Ultrasound Journal最新文献

Background: Point-of-care ultrasound (POCUS) is a valuable skill for generalist physicians, nurse practitioners (NPs), and nurses; however, its utilization remains limited. This study was performed to investigate the current status, barriers, and facilitators of POCUS implementation among physicians, NPs, and nurses in family and hospital medicine in Japan and to identify differences in influencing factors between physicians and NPs/nurses.

Results: A web-based survey was distributed via the mailing lists of four major academic societies in general medicine in Japan-the Japanese Society of Hospital General Medicine, the Japan Primary Care Association, the Japanese Association for Home Care Medicine, and the Japan Society of Nurse Practitioner-from April to June 2024. The respondents included physicians, NPs, and nurses affiliated with these societies. Responses from other professions, duplicate entries, and incomplete surveys were excluded from the analysis, resulting in 913 valid responses (692 physicians and 221 NPs/nurses). Physicians reported a higher POCUS implementation rate than NPs/nurses (73.0 vs. 63.4%, p = 0.006). The top two barriers were consistent across both groups: lack of training opportunities (p = 0.385) and lack of image acquisition skills (p = 0.369). However, NPs/nurses reported significantly greater barriers than did physicians, including lack of mentors (p < 0.001), lack of interpretation skills (p = 0.007), lack of confidence (p < 0.001), poor access to ultrasound devices (p < 0.001), and absence of institutional guidelines (p < 0.001). The top facilitators for both groups were good access to ultrasound devices (p = 0.078) and increased training opportunities (p = 0.240), with no significant differences between them. Compared with physicians, NPs/nurses expressed a significantly higher demand for nearby mentors (p < 0.001), institutional support (p < 0.001), and POCUS certification (p = 0.005).

Conclusions: There is currently a lack of POCUS training opportunities across all professional roles. To promote POCUS adoption among NPs and nurses, it is essential to develop mentorship programs, establish institutional guidelines, and create an environment that enables NPs and nurses to perform POCUS confidently through measures such as certification programs.

Background: Pulmonary embolism (PE) is one of the most challenging diagnoses in emergency medicine, mainly because symptoms range from asymptomatic disease to sudden death. The role of echocardiography in the workup of suspected PE has been supportive and used primarily to assess the right ventricular (RV) size and function, which is important for risk stratification. Several echocardiographic parameters described in the literature lack the desired accuracy. Recently, a potential value of less well-recognized RV outflow tract (RVOT) Doppler variables has been reported. The early systolic notching (ESN) pattern was observed in 92% of patients with high and intermediate risk PE, making it a promising sign in selected PE patients.

Case presentation: In this case series, we demonstrate a typical ESN pattern on RVOT Doppler evaluation in three patients with intermediate-risk PE presenting to our emergency department (ED). None of the patients had been previously diagnosed with pulmonary hypertension or other chronic pulmonary and cardiac disease. The pre-test probability was low. Massive proximal emboli were found on CT angiograms, involving pulmonary truncus or main pulmonary arteries. Previously, the ESN pattern was identified on a focused echocardiogram, which was the only echocardiographic indicator of increased pulmonary vascular resistance.

Conclusions: RVOT Doppler flow pattern of ESN has potential clinical utility for the detection of PE in ED patients. ESN could identify patients at higher risk, which are otherwise stratified as low risk according to the latest guidelines. Moreover, this case series illustrates that even in the absence of other echocardiographic findings of RV strain, the presence of ESN should alert to the possibility of acute PE. Further prospective studies are needed to assess its diagnostic value in a selected subgroup of patients, similar to the cases presented, that would have no other obvious reason for the altered RVOT Doppler curve.

Background: Venous congestion is associated with adverse cardiovascular outcomes, necessitating accurate venous pressure assessment. Current methods, such as right heart catheterization (RHC), have limitations. Non-invasive techniques, including venous excess ultrasound (VExUS), inferior vena cava (IVC) assessment, and ultrasound-measured jugular venous pressure (uJVP), show promise but require validation in diverse populations.

