Handheld Ultrasound Research Articles

Internal Medicine Residents’ Experience with using Handheld Ultrasound Machines in Point-of-Care Ultrasonography

Internal Medicine Residents’ Experience with using Handheld Ultrasound Machines in Point-of-Care Ultrasonography

Accurate Estimation of Right-Filling Pressure Using Handheld Ultrasound Score in Patients with Heart Failure

IntroductionThis study aims to evaluate the accuracy of bedside assessment of inferior vena cava (IVC) and right internal jugular (RIJ) vein in predicting right atrial (RA) pressure in heart failure patients. MethodsWe prospectively studied 124 heart failure patients who were referred to our catheterization laboratory for right heart catheterizations to assess hemodynamics and to guide heart failure management. Just prior to the procedure, a handheld ultrasound examination was performed in each patient. The volume status was assessed by estimating RA pressure using end-expiratory IVC dimension, IVC respiratory collapsibility, and RIJ respiratory collapsibility. Patients were divided into 2 groups based on invasive RA pressure value. Multiple logistic regression models were used to identify factors associated with RA ≥10 mm Hg; a 3-point simple score was then created. The performance of this score was assessed using the receiver operating characteristics curve. ResultsIn this study 124 heart failure patients were included; median age was 59 years (interquartile range 48-65), and 40% were female. RIJ respiratory collapsibility <50%, end-expiratory IVC dimension ≥21 mm, and respiratory collapsibility <50% were significantly associated with elevated RA pressure, and were used to build the score. The area under the receiver operating characteristics curve (AUC) for the 3-point score was 0.84 (0.77-0.92), and it performed better than 2-point score using IVC characteristics alone (AUC 0.84 [0.77-0.92] vs 0.75 [0.67-0.83]; P = .003). Of 124 patients, 90 patients (72.5%) had concordant RA pressure and pulmonary capillary wedge pressure. ConclusionConcomitant ultrasound assessment of RIJ and IVC correlated better with RA pressure than IVC alone. A simple 3-point score can provide a useful and easily accessible tool to estimate volume status, and further guide management of heart failure patients.

Interobserver Agreement and Correlation of an Automated Algorithm for B-Line Identification and Quantification With Expert Sonologist Review in a Handheld Ultrasound Device.

B-lines are ultrasound artifacts that can be used to detect a variety of pathologic lung conditions. Computer-aided methods to detect and quantify B-lines may standardize quantification and improve diagnosis by novice users. We sought to test the performance of an automated algorithm for the detection and quantification of B-lines in a handheld ultrasound device (HHUD). Ultrasound images were prospectively collected on adult emergency department patients with dyspnea. Images from the first 124 patients were used for algorithm development. Clips from 80 unique subjects for testing were randomly selected in a predefined proportion of B-lines (0 B-lines, 1-2 B-lines, 3 or more B-lines) and blindly reviewed by five experts using both a manual and reviewer-adjusted process. Intraclass correlation coefficient (ICC) and weighted kappa were used to measure agreement, while an a priori threshold of an ICC (3,k) of 0.75 and precision of 0.3 were used to define adequate performance. ICC between the algorithm and manual count was 0.84 (95% confidence interval [CI] 0.75-0.90), with a precision of 0.15. ICC between the reviewer-adjusted count and the algorithm count was 0.94 (95% CI 0.90-0.96), and the ICC between the manual and reviewer-adjusted counts was 0.94 (95% CI 0.90-0.96). Weighted kappa was 0.72 (95% CI 0.49-0.95), 0.88 (95% CI 0.74-1), and 0.85 (95% CI 0.89-0.96), respectively. This study demonstrates a high correlation between point-of-care ultrasound experts and an automated algorithm to identify and quantify B-lines using an HHUD. Future research may incorporate this HHUD in clinical studies in multiple settings and users of varying experience levels.

