Handheld Ultrasound Research Articles

Diagnostic Efficacy of Five Different Imaging Modalities in the Assessment of Women Recalled at Breast Screening-A Systematic Review and Meta-Analysis.

There are variations in the assessment pathways for women recalled at screening, and the imaging assessment pathway with the best diagnostic outcome is poorly understood. This paper examines the efficacy of five imaging modalities for the assessment of screen-recalled breast lesions. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) strategy was employed to identify studies that assessed the efficacy of imaging modalities in the assessment of lesions recalled at screening from the following eight databases: Medline, Web of Science, Embase, Scopus, Science Direct, PubMed, CINAHL, and Global Health. Search terms included "Breast assessment" AND "Diagnostic Workup" OR "Mammography" AND "Digital Breast tomosynthesis" AND "contrast enhanced mammography and Magnetic Resonance imaging" AND "breast ultrasound". Studies that examined the performance of digital mammography (DM), digital breast tomosynthesis (DBT), handheld ultrasound (HHUS), contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI) in screen-recalled lesions were reviewed. Meta-analyses of these studies were conducted using the MetaDisc 2.0 software package. Results: Fifty-four studies met the inclusion criteria and examined between one and three imaging modalities. Pooled results of each imaging modality demonstrated that CEM has the highest sensitivity (95; 95% CI: 90-97) followed by MRI (93; 95% CI: 88-96), DBT (91; 95% CI: 87-94), HHUS (90; 95% CI: 86-93), and DM (85; 95% CI: 78-90). The DBT demonstrated the highest specificity (85; 95% CI: 75-91) followed by DM (77; 95% CI: 66-85), CEM (73; 95% CI: 63-81), MRI (69; 95% CI: 55-81), and HHUS (65; 95% CI: 46-80). Conclusions: The CEM, MRI, DBT, and HHUS demonstrate excellent performance in correctly identifying and classifying cancer lesions referred for diagnostic work-up, but HHUS, MRI, and CEM have a more limited ability to discriminate benign lesions than DBT and DM.

The Potential of Tele-Ultrasound, Handheld and Self-Operated Ultrasound in Pregnancy Care: A Systematic Review.

To explore the use of tele-ultrasound and handheld or self-operated ultrasound in pregnancy. A systematic search provided 31 studies. The risk of bias for each study was assessed. Results were analyzed and presented in a narrative overview in four domains: tele-ultrasound, patient-operated ultrasound, handheld devices and low- and middle-income countries (LMIC). The quality of studies was generally low or fair based on the NIH Quality Assessment Tools. Fetal tele-ultrasound services (11 studies) are feasible and especially helpful in rural areas or with increased centralization of specialist care. Three studies with patient-operated ultrasound concluded its feasibility with good-to-high experiences. The use of handheld devices in pregnancy (eight studies) showed similar ultrasound results when compared to standard devices. In LMICs, innovative use of ultrasound (nine studies) can facilitate access to obstetric care performed by trained as well as unskilled caregivers combined with remote evaluation by an expert. Innovations in ultrasound in pregnancy care have shown promising results for application. Although most studies demonstrated benefits for pregnant women or care providers, high-level evidence is scarce. High-quality studies on innovations are needed to assess medical outcomes, patient and provider experiences and costs.

Real-world effectiveness and safety of handheld ultrasound in pleural procedures.

The use of ultrasound for pleural procedures is associated with a decreased risk of complications. Handheld ultrasounds allow for easier evaluation of the pleural space. Limited data exists for the use of such devices for pleural procedures. The primary objective of our study was to assess the effectiveness and safety of handheld ultrasound for pleural procedures. We performed a prospective observational study, including all consecutive patients who underwent pleural procedures using the handheld ultrasound between September 2021 and November 2023. A total of 332 pleural procedures were attempted with handheld ultrasound, of which 329 pleural procedures (99.1%) were successfully performed. The median volume of fluid drained was 500 (interquartile range: 300-800). Thoracentesis was performed in 127 patients (38.5%), tube thoracostomy in 179 patients (54.4%), and medical thoracoscopy in 23 patients (7.0%). Exudative pleural effusions were found in 264 patients (80.0%), of which 152 (46.2%) were determined to be due to infectious etiologies. A total of 4 (1.2%) patients had a complication due to the procedure. 2 patients (0.6%) had a pneumothorax, while 2 patients (0.6%) developed a hemothorax. A total of 101 patients had either low platelets (<50×109/L) or use of anti-platelet or anti-coagulant drugs. 128 patients (38.8%) were on positive pressure support during the pleural procedure. Our study shows that handheld ultrasounds are effective and safe for pleural procedures, including cases with septated pleural effusions and patients on anti-platelet or anti-coagulant drugs.

Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study

IntroductionUltrasound guided IV catheter (USGIV) access occurs frequently in Emergency Departments (EDs). This task is often performed using large, expensive, cart-based ultrasound systems (CBUS) which are frequently needed for other ED ultrasound functions and can be cumbersome to use and store. Handheld ultrasounds (HHUs) may be able to meet this need, but it is unknown if they function interchangeably with CBUS for USGIV placement. We performed a prospective, randomized, noninferiority study to compare the success rate of HHUs to CBUSs for placing USGIVs. MethodsED patients 18 and older needing an USGIV were approached for enrollment and randomized to receive an USGIV placed by CBUS or HHU. USGIVs were placed by any ED physician or nurse trained in placement. A placement was considered attempted upon needle entry into the skin. An USGIV was successful if it was immediately flushable with saline. Data was collected on the success of IV placement, number of attempts, IV and provider characteristics, patient demographics, and length of time the USGIV lasted. Demographics and operator and IV characteristics were analyzed using Pearson's Chi square, Fischer's Exact test, or Wilcoxon rank sum tests. Non-inferiority was assessed using the Farrington-Manning test. Results were approached per protocol and analyzed in R. Results312 patients were enrolled. Patient and IV characteristics were similar between groups. There was no difference in the number of successful USGIVs placed in either group (p≥0.9) with 146 in the CBUS group and 145 in the HHU group. There was no difference in the first attempt success rate between groups (p = 0.8) and HHU was noninferior to CBUS for successful USGIV placement (p = 0.0001). The rate of premature USGIV failure was similar between HHU and CBUS (4.0 % and 6.7 %). ConclusionHHU was noninferior to CBUS for successful USGIV placement. There was no difference in the rate of first attempt success at placement or USGIV survival to a patient's ED disposition between groups. No significant additional training was required for ED providers of all levels to use the HHUs.

Comparing New Smartphone-Connected Handheld Ultrasound Device vs. Traditional Ultrasound in Vitreo-Retinal Disease Diagnosis.

(1) Background: Ocular emergencies account for 1.5-3% of emergency department (ED) visits and require urgent diagnosis to prevent serious complications. Ultrasonography is a crucial, non-invasive diagnostic tool for these conditions but traditionally lacks portability and integration with modern electronic smart devices. The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound device in comparison to a conventional cart-based sonographic machine in patients attending to the ED for vitreo-retinal diseases. (2) Methods: three specialists in ophthalmology, with at least 4-year experience in vitreo-retinal diseases and eye ultrasound, evaluated images of 50 eyes with both portable and traditional ultrasound probes. Each specialist made the diagnosis based on the images captured with both probes and then rated their overall image quality and confidence of diagnosis with a five-point Likert scale. The concordance of diagnosis between the two probes was evaluated. (3) Results: The sample comprised 42 patients. Twenty (40%) healthy eyes and thirty eyes with the following vitreo-retinal interface conditions were examined: 12 retinal detachment (24%), 8 vitreous hemorrhage (16%), and 10 posterior vitreous detachment (20%). The overall accuracy of the two devices appeared to be comparable (70.7% vs. 69.3%). The Butterfly iQ+ probe showed similar sensitivity in retinal detachment diagnosis (91.7% vs. 94.4% of the Accutome B-scan Pro), while it showed poor performance in diagnosing posterior vitreous detachment (sensitivity = 27.2%); (4) Conclusions: The Butterfly iQ+ device demonstrated high sensitivity in the diagnosis of retinal detachment. Significant adjustments are still needed to improve the resolution of the vitreous body.

