Point-of-Care Ultrasound: New Concepts and Future Trends

doi:10.37015/AUDT.2021.210023

Abstract

Abstract:

Ultrasound (US) technology, with major advances and new developments, has become an essential and first-line imaging modality for clinical diagnosis and interventional treatment. US imaging has evolved from one-dimensional, two-dimensional to three-dimensional display, and from static to real-time imaging, as well as from structural to functional imaging. Based on its portability and advanced digital imaging technique, US was first adopted by emergency medicine in the 1980s and gradually gained popularity among other specialists for clinical diagnosis and interventional treatment. Point-of-Care Ultrasound (POCUS) was then proposed as a new concept and developed for new uses, which greatly extended clinical US applications. Nowadays, artificial intelligence (AI), cloud computing, 5G network, robotics, and remote technologies are starting to be integrated into US equipment. US systems have gradually evolved to an intelligent terminal platform with powerful imaging and communication tools. In addition, specialized US machines tend to be more suitable and important to meet increasing demands and requirements by various clinical specialties and departments. In this article, we review current US technology and POCUS as new concepts and its future trends, as well as related technological developments and clinical applications.

Key words: Ultrasound; Point-of-care ultrasound; Specialty ultrasound; Artificial intelligence; 5G network; Application

Yaoting Wang, MD, Huihui Chai, MD, Ruizhong Ye, MD, Jingzhi Li, MD, PhD, Ji-Bin Liu, MD, Chen Lin, Chengzhong Peng, MD. Point-of-Care Ultrasound: New Concepts and Future Trends. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(3): 268-276.

