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September 19-21 | Philadelphia, PA

We’ve got HEART! We’ve got GRIT! We are FAMILY MEDICINE!

2023 FMEC Annual Meeting

September 19-21, 2024 #fmec2024

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Practical Implementation & Education of Point-of-Care Ultrasound for a Full-Spectrum Family Physician

Henry Del Rosario MD

Assistant Professor

Department of Family Medicine & Community Health

UMass Chan Medical School

Hahnemann Family Medicine Health Center

UMass Memorial Family Medicine Hospitalist Group

UMass Memorial Health

Ultrasound for the Uninitiated: Learning Hacks for the Busy Family Doc

September 19-21, 2024 #fmec2024

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Contact Information

Henry Del Rosario

Henry.delrosario@umassmemorial.org

Cell: 770-833-5576

www.henrydelrosario.com

September 19-21, 2024 #fmec2024

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Faculty Disclosure

It is the policy of the FMEC that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose.

The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.

I have nothing to disclose.

September 19-21, 2024 #fmec2024

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Learning Objectives

Review a case study of a full-time working physician learning ultrasound
Develop a structured learning system for ultrasound
Employ practical first steps for integrating ultrasound into your clinic workflow
Identify free and low-cost ultrasound education resources

September 19-21, 2024 #fmec2024

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Outline Presentation Links

My Personal Journey
Surprising Facts for Beginners
Two US Cases
Clinical Workflow for US
Tips for Beginners
Free US Educational Resources
Handheld US Reviews

September 19-21, 2024 #fmec2024

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My Personal Journey

None or minimal ultrasound training in Medical School and Residency
7 years as full-time full-spectrum Family Medicine attending
Faculty at an Academic Institution/Residency clinic site
FTE breakdown: 40% Outpatient clinic, 20% Hospital Medicine, 20% Inpatient Obstetrics; 20% Epic work
Three kids under five + full-time physician spouse

September 19-21, 2024 #fmec2024

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My Personal Journey

Exceptional residents were inspirational
UMass Primary Care US half-day workshop for attendings
Departmental Support

Created offsets for an US director and Residency US educational director to guide/train faculty and residents
CME money can be used for an ultrasound (I obtained a VScan)
Ultrasounds given to residency clinics (Lumify)
Checked with medicolegal

What do “we” do now? Do I need to go back to medical school, redo residency, or do a fellowship?!

September 19-21, 2024 #fmec2024

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Personal Log

Scan conditions:

Scan time <5-10 min
Real patients
All during real patient loads (fully scheduled clinic sessions or inpatient lists)

September 19-21, 2024 #fmec2024

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Personal Breakdown after 1 year of Scanning

Scan conditions:

Scan time <5-10 min
Real patients
All during real patient loads (fully scheduled clinic sessions or inpatient lists)

September 19-21, 2024 #fmec2024

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Personal Breakdown after 1 year of Scanning

My personal FTE breakdown:

40% Outpatient clinic
20% Hospital Medicine
20% Inpatient Obstetrics
20% Epic work

September 19-21, 2024 #fmec2024

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448 Scans over 1 year

Number of Scans	Percentage of Total	Category	Details
116	25.89%	OB/GYN	Uterus, Ovaries, IUP confirmation, Dating, EFW, AFI
79	17.63%	MSK/Injections	Knee, Shoulder, Hip, Wrist, Hand, Fingers, Elbow, Foot, Ankle, Bones, Muscle; Hernias; Injections, Aspirations
59	13.17%	Lungs
59	13.17%	Abdomen	Gallbladder, Liver, Spleen, Large/Small Intestine, Ascites; Paracentesis
41	9.15%	Soft tissue	Bumps/lumps, Abscess/cysts, Hematomas, I&D, foreign bodies
39	8.71%	Heart
34	7.59%	Vascular	DVT r/o, Aorta, IVC
25	5.58%	Genitourinary	Kidney, Bladder, Prostate, Scrotum
18	4.02%	Thyroid, Eye, Other

September 19-21, 2024 #fmec2024

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Frequency of Ultrasound Use for GPs Literature

Number of Scans per year	Category
131-601	Total
72-133	OB/Gyn
58	Abdomen
100	Genitourinary
43	Broad screening (ultrasound-assisted physical examination)

Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med. 2019 Jan;17(1):61-69. doi: 10.1370/afm.2330. PMID: 30670398; PMCID: PMC6342599.

