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

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