References

[1]	Dong BW. The third revolution of modern ultrasound imaging: real-time contrast-enhanced ultrasound technology (outline). Hainan: Proceedings on New Advances in Ultrasound Medicine of the Chinese Medical Association Conference, 2004: 29-32.
[2]	Li L. Emergency ultrasound-based on today, looking forward to the future. Chinese Journal of Emergency Medicine 2020; 29:8-11.
[3]	Liu Y, Lv F, Li T. The 5G ultrasound era is coming: the current status and progress of remote ultrasound applications. Chinese Journal of Medical Ultrasound (Electronic Edition) 2019; 16:241-243.
[4]	Wang DC, Jang HJ, Kim TK. Characterization of indeterminate liver lesions on CT and MRI with contrast-enhanced ultrasound: What is the evidence? AM J Roentgenol 2020; 214:1295-1304.
[5]	Edler I, Lindström K. The history of echocardiography. Ultrasound Med Biol 2004; 30:1565-1644.
[6]	Bonagura JD, Blissitt KJ. Echocardiography. Equine Vet J Suppl 1995; 19:5-17.
[7]	Kim ES, Sharma AM, Scissons R, Dawson D, Eberhardt RT, Gerhard-Herman M, et al. Interpretation of peripheral arterial and venous Doppler waveforms: a consensus statement from the society for vascular medicine and society for vascular ultrasound. VASC Med 2020; 25:484-506.
[8]	Stevenson JG. The development of color Doppler echocardiography: innovation and collaboration. J Am Soc Echocardiogr 2018; 31:1344-1352.
[9]	Baum G, Greenwood I. Orbital lesion localization by three-dimensional ultrasonography. N Y State J Med 1961; 61:4149-4157.
[10]	Adriaanse BM, van Vugt JM, Haak MC. Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview. J Perinatol 2016; 36:685-693.
[11]	Goo HW, Park SJ, Yoo SJ. Advanced medical use of three-dimensional imaging in congenital heart disease: augmented reality, mixed reality, virtual reality, and three-dimensional printing. Korean J Radiol 2020; 21:133-145.
[12]	Erlichman DB, Weiss A, Koenigsberg M, Stein MW. Contrast enhanced ultrasound: a review of radiology applications. Clin Imaging 2020; 60:209-215.
[13]	Bank AJ, Kelly AS. Tissue Doppler imaging and left ventricular dyssynchrony in heart failure. J Card Fail 2006; 12:154-162.
[14]	Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics 2017; 7:1303-1329.
[15]	Chong WK, Papadopoulou V, Dayton PA. Imaging with ultrasound contrast agents: current status and future. Abdom Radiol (NY) 2018; 43:762-772.
[16]	Wang Y, Yang Y, Wang K, Tang S. The value of contrast-enhanced ultrasound-guided contrast injection via the endoscopic nasobiliary drainage duct in diagnosing residual common bile duct stones. Biomed Res Int 2020: 3281241.
[17]	Chua Me, Kim JK, Mendoza JS, Fernandez N, Ming JM, Marson A, et al. Evaluation of vesicoureteral reflux among children using contrasted-enhanced ultrasound: a literature review.[J]Pediatr Urol 2019; 15:12-17.
[18]	He X, Sun J, Huang X, Zeng C, Ge Y, Zhang J. Comparison of oral contrast-enhanced transabdominal ultrasound imaging with contrast-enhanced computed tomography in preoperative tumor staging of advanced gastric carcinoma. J Ultrasound Med 2017; 36:2485-2493.
[19]	Moro F, Gui B, Arciuolo D, Bertoldo V, Borzi R, Romeo P, et al. Fusion imaging of ultrasound and MRI in the assessment of locally advanced cervical cancer: a prospective study. Int J Gynecol Cancer 2020; 30:456-465.
[20]	Xu E, Li K, Long Y, Luo L, Zeng Q, Tan L, et al. Intra-procedural CT/MR-ultrasound fusion imaging helps to improve outcomes of thermal ablation for hepatocellular carcinoma: results in 502 nodules. Ultraschall Med 2021; 42:e9-e19.
[21]	Gleeson T, Blehar D. Point-of-care ultrasound in trauma. Semin Ultrasound CT MR 2018; 39:374-383.
[22]	Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja Oh, Dong Y, et al. Point of care ultrasound: A WFUMB position paper. Ultrasound Med Biol 2017; 43:49-58.
[23]	Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364:749-757.
[24]	Soni NJ, Lucas BP. Diagnostic Point-of-care ultrasound for hospitalists. J Hosp Med 2015; 10:120-124.
[25]	Liao SF, Chen PJ, Chaou Ch, Lee Ch. Top-cited publications on point-of-care ultrasound: the evolution of research trends. Am J Emerg Med 2018; 36:1429-1438.
