Handheld ultrasound in training - The future is getting smaller!

Abstract

Traditional ultrasound teaching is normally delivered using large, costly and often quite advanced cart-based systems. These carts are often large systems on wheels, usually limited to the departments that own them i.e. clinics, wards or radiology. Portability has been further improved by the development of laptop style systems, which are easier to wheel in-between patients/departments. In our experience and anecdotally, many of these systems can be intimidating to the novice and can lead to early attrition or poor uptake of ultrasound into clinical practice. Carts can also restrict the amount of training deliverable to practitioners, as they are limited in number due to cost and can take quite some time to boot up, reducing convenience. This dogma is being progressively changed with the advent of smaller handheld devices, some clearly within the financial grasps of most practitioners, and even to the point of medical schools offering students their own personal device.^1,2 This relative inexpensiveness can lead to the purchase of these devices for novelty and convenience, over need. Obvious caution is needed in these circumstances, but with increased ease of purchase, better availability and inbuilt simplicity, ultrasound learning can be seamlessly integrated into day-to-day practice. This review discusses how one of the most disruptive innovations in modern medicine is changing ultrasound from a classic imaging modality to become integrated as the fifth pillar of clinical examination, and how these new devices can serve as springboards to more advanced ultrasound training. In fact, within what has become a bigger area of clinical examination, things are getting smaller.

Keywords: Ultrasound; handheld ultrasound; pocket ultrasound; point of care; point of care ultrasound; training.

Figure 1.

Some of the features of a few of the market-leading devices. (Taken from www.criticalcarenorthampton.com).

Figure 3.

Advantages and disadvantages of many portable ultrasound devices.

Figure 2.

Various images obtained from two popular portable handheld devices. (a) Apical four-chamber view with auto ejection fraction calculation. (b) Apical four-chamber view with saline auto-contrast demonstration in right heart during adrenaline minijet administration for cardiac arrest. (c) Left lung base scan demonstrating relevant anatomy. (d) Scan of the upper chest wall demonstrating a lung point where normal pleural sliding meets the interface with the non-sliding part of the pneumothorax. (e) Colour flow Doppler across jugular vein and carotid artery. (f) Normal parasternal long axis view of the heart. (g) Right lung base/right upper quadrant view showing cirrhotic liver, ascites and parapneumonic fluid. (h) Subcostal diaphragm scan used later to perform M-mode for excursion fraction calculation in a weaning patient.

Figure 2.

Various images obtained from two popular portable handheld devices. (a) Apical four-chamber view with auto ejection fraction calculation. (b) Apical four-chamber view with saline auto-contrast demonstration in right heart during adrenaline minijet administration for cardiac arrest. (c) Left lung base scan demonstrating relevant anatomy. (d) Scan of the upper chest wall demonstrating a lung point where normal pleural sliding meets the interface with the non-sliding part of the pneumothorax. (e) Colour flow Doppler across jugular vein and carotid artery. (f) Normal parasternal long axis view of the heart. (g) Right lung base/right upper quadrant view showing cirrhotic liver, ascites and parapneumonic fluid. (h) Subcostal diaphragm scan used later to perform M-mode for excursion fraction calculation in a weaning patient.

Figure 4.

A web of science search for publications on ‘handheld ultrasound’, ‘hand carried ultrasound’ and ‘pocked sized ultrasound’.