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Vega R, Kwok C, Rakkunedeth Hareendranathan A, Nagdev A, Jaremko JL. Assessment of an Artificial Intelligence Tool for Estimating Left Ventricular Ejection Fraction in Echocardiograms from Apical and Parasternal Long-Axis Views. Diagnostics (Basel) 2024; 14:1719. [PMID: 39202209 PMCID: PMC11353168 DOI: 10.3390/diagnostics14161719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
This work aims to evaluate the performance of a new artificial intelligence tool (ExoAI) to compute the left ventricular ejection fraction (LVEF) in echocardiograms of the apical and parasternal long axis (PLAX) views. We retrospectively gathered echocardiograms from 441 individual patients (70% male, age: 67.3 ± 15.3, weight: 87.7 ± 25.4, BMI: 29.5 ± 7.4) and computed the ejection fraction in each echocardiogram using the ExoAI algorithm. We compared its performance against the ejection fraction from the clinical report. ExoAI achieved a root mean squared error of 7.58% in A2C, 7.45% in A4C, and 7.29% in PLAX, and correlations of 0.79, 0.75, and 0.89, respectively. As for the detection of low EF values (EF < 50%), ExoAI achieved an accuracy of 83% in A2C, 80% in A4C, and 91% in PLAX. Our results suggest that ExoAI effectively estimates the LVEF and it is an effective tool for estimating abnormal ejection fraction values (EF < 50%). Importantly, the PLAX view allows for the estimation of the ejection fraction when it is not feasible to acquire apical views (e.g., in ICU settings where it is not possible to move the patient to obtain an apical scan).
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Affiliation(s)
| | - Cherise Kwok
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
| | - Abhilash Rakkunedeth Hareendranathan
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
| | - Arun Nagdev
- Alameda Health System, Highland General Hospital, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
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Integrated Assessment of Heart, Lung and Lower Extremity Veins Using Hand-Held Ultrasound Device in COVID-19 Patients: Feasibility and Clinical Application. Diagnostics (Basel) 2023; 13:diagnostics13040724. [PMID: 36832210 PMCID: PMC9954818 DOI: 10.3390/diagnostics13040724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/24/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
The emergence of the COVID-19 pandemic caused a significant shortage of medical personnel and the prioritization of life-saving procedures on internal medicine and cardiology wards. Thus, the cost- and time-effectiveness of each procedure proved vital. Implementing elements of imaging diagnostics into the physical examination of COVID-19 patients could prove beneficial to the treatment process, providing important clinical data at the moment of admission. Sixty-three patients with positive COVID-19 test results were enrolled into our study and underwent physical examination expanded with a handheld ultrasound device (HUD)-performed bedside assessment included: right ventricle measurement, visual and automated LVEF assessment, four-point compression ultrasound test (CUS) of lower extremities and lung ultrasound. Routine testing consisting of computed-tomography chest scanning, CT-pulmonary angiogram and full echocardiography performed on a high-end stationary device was completed in the following 24 h. Lung abnormalities characteristic for COVID-19 were detected in CT in 53 (84%) patients. The sensitivity and specificity of bedside HUD examination for detecting lung pathologies was 0.92 and 0.90, respectively. Increased number of B-lines had a sensitivity of 0.81, specificity 0.83 for the ground glass symptom in CT examination (AUC 0.82; p < 0.0001); pleural thickening sensitivity 0.95, specificity 0.88 (AUC 0.91, p < 0.0001); lung consolidations sensitivity 0.71, specificity 0.86 (AUC 0.79, p < 0.0001). In 20 patients (32%), pulmonary embolism was confirmed. RV was dilated in HUD examination in 27 patients (43%), CUS was positive in two patients. During HUD examination, software-derived LV function analysis failed to measure LVEF in 29 (46%) cases. HUD proved its potential as the first-line modality for the collection of heart-lung-vein imaging information among patients with severe COVID-19. HUD-derived diagnosis was especially effective for the initial assessment of lung involvement. Expectedly, in this group of patients with high prevalence of severe pneumonia, HUD-diagnosed RV enlargement had moderate predictive value and the option to simultaneously detect lower limb venous thrombosis was clinically attractive. Although most of the LV images were suitable for the visual assessment of LVEF, an AI-enhanced software algorithm failed in almost 50% of the study population.
