General practitioners accurately diagnose DVT with US

By AuntMinnie.com staff writers

November 17, 2017 -- General practitioners can be trained in compression ultrasonography to accurately diagnose deep vein thrombosis (DVT), according to research published in the November/December issue of the Annals of Family Medicine.

A team led by Dr. Nicola Mumoli of the Ospedale Civile di Livorno in Italy found a 95% diagnostic agreement rate between general practitioners trained in lower limb compression ultrasound and radiologists who were experienced in vascular ultrasound (Ann Fam Med, November/December 2017, Vol. 15:6, pp. 535-539).

The study included 1,107 patients with suspected DVT; patients underwent bilateral proximal lower limb compression ultrasound conducted by both general practitioners and by vascular ultrasound radiologists between May 2014 and May 2016. Each group was blinded to the other's findings.

The radiologists diagnosed deep vein thrombosis in 200 patients, for an overall prevalence rate of 18.1%. The agreement between the trained GPs and experts was excellent (95% confidence interval: 0.84-0.88).

Compression ultrasound performed by general practitioners had a sensitivity of 90%, specificity of 97.1%, and diagnostic accuracy of 95.8% for identifying these DVT cases, the researchers found.

"Our results suggest that, even in hands of physicians not expert in vascular ultrasound, compression ultrasound can be a reliable tool in the diagnosis of DVT," they concluded. "We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill.

HCC Risks and SWE

Abstract

Teleultrasound is beneficial for assessing fetal health

By Kate Madden Yee, AuntMinnie.com staff writer

November 8, 2017 -- An anatomic survey of the fetus is a critical aspect of prenatal care; however, not all communities have access to ultrasound specialists. One solution is teleultrasound, which shows promise for assessing fetal health in rural or underserved areas, according to a study published in the November issue of the Journal of Ultrasound in Medicine.

Teleultrasound allows medically underserved patients to benefit from the expertise of a subspecialist, wrote a team led by Dr. Nader Rabie from Tripler Army Medical Center in Honolulu. But the question of how effective teleultrasound actually is has not been thoroughly addressed. To remedy this, Rabie's group conducted a study to explore the sensitivity and accuracy of teleultrasound in the prenatal diagnosis of fetal structural anomalies.

"Initially, the feasibility of teleultrasound was limited by the technology required to transmit high-quality ultrasound images," the group wrote. "[Now] the focus is on expanding the use and accuracy of teleultrasound, as well as improving the patient experience."

Medically underserved

Rabie and colleagues used data from Arkansas for the study because the state has been using teleultrasound for more than 10 years to serve its primarily rural population; 73 of Arkansas' 75 counties are considered medically underserved, according to the researchers (J Ultrasound Med, November 2017, Vol. 36:11, pp. 2329-2335).

The study included 2,368 fetal anatomic survey ultrasound exams that had been performed by six sonographers at 28 sites in Arkansas between November 2010 and August 2012. These exams were referred to teleultrasound due to abnormal serum screening results, abnormal ultrasound findings by the sonographer at the time of the exam, a family history of birth defects, and/or other patient medical factors such as obesity, diabetes, or lupus. Remote readers interpreted the exams within 24 hours after they were performed.

From each ultrasound report, Rabie and colleagues collected demographic information, gestational age (only pregnancies of at least16 weeks' gestation were included in the research), any fetal structural anomalies, and amniotic fluid volume.

The researchers found a congenital anomaly rate of 5.6% -- substantially higher than the 2.8% prevalence in the general population, they noted.

"This finding was not unexpected, since our cohort represented a high-risk population: due to either specific conditions (e.g., pregestational diabetes, obesity, and advanced maternal age) or the known presence of a fetal anomaly on prior screening ultrasound examination," Rabie and colleagues wrote.

Teleultrasound's performance was consistent with previous research of onsite prenatal ultrasound, with a sensitivity rate of 57.4%, specificity of 98.1%, and accuracy of 95.9%.

"Our study demonstrates that teleultrasound has similar rates of sensitivity and accuracy as published data on onsite ultrasound," the group wrote. "This finding is especially reassuring because in a rural area, onsite ultrasound examinations are likely not of the same quality as those performed at a tertiary care center."