September 19-21, 2024 #fmec2024

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Surprising Facts When Starting

Patients are exceptionally receptive
There are innumerable free resources online
Ultrasound can be more accurate than radiography or MRI
Clinic can be fun again!
You can ultrasound more than you realize

September 19-21, 2024 #fmec2024

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POCUS has many highly sensitive applications

Bornemann P, Jayasekera N, Bergman K, Ramos M, Gerhart J. Point-of-care ultrasound: Coming soon to primary care? J Fam Pract. 2018 Feb;67(2):70-80. PMID: 29400896.

September 19-21, 2024 #fmec2024

https://pubmed.ncbi.nlm.nih.gov/29400896/

https://cdn.mdedge.com/files/s3fs-public/Document/February-2018/JFP06702070.PDF

Just a few applications. POCUS for MSK for example has many highly sensitive applications not listed above

–

1. Diagnosing Pneumonia: POCUS has been shown to be more sensitive than chest radiography (CXR) for diagnosing pneumonia. Studies have demonstrated that lung ultrasound (LUS) can detect pneumonia with higher sensitivity, often identifying consolidations and interstitial patterns that may be missed on CXR. For instance, a study found that LUS had a sensitivity of 95% compared to 60% for CXR in diagnosing pneumonia in the emergency department. Another study reported that LUS had a sensitivity of 94.6% compared to 77.7% for CXR in diagnosing community-acquired pneumonia.[1-2]

2. Diagnosing Acute Decompensated Heart Failure (ADHF): POCUS, specifically lung ultrasound, is more sensitive than CXR for diagnosing ADHF. A meta-analysis found that LUS had a pooled sensitivity of 91.8% compared to 76.5% for CXR in detecting cardiogenic pulmonary edema. Another systematic review and meta-analysis reported that LUS had a sensitivity of 88% compared to 73% for CXR in diagnosing ADHF. The American College of Physicians also supports the use of POCUS in improving diagnostic accuracy for heart failure when added to standard diagnostic pathways.

–

1. Performance Comparison of Lung Ultrasound and Chest X-Ray for the Diagnosis of Pneumonia in the ED.

Bourcier JE, Paquet J, Seinger M, et al.

The American Journal of Emergency Medicine. 2014;32(2):115-8. doi:10.1016/j.ajem.2013.10.003.

2. Lung Ultrasonography: An Effective Way to Diagnose Community-Acquired Pneumonia.

Liu XL, Lian R, Tao YK, Gu CD, Zhang GQ.

Emergency Medicine Journal : EMJ. 2015;32(6):433-8. doi:10.1136/emermed-2013-203039.

3. Meta-Analysis of Point-of-Care Lung Ultrasonography Versus Chest Radiography in Adults With Symptoms of Acute Decompensated Heart Failure.

Chiu L, Jairam MP, Chow R, et al.

The American Journal of Cardiology. 2022;174:89-95. doi:10.1016/j.amjcard.2022.03.022.

4. Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis.

Maw AM, Hassanin A, Ho PM, et al.

JAMA Network Open. 2019;2(3):e190703. doi:10.1001/jamanetworkopen.2019.0703.

5. Point-of-Care Ultrasonography in Patients With Acute Dyspnea: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians.

Gartlehner G, Wagner G, Affengruber L, et al.

Annals of Internal Medicine. 2021;174(7):967-976. doi:10.7326/M20-5504.