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Al-Biltagi M, Elrazaky O, Mawlana W, Srour E, Shabana AH. Tissue Doppler, speckling tracking and four-dimensional echocardiographic assessment of right ventricular function in children with dilated cardiomyopathy. World J Clin Pediatr 2022; 11:71-84. [PMID: 35096548 PMCID: PMC8771319 DOI: 10.5409/wjcp.v11.i1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/21/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Right ventricular (RV) function is frequently overlooked during dilated cardiomyopathy (DCM) evaluation. AIM To evaluate RV function in children with idiopathic DCM using relatively recent echocardiographic modalities. METHODS We prospectively studied the cardiac function in 50 children with idiopathic DCM and 50 healthy children as a control group, using four-dimensional echocardiography (4-DE), Tissue Doppler Imaging (TDI), and two-dimensional-speckles tracking echocardiography (2-D-STE). RV EF was measured by 4-DE. RESULTS The auto left (LV) ejection fractions (EF) measured by 2-D-STE were significantly lower in the patients' group than in the control. The sphericity index was also significantly lower in children with DCM than in the control. RV EF measured by 4-DE was significantly lower in the patient's group than the control. RV S wave, e´/a' ratio, myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE) were significantly impaired in children with DCM than in control. Both LV and RV global longitudinal strains (GLS) were significantly reduced in children with DCM than in control. RVGLS was significantly associated with the duration since diagnosis, tricuspid annulus S wave, RV MPI, and TAPSE, but not with the age of the patients, RV EF, or e´/a' ratio. CONCLUSION There was impairment of the RV LGS and other systolic and diastolic parameters in children with DCM. STE and TDI can help to detect the early decline of RV function.
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Affiliation(s)
- Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Osama Elrazaky
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Algharbia, Egypt
| | - Wegdan Mawlana
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Algharbia, Egypt
| | - Esraa Srour
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Algharbia, Egypt
| | - Ahmed Hamdy Shabana
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Algharbia, Egypt
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Abstract
The use of portable ultrasound (US) devices has increased in recent years and the market has been flourishing. Portable US devices can be subdivided into three groups: laptop-associated devices, hand-carried US, and handheld US devices. Almost all companies we investigated offer at least one portable US device. Portable US can also be associated with the use of different US techniques such as colour Doppler US and pulse wave (PW)-Doppler. Laptop systems will also be available with contrast-enhanced US and high-end cardiac functionality. Portable US devices are effective in the hands of experienced examiners. Imaging quality is predictably inferior to so-called high-end devices. The present paper is focused on portable US devices and clinical applications describing their possible use in different organs and clinical settings, keeping in mind that patient safety must never be compromised. Hence, portable devices must undergo the same decontamination assessment and protocols as the standard equipment, especially smartphones and tablets.
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Habeeb NM, Youssef OI, Elguindy WM, Ibrahim AS, Hussein WH. Three Dimensional (3D) Echocardiography as a Tool of Left Ventricular Assessment in Children with Dilated Cardiomyopathy: Comparison to Cardiac MRI. Open Access Maced J Med Sci 2018; 6:2310-2315. [PMID: 30607182 PMCID: PMC6311485 DOI: 10.3889/oamjms.2018.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: Left ventricular (LV) volumes and ejection fraction (EF) is Strong prognostic indicators for DCM. Cardiac MRI (CMRI) is a preferred technique for LV volumes and EF assessment due to high spatial resolution and complete volumetric datasets. Three-dimensional echocardiography is a promising new technique under investigations. AIM: Evaluate 3D echocardiography as a tool in LV assessment in DCM children about CMRI. PATIENTS AND METHODS: A group of 20 DCM children (LVdiastolic diameter < 2 Z score, LVEF < 35%) at Children s Hospital, Ain-Shams University (gp1) (mean age 6.6 years) were compared to 20 age and sex-matched children as controls (gp2). Patients were subjected to: clinical examination, conventional echocardiography, automated 3D LV quantification, 3D speckle tracking echocardiography (3D-STE) (VIVID E9 Vingmed, Norway) and CMRI (Philips Achieva Nova, 1.5 Tesla scanner) for LV end systolic volume (LVESV), LVend diastolic volume (LVEDV) that were indexed to body surface area, EF% and wall motion abnormalities assessment. RESUTS: No statistically significant difference was found between automated 3D LV quantification echocardiography, 3D-STE, and CMRI in ESV/BSA and EDV/BSA assessment (p = 1, 0.99 respectively), between automated LV quantification echocardiography and CMRI in EF% assessment (p = 0.99) and between CMRI and 3D-STE in LV Global hypokinesia detection (P = 0.255). As for segmental hypokinesia CMRI was more sensitive [45% of patients vs. 40%, (P = 0,036), basal septal hypokinesia 85% vs. 75%, (p = 0.045), mid septal hypokinesia 80% vs. 65%, (p = 0.012) and lateral wall hypokinesia 75% vs. 65%, (p = 0.028)]. CONCLUSION: Automated 3D LV quantification echocardiography and 3D-STE are reliable tools in LV volumetric and systolic function assessment about CMRIas a standard method. 3D speckle echocardiography is comparable to CMRI in global wall hypokinesia detection but less sensitive in segmental wall hypokinesia which mandates further studies.
