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Point-of-Care UltrasonographyPoint-of-Care Ultrasonography: Ready to Take Off?: Ready to Take Off? FREE TO VIEW

Muhammad Adrish, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine.

CORRESPONDENCE TO: Muhammad Adrish, MD, Department of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Ave, Ste 12F, Bronx, NY, 10457; e-mail: aadrish@hotmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):e23. doi:10.1378/chest.14-2087
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Published online
To the Editor:

I read with great interest the study by Oks and colleagues1 in a recent issue of CHEST (December 2014) showing the role of point-of-care (POC) ultrasonography (USG) in reducing the number of imaging studies performed by radiology and cardiology services. POC USG performed by intensivists is an indispensable bedside tool that allows for rapid assessment of critically ill patients without the unnecessary delay associated with formal studies. However, certain noteworthy barriers exist that have limited the widespread application of this modality.

USG is a time-consuming procedure, and necessary qualifications are required to safely perform and interpret these studies. Over the past decade, many critical care training programs have integrated POC USG into their curricula. However, there are many more senior intensivists who were never trained or might have lost their USG skills over time. It is also important to understand that these studies are focused and may not answer all clinically relevant questions. A study by Martin and colleagues2 showed that adding handheld ultrasound to physical examination increased the accuracy of hospitalists’ assessment of cardiomegaly, pericardial effusion, and left ventricular dysfunction but failed to improve assessment of valvular heart disease.

Time required to perform these studies also varies with expertise. In a study of experienced sonographers, the imaging time required to complete a standard echocardiogram was approximately 26 min.3 Despite formal training in image acquisition, training in standardized documentation is often lacking, which can create the potential for miscommunication. Although the images acquired during these studies can be saved on a storage device, a formal system to integrate these images and videos into a hospital image archiving system is often lacking. This can not only lead to doubts regarding the validity of these studies among other subspecialties but can also create problems for the performing physician defending his or her decisions in the event of failed treatment or litigation.

It is, therefore, imperative to not only standardize the training in image acquisition but also emphasize standardized documentation. Implementing intrahospital protocols for formally saving these studies in hospital imaging archives will further enhance communication and safe utilization of these studies.

References

Oks M, Cleven KL, Cardenas-Garcia J, et al. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest. 2014;146(6):1574-1577. [CrossRef] [PubMed]
 
Martin LD, Howell EE, Ziegelstein RC, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med. 2009;122(1):35-41. [CrossRef] [PubMed]
 
Kimura BJ, DeMaria AN. Time requirements of the standard echocardiogram: implications regarding limited studies. J Am Soc Echocardiogr. 2003;16(10):1015-1018. [CrossRef] [PubMed]
 

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References

Oks M, Cleven KL, Cardenas-Garcia J, et al. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest. 2014;146(6):1574-1577. [CrossRef] [PubMed]
 
Martin LD, Howell EE, Ziegelstein RC, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med. 2009;122(1):35-41. [CrossRef] [PubMed]
 
Kimura BJ, DeMaria AN. Time requirements of the standard echocardiogram: implications regarding limited studies. J Am Soc Echocardiogr. 2003;16(10):1015-1018. [CrossRef] [PubMed]
 
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