The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

Michael Bachmann Nielsen; Vito Cantisani; Paul S. Sidhu; Radu Badea; Tomasz Batko; Jonathan Carlsen; Michel Claudon; Caroline Ewertsen; Carmen Garre; Jordan Genov; Odd Helge Gilja; Roald Havre; Mateusz Kosiak; Wojciek Kosiak; James Pilcher; Helmut Prosch; Maija Radzina; Vasileios Rafailidis; Alexander Rykkje; Andreas Serra; Alexandros Sotiriadis; Mia Østergaard; Christoph F. Dietrich

doi:10.1055/a-0783-2303

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2019; 40(01): 30-39
DOI: 10.1055/a-0783-2303

Guidelines & Recommendations

The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

Die Anwendung handgeführter Ultraschallgeräte – Ein EFSUMB Positionspapier

Authors

Michael Bachmann Nielsen

¹Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
Vito Cantisani

²Department of Radiological Sciences, Policlinico Umberto I, University Sapienza, Rome, Italy
Paul S. Sidhu

³Department of Radiology, King’s College London, King’s College Hospital, London, UK
Radu Badea

⁴Ultrasound Department, 3 rd Medical Clinic, Institute of Gastroenterolgy and Hepatology “Octavian Fodor” Cluj Napoca, Romania
Tomasz Batko

⁵Ultrasound and Biopsy Diagnostics Lab at the Clinic of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Poland
Jonathan Carlsen

¹Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
Michel Claudon

⁶Department of Radiology, CHRU Nancy, University of Lorraine, Inserm, IADI, F-54000 NANCY, France
Caroline Ewertsen

¹Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
Carmen Garre

⁷Servicio de Aparato Digestivo Hospital Universitarios Virgen de la Arrixaca, Carretera de Cartagena s/n. El Palmar, Murcia Spain
Jordan Genov

⁸Department of Hepatology, Clinic of Gastroenterology, University Hospital "TsaritsaYoanna – ISUL", Sofia, Bulgaria
Odd Helge Gilja

⁹National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland, University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
Roald Havre

¹⁰Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
Mateusz Kosiak

¹¹Medical Centre in Puck, 16 Armii Wojska Polskiego Puck, Poland
Wojciek Kosiak

⁵Ultrasound and Biopsy Diagnostics Lab at the Clinic of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Poland
James Pilcher

¹²Department of Radiology, St George’s Hospital London, UK
Helmut Prosch

¹³Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Währingergürtel, Vienna, Austria
Maija Radzina

¹⁴Diagnostic Radiology Institute, Paula Stradina clinical university hospital, Riga, Latvia
Vasileios Rafailidis

³Department of Radiology, King’s College London, King’s College Hospital, London, UK
Alexander Rykkje

¹Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
Andreas Serra

¹⁵Department of Internal Medicine and Nephrology, Klinik Hirslanden, Zürich
Alexandros Sotiriadis

¹⁶Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, Medical School
Mia Østergaard

¹Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
Christoph F. Dietrich

¹⁷Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Sino-German Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Abstract

The miniaturization of ultrasound equipment in the form of tablet- or smartphone-sized ultrasound equipment is a result of the rapid evolution of technology and handheld ultrasound devices (HHUSD). This position paper of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of HHUSD in abdominal ultrasound, pediatric ultrasound, targeted echocardiography and heart ultrasound, and we will report position comments on the most common clinical applications. Also included is a SWOT (Strength – Weaknesses – Opportunities – Threats) analysis, the use for handheld devices for medical students, educational & training aspects, documentation, storage and safety considerations.

Zusammenfassung

Die Verkleinerung von handlichen zu handgeführten Ultraschallgeräten mit einer Größe und Form von Tablets bzw. Smartphones ist das Ergebnis einer rasanten Technologieentwicklung. Dieses Positionspapier der Europäischen Ultraschallgesellschaft (EFSUMB, European Federation of Societies in Ultrasound and Medicine) beschreibt aktuelle Anwendungen von kleinen und kleinsten Ultraschallgeräten am Thorax und Abdomen. Häufige angewandte Applikationen werden beschrieben. Das Positionspapier beinhaltet auch eine SWOT-Analyse (Strength – Weaknesses – Opportunities – Threats). Anwendungen durch Medizinstudenten sowie Ausbildungs- und Trainingsaspekte, Dokumentation, Speicherung von Daten sowie Sicherheitsaspekte werden beleuchtet.