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Affiliation(s)
| | | | | | - Ahmed Samir Ibrahim
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walaa Hamed Hussein
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Galusko V, Bodger O, Ionescu A. A systematic review of pocket-sized imaging devices: small and mighty? Echo Res Pract 2018; 5:113-138. [PMID: 30304538 PMCID: PMC6198255 DOI: 10.1530/erp-18-0030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Hand-held imaging devices are widely used in clinical practice and are a useful tool. There is no published review examining the diagnostic parameters achieved with these devices in clinical practice. Methods We searched three online medical literature databases (PubMed, EMBASE and MEDLINE) for all literature published up until January 2018. We selected studies that (1) were conducted in the adult population; (2) used a truly hand-held device; (3) featured sensitivities and/or specificities on the use of the hand-held scanner. We extracted and summarised the diagnostic metrics from the literature. Results Twenty-seven articles were excluded from the initial 56 relevant articles, as the device featured was not truly hand-held. Ultimately a total of 25 studies were analysed. Sixteen studies were carried out by experienced users, seven by users with little previous experience and two studies by nurses. High diagnostic parameters were achieved by all three groups when scanning cardiac pathology and intra-abdominal structures. Training of non-expert users varied, taking a mean of 21.6 h. These hand-held devices can change diagnoses at the bedside and be used as gate-keepers to formal echocardiography. Individual studies show them to be cost-effective. Conclusion Hand-held echocardiography is a useful tool in the hands of experts and novices alike. Studies conducted are highly heterogeneous making it difficult to pool data for the diagnostic metrics. Further studies with rigorous methodology are needed to evaluate the true diagnostic potential in the hands of non-experts and in the community as well as to validate training protocols.
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Affiliation(s)
- Victor Galusko
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
| | - Owen Bodger
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
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Galusko V, Bodger O, Rees E, Ionescu A. Hand-held ultrasonography: An opportunity for "hands-on" teaching of medicine. MEDEDPUBLISH 2018; 7:103. [PMID: 38074553 PMCID: PMC10699386 DOI: 10.15694/mep.2018.0000103.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: As ultrasound offers students an opportunity to study anatomy, physiology and pathophysiology actively, we used hand-held ultrasound (HHU) devices to augment current teaching of cardiac murmurs and pathology. Methods: Three types of teaching sessions (of different duration) were explored: 1) compulsory teaching on cardiac murmurs (n=40); 2) extra-curricular teaching of cardiac murmurs (n=8); 3) extra-curricular ultrasound course (n=6). We assessed students' ability to identify valvular lesions on auscultation, and anatomy and pathology on echocardiography, and sought qualitative feedback. Results: Using echocardiography to teach murmurs improved murmur recognition by auscultation alone from 23% pre-test to 93% post-test (p=0.017). Students were able to identify major cardiac anatomical landmarks on echo images (57% vs 98% ( p=0.027) in the voluntary teaching session lasting 90 minutes, and 40% vs 82% ( p=0.027) after the 3 week cardiac ultrasound course. The mean accuracy for diagnosing cardiac pathology on a printed image alone after the 3 week ultrasound course was 71%. Students unanimously found the sessions useful and engaging, and reported they would like further teaching about using ultrasound. Conclusion: Medical students found the sessions engaging, enjoyed this novel way of teaching and would like further teaching using ultrasound. Using hand-held ultrasound scanners to augment the teaching of cardiac murmurs to medical students is feasible and effective.
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Affiliation(s)
| | | | - Emma Rees
- College of Human and Health Sciences
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Galusko V, Khanji MY, Bodger O, Weston C, Chambers J, Ionescu A. Hand-held Ultrasound Scanners in Medical Education: A Systematic Review. J Cardiovasc Ultrasound 2017; 25:75-83. [PMID: 29093769 PMCID: PMC5658292 DOI: 10.4250/jcu.2017.25.3.75] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/16/2023] Open
Abstract
Background Ultrasound imaging devices are becoming popular in clinical and teaching settings, but there is no systematic information on their use in medical education. We conducted a systematic review of hand-held ultrasound (HHU) devices in undergraduate medical education to delineate their role, significance, and limitations. Methods We searched Cochrane, PubMed, Embase, and Medline using the strategy: [(Hand-held OR Portable OR Pocket OR "Point of Care Systems") AND Ultrasound] AND (Education OR Training OR Undergraduate OR "Medical Students" OR "Medical School"). We retained 12 articles focusing on undergraduate medical education. We summarised the patterns of HHU use, pooled and estimated sensitivity, and specificity of HHU for detection of left ventricular dysfunction. Results Features reported were heterogeneous: training time (1-25 hours), number of students involved (1-an entire cohort), number of subjects scanned (27-211), and type of learning (self-directed vs. traditional lectures + hands-on sessions). Most studies reported cardiac HHU examinations, but other anatomical areas were examined, e.g. abdomen and thyroid. Pooled sensitivity 0.88 [95% confidence interval (CI) 0.83-0.92] and specificity 0.86 (95% CI 0.81-0.90) were high for the detection of left ventricular systolic dysfunction by students. Conclusion Data on HHU devices in medical education are scarce and incomplete, but following training students can achieve high diagnostic accuracy, albeit in a limited number of (mainly cardiac) pathologies. There is no consensus on protocols best-suited to the educational needs of medical students, nor data on long-term impact, decay in proficiency or on the financial implications of deploying HHU in this setting.
