Prospective Comparison of Nine Different Handheld Ultrasound (HHUS) Devices by Ultrasound Experts with Regard to B-Scan Quality, Device Handling and Software in Abdominal Sonography

Abstract

Background: The HHUS market is very complex due to a multitude of equipment variants and several different device manufacturers. Only a few studies have compared different HHUS devices under clinical conditions. We conducted a comprehensive prospective observer study with a direct comparison of nine different HHUS devices in terms of B-scan quality, device handling, and software features under abdominal imaging conditions.

Methods: Nine different HHUS devices (Butterfly iQ+, Clarius C3HD3, D5CL Microvue, Philips Lumify, SonoEye Chison, SonoSite iViz, Mindray TE Air, GE Vscan Air, and Youkey Q7) were used in a prospective setting by a total of 12 experienced examiners on the same subjects in each case and then assessed using a detailed questionnaire regarding B-scan quality, handling, and usability of the software. The evaluation was carried out using a point scale (5 points: very good; 1 point: insufficient).

Results: In the overall evaluation, Vscan Air and SonoEye Chison achieved the best ratings. They achieved nominal ratings between "good" (4 points) and "very good" (5 points). Both devices differed significantly (p < 0.01) from the other seven devices tested. Among the HHUS devices, Clarius C3HD3 and Vscan Air achieved the best results for B-mode quality, D5CL Microvue achieved the best results for device handling, and SonoEye Chison and Vscan Air achieved the best results for software.

Conclusions: This is the first comprehensive study to directly compare different HHUS devices in a head-to-head manner. While the majority of the tested devices demonstrated satisfactory performance, notable discrepancies were observed between them. In particular, the B-scan quality exhibited considerable variation, which may have implications for the clinical application of HHUS. The findings of this study can assist in the selection of an appropriate HHUS device for specific applications, considering the clinical objectives and acknowledging the inherent limitations.

Keywords: B-mode quality; POCUS; comparison; handheld ultrasound; handling; pocket device; software.

Figure 1

Overview of the devices included in this study: (a): Butterfly iQ+; (b): Clarius C3HD3; (c): D5CL Microvue; (d): Philips Lumify; (e): SonoEye; (f): SonoSite iViz; (g): TE Air; (h): Vscan Air; (i): Youkey Q7.

Figure 2

Exemplary sonographic images of a liver–kidney section of the same subject with the different devices: (a): Butterfly iQ+; (b): Clarius C3HD3; (c): D5CL Microvue; (d): Philips Lumify; (e): SonoEye; (f): SonoSite iViz; (g): TE Air; (h): Vscan Air; (i): Youkey Q7. Due to the transducer ergonomics and device settings, the images are not exactly identical.

Figure 3

Results of the evaluation of the HHUS devices in relation to the items surveyed in the main categories of B-mode image quality (a), device handling (b), software (c), and overall grade (d). The order in which the individual HHUS devices are displayed was determined by the grade achieved. The black dot indicates the mean value. X^(* = p < 0.05; ** = p < 0.01). A complete list of the p-values can be found in Supplementary Table S3.

Figure 4

Specification of a personal favorite after completion of all tests; the devices most frequently in 1st place (a) and 2nd place (b) are listed. The totals may not add up exactly to 100% due to rounding.

Figure 5

Inter-category comparison per device with regard to B-mode quality, device handling, and software, cumulative for nine different devices. Graded from 1 (unsatisfactory) to 5 (very good).

Figure 6

Results of the evaluation of the HHUS devices in relation to the items surveyed in the main categories of B-mode image quality, device handling, and software. (a): Butterfly iQ+; (b): Clarius C3HD3; (c): D5CL Microvue; (d): Philips Lumify; (e): SonoEye; (f): SonoSite iViz; (g): TE Air; (h): Vscan Air; (i): Youkey Q7 (* p < 0.05; ** p < 0.01; **** p < 0.0001).