The proliferation of portable, hand-carried—and now even pocket-sized microportable—ultrasound devices has opened the door to a new mindset for physicians. Instead of moving a patient to the radiology department or rolling imaging equipment to the bedside, a physician can grab a laptop-size scanning system or reach into his lab coat, turn on a smartphone-sized ultrasound scanner and begin scanning anywhere care is administered. Portable ultrasound systems are becoming a part, too, of the overall physical exam—a visual “stethoscope” of sorts to immediately peer into a patient to screen or search for underlying issues.
Opening new doors
Ultrasound scanning outside of the hospital setting isn’t new, but it is becoming more common, namely in emergency, military and disaster settings, says Robert J. Tillotson, DO, chairman and medical director of the emergency department at St. Michael’s Hospital in Stevens Point, Wis.
Tillotson recently returned from a trip to Peru where he took along a portable ultrasound system that he used to scan about 55 patients in four days at a temporary clinic. Describing the makeshift clinic set up on a cement slab, he says that he examined women for breech pregnancies, gall stones and fetal viability.
The Zonare z.one convertible ultrasound system, which he uses everyday at St. Michael’s and brought with him to Peru, lends itself to the scanning of patients with many disease states and in most clinical departments outside of the emergency department, including cardiac, gynecology and ocular. Teaching infrequent users how to scan also comes easily, too, due to the system’s auto-optimize button that produces a clear image without a lot of operator knowledge or training, notes Tillotson.
While the ultrasound system looks like a standard-sized scanner, the actual scanning machine is the size of a small laptop. “When I have to run to a code in the unit or go over to urgent care where I don’t want a big machine in the way, I can bring in [the system] in one hand and scan with the other,” he says.
Portable ultrasound devices have come a long way, Tillotson notes. The first hand-held scanners had poor image quality and small screens, he explains. Once laptop-sized equipment was developed, the hand-held capabilities were lost, but better image quality was gained.
The market has again opened up to handheld equipment, according to Tillotson, along with continually improved image quality. Portable ultrasound is allowing swifter, more-knowledgeable triage decision-making such as whether an accident victim should be rushed into surgery or have a CT scan first. This can potentially cut down the time it takes for patients to receive an imaging exam by hours and thus facilitate faster and hopefully better care, he says. The scanners allow for the evaluation of emergency medical conditions and diagnosis, resuscitation of acutely ill, critically ill or injured patients, guidance of high-risk or difficult procedures, monitoring of certain pathologic states and as an adjunct to therapy—all right at the bedside.
Despite the improvements made recently within ultrasound, Tillotson says that “emergency ultrasound is complimentary to the physical examination, but should be considered a separate entity that adds anatomic, functional and physiologic information to the care of the emergency patient.”
Like Tillotson, Bruce Kimura, MD, of the department of cardiology at Scripps Mercy Hospital in San Diego, notes that there has been a decrease in size and an increase in portability in hand-carried ultrasound devices, particularly in the last two years. “They have gone from luggable laptop-size devices down to pocket-sized devices,” he says.
Kimura, who utilizes Siemens’ P10 portable ultrasound system, says that its ultraportability allows him to use it routinely during each patient encounter. He scans all patients for an initial evaluation. “That includes new patient consultations in both inpatient and outpatient settings, as well as established patients who develop new symptomology,” he says. He notes that the system is very useful in the screening of abdominal aortic aneurysms, plural diffusions, central venous pressure and renal asymmetry.