Identifying anomalies

Finding fetal anomalies early can help direct prenatal care and determine whether a fetus may need to be delivered at a tertiary care center, according to the researchers. This makes the use of teleultrasound beneficial in rural or poor areas where subspecialist interpretation isn't easily accessible.

"Teleultrasound is a convenient, potentially cost-effective solution for patients living in remote or underserved areas," the group wrote. "[We plan to continue our research] to demonstrate that teleultrasound is not inferior to onsite ultrasound within the same population, as well as to conduct a prospective comparison of the detection rates of teleultrasound and onsite ultrasound."

UNDESCENDED TESTES

Butterfly iQ, CUỘC CÁCH MẠNG KỸ THUẬT TRONG SIÊU ÂM: M E M S

Butterfly Network, a firm based in Guilford, Connecticut, won FDA clearance and is introducing its Butterfly iQ portable ultrasound system. It consists of a portable transducer that connects directly to an iPhone, and an iOS app to display the images and to control settings.
The device actually works as three different transducers thanks to an ultra wide band matrix array. This allows a clinician to perform a bunch of different scans and for the Butterfly iQ to be applicable in different clinical settings. The matrix array of microelectromechanical (MEMS) sensors is directly integrated onto an integrated circuit that contains all the necessary electronics. This tight integration supposedly results in a fast, high-resolution device that can perform tasks that only full size ultrasound machines were capable just a few short years ago. The firm compares its technology to how photo camera sensors have been integrated within smartphones, enabling anyone to have high quality photo imaging in their pocket.

Perhaps the biggest deal with the Butterfly iQ is that it costs under $2,000. Previous portable, hand-held ultrasounds have often been priced at more than $10,000.

(Từ MedGarget)

Hãng Butterfly Network,  ở Guilford, Connecticut đã được FDA duyệt và đang giới thiệu máy siêu âm xách tay  bỏ túi Butterfly iQ, gồm đầu dò kết nối trực tiếp với iPhone và iOS app để hiển thị hình và  cài đặt định hướng.
Máy hoạt động như 3 đầu dò khác nhau nhờ ma trận dải biến tử siêu rộng [ultra wide band matrix array] giúp Butterfly iQ và người khám thực hiện tập họp nhiều loại khám lâm sàng khác nhau. Các bộ cảm biến Ma trận biến tử vi điện tử cơ khí  [sensors của  MEMS ]được tích hợp trực tiếp trên mạch tích hợp gồm tất cả tổ hợp điện tử cần thiết. Việc tích hợp chặt này giúp máy siêu âm xách tay bỏ túi  này  hoạt động nhanh và có độ ly giải cao như máy siêu  âm truyền thống vài năm trước. Kỹ thuật của hãng so sánh với cách như  mà  sensor photo camera được tích hợp vào điện thoại thông minh, nên bất kỳ ai cũng có thể tạo hình ảnh chất lượng cao với máy siêu âm bỏ túi. Butterfly iQ có thỏa thuận lớn nhất là giá dưới 2.000 đô trong khi các máy siêu âm xách tay khác  có giá hơn 10.000 đô.

Trong máy siêu âm cầm tay Butterfly iQ, các tinh thể được thay bằng các đầu dò siêu âm điện dung – về cơ bản, nó là các tấm kim loại có dạng hình trống, được treo lơ lửng giữa 2 điện cực. Có tất cả 10.000 kênh đầu dò có thể cộng hưởng tần  số phù hợp với các loại mô khác nhau khi được cung cấp điện áp.

Butterfly gọi đây là cấu trúc "mạng bướm" thông minh, với các kênh dò xử lý độc lập có thể thực hiện khoảng nửa nghìn tỷ phép tính mỗi giây trong quá trình quét - đủ để cung cấp hình ảnh siêu âm 3 chiều của bất kỳ vùng nào trên cơ thể.