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Affiliation(s)
- Victor Galusko
- Swansea University Medical School, Singleton Park, Swansea, UK
| | | | - Owen Bodger
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - Clive Weston
- Swansea University Medical School, Singleton Park, Swansea, UK
| | | | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
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Cullen MW, Geske JB, Anavekar NS, Askew JW, Lewis BR, Oh JK. Handheld echocardiography during hospitalization for acute myocardial infarction. Clin Cardiol 2017; 40:993-999. [PMID: 28724192 DOI: 10.1002/clc.22754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/31/2017] [Accepted: 06/06/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Handheld echocardiography (HHE) is concordant with standard transthoracic echocardiography (TTE) in a variety of settings but has not been thoroughly compared to traditional TTE in patients with acute myocardial infarction (AMI). HYPOTHESIS Completed by experienced operators, HHE provides accurate diagnostic capabilities compared with standard TTE in AMI patients. METHODS This study prospectively enrolled patients admitted to the coronary care unit with AMI. Experienced sonographers performed HHE with a V-scan. All patients underwent clinical TTE. Each HHE was interpreted by 2 experts blinded to standard TTE. Agreement was assessed with κ statistics and concordance correlation coefficients. RESULTS Analysis included 82 patients (mean age, 66 years; 74% male). On standard TTE, mean left ventricular (LV) ejection fraction was 46%. Correlation coefficients between HHE and TTE were 0.75 (95% confidence interval: 0.66 to 0.82) for LV ejection fraction and 0.69 (95% confidence interval: 0.58 to 0.77) for wall motion score index. The κ statistics ranged from 0.47 to 0.56 for LV enlargement, 0.55 to 0.79 for mitral regurgitation, and 0.44 to 0.57 for inferior vena cava dilatation. The κ statistics were highest for the anterior (0.81) and septal (0.71) apex and lowest for the mid inferolateral (0.36) and basal inferoseptal (0.36) walls. CONCLUSIONS In patients with AMI, HHE and standard TTE demonstrate good correlation for LV function and wall motion. Agreement was less robust for structural abnormalities and specific wall segments. In experienced hands, HHE can provide a focused assessment of LV function in patients hospitalized with AMI; however, HHE should not substitute for comprehensive TTE.
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Affiliation(s)
- Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - J Wells Askew
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Costa JA, Almeida MLP, Estrada TCD, Werneck GL, Rocha AM, Rosa MLG, Ribeiro ML, Mesquita CT. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery. Arq Bras Cardiol 2016; 107:420-426. [PMID: 27982268 PMCID: PMC5137386 DOI: 10.5935/abc.20160169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 06/09/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. OBJECTIVES: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. METHODS: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. RESULTS: Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). CONCLUSION: There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. FUNDAMENTO: O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. OBJETIVO: Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos a cirurgias não-cardíacas eletivas, classificados como ASA 1 ou ASA 2 na classificação de risco cirúrgico. MÉTODOS: Foram incluídos 211 pacientes direcionados para cirurgias eletivas diversas e sem suspeita prévia de cardiopatia. Os pacientes foram avaliados por técnica ecocardiográfica convencional, usando o aparelho ultraportátil V Scan (GE) logo após a avaliação clínica pré-anestésica. Avaliamos o impacto clínico dos resultados da ecocardiografia por um questionário dirigido ao anestesista. RESULTADOS: A idade média dos pacientes foi 68,9 ± 7,0 anos, 154 do sexo feminino. As cirurgias mais frequentes foram: a) Facectomia-catarata - 18; b) Herniorrafia inguinal - 18; c) Colecistectomia - 16. No total, foram observados 58 exames normais (27,5%), 70 (33,2%) exames que apresentavam leves refluxos valvares e 83 (39,3%) exames com alguma anormalidade relevante, como aumento de câmara cardíaca, disfunção contrátil global e/ou segmentar, disfunção valvar mais significativa ou outra não especificada. Os resultados determinaram que 20 (9,5%) pacientes tivessem seus procedimentos cirúrgicos adiados até avaliação cardiológica mais detalhada e em 7 (3,3%) houve mudança na conduta anestésica. CONCLUSÃO: Houve um impacto clínico considerável com o uso da ecocardiografia ultraportátil, pois um em cada dez pacientes avaliados sofreu modificação na conduta clínica, em função da detecção de cardiopatias significativas, não suspeitadas previamente, e com potencial para complicações graves.
