Links To And Excerpts From “Comparison of four handheld point-of-care ultrasound devices by expert users” From The Ultrasound Journal

In this post, I link to and excerpt from The Journal Of Ultrasound article, Comparison of four handheld point-of-care ultrasound devices by expert users [PubMedA Abstract] [Full-Text HTML] [Full-Text PDF], 2022 Jul 7;14(1):27.

All that follows is from the above resource.

Background: Point-of-care ultrasound (POCUS) is rapidly becoming ubiquitous across healthcare specialties. This is due to several factors including its portability, immediacy of results to guide clinical decision-making, and lack of radiation exposure to patients. The recent growth of handheld ultrasound devices has improved access to ultrasound for many clinicians. Few studies have directly compared diferent handheld ultrasound devices among themselves or to cart-based ultrasound machines. We conducted a prospective observational study comparing four common handheld ultrasound devices for ease of use, image quality, and overall satisfaction. Twenty-four POCUS experts utilized four handheld devices (Butterfy iQ+™ by Butterfy Network Inc., Kosmos™ by EchoNous, Vscan Air™ by General
Electric, and Lumify™ by Philips Healthcare) to obtain three ultrasound views on the same standardized patients using
high- and low-frequency probes.
Results: Data were collected from 24 POCUS experts using all 4 handheld devices. No single ultrasound device was superior in all categories. For overall ease of use, the Vscan Air™ was rated highest, followed by the Lumify™. For overall image quality, Lumify™ was rated highest, followed by Kosmos™. The Lumify™ device was rated highest for overall satisfaction, while the Vscan Air™ was rated as the most likely to be purchased personally and carried in one’s coat pocket. The top 5 characteristics of handheld ultrasound devices rated as being “very important” were image quality, ease of use, portability, total costs, and availability of diferent probes.
Conclusions: In a comparison of four common handheld ultrasound devices in the United States, no single hand‑
held ultrasound device was perceived to have all desired characteristics. POCUS experts rated the Lumify™ highest for
image quality and Vscan Air™ highest for ease of use. Overall satisfaction was highest with the Lumify™ device, while the most likely to be purchased as a pocket device was the Vscan Air™. Image quality was felt to be the most important characteristic in evaluating handheld ultrasound devices.
Keywords: Handheld ultrasound, Point-of-care ultrasound, POCUS, Portable ultrasound diagnostic imaging, Procedures

Point-of-care ultrasound (POCUS), or use of bedside ultrasound by a clinician to answer a specifc diagnostic question or guide performance of an invasive procedure, is becoming more common across healthcare specialties. Historically, POCUS has been performed using portable cart-based ultrasound machines that ofer a wide range of modalities and consistently generate high-quality images, but access to portable ultrasound machines has been a top barrier to POCUS use [1–6]. In recent years,
ultraportable handheld ultrasound devices have emerged improving access to POCUS technology at a fraction of the cost, especially in resource-limited settings [7]

Handheld ultrasound devices have demonstrated similar accuracy compared to cart-based ultrasound machines for multiple applications including bedside procedures, such as thoracentesis and epidural analgesia, and diagnostic evaluation of left ventricular function, female reproductive organs, abdominal pathologies (ascites, hydronephrosis, abdominal aortic aneurysm), musculoskeletal system, and lungs/pleura [8–16]. Discrepant fndings between handheld ultrasound devices and cart-based ultrasound machines were not clinically
signifcant in these studies [17, 18].

In contrast, few studies have performed head-to-head comparisons of different handheld ultrasound devices. Though a simple comparison of available modes, settings, and probes of
diferent handheld devices can be performed relatively easily [19], POCUS users are seeking comparative data on the performance of handheld ultrasound devices to guide purchasing decisions.

We compared four commonly available handheld ultrasound devices in the United States for ease of use, image quality, and overall satisfaction with a multidisciplinary group of POCUS experts as operators. Our secondary objective was to identify the characteristics that POCUS experts consider to be most important when comparing diferent handheld ultrasound devices for use in clinical practice.

Four handheld ultrasound devices with both low- and
high-frequency transducer capabilities were compared:
Butterfy iQ+ ™ (Butterfy Network, Inc.) probe connected by a USB-C cable to an Apple iPhone™ (iPhone 11 Pro Max™); Kosmos™ (EchoNous, Inc.) probe connected
by a cord to a proprietary tablet as one unit; Lumify™
(Philips Healthcare) connected by a USB-C cable to
an Apple iPad™ (8th generation), and Vscan Air™ (GE
Healthcare) connected wirelessly to a Samsung Galaxy
S7™ tablet.