[26]	Hussain A, Via G, Melniker L, Goffi A, Tavazzi G, Neri L, et al. Multi-organ point-of-care ultrasound for COVID-19 (POCUS4COVID): International Expert Consensus. Crit Care 2020; 24:702.
[27]	Lv F, Wang J, Yu X, Yang A, Liu JB, Qian L, et al. Chinese expert consensus on critical care ultrasound applications at COVID-19 pandemic. Advanced Ultrasound in Diagnosis and Therapy 2020; 4:27-42.
[28]	Gillman LM, Kirkpatrick AW. Portable bedside ultrasound: The visual stethoscope of the 21st century. Scand J Trauma Resusc Emerg Med 2012; 20:18.
[29]	Varsou O. The use of ultrasound in educational settings: What should we consider when implementing this technique for visualisation of anatomical structures? Adv Exp Med Biol 2019; 1156:1-11.
[30]	Zhou J, Huang J, Wu H, Jiang H, Zhang H, Prasoon P, et al. Screening of ultrasonography of 2,204 patients with blunt abdominal trauma in the Wenchuan earthquake. J Trauma Acute Care Surg 2012; 73:890-894.
[31]	Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Han-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended assessment with sonography for trauma (EFast). J Trauma 2004; 57:288-295.
[32]	Wang XT, Liu DW, Zhang HM, He HW, Liu Y, Chai WZ, et al. The value of bedside lung ultrasound in emergency-plus protocol for the assessment of lung consolidation and atelectasis in critical patients. Chinese Journal of Internal Medicine 2012; 51:948-951.
[33]	Wang XT, Liu DW, Jiang K, Guan XD, Ma XC, Yan J, et al. The consensus of Chinese Critical Ultrasound Experts. Clinical Focus 2017; 32:369-383.
[34]	Liu DW, Wang XT, Zhang HM, Jiang K, Long Y, Tang YQ, et al. Treatment of severe hemodynamics-Beijing consensus. Chinese Journal of Internal Medicine 2015; 54:248-271.
[35]	Li L, Yong RJ, Kaye AD, Urman Rd. Perioperative point of care ultrasound (Pocus) for anesthesiologists: an overview. Curr Pain Headache Rep 2020; 24:20.
[36]	Pulton D, Feinman J. Hocus POCUS: Making barriers to perioperative point-of-care ultrasound disappear. J Cardiothorac Vasc Anesth 2019; 33:2419-2420.
[37]	Schoch M, Bennett PN, Currey J, Hutchinson AM. Point-of-care ultrasound use for vascular access assessment and cannulation in nutritional status: a scoping review. Semin Dial 2020; 33:355-368.
[38]	Arnold MJ, Jonas CE, Carter RE. Point-of-care ultrasonography. Am Fam Physician 2020; 101:275-285.
[39]	Situ-LaCasse E, Grieger RW, Crabbe S, Waterbrook AL, Friedman L, Adhikari S. Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology. World J Emerg Med 2018; 9:262-266.
[40]	Grytten J, Skau I, Sørensen R, Eskird A. Does the use of diagnostic technology reduce fetal mortality? Health Serv Res 2018; 53:4437-4459.
[41]	Barreiros AP, Dong Y, Ignee A, Wastl D, Dietrich CF. EchoScopy in scanning abdominal diseases; a prospective single center study. Med Ultrason 2019; 21: 8 to 15.
[42]	Lavi A, Tzemah S, Hussein A, Bishara I, Shcherbakov N, Zelichenko G, et al. A urologic stethoscope? Urologist performed sonography using a pocket-size ultrasound device in the point-of-care setting. Int Urol Nephrol 2017; 49:1513-1518.
[43]	Volpicelli G, Mayo P, Rovida S. Focus on ultrasound in intensive care. Intensive Care Med 2020; 46:1258-1260.
[44]	Neskovic AN, Skinner H, Price S, Via G, De Hert S, Stankovic I, et al. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018; 19:475-481.
[45]	Montoya J, Stawicki SP, Evans DC, Bahner DP, Sparks S, Sharpe RP, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg 2016; 42:119-126.
[46]	Douflé G, Roscoe A, Billia F, Fan E. Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Crit Care 2015; 19:326.
[47]	Ntoumenopoulos G, Buscher H, Scott S. Lung ultrasound score as an indicator of dynamic Lung compliance during veno-venous extra-corporeal membrane oxygenation. Int J Artif Organs 2021; 44:194-198.
[48]	Manson WC, Kirksey M, Boublik J, Wu CL, Haskins SC. Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist. Reg Anesth Pain Med 2019; 44:540-548.
[49]	Urman RD, Kaye AD. Recent advances in regional anesthesia and ultrasound techniques. Best Pract Res Clin Anaesthesiol 2019; 33:373-375.
