PocUS : A WFUMB Position Paper

 ABSTRACT:

Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, ‘‘ultrasound performed at the bedside and interpreted directly by the treating clinician.’’ PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access  to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice. However, its use and teaching are different from continent to continent and from country to country. This World Federation for Ultrasound in Medicine and Biology position paper discusses the current status and future perspectives of PoC-US. Particular attention is given to the different uses of PoC-US and its clinical significance, including within emergency and critical care medicine, cardiology, anesthesiology, rheumatology, obstetrics, neonatology, gynecology, gastroenterology and many other applications. In the future, PoC-US will be more diverse than ever and be included in medical student training.

(E-mail: Christoph.dietrich@ckbm.de) 2016 World Federation for Ultrasound in Medicine & Biology.

Key Words: Guidelines, Intervention, Neonatology, Echoscopy, Stethoscope.

OPEN QUESTIONS

A current unresolved issue is the recording and storage of images. Best practice requires storing images or videos from prior studies so they are available for review and future comparison. Tension will always exist as to the exact boundaries of non-specialists performing focused exams and specialists performing comprehensive exams. These issues are mirrored in all aspects of medical practice and are best viewed more as issues of training, credentialing and quality assurance rather than definitions of specialties or practice.

FUTURE PERSPECTIVES

As new specialties and practitioners take up ultrasound in their daily clinical practice, we may see a radical change in the content of the physical examination. Given the inadequacy of the physical examination in the hands of most clinicians for many disorders and the superiority of PoC-US, the typical examination in most clinical settings is likely to be a combination of traditional skills and focused ultrasound for evaluation of any questionable findings or areas of specific interest. For patients this will mean increased accuracy and more rapid diagnosis  and hence treatment. For clinicians, the benefits will include greater efficiency, but also increased satisfaction in their diagnostic and procedural capabilities. Several additional evolutionary steps are likely to be forthcoming in PoC-US. These will be welcome additions that will lead to even greater expansion of diagnostic and procedural PoC-US capabilities. Live 3-D or volumetric ultrasound transducers have the capability to capture large volumes of data in real time and not only allow clinicians a new way to look at anatomy and pathology but also enable greater automation by the ultrasound machine. For example, it may become possible to only have to obtain an adequate apical cardiac window and have the machine make multiple hemodynamic calculations of cardiac function.

To further improve the use of PoC-US, the very nature of imaging data delivery to the user may have to change to enable more efficient procedure performance and also more convenient diagnostic scanning. Optimized adjuncts such as goggle or monocle displays, projections onto walls and other wireless image transmission will make ultrasound less cumbersome in critical and cramped situations.

It is crucial that imaging specialists (radiology, obstetrics, cardiology) and PoC-US users work together to recognize its potential and its limitations, to teach current and future care providers how to use ultrasound responsibly and to create an infrastructure that maximizes quality of care while minimizing patient risk.

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