Vscan family of handheld ultrasound systems:
Redefining portable ultrasound

Improving Patient Care.

Diagnosing Pleural Effusion: Can Handheld Ultrasound Fill X-ray Gaps?

Pleural effusion is a common problem in many patient groups — in particular, for those in intensive care units and those with underlying cardiovascular issues. Fortunately, handheld ultrasound may aid in diagnosing this condition.

How Does Handheld Ultrasound Play a Role in Diagnosis?
The typical method for diagnosing pleural effusion is by examining the patient with a stethoscope during a physical exam and then requesting a chest X-ray. Listening with a stethoscope provides some clues, and in order for X-ray changes to show, there has to be a significant volume of fluid. This can lead to a chest X-ray underestimating the amount of fluid present. Handheld ultrasound examination, on the other hand, may identify even just a few milliliters of fluid. Using a handheld ultrasound device is a quick way to identify the presence of pleural fluid and, therefore, can help in diagnosing pleural effusion.

As an article in Acta Radiologica identified, "Due to its ease of use and its high diagnostic yield, [hand-carried ultrasound] systems of the latest generation constitute a helpful technique for the primary assessment of [pleural effusion]."

This may be useful not only for acute pleural effusions, but also in the assessment of patients with heart failure. Pleural effusions can present as a part of worsening heart failure, and detecting them may help assess the patient's progress. One study reported in the journal Heart concluded that "[u]ltrasound examinations of the pleural cavities and [inferior vena cava] by nurses may improve diagnostics and patient care in [heart failure] patients at an outpatient clinic," although additional research is needed.

How Long Would It Take to Detect Pleural Effusion?
Learning to use a handheld ultrasound device to detect a pleural effusion is straightforward. The European Journal of Cardiovascular Nursing reported a study that concluded, "After brief training, heart failure nurses can reliably identify pulmonary congestion and pleural effusion with a [pocket-sized ultrasound device]."

Another article in the European Journal of Cardiovascular Nursing concluded the following: "Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by [a pocket-size imaging device] and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy."

What Are the Benefits of Fast Detection?
Detecting pleural effusion via handheld ultrasound is a quick process. One study in the European Journal of Echocardiography identified that "[p]ocket- sized echocardiographic examinations of [approximately four minutes], performed at the bedside by experts, offer reliable assessment of cardiac structures, the pleural space and the large abdominal vessels."

Ultimately, identifying a pleural effusion more quickly through handheld ultrasound examination (rather than waiting for a chest X-ray) may enable the delivery of faster patient care. Once quickly diagnosed, prompt management can be implemented — for example, by inserting a chest drain. This also potentially avoids the need for ionizing radiation through a chest X-ray.

Being able to perform quick and reliable bedside tests may lead to improved outcomes for patients. The Scandinavian Cardiovascular Journal reported the following: “Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.”

With all this in mind, it seems that using handheld ultrasound in diagnosing pleural effusions is a fast and accurate option.
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Handheld Ultrasound Education.

Embrace Handheld Ultrasound Training to Expand Patient Engagement

Handheld ultrasound may present the opportunity to help physicians further engage their patients, which is why some are evaluating adding it to their practices. After all, having another diagnostic tool is appealing to providers looking to improve patient care. However, bringing in this new technology requires training to get the most out of it. 

Many technologies have been presented as solutions, but few offer the accessibility, results and efficiency of hand-held ultrasound. For example, a study in Clinical Cardiology demonstrated "that the pocket-sized [portable transthoracic echocardiography (pTTE)] provides accurate detection of cardiac structural and functional abnormalities beyond the [electrocardiogram]." It also found that "the use of pTTE as an initial screening tool prior to [standard TTE] is cost-effective." And yet, the benefits don't stop there.

An Exceptional Patient Experience
The majority of patients most likely appreciate fewer tests, more convenience and reduced complications in their billing and financial experiences. Reducing unnecessary tests is important, and point of care ultrasound may be a practical step toward achieving that goal. According to Heart, "[Hand-held cardiac ultrasound] performed at the point of care by [family doctors] with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies."

Increased Physician Engagement
Put simply, becoming a more confident user of handheld ultrasound gives physicians another way to engage their patients. According to the Journal of Ultrasound in Medicine, "By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care, we corrected, verified or added important diagnoses in more than 1 of 3 emergency medical admissions. Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability."

Empowerment Through Ultrasound Training
Giving physicians access to the benefits of these new approaches to ultrasound and the physical examination requires training that is adaptable and that empowers physicians to optimize their results and maintain their skills over time.

On-Demand Training
The benefits of portable ultrasound training shouldn't be limited just to residents. Physicians who are advanced in their careers need flexible training methods to maintain and refresh their ultrasound skills over time.
Comprehensive, on-demand options facilitate continuous education and are accessible to physicians ranging from novice users who are just learning the technology to experienced practitioners who want to keep their skills sharp. These options include the following:
  • Focused courses.
  • Online videos and tutorials.
  • Point-of-care technology courses.
  • Point-of-care preceptorship courses.
  • Third-party training options.
  • Coaches.
  • Webcasts and webinars.
Learning Online
Online training now offers flexibility and continuous education that wasn't possible in the past. GE's POCUS FocusClass by 123 Sonography may help doctors gain confidence in performing basic ultrasound studies and interpretation. Physicians have access to modular options that can be tailored to training budgets, schedules and learning styles. These include common applications involving the following:
  • Heart.
  • Lung.
  • Obstetrics.
  • Kidney.
  • Vascular (abdominal aorta and deep vein thrombosis).
  • Biliary tract.
This type of training is designed specifically for primary care physicians and their busy schedules so that proficiency can be developed with maximum efficiency.