Comparison of 3D-Automated Breast Ultrasound With Handheld Breast Ultrasound Regarding Detection and BI-RADS Characterization of Lesions in Dense Breasts: A Study of 592 Cases

We aimed to compare the diagnostic performance of an automated breast ultrasound system (ABUS) with handheld ultrasound (HHUS) in the detection and characterization of lesions regarding BI-RADS classification in women with dense breasts. After ethical approval, from July 2017 to August 2019, 592 consecutive patients were enrolled in this prospective study. On the same day, patients underwent ABUS followed by HHUS. Three breast radiologists participated in this study. The number and type of lesions and BI-RADS categorization of both ABUS and HHUS examinations of each patient were recorded in an excel file. The level of agreement between the two ultrasound systems in terms of lesion number and BI-RADS category were analyzed statistically. ABUS and HHUS detected 1005 and 1491 cystic and 270 and 336 mass lesions in 592 patients respectively. ABUS and HHUS detected 171 and 167 positive/suspicious cases (BIRADS 0/3/4/5). Forty suspicious lesions underwent core needle biopsy whereas 11 malignant lesions were detected by both methods. The remaining lesions were followed with a mean of 31 months. The mean size of solid lesions detected by HHUS and ABUS was 7.67 mm (range 2.1-41 mm) and 7.74 mm (range 2-42 mm) respectively. The agreement for detection of cystic lesions between two methods for each breast was good (kappa: 0.61-0.62 p < 0.001). The agreement of two methods for solid mass lesions for each breast was moderate (k=0.57-0.60 p < 0.001). There was good agreement between the two methods for detecting suspicious lesions (kappa=0.66 p < 0.001). The level of agreement of ABUS and HHUS for dichotomic assignment of BIRADS categories was good. Although ABUS detected fewer lesions compared to HHUS, both methods detected all malignant lesions. ABUS is a reliable method for the detection of malignancy in dense breasts.

Dependability of Automated Breast Ultrasound (ABUS) in Assessing Breast Imaging Reporting and Data System (BI-RADS) Category and Size of Malignant Breast Lesions Compared with Handheld Ultrasound (HHUS) and Mammography (MG).

PurposeThis study aimed to evaluate the dependability of automated breast ultrasound (ABUS) compared with handheld ultrasound (HHUS) and mammography (MG) on the Breast Imaging Reporting and Data System (BI-RADS) category and size assessment of malignant breast lesions.Patients and MethodsA total of 344 confirmed malignant lesions were recruited. All participants underwent MG, HHUS, and ABUS examinations. Agreements on the BI-RADS category were evaluated. Lesion size assessed using the three methods was compared with the size of the pathological result as the control. Regarding the four major molecular subtypes, correlation coefficients between size on imaging and pathology were also evaluated.ResultsThe agreement between ABUS and HHUS on the BI-RADS category was 86.63% (kappa = 0.77), whereas it was 32.22% (kappa = 0.10) between ABUS and MG. Imaging lesion size compared to pathologic lesion size was assessed correctly in 36.92%/52.91% (ABUS), 33.14%/48.84% (HHUS) and 33.44%/43.87% (MG), with the threshold of 3 mm/5 mm, respectively. The correlation coefficient of size of ABUS-Pathology (0.75, Spearman) was statistically higher than that of the MG-Pathology (0.58, Spearman) with P < 0.01, but not different from that of the HHUS-Pathology (0.74, Spearman) with P > 0.05. The correlation coefficient of ABUS-Pathology was statistically higher than that of MG-Pathology in the triple-negative subtype, luminal B subtype, and luminal A subtype (P<0.01).ConclusionThe agreement between ABUS and HHUS in the BI-RADS category was good, whereas that between ABUS and MG was poor. ABUS and HHUS allowed a more accurate assessment of malignant tumor size compared to MG.

Comparison between handheld ultrasound and regional and whole-body dual energy x-ray absorptiometry (DXA) for body fat assessment.

