Comparative analysis of hand-held and stationary ultrasound for detection of sarcopenia in acutely hospitalised older adults-a validity and reliability study.

BACKGROUND AND PURPOSE: Sarcopenia is a growing health concern among geriatric patients. Early diagnostics is importance to intervene and better muscle status and thus physical function. Ultrasound can be a valuable tool for patient-near diagnostics of sarcopenia. In recent time, ultrasound devices have evolved from larger stationary devices to minor hand-held devices that are more portable. However, the literature lacks research comparing quality of the different devices. The purpose of this study was to compare hand-held ultrasound (HH-US) to stationary ultrasound (S-US) in muscle assessment for detection of sarcopenia in acutely hospitalized older adults. METHODS: A cross-sectional study using a convenience sample of acutely admitted older patients examined with both HH-US and S-US within a single session by the same examiner. Image analysis was performed using ImageJ, and was conducted by two raters: Rater 2 an experienced US examiner and Rater 1 an US examiner who received training from Rater 2. The Ultrasound sarcopenia index (USI) was used for evaluating sarcopenia. Validity and reliability of HH-US were analyzed using Cohen's Kappa and Student's t-test. RESULTS: 21 participants (mean age 83.4 years, 52% female). Results showed "substantial" intra-rater reliability (κ = 0.77 for Rater 1) and 'near-perfect' validity (κ = 0.92 for Rater 2). Inter-rater comparisons revealed no significant differences (p < 0.05). CONCLUSION: HH-US is a potential method for detection of sarcopenia in acutely hospitalized older adults.

[Prehospital ultrasound in emergency medicine]. / Prähospitaler Ultraschall in der Notfallmedizin.

Small, portable hand-held ultrasound devices nowadays enable a widespread use of prehospital point-of-care ultrasound (pPOCUS), which has so far only been used hesitantly, especially in ground-based emergency services. Many critical or even life-threatening conditions or internal injuries can often be better diagnosed or ruled out using pPOCUS, which can enable faster and more suitable goal-directed treatment and hospital transport. This article critically discusses relevant data, clinical benefits, limitations and challenges to be overcome when using pPOCUS for the most important life-threatening situations and aims to call for intensifying training and the extensive use of pPOCUS.

Comparative analysis of automated breast volume scanner (ABVS) combined with conventional hand-held ultrasound and mammography in female breast cancer detection.

Objective and background: This study aimed to compare the diagnostic value of an automated breast volume scanner (ABVS) combined with conventional hand-held ultrasound and mammography in detecting female breast cancer. Early detection is vital in improving patient outcomes for this prevalent disease. Methods: Seventy-eight suspicious breast lesions from 60 patients were examined between August 2019 and July 2020. Each patient underwent ABVS, conventional hand-held ultrasound, and mammography. Diagnostic values, including coincidence rate, sensitivity, specificity, positive predictive value, and negative predictive value, were calculated using histopathology results as the "gold standard." Results: Histopathology confirmed 55 malignant (70.51%) and 23 benign lesions (29.48%). ABVS combined with conventional hand-held ultrasound identified 56 malignant (52 confirmed, 4 benign) and 22 benign nodules (3 confirmed, 19 benign). Mammography detected 48 malignant (45 confirmed, 3 benign) and 30 benign nodules (10 confirmed, 20 benign). ABVS combined with conventional hand-held ultrasound had a sensitivity of 94.5%, specificity of 82.6%, positive predictive value of 92.9%, and negative predictive value of 86.4%. Mammography showed a sensitivity of 81.8%, specificity of 87.0%, positive predictive value of 93.8%, and negative predictive value of 66.7%. Conclusion: ABVS combined with conventional hand-held ultrasound showed high diagnostic value in detecting female breast cancer. The "convergence sign" in the coronal section played a significant role. It slightly outperformed mammography and offered advantages in terms of cost, convenience, comfort, and absence of radiation. Further promotion and implementation are supported.

A training program for obstetrics point-of-care ultrasound to 514 rural healthcare providers in Kenya.

BACKGROUND: Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfly Network, Global Ultrasound Institute, and Kenyatta University. METHODS: As part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were recruited from rural Kenyan hospitals for participation in a series of five-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students' scanning and image interpretation occurred over the training period. Assessment of knowledge and confidence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion. RESULTS: Five hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a three-month period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fluid volume. There was marked improvement in the post training test scores compared to the pretest scores. CONCLUSION: Our implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.

