Point-of-care Ultrasound Research Articles

Using Point-of-Care Ultrasonography (POCUS) in Volume Assessment in Patients on Hemodialysis

Using Point-of-Care Ultrasonography (POCUS) in Volume Assessment in Patients on Hemodialysis

Utility of Point-of-Care Ultrasonography (POCUS) in Guiding Clinical Decision-Making

Utility of Point-of-Care Ultrasonography (POCUS) in Guiding Clinical Decision-Making

Kidney Point-of-Care Ultrasonography (POCUS): Development and Evaluation of a Training Program for Nephrology Fellows

Kidney Point-of-Care Ultrasonography (POCUS): Development and Evaluation of a Training Program for Nephrology Fellows

Interdisciplinary Point-of-Care Ultrasonography (POCUS) Program Led by Nephrology

Interdisciplinary Point-of-Care Ultrasonography (POCUS) Program Led by Nephrology

Back to Bedside: Kidney Point-of-Care Ultrasonography (POCUS) by Resident Physicians for Identification of Hydronephrosis in Patients with AKI

Back to Bedside: Kidney Point-of-Care Ultrasonography (POCUS) by Resident Physicians for Identification of Hydronephrosis in Patients with AKI

Accuracy of Inferior Vena Cava (IVC) and Lung Point-of-Care Ultrasonography (POCUS) as an Adjunct in the Evaluation of Hypervolemia among Patients on Maintenance Hemodialysis

Accuracy of Inferior Vena Cava (IVC) and Lung Point-of-Care Ultrasonography (POCUS) as an Adjunct in the Evaluation of Hypervolemia among Patients on Maintenance Hemodialysis

How to perform Point of Care Ultrasound at resuscitation and when it is useful.

Point of Care Ultrasound (POCUS) can be useful as a tool before, during and after the performance of cardiopulmonary resuscitation (CPR). Before or after resuscitation it can help with monitoring unstable hemodynamics, has the potential to identify reversible causes if patient deteriorates. During resuscitation POCUS can help detect potentially treatable causes of the cardiac arrest. Performance of POCUS while resuscitation requires experienced sonologists and a good team structure to embed the examination in advanced cardiovascular life support (ACLS) algorithms. This article gives an overview and tips about how to detect potential reversible causes of patient deterioration in all three phases of CPR. We describe some special situations in which resuscitation could take place. Further we give a comment about sonographic education of physicians and nonacademic medical staf.

The POISE Study: POcus for Identification of Sarcopenia in Emergency departments

Abstract Background Sarcopenia is a progressive loss of muscle mass and strength, primarily affecting older adults, with a prevalence of up to 20% in >65-year-olds. It is associated with poor outcomes such as fractures, falls, loss of independence and mortality. Recent studies into the use of ultrasonography for sarcopenia diagnosis have yielded promising results, with good validity to estimate muscle mass when compared to DXA, CT or MRI. While point-of-care ultrasound (POCUS) is a commonly used technique in Emergency Medicine, its applicability to sarcopenia diagnosis in an ED setting has not been investigated. Methods This was a prospective, cross-sectional, observational pilot study. Patients >65 years were recruited sequentially from the ED triage list. Each subject had a POCUS scan of their thighs, to visualise and measure the thickness of the femoral quadriceps. Subjects’ handgrip was then measured using a digital grip strength dynamometer. Subjects’ gait speed was measured in metres per second using a standard 6 metre walk test. Data was then analysed to examine any correlation between muscle thickness on POCUS and functional measures of sarcopenia. Results 60 patients were recruited into this pilot study. Of these, 50% had evidence of sarcopenia on functional assessment. There was a statistically significant correlation between muscle thickness on POCUS and performance on functional assessment. Conclusion This pilot study demonstrates a possible new application for POCUS in the ED. This could guide therapy for falls prevention and may prevent further morbidity in this vulnerable population. Further research is needed to confirm the results of this pilot study within a wider population. Additional research examining the correlation between POCUS findings, Clinical Frailty Scale, and BMI would also be of benefit.

Diagnosis of suspected pediatric distal forearm fractures with point-of-care-ultrasound (POCUS) by pediatric orthopedic surgeons after minimal training

BackgroundSeveral studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training.MethodsThis diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital’s routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard.ResultsFrom February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria.ConclusionPediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray.

Hair Today, OR Tomorrow: A Multicenter Case Series of Gastric Bezoars in Children Diagnosed With Point-of-Care Ultrasound.

Point-of-care ultrasound (POCUS) can expedite the diagnosis of pediatric abdominal pathologies including appendicitis and intussusception. In this patient series, we present cases from multiple pediatric emergency departments that demonstrate the use of POCUS in the diagnosis of trichobezoars in children. POCUS findings include the presence of an intragastric hyperechoic mass or a hyperechoic arch and associated posterior acoustic shadowing. These findings in the appropriate clinical context should prompt further diagnostic imaging and/or surgical consultation for removal.

Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load

BackgroundAugmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings.MethodsThis randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1–4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration.ResultsWe found AR technology reduced the time required for critical steps in CVC placement, while minimizing users’ neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees’ effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees’ effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant.ConclusionsAR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education.Trial registrationThe trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT 06055400.

Insights into an innovative point of care ultrasound curriculum for Ontario primary maternity care providers

Point of care ultrasound (POCUS) has increasingly been used by midwives worldwide. In 2018, the scope of midwifery care in Ontario was expanded to include POCUS to allow practitioners to provide more comprehensive care. In response to the scope expansion, a new continuing POCUS education course was created in collaboration with faculty and clinicians from obstetrics, midwifery, and medical radiation sciences. The continuing education sonography course focused on fostering the knowledge, skills and judgment Ontario midwives required to safely perform these new POCUS skills. The course included online modules, a two-day hands-on bootcamp workshop, and a clinical practicum under the supervision of a sonographer to confirm competency across the three trimesters of pregnancy. The first cohort of 17 learners completed the course in Fall 2019, the new curriculum was well received by learners for its many benefits into learning and applying bedside sonography to clinical care. This paper outlines our process for POCUS curriculum development and implementation in pregnancy care. This POCUS continuing education course should continue to be offered in the future to give more practitioners the ability to perform point of care pregnancy scans.

The Use of Point-of-Care Ultrasound (POCUS) in Anesthesiology: A Narrative Review.

Point-of-care ultrasound (POCUS) has become an essential tool in modern anesthesiology, offering real-time imaging that aids in diagnosis, treatment, and procedural guidance. Its applications have expanded significantly, from routine assessments to complex perioperative management, enhancing patient care across various domains. This study aimed to review and summarize the current literature on the applications of POCUS in anesthesiology, focusing on its utility in airway management, cardiac assessment, lung ultrasound (LUS), and abdominopelvic evaluations. Additionally, it discusses the challenges and strategies for overcoming barriers to its widespread adoption. A narrative literature review was conducted, encompassing studies on using POCUS in anesthesiology. Key databases were searched for relevant articles ("Point-of-care ultrasound,""Focused cardiac ultrasound,""Lung ultrasound"),and studies were selected based on their relevance to the main topics of interest: airway management, cardiac ultrasound, LUS, and abdominopelvic and gastric ultrasound. Both observational studies and randomized controlled trials were included. POCUS improves the safety and accuracy of regional anesthesia and airway procedures, enhancing patient outcomes by providing real-time visualization. Focused cardiac ultrasound is valuable in preoperative, intraoperative, and postoperative care, allowing for tailored anesthesia plans and timely interventions based on cardiac function. The US is an effective diagnostic tool for assessing pulmonary conditions, with specific signs and artifacts aiding in identifying pathologies such as pneumothorax, pleural effusions, and pulmonary congestion. Despite its benefits, POCUS faces barriers such as limited access to training, the need for standardized protocols, and the high equipment cost, especially in low-resource settings. While its integration into clinical practice continues to grow, overcoming challenges related to training, standardization, and equipment access is essential to realize its full potential. Continued efforts in education and research are needed to support the widespread adoption of POCUS in anesthesiology.

Role of teleradiology in the interpretation of ultrasound images acquired in the emergency setting

BACKGROUND: Teleradiology has become an important tool in emergency medicine, particularly in the interpretation of emergency ultrasonography. In emergency situations, where time is essential, rapid diagnosis and treatment can mean the difference between life and death. Teleradiology is an innovative alternative to augment the staffing and fill the gaps of onsite radiology personnel in emergency departments or during off-hours. AIM: To assess the effectiveness/impact of teleradiology in emergency ultrasound interpretation. MATERIALS AND METHODS: A retrospective study was performed in a cohort of 33,616 patients from 86 hospitals across the USA between January and December 2022. The study involved radiological interpretations of 37,253 ultrasound images acquired in the emergency setting by American Board Certified Radiologists empaneled by a teleradiology service provider, headquartered in Bangalore, India. RESULTS: The proposed telehealth model provided timely and quality reporting of 37,253 scans of patients with a mean turnaround time of 35.71 min (95% confidence interval 35.50–35.91). CONCLUSION: This study demonstrates that a structured telesonography program with defined protocols for image capture, transmission, and clinical communication can allow for successful immediate reporting of ultrasound data in the emergency care setting.

The development of point-of-care ultrasound (POCUS): Worldwide contributions and publication trends.

Point-of-care ultrasound (POCUS) concept is widely used in both emergency medicine (EM) and intensive care medicine (ICM). This study aimed to analyze the scientific articles on POCUS published by statistical methods and to evaluate the subject holistically. This study is bibliographical, descriptive, and analytical in nature. POCUS-related publications published were downloaded from the Web of Science (WoS) database and analyzed using statistical methods. Network visualization maps were used to identify trending topics. The literature search revealed 5714 publications on POCUS in the WoS database. According to the WoS categorization of publications, the most common categories were emergency medicine (1751; 30.6%). The topics studied in recent years were deep learning, artificial intelligence, COVID-19, acute kidney injury, heart failure, and telemedicine. This study on POCUS, we summarized 5714 publications published. According to our results, the trending topics in POCUS research in recent years include deep learning, artificial intelligence, COVID-19, acute kidney injury, heart failure and telemedicine. Our study can be a valuable resource for clinicians and scientists who are working on POCUS or will be working on POCUS in the future.

The Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.

To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock. We searched MEDLINE, Embase, and unpublished sources from inception to December 2023. We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock. We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes. We identified 18 eligible RCTs. POCUS slightly influences physicians' plans for IV fluid (IVF) and vasoactive medication prescription (moderate certainty), but results in little to no changes in the administration of IVF (low to high certainty) or inotropes (high certainty). POCUS may result in no change in the number of CT scans performed (low certainty) but probably reduces the number of diagnostic echocardiograms performed (moderate certainty). POCUS-guided resuscitation probably reduces 28-day mortality (relative risk [RR] 0.88; 95% CI, 0.78-0.99), the duration of vasoactive medication (mean difference -0.73 d; 95% CI, -1.16 to -0.30), and the need for renal replacement therapy (RRT) (RR 0.80; 95% CI, 0.63-1.02) (low to moderate certainty evidence), and lactate clearance (high certainty evidence). POCUS-guided resuscitation may results in little to no difference in ICU or hospital admissions, ICU and hospital length of stay, and the need for mechanical ventilation (MV) (low to moderate certainty evidence). There is an uncertain effect on the risk of acute kidney injury and the duration of MV or RRT (very low certainty evidence). POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes.

A Multi-step Integrative Workflow Implementation to Improve Documentation of Point of Care Ultrasound in Medical Intensive Care Unit.

Point of care ultrasound (POCUS) provides quick bedside assessment for diagnosing and managing life-threatening conditions in critical care medicine. There has been increasing interest in developing infrastructure to archive images, record clinical interpretation, assess quality, and recoup revenue for POCUS. We present a simple workflow by systems integration of electronic medical record, ultrasound machines, picture archiving, and communication system to facilitate POCUS documentation and billing. We recorded a trend on the number of POCUS performed before and after introduction of the structured integration. We observed and recorded a linear increase over time post-intervention. Our innovative and integrated POCUS workflow is an effective way to document and bill POCUS.

Roadmap to success: Blueprint for enterprise-wide deployment of a point-of-care ultrasound platform, inclusive of governance, policy, education, credentialing, and quality assurance.

Point-of-care ultrasound (POCUS) has emerged as a cost-effective diagnostic tool that significantly augments physical examinations. Positioned as an extension of traditional examination methods, particularly appealing to the upcoming generation of clinicians, it holds promise in potentially replacing the stethoscope in various medical assessments and procedures. The University of Rochester is deploying 2500 POCUS machines, enhancing compliance for image storage and documentation. Halfway through our 4-year deployment plan, we will discuss our governance structure, educational initiatives, and credentialing strategies. While POCUS adoption has seen organic growth over the past decade, our aim is to implement a comprehensive strategy ensuring adherence to established protocols for image storage and documentation. At present, we have successfully deployed 789 probes, with integration across 64 departments or divisions into our IT platform. Notably, this implementation has resulted in a remarkable 116% increase in hospital charges, underscoring the tangible impact of POCUS integration. However, achieving compliance and education among established providers has proven to be challenging.

The Impact of a Student-Taught Point-of-Care Ultrasound Workshop on Confidence in Medical and Pre-Medical Students

Background: The vast utilization of Point-of-Care Ultrasound (POCUS) across medical specialties has increased the need for enhanced undergraduate medical education in image acquisition and interpretation among medical students. However, challenges such as the need for a standardized medical school curriculum and limited trained faculty preceptors restrict its implementation. The literature highlights the potential of student-taught POCUS workshops in expanding access and enhancing learning. This study seeks to evaluate the efficacy of a student-run POCUS workshop for medical and pre-medical students. Methods: A prospective, cross-sectional study assessed the efficacy of first and second-year medical students teaching a POCUS workshop on the Focused Assessment with Sonography for Trauma (FAST) exam. Student workshop participants were asked to complete pre- and post-workshop surveys to assess their confidence in utilizing POCUS and identifying relevant organs and landmarks. Surveys employed a standardized five-point Likert Scale. Results: Of the 43 initial participants, 29 completed both surveys. Results showed a significant increase in self-reported ultrasound experience (1.7 to 3.2, p < 0.001) and confidence in performing the FAST exam and organ identification (2.2-fold increase, p < 0.001). Both medical and pre-medical student cohorts exhibited similar confidence improvements in confidence. Conclusion: This study supports the literature that student-taught POCUS programs may be a viable adjunct to an institution's ultrasound curriculum. Implementing medical student-led workshops could help address current training gaps, enhance students' teaching and leadership skills, and improve confidence in utilizing and interpreting ultrasound images.

The inauguration of point-of-care ultrasound (POCUS) workshops to frontline NHS medical trainees in the Wessex Deanery: a quality improvement initiative

The inauguration of point-of-care ultrasound (POCUS) workshops to frontline NHS medical trainees in the Wessex Deanery: a quality improvement initiative