To determine the extent of agreement between a handheld ultrasound (US) attached to an android tablet and the reference method dual energy x-ray absorptiometry (DXA) for the measurement of adiposity. A whole-body DXA scan and abdominal adipose tissue thickness measurements using a handheld US were obtained from 104 adults (63 females, 41 males). Body fat percent (BF%), total fat mass (kg), and trunk fat mass (kg) were obtained from DXA. Subcutaneous adipose tissue (SAT), superficial subcutaneous adipose tissue (SSAT), and deep subcutaneous adipose tissue (DSAT) thickness were obtained from US. Sex-specific total fat mass, trunk fat mass, and BF% estimates by US were compared with DXA. Spearman's correlations and Bland-Altman plots were used to assess agreement between the methods. US SAT correlated strongly with total fat mass for both females (rs=0.74) and males (rs=0.87) as did trunk fat mass (females, rs=0.81; males, rs=0.83); as did SSAT and DSAT (females: rs=0.65 and rs=0.66; males: rs=0.63 and rs=0.85, respectively, all p-values < 0.0001). Bland-Altman plots demonstrated strong agreement for total and trunk fat mass for both males and females. For BF%, acceptable limits of agreement were observed for males but not for females, substantial proportional bias as indicated by a negative slope was noted for BF% using SAT (r=-0.298, p=0.0177). The handheld US and technique to analyze abdominal adipose tissue thickness showed strong agreement with DXA results and generated highly comparable estimates for total and trunk fat mass for both sexes.

Clinical Application of Automated Breast Ultrasound

Automatic breast ultrasound (ABUS) has been developed to compensate for the shortcomings of hand-held ultrasound (HHUS) and is mainly used for breast cancer screening purposes in women with dense breasts. Since 2021, ABUS has been covered by the Korean National Health Insurance System. It is important to scan the entire breast on ABUS and to identify the poor-quality images requiring re-scanning. In addition, a general understanding of the unique ABUS display mode, distinguishing benign from malignant lesions, the diagnostic performance of breast cancer screening, and the application of computer-aided detection/diagnosis systems is necessary to use ABUS efficiently. This review explores the acquisition method, image quality, and image characteristics of ABUS to improve general understanding of this procedure and its advantages over HHUS, so that ABUS can be applied efficiently in clinical practice.

Outcomes of Return to Routine Screening for BI-RADS 3 Lesions Detected at Supplemental Automated Whole-Breast Ultrasound in Women With Dense Breasts: A Prospective Study.

BACKGROUND. Supplemental screening breast ultrasound (US) detects additional cancers in women with dense breasts but identifies many BI-RADS 3 lesions that result in short-term follow-up and biopsies. OBJECTIVE. The purpose of this study was to evaluate outcomes in patients recommended for return to routine screening for lesions assessed as BI-RADS 3 on supplemental automated whole-breast US. METHODS. This prospective study invited patients with BI-RADS 1 or 2 on screening mammography and breast density C or D to undergo supplemental automated breast US (ABUS). ABUS was interpreted as BI-RADS 1, 2, 3, or 0. Return to routine screening was recommended for ABUS BI-RADS 1, 2, or 3. ABUS BI-RADS 0 lesions underwent targeted handheld US. Remaining patients were followed for 2 years. Malignancy rates were compared using Fisher exact tests. RESULTS. A total of 2257 women (mean age, 58.0 ± 11.2 [SD] years) were included. Supplemental ABUS was scored as BI-RADS 1 in 1186 (52.5%) women, BI-RADS 2 in 591 (26.2%), BI-RADS 3 in 395 (17.5%), and BI-RADS 0 in 85 (3.8%). A total of 394 patients with ABUS BI-RADS 3 had 2-year follow-up, during which no cancer (0%; 95% CI, 0.0-0.9%) was diagnosed in the quadrant of the lesion. Among patients with 2-year follow-up, breast cancer was diagnosed in 4/1117 (0.4%) with ABUS BI-RADS 1, 2/556 (0.4%) with ABUS BI-RADS 2, and 2/394 (0.5%) with ABUS BI-RADS 3 (cancer in other quadrant than the lesion). Malignancy rates were not different between ABUS BI-RADS 1, 2, and 3 (p = .28). The ABUS recall rate was 3.8% (85/2257; 95% CI, 3.6-4.0%). If short-term follow-up had been recommended for ABUS BI-RADS 3, the ABUS recall rate would have been 21.3% (480/2257, 95% CI 19.6-23.0%). The biopsy rate was 0.5% (12/2257; 95% CI, 0.3-0.9%); the positive biopsy rate was 58.3% (7/12). One of seven cancers diagnosed by initial supplemental ABUS and none of eight cancers diagnosed during subsequent follow-up were node-positive cancer. CONCLUSION. Return to routine screening for ABUS BI-RADS 3 lesions results in a substantial decrease in recall rate and is unlikely to result in an adverse outcome. CLINICAL IMPACT. This prospective study supports a recommendation for routine annual follow-up for BI-RADS 3 lesions at supplemental ABUS. TRIAL REGISTRATION. ClinicalTrials.gov NCT02650778.