A Cadaveric Study Examining the Accuracy of Wireless Hand-Held Guided Ultrasound Injections Versus Blind Injections in the Flexor Tendon Sheath.

Purpose: Hand-held ultrasound (HHUS) is gaining popularity among clinicians. Although its use for procedural guidance could have several advantages in hand surgery, other surgeons may wonder about its added benefits. This cadaveric study aimed to examine the hypothesis of increased accuracy of wireless HHUS-guided injections versus that of blind injections into the flexor sheath. Methods: Our series included 20 fresh cadaveric hands with 80 fingers randomly assigned to 2 groups. In group A, 10 hands were randomly assigned to receive a landmark injection and then received a blinded injection to the flexor tendon sheath (FTS). In group B, 10 hands were blinded in the same manner and received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomic dissection was performed to evaluate the injection accuracy based on the dye's filling pattern in the FTS as stage I (no filling), stage II (<50% filling), and stage III (>50% filling). Statistical analysis was performed, and P <.05 indicated a significant difference. Results: One finger was excluded because of severe Dupuytren contracture. In group A, 39 blind injections of the FTS were performed, with 82% (32/39) fingers achieving stage III filling. In group B, 40 ultrasound-guided FTS injections were performed, with 90% (36/40) of fingers achieving stage III filing. Our study did not reveal any superiority in accuracy when ultrasound guidance was used (P = .35). Conclusions: Hand-held ultrasound-guided FTS injections were not more accurate than blind injections performed by an experienced hand surgeon. These findings suggest that blind injections can be used as routine practice when performed by experienced operators to treat trigger finger. However, the use of HHUS may offer other advantages in hand surgery practice. Clinical relevance: Ultimately, choosing to perform HHUS-guided injection versus blind injection to treat trigger finger depends on the surgeon's experience and preference for a particular technique.

Accuracy of Wireless Hand-Held Guided Ultrasound Injections in the Trapeziometacarpal Joint: A Cadaveric Study.

Background Symptomatic trapeziometacarpal osteoarthrosis can be treated with an ultrasound-guided injection in the early stages. This cadaveric study aimed to assess the hypothesis suggesting enhanced accuracy and reliability of hand-held ultrasound (HHUS) injections compared to blind injections into the trapeziometacarpal joint (TMC). Materials and method Our series included 20 fresh cadaveric hands, with a total of 20 TMC randomly assigned to two groups. In group A, 10 TMC received a blinded injection, and in group B, 10 TMC received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomical dissection was performed to assess the intra-articular location of the dye. The injection was considered accurate if the intra-articular synovial fluid was stained after opening the articular capsule on the dorsal approach. If there was no injection, it was inaccurate. A statistical analysis was performed, and p <.05 indicated a significant difference. Results Two thumbs were excluded during the study due to an existing trapeziectomy. In group A, 10 blind injections of TMC were performed, with 70% (7/10) of injections graded as accurate. In group B, eight ultrasound-guided injections were performed, with 75% (6/8) achieving accuracy. A Fisher's exact test was performed, and the results indicated no statistically significant difference in injection accuracy between the two groups (P = 1, odds ratio = 0.788). Conclusion Hand-held ultrasound guided TMC injections were not more accurate than blind injections performed by an experienced hand surgeon. Nonetheless, additional studies with a larger sample and comparative studies with conventional cart-based machines are necessary to evaluate the potential of this newly accessible device.

Integrated Assessment of Heart, Lung and Lower Extremity Veins Using Hand-Held Ultrasound Device in COVID-19 Patients: Feasibility and Clinical Application.

