Experience and Enlightenment of Handheld Ultrasound Applications in Multiple Scenarios Based on 5G Technology

doi:10.37015/AUDT.2023.230029

Abstract

Abstract:

In the digital age, the miniaturization of portable ultrasound equipment has brought both opportunities and challenges to the healthcare industry. Handheld ultrasound (HHU) devices are tablet or smartphone-sized scanners that are highly portable, have lower costs, produce no harmful side effects, and consume less power, making them suitable for use in different environments. HHU devices are primarily designed for new users of ultrasound scanners with varying backgrounds to evaluate different structures of the human body in various clinical settings. HHU applications based on Fifth-generation (5G) wireless network communication and artificial intelligence (AI) technology provide new healthcare solutions. The main application scenarios for HHU devices currently include in-hospital use, remote medical treatment, emergency rescue, and home monitoring. These scenarios allow for rapid image acquisition and real-time image interpretation, thereby improving the efficiency and quality of healthcare, reducing medical costs, and improving the allocation and utilization of medical resources. However, there remain some technical challenges and weaknesses such as device safety, data privacy, and network stability. With the continuous integration of AI technology, HHU applications will find wider use and promotion, bringing about more opportunities and challenges to the healthcare industry. This article reviews the application experience and insights of 5G technology in the field of HHU, aiming to provide fresh evidence and references for future research and applications.

Key words: Handheld ultrasound; Multi-scenario application; 5G technology; Artificial intelligence; Healthcare

Huihui Chai, MS, Xiaowan Bo, MD, Lehang Guo, MD, Chengzhong Peng, MD. Experience and Enlightenment of Handheld Ultrasound Applications in Multiple Scenarios Based on 5G Technology. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(4): 356-365.