Cost-Benefit relationship between Hand Held Ultra-Sound (HHUS) and Automated Breast Ultra-Sound (ABUS) as a complementary scan for Mammography in detection of breast lesions

Abstract Aim of the Work to compare between HHUS and 3D ABUS, according to their benefits and limitations as a complementary scan for mammography in detection of breast lesions. Patients and Methods The study was conducted on 30 female patients with breast masses diagnosed by clinical examination or by sonomammography in Radiology Department at Al Sheikh Zayed Aal Nahian hospital and Ain Shams University Hospitals during the period from October 2018 and August 2019. Findings were confirmed by histopathological biopsy or at least 6 months follow up. Results Statistically significant difference between ABUS and HHUS time of examination in favor of ABUS with P-value &amp;gt;0.0001 and 95%CI-5.7:-4.4, as ABUS time of examination was (mean+/- SD: 4.1 +/-0.9) and HHUS was (mean +/- SD: 9.2 +/-2.0). In this study; 8 out of 30 were malignant lesions and 22 were benign findings. HHUS showed higher sensitivity than ABUS (100% versus 88%); specificity (86%, 91%), positive predictive value (73%, 78%) and negative predictive value (100%, 95%) respectively. HHUS and ABUS shows nearly perfect agreement regarding lesion classification(benign &amp;malignant).with Cohen’s kappa (κ) 0.85, and also regarding BIRADS classification With Weighted kappa 0.824. Conclusion There is a near perfect agreement between ABUS and HHUS diagnostic performance (κ) 0.85,and statistically significant difference in time of examination in favor of ABUS as it is operator independent and provide large scanned area in every single sweep and also aided with computer software, but HHUS still have higher sensitivity than ABUS and that may be attributed to ABUS limitations to evaluate axillary lymph nodes and lack of Doppler, so ABUS may serve as an effective, adjunct, screening tool to mammography and hand held Sonography.

124 Comparison of First-Pass Peripheral Intravenous Cannulation Using a Handheld Ultrasound Device to Using a Traditional High-End Ultrasound System: A Randomized Controlled Trial

As handheld ultrasound (US) devices have become more commonplace in the practice of emergency medicine (EM), this study aimed to compare the efficacy of a novel handheld ultrasound device (HHUD), the Butterfly IQ (Butterfly Network Inc., Guilford, CT), to that of a traditional high-end ultrasound system (HEUS), the Mindray TE7 (Mindray North America, Mahwah, NJ), in gaining peripheral intravenous (PIV) access on first attempt at an EM residency program.

The Role of a Handheld Ultrasound Device to Facilitate Remote Learning for a Point-of-Care Ultrasound Certificate Program.

Point-of-care ultrasound is a growing field within anesthesiology as well as several other medical and surgical specialties. The recent development of handheld ultrasound devices has the potential to expand the use or this technology by decreasing the cost and increasing accessibility for the healthcare provider. These handheld devices may be used to assist with education, training, and even direct patient care. We outline our process for using a handheld ultrasound device, the Lumify, to assist in the completion of a point-of-care ultrasound certificate program offered by the American Society of Anesthesiologists. We outline the unique advantages of this device as it relates to cost, portability, and applicability of its web-based technology compared to a traditional standalone ultrasound machine for the completion of this course.