The emergence of the COVID-19 pandemic caused a significant shortage of medical personnel and the prioritization of life-saving procedures on internal medicine and cardiology wards. Thus, the cost- and time-effectiveness of each procedure proved vital. Implementing elements of imaging diagnostics into the physical examination of COVID-19 patients could prove beneficial to the treatment process, providing important clinical data at the moment of admission. Sixty-three patients with positive COVID-19 test results were enrolled into our study and underwent physical examination expanded with a handheld ultrasound device (HUD)-performed bedside assessment included: right ventricle measurement, visual and automated LVEF assessment, four-point compression ultrasound test (CUS) of lower extremities and lung ultrasound. Routine testing consisting of computed-tomography chest scanning, CT-pulmonary angiogram and full echocardiography performed on a high-end stationary device was completed in the following 24 h. Lung abnormalities characteristic for COVID-19 were detected in CT in 53 (84%) patients. The sensitivity and specificity of bedside HUD examination for detecting lung pathologies was 0.92 and 0.90, respectively. Increased number of B-lines had a sensitivity of 0.81, specificity 0.83 for the ground glass symptom in CT examination (AUC 0.82; p < 0.0001); pleural thickening sensitivity 0.95, specificity 0.88 (AUC 0.91, p < 0.0001); lung consolidations sensitivity 0.71, specificity 0.86 (AUC 0.79, p < 0.0001). In 20 patients (32%), pulmonary embolism was confirmed. RV was dilated in HUD examination in 27 patients (43%), CUS was positive in two patients. During HUD examination, software-derived LV function analysis failed to measure LVEF in 29 (46%) cases. HUD proved its potential as the first-line modality for the collection of heart-lung-vein imaging information among patients with severe COVID-19. HUD-derived diagnosis was especially effective for the initial assessment of lung involvement. Expectedly, in this group of patients with high prevalence of severe pneumonia, HUD-diagnosed RV enlargement had moderate predictive value and the option to simultaneously detect lower limb venous thrombosis was clinically attractive. Although most of the LV images were suitable for the visual assessment of LVEF, an AI-enhanced software algorithm failed in almost 50% of the study population.

Handheld ultrasonography in cardiovascular medicine, updates and controversies.

A variety of hand-held ultrasound (HHU) machines have recently become available and offer different capabilities and features. Despite the differences of the individual HHU devices, all offer the potential for faster diagnoses and are more sensitive than clinical assessment in identifying cardiovascular abnormalities. In addition, they provide enhanced transportability, can potentially reduce waiting time for full echocardiograms, and may save health-care resources. Significant potential for the growth of HHU as a tool to facilitate patient care exists when performed by well-trained and competent providers is anticipated. This paper presents the characteristics, benefits, limitations, and future perspectives of HHU devices.

Supine versus Prone 3D Abus Accuracy in Breast Tumor Size Evaluation.

Breast-conserving surgery (BCS) with negative resection margins decreases the locoregional recurrence rate. Breast cancer size is one of the main determinants of Tumor-Node-Metastasis (TNM) staging. Our study aimed to investigate the accuracy of supine 3D automated breast ultrasound (3D ABUS) compared to prone 3D ABUS in the evaluation of tumor size in breast cancer patient candidates for BCS. In this prospective two-center study (Groups 1 and 2), we enrolled patients with percutaneous biopsy-proven early-stage breast cancer, in the period between June 2019 and May 2020. Patients underwent hand-held ultrasound (HHUS), contrast-enhanced magnetic resonance imaging (CE-MRI) and 3D ABUS-supine 3D ABUS in Group 1 and prone 3D ABUS in Group 2. Histopathological examination (HE) was considered the reference standard. Bland-Altman analysis and plots were used. Eighty-eight patients were enrolled. Compared to prone, supine 3D ABUS showed better agreement with HE, with a slight tendency toward underestimation (mean difference of -2 mm). Supine 3D ABUS appears to be a useful tool and more accurate than HHUS in the staging of breast cancer.

Effectiveness of Ultrasound Cardiovascular Images in Teaching Anatomy: A Pilot Study of an Eight-Hour Training Exposure.

The present study aimed to evaluate the students' progress in evaluating ultrasound (US) and cadaveric cardiac images and long-time retention of information. First-year medical students were invited to participate in four two-hour online lectures during one week voluntarily. The students were trained to recognize cardiovascular anatomical structures on US and cadaveric images during the intervention. The participants' abilities to identify specific anatomical structures were tested before, immediately after and six months after the training. A group of second-year students without US training participated as a control group and filled the same test once. Ninety-one first-year students agreed to participate, and forty-nine completed all three tests. The performances in the correct identification of cardiovascular structures on the US images significantly improved after the training but significantly decreased after six months. In the intervention group, the accurate identification of cardiovascular structures was significantly higher on cadaveric images (80% vs. 53%, p-value < 0.0001, n = 91 at post-training; 70% vs. 33%, p-value < 0.0001, n = 49 at 6 months after training). The correct answers percentage score in the control group varied from 6.7% to 66.7% for US cardiovascular anatomical without a significant difference than the intervention group (p-value = 0.7651). First-year students' knowledge of heart US anatomy proved less effective than cadaveric images, significantly improved after training and decreased over time, indicating the need for repetition reinforcement.

