A Freehand 3D Ultrasound Carotid Scanning System for Point-of-Care Ultrasonography

Stroke is a leading cause of morbidity and mortality throughout the world. Three-dimensional ultrasound (3DUS) imaging was shown to be more sensitive to treatment effect and more accurate in stratifying stroke risk than two-dimensional ultrasound (2DUS) imaging. Point-of-care ultrasound screening (POCUS) is important for patients with limited mobility and at times when the patients have limited access to the ultrasound scanning room, such as in the COVID-19 era. We used an optical tracking system to track the 3D position and orientation of the 2DUS frames acquired by a commercial wireless ultrasound system and subsequently reconstructed a 3DUS image from these frames. The tracking requires spatial and temporal calibrations. Spatial calibration is required to determine the spatial relationship between the 2DUS machine and the tracking system. Spatial calibration was achieved by localizing the landmarks with known coordinates in a custom-designed Z-fiducial phantom in an 2DUS image. Temporal calibration is needed to synchronize the clock of the wireless ultrasound system and the optical tracking system so that position and orientation detected by the optical tracking system can be registered to the corresponding 2DUS frame. Temporal calibration was achieved by initiating the scanning by an abrupt motion that can be readily detected in both systems. This abrupt motion establishes a common reference time point, thereby synchronizing the clock in both systems. We demonstrated that the system can be used to visualize the three-dimensional structure of a carotid phantom. The error rate of the measurements is 2.3%. Upon in-vivo validation, this system will allow POCUS carotid scanning in clinical research and practices. © 2023 SPIE.

Multi-organ ultrasound for SARS-COV-2 disease

Aim: There is growing evidence regarding the imaging ultrasound findings of coronavirus disease 2019 COVID-19. Multi-organ ultrasound has played a significant role in the diagnosis and follow-up of these patients. The aim of this study was to describe the ultrasound findings at pulmonary, cardiac and deep venous system of the lower extremities in patients with SARS-COV-2 infection. Material and method: Prospective, cross-sectional, observational study was conducted in patients with confirmed COVID-19 who underwent a multi-organ point-of-care ultrasound (POCUS) examination during hospitalization. Results: A total of 107 patients were enrolled. Lung involvement was present in 100% of the patients, 93.4% bilaterally involvement. The most affected lung area was the posteroinferior (94.39%) followed by the lateral (89.72%). Subpleural consolidations were present in 71% of patients and consolidations larger than 1 cm in 25%. More echographic lung involvement is relational with the degree of respiratory insufficiency. Only two patients had proximal deep vein thrombosis in the lower extremities, 27 angiography tomography scan were performed and pulmonary thromboembolism was confirmed in 14 patients. The most frequent echocardiographic findings were impaired left ventricular relaxation and left ventricular hypertrophy. All patients with thromboembolic disease had severe or critical echocardiographic pulmonary involvement. Conclusions: Multi-organ POCUS ultrasound may be useful for the manifestations of COVID-19. The degree of lung ultrasound involvement was related to the degree of respiratory failure and to the presence of VTED. The relationship between DVT and PTE was lower than expected. Cardiac involvement has little relevance in our series.

A Proposed Approach for the Management of Clot-in-Transit.

Clot-in-transit (CIT) is defined as a mobile echogenic material in the right atrium or ventricle as observed on ultrasound. A right heart free-floating thrombus is unusual when there is no structural disease of the heart or atrial fibrillation. Cardiopulmonary collapse and quick death can come from CIT, which occurs when a blood clot moves from the heart to the lungs. There are some clinical case reports of a large volume thrombus that was freely floating in the right heart in an asymptomatic patient, and the best therapeutic options are uncertain. Although several trials have been conducted on the treatment of CIT, clinical judgment is still used to determine the best treatment for right heart thrombus (RHT), especially when associated with pulmonary embolism (PE). In this review article, we discuss various diagnostic modalities and treatment options for this rare malady. We studied in detail their clinical impact on patients according to past research studies.

CapsCovNet: A Modified Capsule Network to Diagnose COVID-19 From Multimodal Medical Imaging.

Since the end of 2019, novel coronavirus disease (COVID-19) has brought about a plethora of unforeseen changes to the world as we know it. Despite our ceaseless fight against it, COVID-19 has claimed millions of lives, and the death toll exacerbated due to its extremely contagious and fast-spreading nature. To control the spread of this highly contagious disease, a rapid and accurate diagnosis can play a very crucial part. Motivated by this context, a parallelly concatenated convolutional block-based capsule network is proposed in this article as an efficient tool to diagnose the COVID-19 patients from multimodal medical images. Concatenation of deep convolutional blocks of different filter sizes allows us to integrate discriminative spatial features by simultaneously changing the receptive field and enhances the scalability of the model. Moreover, concatenation of capsule layers strengthens the model to learn more complex representation by presenting the information in a fine to coarser manner. The proposed model is evaluated on three benchmark datasets, in which two of them are chest radiograph datasets and the rest is an ultrasound imaging dataset. The architecture that we have proposed through extensive analysis and reasoning achieved outstanding performance in COVID-19 detection task, which signifies the potentiality of the proposed model.

Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre-post study.

BACKGROUND: Point-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians' knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians' attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys. RESULTS: There was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p < 0.0001). There was no difference in baseline cleaning rates before (0.63, SE 0.09) and after (0.61, SE 0.1) the onset of the COVID-19 pandemic (p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning. CONCLUSION: Thoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.