Tinh thể đầu dò ở các máy siêu âm truyền thống phải được điều chỉnh để tạo ra sóng siêu âm để chụp cơ thể ở từng những độ sâu riêng lẻ. Nhưng những tấm kim loại của Butterfly iQ đã khắc phục được nhược điểm này.

Bằng cách điều chỉnh trường điện từ của đầu dò điện dung, các tần số sóng có thể thay đổi liên tục trong quá trình quét. "Chúng tôi có thể làm cho chúng rung tại tần số 1 MHz nếu chúng tôi muốn chụp sâu, hoặc 5MHz nếu chúng tôi muốn chụp nông", tiến sĩ Jonathan Rothberg, nhà sáng lập Butterfly nói.

First Ultrasound-on-a-Chip receives broadest FDA 510(k) clearance

A window into the human body for less than $2,000 enabled by breakthrough Ultrasound-on-a-Chip technology

GUILFORD, CT--(Marketwired - October 27, 2017) - Butterfly Network Inc. announced today that it has received FDA 510(k) clearance for the world's first Ultrasound-on-a-Chip based imaging system, the Butterfly iQ® for iPhone. The clearance covers 13 clinical applications, the broadest ever for a single ultrasound transducer. By combining almost 10 thousand sensors, 40 times more than systems costing 100 times as much, Butterfly ushers in a new era of accessible, high-performance medical imaging.

"Offering a unique blend of affordability, diagnostic versatility, and assistive intelligence, Butterfly has the potential to impact human health more profoundly than any diagnostic device since the stethoscope, invented over 200 years ago. At less than $2,000, healthcare providers can purchase an easy-to-use, powerful, whole-body medical imaging system that fits in their pocket," said Dr. John Martin, Butterfly Network's Chief Medical Officer. "By removing the barrier of price, I expect Butterfly to ultimately replace the stethoscope in the daily practice of medicine. We can now provide a diagnostic system to address the millions of children that die of pneumonia each year and the hundreds of thousands of women that die in childbirth, and these are just two examples of the impact this technology will have."

First of its kind 3-in-1 transducer provides maximum versatility and convenience

To image the entire body, a traditional ultrasound system requires a large, expensive cart or box which connects to three or more piezoelectric-based transducers, each costing thousands to tens of thousands of dollars. Butterfly's Ultrasound-on-a-Chip technology combines the capabilities of the typical three probes into a single ultra wide-band, 2D matrix array comprised of thousands of microelectromechanical systems (MEMS). These sensors are directly overlaid on an integrated circuit encompassing the electronics of a high performance ultrasound system. The acoustic bandwidth and processing power available from the MEMS and electronics fusion creates unprecedented diagnostic versatility, speeds, modes, and resolutions. 

Moving the ultrasound machine to a chip allows it to be produced at unprecedented scales, at prices and rates of improvements that obey Moore's law and will enable a series of future form factors.

Semiconductor fabrication reduces hardware costs 10 to 100 fold.

The Butterfly iQ's disruptively low price is enabled by breakthrough engineering and is covered by 33 issued patents uniquely melding micromachines and integrated circuits. Butterfly directly leverages the $3 trillion dollars that went into developing the global semiconductor supply chain, currently at the heart of the revolution in consumer electronics, telecommunications, computers, and smartphones.

"Just as putting a camera on a semiconductor chip made photography accessible to anyone with a smart phone and putting a computer on a chip enabled the revolution in personal computing before that, Butterfly's Ultrasound-on-a-Chip technology enables a low-cost window into the human body, making high-quality diagnostic imaging accessible to anyone," said Dr. Jonathan Rothberg, founder and chairman of Butterfly Network. "Two thirds of the world's population has no access to medical imaging, that's not ok, and today our team is doing something about it. And they are just getting started."

Ultrasound that learns

Butterfly Network has developed deep learning-based artificial intelligence applications that are tightly coupled to the hardware and assist clinicians with both image acquisition and interpretation. "Deep learning and ultrasound imaging are a perfect combination," said President Gioel Molinari. "As physicians use our devices in the field, they help improve the neural network models. The more physicians use Butterfly devices, the better they will get. Improvements to acquiring and interpreting images will ultimately enable less skilled users to reliably extract life-saving insight from ultrasound." Butterfly plans to release assistance and interpretation functionality in 2018 as a software add-on to the Butterfly iQ system.