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POCUS has many highly sensitive applications

EF 15%

PNA

DVT

AAA Screening

September 19-21, 2024 #fmec2024

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Top 4 fun and surprisingly ultrasound-able organs

Eye

Prostate

Dating

Tonsils

September 19-21, 2024 #fmec2024

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Case 1

64 yo F with a PMH of HFrEF (EF 47%) and COPD, presented to the clinic with wheezing and dyspnea.
No fevers. Sat well on RA. Rales on exam. At baseline LE edema: 1+ pitting.
Resident precepted the patient to me and wanted to treat her for COPD ex.

Spleen

Diaphragm

Lung

*

Spine sign

September 19-21, 2024 #fmec2024

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Case 2

44 yo F w/ a history of c-section presented to the clinic for abdominal pain and vomiting bile.
10-15 cm soft mass protruding from anterior right side of abdomen (red oval) on exam that was very tender.

September 19-21, 2024 #fmec2024

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Normal

Bowel wall

Transverse plane of patient’s left anterior abdominal wall near the umbilicus for comparison (10 cm depth); Normal tissue

Transverse plane of patient’s right anterior abdominal wall near the umbilicus (10 cm depth): hernia

Epidermis/Dermis

Normal

Subcutaneous Tissue

*

Free fluid in hernia sac

Hernia

Intestine bowel loops outside abdominal wall in subcutaneous layer of abdomen. Evidence of anechoic space outside the loops of bowel suggesting free fluid. Fluid in bowel (*). Signs suggestive of incarcerated abdominal wall hernia.

*

September 19-21, 2024 #fmec2024

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Intestine bowel loops outside abdominal wall in subcutaneous layer of abdomen. Evidence of anechoic space outside the loops of bowel suggesting free fluid. Fluid in bowel. Signs suggestive of incarcerated abdominal wall hernia.

CTAP with contrast: “Closed loop small bowel obstruction in the central abdomen with incarceration within a complex ventral hernia. The obstructed bowel is hypoenhancing, highly concerning for ischemia.“

September 19-21, 2024 #fmec2024

44 yo F w/ a h/o c/s p/w to the clinic for abdominal pain and vomiting bile. 10-15 cm soft mass protruding from anterior right side of abdomen on exam that was very tender. Signs of incarceration on US with possible strangulation so sent to the ED from clinic. Lactate 2.4, WBC 13. CTAP showing evidence of incarcerated ventral hernia with question of intestinal hypoperfusion. Bedside reduction attempted by surgery but not successful. CT angiogram done showing persistent hernia and “Essentially unchanged appearance of thickened hypoenhancing obstructed mid small bowel loops with two discrete transition points consistent with a closed loop obstruction and partial herniation into a complex ventral hernia.”

Went to surgery for exploratory laparotomy, lap assisted small bowel resection and incisional hernia repair. 70 cm small intestine resected.

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All these ultrasound scans are my own

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Clinical Workflow for US

Pre-chart / Learn

Scan your patient list for US opportunities (a few seconds)
Review prior imaging (US, Radiographs, CT scans, MRIs) (2 min)
Watch videos (5 min)
Read a chapter or article (5 min)
Practice on yourself or a family member the night before (5-10 min)
Listen to a video or podcast during commute (30 min)

September 19-21, 2024 #fmec2024

What does using ultrasound look like in a narrow scope? Realistically in detail?

After my kids finally fall asleep, I am in bed around 9 pm. I spend a few minutes scrolling on Haiku looking at my patient list to look for ultrasound opportunities.

For example, if I see knee pain at 9 am tmrw, I mentally prepare.

Has anyone scanned or x-rayed their knees? If so, I review that imaging right then and there in my bed for a minute!

I then look up a youtube video by searching “knee pocus” and see any new or exciting take on knee US.

