Handheld Ultrasound Research Articles

356: The Utility of Handheld Ultrasound Evaluation in an Austere Medical Setting After a Natural Disaster

This is a report of the utility, applications, and sonographic findings of all patients who presented for care to a local emergency department and hospital over a 2-week period after a major natural disaster with complaints warranting ultrasound (US) evaluation. The utility of US after natural disasters and in austere medical settings is not well known.

Bedside Handheld Ultrasound Video Education for Emergency Medicine Residents

Bedside Handheld Ultrasound Video Education for Emergency Medicine Residents

3047: Bed-side assessment of the post liver transplant patients for evaluation of vascular and extravascular complications: Value of hand-held ultrasound device

Objectives: The purpose of this study was to evaluate the usefulness of a hand-held ultrasonography (US) device in bed-side assessment of the post liver transplant patients for detection of vascular and extravascular complications.

Review of monitoring free muscle flap transfers in reconstructive surgery: role of 99mTc sestamibi scintigraphy

Free tissue transfer is a method of moving any tissue from a donor area of the body to a recipient site and re-attaching the arteries and veins to the blood vessels at the recipient site by microvascular surgery. Improved microsurgical techniques have resulted in a high percentage of successful free tissue transfers. Post-operative monitoring of tissue viability can detect early problems in free tissue transfer which may allow early intervention and salvage. Although many flap monitoring methods have been described, there is still no consensus on which of these techniques will become the standard accepted method for monitoring free muscle flaps. In present study, we investigated the use of 99mTc sestamibi scintigraphy in determining free muscle flap viability and complications, and also in directing treatment. Thirteen patients were examined prospectively during the post-operative period after free tissue transfer for foot defects. The cause of the defect was diabetic foot ulcer in 10 patients, dermatofibrosarcoma in one patient, squamous cell carcinoma in one patient and gunshot wound in one patient. Foot defect covering was carried out with a free latissimus dorsi muscle flap and skin graft (n=12) and a free gracilis muscle flap (n=1). All patients were examined with a monitoring system that consisted of visual inspection, hand-held Doppler ultrasonography and scintigraphic examinations. Scintigraphic imaging of all cases was performed routinely within the first 48 h post-operatively, and also on days 10 and 91 in two patients. There were four flap failures during the study. One of these patients had viable findings upon visual inspection and no evidence of vascular compromise on Doppler at the first examination. In the other patient, visual inspection of the flap showed that it was ischaemic in one region, but there was no vascular compromise on Doppler examination. Scintigraphic images of each of these patients showed a partial hypoperfused area in the flap region. Later, these two flaps showed positive clinical indications of hypoperfusion (colour of muscle and appearance of skin graft) and Doppler abnormalities. The remaining two patients had non-viable scintigraphic images as well as positive clinical indicators of hypoperfusion and evidence of vascular compromise on Doppler. Nine patients each had a viable flap. In these patients, all three examination tools demonstrated that the flaps were totally viable and there were no vascular complications. According to the results of this study, 99mTc sestamibi scintigraphy appears to be a feasible and promising method in the evaluation of free muscle flap viability and complications. On the other hand, to demonstrate any impact on management or patient outcome, further evaluation of 99mTc sestamibi imaging, including comparative studies with different established methods in a larger patient population, is highly recommended.

Recurrent varicose veins: assessment of the saphenofemoral junction.

Thirty-six consecutive unselected patients, who had apparently previously undergone saphenofemoral ligation for primary uncomplicated long saphenous varicosities and who had then re-presented with recurrent thigh varices emanating from the groin, underwent preoperative clinical assessment, hand-held Doppler and duplex ultrasonographic examination and varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent reexploration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or perineal veins (type II recurrence). Clinical examination alone was poor at distinguishing type I from type II recurrence. Doppler ultrasonography was sensitive (88 per cent) but non-specific (40 per cent). In contrast, duplex scanning was insensitive (42 per cent) but extremely specific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive predictive value of 100 per cent, a sensitivity of 73 per cent and in addition provided a precise anatomical 'road-map'. A combination of clinical examination and hand-held Doppler ultrasonography seems to be the most appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additional useful information about both the SFJ and the presence of thigh perforators. Contrast examination may be reserved for patients who have equivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous disease.