A comparison of handheld versus cart-based ultrasound in the evaluation and diagnosis of carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) is responsible for over 90 % of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting. Methods43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8–20 MHz transducer. The GE Venue Go with a 4–20 MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired t-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p < 0.05). ResultsThe average CSA measurement obtained with the GE was 14.21 ± 4.89 mm2. The average CSA measurement obtained with the Clarius handheld transducer was 13.54 ± 4.50 mm2. The mean difference between the GE and Clarius groups was 0.62 mm2 (95 % CI = −1.47 to 2.71), p = 0.55. ConclusionCSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.

Prospective Comparison of Nine Different Handheld Ultrasound (HHUS) Devices by Ultrasound Experts with Regard to B-Scan Quality, Device Handling and Software in Abdominal Sonography.

The HHUS market is very complex due to a multitude of equipment variants and several different device manufacturers. Only a few studies have compared different HHUS devices under clinical conditions. We conducted a comprehensive prospective observer study with a direct comparison of nine different HHUS devices in terms of B-scan quality, device handling, and software features under abdominal imaging conditions. Nine different HHUS devices (Butterfly iQ+, Clarius C3HD3, D5CL Microvue, Philips Lumify, SonoEye Chison, SonoSite iViz, Mindray TE Air, GE Vscan Air, and Youkey Q7) were used in a prospective setting by a total of 12 experienced examiners on the same subjects in each case and then assessed using a detailed questionnaire regarding B-scan quality, handling, and usability of the software. The evaluation was carried out using a point scale (5 points: very good; 1 point: insufficient). In the overall evaluation, Vscan Air and SonoEye Chison achieved the best ratings. They achieved nominal ratings between "good" (4 points) and "very good" (5 points). Both devices differed significantly (p < 0.01) from the other seven devices tested. Among the HHUS devices, Clarius C3HD3 and Vscan Air achieved the best results for B-mode quality, D5CL Microvue achieved the best results for device handling, and SonoEye Chison and Vscan Air achieved the best results for software. This is the first comprehensive study to directly compare different HHUS devices in a head-to-head manner. While the majority of the tested devices demonstrated satisfactory performance, notable discrepancies were observed between them. In particular, the B-scan quality exhibited considerable variation, which may have implications for the clinical application of HHUS. The findings of this study can assist in the selection of an appropriate HHUS device for specific applications, considering the clinical objectives and acknowledging the inherent limitations.

Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study.

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.

Utility of Handheld Ultrasound in Identifying Millimeter-Sized Vasculature in Living and Cadaveric Subjects.

Objective This study aimsto investigate the utility of handheld, Bluetooth-capable ultrasound in identifying millimeter-sized vasculature in both living and cadaveric subjects. Methods Using handheld, linear ultrasound probes, the carpal tunnel of 87 living individuals (174 forearms) was assessed for the presence of a persistent median artery (PMA). Radial, ulnar, and persistent median arterial diameters were measured, along with forearm circumference. Using the same probes, 46 cadaveric forearms were assessed for the presence of a "potential" PMA. Those same forearms were subsequently dissected to confirm the presence of the artery. Results A PMA was identified in 3.4% of individuals (1.7% of forearms). Radial, ulnar, and persistent median arterial diameters were 2.12 ± 0.40 mm, 1.89 ± 0.41 mm, and 0.82 ± 0.33 mm, respectively. The radial artery was significantly larger than the ulnar artery (p < 0.0001). In cadaveric subjects, four "potential" PMAs were identified by pre-dissection ultrasound. Upon dissection, only one of the "potential" PMAs was confirmed, and three previously unidentified PMAs were identified. Conclusions The prevalence of PMA in living subjects was lower than previously reported. Additionally, handheld ultrasound had low accuracy in identifying PMAs in cadavers prior to dissection. This could be an indication that current handheld ultrasound lacks the sensitivity to identify millimeter-sized vasculature, such as a PMA. In both populations of subjects, key, non-anomalous anatomy was readily seen, indicating the utility of handheld ultrasound in the proper context.

