
Portable Ultrasound Proves a Potent Weapon in the Fight Against Covid-19 - sohkamyung
https://spectrum.ieee.org/the-human-os/biomedical/imaging/portable-ultrasound-proves-potent-weapon-fight-against-covid19
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unsrsly
I will make the (likely unpopular) comment that point of care ultrasound
(POCUS) doesn't have a large impact for Covid-19, because Covid-19 is
primarily diagnosed via PCR of a nasopharyngeal swab, and pneumonia is
primarily a clinical diagnosis confirmed by a chest X-ray. There are already
portable chest X-ray machines in the ICU. However, if a patient develops fluid
around their lung (pleural effusion), lung POCUS can be used to guide a needle
into the fluid pocket and drain it (thoracentesis). This can help patients
breathe better and is truly useful. Modern ICU's already have fancy portable
ultrasound machines available, so the main difference in the handheld
ultrasound versions is the lower price and inferior image quality.

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sjg007
The handheld version is easier to clean basically and apparently reliable
enough for diagnosis. Did you read the article?

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unsrsly
From firsthand experience, I can tell you the handheld versions make it more
challenging to obtain a diagnostic quality image. Also, many of them are
intended to be plugged into a personal device (like an iPhone) which I would
not want to bring into a Covid patient's room. But in the right hands, they
are a decent alternative to a more sophisticated ultrasound machine. They are
not a "potent weapon" compared with other more expensive tech that already
exists. They are just a cheaper substitute, which is a great but incremental
innovation.

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canada_dry
Initiatives like this need more love:
[http://www.echopen.org/](http://www.echopen.org/)

Why don't have a much more active/thriving medical hackers community?

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lnsru
I quickly loose an appetite to do anything in medical space due to hardcore
regulation. I applied couple times at medical equipment manufacturers and I
was always told, that I’ll spend at least 2 days every week documenting things
for examination later. I don’t think, hackers love documentation.

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m4r35n357
I don't think dying patients love bugs, either.

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ethanwillis
A better solution could be to let people who enjoy technical writing do
technical writing.

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rediguanayum
Talking with real doctors, POCUS as its called, definitely helps but a lot
depends on the skill of the operator as Covid-19 disease is complicated and
has multiple presentations. You can a sense of that in this video:
[https://www.youtube.com/watch?v=y5QJ5O3ldE0](https://www.youtube.com/watch?v=y5QJ5O3ldE0)

The fundamentals of POCUS are good though. At my wife's hospital, disinfecting
the CT suite after a Covid-19 patient is a real barrier to using it. POCUS
doesn't have that problem. I think what needs to be done for POCUS is to make
the diagnostic capability easier for non-radiology medical providers to use
i.e. make the view more like a CT or MRI scan and less like looking through a
straw. That's something the HN folks can very much help with.

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m463
A few years ago someone I knew was in the hospital so I spent a lot of time
there.

I observed an interesting hack.

They have these "bladder" ultrasound machines to check if a patient's bladder
is full and how much.

What was interesting was that as far as I can tell, they were regular
ultrasounds, but the "subject" was shown on the display as a yellowish color.

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tomohawk
> I’m not going in a second time just to do an ultrasound. I just take it in
> with me, and do everything I need to do in that one episode of care.

This is huge, as treating C19 patients requires full change of PPE each time
you go into the room in many settings.

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mnw21cam
Can anyone see the content of the article? What does it say?

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binstub
The COVID-19 epidemic in China was gathering terrible force when 11 overworked
Chinese physicians found time to write a research paper. At the time, in mid
February, confirmed cases of the disease were inching towards 60,000 and the
death toll stood at nearly 1,400. The doctors, most of them pulmonary
specialists at the Xi’an Chest Hospital, had already treated scores of people
seriously stricken with the disease.

Weary as they were, they had something they wanted to tell the world:
“Ultrasound is playing an indispensable role in the diagnosis, treatment and
efficacy evaluation of severe acute pneumonia,” the life-threatening illness
associated with the most severe cases of COVID-19.

Medical ultrasound, which provides instant, full-motion video of a cross-
section of the patient’s body, is of course well known for its role in fetal
imaging. It’s also frequently used to image organs such as the heart, liver,
gallbladder, and kidneys. Lung ultrasound is a relatively recent medical
technique, dating to pioneering work by Daniel A. Lichtenstein in France and
described in a research paper published in 2008.