Figures/Tables 4

Table 1

Table 2

Figure 1

Figure 2

References 62

[1]	Zieleskiewicz L, Muller L, Lakhal K, Meresse Z, Arbelot C, Bertrand PM et al. Point-of-care ultrasound in intensive care units: Assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015; 41:1638-1647. doi: 10.1007/s00134-015-3952-5 pmid: 26160727
[2]	Tse KH, Luk WH, Lam MC. Pocket-sized versus standard ultrasound machines in abdominal imaging. Singapore Med J 2014; 55:325-333.
[3]	Shah S, Bellows BA, Adedipe AA, Totten JE, Backlund BH, Sajed D. Perceived barriers in the use of ultrasound in developing countries. Crit Ultrasound J 2015; 7:28. doi: 10.1186/s13089-015-0028-2 pmid: 26123609
[4]	Solomon SD, Saldana F. Point-of-care ultrasound in medical education--stop listening and look. N Engl J Med 2014; 370:1083-1085. doi: 10.1056/NEJMp1311944
[5]	Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography.N Engl J Med 2021;385:1593-1602.
[6]	Le MT, Voigt L, Nathanson R, Maw AM, Johnson G, Dancel R, et al. Comparison of four handheld point-of-care ultrasound devices by expert users. Ultrasound J 2022; 14:27. doi: 10.1186/s13089-022-00274-6
[7]	Baribeau Y, Sharkey A, Chaudhary O, Krumm S, Fatima H, Mahmood F, et al. Handheld point-of-care ultrasound probes: The new generation of POCUS. J Cardiothorac Vasc Anesth 2020; 34:3139-3145. doi: 10.1053/j.jvca.2020.07.004 pmid: 32736998
[8]	Chai HH, Ye RZ, Xiong LF, Xu ZN, Chen X, Xu LJ et al. Successful use of a 5G-based robot-assisted remote ultrasound system in a care center for disabled patients in rural china. Front Public Health 2022; 10:915071. doi: 10.3389/fpubh.2022.915071
[9]	Yu RZ, Li YQ, Peng CZ, Ye RZ, He Q. Role of 5g-powered remote robotic ultrasound during the covid-19 outbreak: Insights from two cases. Eur Rev Med Pharmacol Sci 2020; 24:7796-7800.
[10]	Michon A, Jammal S, Passeron A, De Luna G, Bomahou C, Jullien V et al. [use of pocket-sized ultrasound in internal medicine (hospitalist) practice: Feedback and perspectives]. Rev Med Interne 2019; 40:220-225. doi: S0248-8663(18)30639-8 pmid: 30078545
[11]	Miles DA, Levi CS, Uhanova J, Cuvelier S, Hawkins K, Minuk GY. Pocket-sized versus conventional ultrasound for detecting fatty infiltration of the liver. Dig Dis Sci 2020; 65:82-85. doi: 10.1007/s10620-019-05752-x
[12]	Malik AN, Rowland J, Haber BD, Thom S, Jackson B, Volk B et al. The use of handheld ultrasound devices in emergency medicine. Curr Emerg Hosp Med Rep 2021; 9:73-81. doi: 10.1007/s40138-021-00229-6
[13]	Rykkje A, Carlsen JF, Nielsen MB. Hand-held ultrasound devices compared with high-end ultrasound systems: A systematic review. Diagnostics (Basel) 2019;9.
[14]	Kimura BJ, Amundson SA, Willis CL, Gilpin EA, DeMaria AN. Usefulness of a hand-held ultrasound device for bedside examination of left ventricular function. Am J Cardiol 2002; 90:1038-1039. pmid: 12398984
[15]	Martinoli C, Di Minno MN, Pasta G, Tagliafico A. Point-of-care ultrasound in haemophilic arthropathy: Will the head-us system supplement or replace physical examination? Haemophilia 2016; 22:20-21. doi: 10.1111/hae.12840 pmid: 26663313
[16]	Rugolotto M, Chang CP, Hu B, Schnittger I, Liang DH. Clinical use of cardiac ultrasound performed with a hand-carried device in patients admitted for acute cardiac care. Am J Cardiol 2002; 90:1040-1042. pmid: 12398985
[17]	Nations JA, Browning RF. Battlefield applications for handheld ultrasound. Ultrasound Q 2011; 27:171-176. doi: 10.1097/RUQ.0b013e31822b7c14 pmid: 21873854
[18]	Ultrasound guidelines: Emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emerg Med 2017; 69:e27-e54.
[19]	Ligtvoet C, Rijsterborgh H, Kappen L, Bom N. Real time ultrasonic imaging with a hand-held scanner. Part i--technical description. Ultrasound Med Biol 1978; 4:91-92. pmid: 734796
[20]	Yamada H, Ito H, Fujiwara M. Cardiac and vascular point-of-care ultrasound: Current situation, problems, and future prospects. J Med Ultrason (2001) 2022; 49:601-608. doi: 10.1007/s10396-021-01166-3
[21]	Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: A systematic review of the literature. Trop Med Int Health 2016; 21:294-311. doi: 10.1111/tmi.12657 pmid: 26683523
[22]	Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Trop Med Int Health 2005; 96:1002-1006.