Automatic tablet-based monoplane quantification of stroke volume and left ventricular ejection fraction: A comparative assessment against computer-based biplane and monoplane tools.

Point-of-care cardiovascular left ventricle ejection fraction (LVEF) quantification is established, but automatic tablet-based stroke volume (SV) quantification with handheld ultrasound (HAND) devices is unexplored. We evaluated a tablet-based monoplane LVEF and LV volume quantification tool (AutoEF) against a computer-based tool (Tomtec) for LVEF and SV quantification. Patients underwent HAND scans, and LVEF and SV were quantified using AutoEF and computer-based software that utilized either apical four-chamber views (Auto Strain-monoplane [AS-mono]) or both apical four-chamber and apical two-chamber views (Auto Strain-biplane [AS-bi]). Correlation and Bland-Altman analysis were used to compare AutoEF with AS-mono and AS-bi. Out of 43 participants, eight were excluded. AutoEF showed a correlation of.83 [.69:.91] with AS-mono for LVEF and.68 [.44:.82] for SV. The correlation with AS-bi was.79 [.62:.89] for LVEF and.66 [.42:.81] for SV. The bias between AutoEF and AS-mono was 4.88% [3.15:6.61] for LVEF and 17.46mL [12.99:21.92] for SV. The limits of agreement (LOA) were [-5.50:15.26]% for LVEF and [-8.02:42.94] mL for SV. The bias between AutoEF and AS-bi was 6.63% [5.31:7.94] for LVEF and 20.62mL [16.18:25.05] for SV, with LOA of [-1.20:14.47]% for LVEF and [-4.71:45.94] mL for SV. LVEF quantification with AutoEF software was accurate and reliable, but SV quantification showed limitations, indicating non-interchangeability with neither AS-mono nor AS-bi. Further refinement of AutoEF is needed for reliable SV quantification at the point of care.

A Handheld Ultrasound Device Can Predict Constipation with Rectal Fecal Retention in a Palliative Care Setting.

Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs' usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.

Handheld Ultrasound Detection of Supratrochlear Artery in Forehead Flap Surgery: A Feasibility Study.

Handheld Ultrasound Detection of Supratrochlear Artery in Forehead Flap Surgery: A Feasibility Study.

Improving Lesion Location Reproducibility in Handheld Breast Ultrasound.

Interoperator variability in the reproducibility of breast lesions found by handheld ultrasound (HHUS) can significantly interfere with clinical care. This study analyzed the features associated with breast mass position differences during HHUS. The ability of operators to reproduce the position of small masses and the time required to generate annotations with and without a computer-assisted scanning device (DEVICE) were also evaluated. This prospective study included 28 patients with 34 benign or probably benign small breast masses. Two operators generated manual and automated position annotations for each mass. The probe and body positions were systematically varied during scanning with the DEVICE, and the features describing mass movement were used in three logistic regression models trained to discriminate small from large breast mass displacements (cutoff: 10 mm). All models successfully discriminated small from large breast mass displacements (areas under the curve: 0.78 to 0.82). The interoperator localization precision was 6.6 ± 2.8 mm with DEVICE guidance and 19.9 ± 16.1 mm with manual annotations. Computer-assisted scanning reduced the time to annotate and reidentify a mass by 33 and 46 s on average, respectively. The results demonstrated that breast mass location reproducibility and exam efficiency improved by controlling operator actionable features with computer-assisted HHUS.

Handheld Ultrasound Parameters of Lower Limb Muscles versus Bioelectrical Impedance Analysis Parameters for Skeletal Muscle Assessments in Arabic Female Adults.