Key words

abdomen - chest - gynecology - obstetrics

Full Text

References

References
1 Nielsen MB. Handheld Ultrasound devices (HHUSD): A short review of the equipment available on the market as of September 2017. Ultraschall in Med 2017; 38: 668-668
2 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43: 49-58
3 Birth of „Echoscopy“ – The EFSUMB Point of View. Ultraschall in Med 2013 34. 92
4 Dietrich CF, Rudd L, Saftiou A. et al. The EFSUMB website, a great source for ultrasound information and education. Med Ultrason 2017; 19: 102-110
5 Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason 2013; 15: 215-223
6 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364: 749-757
7 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
8 Kjesbu IE, Laursen CB, Graven T. et al. Feasibility and Diagnostic Accuracy of Point-of-Care Abdominal Sonography by Pocket-Sized Imaging Devices, Performed by Medical Residents. J Ultrasound Med 2017; 36: 1195-1202
9 Mjolstad OC, Dalen H, Graven T. et al. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med 2012; 23: 185-191
10 Hall MK, Hall J, Gross CP. et al. Use of Point-of-Care Ultrasound in the Emergency Department: Insights From the 2012 Medicare National Payment Data Set. J Ultrasound Med 2016; 35: 2467-2474
11 Ojeda JC, Colbert JA, Lin X. et al. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30: 199-206
12 Coşkun F, Akıncı E, Ceyhan MA. et al. Our new stethoscope in the emergency department: handheld ultrasound. Ulus Travma Ve Acil Cerrahi Derg 2011; 17: 488-492
13 Stock KF, Klein B, Steubl D. et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: diagnostic value and time required in bedside ultrasound examination. Abdom Imaging 2015; 40: 2861-2866
14 Keil-Ríos D, Terrazas-Solís H, González-Garay A. et al. Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis. Intern Emerg Med 2016; 11: 461-466
15 Landers A, Ryan B. The use of bedside ultrasound and community-based paracentesis in a palliative care service. J Prim Health Care 2014; 6: 148-151
16 Dijos M, Pucheux Y, Lafitte M. et al. Fast track echo of abdominal aortic aneurysm using a real pocket-ultrasound device at bedside. Echocardiography 2012; 29: 285-290
17 Andersen GN, Graven T, Skjetne K. et al. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med 2015 2015; 34: 627-636
18 Colli A, Prati D, Fraquelli M. et al. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PloS One 2015; 10: e0122181
19 Alnaif B, Drutz HP. The accuracy of portable abdominal ultrasound equipment in measuring postvoid residual volume. Int Urogynecol J Pelvic Dysfunct 1999; 10: 215-218
20 Lavi A, Tzemah S, Hussein A. et al. A urologic stethoscope? Urologist performed sonography using a pocket-size ultrasound device in the point-of-care setting. Int Urol Nephrol 2017; 49: 1513-1518
21 Kameda T, Uebayashi K, Wagai K. et al. Assessment of the renal collecting system using a pocket‐sized ultrasound device. J Med Ultrason 2018; 45: 577-581
22 Chen Y, Zheng H, Zang Z. et al. Real-Time Ultrasound-Guided Percutaneous Nephrolithotomy Using Newly Developed Wireless Portable Ultrasound: A Single-Center Experience. Surg Innov 2018; 25: 333-338
23 Bruns RF, Menegatti CM, Martins WP. et al. Applicability of pocket ultrasound during the first trimester of pregnancy. Med Ultrason 2015; 17: 284-288
24 Sayasneh A, Preisler J, Smith A. et al. Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology?. Ultrasound Obstet Gynecol 2012; 40: 145-150
25 Galjaard S, Baeck S, Ameye L. et al. Use of a pocket-sized ultrasound machine (PUM) for routine examinations in the third trimester of pregnancy. Ultrasound Obstet Gynecol 2014; 44: 64-68
26 Troyano Luque JM, Ferrer-Roca O, Barco-Marcellán MJ. et al. Modification of the hand-held Vscan ultrasound and verification of its performance for transvaginal applications. Ultrasonics 2013; 53: 17-22
27 Mirabel M, Celermajer D, Beraud A-S. et al. Pocket-sized focused cardiac ultrasound: strengths and limitations. Arch Cardiovasc Dis 2015; 108: 197-205
28 Testuz A, Müller H, Keller P-F. et al. Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting. Eur Heart J Cardiovasc Imaging 2013; 14: 38-42
