Point-of-care Ultrasound Research Articles

Point-of-Care Ultrasound in Nephrology: Beyond Kidney Ultrasound

Point-of-care ultrasound (POCUS) has increasingly become an integral part of clinical practice, particularly in nephrology, where its use extends beyond renal assessment to include multi-organ evaluations. Despite challenges such as limited ultrasound training and equipment access, especially in low- and middle-income countries, the adoption of POCUS is steadily rising. This narrative review explores the growing role of multi-organ POCUS in nephrology, with applications ranging from the assessment of congestion phenotypes, cardiorenal syndrome, and hemodynamic acute kidney injury (AKI) to the evaluation of arteriovenous fistulas and electrolyte disorders. In nephrology, POCUS enhances clinical decision making by enabling rapid, bedside evaluations of fluid status, cardiac function, and arteriovenous access. Studies have demonstrated its utility in diagnosing and managing complications such as heart failure, cirrhosis, and volume overload in end-stage renal disease. Additionally, POCUS has proven valuable in assessing hemodynamic alterations that contribute to AKI, particularly in patients with heart failure, cirrhosis, and systemic congestion. This review highlights how integrating ultrasound techniques, including lung ultrasound, venous Doppler, and focused cardiac ultrasound, can guide fluid management and improve patient outcomes. With advancements in ultrasound technology, particularly affordable handheld devices, and the expansion of targeted training programs, the potential for POCUS to become a global standard tool in nephrology continues to grow, enabling improved care in diverse clinical settings.

A Comparison of the Diagnostic Value of Multiorgan Point-of-care Ultrasound between High-risk and Medium-to-low-risk Pulmonary Embolism Cases.

This study aimed to explore the diagnostic value of multiorgan (heart, lungs, blood vessels) point-of-care ultrasound (PoCUS) in patients with high-risk and medium-to-low-risk pulmonary embolism (PE). Clinical data of 92 patients with suspected PE, admitted to Hangzhou TCM Hospital affiliated with Zhejiang Chinese Medical University from July 2021 to June 2023, were retrospectively analyzed. According to hemodynamic status, patients were divided into the high-risk (n=28) and the medium-to-low-risk groups (n=64). Using computed tomography (CT) and pulmonary angiography (CTPA) as the gold standard, all patients underwent multiorgan PoCUS examination. The sensitivity, specificity, and accuracy of different methods for diagnosing PE, as well as the time difference between multiorgan PoCUS examination and CTPA, were compared. Differences in measurement values of relevant indicators in all groups were analyzed. In the high-risk group of patients, CTPA identified 15 cases of PE. In contrast, the PoCUS examination confirmed PE diagnosis in 14 cases (true positive), while 10 cases were diagnosed as true negative, one case as false negative, and three cases as false positive. In the medium-to-low-risk group, CTPA identified 50 patients with PE, while multiorgan PoCUS confirmed PE diagnosis in 33 cases (true positive), and identified 9 true negative, 17 false negative, and 5 false positive PE cases. Kappa test of the consistency between the results of multiorgan PoCUS and CTPA showed that multiorgan PoCUS had higher sensitivity, negative predictive value, and accuracy in the high-risk group compared to the medium-tolow- risk group (p<0.05). Cohen's Kappa value of the high-risk group was 0.710, indicating moderate consistency between PoCUS and CTPA results, while Cohen's Kappa value of 0.231 for the medium and low-risk group indicated poor consistency. There was a significant difference in ultrasound parameters between the high-risk and the medium-to-low-risk group (p<0.05). The time required for multiorgan PoCUS in both groups was significantly shorter than that for the CTPA. There was no significant difference in the time required for PoCUS between the two groups (p>0.05). Multiorgan PoCUS has been found to have higher sensitivity and accuracy in diagnosing patients with high-risk PE compared to those with medium-to-low-risk PE, and a shorter imaging time compared to CTPA.

Point-of-care ultrasound in the diagnosis of hepatic gas gangrene.