Ultrasound (US) is a promising tool for skeletal muscle assessment; however, US studies have scarcely focused on Arabic populations. This study examined the association of handheld US indicators and bioelectrical impedance analysis (BIA) parameters in healthy Arabic females. A cross-sectional study was conducted on 60 healthy Arabic females whose muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris (RF) were measured alongside their MT and pennation angle (PA) of the medial gastrocnemius (MG) muscle (both muscles on the dominant side). Anthropometric and body composition analyses quantified fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM). Muscle strength was assessed using a handgrip dynamometer, and physical activity levels were recorded with the Global Physical Activity Questionnaire (GPAQ). The CSA of the RF and the MT of both the RF and MG correlated significantly with FFM and ASMM. The PA of MG showed no significant correlations with ASMM, FFM, or handgrip strength. The CSA of RF was significantly correlated with handgrip strength (r = 0.313, p = 0.015), while the PA of MG correlated positively with GPAQ score (r = 0.346, p = 0.007). The CSA of RF significantly predicted both ASMM (β = 0.883, p = 0.0002) and FFM (β = 1.935, p = 0.0001). In conclusion, handheld US parameters, especially the RF's CSA, correlate with and can predict BIA-based FFM and ASMM in healthy females.

Comparative analysis of hand-held and stationary ultrasound for detection of sarcopenia in acutely hospitalised older adults—a validity and reliability study

Key summary pointsAimTo compare hand-held ultrasound (HH-US) to stationary ultrasound (S-US) in muscle assessment for detection of sarcopenia in acutely hospitalised older adults.FindingsRater 1 had ‘substantial’ agreement between HH-US and S-US (κ = 0.77), whereas Rater 2 had ‘almost perfect’ agreement (κ = 0.92). Finally, no significant differences were seen on any US variables among the two raters when comparing the results from both HH-US and S-US.MessageHH-US scanners could be feasible, valid, and reliable for detection of loss of muscle mass associated with sarcopenia in acutely admitted older patients, in the hands of an experienced examiner.

Handheld Ultrasound Bladder Volume Assessment Compared to Standard Technique.

Urinary retention is a common complaint encountered in the emergency department (ED).Current tools for the assessment of urinary retention are either bladder volume estimation with a bladder scanner performed by nursing staff or direct visualization and measurement via bedside ultrasound performed by an emergency physician. Newer handheld ultrasound devices such as the Butterfly iQ have been brought to the market to bring ultrasound more conveniently to the bedside.A recently released handheld auto-calculation tool produces a 3D image of the bladder and instant bladder volume measurement in milliliters. However, there is a paucity of data assessing the validity of the new Butterfly iQ at the bedside. This study sought to compare the diagnostic accuracy and rated user convenience of the nursing bladder scanner, the cart-based ultrasound machine, and the Butterfly iQ auto-bladder volume tool. ED patients were prospectively enrolled and underwent bladder measurements in a randomized, pre-determined order with each modality. Measurements were subsequently compared to the gold standard of catheterization. Cart-based ultrasound had the highest agreement to catheterization when compared to the RN scanner and the Butterfly iQ.However, the Butterfly iQ and RN scanner were both considered more convenient measurement modalities than the cart-based ultrasound. The Butterfly iQ serves as a cost-effective alternative to cart-based ultrasound while providing greater general utility compared to bladder scanners.

Using Ultrasound to Improve Diagnostic Confidence and Management of Psoriatic Disease: Highlights From the GRAPPA 2023 Ultrasound Workshop.

The sensitivity of ultrasound (US) to detect, characterize, and monitor the relevant pathologies of psoriatic arthritis (PsA), including synovitis, enthesitis, tenosynovitis, and dactylitis, has made it an attractive tool for informing clinical decisions. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) US working group ran 2 sessions during the annual GRAPPA meeting held in July 2023 in Dublin, Ireland. During the first workshop, the group presented 2 topics, followed by a live demonstration and a group discussion. The 2 topics were (1) an overview of the Diagnostic Ultrasound Enthesitis Tool (DUET) enthesitis scoring methodology, and (2) small hand-held probes-will the promise deliver? The live demonstration that followed compared the performance of 2 hand-held US (HHUS) devices vs a console US machine in patients with PsA, and the interactive group discussion considered gaps in the literature and future research suggestions relating to HHUS and its application in psoriatic disease. During the second session, the US working group provided further updates regarding the GRAPPA US studies currently underway or recently completed.

Development of an e-learning program for biofeedback in pelvic floor muscle training for adult women using self-performed ultrasound: An observational study.

