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Imaging leaders from throughout the United States join ICE Magazine to share insights in the new monthly Director’s Circle article. This roundtable formatted article provides a panel discussion of sorts where experts can share their wisdom. ICE Magazine Editor John Wallace kicks off the series of monthly feature articles with a look at the subject of this month’s Product Focus – POCUS and Mobile Imaging.
Participants in the inaugural Director’s Circle are Cabell Huntington Hospital Inc. Director of Radiology Nancy Godby, St. Luke’s Health Brazosport Director of Imaging Services Kelsey Mach, Vanderbilt University Medical Center Professor of Radiology Reed Omary and JPS Health Network Clinical Operations Administration Director of Radiology and Patient Transportation Cindy Winter.
Q: How has the technology of point-of-care ultrasound (POCUS) increased over the past 5 years?
Godby: I recall when it was first introduced in the ER setting years ago at another facility and it created a controversy at that time. Today, it is not only an accepted practice but has become standard of care not only in our ER but across our system in a variety of settings.
Mach: In the past few years, there has been an explosion in the use of POCUS. Vendors have released numerous small pocket-sized, or slightly larger cart or wall-mounted, basic ultrasound systems to allow a quick look inside the patient for more accurate and faster assessments, or to determine if a higher level of care is needed.
Omary: Nationally, it continues to increase, especially with some of the newer entrants into the medical device space.
Winter: Over the past five years, POCUS technology has seen significant advancements. These advancements are primarily driven by the integration of Artificial Intelligence and the development of compact, handheld devices. These developments have expanded the use of POCUS from general ultrasound departments and ED FAST scans to a vast number of specialties and settings, such as anesthesiology, vascular access technology, respiratory therapy, sports medicine, orthopedics and so much more. AI has enhanced image acquisition and interpretation, making POCUS more user-friendly and accurate, even for less-experienced operators. Handheld devices have become more powerful and versatile, by offering increased depth penetration, higher resolution images, duplex Doppler, auto-focus and needle tracking. These high-quality imaging capabilities are very comparable to what was offered on traditional, bulkier ultrasound machines. In addition, POCUS units have easy to install software updates to enhance new AI capabilities as they are introduced and become available to the user.
Q: Is POCUS used more often today than it was 3 years ago? Why?
Godby: Absolutely, it is used more often and as stated above in a variety of settings. POCUS allows providers to expedite the care needed to treat patients, especially in an emergency setting.
Mach: POCUS is used more often today because of the advancements. Ultrasound manufacturers see the rise in demand and are now making units that are more affordable and much more diagnostic than in years prior. The units can aid in diagnosing issues faster and while bedside. It also frees up the radiologist and technicians to focus on the larger issues and not become overwhelmed.
Omary: Yes. Easier access to portable equipment, along with IT solutions, are major drivers. Plus, educating non-radiologists.
Winter: Yes, POCUS usage has increased considerably within the past three years. This rise in usage can be attributed to its convenience, affordability, portability, and the immediate diagnostic insights it provides, especially in the emergency and critical care settings. Furthermore, the COVID-19 pandemic also accelerated the adoption of POCUS, as it allowed for rapid, bedside assessments while reducing the need for patient transport, exposure and disinfection of larger pieces of equipment. This is demonstrated in the expanded usage of POCUS in specialty areas outside of radiology and the ED. Additionally, the growing proficiency of health care professionals in ultrasound technology with the use of Artificial Intelligence, targeted imaging and simplified operations.
Q: What should hospitals and imaging centers look for when purchasing POCUS devices?
Godby: Hospitals and imaging centers should look for devices that provide the same clarity obtained in a dedicated ultrasound setting and ensure all providers are fully trained to operate not only the POCUS but also the required method for High Level Disinfection (HLD).
Mach: When purchasing a POCUS device, hospitals should consider the following factors: intended usage, portability, what features the unit has, and price. The hospital should also consult the radiologist, emergency room physicians and hospitalist on what is appropriate for use and when to call for a real ultrasound conducted by a technician and read by a radiologist.
Omary: Ensuring quality should be priority #1. That means equipment and training of physicians. Also, cybersecurity, regulatory compliance, patient confidentiality and integration with PACS systems.
Winter: When purchasing POCUS devices, hospitals and imaging centers should consider factors such as image quality, ease of use, portability, battery life, warranty and connectivity options. The ability of a device to offer AI for enhanced image analysis and decision support is crucial. Durability and the ability to disinfect the device easily are important for infection control, in particular high-level disinfection. Compatibility with existing workflow software for seamless integration into RIS, HIS and PACS. Those looking to purchase POCUS devices should look to systems that are able to be upgraded and offer technical support. Additional considerations should be the reputation of the product, cost of upgrades and educational support.
Q: What other types of mobile imaging do you recommend for health care facilities? Why?
Godby: We also have mini C-Arms in our orthopedic settings utilized by providers, both in the orthopedic clinics and in surgical settings.
Mach: I would suggest every smaller hospital to have a mobile PET scanner. Usually the mobile imaging provider supplies everything necessary to perform clinical studies including the equipment, patient consumables and clinical staff. They operate as an extension of the hospital, which allows the facility to remove the overhead, space requirement and staffing costs.
Omary: We are seeing an increase in all types of mobile imaging. Instead of moving patients to scanners, we are seeing scanners moved to patients. For patients in complex medical care settings, it can be easier to move scanners than to move patients. For mobile equipment that uses ionizing radiation, it’s vitally important to have training in safety.
Winter: Besides POCUS, health care facilities should consider mobile X-ray as a standard, and more recently, portable CT scanners. Mobile X-rays are invaluable for bedside imaging, especially for patients who cannot be easily transported. Portable CT scanners are beneficial for rapid neuroimaging in stroke care and for critical care units, reducing the time to diagnosis and treatment. Both modalities enhance patient comfort, reduce transport risks and provide timely diagnostic information.
Q: Is there anything else ICE Magazine readers should be aware of regarding POCUS and mobile imaging?
Godby: Yes, it is also important to have a mechanism to capture imaging for some certification programs. This is especially true for Trauma Center of Excellence.
Mach: One thing that every reader who is considering using a POCUS should be aware of is image quality. These devices are only used to quickly figure out if there is a problem. If there is a problem, then the radiology department should be called and asked to complete a complete diagnostic test of the area. I would also be aware of maintenance and support. This includes factors such as availability of technical support, availability of replacement parts, and the cost of repairs and training for staff. Each area that a POCUS is placed in must have written protocols and procedures. Each and every individual that is using the POCUS must also be trained initially and each year.
Omary: Patient safety and quality are paramount. Never forget that we are here to serve patients.
Winter: Readers should be aware of the ongoing evolution in POCUS and mobile imaging technologies, particularly the expanding role of AI. Artificial Intelligence’s role in automating measurements, improving diagnostic accuracy and providing training support is crucial to medical professionals at all levels of competency. POCUS are continuing to be seen in many new and varied venues from prior years, such as primary care provider offices, medical students, veterinarians, ambulances, nursing homes, orthopedic clinics, sports medicine, OB/GYN, and minute clinics just to name a few.•