Cloud and Storage Solutions

The Butterfly iQ is paired with a HIPAA-compliant cloud which enables image storage and collaboration among clinicians as well as connectivity with traditional hospital medical record systems. Butterfly Cloud's fleet management capabilities offer healthcare administrators a top-down window into the utilization and return-on-investment of ultrasound in their facilities.

Learn more at www.butterflynetwork.com

ACEP
Butterfly Network will be demonstrating the iQ at the American College of Emergency Physicians (ACEP) conference in Washington DC. Attendees can visit at booth 1549 for a demonstration from Oct. 29 to Oct. 31. The Butterfly iQ will also be on display at the InnovatED section of the ACEP exhibition.

About
Butterfly Network has created and brought to market the first FDA-cleared device based on putting an ultrasound machine on a semiconductor chip. Pairing ultrasound-on-a-chip with the cloud and AI, they are on a mission to democratize medical imaging. Butterfly Network is a member of the 4Catalyzer life sciences incubator, founded by Dr. Jonathan Rothberg, best known for inventing next-generation DNA sequencing technology underlying the personal and precision medical revolution.

MEDIC Hòa Hảo đã thêm 6 ảnh mới.

1 Tháng 11 lúc 20:36 · 

FDA vừa chuẩn y cho một máy siêu âm cầm tay gọn nhẹ, kết hợp iPhone, của hãng Butterfly Network, được họ tự hào gọi là "Ultrasound on a chip" (một con chip gắn ngay đầu dò siêu âm, truyền tín hiệu hình ảnh đến iPhone). Sản phẩm đang được giới thiệu tại Hội nghị ACEP 2017 tại Washington DC (29/10 - 01/11/2017,... Hình ảnh xem trên iPhone quá đẹp !

Bs mỗi sáng khám bệnh, đến bên giường bệnh nhân mà có công cụ này thì còn gì bằng, giảm thiểu bao nhiêu là thời gian, phiền hà cho bệnh nhân, điều dưỡng & hộ lý cũng bớt việc.

Team focus is on ultrasound window

…

Antonio Regalado, the senior editor for biomedicine for MIT Technology Review, said the device uses capacitive micro-machined ultrasound transducers, or CMUTs, "tiny ultrasonic emitters layered on a semiconductor chip a little larger than a postage stamp."

Regalado wrote that ultrasound works by shooting sound into the body and capturing the echoes and usually, the sound waves are generated by a vibrating crystal. Butterfly's machine, though, "uses 9,000 tiny drums etched onto a semiconductor chip." Their company release said their ultrasound-on-a-chip technology combines capabilities of the typical three probes into a single, ultra wide-band, 2-D matrix array comprised of thousands of microelectromechanical systems. The sensors are overlaid on an integrated circuit encompassing the electronics of a high-performance ultrasound system. "Just as putting a camera on a semiconductor chip made photography accessible to anyone with a smart phone and putting a computer on a chip enabled the revolution in personal computing before that, Butterfly's Ultrasound-on-a-Chip technology enables a low-cost window into the human body, making high-quality diagnostic imaging accessible to anyone," said Dr. Jonathan.

Rothberg, founder and chairman of Butterfly Network. Butterfly iQ is FDA 510(k) cleared for diagnostic imaging across 13 clinical applications, said the Butterfly Network site, spanning the body. Storage is HIPAA-compliant. (The Butterfly iQ is paired with a HIPAA-compliant cloud for image storage and collaboration among clinicians and connectivity with traditional hospital medical record systems.) 

The site carries the supported iPhone models. Butterfly Network's "About Us" statement on their site said, "We are dedicated to democratizing ultrasound. Our dream becomes reality at the intersection of semiconductor engineering, artificial intelligence, and the cloud." Eliza Strickland in IEEE Spectrum, meanwhile, said "Beyond price and portability, the Butterfly iQ's other big selling point is its incorporation of artificial intelligence for both image acquisition and analysis." She said its engineers trained the software on vast datasets of ultrasound images, teaching it the difference between a high- and poor-quality image for body parts. For example, when "the user brings the probe to a patient's chest for a cardiac exam, the iPhone display helps them find the right spot."

