How to perform examination with pocket echocardiograph

Transcription

1 How to perform examination with pocket echocardiograph Piotr Lipiec MD PhD FESC Department of Cardiology Medical University of Łódź, Poland

2 Potential conflicts of interest: Speaker s / investigator s fees from: GE, Philips, Siemens, Bracco

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4 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

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6 Is it really POCKET-size? Weight: 390 / 730 grams Display: 3.5 / 3.7 inches

7 Is it easy to use? Boot time around 10 seconds

8 Pocket echo technical characteristics / 2 4 MHz probe Greyscale 2D imaging Sector angle <75 Sector depth < 25 cm Colour flow imaging (one product) Sector angle - 30 Fixed repetition frequency Simple measurements (distance and areas)

9 Only for the heart? Cardiac adult and pediatric Abdominal Urology Fetal Peripheral vascular Thoracic/Pleural fluid detection

10 Presets / Exam types CARDIAC Heart, Aorta, Thoracic/Pleural fluid detection ABDOMINAL Liver, Kidney, Gall bladder, Spleen, Urology, Peripheral vascular OB/Gyn OBSTETRICS

11 The docking station Connecting the PSID to a computer Charging the battery Storing the PSID when not in use

12 The rechargeable battery Capacity min of active use Charging time hours Spare battery may be charged outside the PSID

13 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

14 EAE RECOMMENDATION PSID does not provide or replace complete diagnostic echocardiographic examination - the patient should be informed about it

15 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

16 Patient identification ID number Name (keypad) one product Voice recording one product

17 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

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19 Pathology-oriented protocol: examples Global and regional LV systolic function assessment e.g.: Pts with heart failure Pts with ACS Razi R et al. JASE 2011

20 Pathology-oriented protocol: examples Inferior vena cava diameter and respiratory variations Pericardial effusion Right ventricular dilatation Biais et al. Critical Care 2012

21 Pathology-oriented protocol: examples

22 Pathology-oriented protocol: examples Iatrogenic (post-catheterization) femoral pseudo-aneurysm

23 Overall assessment of cardiac morphology and function with PSID How complete / long should the protocol be? Diagnostic information Expert Novice Examination length

24 Indications for PSID examination

25 Overall assessment of cardiac morphology and function with PSID: example

26 PSID - beyond the heart cardiac screening - 4.3±1.6 min abdominal screening - 2.5±1.1 min gallbladder, liver, kidneys, abdominal aorta

27 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

28 Greyscale image optimization Depth Overall gain Auto optimize / TGO function (image settings optimized based on the current acquisition)

29 Color image optimization Movement of the color box fixed size/angle of the color sector Overall gain

30 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

31 EAE RECOMMENDATION Image data should be stored according to national regulations

32 Defining the cardiac cycle (for storing the cineloops) No ECG module Manual definition AutoCycle feature one product Range: BPM Otherwise 2-sec cineloops The detected start and stop times are not necessarily in phase with the QRS complex!!

33 1. Technical issues 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

34 Viewing of the stored images On the PSID Data transfer to external computer using dedicated software Removing the microsd from the PSID and using the card reader in external computer (mp4 format) one product

35 Viewing of the stored images Honduran village Washington, USA

36 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

37 EAE RECOMMENDATION Imaging assessment with PSID should be reported as part of physical examination

38 1. Technical background 2. Patient information 3. Patient identification 4. Examination protocol 5. Image optimization 6. Image storing 7. Image viewing 8. Reporting 9. Reimbursement

39 Current-generation pocket-size imaging devices do not allow complete diagnostic examination and should be rather regarded as a tool to complement a physical examination. Therefore no reimbursement should be waranted

40 PSID - take-home messages It s really easy to use PSID does not provide or replace complete diagnostic echo - the patient should be informed about it Adjust the examination protocol to clinical scenario Images should be stored The examination should be reported as part of physical examination Do not expect reimbursement

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