Traditional ultrasound teaching is normally delivered using large, costly, and often quite advanced cart-based systems. These carts are often large systems on wheels, usually limited to the departments that own them i.e. clinics, wards or radiology. Portability has been further improved by the development of laptop-style systems, which are easier to wheel in-between patients/departments. In our experience and anecdotally, many of these systems can be intimidating to the novice and can lead to early attrition or poor uptake of ultrasound into clinical practice. Carts can also restrict the amount of training deliverable to practitioners, as they are limited in number due to cost and can take quite some time to boot up, reducing convenience.
This dogma is being progressively changed with the advent of smaller handheld devices, some clearly within the financial grasps of most practitioners, and even to the point of medical schools offering students their own personal devices. This relative inexpensiveness can lead to the purchase of these devices for novelty and convenience, over need. Obvious caution is needed in these circumstances, but with increased ease of purchase, better availability, and inbuilt simplicity, ultrasound learning can be seamlessly integrated into day-to-day practice.
This review discusses how one of the most disruptive innovations in modern medicine is changing ultrasound from a classic imaging modality to become integrated as the fifth pillar of clinical examination, and how these new devices can serve as springboards to more advanced ultrasound training. In fact, within what has become a bigger area of clinical examination, things are getting smaller.
Portable US solutions have been continuously evolving and as a result, continue to challenge the place of the stethoscope. Insonation, as the fifth pillar of clinical examination, has become a true reality.13 It has transported US from the radiology department/US laboratory, direct to the patient; whether on the intensive care unit (ICU), the hospital ward, in their general practitioner (GP) surgery or at the roadside in the prehospital environment. There is often confusion/debate as to which device is most fit-for-purpose. Figure 1 delineates some of the most popular devices and their attributes. Many of the devices have been tried and tested in order to clear up confusion as to which to purchase for institutions or individuals. We wish to point out that these reviews are written by a small subset of clinicians and they do. Not directly compare cart-based devices.
