Feature | April 13, 2011 | Helen Kuhl

Good Things in Small Packages

Portable ultrasound systems have become a useful tool in a variety of healthcare settings

One might not expect the old adage “good things come in small packages” to have validity when speaking about imaging systems, where some modalities require a room-size space to be utilized. But in the case of ultrasound, portable systems as small as a smart phone have made inroads in a variety of settings, with proponents wondering how they lived without them.

Two well-known manufacturers of portable ultrasound systems are SonoSite, with its NanoMaxx, M-Turbo, S-Series and MicroMaxx systems, and GE Healthcare, with its newer Vscan. Physicians using these systems attest to several applications where they are proving to be small but mighty.

One is Richard Milani, M.D., vice chairman, department of cardiology at Ochsner Health System in New Orleans, who has had a GE Vscan for only six months but already is using it in a number of ways. In his cardiovascular practice, he treats different types of heart patients suffering from multiple problems, such as congestive heart failure, hypertrophy of the heart, valve and coronary diseases, and blocked arteries. In the procedure lab, having the Vscan available to give a quick answer makes a difference, he said.

“In the procedure labs, it’s a rare complication (but not so rare that you don’t think of it happening) that a tamponade can occur, where you have blood leaking and you have to make a quick diagnosis. When it happens, you need to know right away,” he said. “Having the device right in the lab can help. You don’t have to wait for a big, bulky ultrasound machine to arrive from another department. In the time it would take to call for one, you have an answer. And if there is something that concerns you a little, you can turn the device on and get an immediate answer.”

The small size of the Vscan is an advantage as well, Milani said. “It’s nice that it takes up less space in that type of situation. You don’t have to work around a big ultrasound machine in a crowded area.”

Milani added that being able to make a quick diagnosis is helpful in non-emergency situations as well. “Either in the office or the hospital, you have situations where you don’t need a full echo. You can pull the device out, use it and get quick information that could lead you to an echo or help you avoid one.”

There have been unanticipated ways in which the portable ultrasound has come in handy as well, particularly as an educational tool for both patients and students.

“Beforehand, we didn’t realize how helpful it would be for patient education,” Milani said. “There always is a question about how much information patients actually retain after a doctor talks to them. It is usually just a small amount that they can relay back to a loved one, so anything we can do to help in this regard is a great thing. With the Vscan, we can hold up the device and show them, for example, how their heart valve is leaking. This forms an indelible image with patients and their family members and helps them understand. This was one unexpected benefit of having the device, and it has a big impact.”

Similarly it is useful for teaching med students, Milani noted. He is in a teaching institution and said the device helps him teach doctors in training. “If I’m with students and talking about a heart murmur or a disease, I can quickly show them what it looks like,” he said.

Greater Efficiency in Preventing Pain
Stuart Grant, MB, ChB, who is professor of anesthesiology at Duke University Medical Center in Durham, N.C., has an altogether different use for the portable ultrasound units he has utilized for eight years. He treats patients with a variety of problems, including a lot of orthopedics, and uses ultrasound to visualize needle placement in administering anesthetics. It is especially useful for situations involving difficult femoral access, peripheral nerve blocks or venous access. For him, having a small unit that can be moved easily from pre-op to the operating room (OR) in order to put in a line is quite important.

“The size is an advantage when you are dealing with tight doorways, entrances and exits,” he said. “Having a small unit is good.”

The Duke medical center has several NanoMaxx, M-Turbo and S-Series ultrasound units from SonoSite that not only are used in pre-op and the OR, but also in intensive care for post-operative pain control. “One change occurring in anesthesia today is the ability to provide post-operative pain control with ultrasound,” Grant said. “You can visualize where the needle is more accurately and safely when you are depositing a local anesthetic. We now have several portable devices just for the intensive care unit.

“Before we used ultrasound, we used landmark techniques,” he added. “But this has gotten more difficult with larger-size patients today. Ultrasound greatly improves efficiency and, I believe, also improves safety.”

Although the portable units have been around for several years, Milani said he believes that many people in the industry are not really familiar with them. “It is still a novelty that they haven’t seen yet,” he said. “People might have seen one in a commercial or an advertisement one time, but most people haven’t seen it in action.”

His is always in his lab coat, he added. “It’s something that the more you think about it, the more you realize how helpful it is and how much you can use it.”

Siemens Hand-Held Unit Also Available
Siemens also offers a hand-held ultrasound unit, the Acuson P10. Introduced in 2008, it is a diagnostic and screening tool designed for physicians, nurses and emergency medical technicians (EMTs). Siemens says it can be used in an array of applications from cardiology and OB/GYN.

Eyal Herzog, M.D., director of cardiac care at St. Luke’s Roosevelt Hospital in New York, was one of the first to use the Acuson P10 in a trial and described his experiences in a short video for Siemens. He pointed out its usefulness in critical care situations because of its small size and portability, as well as the benefits of providing information quickly.

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