Vscan family of handheld ultrasound systems:
Redefining portable ultrasound

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.
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Handheld Ultrasound Education.

How Handheld Cardiac Ultrasound Aids in Diagnosis

Handheld cardiac ultrasound does not aim to replace routine comprehensive echocardiography, but its use may decrease the frequency of comprehensive scans. As a result, it might not only make clinicians' lives easier, but it may also lead to better patient experiences and outcomes.

Making a Cardiology Diagnosis
There are many applications for handheld ultrasound in making a cardiology diagnosis. For example, it may be used specifically to assess cardiac chamber size and function and valvular regurgitation. An article in Clinical Cardiology reported that "the pocket-sized [portable transthoracic echo (pTTE)] provides accurate detection of cardiac structural and functional abnormalities beyond the [electrocardiogram (ECG)]. In addition, the use of pTTE as an initial screening tool prior to [standard TTE] is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice."

Non-cardiologists may use handheld ultrasound as a tool for aortic stenosis and mitral regurgitation. This means that the ultrasound may be an adjunct to clinical examination in patients where a murmur is heard. Wiener Klinische Wochenschrift reports, "Pocket-size ultrasound imaging devices without continuous and pulse wave Doppler modalities can, even in the hands of a non-cardiologist with limited cardiac ultrasound instructions with high sensitivity and specificity, be a useful tool for detecting more than mild aortic stenosis and more than mild mitral regurgitation."

Handheld ultrasound may also be used to assess the volume status of the patient, via the inferior vena cava (IVC) diameter, as an indicator of progression of heart failure. As discussed in the American Journal of Cardiology, this use of ultrasound "is associated with an increased risk of heart failure admission and may provide clinically useful information at the point of care to guide heart failure management."

Augmenting Workflow
Handheld ultrasound may be used by primary care physicians to detect cardiovascular disease, and this may decrease the number of unnecessary formal echocardiograms. One study, published in Heart, used remote expert support to help interpret the handheld ultrasound images and found it to be "rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies."

Having repeat formal transthoracic echocardiograms (TTEs) to detect problems such as impaired ventricular function, pericardial effusion and IVC collapse is common. Using handheld, focused ultrasound scans of the heart may reduce the need for so many follow-up TTEs in a short space of time. A paper in the Journal of the American Society of Echocardiography concluded that "[t]he judicious use of expert focused cardiac ultrasound in place of repeat inpatient TTE has the potential to deliver quality cardiac imaging at reduced cost."

In some patients who are acutely unwell, moving them into a good position in their bed for a formal echocardiogram could be challenging. Handheld ultrasound may have an advantage as it can be used on patients in a semi-recumbent position. An article in Acta Anaesthesiologica Scandinavia concluded that "[t]he apparatus is well-suited for performing a [focus-assessed transthoracic echocardiography] examination in a one-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness."

Streamlining Care
What's more, handheld ultrasound may be used by cardiologists on their ward rounds. Being able to do a bedside ultrasound may reduce the number of formal echo studies that need to be done. As described in the American Journal of Medicine, "For hospitalized patients, [t]his finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies."

In emergency departments, handheld ultrasound may reduce the time to diagnosis in patients presenting with shortness of breath. Herz reported, "One-third of patients had significant findings on the scans to possibly aid diagnosis and prevent misdiagnosis. This has the potential to reduce time to diagnosis in the [emergency department]."

Handheld ultrasound may be used by a broad range of healthcare professionals in different specialties to help streamline patient care, improve diagnosis and direct therapy — and it might be a beneficial adjunct to formal echocardiography.
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Handheld Ultrasound Education.

A New Hero in Reducing Healthcare Costs: Handheld Ultrasound

Value-based care might be a big focus in the industry, but reducing healthcare costs is still a major priority for leaders who are dealing with tight margins and fee-for-service contracts as well. Solutions such as handheld ultrasound have demonstrated cost-saving benefits for both patients and providers.

A Win for Both Hospitals and Patients
Hospitals are under increasing pressure to provide a balance of improved outcomes and cost efficiency for their care populations. These pressures have led effective administrators and leadership teams to seek out cost-effective solutions that don't compromise on quality or the patient experience.

Handheld ultrasound is a pocket-sized device that empowers clinicians, including cardiologists, general practitioners, OB/GYNs, primary care providers, emergency physicians and intensivists to conduct focused imaging at the point of care. Patients are provided with an optimized diagnostic journey at a lower cost — a benefit that's attractive as they take on a larger portion of the financial burden of care.

Reducing Healthcare Costs With Handheld Ultrasound
Handheld devices reduce costs, and it's more than simply being less expensive than traditional ultrasound models.
Handheld ultrasound devices are so small that providers are able to keep them on hand at all times. This means that providers are ready to conduct a variety of short, focused exams when appropriate, including the following:
  • Abdominal
  • Cardiology
  • Lung
  • Obstetric
  • Urology
  • Vascular
     
This enables simpler workflows and enables patients to start on the path to treatment faster because they don't need to wait for more comprehensive imaging modalities.