Diagnostic performance of combined use of automated breast volume scanning & hand-held ultrasound for breast lesions

Background & objectives:Breast cancer being one of the most common malignant tumours among women, diagnostic modalities for early detection of the same become of paramount importance. In this context, the hand-held ultrasound (HHUS) and automated breast volume scanner (ABVS) could provide valuable information for clinicians to diagnose breast diseases. This study aimed to compare and evaluate the diagnostic performance of combined use of HHUS and ABVS for the differentiation of benign and malignant breast lesions.Methods:A total of 361 female patients, who underwent both HHUS and ABVS examinations were included in this study. ABVS and HHUS images were interpreted using the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS). The distributions of the BI-RADS categories and pathology results were shown as specific numbers. Kappa coefficients test (κ) was calculated to compare the diagnostic results amongst the ABVS, HHUS and ABVS combined with HHUS. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the three diagnostic methods were calculated and their respective diagnostic performance was analyzed by receiver operator characteristic curve.Results:Of a total of 431 lesions, 153 (35.5%) were malignant and 278 (64.5%) were benign. With respect to the pathology results, the value of κ was 0.713 (P<0.001) for HHUS, κ=0.765 (P<0.001) for ABVS and κ=0.815 (P<0.001) for HHUS+ABVS. The sensitivity, specificity, accuracy, PPV and NPV for HHUS combined with ABVS were 96.08 (147/153), 88.49 (246/278), 91.18 (393/431), 82.12 (147/179) and 97.62 per cent (246/252) respectively. For HHUS, these were 90.20 (138/153), 84.17 (234/278), 86.31 (372/431), 75.82 (138/182) and 93.98 per cent (234/249) respectively; and for ABVS these were 92.16 (141/153), 87.05 (242/278), 88.86 (383/431), 79.66 (141/177) and 95.28 per cent (242/254), respectively. There was no significant difference amongst these three methods, but the diagnostic performance of HHUS combined with ABVS was better than, or at least equal to, that of HHUS or ABVS alone.Interpretation & conclusions:The results of this study suggest that ABVS is a promising and advantageous modality for breast cancer detection. Furthermore, the combination of HHUS and ABVS showed a more comparable diagnostic performance than HHUS or ABVS alone for distinguishing between benign and malignant breast lesions.

Comparison of Mammography and Ultrasonography for Early Detection of Breast Cancer

Aim: This systematic review is specifically aimed to compare mammography and ultrasonography in early detection of breast cancer. For this systematic review, major purpose is to compare both screening methods and also analyze the performance of supplemental ultrasonography for early detection of breast cancer. Methodology: For this systematic review, total 23 studies are included which follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic articles from year 2007 to from year 2017 on PUB Med, online Willey library, and Science Direct site were searched by using keywords related to sonographic and mammography imaging for breast cancer. Results: Out of 23 studies, 12 studies are conducted on women with dense breasts. Twenty studies performed their imaging with hand held ultrasound (HHUS). Out of twenty-three studies, sixteen studies followed BI-RADS procedures. In eleven studies that used joint methods, it was observed that mammography (MAM) has 65% whereas ultrasound (US) has 68% efficiency for early detection of breast cancer. 88% area under a cover (AUCs) among MAM and 98% among US imaging was observed. No major difference was found in sensitivity and specificity of both techniques. Conclusion: Study concludes that Ultrasound is more efficient to diagnose factors suggestive of breast cancer that cannot be detected on mammography. It also has the potential to evaluate cancer among dense breast women but unfortunately in some cases, it may cause a high recall rate. Keywords: Breast, Cancer, Mammography, Ultrasonography, Screening.