Now, with COVID-19 cases worldwide surpassing 2.5 million and the death count
standing at more than 176,000, lung ultrasound has emerged as a top medical
tool in the global struggle against the disease. Hospitals are using it to
monitor and even diagnose cases, particularly in places where tests are scarce
or unavailable. They’re relying on it to decide who gets into hospital
emergency rooms, and who will go to the intensive-care unit.

Intriguingly, as their front-line systems, many hospitals are relying not on
their biggest, most sophisticated systems—stationary or cart-based machines
that can cost between US $50,000 and $100,000—but rather on handheld,
pocketable systems that cost a tenth as much or less.

Philips, GE, Siemens, Canon, and a couple of startups, Butterfly Network Inc.
and Clarius Mobile Health, are key suppliers of the handheld ultrasound
systems, which began proliferating in the medical community only about 10
years ago. These pocket-size systems consist of a transducer, which is held
against the patient’s body and is about the size and shape of a small electric
hair trimmer, which plugs into a smart mobile device, such as a smartphone or
a tablet.

“We are selling them as quickly as we can make them,” says Anthony Gades,
director of clinical science at Philips Point-Of-Care Ultrasound in Bothell,
Washington. “We’re seeing huge orders from healthcare systems.”

It’s a surprising turn for the medical imaging technology. Because ultrasound
is quickly dissipated in air, the technique was for years thought to be of
little use for studying the lungs. “Ultrasound is not a natural candidate, you
might think, to assess the lungs,” says Mathias Goyen, chief medical officer,
Europe, for GE Healthcare. “But here, dealing with the pandemic, all of a
sudden ultrasound really has a great place, a great role. You can use it in
the ICU, you don’t have to bring the patient to the radiology department. It’s
inexpensive; it’s available; it’s a bedside test. There’s a huge, huge
demand.”

Ultrasound’s indispensability in the current crisis starts with the fact that
it can quickly and easily spot the viral pneumonia associated with the most
serious cases of COVID-19, says Cindy Owen, director of clinical insights and
development for GE Healthcare’s Point-of-Care Ultrasound.

Video: GE Healthcare Critical Case: A lung ultrasound scan of a patient with
advanced COVID-19 shows characteristic signs. In this video, recorded using a
GE Vscan Extend handheld ultrasound unit, an irregular and thickened pleural
line is visible as bright horizontal layers near the top. Radiating down from
them are B-lines, which are also beginning to thicken and consolidate into a
wide smudge—an indication of substantial fluid in the lungs. In examining a
lung, physicians begin by looking for the pleural line, a bright streak in the
image that corresponds to the pleura, the layered sheet of tissue that
envelops the outside of the lungs and encloses the chest cavity. “You look at
the pleural line,” Owen explains. “If the lungs are normal, you see
equidistant horizontal lines called A lines. But if there’s fluid,” an
indication of pneumonia, “you see bright streaks that move with the patient’s
breathing, called B lines.” As the pneumonia becomes more serious, the B lines
merge in some places into what are called coalesced, or confluent, B lines,
and the pleural line appears thickened.

On ultrasound, the lungs of patients seriously infected with COVID-19 show up
with a characteristic variegated pattern. “That pattern—the pleural
thickening, the B lines, and confluent B lines, in a distribution that is
patchy and bilateral, that is, for me, COVID until proven otherwise,” says
Bilal Jalil, an intensive-care and pulmonary physician in the Dallas, Texas
area.

These ultrasound indicators of COVID are so characteristic that some doctors
are now using ultrasound as a kind of provisionary test for the disease. The
most accurate chemically-based diagnostic test, which makes use of polymerase
chain reaction, is still scarce in some places, takes days to deliver results,
and has been plagued with false negatives. Many hospitals in COVID hotspots
are foregoing the test, at least initially, and using handheld ultrasound as a
literal front line. Using the handheld systems, they’re examining patients’
lungs to determine whether they should be admitted and if so, whether they
need intensive care.