Hepatic gas gangrene (HGG) is a rare but life-threatening condition typically caused by anaerobic bacteria such as Clostridium perfringens, though Gram-negative bacteria like Escherichia coli and Klebsiella species have also been implicated. Traditionally diagnosed via computed tomography (CT), point-of-care ultrasound (POCUS) has emerged as a valuable tool in critical care settings for its non-invasive, bedside utility. We report the case of a 51-year-old female with choledochal syndrome secondary to cholangiocarcinoma who developed HGG following left extended hepatectomy and biliary reconstruction. POCUS revealed free subhepatic fluid, hypoechogenicity in the right hepatic lobe, and comet-tail artifacts suggestive of intrahepatic gas, leading to prompt surgical intervention. Despite maximal supportive measures, the patient succumbed to refractory shock. This case underscores the utility of POCUS in the rapid diagnosis and management of HGG, offering a non-invasive alternative to traditional imaging, and highlights its potential as a primary diagnostic tool for HGG in critically ill patients.

P0391 The impact of point of care ultrasound on time to initiating advanced therapy in IBD (GUIDE-IBD): A randomised controlled trial

Abstract Background Intestinal ultrasound is an accurate tool for assessing inflammatory bowel disease activity1. Previous studies showed point-of-care ultrasound (POCUS) can impact treatment decisions in 48% of appointments2. Early diagnosis and treatment improves outcomes in Crohn’s disease (CD). We aimed to investigate if POCUS in the IBD clinic led to earlier initiation of advanced therapies using a randomised controlled trial. Methods Patients attending an IBD clinic at a UK tertiary referral centre with known or suspected IBD (with a high likelihood) were eligible. During the primary clinic appointment clinicians’ investigation and treatment decisions were recorded. Immediately following this they were randomised 1:1 to POCUS or standard of care (SOC). The POCUS group then had further review with an option to alter treatment decisions. The primary end-point was time to initiating definitive therapy (in days) (new/changed immunomodulator, advanced therapy or surgery only). Secondary end-points included clinical score (HBI, SCCAI), calprotectin and patient tolerability. Patients were followed for 12 months. Results 122 patients were enrolled between 1st June and 1st November 2023. Median age was 25 years (16-79) and 50% male with a final diagnosis of 87 CD, 23 UC, 4 IBD-U and 8 non IBD (new referrals). 63 had POCUS and 59 SOC. POCUS was performed by one of two sonographers (one gastroenterologist and one radiologist). 65 (53%) were on advanced therapy or immunomodulators at baseline. 99 (81%) had advanced therapy, immunomodulators or surgery during the study period. Mean time to definitive treatment decision was 43 days with POCUS compared to 92 days in SOC (p&amp;lt;0.01). 65 (53%) patients had a change of, or started a new therapy and mean time to treatment initiation was also significantly shorter in the POCUS group, 75 days, compared to SOC, 131 days (p=0.033). In a sub-group of 20 new referrals, 12 were diagnosed with IBD. Mean time to treatment initiation was shorter with POCUS (82 vs 151 days). Steroid prescriptions at the baseline appointment were significantly higher in the POCUS group, 11/63 vs 2/59 (p = 0.012). Any change to treatment in the POCUS group occurred in 29/63 (46%) patients. Scans took an average of 7.5 minutes with 100% patient acceptability. Conclusion POCUS leads to earlier IBD-related decision making which translates into earlier initiation of effective therapy. This should, in turn, lead to improved care with shorter time to remission and reduced complications. Pathways to incorporate POCUS into routine clinical practice to optimise its effectiveness need further evaluation. This will require collaborative training and working across multiple specialties to effectively deliver this service. References (1)Taylor SA, Mallett S, Bhatnagar G, et al. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol. 2018;3(8):548-558. doi:10.1016/S2468-1253(18)30161-4 (2)Bots S, De Voogd F, De Jong M, et al. Point-of-care Intestinal Ultrasound in IBD Patients: Disease Management and Diagnostic Yield in a Real-world Cohort and Proposal of a Point-of-care Algorithm. J Crohns Colitis. 2022;16(4):606-615. doi:10.1093/ecco-jcc/jjab175

Sonographer Experiences of Interprofessional Ultrasound Education: A Qualitative Study.

