel an objektiven Messungen zur Bewertung klinischer Ultraschallgeräte hinweist.

Keywords

Education, Training, Quality Assurance - Physics and Technology - Abdomen - Handheld ultrasound - Gastrointestinal Tract

Publication History

Received: 18 August 2023

Accepted after revision: 08 December 2023

Article published online:
01 March 2024

• References

• 1 Maw AM, Huebschmann AG, Mould-Millman NK. et al. Point-of-Care Ultrasound and Modernization of the Bedside Assessment. J Grad Med Educ 2020; 12: 661-665
• 2 Barreiros AP, Cui XW, Ignee A. et al. Initial experiences using EchoScopy in scanning abdominal diseases. Ultraschall Med – Eur J Ultrasound 2013; 34: WS_SL14_04
• 3 Maw AM, Morris MA, Barnard JG. et al. Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center. Diagn Basel Switz 2021; 11: 1172
• 4 Andrea S, Giovanna L, Pietro C. et al. Teaching echoscopy for the early diagnosis of ascites in cirrhosis: assessment of an objective structured clinical examination (OSCE). J Ultrasound 2017; 20: 123-126
• 5 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
• 6 Coşkun F, Akıncı E, Ceyhan MA. et al. Our new stethoscope in the emergency department: handheld ultrasound. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES 2011; 17: 488-492
• 7 Del Medico M, Altieri A, Carnevale-Maffè G. et al. Pocket-size ultrasound device in cholelithiasis: diagnostic accuracy and efficacy of short-term training. Intern Emerg Med 2018; 13: 1121-1126
• 8 Miles DA, Levi CS, Uhanova J. et al. Pocket-Sized Versus Conventional Ultrasound for Detecting Fatty Infiltration of the Liver. Dig Dis Sci 2020; 65: 82-85
• 9 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
• 10 Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics 2019; 9: 61
• 11 Le M-PT, Voigt L, Nathanson R. et al. Comparison of four handheld point-of-care ultrasound devices by expert users. Ultrasound J 2022; 14: 27
• 12 Baiu C, Garra BS, Hangiandreou N. et al. AIUM Routine Quality Assurance of Clinical Ultrasound Equipment. Guid Am Inst Ultrasound Med. 2020 Accessed March 09, 2023 at: http://aium.s3.amazonaws.com/resourceLibrary/rqa2.pdf
• 13 Goodsitt MM, Carson PL, Witt S. et al. Real-time B-mode ultrasound quality control test procedures. Report of AAPM Ultrasound Task Group No. 1. Med Phys 1998; 25: 1385-1406
• 14 Kollmann C, deKorte C, Dudley NJ. et al. Guideline for Technical Quality Assurance (TQA) of ultrasound devices (B-Mode)--version 1.0 (July 2012): EFSUMB Technical Quality Assurance Group--US-TQA/B. Ultraschall Med Stuttg Ger 1980 2012; 33: 544-549
• 15 Sassaroli E, Scorza A, Crake C. et al. Breast Ultrasound Technology and Performance Evaluation of Ultrasound Equipment: B-Mode. IEEE Trans Ultrason Ferroelectr Freq Control 2017; 64: 192-205
• 16 Long Z, Tradup DJ, Stekel SF. et al. Evaluations of UltraiQ software for objective ultrasound image quality assessment using images from a commercial scanner. J Appl Clin Med Phys 2018; 19: 298-304
• 17 Maaser C, Maconi G, Kucharzik T. et al. Ultrasonography in inflammatory bowel disease – So far we are?. United Eur Gastroenterol J 2022; 10: 225-232
• 18 Nardone OM, Calabrese G, Testa A. et al. The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons. Front Med 2022; 9: 898092
• 19 Rispo A, de Sire R, Mainenti PP. et al. David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn’s Disease. Inflamm Bowel Dis 2022; izac116
• 20 Davis CK, Schoffstall RO. Correlation of ultrasonic gallbladder studies with operative findings. South Med J 1981; 74: 781-784
• 21 Park SE, Nam IC, Baek HJ. et al. Effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage to reduce radiation exposure: A single-center experience. PLOS ONE 2022; 17: e0277272
• 22 Nielsen MB, Havre RF, Ewertsen C. et al. Ultrasound handheld devices – potential problems and possible solutions. Ultraschall Med – Eur J Ultrasound 2016; 37: 313-314
• 23 Nielsen MB, Cantisani V, Sidhu PS. et al. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper. Ultraschall Med – Eur J Ultrasound 2020; 30-39
• 24 Heinitz S, Müller J, Jenderka K-V. et al. The application of high-performance ultrasound probes increases anatomic depiction in obese patients. Sci Rep 2023; 13: 16297