Adaptation of an anatomy graduate course in ultrasound imaging from in-person to live, remote instruction during the Covid-19 pandemic.

Health concerns during the Covid-19 pandemic required the adaptation of a lecture-laboratory course in ultrasound imaging for graduate students from an in-person to a live, remote learning format. The adaptation of in-person lectures to live, remote delivery was achieved by using videoconferencing. The adaptation of in-person laboratory sessions to live, remote instruction was achieved in the first half of the course by providing a hand-held ultrasound instrument to each student who performed self-scanning at their remote locations, while the instructor provided live instruction using videoconferencing. In the second half of the course, the students transitioned to using cart-based, hospital-type instruments and self-scanning in the ultrasound laboratory on campus. The aim of this study was to measure the success of this adaptation to the course by comparing assessment scores of students in the live, remote course with assessment scores of students in the in-person course offered in the previous year. There were no statistically significant differences in the assessment scores of students in the two courses. The adaptation of a course in ultrasound imaging from an in-person to a live, remote learning format during the Covid-19 pandemic described here suggests that contrary to the prevailing view, ultrasound imaging can be taught to students without in-person instruction. The adapted course can serve as a model for teaching ultrasound where instructors and learners are physically separated by constraints other than health concerns during a pandemic.

Diagnostic value of automated breast volume scanning versus hand-held ultrasound for benign and malignant lesions in breast: a Meta-analysis / 肿瘤研究与临床

Objective:To systematically assess the diagnostic value of automated breast volume scanning (ABVS) versus hand-held ultrasound (HHUS) in benign and malignant breast lesions.Methods:The Cochrane Library, PubMed, Embase, Ovid, China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biology Medicine (CBM) and other databases were searched from the beginning of database construction to January 2022. Relevant literatures were screened and included, and the characteristics of the literatures were extracted. Meta-disc 1.4 statistic software was used to analyze the pooled diagnostic odds ratio (DOR), specificity, sensitivity, 95% CI, the summary receiver operating characteristic (SROC) curve and the area under the curve of ABVS and HHUS. The heterogeneity and publication bias were also evaluated. Results:A total of 26 studies were included. Heterogeneity test showed no threshold value effect; random effect model was used to pool specificity, sensitivity and DOR.The pooled sensitivity of ABVS and HHUS was 0.86 (95% CI 0.84-0.87), 0.80 (95% CI 0.78-0.82), respectively; I2 was 89.7% and 82.3%, respectively; the pooled specificity of ABVS and HHUS was 0.91 (95% CI 0.90-0.92), 0.84 (95% CI 0.83-0.86), I2 was 89.7% and 92.2%, respectively. AUC of ABVS, HHUS, and joint diagnosis of the two was 0.954, 0.883, 0.958, respectively. No evidence of publication bias was shown in the funnel plot analysis. Conclusion:ABVS has a higher clinical value compared with HHUS in the diagnosis of benign and malignant breast lesions.

Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the Time of COVID-19.

The coronavirus pandemic abruptly halted all in-person clerkships, or clinical rotations, for clinical veterinary students across the United States. Online clerkships in radiology offered the opportunity to expand the student's ability to interpret medical images but did not allow for the development of physical hands-on imaging skills recognized as core competencies in veterinary medicine. The present report highlights the value of providing veterinary students with a smartphone-associated Butterfly iQ point-of-care ultrasound during a 3-week self-driven virtual clerkship. During the virtual rotation, the student was able to develop the skills required to generate sufficient quality images using three horses residing on her property. The affordability, portability, ease of use of the Butterfly iQ and availability of animals made it possible to develop hands-on imaging skills when distance learning was required.

Dependability of Automated Breast Ultrasound (ABUS) in Assessing Breast Imaging Reporting and Data System (BI-RADS) Category and Size of Malignant Breast Lesions Compared with Handheld Ultrasound (HHUS) and Mammography (MG).

