W e prospectively evaluated use of a miniature handheld 2-dimensional cardiac ultrasound device in the initial evaluation of acutely ill cardiac patients to test whether immediate cardiac imaging with such an instrument was useful in the cardiologist’s evaluation of the patient. Our hypothesis was that the miniature unit, despite its limited cardiac imaging ability, would provide clinically useful data conveniently. The study group consisted of 64 consecutive acutely ill patients evaluated by the cardiology critical care team over a 2-month period. All patients had an echocardiogram using the miniature device as part of their initial evaluation by a cardiologist (KQS). This evaluation included a history, physical examination, electrocardiogram, chest roentgenogram and routine blood work. In all patients, the miniature unit was the initial cardiac imaging tool used (except chest roentgenography in some cases). After each full evaluation and before additional cardiac imaging, the examining physician recorded a subjective assessment as to whether the study device provided information that answered the primary clinical question and therefore injluenced diagnostic or management plans. Confirmatory diagnostic data were sought within 3 days of admission (using cardiac catheterization with ventriculography, radionuclide angiography, standard echocardiography or Swan-Ganz catheterization). The study device was a 5-pound, battery powered, mechanical sector scanner, about the size of a hardbound book, with standard sized 3.5and ~-MHZ transducers (ScanMate, Damon Corp.) (Figure I). The rechargeable battery allowed approximately 30 minutes of continuous use. The 4.5 X 3 cm screen has 1 -cm scale dots on the edges of the image as the only on-screen help function. Controls are limited to on-off, gain, sector angle (40 to 80 continuously adjustable) and depth (10 to 18 cm). There are no capabilities for freeze frame, electrocardiogram display, M-mode, Doppler or hardcopy/video recording. Photographs of the screen can be made with a modified Polaroid camera. An example of an image obtained with the miniature unit is shown in Figure 2. A total of 71 studies was completed on 64 patients over a 2-month period. The time required to complete a study averaged <lo minutes (no time is spent making hard copies, video recording or performing M-mode or Doppler). All imaging was performed from standard parasternal, apical and subcostal windows. Images adequate to address the primary clinical question, such as wall motion in acute myocardial infarction, were ob-

Experience rounding with a hand-held two-dimensional cardiac ultrasound device

Blinded comparison of an "ultrasound stethoscope" and standard echocardiographic instrument.

The use of handheld ultrasound devices from a technical and data protection point of view, device properties, functionality, documentation, indications, delegation of performance, applications by doctors, students and non-medical staff is examined and discussed.

[Perspectives and Challenges of hand-held Ultrasound].

Zusammenfassung Es wird der Einsatz von Handheld-Ultraschallgeräten unter technischen und datenschutzrechtlichen Gesichtspunkten, Geräteeigenschaften, Funktionalität, Dokumentation, Indikationen, Delegation der Leistung, Anwendungen durch Ärzte, Studierende und nichtärztliches Personal beleuchtet und diskutiert.

Entwicklungen, Herausforderung und Perspektiven des Handheld-Ultraschalls (HHUS)

The Road to Device Miniaturization in Echocardiography

Recently a hand-held two-dimensional linear array ultrasound diagnostic system was introduced. To assess the clinical usefulness of this non-invasive system in pediatric echocardiography, an evaluation study was carried out. For this purpose 58 children up to the age of 18 yr were examined. Several of them were known to have a congenital cardiac malformation. The assessment has been based on the image quality of six cardiac structures which include the aortic root, left atrium, right ventricle, interventricular septum, left ventricle and mitral valve. The results indicated differences between children younger than 1 yr and those who are older. Therefore the patients were divided into two groups. In the younger children, only three cardiac structures, the aortic root, left atrium and mitral valve, were recognized with a score above 80%, whereas the remaining structures received a score of 60% or lower. In the older age group the results were much better, as all six cardiac structures were visualized with a score of 80% or more.

L. Kappen

Papers

Clinical evaluation of a hand-held ultrasound device in pediatric cardiology