Point-of-care ultrasound (POCUS) technology has evolved rapidly and is being embraced by many health professionals as a valuable clinical tool. Sonographers are now teaching ultrasound skills to other health professionals in the clinical setting, including doctors, nurses, midwives, paramedics, and physiotherapists. The purpose of this study was to understand the breadth of the opportunities, transitions, and challenges experienced by sonographer educators navigating new interprofessional teaching roles. Sonographers, who had participated in an initial phase Delphi study defining sonographer competencies in POCUS education, were invited to participate in a follow-up interview. Semi-structured interviews were conducted, and the interview data were thematically analyzed to understand the experiences and perceptions of participants. Twenty sonographer educators were interviewed. Participants were clinically experienced sonographers from Australia and New Zealand with diverse professional experience in clinical teaching, university academic, ultrasound leadership, health management, and corporate roles. The transition to teaching interprofessional cohorts of learners in different clinical settings was substantial. The experiences of sonographers undertaking these new roles were described under the themes of "sonographer perceptions"; "educator knowledge"; "understanding learners"; "teaching dynamics"; and "ultrasound evolution." This study is the first to describe the experiences of sonographers engaged in interprofessional POCUS teaching. The results provide insight into the training needs of sonographers in this emerging area and will be used to inform the development of continuing education resources.

Use of Point-of Care Ultrasound for the Identification of a Greater Tuberosity Avulsion Fracture

Use of Point-of Care Ultrasound for the Identification of a Greater Tuberosity Avulsion Fracture

Training, experience and perceptions of point of care ultrasound amongst internal medicine trainees: implications for training, curriculum development and service delivery.

Point of care ultrasound (POCUS) has revolutionised modern day medicine and has widespread utilisation throughout healthcare settings. Despite the availability of ultrasounds, there are no requirements for internal medicine trainees (IMTs) to undergo any form of POCUS training. This study aimed to explore the perceptions and experience of IMTs of POCUS. A multicentre survey was distributed via mass email to all internal medicine trainees (IMT1-ST8) across two deaneries in Southwest England. A total of 42% (213/509) IMTs completed the survey. Of these 97% (207/213) contributed to the acute medical or general medical rota and 95% (202/213) of trainees reported performing invasive procedures on call. Training in ultrasound site selection was reported by 30% (63/213) of IMTs and 11% (23/213) worked in a trust with accessible POCUS training. Formal POCUS accreditation was reported by 16.0% (34/213) of trainees. Identifying sonographic findings of common medical conditions was considered useful by 86.9% of trainees. Identifying pleural effusions being the most useful (99%, 211/213), whilst identifying a deep vein thrombosis was the least (87%,185/213). Higher confidence scores were reported for ultrasound assisted as opposed to ultrasound guided ascitic or pleural procedures, although this was not significant. On a 10-point Likert scale most trainees highly rated POCUS training (Median = 10, interquartile range 8-10). Free text responses supported POCUS training in the IMT curriculum. We found IMTs perceive POCUS training as highly valuable. However, few IMT trainees are obtaining sufficient experience or training of POCUS. Opportunities for enhanced POCUS training should be embedded in training programmes.

Sensitivity of Lung Point-of-Care Ultrasound (POCUS) to Predict Oxygen Requirements in Emerging Viral Infections.