PURPOSE: This study aimed to evaluate the dependability of automated breast ultrasound (ABUS) compared with handheld ultrasound (HHUS) and mammography (MG) on the Breast Imaging Reporting and Data System (BI-RADS) category and size assessment of malignant breast lesions. PATIENTS AND METHODS: A total of 344 confirmed malignant lesions were recruited. All participants underwent MG, HHUS, and ABUS examinations. Agreements on the BI-RADS category were evaluated. Lesion size assessed using the three methods was compared with the size of the pathological result as the control. Regarding the four major molecular subtypes, correlation coefficients between size on imaging and pathology were also evaluated. RESULTS: The agreement between ABUS and HHUS on the BI-RADS category was 86.63% (kappa = 0.77), whereas it was 32.22% (kappa = 0.10) between ABUS and MG. Imaging lesion size compared to pathologic lesion size was assessed correctly in 36.92%/52.91% (ABUS), 33.14%/48.84% (HHUS) and 33.44%/43.87% (MG), with the threshold of 3 mm/5 mm, respectively. The correlation coefficient of size of ABUS-Pathology (0.75, Spearman) was statistically higher than that of the MG-Pathology (0.58, Spearman) with P < 0.01, but not different from that of the HHUS-Pathology (0.74, Spearman) with P > 0.05. The correlation coefficient of ABUS-Pathology was statistically higher than that of MG-Pathology in the triple-negative subtype, luminal B subtype, and luminal A subtype (P<0.01). CONCLUSION: The agreement between ABUS and HHUS in the BI-RADS category was good, whereas that between ABUS and MG was poor. ABUS and HHUS allowed a more accurate assessment of malignant tumor size compared to MG.

Feasibility and Clinical Impact of Point-of-Care Carotid Artery Examinations by Experts using Hand-Held Ultrasound Devices in Patients with Ischemic Stroke or Transitory Ischemic Attack.

BACKGROUND AND PURPOSE: To evaluate the feasibility and clinical influence of carotid artery examinations in patients admitted with stroke or TIA with hand-held ultrasound by experts, to identify individuals not in need of further carotid artery diagnostics. MATERIALS AND METHODS: Cardiologists experienced in carotid ultrasound examined 80 patients admitted to a stroke unit with suspected stroke or TIA with hand-held ultrasound devices (HUD). Grey scale and color Doppler images were stored using a GE Vscan with dual probe (phased array and linear transducer). High-end triplex ultrasound performed by a cardiologist, blinded to the details of the HUD study, was performed in all patients and used as reference. Computer tomography angiography was performed when clinically indicated. RESULTS: Stroke or TIA was diagnosed in 62 (78%) patients. Age was median (range) 72 (23-93) years. A significant stenosis (> 50% diameter reduction) was ruled out in 61 (76%) of patients by the HUD examinations. Sensitivity and specificity for diagnosing a significant stenosis was 92% and 93%, respectively. One of 12 significant stenoses was missed by HUD. All four patients in need of surgery were identified by the HUD examination. Sensitivity and specificity to identify a significant stenosis by HUD was 87% and 83%, respectively, compared to CT angiography. CONCLUSION: HUD examinations of the carotid arteries by experts, using hand-held ultrasound devices, were feasible and may reduce the need for high-end diagnostic imaging of the carotid vessels in patients with stroke and TIA. Thus, HUD may improve diagnostic workflow in stroke units in the future.

Hand-Held Ultrasound of the Lung: A Systematic Review.

BACKGROUND: The ultrasound examination is a surface technique with an accurate diagnosis of pathological processes adjacent to the pleural line. The purpose of the study was to evaluate the role of hand-held ultrasound devices (visual stethoscopes) in the diagnosis of peripheral lung disease. METHODS: We conducted a systematic search of literature comparing the diagnostic accuracy of truly hand-held ultrasound devices compared to conventional high-end ultrasound devices, chest X-rays, thoracic CT (computer tomography), or physical examinations to diagnose peripheral lung lesions. ScienceDirect, PubMed, and PubMed Central bibliographic databases were searched within a time limit of 15 years. RESULTS: The applied search strategy retrieved 439 studies after removing duplicates; 34 were selected for full-text review, and 15 articles met all inclusion criteria and were included in the analysis. When comparing hand-held ultrasound devices to chest X-rays, negative predictive values were above 90%, while positive predictive values tended to be lower (from 35% to 75.8%). Hand-held ultrasound reached a correlation of 0.99 as associated with conventional ultrasound with a Bland-Altman bias close to zero. CONCLUSIONS: Being accessible, radiation-free, and comparatively easy to decontaminate, hand-held ultrasound devices could represent a reliable tool for evaluating peripheral lung diseases. This method can be successfully employed as an alternative to repeated X-ray examinations for peripheral lung disease monitoring.