Today's ultrasound training options offer a wide range of benefits, including providing opportunities for physician champion projects, patient interaction initiatives and overall engagement goals. Clinical leaders invested in keeping their teams up to date in a fast-changing clinical technology landscape should keep ultrasound training on their shortlist of priorities.
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Improving Patient Care.

Handheld Ultrasound for Gallstones Improves Physician Effectiveness

Patients visiting their physician with right upper quadrant (RUQ) pain may have vague symptoms that are difficult to diagnose. A condition that physicians commonly check for is gallstones, but it is difficult to reliably diagnose with a physical exam and review of medical history alone.

Bedside ultrasound is an option for providers who are interested in expanding their ability to diagnose patients who are clinically suspected of having acute calculous cholecystitis.

Why Handheld Ultrasound for Gallstones
According to a piece in the Atlas of Handheld Ultrasound, "Bedside [ultrasound (US)] of the biliary system has been shown to decrease the costs as well as emergency department length of stay in patients with cholelithiasis. Bedside US can detect gallstones, a thickened gallbladder wall, pericholecystic fluid, and a sonographic Murphy sign to assist in diagnosis of acute cholecystitis. Also, point-of- care US for gallbladder disease is a skill that can be learned by physicians at all levels of training."

Pocket-sized mobile ultrasound devices (PUDs) have also been found to be a helpful addition to the physical exam. According to a study published in PLOS One, " After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.”

How Handheld Ultrasound Stacks Up
Handheld ultrasound offers clinicians portability and easy point-of-care imaging that ultimately transforms the traditional physical exam and expands its capabilities into areas that were previously only available through slow and expensive testing. According to the Journal of Ultrasound in Medicine, "Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability."

Additionally, a study in the Internal and Emergency Medicine journal noted, “PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short-focused training.”

As diagnostic demands on physicians increase, handheld ultrasound options could be a primary consideration for physician leaders who want to best serve their patients, improve outcomes and increase the effectiveness of individual practitioners.
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Handheld Ultrasound Trends.

Prehospital Ultrasound in Emergency Medicine: Think Outside the 4 Walls

In cardiac care, mere minutes matter. That's why some medical specialists today may be turning to prehospital ultrasound to accelerate treatment, ensuring patients receive life-saving therapies faster.

In the hands of paramedics and other emergency services providers, handheld ultrasound devices, such as GE's Vscan Extend™, may obtain cardiac images sufficient enough for interpretation even before patients arrive in the emergency department. With proper training, prehospital clinicians can not only use ultrasound to identify a problem, but also to help triage patients.

Benefits of Prehospital Use
Point-of-care ultrasound (PoCUS) has already been shown to potentially help diagnose a plethora of life-threatening conditions, such as hemoperitoneum, pericardial effusion, cardiac tamponade, pneumothorax and abdominal aortic aneurysm. Prehospital ultrasound can also identify situations where resuscitative efforts could be beneficial and should be continued. Putting those diagnostic capabilities to use en route to a hospital may save more lives.

For example, according to investigators in a World Journal of Emergency Medicine study, PoCUS education for paramedics can be helpful to patients: "Our pilot study suggests that with minimal training, paramedics can use [ultrasound] to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill."

An American Journal of Emergency Medicine editorial also discussed the importance of using prehospital ultrasound in situations with critical patients.

"Streamlined [focused assessment with sonography for trauma] may increase triage accuracy of blunt torso trauma patients in mass casualty incidents with limited medical resources," the authors noted. "We recommend the use of [streamlined focused assessment with sonography for trauma] to decrease patient triage to treatment time in any unfortunate future disasters."

In many instances, prehospital clinicians are the first to interact with critically ill patients. Consequently, having PoCUS available to provide real-time internal images may provide significant benefits to both cardiac life support and advance trauma support. Not only may it assist with any prehospital decision-making, but it may also help inform how physicians proceed once patients arrive in the emergency department.

Real-World Implementation
Prehospital ultrasound offers a real-world option in helping to provide immediate care to patients in acute situations. Using GE Vscan Extend™, a helicopter paramedic unit in New Zealand screened airlifted patients for potential cardiac problems prior to landing at Dunedin Hospital, which is located in an area where road travel can be precarious.

In these and other frenetic conditions, PoCUS is helpful because paramedics may clearly see heart function. With ultrasound, New Zealand's paramedics assessed cardiac activity and checked for internal bleeding, thoracic injuries and pulmonary embolisms. They also used handheld ultrasound to side-step unnecessary procedures. For example, PoCUS use determined a suspected pneumothorax in one patient did not exist, so paramedics opted not to decompress the chest.

Prehospital ultrasound may also be used to triage patients who should be taken immediately to the operating room. Doing so saves valuable time otherwise spent running further diagnostic tests in the emergency department.

PoCUS Training
Handheld ultrasound can be a valuable tool for nearly any healthcare provider who receives proper training. Paramedics and other prehospital clinicians may achieve the same level of skill as physician sonographers if they undergo comparable instruction.

This level of accuracy may alter and positively impact the care a patient receives upon arriving at the hospital by giving physicians insight into a patient's condition.

While research into the use of prehospital ultrasound is in the early phases, study results and real-world implementation have already shown it may play a vital role in time-sensitive, critical conditions. All in all, proper use may decrease both mortality and morbidity, improving overall patient outcomes.
 

The device has been verified for limited use outside of professional healthcare facilities including during transport. Use is restricted to environmental properties described in the user manual , please contact your GE Healthcare sales representative for detailed information

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