Ultrasound News: Ultrasound On the Go
By Arun Nagdev, MD
Radiology Today
Vol. 22 No. 7 P. 32

Handheld ultrasound—portable ultrasound devices that fit into the pockets of emergency physicians and primary care providers—is transforming how, when, and where medical imaging can be integrated into the global health care system. This technology allows clinicians to employ imaging at the bedside to define patient pathology efficiently and accurately. It also breaks down two of the biggest barriers to wider ultrasound adoption across medical care: cost and availability.

Benefits in Hand
The emergence of handheld ultrasound has dramatically reduced the cost of ultrasound, allowing more clinicians access to this powerful diagnostic tool. Hospitals and clinics outside major metropolitan areas, where imaging is often difficult for patients to obtain, will especially benefit from this advancement. Radiologists and emergency physicians can leverage the new capabilities of handheld ultrasound, such as the telehealth capabilities enabled by this new technology, to improve patient care.

Handheld ultrasound can also consolidate the need for multiple ultrasound probes into one seamless unit, making handheld ultrasound portable and practical in almost all medical settings. Integrated software solutions can connect radiology and emergency physicians as well, allowing for the rapid sharing of information through a robust user interface designed for the provider.

Much as digital advancements in radiology allowed off-site work decades ago, handheld ultrasound and advancements in software will open up new collaborations between radiology and clinicians in remote medical settings. Now, both medical imaging and the expertise to interpret and diagnose studies can be brought to populations that never had access to ultrasound. For example, a physician in a rural clinic could potentially image a patient at the bedside and then send that image to radiology experts in an urban medical center for diagnosis, unlocking a quality of care for rural patients that was unavailable before.

The COVID-19 pandemic showcased other useful applications of handheld ultrasound. With concerns over contamination associated with moving patients back and forth from radiology, handheld ultrasound became an imaging solution because of portability as well as ease of decontamination. The tool became ideal for determining the presence of pulmonary COVID as well as determining other causes of respiratory difficulty—eg, decompensated congestive heart failure and pulmonary embolism—and negating the need for traditional chest X-rays.

Broader Use
While it is now clear that handheld ultrasound is a powerful diagnostic tool that can help clinicians improve care while working seamlessly with current radiology imaging, what does this mean for patients, providers, and radiologists? For patients, handheld ultrasound enables early imaging to be performed conveniently in various environments, allowing ultrasound to reach rural and more austere environments.

For physicians, it means a powerful tool that brings health care into the 21st century. Technological advances allow the clinician rapid diagnostic answers at the bedside while improving procedural success. Early diagnostic certainty with handheld ultrasound can help reduce clinical errors and prevent delays in diagnosis.

For radiologists, handheld ultrasound expands diagnostic imaging from the confines of radiology to all providers, establishing a partnership with clinicians to offer optimal care. This is similar to the revolution that brought digital imaging to radiology 20 years ago. Much as that technological advancement improved radiological processes, this will also be a pivot in the field of radiology; more people will have access to imaging and radiologists will help define ultrasound’s new role in transforming patient care.

As we move into this new era of ultrasound, radiologists have some valid questions. As the director of emergency ultrasound at Highlands Hospital in Oakland, California, I have seen this new era of ultrasound in action for years now, and I can shed more light on how handheld ultrasound and radiology interact.

Handheld ultrasound and comprehensive/radiology ultrasound can work together.
Comprehensive/radiology ultrasound and handheld ultrasound may seem different, but they are almost intertwined. They can coexist and complement each other in a way that improves patient care. While handheld ultrasound can image a patient in an environment where radiology is not available, both in rural settings and during overnight hours, it can also leverage radiology in a way that directs further imaging. This allows physicians to expedite care while harnessing experienced radiologists to offer confirmatory imaging, diagnostic expertise, and more targeted imaging as patient care continues.

Handheld ultrasound expands imaging to places radiology departments can’t reach.
Radiologists understand the power of imaging. In today’s disparate health care settings, there are large pockets of the country and the world that don’t have access to affordable imaging. Handheld ultrasound can be a solution for this large swath of patients. Inexpensive handheld systems will be the primary driver of imaging in many parts of the world where there currently is no imaging.

Handheld ultrasound brings powerful workflow innovation with it.
A transformation in workflow is occurring alongside handheld ultrasound adoption. By putting the clinician at the center of the process, technology now empowers, rather than impedes, clinicians as they collaborate, share information, and leverage the power of technology. These new workflow solutions are built on top of existing tablet and smartphone technology architecture, replacing previously inefficient systems with workflow that gives clinicians the power to diagnose, record, and transmit data seamlessly.

One example of this process in action is a program in Peru that utilizes handheld ultrasound to improve care in Lima. Because of advancements in telehealth and workflow built into handheld ultrasound, I have been able to provide numerous on-demand telehealth consultations in real time for clinicians. The built-in telesonography features of the handheld ultrasound system have allowed me to confirm life-threatening diagnoses as well as guide less experienced clinicians through ultrasound-guided procedures. This closing of the imaging gap, elimination of geographic barriers, and seamless implementation of technology represent the true promise of handheld ultrasound. It is the way that radiologists, physicians, and hospital administrators can all forge a future that makes imaging more accessible and affordable to patients and physicians across the globe.

— Arun Nagdev, MD, is the senior director of clinical education at Exo and the director of emergency ultrasound at Highlands Hospital in Oakland, California. He started the POCUS program and fellowship at Brown University and has since been at the forefront of handheld ultrasound’s rapid expansion.

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