Use of Handheld Ultrasound to Estimate Right Atrial Pressure in a Pulmonary Hypertension Clinic

Rationale: Point-of-care ultrasonography is an invaluable asset for inpatient decision-making. Whether handheld ultrasound can be used in the outpatient management of pulmonary hypertension is unknown. Objectives: We investigated whether a handheld ultrasound estimate of right atrial pressure correlates with B-type natriuretic peptide (BNP) and clinical outcome over time in outpatients with pulmonary hypertension. Methods: This prospective study included outpatients in a Pulmonary Hypertension Comprehensive Care Center clinic who had a same-day BNP concentration. We used a handheld ultrasound to measure inferior vena cava size and collapsibility, which were used to estimate right atrial pressure (eRAP) and categorize it as normal, intermediate, or high. Correlation analysis was used to compare these ultrasound measurements with BNP at baseline and over time. Cox regression was used to determine whether these measurements were associated with time to clinical worsening. Results: Ninety patients (60% Group 1 pulmonary hypertension) were enrolled. Patients with an intermediate or high eRAP category at baseline had higher BNP concentrations than patients with normal eRAP. For every transition in eRAP category (e.g., from normal to intermediate) between clinic visits, BNP changed by an average of 155 pg/ml (95% confidence interval [CI], 84-227). Higher baseline eRAP category was independently associated with more than twofold increased risk for clinical worsening (hazard ratio, 2.44; 95% CI, 1.47-4.07). Conclusions: Right atrial pressure estimated by portable handheld ultrasound correlates with BNP at baseline and serially over time. Furthermore, eRAP is independently associated with clinical worsening. The use of portable handheld ultrasound to estimate right atrial pressure should be considered in pulmonary hypertension clinics. Clinical trial registered at clinicaltrials.gov (NCT02873039).

Validation of a novel handheld 3D ultrasound system for imaging scoliosis - phantom study.

Use of 3D ultrasound (US) scanners to detect and monitor scoliosis have been validated. The Cobb angle, axial vertebral rotation, spinal flexibility, curvatures in the sagittal profile and the Cobb angle on the plane of maximum curvature (PMC) can be measured from coronal, transverse and sagittal planes of ultrasound images. However, traditional 3D ultrasound scanners are relatively bulky and expensive. 2D US handheld and low-cost scanners are widely available. To adapt the 2D scanners for scoliosis applications, a position and orientation system is integrated with the scanner. The objective of this study was to validate a newly developed 3D handheld US system to image the spine. The wireless handheld US scanner (C3-HD, Clarius, Canada) was selected because of its high resolution and availability of raw data. A wireless tracking system based on electromagnetic (G4 system, Polhemus, USA) was integrated with the Clarius ultrasound. During scanning, the ultrasound information was synchronized with the scanner's position and orientation by using custom developed software. Both information were streamed wirelessly to a laptop. Custom software reconstructed and displayed the 3D spinal image in real-time. A single 3D printed vertebra, two full plastic spine phantoms from T1-T12 vertebrae and a non-scoliotic volunteer were scanned. The 3D reconstruction process of a spine image was less than 3 seconds. The dimensional and the angle errors were 1 mm and 3°, respectively. This study demonstrated that a low-cost ($11,000 USD) handheld 3D ultrasound system was developed and validated. Clinical trials on subjects attending will be the next step.

Performance of a Handheld Ultrasound Device to Assess Articular and Periarticular Pathologies in Patients with Inflammatory Arthritis.

The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.

Feasibility of ABUS as an Alternative to Handheld Ultrasound for Response Control in Neoadjuvant Breast Cancer Treatment