Demonstration of reversed flow in segmental branches of the portal vein with hand-held color Doppler ultrasonography after hematopoietic stem cell transplantation

Hepatic veno-occlusive disease (VOD) is a severe complication of hematopoietic stem cell transplantation (SCT). When monitored with hand-held color Doppler ultrasonography during day -7 to +35 around SCT, reversed blood flow in the segmental branches of the portal vein was detected in nine of 56 patients who had undergone SCT. Three of nine patients had clinical evidence of VOD, but six patients did not fulfill the criteria for diagnosis of VOD initially. Two patients progressed to clinical VOD at a later date and the reversed portal flow disappeared with or without treatment for VOD in the other four patients. Monitoring for reversed portal flow with color Doppler ultrasonography may be a useful tool for the early diagnosis of VOD, and may improve prognosis by allowing early initiation of treatment.

Emergency Nurses' Utilization and Accuracy of Handheld Ultrasound Devices for Detection of Fetal Heart Tones in Pregnant Patients

Emergency Nurses' Utilization and Accuracy of Handheld Ultrasound Devices for Detection of Fetal Heart Tones in Pregnant Patients

Image Quality Assessment via Segmentation of Breast Lesion in X-ray and Ultrasound Phantom Images from Fischer's Full Field Digital Mammography and Ultrasound (FFDMUS) System

Fischer has been developing a fused full-field digital mammography and ultrasound (FFDMUS) system funded by the National Institute of Health (NIH). In FFDMUS, two sets of acquisitions are performed: 2-D X-ray and 3-D ultrasound. The segmentation of acquired lesions in phantom images is important: (i) to assess the image quality of X-ray and ultrasound images; (ii) to register multi-modality images; and (iii) to establish an automatic lesion detection methodology to assist the radiologist. In this paper we developed lesion segmentation strategies for ultrasound and X-ray images acquired using FFDMUS. For ultrasound lesion segmentation, a signal-to-noise (SNR)-based method was adapted. For X-ray segmentation, we used gradient vector flow (GVF)-based deformable model. The performance of these segmentation algorithms was evaluated. We also performed partial volume correction (PVC) analysis on the segmentation of ultrasound images. For X-ray lesion segmentation, we also studied the effect of PDE smoothing on GVF's ability to segment the lesion. We conclude that ultrasound image qualities from FFDMUS and Hand-Held ultrasound (HHUS) are comparable. The mean percentage error with PVC was 4.56% (4.31%) and 6.63% (5.89%) for 5 mm lesion and 3 mm lesion respectively. The mean average error from the segmented X-ray images with PDE yielded an average error of 9.61%. We also tested our program on synthetic datasets. The system was developed for Linux workstation using C/C++.

The hand-held ultrasound examination for penetrating abdominal trauma

Background An evaluation of hand-held ultrasonography (US) in the assessment of penetrating torso trauma has not yet been reported. Methods A 2.4 kg hand-held ultrasound device was used to examine penetrating trauma victims in an exam designated as the Hand-Held Focused Assessment with Sonography for Trauma (HHFAST). Results were compared with other US examinations including formal FAST (FFAST), computed tomography, diagnostic peritoneal lavage, operative and autopsy findings, and serial examination. Performance considered both the detection of fluid and injuries requiring intervention. Results The HHFAST was excellent for detecting free intraperitoneal fluid, which had 100% specificity for peritoneal penetration, but was only moderately sensitive for injuries requiring therapy. Conclusions Hand-held sonography can quickly detect intraperitoneal fluid, which has good test performance in determining the presence of an intra-abdominal injury. Negative FAST examinations after penetrating trauma should be followed up with another diagnostic modality.

Handheld Ultrasonography for the Localization of the Cricothryoid Membrane

Handheld Ultrasonography for the Localization of the Cricothryoid Membrane

Ultrasound for the air medical clinician

Recent advances in technology have made the use of ultrasound (US) a possibility in air medicine. A handheld US machine that appears promising as a diagnostic tool within the helicopter theater was developed recently (Sonosite Corp., Bothell, Wash.). Several air medical programs have begun using US as the focused abdominal sonography for trauma (FAST) examination during helicopter transport.1,2

A prospective study of a hand-held ultrasound device in abdominal aortic aneurysm evaluation

