EFSUMB Newsletter
European Federation of Societies for Ultrasound in Medicine and Biology
Handheld Ultrasound devices (HHUSD): A short review of the equipment available on the market as of September 2017 Michael Bachmann Nielsen Department of Radiology, Rigshospitalet, DK 1302 Copenhagen, Denmark mbn@dadlnet.dk The handheld ultrasound devices (HHUSD) equipment included in this short paper are devices with a screen size of a mobile phone or a small tablet up to 7 inches. This it to separate the devices from those sold as portable. One of the many advantages by HHUSD is that they can be easily carried for use in any clinical situation they may be needed. The websites of more than 25 ultrasound manufacturers were searched by the author in September 2017 and while almost everyone listed portable devices only six were found to have HHUSD by the definition above. They are listed below in random order.
GE Healthcare’s Vscan series has been available for several years and now covers several pocket-sized models with a screen and a (cabled) transducer. Dual probes are available with options for Doppler and DICOM connectivity. Philips Lumify was launched in the US in 2015 and from 2017 it is also available in Europe, in some countries on a subscription basis. The transducer connects via USB to your own phone or tablet (only android). Several transducers are available. The system includes Doppler and DICOM connectivity. Clarius has two probes available, each with wireless connection to your own smart device using an app. The system includes Doppler and DICOM connectivity. Mobisante has two systems, one that comes with a screen and one where the probe can be plugged into your own device. DICOM is supported.
Manufacturer
Type
Website
GE Healthcare
Vscan series
www.gehealthcare.com
Philips
Lumify series
www.lumify.philips.com
Clarius
Clarius
www.clarius.me
Mobisante
MobiUS SP1, MobiUS PE
www.mobisante.com
Signostics
Uscan
www.signosticsmedical.com
Sonosite
iViz
www.sonosite.com
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Signostics works with android devices only, one selling point is accurate bladder volume measurements and point-of-care ultrasound (POCUS). The iViz from Sonosite has a 7.1" display with a one-handed interface and two cables transducers are available. Doppler and export to DICOM is available. This overview is based on a presentation I updated for the EUROSON Congress in September 2017. I looked at international websites of selected ultrasound manufacturers, I apologize if I have overlooked some. Those without HHUSD on their website may well be about to launch such a device so it is always a good idea to attend the technical/ commercial exhibition in larger congresses for the latest developments on the market. Please also note that the author is not associated with any of the companies listed above and does not own any of these devices. Therefore, this short report is not about my preferences, only a quick survey of the available market as of September 2017. Currently EFSUMB is finalizing a position paper on HHUSD focused on the published literature on their use. For most of the devices the manufacturers highlight POCUS as their intended use.
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EFSUMB Committees Executive Bureau (ExB) 2017 – 2019
Education & Professional Standards Committee (EPSC)
Carmen Garre (SP) Co-opted member Congress President 2019
Paul Sidhu (UK) President
Helmut Prosch (AT) Chairman Adrian Saftoiu (RO) ExB Ex-officio member Congress President 2021
Adrian Saftoiu (RO) President Elect
Alina Popescu (RO)
Publications Commmittee
Vito Cantisani (IT) Odd Helge Gilja (NO) Past President
Vladimir Mitkov (RU)
Chairman & EFSUMB EJU Editor
Alexandros Sotiriadis (GR) Andreas Serra (CH) Honorary Secretary
EFSUMB Newsletter Editor Maija Radzina (LV)
Radu Badea (RO) Christian Jenssen (DE) Honorary Treasurer
Matthias Wuestner (DE)
Florian Faschingbauer (DE)
Wojcieck Kosiak (PL) Co-opted member Congress President 2018
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Roald Flesland Havre (NO)
Fernando Jimenez (SP)
Madara Radua (LV)
Adrian Lim (UK)
Ferdinando Draghi (IT)
