Cart-based System Research Articles

Does Size Matter? A Prospective Study on the Feasibility of Using a Handheld Ultrasound Device in Place of a Cart-Based System in the Evaluation of Trauma Patients

BackgroundAs emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. ObjectiveWe aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during the evaluation of trauma patients using the Focused Assessment with Sonography for Trauma (FAST) examination. MethodsThis was a prospective study of adult trauma patients who received a FAST examination as part of their evaluation. A FAST examination was performed using a cart-based machine and a handheld device. The results of the examinations were compared with computed tomography imaging. Images obtained from both ultrasound devices were reviewed by an expert for image quality. ResultsA total of 62 patients were enrolled in the study. The mean (SD) time to perform a FAST examination using the handheld device was 307.3 (65.3) s, which was significantly less (p = 0.002) than the 336.1 (86.8) s with the cart-based machine. There was strong agreement between the examination results of the handheld and cart-based devices and between the handheld and computed tomography. Image quality scores obtained with the handheld device were lower than those from the cart-based system. Most operators and reviewers agreed that the images obtained from the handheld were adequate for medical decision making. ConclusionsData support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system.

Use of a novel handheld ultrasound device with continuous-wave doppler capability for the assessment of valvular heart disease

Abstract Background/Introduction Echocardiography is the primary non-invasive imaging method for the diagnosis and evaluation of valvular heart disease. Doppler echocardiography provides accurate non-invasive evaluation of valve hemodynamics. Recent technological advancements have enabled the acquisition of echocardiographic images at the point-of-care by using small handheld ultrasound devices (HUDs); their availability and relatively low cost compared to the high-end systems have made these devices attractive to use for rapid medical decision making. However, the inability to quantify flow velocity has been a major limitation for HUDs; the lack of spectral Doppler capability has so far hindered the comprehensive assessment of haemodynamic data and valve function. Purpose To evaluate for the first time the accuracy of a novel HUD with continuous-wave (CW) Doppler capability to measure flow velocity in valvular heart disease. Methods We prospectively included 56 consecutive patients who were referred to the echocardiography laboratory of a tertiary hospital. All patients were scanned with both the Kosmos HUD and the standard echocardiography cart-based system (reference standard) in a randomized order. CW Doppler measurements of maximum velocities (Vmax) were obtained from the apical five-chamber view for the aortic ejection and regurgitation and from the apical four-chamber view for the mitral and tricuspid regurgitation (presence assessed by colour Doppler), maintaining a parallel orientation between the ultrasound beam and the blood flow. All measurements were compared to assess inter-method agreement using linear regression and Bland-Altman analysis. Results The acquisition of CW Doppler signal using the HUD was feasible in 55 out of 56 patients (mean age 66±16 years old, 40% female). Among them, there were 31 cases of (at least mild) aortic stenosis and 23 cases of valvular regurgitation (4 aortic, 6 mitral and 13 tricuspid regurgitations). There was excellent correlation between the HUD and the cart-based system CW Doppler for the aortic Vmax measurements (r=0.99, p<0.001) and for the valvular regurgitation Vmax measurements (r=0.98, p<0.001). The corresponding Bland-Altman plots showed a small underestimation bias of −0.13 m/sec (p<0.001), with limits of agreement ±0.41 m/sec for the aortic Vmax and −0.21 m/sec (p=0.003), with limits of agreement ±0.57 m/sec for the valvular regurgitation Vmax measurements. Conclusion A novel HUD with CW Doppler spectral analysis was able to provide peak jet velocity measurements comparable to the standard cart-based echocardiography systems, in patients with valvular stenosis and regurgitation. Such expanded capabilities of HUDs show clinical potential and may lead to the improvement of the assessment of valvular pathology at the point-of-care. Funding Acknowledgement Type of funding sources: None.

Handheld ultrasound device with continuous-wave doppler capability: is it feasible?