More information: www.butterflynetwork.com/index.html

© 2017 Tech Xplore APA citation: Team focus is on ultrasound window

Focused USD and Parkinson's Tremors

Focused ultrasound improves Parkinson's tremors

By AuntMinnie.com staff writers

October 31, 2017 -- A new trial found that Parkinson's patients who received MRI-guided focused ultrasound had a 62% median improvement in their hand tremor three months later. However, those who underwent a sham procedure also improved to a lesser degree, suggesting some placebo effect, according to the researchers.

Dr. Jeff Elias from the University of Virginia School of Medicine and colleagues at the Swedish Neuroscience Institute in Seattle enrolled 27 patients with tremor-dominant Parkinson's disease. The researchers randomly assigned 20 subjects to be treated with focused ultrasound waves, while seven others received a fake procedure. (They were later offered the opportunity to have the actual procedure).

All had tremor that resisted medical treatment, and all continued taking their existing Parkinson's medication.

Using focused ultrasound, clinicians can interrupt faulty brain circuits or destroy unwanted tissue without the need to drill or cut into the skull. MRI allows the researchers to monitor the location and intensity of the procedure in real-time.

While all focused ultrasound participants showed improvement in their hand tremors, side effects also occurred; the most significant were mild numbness on one side of the body, which improved, and numbness of the face and finger, which was persistent. Two subjects also experienced partial weakness that recovered or improved during the study. The procedure has since been modified to mitigate the risk of weakness, the researchers said.

A larger, multicenter study is needed to better define the potential role of focused ultrasound in managing Parkinson's disease, according to Elias and colleagues.

PoC US Helps Finding Fluid

Point-of-care ultrasound helps find fluid

By Kate Madden Yee, AuntMinnie.com staff writ

October 26, 2017 -- Point-of-care ultrasound (POCUS) is an effective tool that is increasingly being implemented to help diagnose disease and plan treatment. The technology is particularly useful for finding fluid, according to a study published online October 23 in JAMA Internal Medicine.

Dr. Rachel Liu from Yale School of Medicine.

Localizing fluid can make ensuing procedures safer and more effective, according to a team led by Dr. Rachel Liu of Yale School of Medicine.

"[Point-of-care ultrasound] can improve the safety and success of accessing fluid-filled spaces through procedural guidance, and guidelines increasingly recognize ultrasonographic guidance as the standard of care," the group wrote.

However, POCUS does require some skill, according to Liu and colleagues.

"Appropriate use of point-of-care ultrasound requires investment in equipment, adequate education and training, and understanding limitations of both the technology and the user," the researchers wrote. "Performing high-quality POCUS requires comprehension of basic concepts in ultrasonography, knowledge of normal and pathological anatomy, and skill in both acquiring and interpreting images."

Particular procedures

POCUS has been shown to reduce hospital stays and healthcare costs, while also improving diagnostic accuracy and the safety and success of procedures, Liu and colleagues wrote. In fact, some compare it to the stethoscope in its potential to influence medical practice (JAMA Intern Med, October 23, 2017).

"Just as the stethoscope improved upon existing examination techniques, POCUS used by medical students and residents with focused training has been shown to offer more diagnostic accuracy than either their own physical examinations or those of experienced clinicians," the researchers wrote.