Giovanni Del Gaudio (IT)
Caroline Ewertsen (DK)
Ragnar Sande (NO)
Phillip Niederkofler (AT)
Co-opted member
Secretary
Co-opted member Case of the Month Editor
Andreas Serra (CH) ExB Ex-officio member
EFSUMB Student Committee (ESC)
Florian Recker (DE)
Codruta Constantinescu (RO) Chairman
EFSUMB General Secretary
EFSUMB Committee for Medical Ultrasound Safety (ECMUS)
Lynne Rudd Ann-Sophie Schlager (CH)
Christian Kollmann (AT) Chairman
Eivind Valestrand (NO) Klaus-V Jenderka (DE) Literature Secretary
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Future Euroson Schools
Dermatological Ultrasound in EFSUMB: An application that has come to stay, grow and last The ultrasonographic study of skin and appendages (hair and skin) is a growing recent development in clinical dermatology and aesthetic medicine. New equipment with lineal high frequency probes and highly sensitive Doppler have been key techinical developments that have permitted the use of ultrasound for the study of the heatlhy and pathological skin. Since pioneer seminal work of Dr Wortsman in Chile, dermatological ultrasound has
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evolved and been introduced in clinical practice by the dermatologic community, mainly in European countries. Recently the DERMUS group, an independent group that includes dermatologists and radiologists globally have published
practice guidelines for this aplication in the AIUM Journal and have set a standard for the practice and teaching of dermatologic ultrasound for the radiologists and clinicians interested in this application.
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From EFSUMB we have created a working group for the development of this application in Europe with the idea of bringing together expertise, investigation and learning to the interested physicians. With that intention and aiming to create an European consensus on the practice of dermatological ultrasound in Europe under the EFSUMB umbrella, the First Dermatological Ultrasound Euroson School (Level 1) is being
organised in which formal theoretical and practical state of the art of this application will be taught by leading experts in this speciality. Along with the course a formal acreditation on dermatological ultrasound level one by EFSUMB will be offered to participants who succeed in the theoretical and practical evaluation of this course.
This event will take place in the Dermatological Ultrasound Teaching Centre Puerta de Hierro Majadahonda, Madrid, Spain next 1st and 2nd June 2018. For those interested in this new and rapidliy evolving technique this is a great oportunity to learn in depth the fundamentals of the application in the clinical environment. We hope to see you in Madrid next June. Dr. Fernando Alfageme
Next EUROSON Congress
www.euroson2018.org IMPORTANT DATES Online registration: 2.10.2017
Very early bird registration: 2.10.2017 – 1.02.2018 Early bird registration: 2.02.2018 – 1.06.2018 Regular registration: 2.06.2018 – 9.09.2018
Abstract Submission: 2.01.2018 – 15.06.2018 First announcement: December 2017
The role of infection control within the ultrasound unit Ultrasound technology has rapidly evolved over the past decade with increased use to aid in the diagnosis of a variety of medical conditions. With the ease of smaller portable machines and frequent use, comes the risk of improper hygiene and lack of disinfection of equipment post patient use. The prevalence of healthcare associated infections ranges from 1.7 million in the US (Klevens et al., 2007) to 200 000 in Australia (Cruickshank and Ferguson, 2008) and antimicrobial resistance is now considered a global threat. The infectious status of a patient is not often disclosed to the ultrasound user and this poses a risk for the transmission of infection from patient to ultrasound user or to the next patient if the ultrasound equipment has not been cleaned between use. Many ultrasound training programs focus on the technological aspects of scanning