The prognostic characteristics of lung point-of-care ultrasound (L-POCUS) to predict respiratory decompensation in patients with emerging infections remains unstudied. Our objective was to examine whether scored lung ultrasounds predict hypoxia among a nonhypoxic, ambulatory population of patients with COVID-19. This was a diagnostic case-control study. Three academic emergency departments across the United States collected a convenience sample of nonhypoxic subjects with COVID-19, scored subjects' hemithorax at 7 locations using lung ultrasound, and followed outcomes for 40 days. We defined cases as hypoxia (≤91% by pulse oxygenation) from 2 hours after index presentation to day 40. Follow-up was by telephone plus home pulse oximeter and by chart review. We conducted a logistic regression to test the association between L-POCUS scores and hypoxia. To evaluate lung ultrasound score prediction of a hypoxic event, we calculated sensitivity and specificity at optimal cut off scores and report receiver operating characteristic curve and area under the curve. We enrolled 163 subjects but excluded 15 (3 duplicate entries; 12 lost to follow up). Median age was 41 years (interquartile range [IQR] 31-56); 83 (56%) were female, and median body mass index was 29 (IQR 25-35). We classified 47 of 148 as hypoxic cases (32%, 95% confidence interval [CI]: 25-40), leaving 101 controls. L-POCUS scores associated with hypoxia by logistic regression (odds ratio = 1.05, 95% CI: 1.02-1.08), with a 5% increase in odds of hypoxia for each 1-unit increase in L-POCUS score. The optimal cut-off score was 15 (sensitivity, 0.60; specificity, 0.73) and the area under the curve was 0·66 (95% CI 0·58-0·75). The correctly classified proportion was 69% (95% CI: 61-76). Among nonhypoxic COVID-19 patients, higher L-POCUS rubric scores were associated with hypoxia but no scoring threshold strongly predicts hypoxia at 40 days.

Cholecystoduodenal Fistula and Urosepsis in A Febrile Emergency Department Patient: A Case Report

Introduction: Point-of-care ultrasound (POCUS) is a rapid bedside tool, particularly in undifferentiated emergency department patients. Point-of-care ultrasound can investigate potential intra-abdominal infections in febrile patients, especially in the elderly, who often present atypically without abdominal pain or localizing symptoms. Case Report: We highlight the important POCUS findings of cholecystoduodenal fistula and staghorn calculus in a febrile, elderly patient with dementia. Conclusion: Early recognition of cholecystoduodenal fistula and staghorn calculus using POCUS can expedite appropriate antibiotic and interventional treatment for improved patient outcomes.

Impact of worklist selection on point-of-care ultrasound workflow – a quality improvement project

BackgroundResearch demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an “encounter-based” system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry.MethodsA new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical record number (MRN) entry errors prior to and following implementation was manually reviewed and calculated.ResultsThere was a strong preference for the new workflow, with 36 of 38 (94.7%) clinicians finding it to be more convenient and 37 of 38 (97.4%) finding it to be preferable to use compared to the old workflow. Implementation also resulted in a 36% reduction in database studies containing an MRN data entry error.ConclusionsAn “encounter-based” workflow is strongly preferred over manual data entry for POCUS workflow among clinicians. Additionally, there was no cost to the intervention and the total data entry errors were significantly reduced, allowing for improved quality review and increased revenue.

Current Concepts in Fluid Resuscitation and Vasopressor Use in Cirrhosis.

Critically ill patients with cirrhosis and liver failure not uncommonly have hypotension due to multifactorial reasons, that include hyperdynamic state with increased cardiac index, low systemic vascular resistance due to portal hypertension, following the use of beta blocker or diuretic therapy, and severe sepsis. These changes are mediated by microvascular alterations in the liver, systemic inflammation, activation of renin angiotensin aldosterone system, and vasodilatation due to endothelial dysfunction. Hemodynamic assessment includes measuring inferior vena cava indices, cardiac output and systemic vascular resistance using point-of-care ultrasound (POCUS), in addition to arterial waveform analysis, or pulmonary artery pressures, and lactate clearance to guide fluid resuscitation. Fluid responsiveness reflects the ability of fluid bolus to increase the cardiac output and is assessed effectively by POCUS, passive leg raise manoeuvre, and dynamic tests such as pulse pressure and stroke volume variation both in spontaneously breathing and mechanically ventilated patients. Albumin has pleotropic benefits through anti-inflammatory properties besides its standard action on oncotic pressure and volume expansion in patients with cirrhosis but has potential for precipitating pulmonary edema. In conclusion, fluid therapy in critically ill patients with liver disease is a complex and dynamic process that requires individualised management protocols to optimise patient outcomes.