Aims: We aimed to assess the correlation between right atrial pressure (RAP) via RHC and non-invasive methods, including VExUS, IVC diameter with collapsibility index (CI) by American Society of Echocardiography (ASE) classification, and uJVP.

Methods: In a prospective study involving 73 patients undergoing RHC, we evaluated the correlation between RAP and VExUS, IVC CI by ASE classification, and uJVP. We introduced and compared a modified VExUS grading system.

Results: VExUS significantly correlated with RAP (p < 0.001), especially between VExUS grade 0 and grade 3. RAP significantly differed across IVC classifications by ASE (P < 0.001). VExUS grade 0 correlated with IVC class 1, and VExUS grade 3 correlated with IVC class 3. The modified VExUS grading system improved low and high RAP differentiation. uJVP exhibited a robust, highly significant positive correlation with invasively measured RAP (ρ = 0.67, P < 0.001).

Conclusion: This study establishes a strong correlation between non-invasive ultrasound measurements (VExUS, IVC diameter with CI, and uJVP) and invasively measured RAP. These findings underscore the clinical potential of these non-invasive techniques in venous congestion assessment and patient risk stratification.

There has been a significant interest in venous congestion in recent years, among which the VExUS score has been prominent, both in clinical practice and research efforts. We have noted some recurrent misconceptions among clinicians which are also reflected in certain research efforts. Notably, the misguided attempt to correlate VExUS to volume status, which is only one of the factors influencing it, as well as attempts to re-interpret VExUS in the context of certain pathologies, which reflects a fundamental misunderstanding of its circulatory perspective. In this article we review the physiological basis of the VExUS assessment as a measure and marker of venous congestion from the organs' standpoint and its role as part of the emerging concept of fluid tolerance, in hopes to address these misconceptions for clinicians and for important further studies.

Venous congestion, often associated with elevated right atrial pressure presents a clinical challenge due to its varied manifestations and potential organ damage. Recognizing the manifestations of venous congestion through bedside physical examination or laboratory tests can be challenging. Point-of-care ultrasound (POCUS) is emerging as a valuable bedside tool for assessing venous congestion, with the Venous Excess Ultrasound (VExUS) technique gaining prominence. VExUS facilitates non-invasive quantification of venous congestion, relying on measurements of the inferior vena cava (IVC) size and Doppler assessments of the hepatic vein (HV), portal vein (PV), and intrarenal vein, thereby providing real-time insights into hemodynamic status and guiding therapeutic interventions. The grading system outlined in VExUS aids in stratifying the severity of congestion. However, achieving proficiency in VExUS requires a comprehensive understanding of Doppler techniques and their clinical applications. This review article provides practical guidance on performing VExUS, encompassing equipment requirements, preparation, machine settings, and examination techniques for assessing the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and intrarenal vein. Potential pitfalls and troubleshooting strategies are discussed to ensure accurate interpretation of Doppler waveforms.

Background: Traditionally, ultrasound skills have been taught through a one-on-one approach, where instructors physically guide learners' hands at the bedside or in the workshop. However, this method is frequently challenged by scheduling and cost limitations. Our objective was to create a tele-education model for point-of-care ultrasound training and evaluate its effectiveness and its impact on learners' perceived workload compared to conventional education and self-directed learning methods.

Methods: We conducted a 3-arm randomized trial, comparing tele-education (TE), conventional education (CE) and self-directed learning (SL) methods. All subjects underwent online didactic lectures prior to a hands-on ultrasound workshop. The TE group utilized an ultrasound machine equipped with a speakerphone, a webcam for direct visualization of learner's hand maneuvers, and an analog-to-video converter for the real-time streaming of ultrasound images. This configuration enabled remote instructors to provide immediate verbal feedback to learners. In contrast, the CE group received in-person coaching, while the SL group had no instructors present. Following the coaching session, subjects completed a scenario-based skill test and a survey on the National Aeronautics and Space Administration task load index (NASA-TLX) to measure their ultrasound competency and perceived workload, respectively.