[23]	Kobal SL, Tolstrup K, Luo H, Neuman Y, Miyamoto T, Mirocha J, et al. Usefulness of a hand-carried cardiac ultrasound device to detect clinically significant valvular regurgitation in hospitalized patients. Am J Cardiol 2004; 93:1069-1072 pmid: 15081463
[24]	Appropriate use criteria for handheld/pocket ultrasound devices. Ann Emerg Med 2018; 72:e31-e33.
[25]	Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, et al. The use of handheld ultrasound devices: A position statement of the european association of cardiovascular imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. doi: 10.1093/ehjci/jey145 pmid: 30351358
[26]	Kirkpatrick AW, McKee JL, Couperus K, Colombo CJ. Patient self-performed point-of-care ultrasound: Using communication technologies to empower patient self-care. Diagnostics (Basel) 2022;12.
[27]	Nielsen MB, Cantisani V, Sidhu PS, Badea R, Batko T, Carlsen J, et al. The use of handheld ultrasound devices-an EFSUMB position paper. Ultraschall Med 2019; 40:30-39. doi: 10.1055/a-0783-2303
[28]	Adabifirouzjaei F, Kimura BJ, Khazai B, DeMaria AN. Handheld ultrasonography in cardiovascular medicine, updates and controversies. Prog Cardiovasc Dis 2022; 74:70-79. doi: 10.1016/j.pcad.2022.10.012
[29]	Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. Crit Care 2012; 16:R82. doi: 10.1186/cc11340
[30]	Egan M, Ionescu A. The pocket echocardiograph: A useful new tool? Eur J Echocardiogr 2008; 9:721-725. doi: 10.1093/ejechocard/jen177 pmid: 18579497
[31]	Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011; 24:111-116. doi: 10.1016/j.echo.2010.10.017
[32]	Emergency ultrasound guidelines. Ann Emerg Med 2009; 53:550-570. doi: 10.1016/j.annemergmed.2008.12.013 pmid: 19303521
[33]	Samant S, Tran HV, Uddo RB, deBoisblanc BP, Saketkoo LA, Saito S, et al. Use of handheld ultrasound to estimate right atrial pressure in a pulmonary hypertension clinic. Ann Am Thorac Soc 2022; 19:179-185. doi: 10.1513/AnnalsATS.202101-092OC
[34]	Andersen GN, Haugen BO, Graven T, Salvesen O, Mjølstad OC, Dalen H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011; 12:665-670. doi: 10.1093/ejechocard/jer108 pmid: 21810825
[35]	Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac Ultrasound: Recommendations from the american society of echocardiography. J Am Soc Echocardiogr 2013; 26:567-581. doi: 10.1016/j.echo.2013.04.001
[36]	Sicari R, Galderisi M, Voigt JU, Habib G, Zamorano JL, Lancellotti P, et al. The use of pocket-size imaging devices: A position statement of the european association of echocardiography. Eur J Echocardiogr 2011; 12:85-87. doi: 10.1093/ejechocard/jeq184 pmid: 21216764
[37]	Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012; 10:49. doi: 10.1186/1476-7120-10-49
[38]	Buonsenso D, Pata D, Chiaretti A. Covid-19 outbreak: Less stethoscope, more ultrasound. Lancet Respir Med 2020; 8:e27. doi: 10.1016/S2213-2600(20)30120-X pmid: 32203708
[39]	Ricci F, Aquilani R, Radico F, Bianco F, Dipace GG, Miniero E, et al. Role and importance of ultrasound lung comets in acute cardiac care. European heart journal. Eur Heart J Acute Cardiovasc Care 2015; 4:103-112. doi: 10.1177/2048872614553166 pmid: 25267879
[40]	Falgarone G, Pamoukdjian F, Cailhol J, Giocanti-Auregan A, Guis S, Bousquet G, et al. Lung ultrasound is a reliable diagnostic technique to predict abnormal ct chest scan and to detect oxygen requirements in covid-19 pneumonia. Aging 2020; 12:19945-19953. doi: 10.18632/aging.v12i20
[41]	Newhouse SM, Effing TW, Dougherty BD, D'Costa JA, Rose AR. Is bigger really better? Comparison of ultraportable handheld ultrasound with standard point-of-care ultrasound for evaluating safe site identification and image quality prior to pleurocentesis. Respiration 2020; 99:325-332. doi: 10.1159/000505698 pmid: 32208396
[42]	Lin PH, Bush RL, McCoy SA, Felkai D, Pasnelli TK, Nelson JC, et al. A prospective study of a hand-held ultrasound device in abdominal aortic aneurysm evaluation. Am J Surg 2003; 186:455-459. pmid: 14599606
[43]	Fröhlich E, Beller K, Muller R, Herrmann M, Debove I, Klinger C, et al. Point of care ultrasound in geriatric patients: Prospective evaluation of a portable handheld ultrasound device. Ultraschall Med 2020; 41:308-316. doi: 10.1055/a-0889-8070 pmid: 31026863
[44]	Jung EM, Dinkel J, Verloh N, Brandenstein M, Stroszczynski C, Jung F, et al. Wireless point-of-care ultrasound: First experiences with a new generation handheld device. Clin Hemorheol Microcirc 2021; 79:463-474. doi: 10.3233/CH-211197 pmid: 34151848