ADENITE MESENTÉRICA COMO CAUSA DE DOR ABDOMINAL EM CRIANÇAS: REVISÃO INTEGRATIVA

Acute mesenteric adenitis (or mesenteric lymphadenitis, LM) is an inflammatory condition of the mesenteric lymph nodes that can simulate acute appendicitis and is a common cause of abdominal pain in children. This review aims to examine the causes, clinical manifestations, diagnosis, and treatment of LM in pediatric patients. LM is often triggered by viral infections, including coronavirus, and presents symptoms such as pain in the right lower quadrant of the abdomen, fever, nausea and vomiting. The diagnosis is made mainly by exclusion, with the help of imaging tests such as ultrasound, which reveals enlarged lymph nodes. Differential diagnosis with appendicitis is crucial, and ultrasound, including the use of POCUS (point-of-care ultrasound), has proven to be a valuable tool in identifying LM in emergency settings. Treatment is generally conservative, with supportive measures such as analgesics and hydration, in addition to antibiotics when indicated. In some cases, such as prednisone treatment, pain can be significantly relieved. Most LM is self-limited, with recovery usually taking one to four weeks. This review highlights the importance of accurate diagnosis and appropriate management, minimizing unnecessary interventions and providing effective management for affected children.

Diagnosis and Monitoring of Achalasia Utilizing Point-of-Care Ultrasound (POCUS): A Case Report

Diagnosis and Monitoring of Achalasia Utilizing Point-of-Care Ultrasound (POCUS): A Case Report

Rural Canadian emergency physician experiences using point-of-care ultrasound.

Point-of-care ultrasound (POCUS) is a rapidly evolving and clinically significant skill set that has potential for improving patient care for the approximately 7 million Canadians living in rural and under-resourced environments. A national appraisal of rural POCUS training and utilization is needed to understand barriers to funding and training for rural emergency physicians in Canada. The primary objective of this study was to determine the current level of training and types of POCUS utilization by rural emergency physicians in Canada. The secondary objective was to describe the barriers to POCUS use. An online survey of POCUS education, training, and utilization was distributed, in English and French, to rural emergency physicians across Canada via the Canadian Association of Emergency Physicians, Society of Rural Physicians of Canada and College of Family Physicians of Canada listservs. One hundred and sixty-eight physicians completed the survey with a response rate of 10%. Most were family physicians registered with the College of Family Physicians of Canada (68%) and worked in rural communities with under 10,000 residents (64%). The majority of respondents (94%) used a POCUS device in their practice, with 40% always using POCUS and 84% having access to a high-quality device. POCUS was commonly used for abdominal aortic aneurysm, cardiac, and obstetrical exams. Key barriers to training were cost (62%), distance to the training center (48%), inability to take time off work (43%) and insufficient hospital administration support (21%). Eighty percent of respondents agreed that POCUS was valuable in rural and remote areas with limited access to diagnostic imaging and 78% agreed that institutions should fund POCUS training. POCUS is used daily for patient care in rural Canadian emergency departments. Despite widespread access to POCUS, rural emergency physicians face significant barriers in training and utilization.

Assessing Physician Assistant Students' Ability to Accurately Identify the Regional Landmarks of the Fascia Iliaca Compartment With Point of Care Ultrasound After a Brief Training Session.