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Affiliation(s)
- Jean Allan Costa
- Programa de Pós-Graduação em
Ciências Cardiovasculares da Universidade Federal do Rio de Janeiro,
Niterói, RJ - Brazil
| | - Maria Lucia Pereira Almeida
- Programa de Pós-Graduação em
Ciências Cardiovasculares da Universidade Federal do Rio de Janeiro,
Niterói, RJ - Brazil
| | | | | | - Alexandre Marins Rocha
- Programa de Pós-Graduação em
Ciências Cardiovasculares da Universidade Federal do Rio de Janeiro,
Niterói, RJ - Brazil
| | - Maria Luiza Garcia Rosa
- Programa de Pós-Graduação em
Ciências Cardiovasculares da Universidade Federal do Rio de Janeiro,
Niterói, RJ - Brazil
| | - Mario Luiz Ribeiro
- Universidade Federal Fluminense - Hospital
Universitário Antônio Pedro, Niterói, RJ - Brazil
| | - Claudio Tinoco Mesquita
- Programa de Pós-Graduação em
Ciências Cardiovasculares da Universidade Federal do Rio de Janeiro,
Niterói, RJ - Brazil
- Universidade Federal Fluminense - Hospital
Universitário Antônio Pedro, Niterói, RJ - Brazil
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Shalbaf A, AlizadehSani Z, Behnam H. Echocardiography without electrocardiogram using nonlinear dimensionality reduction methods. J Med Ultrason (2001) 2015; 42:137-49. [PMID: 26576567 DOI: 10.1007/s10396-014-0588-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/08/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to evaluate the efficiency of a new automatic image processing technique, based on nonlinear dimensionality reduction (NLDR) to separate a cardiac cycle and also detect end-diastole (ED) (cardiac cycle start) and end-systole (ES) frames on an echocardiography system without using ECG. METHODS Isometric feature mapping (Isomap) and locally linear embeddings (LLE) are the most popular NLDR algorithms. First, Isomap algorithm is applied on recorded echocardiography images. By this approach, the nonlinear embedded information in sequential images is represented in a two-dimensional manifold and each image is characterized by a symbol on the constructed manifold. Cyclicity analysis of the resultant manifold, which is derived from the cyclic nature of the heart motion, is used to perform cardiac cycle length estimation. Then, LLE algorithm is applied on extracted left ventricle (LV) echocardiography images of one cardiac cycle. Finally, the relationship between consecutive symbols of the resultant manifold by the LLE algorithm, which is based on LV volume changes, is used to estimate ED (cycle start) and ES frames. The proposed algorithms are quantitatively compared to those obtained by a highly experienced echocardiographer from ECG as a reference in 20 healthy volunteers and 12 subjects with pathology. RESULTS Mean difference in cardiac cycle length, ED, and ES frame estimation between our method and ECG detection by the experienced echocardiographer is approximately 7, 17, and 17 ms (0.4, 1, and 1 frame), respectively. CONCLUSION The proposed image-based method, based on NLDR, can be used as a useful tool for estimation of cardiac cycle length, ED and ES frames in echocardiography systems, with good agreement to ECG assessment by an experienced echocardiographer in routine clinical evaluation.
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Affiliation(s)
- Ahmad Shalbaf
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Zahra AlizadehSani
- Cardiovascular Imaging, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
| | - Hamid Behnam
- Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran.
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Abstract
Focused cardiac ultrasound (FCU) is a bedside examination of the heart performed with a small, portable ultrasound platform by a physician as an adjunct to their physical examination. The goal is to recognize a narrow list of abnormalities that are both detectable by physicians with limited ultrasound training and have high clinical assessment value. Results from the FCU examination are integrated with traditional bedside assessment (physical examination and history) to provide early management plans and patient triage in settings when echocardiography cannot be obtained or is not immediately available.
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Affiliation(s)
- Kirk T Spencer
- University of Chicago, 5841 S Maryland MC 5084, Chicago, IL, 60637, USA,
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Ojeda JC, Colbert JA, Lin X, McMahon GT, Doubilet PM, Benson CB, Wu J, Katz JT, Yialamas MA. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30:199-206. [PMID: 25387438 PMCID: PMC4314490 DOI: 10.1007/s11606-014-3086-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/17/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded. OBJECTIVE We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice. DESIGN This was a randomized parallel group controlled trial. PARTICIPANTS Forty internal medicine residents in a single program at an academic medical center participated in the study. INTERVENTION Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice. MAIN MEASURES The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound. KEY RESULTS Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023). CONCLUSIONS The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice. TRIAL REGISTRATION clinicaltrials.gov: number NCT01948076; URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2.
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Affiliation(s)
- Jason C Ojeda
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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Abstract
The optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress. It has many advantages as an imaging modality, and recent technological advances have resulted in hand-held, battery-powered ultrasound devices that provide high-quality images. Three broad applications of cardiac ultrasound now exist: conventional echocardiography, focussed echocardiography and the quick-scan. A quick-scan using a hand-held ultrasound device is readily integrated into the bedside clinical assessment, providing information that can be used immediately in diagnostic reasoning; it can also guide pericardiocentesis. Hand-held ultrasound devices can also be used in acute situations, as well as geographically remote areas or special situations (eg disaster zones) where other imaging is not available. However, the diagnostic yield of echocardiography is user dependent, and training is required for its benefits to be realised, adding to the hardware costs. More data are needed on the incremental value of hand-held ultrasonography and a quick-scan over conventional methods of assessment, their impact on clinical outcomes, and cost effectiveness.