I may even pull up my e-book version of Jacobson’s MSK fundamentals and read the chapter on knee (especially to review pathology)

If my wife is willing, I practice for 5 minutes on her knee. If she instead rolls her eyes and says no not again” then I scan my own knee.

I have a long commute and I find that listening to an US video or podcast can reinforce what I need to know that day.

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Clinical Workflow for US

Do it

Always keep ultrasound in pocket (reduce barriers to using the ultrasound; US already in room if it’s a non-pocketable US)
Prepare patients prior to seeing in the room (change into gown, keep bladder full, fast)
Don’t be afraid to pull up references in front of the patient
Scan (<5-10 min)

VScan

(dual probe, wireless, connects to phone)

September 19-21, 2024 #fmec2024

How do I optimize US use when in the clinic?

I always keep my ultrasound in my right pocket. My phone on the left. There is always gel in the room.

The ultrasound should not be in another room or in the hallway. It should be with your or already with the pt.

My US is a VScan that has two probes. It’s wireless and connects to my phone which makes it easy for me to carry on my person at all times.

This is important because for example, if during a physical, the pt tells you they have a bump they want you to look at, I literally take out my US and within 30 seconds scan the bump and tell them what it is.

There are things to optimize with the patient to help you ultrasound.

If I will scan a uterus, I ask that the pt not urinate prior to being scanned because you need the bladder full to scan well.

If I will scan a gallbladder, I ask the medical assistant to call the pt early that day to have them fast at least an hour prior to scanning.

I am also not afraid to pull up references like a diagram or powerpoint even with the patient as I scan them.

I simply tell them this reference will help me not miss things and not one patient has ever had a problem with that.

I scan them, and 100% of the time, the patient loves it.

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Clinical Workflow for US

Review/Study/Re-learn

Log and review (10 min after clinic in one-go or integrate as you finish your notes)
Deep study (10-30 min)

At home or during admin once per week
Copy salient scans into your personal notes or a powerpoint to analyze and teach others
Rewatch videos or reread resources
Compare and contrast your scans from normal and reference scans
Practice scanning again on yourself

September 19-21, 2024 #fmec2024

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Personal Log

Columns:

Date
Organ Category
Clinical Setting
Scan Number
Clinical Notes
Notable Flags

I used my log to practice describing my findings using sonographic language too.

September 19-21, 2024 #fmec2024

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Example “study” slides I make for myself to really study my own scans and compare to diagrams or references scans I find from other resources.

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Tips for Beginners (especially those with no prior training)

Just do it
Go to a half-day US workshop to get inspired and assess feasibility
Build confidence by by scanning yourself, family, easy patients
Structure a self-learning, self-feedback system
Remember to focus on yes or no questions; it’s not about a comprehensive sonographic exam

September 19-21, 2024 #fmec2024

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Skills Build Off Each Other

Abscess vs cellulitis → Lipomas, Soft tissue masses
Bladder → Uterus, Prostate → IUP confirmation → Dating, EFW
Liver → Ascites → Gallbladder → Kidney, Spleen
Effusion → Tendinopathy
Knee → Shoulder → Hip, Foot, Hand

September 19-21, 2024 #fmec2024

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Don’t be intimidated by the breadth of what to scan. Start simple and small. Remember you are a family doctor– master of breadth and incremental improvement!

September 19-21, 2024 #fmec2024

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Skills Build Off Each Other

Aorta ⇔ IVC ⇔ Heart (subxiphoid view)
Femoral vein, artery ⇔ Inguinal Hernias ⇔ DVT rule out ⇔ Hip
Lung ⇔ Bowel with air
Gallbladder “lie” ⇔ Fetal “lie” ⇔ Appendix “lie”
Anisotropy effect on tendons ⇔ Lung A and B-lines ⇔ Fetal EFW planes for measurement

September 19-21, 2024 #fmec2024

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Advance Tips

Inpatient medicine:

offers a plethora of pathology often with prior imaging already done (lead ultrasound rounds with residents)

OB:

When learning dating or EFW, ultrasound your prenatal patient before and after their formal US

Precepting residents in clinic:

Anticipate US needs or learning opportunities, prepare/practice during down time

September 19-21, 2024 #fmec2024

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Advance Tips

Other colleagues:

Review other colleagues schedules for opportunities to use US
Remind folks what US can do; offer to scan their patients

Learn other radiology imaging (CT scans, X-rays, MRIs):

Review the literature comparing how US correlates to other imaging modalities

Cadaver resources:

Pull out your med school cadaver book and relearn!