A doctor in Wuhan, China, uses a Philips Lumify handheld ultrasound system to
examine a COVID-19 patient. Photo: Philips Ultrasound PETITE PROBE: A doctor
in Wuhan, China, uses a Philips Lumify handheld ultrasound system to examine a
COVID-19 patient. The Lumify system consists of a transducer [in the
physician’s right hand] that is connected to a mobile device, in this case an
Android tablet. The tablet is completely sheathed in a plastic covering. A big
advantage of these systems is that it is easier to keep them free of pathogens
because their components are small enough to be sheathed. The huge demand for
the handheld machines isn’t hard to understand, according to Philips’s Gades.
“Because they’re so small, you can put a sheath around the entire system to
prevent any pathogens from contaminating it,” he explains. “Then you discard
the sheath in between patients. That size advantage is huge now.”

Jalil explains that the portability enables him to minimize his—and other
people’s—visits to infected areas. “If I have an intubated patient who’s in
the ICU,” he says, “I’m going to go in, and I’m going to take my machine with
me. Maybe I have to put a central line in. Maybe I have to do a procedure on
that patient. Maybe I just need to go and examine that patient. I’m not going
in a second time just to do an ultrasound. I just take it in with me, and do
everything I need to do in that one episode of care. Once I’m done with that,
I come back out with all the answers I need.”

Another plus of ultrasound, he notes, is that unlike X-rays, there is no
potentially harmful ionizing radiation, meaning that doctors can use the
devices every day to closely track the course of the disease.

A major trend in medical ultrasound, reflecting advances in medical imaging in
general, has been the integration of smart software and apps, including ones
based on artificial intelligence. The COVID-19 crisis seems set to accelerate
many of those initiatives. “Believe me, AI is the number one priority for most
imaging devices,” says Jalil.

These apps and software are typically aimed at assisting relatively
inexperienced users as well as helping veterans work more quickly and
consistently. Gades points out that the Philips handheld, connected to a
smartphone, enables the user to stream live video from the phone’s front-
facing camera as well as the transducer to an observer anywhere in the world,
who can offer pointers on transducer placement and other subtleties. Regarding
AI and other advanced software, he says, “we’ve been devoting tremendous
resources to making this even more usable for those with little training.”

He adds, “we’re actively partnering with the [U.S. Department of Defense] as
well as many medical centers to develop automated ways to address these types
of situations.”

GE already has an AI-based software lung tool for its larger, cart-based Venue
line of ultrasound machines. It automatically counts B lines and
consolidations in imagery and uses the data to calculate a lung “score”
indicating the seriousness of an infection. The company is also working on
advanced apps for its handheld systems, which are called Vscan, according to
Nahi Halmann, chief engineer for GE Point of Care Ultrasound. The current
surge of use in the pandemic will turbocharge those efforts, Halmann adds:
“Groups are collecting data, and this will lead to new ideas about how to
develop future technologies.”

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hef19898
Thanks for the insight! Do you have any idea why lung ultrasound is such a
recent thing?

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twic
From Lichtenstein's 2008 paper [1], mentioned in that article as the start of
it:

> Ultrasound has long shown its utility for plain organs.6 Although the lung
> has traditionally been excluded from its repertoire,7 studies have proven
> that this belief was unfounded.8 Since 1989 in our ICU, using devoted
> logistics,9 the concept of whole-body ultrasound was developed and extended
> to the lungs for managing critical situations.10,11

And in his big guidebook [2]:

> We used ultrasound first in 1983, on occasion in François Fraisse’s ICU in
> 1985–1989, then since 1989 in François Jardin’s ICU, using the on-site 1982
> ADR-4000 devoted to cardiac assessment, in actual fact suitable for whole
> body and lung assessment and not larger than nowadays laptops [1]. At this
> time, although an old idea [2], ultrasound was not routine in the ICUs and
> had neglected this vital organ [3]. Many doctors thought that lung
> ultrasound was unfeasible [4, 5]. For demonstrating that this dogma was
> wrong, deciphering the artifact code was the easy part, but publishing was
> the hard one, far from finished.

It doesn't sound like there was a breakthrough in the instruments, just that
people had written off lung ultrasound quite early, and someone had to go back
and try it properly, and then convince everyone else there was something to
it!

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734893/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734893/)

[2]
[https://annalsofintensivecare.springeropen.com/articles/10.1...](https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-4-1)

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hef19898
Thanks for sharing that!