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Affiliation(s)
- Sandeep S Hothi
- Murray Edwards College, University of Cambridge, Cambridge, UK, and clinical lecturer in cardiology, Glenfield Hospital, Leicester, UK
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Mancuso FJN, Siqueira VN, Moisés VA, Gois AFT, de Paola AAV, Carvalho ACC, Campos O. Focused cardiac ultrasound using a pocket-size device in the emergency room. Arq Bras Cardiol 2014; 103:530-7. [PMID: 25590933 PMCID: PMC4290744 DOI: 10.5935/abc.20140158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. OBJECTIVE To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. METHODS One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. RESULTS The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. CONCLUSION The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.
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Affiliation(s)
- Frederico José Neves Mancuso
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
- Disciplina de Medicina de Urgência - Escola Paulista de
Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP - Brazil
| | - Vicente Nicoliello Siqueira
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
| | - Valdir Ambrósio Moisés
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
| | - Aécio Flavio Teixeira Gois
- Disciplina de Medicina de Urgência - Escola Paulista de
Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP - Brazil
| | - Angelo Amato Vincenzo de Paola
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
| | - Antonio Carlos Camargo Carvalho
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
| | - Orlando Campos
- Disciplina de Cardiologia - Escola Paulista de Medicina -
Universidade Federal de São Paulo (Unifesp); São Paulo, SP - Brazil
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Filipiak-Strzecka D, Michalski B, Kasprzak JD, Lipiec P. Pocket-size imaging devices allow for reliable bedside screening for femoral artery access site complications. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2753-2758. [PMID: 25308945 DOI: 10.1016/j.ultrasmedbio.2014.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/08/2014] [Accepted: 06/30/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.
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Affiliation(s)
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
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Handheld Ultrasound Versus Physical Examination in Patients Referred for Transthoracic Echocardiography for a Suspected Cardiac Condition. JACC Cardiovasc Imaging 2014; 7:983-90. [DOI: 10.1016/j.jcmg.2014.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 11/22/2022]
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Cullen MW, Blauwet LA, Vatury OM, Mulvagh SL, Behrenbeck TR, Scott CG, Pellikka PA. Diagnostic capability of comprehensive handheld vs transthoracic echocardiography. Mayo Clin Proc 2014; 89:790-8. [PMID: 24684783 PMCID: PMC4082693 DOI: 10.1016/j.mayocp.2013.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers. PATIENTS AND METHODS We conducted a prospective study of adult outpatients undergoing comprehensive TTE between July 9, 2012, and April 3, 2013. Experienced sonographers performed a detailed, standardized examination using a handheld ultrasound device that included 2-dimensional and color Doppler images from standard imaging windows. Images from TTE and HHE were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed. RESULTS The study group contained 190 patients (mean ± SD age, 62 ± 17 years; 49% male [n=93]). The κ values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings. CONCLUSION In experienced hands, HHE shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. Even when performed and interpreted by experienced operators, HHE should not be used as a surrogate for standard TTE. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01558518.
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Affiliation(s)
| | - Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ori M Vatury
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Garcia Fernandez MA. Is it possible to train non-cardiologists to perform echocardiography? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:168-70. [PMID: 24774389 DOI: 10.1016/j.rec.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Miguel Angel Garcia Fernandez
- Unidad de Imagen Cardiaca, Instituto Cardiovascular Clínico, Hospital San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Pocket-size echocardiograph--a valuable tool for nonexperts or just a portable device for echocardiographers? Adv Med Sci 2014; 58:67-72. [PMID: 23612676 DOI: 10.2478/v10039-012-0054-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The diagnostic value of examinations performed with the use of pocket-size echocardiograph by medical professionals with different levels of experience remains to be determined. The aim of this study was to assess the diagnostic value of bedside echocardiographic examinations performed with the use of pocket-size echocardiograph by experienced cardiologist and medical students. MATERIAL/METHODS The study group comprised 90 patients (63 men, 27 women; mean age 64±14 years) admitted to the cardiac intensive care unit and 30 patients from an out-patient clinic (21 men, 9 women; mean age 62±17 years). All patients underwent bedside echocardiographic examination performed with pocket-size echocardiograph by two briefly trained medical students (n=90 patients) or cardiologist (n=30 patients). Major findings were recorded using a simplified questionnaire. Within 24 hours standard echocardiographic examination was performed in all patients by another cardiologist using a full sized echocardiograph. The study group was divided into 4 subgroups: A / B - first / second half of in-patients examined by students, group C - inpatients examined by cardiologist, group D- out-patients examined by students. RESULTS The agreement between standard transthoracic echocardiography (sTTE) and major findings on bedside transthoracic echocardiography (bTTE) was fair to moderate (kappa 0.293-0.57) in group A, moderate to very good (kappa 0.535-1.00) in group B, good to very good (kappa 0.734-1.00) in group C and moderate to very good (kappa 0.590-1.00) in group D. CONCLUSIONS Pocket-size echocardiograph enables an expert echocardiographer to perform reliable bedside examinations. When used by briefly trained medical students it provides an acceptable diagnostic value with notable learning curve effect.