September 19-21, 2024 #fmec2024

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Resource	Description	Topics	Professional	Cost
POCUS Geek	YouTube channel with comprehensive and practical 5-20 min videos, ranging from beginner (e.g. liver) to advance applications (e.g. pulse wave doppler). Videos range from quick limited topic videos to long lecture-like videos.	General (ED scope, including OB/gyn)	Jared T. Marx, MD, AEMUS, FPD Ultrasound Director, UNMC Department of Emergency Medicine University of Nebraska Medical Center	Free
POCUS 101 & Website	YouTube channel that correlates well with their own website online course and book. The website is very easy to bookmark and reference on the go and at the bedside (e.g. cardiac views). UMass folks recommended this resource to us all.	General (ED scope, including OB/gyn)	Vi Dinh, MD FACEP RDMS RDCS Professor of Emergency Medicine, Internal Medicine, and Critical Care Ultrasound Director and Fellowship Director Loma Linda School of Medicine	Free (Book is $135 on amazon)
Core Ultrasound Video Library & Website	5-minute videos of various topics and procedures, image review videos, and longer podcast videos. Has some good GI-related videos which is unique (e.g. hernia).	General (ED scope)	Jailyn Avila MD Associate Ultrasound Director and the Director of Faculty Development UHS SoCal MEC Emergency Medicine Residency in Temecula, California	Free
MSK Australia	YouTube channel with 5-minute quick videos (e.g. supraspinatus) and longer lecture-like full joint assessment (1 hour) videos for MSK (e.g. shoulder). Very good for nuances and practical tips for MSK scanning. Good for beginners and good for deep learning.	MSK	Professional group of Radiologists and Sonographers from Australia	Free

Free Video Courses & Online Resources

September 19-21, 2024 #fmec2024

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Resource	Description	Topics	Professional	Cost
Dr. Sam's Imaging Library	YouTube channel with more than a hundred videos of an intelligent soft-spoken radiologist showing side-by-side examples of pathological US scans comparing them to normal. Labeled images. Many OB/GYN topics covered (e.g. abnormal pregnancy).	General (but not ED focus); Heavy OB/GYN, fetus; thyroid, abdomen, breast	Radiologist	Free
Sonosite Webinars	YouTube channel with many videos; the most useful ones are the webinars which are 30 min long but thorough grand-round like lectures on various topics. MSK ones are very good (e.g. hip).	MSK	Ultrasound manufacturer	Free
Clarius	YouTube channel with some decent 2-minute procedure videos. Good procedure videos. Not comprehensive how-to guides but confidence building in that it makes scanning and procedures look easy! MSK webinars are insightful (e.g. shoulder).	Decent MSK, soft tissue, abdomen, lung, breast	Ultrasound manufacturer	Free
The POCUS Atlas	Free website and atlas of pathological/abnormal sonograms. It’s fun to look for specific pathology or just to browse! They also have some great guides (e.g. appendix)	Very comprehensive (including eye, pediatrics, trauma)	Michael Macias MD, Ultrasound Director and Co-Fellowship Director Southwest Healthcare Medical Education Consortium	Free