Purpose Effective treatment of abdominal aortic aneurysm (AAA) requires both early detection and timely repair to reduce aneurysm-related mortality. The purpose of this prospective study was to evaluate the utility of a hand-held ultrasonography (US) device in AAA screening in a Veterans Affairs vascular surgical service. Methods During a 16-month period, patients with risk factors for AAA were evaluated in a blinded fashion with a hand-held US device performed by physicians. A conventional abdominal duplex US examination was also performed by a certified vascular ultrasonographer. Results of the hand-held US was compared with the conventional duplex US examination. Results A total of 104 patients were evaluated (97 men, mean age 67 ± 6.3 years). The mean times for hand-held and conventional duplex US examinations were 5.3 ± 3.2 minutes and 3.1 ± 2.4 minutes (not significant), respectively. Using the conventional duplex US as a reference, the sensitivity and specificity of the hand-held device in detecting a AAA were 93% and 97%, respectively. The positive and negative predictive values of the hand-held device were 89% and 98%, respectively. The likelihood ratios of positive and negative tests of the hand-held US device examination were 82 and 0.14, respectively. The diagnostic accuracy of the hand-held US device as compared with the conventional duplex US was 98%. Conclusions A hand-held portable US device is effective and accurate in AAA screening with results comparable to the conventional abdominal duplex examination. Moreover, hand-held portable US for AAA screening can be performed expeditiously during physical examination. It should be used as an extension in routine physical examination in vascular patients.

Rapid Diagnosis of an Ulnar Fracture with Portable Hand-Held Ultrasound

Orthopedic fractures are a common injury in operational activities, which are injuries that often occur in isolated or hostile environments. Clinical ultrasound devices have become more user-friendly and lighter, allowing them to be easily transported with forward medical teams. The bone-soft tissue interface has a very large acoustic impedance with a high reflectance that can be used to visualize breaks in contour including fractures. Herein reported is a case of an ulnar fracture that was quickly visualized in the early phase of a multisystem trauma resuscitation with a hand-held ultrasound device. The implications for operational medicine are discussed.

Prospective Evaluation of Handheld Ultrasound in the Diagnosis of Blunt Abdominal Trauma

ObjectivesTo evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma.MethodsTrauma ultrasound using the Focused Assessment with Sonar for Trauma (FAST) technique was performed using...

Handheld Ultrasound Machine Saves Patients Trips to Lab

Handheld Ultrasound Machine Saves Patients Trips to Lab

Influence of Preoperative Duplex Ultrasonography on the Operative Procedure for Primary Varicose Vein Surgery

Objective: To evaluate the impact of duplex ultrasonography on the treatment plan of patients with uncomplicated primary varicose veins. Methods: Forty-nine consecutive patients (62 legs) with primary uncomplicated varicose veins were examined clinically and with hand-held Doppler (HHD) and duplex ultrasonography in an outpatient clinic on the same day. The plans for subsequent treatment were recorded separately after the two ultrasound examinations. Results: The accuracy of the HHD examination was 0.71 in the saphenofemoral junction (SFJ) and long saphenous vein (LSV trunk). In fifty-six limbs (90%) duplex scanning did not affect the surgical treatment of the patients. Conclusions: Most operations on primary varicose veins can be performed on the basis of clinical and HHD examinations by an experienced surgeon. Duplex ultrasonography can be used selectively in the patients with suspected saphenopopliteal junction (SPJ) reflux or equivocal HHD findings.

Efficacy of Conventional Monitoring Techniques in Free Tissue Transfer: An 11-Year Experience in 750 Consecutive Cases

Conventional free flap monitoring techniques (clinical observation, hand-held Doppler ultrasonography, surface temperature probes, and pinprick testing) are proven methods for monitoring free flaps with an external component. Buried free flaps lack an external component; thus, conventional monitoring is limited to hand-held Doppler ultrasonography. Free flap success is enhanced by the rapid identification and salvage of failing flaps. The purpose of this study was to compare the salvage rate and final outcomes of buried versus nonburied flaps monitored by conventional techniques. This study is a retrospective review of 750 free flaps performed between 1986 and 1997 for reconstruction of oncologic surgical defects. There were 673 nonburied flaps and 77 buried flaps. All flaps were monitored by using conventional techniques. Both buried and nonburied flaps were used for head and neck and extremity reconstruction. Only nonburied flaps were used for trunk and breast reconstruction. Buried flap donor sites included jejunum (n = 50), fibula (n = 16), forearm (n = 8), rectus abdominis (n = 2), and temporalis fascia (n = 1). Overall flap loss for 750 free flaps was 2.3 percent. Of the 77 buried flaps, 5 flaps were lost, yielding a loss rate of 6.5 percent. The loss rate for nonburied flaps (1.8 percent) was significantly lower than for buried flaps (p = 0.02, Fisher's exact test). Fifty-seven (8.5 percent) of the nonburied flaps were reexplored for either change in monitoring status or a wound complication. Reexploration occurred between 2 and 400 hours postoperatively (mean, 95 hours). All 44 of the salvaged flaps were nonburied; these were usually reexplored early (<48 hours) for a change in the monitoring status. Flap compromise in buried flaps usually presented late (>7 days) as a wound complication (infection, fistula). None of five buried flaps were salvageable at the time of reexploration. The overall salvage rate of nonburied flaps (77 percent) was significantly higher than that of buried flaps (0 percent, p<0.001, chi-square test). Conventional monitoring of nonburied free flaps has been highly effective in this series. These techniques have contributed to rapid identification of failing flaps and subsequent salvage in most cases. As such, conventional monitoring has led to an overall free flap success rate commensurate with current standards. In contrast, conventional monitoring of buried free flaps has not been reliable. Failing buried flaps were identified late and found to be unsalvageable at reexploration. Thus, the overall free flap success rate was significantly lower for buried free flaps. To enhance earlier identification of flap compromise in buried free flaps, alternative monitoring techniques such as implantable Doppler probes or exteriorization of flap segments are recommended.

