Handheld Point-of-Care Ultrasound Probes: The New Generation of POCUS

Abstract

Recent advances in ultrasound technology have made ultrasound equipment more versatile, portable, and accessible than ever. Modern handheld, ultra-portable ultrasound devices have been developed by multiple companies and are contributing to make bedside ultrasound evaluation a practice available to all physicians. The significance of making point-of-care ultrasound (POCUS) a common practice that all physicians eventually can use in the evaluation of their patients is changing the way medicine is practiced, allowing physicians to quickly obtain valuable information to complement the traditional physical examination. Despite the proven benefits of using bedside ultrasound imaging as a part of the patient evaluation and for procedure guidance, adoption of this technology still is not widespread among anesthesiology clinicians nor is there uniform teaching of ultrasound skills to anesthesia residents and faculty. Among obstacles that have been identified as precluding achievement of the goal of widespread utilization of POCUS among anesthesia professionals and trainees, are the availability of equipment for all physicians when it is needed and lack of instructor supervision for trainees who desire to use ultrasound but do not always have an instructor knowledgeable in POCUS with them when an ultrasound examination is warranted. Herein, the characteristics, advantages, and limitations of available ultra-portable, handheld ultrasound devices are analyzed, with a focus on the Butterfly iQ (Butterfly Network, Inc, Guilford, CT) pocket probe, which is available at the authors' institution, and how some of its features, such as the capacity to emulate multiple transducers and its cloud-sharing and teleguidance technology, may contribute to increase the availability and use of POCUS by anesthesia clinicians.

The Use of Handheld Ultrasound Devices in Emergency Medicine

“…The product from Butterfly Network Inc., however, utilizes capacitive micromachined ultrasound transducers on complementary metal oxide semiconductors, or CMUT-on-CMOS technology. CMUTs replace the traditional vibrating piezoelectric crystals with oscillating drums embedded in a single silicon chip, serving the same function of converting electricity into sound waves [ 4 , 5 ]. In addition to decreasing the cost of production, this technology allows a single device to operate at a wider range of frequencies, negating the need for multiple probes [ 5 ].…”

“…Some HHU devices feature artificial intelligence (AI) packages that perform calculations such as ejection fraction and bladder volume measurement [ 5 ]. Image recognition software allows auto-identification and labeling of structures and gives real-time feedback on the quality of the images obtained.…”

“…Understanding the benefits and limitations of HHU is critical to its proper use in the clinical arena. In the same way a POCUS examination is not a comprehensive evaluation, HHU excels when used to evaluate well-defined clinical questions in a manner that respects the limitations of this new technology [ 3 ••, 5 ].…”

“…Most HHU devices offer a battery life that is capable of intermittent scanning for the duration of a clinical shift without being tethered to an electrical outlet [ 5 , 8 , 9 ]. However, this benefit is tempered by the tendency of some devices to overheat after a relatively short period of use [ 5 , 8 ]. Image quality of HHU has a foundation of published literature establishing its non-inferiority to cart-based machines for POCUS applications 1 , though anecdotally HHU-generated images are subjectively of lesser quality (Fig.…”

Global point-of-care ultrasound education and training in the age of COVID-19

“…Tele-ultrasound platforms include cell phones using Facetime (Apple Inc., Cupertino, CA, USA) or WhatsApp ( Facebook Inc., Menlo Park, CA, USA), IIT’s Reacts platform (Innovative Imaging Technologies) through Philips Lumify and Butterfly TeleGuidance through Butterfly IQ (Butterfly Network Inc., Guilford, CT). The presence of artificial intelligence (AI) and augmented reality (AR) yield opportunities to optimize image quality and provide real-time guidance on probe placement; these are newer features on specific platforms in addition to image interpretation support that increase trainee learning while reducing the spread of infection [ 14 ].…”