[45]	Vidakovic R, Schouten O, Feringa HH, Dunkelgrun M, Karagiannis SE, Merks E, et al. Abdominal aortic aneurysm screening using non-imaging hand-held ultrasound volume scanner--a pilot study. Eur J Vasc Endovasc Surg 2006; 32:615-619. doi: 10.1016/j.ejvs.2006.06.012
[46]	Kirkpatrick AW, Sirois M, Ball CG, Laupland KB, Goldstein L, Hameed M, et al. The hand-held ultrasound examination for penetrating abdominal trauma. Am J Surg 2004; 187:660-665. pmid: 15135687
[47]	Stock KF, Klein B, Steubl D, Lersch C, Heemann U, Wagenpfeil S, et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: Diagnostic value and time required in bedside ultrasound examination. Abdom Imaging 2015; 40:2861-2866. doi: 10.1007/s00261-015-0406-z pmid: 25805559
[48]	Coşkun F, Akıncı E, Ceyhan MA, Our new stethoscope in the emergency department: Handheld ultrasound.Ulus Travma Acil Cerrahi Derg 2011;17:488-492.
[49]	Barreiros AP, Cui XW, Ignee A, De Molo C, Pirri C, Dietrich CF. Echoscopy in scanning abdominal diseases: Initial clinical experience. Z Gastroenterol 2014; 52:269-275. doi: 10.1055/s-0033-1350114 pmid: 24622868
[50]	Coombs PR, Warsa M, Hailu T, Agedew E, Tsegaye B. Establishing an ultrasound screening protocol for chronic liver disease with a handheld device: A pilot project in southern ethiopia. Ultrasound Med Biol 2022; 48:702-710. doi: 10.1016/j.ultrasmedbio.2021.12.013 pmid: 35105496
[51]	Galjaard S, Baeck S, Ameye L, Bourne T, Timmerman D, Devlieger R. Use of a pocket-sized ultrasound machine (pum) for routine examinations in the third trimester of pregnancy. Ultrasound Obstet Gynecol 2014; 44:64-68. doi: 10.1002/uog.13285 pmid: 24357339
[52]	Bruns RF, Menegatti CM, Martins WP, Araujo Júnior E. Applicability of pocket ultrasound during the first trimester of pregnancy. Med Ultrason 2015; 17:284-288. doi: 10.11152/mu.2013.2066.173.rfb pmid: 26343074
[53]	Herberg U, Goldberg H, Breuer J. Three- and four-dimensional freehand fetal echocardiography: A feasibility study using a hand-held doppler probe for cardiac gating. Ultrasound Obstet Gynecol 2005; 25:362-371. doi: 10.1002/uog.v25:4
[54]	Sayasneh A, Preisler J, Smith A, Saso S, Naji O, Abdallah Y, et al. Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology? Ultrasound Obstet Gynecol 2012; 40:145-150. doi: 10.1002/uog.11184 pmid: 22605511
[55]	Pedersen JK, Sira C, Trovik J. Handheld transabdominal ultrasound, after limited training, may confirm first trimester viable intrauterine pregnancy: A prospective cohort study. Scand J Prim Health Care 2021; 39:123-130. doi: 10.1080/02813432.2021.1910643
[56]	Haragan AF, Hulsey TC, Hawk AF, Newman RB, Chang EY. Diagnostic accuracy of fundal height and handheld ultrasound-measured abdominal circumference to screen for fetal growth abnormalities. Am J Obstet Gynecol 2015; 212:820.e821-828. doi: 10.1016/j.ajog.2014.07.052
[57]	Troyano Luque JM, Ferrer-Roca O, Barco-Marcellán MJ, Sabatel López R, Pérez-Medina T, Pérez-Lopez FR. Modification of the hand-held vscan ultrasound and verification of its performance for transvaginal applications. Ultrasonics 2013;53:17-22.
[58]	Toscano M, Szlachetka K, Whaley N, Thornburg LL. Evaluating sensitivity and specificity of handheld point-of-care ultrasound testing for gynecologic pathology: A pilot study for use in low resource settings. BMC Med Imaging 2020; 20:121. doi: 10.1186/s12880-020-00518-8 pmid: 33109134
[59]	Corte G, Bayat S, Tascilar K, Valor-Mendez L, Schuster L, Knitza J, et al. Performance of a handheld ultrasound device to assess articular and periarticular pathologies in patients with inflammatory arthritis. Diagnostics (Basel) 2021;11.
[60]	Alhayani B, Kwekha-Rashid AS, Mahajan HB, Ilhan H, Uke N, Alkhayyat A, et al. 5G standards for the industry 4.0 enabled communication systems using artificial intelligence: Perspective of smart healthcare system. Appl Nanosci 2023; 13:1807-1817. doi: 10.1007/s13204-021-02152-4
[61]	Coker BJ, Zimmerman JM. Why anesthesiologists must incorporate focused cardiac ultrasound into daily practice. Anesth Analg 2017; 124:761-765. doi: 10.1213/ANE.0000000000001854 pmid: 28207446
[62]	Wang C, Zheng Y, Xiong C, Sun L, Wang J. Preliminary exploration of theory and practice training of 5G ultrasonic remote consultation in grassroot hospitals. BMC Health Serv Res 2022; 22:817. doi: 10.1186/s12913-022-08221-w pmid: 35739530

