Feasibility and Reliability of Automatic Quantitative Analyses of Mitral Annular Plane Systolic Excursion by Handheld Ultrasound Devices: A Pilot Study.

OBJECTIVES: Handheld ultrasound devices (HUDs) have previously been limited to grayscale imaging without options for left ventricle (LV) quantification. We aimed to study the feasibility and reliability of automatic measurements of mitral annular plane systolic excursion (MAPSE) by HUDs. METHODS: An algorithm that automatically measured MAPSE from live grayscale recordings was implemented in a HUD. Twenty patients at a university hospital were examined by either a cardiologist or a sonographer. Standard echocardiography using a high-end scanner was performed. The apical 4-chamber view was recorded 4 times by both echocardiography and the HUD. MAPSE was measured by M-mode and color tissue Doppler (cTD) during echocardiography and automatically by the HUD. RESULTS: The automatic method underestimated mean MAPSE ± SD versus M-mode (9.6 ± 2.2 versus 10.9 ± 2.6 mm; difference, 1.2 ± 1.4 mm, P < .005). The difference between the automatic and cTD measurements was not significant (0.8 ± 1.8 mm; P = .073). The intraclass correlation coefficients (ICCs) between automatic and M-mode measurements was 0.85, and 0.81 for cTD measurements. There was good agreement between the methods, and the intra- and inter-rater ICCs were excellent for all methods (≥0.86). CONCLUSIONS: In this novel study evaluating automatic quantification of LV longitudinal function by HUD, we showed the high feasibility and reliability of the method. Compared to M-mode imaging, the automatic method underestimated MAPSE by 8% to 10%, but the difference with cTD imaging was nonsignificant. We conclude that this study's method for automatic quantitative assessment of LV function can be integrated in HUDs.

Wireless, Real-Time Plane-Wave Coherent Compounding on an iPhone: A Feasibility Study.

The processing power in commercially available hand-held devices has improved dramatically in recent years. In parallel, techniques used in high-frame-rate medical ultrasound imaging, especially plane-wave (PW) imaging, have reduced the number of ultrasound transmissions and amount of data necessary to reconstruct an ultrasound image. In combination, the processing power and data reduction allow all of the processing steps in ultrasound image formation, from raw ultrasound channel data to final rendering, to be performed on a hand-held device. In this study, we send the raw ultrasound channel data from a research scanner wirelessly to an off-the-shelf hand-held device. The hand-held unit's graphical processing unit is processing the raw ultrasound data into the final image, achieving real-time frame rates on the order of 60-90 frames per second (FPS) for a single-angle PW transmission. Higher quality images are achieved by trading off frame rate by coherently compounding multiple PW images, resulting in frame rates on the order of, e.g., 13 FPS when coherently compounding 7 PW transmissions. The presented setup has the potential of providing image quality which could be valuable for simple medical ultrasound diagnostic scans of, e.g., the carotid artery or thyroid. Also, since the computationally expensive beamforming can be done in off-the-shelf devices, this could reduce the price of hand-held ultrasound systems in the future.