Regional anesthesia, specifically fascia iliaca compartment blocks (FICB), is highly effective in managing pain, especially in military settings. However, a significant barrier to its implementation is the lack of provider confidence in performing ultrasound-guided procedures. This study evaluates the ability of physician assistant (PA) students, who are often first-line providers in austere locations, to identify the fascia iliaca compartment (FIC) using point-of-care ultrasound (POCUS) after a brief training session and assesses their retention of this skill over a 60- to 90-day period. We conducted this prospective observational study involving 10 PA students at an Air Force hospital. Participants underwent a brief training course on FIC identification using POCUS. Their ability to identify 4 anatomical landmarks (fascia iliaca, fascia lata, iliopsoas muscle, and femoral artery) was assessed immediately post-training and again after 60 to 90 days. Initially, participants demonstrated a high success rate in identifying the FIC, with 47 out of 60 attempts (78%) correctly identified. However, follow-up evaluations showed a significant decline, with only 7 out of 54 attempts (13%) correctly identified after 60 to 90 days (P < .001). Identification rates for specific landmarks also declined significantly, except for the femoral artery, which remained the most accurately identified landmark. This study demonstrates that PA students can accurately identify the FIC using POCUS after a brief training session. However, there was a significant decline in skill retention over a 60- to 90-day period, underscoring the need for continuous education and practice to sustain proficiency. Further research with larger sample sizes and diverse settings is needed to develop effective training protocols and ensure long-term retention of U.S.-guided procedural skills.

Point-of-Care Lung Ultrasound in Small Animal Emergency and Critical Care Medicine: A Clinical Review

Thoracic point-of-care ultrasound (T-POCUS) has grown in popularity and usage in small animal emergencies and critical care settings due to its non-invasive nature, mobility, and ability to acquire images in real time. This review summarizes current understanding about T-POCUS in dogs and cats with respiratory illnesses, including normal thoracic ultrasonography appearance and numerous pathological situations. The basics of T-POCUS are covered, including equipment, scanning procedures, and picture settings. Practical applications in patients with respiratory distress are discussed, with an emphasis on pleural space abnormalities and lung diseases. Ultrasound results define pulmonary disorders such as pneumonia, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, lung lobe torsion, pulmonary fibrosis, pulmonary thromboembolism, pulmonary neoplasms, and pulmonary bleeding. The evaluation focuses on T-POCUS diagnostic skills in a variety of clinical settings. Limitations and the need for more study to standardize techniques, establish agreed terminology, and create specialized educational routes are highlighted.

Accuracy of point-of-care ultrasound in diagnosing retained products of conception.

Retained products of conception (RPOC) refers to residual intrauterine tissue in female patients after a recent birth, pregnancy termination, or miscarriage. Ultrasound is the primary diagnostic modality for RPOC, but the accuracy of point-of-care ultrasound (POCUS) has not been evaluated for this diagnosis. Our aim was to determine the test characteristics of POCUS in detecting RPOC, and to evaluate the management of RPOC in the Emergency Department. This was a retrospective cohort study of all patients presenting to an Emergency Department with over 110,000 annual visits between January 1, 2017, and December 31, 2023, who had an Emergency Department performed pelvic POCUS. All Emergency Department patients ≥18years old who had a pelvic POCUS performed during the study period and had no identifiable intrauterine pregnancy were included. Patients were excluded if their sex was male, age was greater than 55, if there was inadequate chart data, or if there were inadequate or no POCUS images saved. Chart review was conducted by three nonblinded investigators, and POCUS review was conducted by two ultrasound fellows, blinded to the chart review. RPOC on POCUS was defined as heterogenous or hyperechoic products within the endometrium measuring greater than 10mm. The gold standard for the diagnosis of RPOC on chart review was radiology ultrasound or obstetrics and gynecology (OBGYN) diagnosis for patients who did not receive a radiology ultrasound. There were 703 patients included in the study while 58 met exclusion criteria, leaving 645 patients for review. Radiology ultrasound was performed in 512 patients (79.4%), and identified 42 cases of RPOC. In the 133 patients who did not receive a radiology ultrasound, 20 were confirmed to have RPOC based on OBGYN diagnosis, for a total of 62 patients with RPOC (a 9.6% prevalence). There were 70 total POCUS examinations identified as RPOC, with 17 indeterminant examinations. In the 265 patients with a history concerning for RPOC based on chart review, the sensitivity and specificity for RPOC on POCUS were 79.0% (95% CI; 66.1%-88.6%) and 93.8% (95% CI; 90.0%-96.6%) respectively when compared to the gold standard diagnosis. If all eight indeterminant POCUS examinations from this group were considered positive, the sensitivity and specificity were 80.7% (95% CI; 68.1%-90.0%) and 90.4% (95% CI; 85.5%-94.0%) and 80.7% (95% CI; 68.1%-90.0%). Of the 62 total patients with RPOC based on chart review, 21 (33.9%) were admitted, 26 (41.9%) had a surgical procedure, 26 (41.9%) were managed medically, and 10 (16.1%) were expectantly managed. POCUS demonstrated high specificity and low sensitivity for diagnosing RPOC in patients with a history concerning for RPOC. POCUS can be used to diagnose RPOC, but caution should be exercised when making the diagnosis in early pregnancy given the variable appearance of the endometrium on transabdominal POCUS during that timeframe.

Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework.

Accurate assessment of a patient's volume status is crucial in many conditions, informing decisions on fluid prescribing, vasoactive agents, and decongestive therapies. Determining a patient's volume status is challenging, due to limitations in examination and investigations and the complexities of fluid homeostasis in disease states. Point-of-care ultrasound (POCUS) is useful in assessing hemodynamic parameters related to volume status, fluid responsiveness, and fluid tolerance. It requires understanding several physiologic concepts to accurately interpret and integrate POCUS findings into volume-related clinical decision-making. The following concepts serve as a scaffold for a comprehensive volume status assessment: central venous pressure, right heart function, left heart assessment, extravascular volume, and venous congestion. POCUS allows us access to these hemodynamic and structural data points as an extension and refinement of the physical exam. Often, multiple POCUS applications are employed, and findings must be integrated with the rest of the clinical evaluation. We illustrate this using three common scenarios: hypotension, hypoxia, and acute kidney injury. Clinicians must be aware of the strengths and weaknesses of findings in different physiologic states, and potential pitfalls of image acquisition and interpretation. Further studies are necessary to determine the benefits and clinical outcomes of a POCUS-directed volume status assessment. Volume status assessment is ubiquitous, yet challenging to perform. This review summarizes foundational physiologic concepts relevant to volume status evaluation, and highlights how multiorgan POCUS informs on hemodynamic parameters that can be combined with the conventional clinical assessment to make fluid-related decisions.

Breast cancer classification in point-of-care ultrasound imaging-the impact of training data.

The survival rate of breast cancer for women in low- and middle-income countries is poor compared with that in high-income countries. Point-of-care ultrasound (POCUS) combined with deep learning could potentially be a suitable solution enabling early detection of breast cancer. We aim to improve a classification network dedicated to classifying POCUS images by comparing different techniques for increasing the amount of training data. Two data sets consisting of breast tissue images were collected, one captured with POCUS and another with standard ultrasound (US). The data sets were expanded by using different techniques, including augmentation, histogram matching, histogram equalization, and cycle-consistent adversarial networks (CycleGANs). A classification network was trained on different combinations of the original and expanded data sets. Different types of augmentation were investigated and two different CycleGAN approaches were implemented. Almost all methods for expanding the data sets significantly improved the classification results compared with solely using POCUS images during the training of the classification network. When training the classification network on POCUS and CycleGAN-generated POCUS images, it was possible to achieve an area under the receiver operating characteristic curve of 95.3% (95% confidence interval 93.4% to 97.0%). Applying augmentation during training showed to be important and increased the performance of the classification network. Adding more data also increased the performance, but using standard US images or CycleGAN-generated POCUS images gave similar results.

Point-of-Care Ultrasound in Gastroenterology and Hepatology.

Point-of-care ultrasound (POCUS) is changing the practice of nearly all specialties and is increasingly being incorporated as a bedside tool by more gastroenterologists and hepatologists. POCUS is most often used to answer focused clinical questions, supplement the traditional physical examination, and guide performance of invasive bedside procedures. This review describes several common POCUS applications used in gastroenterology and hepatology, as well as some novel applications that warrant further investigation.