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Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:567-81. [DOI: 10.1016/j.echo.2013.04.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gianstefani S, Catibog N, Whittaker AR, Ioannidis AG, Vecchio F, Wathen PT, Douiri A, Reiken J, Monaghan MJ. Pocket-size imaging device: effectiveness for ward-based transthoracic studies. Eur Heart J Cardiovasc Imaging 2013; 14:1132-9. [PMID: 23708845 DOI: 10.1093/ehjci/jet091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Pocket-size imaging devices (PSID) are now available; their potential role in a hospital environment has been investigated but still remains undefined. METHODS AND RESULTS We evaluated the effectiveness of PSID in 92 patients referred for bedside transthoracic echocardiogram (TTE). Patients were included where there was a focused clinical question: quantification of left ventricular function (LVF); presence of regional wall motion abnormalities (RWMA); evidence of pericardial effusion, exclusion of significant valve pathology. Each patient underwent an echocardiography evaluation using PSID and TTE. In 83 patients [k = 90%, 95% CI (82.2-95.4)], it was possible to answer the clinical question by PSID examination alone. There was agreement between the findings of PSID and TTE in 86 cases [79%; k = 47%, 95% CI (12.8-82.0)], in three cases, the clinical question was not answered by both modalities. When the clinical question was focused on LVF, the agreement was excellent [k = 96%, 95% CI (95.3-97.9)], as was the agreement in the detection of RWMA [k = 94.57%, 95% CI (82.4-95.1)]. There was also good concordance in the detection of valve pathology and pericardial effusion. Using PSID, the reduction in the scanning and reporting time was 66%. The cost-effectiveness analysis produced very favourable results: with PSE, we obtained an overall cost saving per scan of 76%, compared with TTE. CONCLUSION This study demonstrates that PSID can provide a valuable alternative to TTE in the presence of focused clinical questions and can provide an efficient way of delivering a ward-based transthoracic echo service.
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Pelliccia F, Palmiero P, Maiello M, Losi MA. Italian Chapter of the International Society of Cardiovascular Ultrasound Expert Consensus Document on Training Requirements for Noncardiologists Using Hand-Carried Ultrasound Devices. Echocardiography 2012; 29:745-50. [DOI: 10.1111/j.1540-8175.2012.01720.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R82. [PMID: 22583539 PMCID: PMC3580625 DOI: 10.1186/cc11340] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/14/2012] [Indexed: 11/14/2022]
Abstract
Introduction In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department. Methods During 4 months, patients admitted to our emergency department and requiring transthoracic echocardiography (TTE) were included in this single-center, prospective and observational study. Patients underwent TTE using a PUD and a conventional echocardiography system. Each examination was performed independently by a physician experienced in echocardiography, unaware of the results found by the alternative device. During the focused cardiac echocardiography, the following parameters were assessed: global cardiac systolic function, identification of ventricular enlargement or hypertrophy, assessment for pericardial effusion and estimation of the size and the respiratory changes of the inferior vena cava (IVC) diameter. Results One hundred fifty-one (151) patients were analyzed. With the tested PUD, the image quality was sufficient to perform focused cardiac ultrasonography in all patients. Examination using PUD adequately qualified with a very good agreement global left ventricular systolic dysfunction (κ = 0.87; 95%CI: 0.76-0.97), severe right ventricular dilation (κ = 0.87; 95%CI: 0.71-1.00), inferior vena cava dilation (κ = 0.90; 95%CI: 0.80-1.00), respiratory-induced variations in inferior vena cava size in spontaneous breathing (κ = 0.84; 95%CI: 0.71-0.98), pericardial effusion (κ = 0.75; 95%CI: 0.55-0.95) and compressive pericardial effusion (κ = 1.00; 95%CI: 1.00-1.00). Conclusions In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
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Frederiksen CA, Juhl-Olsen P, Sloth E. Advances in imaging: ultrasound in every physician's pocket. ACTA ACUST UNITED AC 2012; 6:167-70. [PMID: 23480682 DOI: 10.1517/17530059.2012.669368] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advances in medical ultrasound have made the modality widely applicable and the new cart-based and pocket size devices have allowed for relevant point-of-care (POC) ultrasound examinations in many medical specialties. POC ultrasonography is performed as a real-time examination assisting the physician in diagnosis, procedure or screening of the patient without life threatening delays. The examination can be performed at the bedside or wherever the patient may be present. Structured and focused protocols for simple clinical questions have been developed and implemented in the following specialties: Anesthesiology, Cardiology, Critical Care Medicine, Dermatology, Emergency Medicine, Neonatology, Gynecology and Rheumatology and many others. POC ultrasound, as well as ultrasound in general, is very user dependent and the need for quality assurance, formal education and practical training is obvious. With this in mind, POC ultrasound now really has the potential for becoming the physician's new personal universal examination tool. Patients admitted to emergency departments will be able to receive organ or symptom-guided initial focused ultrasound triage as part of the physician's first encounter with the patient. This will allow for more accurate referral, correct diagnosis and relevant screening in turn leading to better overall treatment results.