IntroductionThe Invenia Automated Breast Ultrasound Screening (ABUS) is indicated as an adjunct to mammography for breast cancer screening in asymptomatic women with high-density breast tissue. ABUS provides time-efficient evaluation of the 3-dimensional recordings within 3 to 6 minutes. The role and advantages of ABUS in everyday clinical practice, especially in routine examination during neoadjuvant chemotherapy (NACT), is not clear. The aim of this monocentric, noninterventional retrospective study is to evaluate the use of ABUS in patients who are under NACT treatment for response control. MethodsRegular sonographic response check with handheld ultrasound (HHUS) examination and with ABUS were conducted in 83 women who underwent NACT. The response controls were conducted every 3 to 6 weeks during NACT. The handheld sonography was performed with GE Voluson S8. Handheld sonographic measurements and ABUS measurements were compared with the final pathologic tumor size. ResultsThere was no statistical difference between the measurements with HHUS examination or ABUS compared with final pathologic tumor size (P = .47). The average difference from ABUS measured tumor size to final pathologic tumor size was 9.8 mm. The average difference from handheld measured tumor size to final pathologic tumor size was 9/3 mm. Both the specificity of ABUS and HHUS examination in predicting pathologic complete remission was 100%. ConclusionABUS seems to be a suitable method to conduct response control in neoadjuvant breast cancer treatment. ABUS may facilitate preoperative planning and offers remarkable time saving for physicians compared with HHUS examination and thus should be considered for clinical practice

Correction to: The Use of Handheld Ultrasound Devices in Emergency Medicine

A Correction to this paper has been published: https://doi.org/ https://doi.org/10.1007/s40138-021-00233-w

POS1394 ACCURACY AND PERFORMANCE OF A HANDHELD ULTRASOUND DEVICE TO ASSESS ARTICULAR AND PERIARTICULAR PATHOLOGIES IN PATIENTS WITH INFLAMMATORY ARTHRITIS

Background:Handheld ultrasound (HHUS) devices have increasingly found their way into clinical practice due to several advantages (e.g. portability, significantly lower purchase cost). However, there is no evidence to date on the accuracy and performance of HHUS in patients with inflammatory arthritis (IA).Objectives:To assess accuracy and performance of a new HHUS machine in comparison to a conventional cart-based sonographic machine in patients with IA.Methods:Consecutive IA patients of our outpatient clinic with at least one tender and swollen joint in the 66/68 joint count were enrolled. US was performed on clinically affected joints with corresponding tendons/entheses using a cart-based sonographic device (“Samsung HS40”) and a HHUS device (“Butterfly iQ”) in standard scan positions. One blinded reader scored all images for the presence of following pathologic findings: erosions, bony enlargement, synovial hyperthrophy, joint effusion, bursitis, tenosynovitis and enthesitis. In addition, synovitis was graded (B Mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale [1]. To avoid bias by the blinded reader, who otherwise would have been tempted to identify pathological findings for each examined joint, we also included 67 joints of two healthy volunteers into the evaluation. We calculated the overall concordance and the concordance by type of joint and type of pathological finding between the two devices (percentage of observation pairs in which the same rating was given by both devices). The Cohen’s kappa coefficient (κ) with 95% bootstrap confidence intervals was used to assess the agreement between the two US devices. We also measured the time required for the US examination of one joint with both devices.Results:32 patients (20 rheumatoid arthritis, 10 psoriatic arthritis, 1 gouty arthritis, 1 systemic lupus erythematosus) were included in this study. Mean age of patients was 58.2±13.7 years, 63% were females. In total 186 joints were examined. The overall raw concordance in B-mode between the two devices was 97 %, with an overall κappa for agreement of 0.90, 95% CI (0.89, 0.94). No significant differences were found in relation to type of joint or pathological finding examined. The PD-mode of the HHUS device did not detect any PD-signal, whereas the cart-based device detected a PD-signal in 61 joints (33%). The portable device did not offer any time saving compared to the cart-based device (mean time in seconds per examined region: 47 seconds for the HHUS device versus 46.3 seconds for the cart-based device).Conclusion:The HHUS device “Butterfly iQ” has been shown to be accurate in the assessment of structural joint damage and inflammation in patients with IA, but only in B-mode. Significant improvements are still needed to reliable demonstrate blood flow detection by PD mode.

The Use of Handheld Ultrasound Devices in Emergency Medicine.

Purpose of ReviewUltraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology.Recent FindingsImages obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of “tele-ultrasound” and augmented reality scanning.SummaryThis review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.