Results: Twenty-seven ultrasound novices were randomly allocated into 3 groups. The median skill test score of TE, CE, and SL was 22 [interquartile range (IQR): 18-28], 24 [IQR: 21-31], and 16 [IQR: 15-18], respectively (p < 0.01). Pairwise comparisons of median test scores of 3 groups demonstrated a statistical significance in comparisons of TE vs. SL (22 vs. 16, p = 0.01) and CE vs. SL (24 vs. 16, p < 0.01), but not in TE vs. CE (22 vs. 24, p = 0.56). There was no statistical significance observed in the median NASA-TLX scores among the 3 groups; 54 [IQR:47-61] in TE, 57 [IQR:22-64] in CE, and 66 [IQR: 66-72] in SL (p = 0.05).

Conclusions: Our tele-education model was more effective than self-directed learning. There was no statistically significant difference in effectiveness between the tele-education and the conventional education groups. Importantly, tele-education did not impose a significantly higher workload on learners compared to conventional education or self-directed learning. Tele-education has a substantial potential as an alternative to conventional ultrasound training.

We investigated the relationship between the degree of alveolarization and ultrasound-assessed lung aeration in a validated preterm rabbit model of experimental bronchopulmonary dysplasia (BPD). Lung ultrasound findings were heterogeneously abnormal and consisted of zones with interstitial, interstitial-alveolar or consolidated patterns. The median radial alveolar count was 10.1 [8.4-11.5], 7.8 [6.1-9] and 7.3 [1.8-10.1] in rabbits with interstitial, interstitial-alveolar or consolidated ultrasound pattern, respectively (overall p = 0.036). Alveolar count and lung ultrasound score were significantly correlated (ρ = - 0.044 (95%CI: - 1; - 0.143), p = 0.009; τ_-b = - 0.362 (95%CI: - 0.6; - 0.1), p = 0.017).

Background: Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices ("handhelds") have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ + ^™ by Butterfly Network Inc.; Clarius^™ by Clarius Mobile Health; Kosmos^™ by EchoNous; TE Air^™ by Mindray; Vscan Air^™ SL and CL by General Electric; and Lumify^™ by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed.

Results: Thirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air^™ for the right upper quadrant view, Mindray TE Air^™ for the cardiac apical 4-chamber view, and Lumify^™ for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air^™, Lumify^™, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air^™. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features.

Conclusions: The overall satisfaction with image quality was rated highest with Vscan Air^™, Lumify^™, and Mindray TE Air^™when acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air^™ was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts.

The digitization of medicine will play an increasingly significant role in future years. In particular, telemedicine, Virtual Reality (VR) and innovative Artificial Intelligence (AI) systems offer tremendous potential in imaging diagnostics and are expected to shape ultrasound diagnostics and teaching significantly. However, it is crucial to consider the advantages and disadvantages of employing these new technologies and how best to teach and manage their use. This paper provides an overview of telemedicine, VR and AI in student ultrasound education, presenting current perspectives and controversies.

Background: Accurate assessment of relative intravascular volume is one of the cornerstones for the proper management of hospitalized patients requiring hemodialysis. Currently, the use of dynamic parameters such as bedside ultrasonography is recommended to support the assessment of the intravascular volume profile. This study aimed to prospectively evaluate findings of sonographic assessment of intravascular volume estimate (SAFE-A) protocol among hemodialysis inpatients with end-stage renal disease, before and after the hemodialysis sessions, and correlate these findings with the net ultrafiltrate (UFNET).

Results: A positive correlation was found between the negative variation of 1 point in the score of the SAFE-A protocol with the withdrawal of 426.73 mL of net ultrafiltrate.

Conclusions: There was a strong correlation between the score of the SAFE-A protocol and the net ultrafiltrate. Therefore, this study concludes that the application of the SAFE-A protocol in dialysis patients demonstrates a correlation between the suggested score and volume status, consistent with findings from the original study conducted in a distinct population.