HHU devices	Cost	Imaging modes	Operating system	Charging time	Probe type	Controls	Export
Vscan	$4995 +	2D, M, CDI	Android/Linux	1.5 hour	Dual probe (linear, curvilinear)	Buttons	USB, Email
Lumify	<$10,000	2D, M, CDI	Android	Depends on device used	Separate linear, curvilinear, phased array probes	Touchscreen	DICOM, network share, Local directory, USB, Email
iQ+	$1999 + $420/yr	2D, M, CDI, PDI	Android/iOS	5 hour	3-in-1 single probe (linear, curvilinear, phased array)	Touchscreen	Local PACS, Cloud
iViz	$8,000	2D, M, CDI	Android	2 hour	Separate linear, curvilinear, phased array probes	Touchscreen	Local PACS, Cloud, USB, Email, Printer

Application scenario	Feature	Usage policies
Trauma and Disaster Ultrasound Services	Quickly conduct preliminary diagnosisimprove treatment	Referring to the ACEP guideline [24], If the obtained images have diagnostic quality, examinations performed using pocket-sized devices can be equivalent to emergency ultrasound examinations performed using conventional machines
In-hospital Distributed Ultrasound Diagnosis	Portable, easy to operate, and can perform real-time iagnosis	The European Association of Cardiovascular Imaging acknowledges that HHU can be used to extend physical examination in different hospital clinical scenarios and environments in order to obtain an overview of cardiac structure and function and to follow-up previously diagnosed pathologies [25].
Home Ultrasound Services	Self-tested anytime and anywhere, convenient and fast	The TeleMentored Ultrasound Supported Medical Interventions proposes that adding a remote ultrasound capability to the typical smart home infrastructure may provide the ability to improve home care in almost limitless ways [26].
Community ultrasound Services	Low cost, low power,provide ultrasound diagnostic services to grassroots medical institutions	Referring to the European Federation of Societies in Ultrasound and Medicine position paper [27], HHU is easy to carry in a pocket, cheaper than high-end ultrasound equipment, and consumes less power. It can conveniently provide ultrasound services for users in different environments