COVID-19 pandemic driving increase in ultrasound use

By Theresa Pablos, AuntMinnie staff writer

August 3, 2020 -- The COVID-19 pandemic is driving an increase in the use of lung ultrasonography among physicians in Italy, according to the results of a small survey published in the Journal of Ultrasound in Medicine.

More physicians said they're using ultrasound equipment now than before the pandemic, and experienced physicians are performing more lung ultrasound scans than ever before. The findings support anecdotal evidence that COVID-19 has increased interest in ultrasound, including among clinicians with no prior ultrasound experience.

"Thanks to online resources, many operators could e-learn and apply the technique," wrote the authors, Dr. Allessandro Zanforlin and Dr. Francesco Tursi, who are both members of the Italian thoracic ultrasound academy behind the survey (July 16, 2020, Journal of Ultrasound in Medicine).

The informal, one-week-long survey was conducted by Italian ultrasound society Academia di Ecografia Thoracia after the group noticed its membership spiked from 1,700 members in February to 4,000 members in May. The academy promoted its survey on social media and received 123 responses.

Survey respondents worked in a variety of settings, including on COVID-19 floors (34%), in intensive care units (31%), and in the emergency department (20%). The majority said they used lung ultrasound to monitor pneumonia (63%) and screen for COVID-19 (60%).

A total of 14% of respondents started using lung ultrasound exclusively because of the COVID-19 pandemic. Among these respondents, 81% said they learned how to perform lung ultrasound scans by following video tutorials or participating in webinars. The remaining 19% of respondents gained experience through expert mentoring or local courses.

As the number of patients with COVID-19 surged at hospitals in Italy, so too did the number of lung ultrasound exams. Respondents said the number of daily chest scans increased from an average of three per day before the pandemic to seven per day during the outbreak. For so-called "expert operators" with at least five years of lung ultrasound experience, the number of exams rose from five per day to nine per day.

The majority of respondents also said their lung ultrasound exams had increased in quality (58%) and accuracy (66%) during the pandemic. These percentages were even higher for participants who took an online course or webinar, with 83% of these respondents saying their exams increased in both quality and accuracy.

One factor driving the increase in lung ultrasound exams could be the availability of additional equipment thanks to donations and emergency purchase approvals. More than half of respondents said they acquired new ultrasound equipment during the pandemic, namely portable wheeled systems (37%) or handheld/wireless systems (19%).

The survey adds to the evidence that ultrasound is becoming an invaluable tool for care teams, especially those in Italy, who are treating patients with the novel coronavirus. However, the increase in skilled operators and new equipment may mean the modality will remain prominent for lung imaging even after the pandemic is over.

"What we are learning from this pandemic is the importance of [lung ultrasound] in the diagnosis, evaluations, and monitoring of pneumonia, which, in the hands of many physicians ... could improve the quality of the treatment of respiratory patients," the authors concluded.

US correlates with COVID-19 severity, duration

By Theresa Pablos, AuntMinnie staff writer

July 28, 2020 -- Findings on lung ultrasound scans were correlated with COVID-19 severity and duration in a study published on July 23 in the American Journal of Roentgenology. In particular, pulmonary consolidations distinguished between patients with moderate and severe forms of the novel coronavirus disease

The study included dozens of patients who were consecutively treated for COVID-19 at a Chinese hospital in March. The findings may aid physicians in managing patients with moderate-to-severe COVID-19, the authors noted.

"Our results indicate that lung [ultrasound] findings can be used to reflect both the infection duration and disease severity," wrote the authors, led by Dr. Yao Zhang from Ditan Hospital in Beijing.

Zhang and colleagues enrolled 28 patients consecutively hospitalized for COVID-19 at their institution between March 1 and March 30. The patients all tested positive for the novel coronavirus on a nasopharyngeal test and underwent a bedside lung ultrasound scan in a sitting, supine, and decubitus position.

Every patient in the study had B-lines on their ultrasound scans, which indicate areas of increased interstitial fluids and decreased alveolar air. Another two-thirds of patients had pulmonary consolidation, and 61% had a thickened pleural line. Only one patient had a pleural effusion.

Pulmonary consolidation occurred significantly more often in patients with severe or critical COVID-19 than patients with moderate disease, the authors found. Almost 87% of patients with severe or critical disease had pulmonary consolidation on ultrasound, compared with just 46% of patients with moderate COVID-19.

(A) Lung ultrasound image obtained with a convex probe. The outer arrows show confluent B-lines. The middle arrowheads point to a thickened pleural line. (B) Lung ultrasound image obtained with a linear probe. The arrow points to a B-line. The star denotes a patchy pulmonary consolidation. (C) Chest CT image showing reticular and interlobular septal thickening and patchy, focal opacities associated with architectural distortion. Image courtesy of the American Journal of Roentgenology.

Furthermore, patients with a thickened pleural line had experienced a longer infection period than those without a thickened pleural line. Patients with fewer than 20 days between the day they first noticed COVID-19 symptoms and the day of their ultrasound scan were significantly less likely to have a thickened pleural line than those with a difference of 20 days or more.

The study findings add to the growing body of research demonstrating that severity on lung ultrasound scans can predict worse outcomes and even mortality for patients with COVID-19. The authors emphasized that ultrasound also has unique benefits over other imaging modalities, including CT, for treating patients with the novel coronavirus.

"[Ultrasound] is repeatable in critically ill patients, which ensures that monitoring of the severity of the disease and the effects of therapies can be easily carried out," they wrote. "This capability is particularly important in situations in which chest CT is not available, such as in isolation wards and [intensive care units]."

The authors cautioned that their study focused on a small number of patients and did not evaluate how ultrasound findings might have changed over time. They hope future studies will continue to study the use of lung ultrasound for COVID-19, particularly how lung ultrasound scoring systems might improve COVID-19 assessment and treatment.

"Lung [ultrasound] was highly sensitive for detecting abnormalities in patients with COVID-19, and B-lines, a thickened pleural line, and pulmonary consolidation were the most commonly observed features," the authors concluded.