29 Cullen MW, Geske JB, Anavekar NS. et al. Handheld echocardiography during hospitalization for acute myocardial infarction. Clin Cardiol 2017; 40: 993-999
30 Andersen GN, Haugen BO, Graven T. et al. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011; 12: 665-670
31 Abe Y, Ito M, Tanaka C. et al. A novel and simple method using pocket-sized echocardiography to screen for aortic stenosis. J Am Soc Echocardiogr 2013; 26: 589-596
32 Prinz C, Dohrmann J, van Buuren F. et al. Diagnostic performance of handheld echocardiography for the assessment of basic cardiac morphology and function: a validation study in routine cardiac patients. Echocardiography 2012; 29: 887-894
33 Sicari R, Galderisi M, Voigt J-U. et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. Eur J Echocardiogr 2011; 12: 85-87
34 Tsai BT, Dahms EB, Waalen J. et al. Actual use of pocket-sized ultrasound devices for cardiovascular examination by trained physicians during a hospitalist rotation. J Community Hosp Intern Med Perspect 2016; 6: 33358
35 Mai TV, Shaw DJ, Amundson SA. et al. Learning to apply the pocket ultrasound device on the critically ill: comparing six “quick-look” signs for quality and prognostic values during initial use by novices. Crit Care 2013; 17: 448
36 Platz E, Lewis EF, Uno H. et al. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. Eur Heart J 2016; 37: 1244-1251
37 Platz E, Pivetta E, Merz AA. et al. Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure. Am J Emerg Med 2015; 33: 1552-1556
38 Cogliati C, Antivalle M, Torzillo D. et al. Standard and pocket-size lung ultrasound devices can detect interstitial lung disease in rheumatoid arthritis patients. Rheumatology 2014; 53: 1497-1503
39 Filopei J, Siedenburg H, Rattner P. et al. Impact of pocket ultrasound use by internal medicine housestaff in the diagnosis of dyspnea. J Hosp Med 2014; 9: 594-597
40 Lisi M, Cameli M, Mondillo S. et al. Incremental value of pocket-sized imaging device for bedside diagnosis of unilateral pleural effusions and ultrasound-guided thoracentesis. Interact Cardiovasc Thorac Surg 2012; 15: 596-601
41 Sforza A, Mancusi C, Carlino MV. et al. Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea. Cardiovasc Ultrasound 2017; 15: 16
42 Marin JR, Abo AM, Arroyo AC. et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8: 16
43 McLario DJ, Sivitz AB. Point-of-Care Ultrasound in Pediatric Clinical Care. JAMA Pediatr 2015; 169: 594-600
44 Burdjalov V, Srinivasan P, Baumgart S. et al. Handheld, portable ultrasound in the neonatal intensive care nursery: a new, inexpensive tool for the rapid diagnosis of common neonatal problems. J Perinatol 2002; 22: 478-483
45 Li X, Mack GK, Rusk RA. et al. Will a handheld ultrasound scanner be applicable for screening for heart abnormalities in newborns and children?. J Am Soc Echocardiogr 2003; 16: 1007-1014
46 Spurney CF, Sable CA, Berger JT. et al. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr 2005; 18: 313-319
47 Beaton A, Lu JC, Aliku T. et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. Eur Heart J Cardiovasc Imaging 2015; 16: 475-482
48 Mirabel M, Bacquelin R, Tafflet M. et al. Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach. Circ Cardiovasc Imaging 2015; 8: e002324
49 Beaton A, Aliku T, Okello E. et al. The utility of handheld echocardiography for early diagnosis of rheumatic heart disease. J Am Soc Echocardiogr 2014; 27: 42-49
50 Cramp G, Stonehouse M, Webb R. et al. Undetected rheumatic heart disease revealed using portable echocardiography in a population of school students in Tairawhiti, New Zealand. N Z Med J 2012; 125: 53-64
51 Lee HC, Silverman N, Hintz SR. Diagnosis of patent ductus arteriosus by a neonatologist with a compact, portable ultrasound machine. J Perinatol 2007; 27: 291-296
52 Torrazza RM, Chandran A, Co-Vu J. et al. Pocket echocardiography system for detection of patent ductus arteriosus in neonates. Echocardiogr 2015; 32: 319-324
53 Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration. Ann Emerg Med 1991; 20: 631-635
54 Chen L, Hsiao AL, Moore CL. et al. Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 2005; 115: 108-111
55 Tsung JW, Blaivas M, Cooper A. et al. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 2005; 21: 94-98