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Hellenic Society of Cardiology Background/Introduction: Echocardiography is the key tool for the diagnosis and evaluation of valve disease, and has been the primary non-invasive imaging method for valve stenosis assessment. The antegrade systolic velocity across the aortic valve, or aortic jet velocity, is measured using continuous-wave (CW) Doppler ultrasound and is of paramount importance for diagnosis and prognosis of such patients. Recent technological advancements have enabled the acquisition of echocardiographic images at the point of care by using small handheld ultrasound devices (HUDs); their availability and relatively low cost compared to the high-end, fully equipped systems have made these devices attractive to use for rapid medical decision making. However, the inability to quantify flow velocity has been a major drawback for HUDs, since the lack of spectral Doppler capability makes assessment of valvular pathology difficult. Purpose To evaluate the feasibility and accuracy of a novel HUD with CW Doppler capability to measure aortic jet velocity. Methods We prospectively included 43 consecutive patients who were referred to the outpatient specialist valve clinic of a tertiary hospital. All patients were scanned with both the Kosmos HUD and the standard echocardiography cart-based system (reference standard) in order to obtain CW Doppler signal across the aortic valve. The peak aortic jet velocity measurements used for the analysis were acquired from the apical five-chamber view by both techniques and were compared to assess inter-method agreement using linear regression and Bland-Altman analysis. Results The acquisition of CW Doppler signal using the Kosmos HUD was feasible in 42 out of 43 patients (mean age 65 ± 15 years old, 58% male). Among them, there were 12 patients (29%) with peak aortic jet velocity >3 m/s (which is the cut-off to define at least moderate aortic valve stenosis). The peak aortic jet velocity was measured as 2.15 ± 1.16 m/s with the HUD CW Doppler and 2.28 ± 1.16 m/s using the cart-based system CW Doppler. There was excellent correlation between the HUD CW Doppler and the reference standard with a correlation coefficient r = 0.98, 95%CI 0.97-0.99, (p < 0.001). The corresponding Bland-Altman plot showed a small underestimation bias of -0.13 m/s (p < 0.001), with limits of agreement ±0.42 m/s for the peak aortic jet velocity. Of importance, for the subgroup of patients with aortic jet velocity >3 m/s the correlation remained excellent (r = 0.92, p < 0.001). Conclusion A novel HUD with CW Doppler spectral analysis was able to provide aortic jet velocity measurements similar to the standard cart-based echocardiography systems, including patients with high aortic jet velocities. Such expanded capabilities of HUDs show clinical potential and may lead to the improvement of the assessment of valvular pathology at the point of care. Abstract Figure. Correlation plot Abstract Figure. Bland-Altman plot

Increasing reliability and productivity in hypermarkets by queuing theory analysis and a smart shopping cart-based system

One of the bothering and unavoidable things in most of the shopping centres is billing. This paper focuses on developing an alternative methodology to the existing one by using time study and queuing theory. With help of results, a new methodology is proposed to increase the productivity, swiftness of shopping. The proposal is to departmentalise the billing process and implant smart billing concepts like localised self initiated billing counters or customised trolleys to bill products. This new study results in time saving in the queuing and billing process. The cart is designed using CREO 2.0 software and made smart with the help of wireless sensing devices. With the burgeoning role of wireless sensing devices such as bar-code scanners, this application can be extended to the consumer market such as a supermarket where manual-billing process becomes cumbersome and at the same time involves a hefty waste of time and labour.

Increasing reliability and productivity in hypermarkets by queuing theory analysis and a smart shopping cart-based system

One of the bothering and unavoidable things in most of the shopping centres is billing. This paper focuses on developing an alternative methodology to the existing one by using time study and queuing theory. With help of results, a new methodology is proposed to increase the productivity, swiftness of shopping. The proposal is to departmentalise the billing process and implant smart billing concepts like localised self initiated billing counters or customised trolleys to bill products. This new study results in time saving in the queuing and billing process. The cart is designed using CREO 2.0 software and made smart with the help of wireless sensing devices. With the burgeoning role of wireless sensing devices such as bar-code scanners, this application can be extended to the consumer market such as a supermarket where manual-billing process becomes cumbersome and at the same time involves a hefty waste of time and labour.

Portable ulotrasound unit and docking station

A portable ultrasound unit and docking cart for the unit are provided. When the portable unit is mounted to the docking cart, the docking cart transforms the portable unit into a cart-based system with enhanced features and functionality such as improved ergonomics, ease of use, a larger display format, external communications connectivity, multiple transducer connections, and increased data processing capabilities. A clinician display and patient display may be provided on the cart. Communications circuitry in the docking cart may be used to support communications between the docking cart's processor and external networks and devices. The docking cart may receive physiological signals such as cardiac signals and may use this information to synchronize ultrasound imaging operations with a patient's physiological condition. Adjustable user interface controls, data handling features, security features, power control functions, and thermal management capabilities may be provided in the docking cart.