Liu's team reviewed the principles of diagnostic and procedural ultrasound, outlining its utility in finding and accessing fluid in key thoracic and abdominal areas as a supplement to basic diagnosis and procedures. A few clinical applications are as follows:

• Pulmonary edema. Ultrasound can image the pleural line, where the interaction of the parietal and visceral pleura creates a sliding appearance of lung pleura against the chest wall, the group wrote. The presence of abnormal interstitial fluid is called alveolar interstitial syndrome and can cause pulmonary edema or fibrosis. It can be identified by detecting ultrasound B-lines (the reverberation artifact at the pleural line). A linear probe works best for imaging the pleural line and should be oriented sagittally with the indicator toward the patient's head, Liu and colleagues noted.
  "Most often in the acute medical setting, assessment for B-lines is performed when there is concern for fluid overload states or decompensated heart failure," they wrote.
• Pericardial effusion. Practitioners should use a phased-array probe to evaluate this condition, which can be fatal. The pericardium will appear as a hyperechoic layer around the heart, and effusion will appear as an anechoic or hypoechoic space between the visceral and parietal layers, according to the researchers.
  "While large effusions are often straightforward to diagnose, it is important to be aware of the normal appearance of pericardial fatty tissue to avoid overcalling an effusion," they wrote.
• Peritoneal fluid. Ultrasound is the gold standard for diagnosing ascites, or the buildup of protein-containing fluid within the abdomen. It can identify as little as 100 mL of fluid, while physical examination is estimated to be about 45% to 84% sensitive and 59% to 90% specific, with overall accuracy under 60%, according to Liu's team.
  "The curvilinear probe should be used to assess for intraperitoneal fluid, but a phased-array probe may also suffice," the group wrote. "Typically, the examination begins with the probe placed on the right flank at the midaxillary line, using a coronal orientation."
• Fluid removal. Ultrasound can improve the success of paracentesis and thoracentesis by detecting the largest areas of fluid closest to the skin surface, Liu and colleagues noted. All three probes can be used: The curvilinear and phased array may be more helpful in delineating fluid, while the linear probe offers superficial detail. POCUS has been shown to improve the success of paracentesis compared with the traditional method of using anatomical landmarks, and ultrasound-guided thoracentesis has been shown to reduce morbidity associated with complications from the procedure, such as pneumothorax, the group wrote.

Take time for training

POCUS is a user-dependent technology in two respects: image acquisition and interpretation, Liu's group noted. It definitely requires some training.

"Physicians may think that POCUS is intended to answer yes or no questions -- that it's binary, so it's easy," Liu told AuntMinnie.com. "And sure, the concept of finding fluid isn't rocket science. But a good amount of practice and training is still needed to be accurate in diverse clinical situations. A medical student can pick up a probe and start doing it right away to help learn anatomy, but making complex clinical decisions using POCUS requires dedicated practice."

Are physicians being trained to use ultrasound? Not as they could be, the researchers found. In 2014, only 28% of U.S. medical schools reported having a formal curriculum for ultrasonography, and in 2013, only about a fourth of entering residents reported exposure to bedside ultrasound.

So it's extra important to institute a training program for POCUS, including how to handle incidental findings, Liu and colleagues wrote.

"Ideally, POCUS would be incorporated longitudinally into residency training and overseen by experienced faculty, although this may take time to develop," they wrote. "Learning ultrasonography requires didactic and hands-on instruction combined with proctored clinical use."

Leading the charge

That physicians across many specialties -- emergency department, intensive care, and family practice -- are interested in POCUS is good news for radiology, according to Liu.

"Radiologists can help train other physicians in point-of-care ultrasound -- for example, some have instituted hands-on participation during ward rounds, or they hold regular image review and quality assurance sessions with nonradiology physicians," she told AuntMinnie.com. "Also, some emergency departments employ sonographers to help with residency training and medical student education."

In fact, radiology concepts aren't necessarily emphasized in medical school, and radiologists can help remedy that, she said.

"Medical students might see a CT image next to an anatomy slide, but they don't necessarily learn about imaging at the same time," she said. "These are future doctors who will be making diagnostic decisions for patients, and it would be helpful for them to have a solid understanding of imaging concepts before they begin residency.

SHEAR-WAVE-RELATED ULTRASOUND ELASTOGRAPHY TECHNIQUES

Xem thêm KỸ THUẬT và VẬT LÝ SIÊU ÂM ĐÀN HỒI

FUNCTIONAL US IMAGING of NEWBORN BRAIN

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.

DOWNLOAD FULLTEXT Poc-US: A WFUMB Position Paper