Diagnostic performance of combined use of automated breast volume scanning & hand-held ultrasound for breast lesions.

Background & objectives: Breast cancer being one of the most common malignant tumours among women, diagnostic modalities for early detection of the same become of paramount importance. In this context, the hand-held ultrasound (HHUS) and automated breast volume scanner (ABVS) could provide valuable information for clinicians to diagnose breast diseases. This study aimed to compare and evaluate the diagnostic performance of combined use of HHUS and ABVS for the differentiation of benign and malignant breast lesions. Methods: A total of 361 female patients, who underwent both HHUS and ABVS examinations were included in this study. ABVS and HHUS images were interpreted using the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS). The distributions of the BI-RADS categories and pathology results were shown as specific numbers. Kappa coefficients test (κ) was calculated to compare the diagnostic results amongst the ABVS, HHUS and ABVS combined with HHUS. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the three diagnostic methods were calculated and their respective diagnostic performance was analyzed by receiver operator characteristic curve. Results: Of a total of 431 lesions, 153 (35.5%) were malignant and 278 (64.5%) were benign. With respect to the pathology results, the value of κ was 0.713 (P<0.001) for HHUS, κ=0.765 (P<0.001) for ABVS and κ=0.815 (P<0.001) for HHUS+ABVS. The sensitivity, specificity, accuracy, PPV and NPV for HHUS combined with ABVS were 96.08 (147/153), 88.49 (246/278), 91.18 (393/431), 82.12 (147/179) and 97.62 per cent (246/252) respectively. For HHUS, these were 90.20 (138/153), 84.17 (234/278), 86.31 (372/431), 75.82 (138/182) and 93.98 per cent (234/249) respectively; and for ABVS these were 92.16 (141/153), 87.05 (242/278), 88.86 (383/431), 79.66 (141/177) and 95.28 per cent (242/254), respectively. There was no significant difference amongst these three methods, but the diagnostic performance of HHUS combined with ABVS was better than, or at least equal to, that of HHUS or ABVS alone. Interpretation & conclusions: The results of this study suggest that ABVS is a promising and advantageous modality for breast cancer detection. Furthermore, the combination of HHUS and ABVS showed a more comparable diagnostic performance than HHUS or ABVS alone for distinguishing between benign and malignant breast lesions.

Special Article - The role of hand-held ultrasound for cardiopulmonary assessment during a pandemic.

During the COVID-19 pandemic, we are likely to see a significant increase in the requests for rapid assessment of cardiac function, due to the frequent pre-existence of cardiac pathologies in patients admitted to hospital, and to the emergence of specific cardiac manifestations of this infection, such as myocarditis, sepsis related cardiomyopathy, stress induced cardiomyopathy and acute coronary syndromes. Hand-held, point-of-care ultrasound (HH-POCUS) is particularly suited for the provision of rapid, focused, integrated assessments of the heart and lungs. We present a review of the indications and protocols for focused HH-POCUS use in an acute setting and formulate proposals for streamlining their application in the COVID-19 context towards guiding optimum management of these patients while at the same time allowing adherence to robust infection control measures to provide safety to both the patient and our clinical staff.

Value of Hand-held Ultrasound in the Differential Diagnosis and Accurate Breast Imaging Reporting and Data System Subclassification of Complex Cystic and Solid Breast Lesions.

To explore the value of hand-held ultrasound (HHUS) for diagnosing complex cystic and solid breast lesions, 472 pathologically proven lesions were analyzed. The lesions were divided into four types based on ultrasound features. Positive predictive values (PPVs) for lesion types and risk factor performances were assessed. Furthermore, HHUS and mammography (MAM) performances were compared: 27 lesions missed in MAM were detected in HHUS. Ultrasound feature analysis revealed higher PPVs for type III and IV lesions than for type I and II lesions. In patients older than 51 y, a type III or IV lesion with a diameter greater than 18 mm, an irregular shape, a non-parallel orientation, an uncircumscribed margin, calcification, vascularity and abnormal axillary lymph nodes were suggestive of malignancy; the area under the curve reached 0.869. Thus, ultrasound is useful in diagnosing complex cystic and solid breast lesions, which should be categorized as Breast Imaging Reporting and Data System (BI-RADS) 4B or 4C.