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The stethoscope of the future: a practical introduction to the world of pocket echocardiography

Moderator: M M Madsen (Aarhus N, DK)

Session presentations
  • How to perform examination with pocket echocardiography. Presented by P Lipiec (Lodz, PL) congress 365
  • When and who should do it? Presented by R C Vidal Perez (Santiago De Compostela, ES) congress 365
  • It's easy, do it yourself! - real-life evidence of usefulness for non-experts (with clinical cases). Presented by R Fontes Carvalho (Porto, PT) congress 365
  • Beware of the dangers! - real-life evidence of problems and pitfalls (clinical cases). Presented by I Stankovic (Leuven, BE) congress 365

The session was included in the ESC Cardiologists of Tomorrow (CoT) educational track within the 2012 Congress programme. Junior cardiologists or doctors in training are represented among the cardiovascular medical professionals through the ESC CoT initiative and also in other structures, such as Club 35 of the European Association of Echocardiography (EAE). This generation of doctors from both groups jointly contributed to the development of the session reported here.

Pocket-size ultrasound devices are a result of technical advances in the field of medical imaging. They fit in a white coat pocket and are much more affordable than conventional systems, but offer less functionality. In relation to that, many new issues have emerged, especially relating to the increased availability, potential of overuse, misdiagnosing and inadequate operating competence.
In the first presentation by Piotr Lipiec, many pragmatic aspects of pocket-size echocardiography examination were discussed, such as technical background, detailed steps throughout the course of the study, options to store images and report the results. A position statement of the EAE on the use of pocket-size imaging devices was published last year, and is the very significant reference for this diagnostic approach. The study protocol should be adjusted to clinical scenario and performed as an extended component of physical examination. The patient should also be informed that using miniaturized echocardiography scanners is not a replacement for conventional ultrasound cardiac evaluation. 

In the next presentation, Rafael Vidal reviewed the indications, environmental settings, potential users, competence levels, workflow and image integration. The importance of knowing the limitations was highlighted. The pocket-size device imaging procedure is available for doctors other than those certified for transthoracic echo, but only after appropriate training. The range of indications is limited in comparison to conventional echocardiography and according to the EAE includes:

  • Complement to a physical examination in the coronary and intensive care unit
  • Tool for a fast initial screening in an emergency setting
  • Cardiological counseling in- or outside health-care facilities and hospitals
  • First cardiac evaluation in ambulances
  • Screening programmes in schools, industry, and community activities
  • Triaging candidates for a complete echocardiographic examination
  • Teaching tool
  • Semi-quantification of extravascular lung water,

Then Ricardo Fontes-Carvalho presented illustrative clinical case reports providing evidence for the pocket-size echo devices in the emergency department (hypertrophic obstructive cardiomyopathy in a patient suspected of MI), after invasive procedures (pericardial effusion and thrombus following cardiac surgery), intensive care unit (myocardial infarction complicated by cardiogenic shock) and outpatient cardiology consultation (aortic regurgitation as a cause for heart failure).

Following this, Ivan Stankovic presented real-life evidence of problems and pitfalls related to miniaturized echo devices. He highlighted the image quality, smaller sector size, less accurate colour Doppler. Nevertheless, device-related errors seem to be unlikely, if limitations are respected. On the other hand, operator-related errors could be very common, related to competence-education issues and resulting in false positive, and potentially more hazardous false negative results. The additional difficulty arises from the stressful environment, time constraints, difficult image acquisition conditions and often critical decisions in severely ill patients.

Therefore, adequate training remains a substantial issue. The EAE proposal for an education programme with a pocket-size echocardiography device objective has been mentioned. According to the position statement, the certification should currently be limited to the clinical questions that can potentially be answered by pocket-size devices. In the future, further technical developments cannot be excluded that would have an impact on the functionality of the miniaturized echocardiography scanners. 




The stethoscope of the future: a practical introduction to the world of pocket echocardiography

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.