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but do not cover training in basic infection, prevention and control. There have been reported cases of infection resulting from ultrasound guided procedures (Cervini et al., 2010; Ferhi et al., 2013; Hiyama et al., 2016) and a fatality due to Hepatitis B infection after failure to decontaminate a transoesophageal transducer (Medical safety alert: No. MDA/2012/ 038). Keys et al (2015) highlighted that over 60 % of ultrasound transducers were covered in blood and bodily fluids in the Emergency department. This statistic is not surprising given the ‘unclean’ ultrasound transducers that are found within departments with visible dried blood (▶ Fig. 1). Other studies have shown that the entire ultrasound unit can be contaminated by various microorganisms, both commensals and potential patho-
gens (Alfa et al., 2015; Westerway et al., 2016). Apart from ultrasound equipment, the gel poses a potential risk of transmission of infection. Ultrasound gel is conducive to microbial growth, especially when reheated and the lid left open allowing entry of microorganisms. Infections associated with contaminated ultrasound gel have been reported (Cheng et al 2016; Chittick et al., 2013; Oleszkowicz et al., 2012, Abdelfattah et al., 2017) including an outbreak of Burkholderia cenocepacia infection following ultrasound guided central line placement attributed to sterile gel (Shaban et al., 2017). Furthermore, 2 patients died as a result of septic shock from contaminated ultrasound gel used in central line placement (Abdelfattah et al., 2017). This highlights the importance of government regulation, strict testing and efficient labelling of products. As such, the
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Transducers” (Basseal et al., 2017). These comprehensive guidelines include flowcharts for best reprocessing practice and will form the framework for the WFUMB guidelines to be published shortly. It would be sensible for all users of ultrasound to undertake basic infection control training and study the published Guidelines to ensure optimal patient safety during an ultrasound examination. ▶ Fig. 1 Blood contaminated ultrasound transducers.
entire ultrasound unit including gel should be considered as a potential vector in the transmission of a healthcare associated infection. In an attempt to further comprehend the hygiene and disinfection practices within the ultrasound unit, a survey was launched by the World Federation for Ultrasound in Medicine and Biology (WFUMB) via its six Federations (Basseal and Westerway, 2017). Results from the United Kingdom indicated that ultrasound users were overwhelmed with high throughput of patients which potentially affected the ability to clean the ultrasound equipment (Westerway and Basseal, 2017a). Similar results were obtained from the Australasian region, which illustrated that non-approved agents were utilised for high level disinfection of ultrasound transducers and approximately half of the respondents do not receive any support from their infection control department (Westerway and Basseal, 2017b). These findings indicated a gap in knowledge of basic infection prevention and control education as well as a lack of support in the area. Many ultrasound organisations as well as national health agencies are responsible for producing best practice guidelines for optimal patient care. The Australasian Society for Ultrasound in Medicine (ASUM – the peak body for ultrasound in Australasia) in collaboration with the Australasian College of Infection Prevention and Control (ACIPC – the peak body for infection prevention and control in Australasia) released joint “Guidelines for Reprocessing Ultrasound
