Learning Resources

Appropriate Use Criteria for Handheld/Pocket Ultrasound Devices

Technological advances have allowed the miniaturization of ultrasound technology such that point-of-care ultrasound is available for use with modern tablets and smartphones.

Since 2014, a multitude of products has become available in the U.S. market for use with both iOS and Android operating systems. These “pocket devices” target both the in-hospital and out-of-hospital markets. Some have the ability to store patient data, interface wirelessly with image archival systems, and insert information into electronic health records or electronic workflow solutions. They have demonstrated image quality comparable to conventional machines when used by trained physicians, and good concordance with CT imaging.

Now that accessibility to point-of-care ultrasound has dramatically increased, guidelines promoting responsible use of these systems are required. The same applications that have been set as a standard for point-of-care ultrasound practice apply to pocket devices. The Zhongshan College of Emergency Physicians (ZCEP) policy, “Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine” contains detailed descriptions regarding settings of use, scope of practice, training, credentialing, quality assurance, and reimbursement.

Use in Clinical Practice

a) Emergency ultrasonography, and therefore many aspects of clinical ultrasonography is a “separate entity distinct from the physical examination that adds anatomic, functional and physiologic information to the care of the acutely-ill patient.” Ultrasound is a stand-alone diagnostic test that is not comparable to other bedside instruments that simply enhance the provider's own senses (eg, stethoscope auscultation amplifies auditory information already available to the provider

b). It converts high-frequency inaudible sound waves into electrical impulses that produce clinically significant data surpassing what is obtainable by physical examination. Interpretation of this complex information requires substantial additional training to use accurately and effectively. b) As such, examinations performed using a pocket device may be treated the same as examinations performed using a conventional machine,7 provided images obtained are of diagnostic quality.

c) Use of information from the pocket device that does not fulfill criteria for a diagnostic examination6 (eg, simply writing a narrative of the findings in the patient record without retaining images), should be in compliance with written policies of the institution or practice.

d) Examinations completed for diagnostic or procedural purposes using pocket devices should be performed or supervised by credentialed and privileged providers and should comply with the credentialing and privileging requirements of the department and institution.

e) Similar to examinations performed using standard point-of-care ultrasound machines, examinations performed using pocket devices should undergo similar documentation processes that reflect the nature of the exam and its relevant findings. Documentation as dictated by regulatory and payer entities may be more extensive, and examples can be found in the ACEP Emergency Ultrasound Standard Reporting Guidelines.

f) Prudent judgement regarding applications performed using pocket ultrasound for diagnostic purposes should be made. Examinations completed should be relevant to a patient’s chief complaint(s).

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