The role of lung ultrasound in COVID-19 disease.

This statement summarises basic settings in lung ultrasonography and best practice recommendations for lung ultrasonography in COVID-19, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR). Standard lung settings and artefacts in lung ultrasonography are explained for education and training, equipment settings, documentation and self-protection.

Quantitative pleural line characterization outperforms traditional lung texture ultrasound features in detection of COVID-19.

BACKGROUND AND OBJECTIVE: Lung ultrasound is an inherently user-dependent modality that could benefit from quantitative image analysis. In this pilot study we evaluate the use of computer-based pleural line (p-line) ultrasound features in comparison to traditional lung texture (TLT) features to test the hypothesis that p-line thickening and irregularity are highly suggestive of coronavirus disease 2019 (COVID-19) and can be used to improve the disease diagnosis on lung ultrasound. METHODS: Twenty lung ultrasound images, including normal and COVID-19 cases, were used for quantitative analysis. P-lines were detected by a semiautomated segmentation method. Seven quantitative features describing thickness, margin morphology, and echo intensity were extracted. TLT lines were outlined, and texture features based on run-length and gray-level co-occurrence matrix were extracted. The diagnostic performance of the 2 feature sets was measured and compared using receiver operating characteristics curve analysis. Observer agreements were evaluated by measuring interclass correlation coefficients (ICC) for each feature. RESULTS: Six of 7 p-line features showed a significant difference between normal and COVID-19 cases. Thickness of p-lines was larger in COVID-19 cases (6.27 ± 1.45 mm) compared to normal (1.00 ± 0.19 mm), P < 0.001. Among features describing p-line margin morphology, projected intensity deviation showed the largest difference between COVID-19 cases (4.08 ± 0.32) and normal (0.43 ± 0.06), P < 0.001. From the TLT line features, only 2 features, gray-level non-uniformity and run-length non-uniformity, showed a significant difference between normal cases (0.32 ± 0.06, 0.59 ± 0.06) and COVID-19 (0.22 ± 0.02, 0.39 ± 0.05), P = 0.04, respectively. All features together for p-line showed perfect sensitivity and specificity of 100; whereas, TLT features had a sensitivity of 90 and specificity of 70. Observer agreement for p-lines (ICC = 0.65-0.85) was higher than for TLT features (ICC = 0.42-0.72). CONCLUSION: P-line features characterize COVID-19 changes with high accuracy and outperform TLT features. Quantitative p-line features are promising diagnostic tools in the interpretation of lung ultrasound images in the context of COVID-19.

Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

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.

[German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. / Empfehlungen zur Lungen- und Thoraxsonographie bei Patienten mit COVID-19-Erkrankung.

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV­2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).

Current role of imaging in COVID-19 infection with recent recommendations of point of care ultrasound in the contagion: a narrative review.

Radiological studies have an important role in the diagnosis and follow up of many infectious diseases. With current pandemic of Coronavirus disease 2019 (COVID-19) though the molecular analysis with reverse transcriptase polymerase chain reaction (RT-PCR) remains the cornerstone of diagnosis, the critical role of chest imaging including CT scan and baseline X-ray became apparent early in the course due to concern for less than optimal sensitivity of PCR testing. Delay in molecular diagnosis due to a shortage of testing kits and laboratory personnel also makes imaging an important modality in early diagnosis for appropriate triage and isolation decisions. CT scan technology is widely available in developed parts of the world but in developing countries, CT scanner is not widely available especially in rural settings. CT imaging usually requires patient movement to the radiology department and the scanner is not easy to disinfect. Point of care ultrasound (POCUS) has been used for many years in the assessment of critically ill patients in emergency departments and intensive care units. It is rapidly gaining popularity across many specialties and part of many general medicine training programs across the United States. It can be learned rapidly and with experienced hands, POCUS can help identify disease patterns in the lung parenchyma, and during the current pandemic has been gaining special attention. In this article, we review the most prominent imaging findings on chest X-ray and CT scan in patients with COVID-19. We also focus on the background and evolution of POCUS with studies showing the promising role of this diagnostic modality in COVID-19 infection. In addition, we describe step by step guidance on the use and disinfection of the portable ultrasound machine.

A Review of Early Experience in Lung Ultrasound in the Diagnosis and Management of COVID-19.

A novel coronavirus (2019-nCoV) was identified as the cause of a cluster of pneumonia in Wuhan, China, at the end of 2019. Since then more than eight million confirmed cases of coronavirus disease 2019 (COVID-19) have been reported around the globe. The current gold standard for etiologic diagnosis is reverse transcription-polymerase chain reaction analysis of respiratory-tract specimens, but the test has a high false-negative rate owing to both nasopharyngeal swab sampling error and viral burden. Hence diagnostic imaging has emerged as a fundamental component of current management of COVID-19. Currently, high-resolution computed tomography is the main imaging tool for primary diagnosis and evaluation of disease severity in patients. Lung ultrasound (LUS) imaging has become a safe bedside imaging alternative that does not expose the patient to radiation and minimizes the risk of contamination. Although the number of studies to date is limited, LUS findings have demonstrated high diagnostic sensitivity and accuracy, comparable with those of chest computed tomography scans. In this note we review the current state of the art of LUS in evaluating pulmonary changes induced by COVID-19. The goal is to identify characteristic sonographic findings most suited for the diagnosis of COVID-19 pneumonia infections.