Free Video Courses & Online Resources

September 19-21, 2024 #fmec2024

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Resource	Description	Topics	Professional	Cost
Waco Family Medicine POCUS	A family medicine resource! It’s rare to find family medicine made resources online. It looks like they only started in 2023 and have 20 videos so far. The AAA screening lecture is really good (AAA link).	General; heart, lung, abdomen, MSK	Waco Family Medicine Residency	Free
Henry’s Ultrasound Pathol ogy Case Library	My personal pathology library, going through real clinical case examples, side-by-side normal vs pathology, and relevant review of the literature. It’s primarily for me personally but some folks have found it useful.	General	Me	Free
POCUS DVT Examination Protocol	One-page guide and slide deck for learning DVT rule out. I compare sonograms to anatomy and cadaver anatomy as well. I also review the relevant literature.	LE vasculature	Me	Free
AAA Screening Protocol	One-page guide and slide deck for learning AAA screening for family physicians. I compare sonograms to 3D anatomy models.I also review the relevant literature.	Abdominal aorta	Me	Free

Free Video Courses & Online Resources

September 19-21, 2024 #fmec2024

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Resource	Description	Topics	Cost
Ultrasound in Obstetrics & Gynecology: A Practical Approach by Abuhamad (pdf link here)	A very practical ebook with traditional textbook chapters. Great for learning EFW and dating.	OB/GYN	Free
European Society of MusculoSkeletal Radiology	Quick reference guides for MSK. Search online for the free pdfs (e.g. knee, hip, shoulder). I use often at the bedside for reference!	MSK	Free
Point-of-Care Ultrasound by Soni, N.	Great general reference and beginner POCUS book (lung, heart, etc but little MSK and OB/Gyn)	General	$93 on amazon
Fundamentals of Musculoskeletal Ultrasound by Jacobson, J.	Quintessential MSK US book (also available as an e-book which is nice to search through). Lots of pathology examples.	MSK	$58 on amazon
MSK US of the Knee	Uptodate has a detailed article with pathology examples	MSK	Uptodate subscription

Free or Low-cost Books, PDFs, and Other Resources

September 19-21, 2024 #fmec2024

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Resource	Description	Modality	Cost
Complete Anatomy	3D app that allows you to +/- organ systems and organ layers. I used it to learn tendons, ligaments, gallbladder, really anything! I take screen shots to use when annotating my notes and correlating with scans.	Phone app	$39.99/y student $99.99/y attending
CaseStacks	Free labeled radiological images. I use the axial CT abdomen particularly to help me learn AAA screening and surrounding vasculature (e.g. Axial CTAP). The CTAP stacks and pelvis MRI stacks are free at least. They offer other paid courses and anatomical areas I haven’t explored yet.	Website	Free (CTAP at least)
MSK MRI	Free labeled MRI scans of MSK anatomy. For example, to learn US of the greater trochanter for steroid injection, I can review how the gluteal muscles insert (e.g. MRI hip)	Website	Free
Anatomy Atlases	Free transverse cross-sections of cadavers. Very helpful to me especially for learning DVT rule out and AAA screening (e.g. abdomen)	Website	Free

Anatomy Resources

September 19-21, 2024 #fmec2024

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Resource	Description	Topics	Cost
Sonosim	If you have the money and want a comprehensive all-in-one learning resource, this may be your resource. Website and phone app of videos that go through anatomy, physiology, and step by step how-to scanning technique. Has very reliable/vetted pathology examples. Questions to test knowledge mastery. Has a “virtual”/pretend probe use (not a real probe) that I’m not a fan of but I could see many providers who would find this useful.	Comprehensive and deep	$799 per learning in group package $399 per topic (e.g. aorta and IVC) $2495 for packages (e.g. abdomen)
STFM Teach POCUS Online Modules	Family Medicine made! Mini-course of 10 high-yield modules. Very approachable and not as intimidating as Sonosim.	Broad and high-yield	Cost of STFM membership
STFM FM POCUS Educator's Certificate Program	Curriculum tailored for family medicine faculty: two in-person preconference workshops, a full-day virtual workshop, monthly image review, a set of 10 online modules.	Comprehensive	$4500
Global Ultrasound Institute (GUSI)	Resource I just started using (due to FMEC!). All-in-one learning resource and hub, similar to Sonosim library. Has videos dedicated to troubleshooting which I really like! Questions to test knowledge mastery. In-person workshops. Over-reads. AI feature.	Comprehensive	Individual and group prices Came with FMEC US half-day workshop attendance ($500)
School of Medicine Columbia University of South Carolina Primary Care Workshop	Two-day course. I have never been, but was recommended to me several times. It appears to be very useful especially if you want more than a half-day and want in-person guidance.	AAA, IVC, abdomen, kidneys, bladder, DVT, knee, shoulder, heart, lung, paracentesis, thoracentesis, central line placement, abscess	$1600