Pelvic floor muscle training (PFMT) for urinary incontinence (UI) is recommended in combination with biofeedback to visualize pelvic floor muscles. The focus is on non-invasive hand-held ultrasound (US) measurement methods for PFMT, which can be performed at home. Recently, self-performed US measurements in which the patient applies the US to themself have gradually spreading. This study aimed to develop an educational program for the biofeedback method using self-performed US and to evaluate its feasibility. This study was an observational study. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) was utilized to create an e-learning program for women aged ≥40 years with UI. Participants self-performed bladder US via e-learning, using a hand-held US device with a convex probe. The primary outcome was the number of times the bladder area was successfully extracted using an existing automatic bladder area extraction system. The secondary outcome was the total score of the technical evaluation of the self-performed US, which was evaluated across three proficiency levels. Descriptive statistics were conducted for participant characteristics, presenting categorical variables as percentages and continuous variables as means ± SD. We included 11 participants with a mean age of 56.2 years. Nine participants were able to record US videos, and two were unable to record bladder videos. Regarding the technical evaluation scores, all participants scored ≥80%; four had perfect scores. This study showed that transabdominal self-performed bladder US can be performed in 81.8% of women with UI in their 40-60s by using an e-learning program.

Hand-Held Ultrasound (HHU) as a Diagnostic and therapeutic tool in bedside clinical medicine

Hand-Held Ultrasound (HHU) as a Diagnostic and therapeutic tool in bedside clinical medicine

Diagnostic accuracy of supplemental three-dimensional breast ultrasound in the work-up of BI-RADS 0 screening recalls

ObjectiveTo evaluate the diagnostic accuracy of supplemental 3D automated breast ultrasound (ABUS) in the diagnostic work-up of BI-RADS 0 recalls. We hypothesized that 3D ABUS may reduce the benign biopsy rate.Materials and methodsIn this prospective multicenter diagnostic study, screening participants recalled after a BI-RADS 0 result underwent bilateral 3D ABUS supplemental to usual care: digital breast tomosynthesis (DBT) and targeted hand-held ultrasound (HHUS). Sensitivity, specificity, positive predictive value, and negative predictive value of 3D ABUS, and DBT plus HHUS, were calculated. New 3D ABUS findings and changes of management (biopsy or additional imaging) were recorded.ResultsA total of 501 women (median age 55 years, IQR [51–64]) with 525 BI-RADS 0 lesions were included between April 2018 and March 2020. Cancer was diagnosed in 45 patients. 3D ABUS sensitivity was 72.1% (95% CI [57.2–83.4%]), specificity 84.4% (95% CI [80.8–87.4%]), PPV 29.2% (95% CI [21.4–38.5%]), and NPV 97.1% 95.0–98.4%). Sensitivity of DBT plus HHUS was 100% (95% CI [90.2–100%]), specificity 71.4% (95% CI [67.2–75.2%]), PPV 23.8% (95% CI [18.1–30.5%]) and NPV 100% (95% CI [98.7–100%]). Twelve out of 43 (27.9%) malignancies in BI-RADS 0 lesions were missed on 3D ABUS, despite being detected on DBT and/or HHUS. Supplemental 3D ABUS resulted in the detection of 57 new lesions and six extra biopsy procedures, all were benign.Conclusion3D ABUS in the diagnostic work-up of BI-RADS 0 recalls may miss over a quarter of cancers detected with HHUS and/or DBT and should not be used to omit biopsy. Supplemental 3D ABUS increases the benign biopsy rate.Trial registrationDutch Trial Register, available via https://www.onderzoekmetmensen.nl/en/trial/29659Critical relevance statementSupplemental 3D automated breast ultrasound in the work-up of BI-RADS 0 recalls may miss over a quarter of cancers detected with other methods and should not be used to omit biopsy; ABUS findings did increase benign biopsy rate.Key PointsAutomated breast ultrasound (ABUS) may miss over 25% of cancers detectable by alternative methods.Don’t rely solely on 3D ABUS to assess indication for biopsy.New findings with supplemental 3D ABUS increase the benign biopsy rate.Graphical