Devices enable LifeBridge to move scanning closer to COVID-19 patients, limit their movement, and accelerate diagnoses.
Point-of-care ultrasound has found an important place in the toolkit of clinicians fighting the spread and effects of COVID-19, according to the chief innovation officer of Baltimore-based LifeBridge Health.
A new generation of handheld ultrasound devices, including the Butterfly iQ, allows faster assessment of pulmonary symptoms of the disease, while minimizing the spread of COVID-19 by reducing the need to move patients and equipment during the treatment process.
LifeBridge Health physicians are now using this ultrasound technology in the ICU to confirm COVID-related conditions such as pleural effusion, a build-up of excess fluid between the layers of the pleura outside the lungs, says Daniel J. Durand, MD, chief innovation officer and chair of radiology at the health system.
A handheld probe delivers images directly to the physician's phone or tablet through a wired connection. No additional equipment is used. "It puts the technology in the hands of a doctor that can make a difference for the patient," Durand says.
LifeBridge has more than 20 such devices in use across its four hospitals. "We've done thousands of exams at this point," he says.
Handheld Devices Replace More Expensive Options
Ultrasound use cases can be thought of as falling into two broad categories—conventional machines that allow a radiologist to render a broad range of final diagnoses, and "point of care" devices that allow a frontline clinician to perform a procedure or to initially investigate a potential diagnosis they suspect. The pandemic highlighted the usefulness of the latter category, Durand says.
"We were going to have to buy certain types of point-of-care ultrasound devices to target at specific uses," he says. "You always have to have those around for certain types of procedures, or triage-type things."
By incorporating these devices into the mix, LifeBridge was able to replace older, more expensive units for less money, and gain extra capabilities and uses.
"We're really thinking about democratizing imaging technology and bringing it closer to the patient," Durand says. "If that means that a non-radiologist is doing the imaging, that's fine. What matters is that we're getting more high-quality information and images on the patient quicker, improving diagnosis, and improving their care."
Prior to the arrival of point-of-care ultrasound, clinicians were using more expensive and outdated technology to assist in tasks such as inserting an IV or central line. "Frontline physicians are looking a lot more at the human body than they were before," Durand says.
ICUs in particular are one location where point-of-care ultrasound has thrived during the pandemic at LifeBridge.
Rather than asking another department to bring in imaging equipment and waiting for a diagnosis, Durand says the hand-held device enables clinicians to act in real time,
"It's difficult to quantify the potential impact of Butterfly-type devices on lowering COVID-19 mortality," he says. "You can do it with things that have been studied forever, like mammograms, but it takes [something] like 10 to 20 years."
Despite that, the pandemic demanded new approaches to care. "We all had to think outside the box, and we didn't always have time to design an elegant study, because we were all literally fighting for our lives," Durand says.
"There's plenty of information that shows that ultrasound technology can save lives in the right setting," he says. One such study at Temple University found that point-of-care ultrasound was more sensitive than chest x-rays at identifying COVID-19.
Still, "It's more about the access and the democratization [of ultrasound] and less about being able to say, 'It saved X number of lives,' for better or worse," Durand says.
"How Could This Transform Care?"
Compared to the cost of previous ultrasound gear, the new generation is "extremely low, which almost made us suspicious," Durand says.
Anticipating pushback from cardiologists, anesthesiologists, and ICU personnel, LifeBridge briefed and consulted with them well in advance of deploying the handheld ultrasound devices, Durand says.
"We all thought together, how could this transform care?" he says. "We all agreed and were enthusiastic. A couple of physicians had just purchased them on their own, and were using them at ambulatory offices outside of LifeBridge."
Part of the distinction with this new approach is that it utilizes the screen of the tablet or mobile phone that clinicians already carry and utilize, he adds.
Another cost-cutting measure is in the way the hardware is built, being entirely solid-state complementary metal oxide semiconductor, making it much less susceptible to breakage.
"Ultrasound probes get dropped all the time," Durand says. "There are many instances where the probes in other machines are prone to breaking and actually cost more than the entire Butterfly device."
Although even silicon-based probes are susceptible to breakage, they are much hardier than older, crystal-based ultrasound probes, Durand says.
One other less tangible benefit of Butterfly is its intuitive user interface, Durand says.
"It's from that sort of Steve Jobs school of thought that clearly sat down and reinvented something from scratch and then had a lot of human factors and engineers and designers in on it," he says.
Could Hand-Held Ultrasounds Become as Ubiquitous as Stethoscopes?
The cost of these devices, for now, preclude them from being as ubiquitous as stethoscopes, even though University of California, Irvine School of Medicine made headlines in 2019 by giving every graduate a Butterfly.
Eventually, point-of-care ultrasound will incorporate artificial intelligence algorithms that can provide ever more sophisticated analyses of the ultrasound, Durand says.
"It can do all that in a way that's far more standardized than just us listening to something through some headphones," he says. Plus, the chaotic conditions of COVID-19-era hospitals increased the noise interfering with using a traditional stethoscope.
"There's absolutely no reason that every doctor shouldn't know how to use these at some point in the future," Durand says.
Despite this, LifeBridge has no plans to deploy a point-of-care ultrasound to every doctor—yet. "Certainly, people have talked about it," Durand says. "But that's a big price tag. Medical schools are thinking in the right direction." More study over time will help make the case for it to be standard issue, he adds.
Potential Impact on the Radiology Profession
These portable devices have some wondering about their potential impact on the future of the radiology profession. Similar concerns arose when teleradiology became popular, and Durand points out that other professions have faced similar apprehensions due to innovation.
"A lot of people said that accountants were going to be out of business once TurboTax came out," Durand says. "In fact, accountants make more money today than they did in the mid-1980s, and are happier today."
In addition, says Durand, radiologists have had better wage growth and lower rates of burnout than other physicians, because they work more as consultants to physicians, Durand says. As point-of care ultrasound becomes more popular, "I think you might see a similar phenomenon."
Editor's note: This story was revised on Feb. 23 to clarify the FDA's definition of diagnostic quality and on Feb. 24 to further clarify the different types of ultrasound devices.
“We're getting more high-quality information and images on the patient quicker, improving diagnosis, and improving their care.”
Daniel Durand, MD, chief innovation officer and chair of radiology, LifeBridge Health
Scott Mace is a contributing writer for HealthLeaders.
Point-of-care ultrasound democratizes diagnostic access among clinicians and brings equipment closer to patients.
Use of these devices in ICUs can speed patient assessment and reduce spread of COVID-19.
Ongoing costs are "extremely low" versus previous generations of ultrasound, but the devices do not yet belong in every physician's toolkit, says LifeBridge chief innovation officer.