Each standardized patient was assigned to one of three
POCUS views: Focused Assessment with Sonography
in Trauma (FAST) right upper quadrant view, transverse view of the neck with the internal jugular vein and
carotid artery, or parasternal long-axis view of the heart.

Using the four handheld devices, all 24 POCUS experts
independently acquired the same view on the same

For the parasternal long-axis view, experts were instructed to use the low-frequency probe with a cardiac preset and focus on the mitral valve, aortic valve, and endocardial lining. Color fow Doppler was then applied over the mitral and aortic valves.

For the right upper quadrant FAST view, experts were instructed to use the low-frequency probe with an abdominal preset and focus on the liver, kidney, and diaphragm. For the transverse view of the neck, experts were instructed to use the high frequency probe with a venous or vascular preset and focus on the internal jugular vein and common carotid artery.

Data collection
Data were collected on ease of use, image quality, and
overall satisfaction (Additional fle 1).

For ease of use, experts rated the physical characteristics, software navigation, maneuverability of the probe and tablet for imaging, and overall satisfaction.

For image quality, experts rated the detail resolution, contrast resolution, penetration, clutter, and overall satisfaction.

The overall ranking assessed satisfaction and recommendation for purchase.

Ratings were made using standardized statements on a Likert scale of 1 (“strongly disagree” or “very dissatisfed”) to 5 (“strongly agree” or “very satisfed”).

Qualitative feedback was collected in each category using free
text. Experts completed the data collection form after
scanning each model (<72 h). All data were captured
electronically using REDCap™ (Vanderbilt University,
Nashville, TN, USA).

Ratings of the handheld ultrasound devices’ ease of
use and image quality are displayed in Table 2.

The mean ratings for ease of use and image quality are
displayed in Fig. 1.

Examples of the parasternal long-axis view captured in early systole using the four handheld ultrasound devices are shown in Fig. 2.

From the qualitative data, two main themes emerged.

First, there is not yet a perfect handheld device. Experts perceived all four devices as having notable advantages
and disadvantages. Experts valued high image quality, the convenience of having only one probe, intuitive user interfaces, and advanced features, like Doppler ultrasound and artifcial intelligence (AI). Ultimately, no single device was perceived as having all desired qualities or features.

Second, adequate image quality was considered the most important aspect of a handheld device because it determined the user’s ability to make a clinical decision. Multiple experts commented that poor image quality limited clinical decisions and for this reason devices with poor image quality were considered unusable by some experts.

One expert stated, “The poor image quality is a deal breaker,” and another said, “Image quality is poor and would result in me getting a larger machine to confdently make a clinical decision which is double the work in my mind.”

Some experts also noted poor image quality may negatively afect the ability for inexperienced POCUS users to attain competency. Oneexpert remarked, “This (device) is being marketed to physicians with minimal training, and if you take a minimally trained physician and give them a device that is very poor quality, then you have a recipe for disaster”.

Ultimately, no single handheld ultrasound device was rated highest in all categories. A lack of consensus of a single handheld ultrasound device being superior to others was similar to the fndings by Toscano et al. in which investigators sought one suitable handheld device to perform gynecologic ultrasound exams in a resource-poorsetting and ultimately selected the Lumify™ based on itsease of use, battery-life, portability, cost, and ease withdepth and gain adjustments [12]. Even though POCUSexperts rated Lumify™ highest for “overall satisfaction” in our study, more experts selected Vscan Air™ as the device
they would buy “today as a personal device to carry in my
coat pocket”.

Our study sought to identify specific characteristics of handheld ultrasound devices that expert POCUS users considered important. Quantitative and qualitative data demonstrated image quality to be the most important characteristic. Comments from experts refected that image quality is the most important characteristic because poor quality images require a repeat evaluation with a cart-based ultrasound machine, negating the benefts of having a handheld.

After image quality, the most important characteristics of handheld devices were ease of use, portability, total costs, and availability of diferent probe types. Perhaps once image quality is adequate for clinical decision-making, these secondary characteristics, such as ease of use and software options, become more of a deciding factor in selecting a handheld ultrasound device.

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