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Affiliation(s)
- Christian Alcaraz Frederiksen
- Aarhus University Hospital, Department of Anesthesiology and Intensive Care , Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N , Denmark +45 7845 1028 ;
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Abstract
Heart failure is a major source of cardiovascular morbidity, including acute decompensations requiring hospitalization. Because most therapeutic interventions in acute heart failure target optimization of cardiac output and volume status, accurate assessment of these parameters at the point of care is critical to guide management. However, physician bedside assessments of left ventricular (LV) function and volume status have limited accuracy. Traditional echocardiographic platforms, while useful for assessing ventricular and valvular function and volume status, have limitations for bedside use or frequent serial evaluation. Handcarried cardiac ultrasound devices, with their substantially lower costs, portability, and ease of use, circumvent many of the limitations of traditional echocardiographic platforms. The diagnostic capabilities of handcarried devices provide the opportunity for ultrasound assessment of LV function and serial bedside evaluation of volume status in patients with acutely decompensated heart failure.
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Sicari R, Galderisi M, Voigt JU, Habib G, Zamorano JL, Lancellotti P, Badano LP. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:85-7. [PMID: 21216764 DOI: 10.1093/ejechocard/jeq184] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram.
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Affiliation(s)
- Rosa Sicari
- CNR, Institute of Clinical Physiology, Italy.
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Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2010; 24:111-6. [PMID: 21126857 DOI: 10.1016/j.echo.2010.10.017] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the imaging capabilities of recent hand-held ultrasound scanners. METHODS Three hundred forty-nine patients were scanned with hand-held ultrasound (HAND) and high-end echocardiography (HIGH). Segmental endocardial border delineation was scored (2 = good, 1 = poor, 0 = invisible) to describe image quality. Assessments of left ventricular (LV) dimensions, regional and global LV function, and grades of valve disease were compared. RESULTS The mean endocardial visibility grades were 1.6 ± 0.5 with HAND and 1.7 ± 0.4 with HIGH (P < .01). Regional wall motion was scored very similarly (κ = 0.73, P < .01). Ejection fraction assessment (bias = 1.8%, 1.96 × SD = 8.3%) and LV measurements (r = 0.99, P < .01; interventricular septum: bias = 0.91 mm, 1.96 × SD = 2.1 mm; LV end-diastolic diameter: bias = 0.5 mm, 1.96 × SD = 4.1 mm; LV posterior wall: bias = 0.61 mm, 1.96 × SD = 2.4 mm) showed negligible deviations. No pericardial effusion or valve stenosis was missed. Regurgitations missed by HAND were all graded "minimal" on HIGH. Regurgitations were mildly overestimated by HAND. Overall concordance for detection of regurgitations was very good (κ = 0.9, P < .01). CONCLUSIONS Handheld echocardiography was feasible and missed no relevant findings. Given the future implementation of spectral Doppler capabilities, this handheld scanner can safely be used in clinical routine.
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Giusca S, Jurcut R, Ticulescu R, Dumitru D, Vladaia A, Savu O, Voican A, Popescu BA, Ginghina C. Accuracy of Handheld Echocardiography for Bedside Diagnostic Evaluation in a Tertiary Cardiology Center: Comparison with Standard Echocardiography. Echocardiography 2010; 28:136-41. [DOI: 10.1111/j.1540-8175.2010.01310.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Aase SA, Snare SR, Dalen H, Støylen A, Orderud F, Torp H. Echocardiography without electrocardiogram. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:3-10. [PMID: 20817693 DOI: 10.1093/ejechocard/jeq112] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS automatic detection of the QRS complex on electrocardiogram (ECG) is used on cardiac ultrasound scanners to separate ultrasound image series into cardiac cycles for playback and storage. On small hand-held scanners it is unpractical to connect ECG cables. We therefore aim to do automatic cardiac cycle separation using apical B-mode ultrasound images. METHODS AND RESULTS cardiac cycle length is estimated by cyclicity analysis of B-mode intensities. To determine a cycle start estimate near QRS, a deformable model is fitted to the left ventricle in real-time. The model is used to initialize and constrain a speckle tracker positioned near the mitral annulus. In the displacement curve generated by the speckle tracker, a time point near maximum distance from the probe is detected as a cardiac cycle start estimate. Validation against ECG was done on 233 recordings from normal subjects and 46 recordings from subjects with coronary pathology. Several test cases were run for each recording to emulate B-mode series starting at all time points in the cardiac cycle. Totally, 11 886 test cases were run. Cycle length estimation was feasible in 98% of normal subject cases and 91% of pathology cases. Median difference in cycle length by ECG was 0 and -3 ms, respectively. Cycle start estimation was feasible in 90% of normal subject cases and 77% of pathology cases. Median difference to cycle start by ECG was 62 and 76 ms, respectively. CONCLUSION apical B-mode series can automatically be separated into cardiac cycles without using ECG.
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Affiliation(s)
- Svein Arne Aase
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Postboks 8905, Medisinsk teknisk forskningssenter, NO-7491 Trondheim, Norway
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Medan MS, Abd El-Aty A. Advances in ultrasonography and its applications in domestic ruminants and other farm animals reproduction. J Adv Res 2010. [DOI: 10.1016/j.jare.2010.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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