56 Mahmud N. Measurement of thyroid volume in children using a portable ultrasound machine: a technical note. Asia Pac J Public Health 2001; 13: 36-39
57 Fox JC, Schlang JR, Maldonado G. et al. Proactive medicine: the “UCI 30,” an ultrasound-based clinical initiative from the University of California, Irvine. Acad Med 2014; 89: 984-989
58 Cawthorn TR, Nickel C, O’Reilly M. et al. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J Am Soc Echocardiogr 2014; 27: 302-309
59 Wittich CM, Montgomery SC, Neben MA. et al. Teaching cardiovascular anatomy to medical students by using a handheld ultrasound device. JAMA 2002; 288: 1062-1063
60 Ho AM-H, Critchley LAH, Leung JYC. et al. Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation. Teach Learn Med 2015; 27: 307-313
61 Galusco V, Khanji MY, Bodger O. et al. Hand-held ultrasound scanners in medical education: A Systematic review. J Cardiovasc Ultrasound 2017; 25: 75-83
62 Ringsted C, Hodges B, Scherpbier A. “The research compass”: an introduction to research in medical education: AMEE Guide no. 56. Med Teach 2011; 33: 695-709
63 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2: E2-E7
64 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB statement on medical student education in ultrasound [short version]. Ultraschall in Med 2016; 37: 100-102
65 Dietrich CF. Ultrasound student education. Med Ultrason 2017; 19: 131-133
66 Seitz K. Who’s Doing Your Scan? The German Perspective on Ultrasound Services: Ultrasound is More Than a Technique, it’s a Medical Art. Ultraschall in Med 2017; 38: 661-663
67 American College of Radiology. Digest of Council Actions.pdf [Internet], page 54. Available from: https://www.acr.org/~/media/ACR/Documents/PDF/Membership/Governance/Digest-of-Council-Actions.pdf (August 2018)
68 American College of Emergency Physicians. ACEP emergency ultrasound guidelines-2001. Ann Emerg Med 2001; 38: 470-481
69 Mollenkopf M, Tait N. Is it time to include point-of-care ultrasound in general surgery training? A review to stimulate discussion. ANZ J Surg 2013; 83: 908-911
70 Mandavia DP, Aragona J, Chan L. et al. Ultrasound training for emergency physicians--a prospective study. Acad Emerg Med 2000; 7: 1008-1014
71 Blehar DJ, Barton B, Gaspari RJ. Learning curves in emergency ultrasound education. Acad Emerg Med 2015; 22: 574-582
72 Jang TB, Ruggeri W, Dyne P. et al. The learning curve of resident physicians using emergency ultrasonography for cholelithiasis and cholecystitis. Acad Emerg Med 2010; 17: 1247-1252
73 Dyre L, Nørgaard LN, Tabor A. et al. Collecting Validity Evidence for the Assessment of Mastery Learning in Simulation-Based Ultrasound Training. Ultraschall in Med 2016; 37: 386-392
74 Østergaard ML, Ewertsen C, Konge L. et al. Simulation-Based Abdominal Ultrasound Training – A Systematic Review. Ultraschall in Med 2016; 37: 253-261
75 Østergaard ML, Nielsen KR, Albrecht-Beste E. et al. Development of a reliable simulation-based test for diagnostic abdominal ultrasound with a pass/fail standard usable for mastery learning. Eur Radiol 2018; 28: 51-57
76 AIUM Practice Parameter for Documentation of an Ultrasound Examinationdocumentation.pdf [Internet]. [cited 2018 Aug]. Available from: http://www.aium.org/resources/guidelines/documentation.pdf
77 Becker DM, Tafoya CA, Becker SL. et al. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016; 21: 294-311
78 Shorter M, Macias DJ. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehospital Disaster Med 2012; 27: 172-177
79 Terry B, Polan D, Islam R. et al. Rapid Internet-based review of point-of-care ultrasound studies at a remote hospital in Uganda. Ann Glob Health 2014; 80: 222-223
80 Nielsen MB, Havre RF, Ewertsen C. et al. Ultrasound handheld devices – potential problems and possible solutions. Ultraschall in Med 2016; 37: 313-314
81 Expert RoundTable on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med 2011; 37: 1077-1083
82 Seward JB, Douglas PS, Erbel R. et al. Hand-carried cardiac ultrasound (HCU) device: recommendations regarding new technology. A report from the Echocardiography Task Force on New Technology of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 369-373