Microsurgery Costs and Outcome

Reliable information on cost and value in microsurgery is not readily available in the literature. Driving factors for cost, determinants of complications, and cost-reduction strategies have not been elucidated in this population, despite such progress in other areas of medicine. Clearly, the time-consuming and costly nature of this endeavor demands that appropriate indications and patient management be delineated; to operate proactively in this cost-conscious time, financial and outcome determinations are critical. One hundred seven consecutive free-tissue transfers performed from 1991 to 1994 by a single microsurgeon were studied. Retrospective chart review for clinical parameters was combined with analysis of hospital costs and professional charges. Operating room and anesthesia costs were based on a microcost analysis of actual operating room time, materials, labor, and overhead. Other patient level costs were generated by Transition 1, a hospital cost-accounting system. The following issues were addressed: (1) flap survival; (2) total costs and length of stay for all free flaps; (3) payments received from various insurers; (4) breakdown of operating room costs by labor, supplies, and overhead; (5) breakdown of inpatient costs by category; (6) additional costs of complications and takebacks; (7) factors associated with complications and flap takebacks; and (8) cost-reduction strategies. Mean free flap operating room costs (exclusive of professional fees) ranged among case types from $4439 to $6856 and were primarily a function of operating room times. Elective patient cases lasted a mean 440 minutes. There was a large disparity in reimbursement: private insurers covered hospital costs (not charges) completely, whereas Medicare paid 79 percent and Medicaid only 64 percent. Length of stay, operative procedures, and complications had the greatest influence on inpatient costs in this group of free flap patients. Potential cost savings as a result of possible practice changes (e.g., shortening intensive care unit stays and avoiding staged operations) can be predicted. This analysis has caused a revision in these institutions' practice patterns and lays the foundation for planned outcome studies in this population.

Return of the internal jugular vein—development of collateral drainage following neonatal ligation of the vein

The development of collateral venous drainage in the neck of a child, who as a neonate had undergone ligation and cannulation of the right internal jugular vein, is described. The resultant vessels were of sufficient calibre to be considered as potential sites for vascular access, although it is possible that their course in the thorax may preclude correct placement of a central venous catheter. Nevertheless, we feel that this case further illustrates the benefit of hand-held ultrasonography in visualizing the vascular structures of the neck. Moreover, ligation of a vein in the neonatal period should not be a contraindication to subsequent assessment of that site for vascular access.

Potential of a Hand-Held Ultrasound in Assessment of the Injured Patient

Current studies indicate that portable ultrasound used by trained trauma surgeons in the emergency room can be performed using the focused abdominal sonogram for trauma technique in approximately 2 minutes to evaluate patients with blunt torso trauma. It has been shown to be as accurate as DPL and computed tomography (CT) in the detection of hemoperitoneum following abdominal trauma. It is also very accurate in detecting pericardial fluid and may have a role in the evaluation of penetrating injuries of the thorax, either from stab or gunshot wounds. The examination is best performed early on in the secondary survey of the injured patient. Miniaturization and hand-held ultrasound units are on the horizon. The faculty of the University of Washington in Seattle in conjunction with the Advanced Technology Laboratories in Seattle and the Advanced Research Project Agency of the Department of Defense are producing a battlefield hand-held ultrasound with the ultimate goal to have an ultrasound unit that will fit in the trauma surgeon's pocket. With the use of this new technology, the potential for early diagnosis of victims of trauma and prompt treatment is at hand. One of the greatest challenges remaining is that of training surgeons in the use of ultrasound. The author's experience in conducting ultrasound courses for surgeons at the Uniformed Services University of the Health Sciences is described.