Other ($$$) Resources

September 19-21, 2024 #fmec2024

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Sonosim

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GUSI

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VScan Air CL Review

Pros:

Wireless/Cordless (charges via Qi chargers)
Two transducers in one (curvilinear + linear)
One study showed it was the best value in terms of price and image quality, and satisfcation compared to Lumify, Kosmos, Butterfly iQ+, etc (Perez-Sanchez, Ultrasound Journal 2024)
Good value ($4855, no subscriptions)
You can measure and annotate even after the exam is “ended” (unlike Lumify)

Cons:

Total continuous scan time is 1 hour (works all clinic day if you charge in between patients)
Can get hot
Less AI/fancy calculations (vs Butterfly)

Henry’s one-page quick guide for VScan link

September 19-21, 2024 #fmec2024

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Lumify Review

Pros:

Very good image quality(Perez-Sanchez, Ultrasound Journal 2024)
Easy integration with EMR systems
No subscriptions

Cons:

Corded (our cords needed replacement in 2 years)
Highest cost compared to other bedside handheld ultrasounds ($6000 per probe; no subscription)
Needs separate power module ($880) to connect to a phone
Needs measurements to be taken “during” exam; you cannot go back to old images to measure or calculate

Henry’s one-page quick guide for Lumify link

September 19-21, 2024 #fmec2024

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Butterfly Review

Pros:

More affordable (iQ+: $2699, iQ3: $3899)
Promising AI and software (AI labels your images in real time!)

Cons:

Fair image quality
Subscription fee model ($299/y for core; $420/y or $1500 one-time payment for “ advanced”: power and pulse-wave doppler, AI tools)

September 19-21, 2024 #fmec2024

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Le, MP.T., Voigt, L., Nathanson, R. et al. Comparison of four handheld point-of-care ultrasound devices by expert users. Ultrasound J 14, 27 (2022). https://doi.org/10.1186/s13089-022-00274-6

September 19-21, 2024 #fmec2024

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Perez-Sanchez, A., Johnson, G., Pucks, N. et al. Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: a cross-sectional study. Ultrasound J 16, 45 (2024). https://doi.org/10.1186/s13089-024-00392-3

September 19-21, 2024 #fmec2024

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Other Handheld/Pocket Ultrasounds

Sonoque – linear and convex dual probe - $3150

Clarius – single probes - $3595 + $595 membership

Ultimately just get any ultrasound and start learning and scanning

September 19-21, 2024 #fmec2024

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One Year of Potential Billing

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One Year of Potential Billing

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Free Resources List QR Code

Feel free to take and share with your colleagues and other residents.

I want all family doctors to learn ultrasound!

September 19-21, 2024 #fmec2024

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More Cases & Links!

Ultrasound Guides:

Ultrasound Pathology Library for Family Physicians:

A small icon of a probe denotes which US images are from my own scans

Lumify Curvilinear

Lumify

Linear

Lumify

Phase Array

VScan Curvilinear

VScan Linear

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Contact Information

Henry Del Rosario

Henry.delrosario@umassmemorial.org

Cell: 770-833-5576

www.henrydelrosario.com

September 19-21, 2024 #fmec2024