Lowering the Cost of Abdominal Paracentesis Procedures
According to the Journal of Medical Economics, "The use of ultrasound guidance in abdominal paracentesis procedures is associated with fewer [adverse events]." It has also been found to be associated with "lower hospitalization costs than other procedures where ultrasound is not used."

Savings in Thoracentesis Procedures
Another study, published in the Journal of Clinical Ultrasound, noted that "[ultrasound-guided] thoracentesis is associated with lower total hospital stay costs." It is also associated with a "lower incidence of pneumothorax and hemorrhage."

Cost-Effective Transthoracic Echocardiographic Imaging
A study published in Clinical Cardiology demonstrated that "pocket-sized [portable transthoracic echocardiography] provides accurate detection of cardiac structural and functional abnormalities beyond the ECG." What's more, the study says "the use of [portable transthoracic echocardiography] as an initial screening tool prior to [standard transthoracic echocardiography] is cost-effective, suggesting that the pocket-sized [portable transthoracic echocardiography] is poised to alter the current diagnostic strategy in clinical practice."

Moving Forward
Using a cost-effective ultrasound solution contributes to more efficient clinical processes and a better imaging experience for the patient. Options like handheld ultrasound should be a standard in implementing cost-focused best practices for forward-thinking healthcare organizations that prioritize increasing asset performance and reducing healthcare costs.
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Handheld Ultrasound Practice Areas.

How a Handheld Ultrasound Exam Could Help in Three Scenarios

The handheld ultrasound exam offers incredible potential for today's primary care physicians (PCPs) — it can, and should, be used as a key diagnostic tool. According to a study in The World Book of Family Medicine, "Ultrasonography should be a diagnosis tool beside the stethoscope in the general practitioner office ... the two instruments should be considered as complementary."

Further, a study in PLoS One identified that "after a simple and short training course, a pocket-sized ultrasound device examination can be used in addition to a physical examination to improve the answer to ... common clinical questions concerning in- and outpatients and can reduce the need for further testing."

Specifically, a focused ultrasound exam may be used to complement the PCP's physical examination in three common diagnostic areas: right upper quadrant pain; flank pain; and deep vein thrombosis (DVT).

Right Upper Quadrant Pain
Right upper quadrant pain is a common presentation in primary care. The handheld ultrasound exam of the right upper quadrant of the abdomen can look for signs of gross abnormalities of the liver and gallbladder.

Point of care ultrasound may be used to identify the presence of gallstones and to assess for acute cholecystitis by detecting Murphy sign, anterior gallbladder wall thickening and pericholecystic fluid. The handheld ultrasound may also be used to assess potential bile obstruction by measuring the common bile duct diameter. This may help the physician pursue non-gallbladder sources of epigastric discomfort.

Flank Pain
When it comes to flank pain, a handheld ultrasound device may be used to assess the kidneys and, specifically, to look for hydronephrosis, identify renal or ureteral stones and to check the post-void residual bladder volume. This may provide a physician with more context in relation to the physical exam.

A study in Urology noted that a urologist "using handheld-pocket-size device is equivalent to a sonographist-performed ultrasound study using a standard device in most parameters examined. The handheld device can be used in evaluating the upper and lower urinary tract with the exception of renal masses and therefore can be of great assistance in a wide variety of the daily urological practice scenarios."

Deep Vein Thrombosis
There is a potential benefit in using handheld ultrasound devices when dealing with DVT. According to the Journal of the American College of Cardiology: Cardiovascular Imaging, "The accurate and immediate decision-making allowed by the pocket-size ultrasound examination (PUE) has the potential to exert a significant impact on the current diagnostic strategies for DVT. Positive PUE can make other diagnostic or therapeutic procedures available earlier for the patient without standard ultrasound examination."

Handheld ultrasound devices can potentially allow physicians to scan anyone suspected of having DVT without them having to wait for blood test results. A paper in Thrombus stated that "reducing the time to diagnose DVT could potentially avoid the use of self-injected low molecular weight heparin by patients."

Training for Success
As with any technology, getting the proper training is a key component for reaching positive results. An article in the Annals of Internal Medicine encourages "residency training programs to teach PoCUS, practicing hospitalists to incorporate it into daily practice, and hospitals and hospital medicine programs to provide easy access to the necessary technology."

A study in BMC Medical Education concluded that "medical students with minimal training were able to use (a pocket-size imaging device) as a supplement to standard physical examination and successfully acquire acceptable relevant organ images for presentation and correctly interpret these with great accuracy." And, according to the Annals of Internal Medicine study, the "use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process."

By adding handheld ultrasound to the routine examination, PCPs may have the potential to reduce waiting times and ultimately deliver better care to those who need it.
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