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Quality assessment of ultrasound medical systems is a demanding task due to the high number of parameters to quantify their performance: in the present study, a Kiviat diagram-based integrated approach was proposed to effectively combine the contribution of some experimental parameters and quantify the overall performance of pulsed wave Doppler (PWD) systems for clinical applications. Four test parameters were defined and assessed through custom-written measurement methods based on image analysis, implemented in the MATLAB environment, and applied to spectral images of a flow phantom, i.e., average maximum velocity sensitivity (AMVS), velocity measurements accuracy (VeMeA), lowest detectable signal (LDS), and the velocity profile discrepancy index (VPDI). The parameters above were scaled in a standard range to represent the four vertices of a Kiviat plot, whose area was considered the overall quality index of the ultrasound system in PWD mode. Five brand-new ultrasound diagnostic systems, equipped with linear array probes, were tested in two different working conditions using a commercial flow phantom as a reference. The promising results confirm the robustness of AMVS, VeMeA, and LDS parameters while suggesting further investigations on the VPDI.

Color Doppler (CD) imaging is widely used in diagnostics since it allows real-time detection and display of blood flow superimposed on the B-mode image. Nevertheless, to date, a shared worldwide standard on Doppler equipment testing is still lacking. In this context, the study herein proposed would give a contribution focusing on the combination of five test parameters to be included in a novel Quality Assessment (QA) protocol for CD systems testing. A first approach involving the use of the Kiviat diagram was investigated, assuming the diagram area, normalized with respect to one of the gold standards, as an index of the overall Doppler system performance. The QA parameters were obtained from the post-processing of CD data through the implementation of custom-written image analysis methods and procedures, here applied to three brand-new high-technology-level ultrasound systems. Experimental data were collected through phased and convex array probes, in two configuration settings, by means of a Doppler flow phantom set at different flow rate regimes. The outcomes confirmed that the Kiviat diagram might be a promising tool applied to quality controls of Doppler equipment, although further investigations should be performed to assess the sensitivity and specificity of the proposed approach.

Background Chronic ankle instability (CAI) may result from repeated, frequent ankle sprains during sports activities. Manual examination for CAI is conducted; however, quantitative methods for the evaluation of CAI have not been established, and the reproducibility of the amount of stress is low. This cross-sectional study aimed to use a stress device and ultrasound for the quantitative evaluation of the change in the length of the anterior talofibular ligament (ATFL) during simulated anterior drawer and ankle inversion stress tests. Methods Questionnaires were provided to 160 healthy college students (86 men, 74 women; 320 ankles). We extracted two groups from them: control subjects without a history of ankle injury ( n  = 64 ankles) and subjects with CAI ( n  = 54 ankles). We calculated the change in the length of the ATFL with anterior drawer and inversion stress tests at ankle joint plantar flexions of 0°, 20°, and 45° using ultrasound images. Results The anterior length change rates were significantly higher in the CAI group than in the control group at ankle joint plantar flexions of 20° and 45° in men ( P  < 0.05). The inversion length change rates were significantly higher in the CAI group at ankle joint plantar flexion of 20° in men ( P  < 0.05). No significant between-group difference in the anterior and inversion length change rates was observed in women. Conclusions Stress ultrasound revealed greater length changes in the ATFL in the CAI group than in the control group. The stress test may be useful at ankle joint plantar flexion of 20° for men.

Ultrasound examinations tend to put sonographers in unnatural postures, which may lead to musculoskeletal disorders. In order to address this issue, in this study, we focused on the horizontal position of the console of a diagnostic ultrasound system to quantitatively assess the influence of the work plane position on musculoskeletal stress cardiac ultrasonic diagnosis in the bed-sitting position. Five subjects were asked to simulate a scanning task that involved touching five points on the console, setting the work plane at different positions in the space. Electromyogram of each part of the body indicated that the least stressful position of the left hand was about 350 mm from the center of the trunk in the longitudinal (front-rear) direction and 100 mm left from the center of the trunk in the lateral (left–right) direction. It is necessary to rotate the console in front of the operator for this purpose.

Ultrasound examinations may require sonographers to adopt unnatural postures, which can lead to musculoskeletal disorders. We previously assessed the effect of a vertical operation panel on muscular stress. In this study, we focused on the horizontal positioning of the control panel of a diagnostic ultrasound system to quantitatively assess the influence of work plane position on musculoskeletal stress during scanning. Five subjects were asked to perform a simulated scanning task that involved touching five points on the control panel, with the work plane set at different positions in space. Electromyograms of each part of the body and wrist joint angles indicated that the least stressful position of the left hand was about 350 mm from the center of the trunk in the longitudinal (front–back) direction and 100 mm left of the center of the trunk in the lateral (right–left) direction.

Ultrasound examinations tend to put sonographers in unnatural postures, which may lead to musculoskeletal disorders. In this study, we focused on the height of the operation panel of the diagnostic ultrasound system to quantitatively assess the effects of panel height (work plane height) on musculoskeletal stress during scanning in a sitting position. Eight subjects were asked to perform a simulated scanning task that involved touching nine points on the operation panel at four different panel heights. Electromyogram, left wrist joint angle, and subjective evaluation on ease of manipulation, etc., indicated that the optimum height of the operation panel during scanning in a sitting position is elbow height.

Point of Care ultrasound (POCUS) of the lungs, also known as lung ultrasound (LUS), has emerged as a technique that allows for the diagnosis of many respiratory pathologies with greater accuracy and speed compared to conventional techniques such as chest x-ray and auscultation. The goal of this narrative review is to provide a simple and practical approach to LUS for critical care, pulmonary, and anesthesia providers, as well as respiratory therapists and other health care providers to be able to implement this technique into their clinical practice. In this review, we will discuss the basic physics of LUS, provide a hands-on scanning technique, describe LUS findings seen in normal and pathological conditions (such as mainstem intubation, pneumothorax, atelectasis, pneumonia, aspiration, COPD exacerbation, cardiogenic pulmonary edema, ARDS, and pleural effusion) and also review the training necessary to achieve competence in LUS.

This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the “go to” modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

PurposeTo analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history.MethodsThis is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed.ResultsWe studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23–91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55–91.65%) that was higher in the mild phenotype (94.4%; CI 90.0–97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6–6.7, p < 0.0001).ConclusionCombining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients’ management during a pandemic surge.