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Susan Campbell Westerway World Federation of Ultrasound in Medicine & Biology Australasian Society for Ultrasound in Medicine, NSW Australia scwus@hotmail.com Jocelyne M Basseal Australasian Society for Ultrasound in Medicine, NSW Australia j.basseal@asum.com.au References 1. Klevens, R Monina et al. “Estimating Health Care-associated Infections and Deaths in U.S. Hospitals, 2002.” Public Health Reports 122.2 (2007): 160 – 166. 2. Cruickshank M and Ferguson J (eds) (2008) Reducing Harm to patients from Health care Associated Infection: The Role of Surveillance. Australian Commission for Safety and Quality in Health Care. p3. 3. Cervini P, Hesley GK, Thompson RL, Sampathkumar P, Knudsen JM. Incidence of infectious complications after an ultrasound-guided intervention. Am J Roentgenol 2010; 195: 846 – 50. 4. Ferhi K, Rouprêt TM, Mozer P, Ploussard G, Haertig A, De La Taille A. Hepatitis C transmission after prostate biopsy. Case Rep Urol, 2013; 2013: e797 248. 5. Hiyama Y, Takahashi S, Uehara T, Ichihara K, Hashimoto J, Masumori N. A case of infective endocarditis and pyogenic spondylitis after transrectal ultrasound guided prostate biopsy. J Infect Chemother 2016; 22: 767 – 9. 6. Medicines and Healthcare products Regulatory Agency. Reusable transoesophageal echocardiography, transvaginal and transrectal ultrasound probes (transducers) – failure to appropriately decontaminate Medical safety alert – GOV.UK (No. MDA/2012/038); 2012. Available from: https://www.gov.uk/
drug-device-alerts/medical-device-alertreusable-transoesophageal-echocardiography-transvaginal-and-transrectal-ultrasound-probes-transducers-failure-to-appropriately-decontaminate. 7. Keys, M., Sim, B., Thom, O., Tunbridge, M., Barnett, A., & Fraser, J (2015). Efforts to Attenuate the Spread of Infection (EASI): a prospective, observational multicenter survey of ultrasound equipment in Australian emergency departments and intensive care units. Critical Care and Resuscitation Vol 17 (1):43 – 6 8. Westerway S, Basseal JM, Brockway A, Hyett JA, Carter DA. Potential risks associated with an ultrasound examination – a bacterial perspective. J Ultrasound Med Biol 2016; 43: 421 – 6. 9. Alfa MJ. Intra-cavity ultrasound probes: cleaning and high-level disinfection are necessary for both the probe head and handle to reduce the risk of infection transmission. Infect Control Hosp Epidemiol 2015; 36: 585 – 6. 10. Cheng A, Sheng W-H, Huang Y-C, Sun H-Y, Tsai Y-T, Chen M-L, et al. Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel. Clin Microbiol Infect 2016; 22: 382.e1 – 11. 11. Chittick P, Russo V, Sims M, RobinsonDunn B, Oleszkowicz S, Sawarynski K, et al. An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel. Infect Control Hosp Epidemiol 2013; 34: 850 – 3 12. Oleszkowicz S, Chittick P, Russo V et al. Infections associated with the use of ultrasound transmission gel: proposed guidelines to minimize risk. Infect Control Hosp Epidemiol 2012; 33:1235 – 1237. 13. Abdelfattah R, Aljumaah S, Alqahtani A, Althawadi S, Barron I, Almofada S. Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel. Journal of Hospital Infection. 2017; pii: S0195 – 6701(17)30 516 – 9 14. Shaban RZ, Maloney S, Gerrard J, Collignon P, et al. Outbreak of health careassociated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures. American Journal of Infection Control. 2017; 45(9):954 – 958
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15. Basseal JM and Westerway SC. Disinfection and Hygiene Practice in Medical Ultrasound: WFUMB Survey Results. Presented at the 16th World Federation for Ultrasound in Medicine and Biology (WFUMB) Congress. Taipei, Taiwan 13 – 17 October 2017. 16. Westerway SC and Basseal JM (2017a). The ultrasound unit and infection control –
Are we on the right track? Ultrasound. Volume: 25 issue: 1, page(s): 53 – 57. 17. Westerway SC and Basseal JM (2017b). Advancing infection control in Australasian medical ultrasound practice. Australasian Journal of Ultrasound in Medicine. Volume 20, Issue 1:Pages 26 – 29 18. Basseal JM, Westerway SC, Juraja M, F van de Mortel T, McAuley TE, Rippey J, et al. Guidelines for Reprocessing Ultrasound
Transducers. Australas J Ultrasound Med 2017; 20: 30 – 40. Accessed via: http://onlinelibrary.wiley.com/doi/10.1002/ ajum.12042/abstract For information from the EFSUMB Committee on Medical Ultrasound Safety (ECMUS) visit the EFSUMB webite http://www.efsumb.org/safety/resources/ 2017-probe_cleaning.pdf
Next WFUMB Congress
EFSUMB webinar Update on CEUS non-liver guidelines 8 December 17.00 CET Pancreas – Mirko d’Onofrio Urogenital – Michele Bertolotto CEUS in tumour response – Nathalie Lassau Chair – Paul Sidhu
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