[50]	Ye R, Zhou X, Shao F, Xiong L, Hong J, Huang H, et al. The feasibility of a 5G-based robot assisted remote ultrasound system for cardiopulmonary assessment of patients with coronavirus disease 2019. Chest 2021; 159:270-281.
[51]	Lin X, Hu J, Ren L, Huang Y, Wu D, Zhao S, et al. Application of remote ultrasound in COVID-19 isolated intensive care unit. Advanced Ultrasound in Diagnosis and Therapy 2020, 4:123-127.
[52]	Nyeem H, Boles W, Boyd C. A review of medical image watermarking requirements for teradiology. J Digit Imaging 2013; 26:326-343.
[53]	Choudhri AF, Chatterjee AR, Javan R, Radvany MG, Shih G. Security issues for mobile medical imaging: A primer. Radiographics 2015; 35:1814-1824.
[54]	Cantisani V, Grani G, Tovoli F, Piscaglia F, Catalano C. Artificial intelligence: What is it and how can it expand the ultrasound potential in the future? Ultraschall Med 2020; 41:356-360.
[55]	Muse ED, Topol EJ. Guiding ultrasound image capture with artificial intelligence. Lancet 2020; 396:749.
[56]	Chan HP, Samala RK, Hadjiiski LM, Zhou C. Deep learning in medical image analysis. Adv Exp Med Biol 2020; 1213:3-21.
[57]	Gao J, Jiang Q, Zhou B, Chen D. Convolutional neural networks for computer-aided detection or diagnosis of medical image analysis: an overview. Math Biosci Eng 2019; 16:6536-6561.
[58]	Buda M, Wildman-Tobriner B, Hoang JK, Thayer D, Tessler FN, Leton WD, et al. Management of nodules seen on US images: deep learning may match performance of radiologists. Radiology 2019; 292:695-701.
[59]	Zhou LQ, Wang JY, Yu SY, Wu GG, Wei Q, Deng YB, et al. Artificial intelligence in medical imaging of the liver. World J Gastroenterol 2019; 25:672-682.
[60]	Bowness J, El-Boghdadly K, Burckett-St Laurent D. Artificial intelligence for image interpretation in ultrasound-guided regional anaesthesia. Anaesthesia 2021; 76:602-607.
[61]	Wildman-Tobriner B, Buda M, Hoang JK, Middleton WD, Thayer D, Short RG, et al. Using artificial intelligence to revise ACR TI-RADS risk stratification of thyroid nodules: diagnostic accuracy and utility. Radiology 2019; 292:112-119.
[62]	Le EPV, Wang Y, Huang Y, Hickman S, Gilbert FJ. Artificial intelligence in breast imaging. Clin Radiol 2019; 74:357-366.
[63]	Shin Y, Yang J, Lee YH, Kim S. Artificial intelligence in musculoskeletal ultrasound imaging. Ultrasonography 2021; 40:30-44.
[64]	Reismann J, Romualdi A, Kiss N, Minderjahn MI, Kallarackal J, Schad M, et al. Diagnosis and classification of pediatric acute appendicitis by artificial intelligence methods investigator-independent approach. PloS One 2019; 14:e0222030.
[65]	Leeson P, Fletcher AJ. Combining artificial intelligence with human insight to automate echocardiography. Circ Cardiovasc Imaging 2019; 12:e009727.
[66]	Ma J, Wu F, Zhu J, Xu D, Kong D. A pre-trained convolutional neural network based on thyroid nodule diagnosis. Ultrasonics 2017; 73:221-230.
[67]	Bi WL, Hosny A, Schabath MB, Giger ML, Birkbak NJ, Mehrtash A, et al. Artificial intelligence in cancer imaging: Clinical Challenges and Applications. CA Cancer J Clin 2019; 69:127-157.
[68]	Sobeslav V, Maresova P, Krejcar O, Franca TC, Kuca K. Use of cloud computing in biomedicine. J Biomol Struct Dyn 2016; 34:2688-2697.
[69]	Lin CW, Abdul SS, Clinciu DL, Scholl J, Jin X, Lu H, et al. Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China. Comput Methods Programs BioMed 2014; 113:585-592.
[70]	Hsieh JC, Li AH, Yang CC. Mobile, cloud, and big data computing: Challenges, and new directions in telecardiology. Int J Environ Res Public Health 2013; 10:6131-6153.
[71]	König IR, Fuchs O, Hansen G, von Mutius E, Kopp MV. What is precision medicine? Eur Respir J 2017; 50:1700391.
[72]	Gummadi S, Eisenbrey J, Li J, Li Z, Forsberg F, Lyshchik A, et al. Advances in modern clinical ultrasound. Advanced Ultrasound in Diagnosis and Therapy 2018, 2:51-63.
[73]	Bobbia X, Muller L, Claret PG, Vigouroux L, Perez-Martin A, De La Coussaye Je, et al. A new echomapping tool for cardiac output evaluation: an experimental study. Shock 2019; 52:449-455.