Experts published first protocol for the use of lung ultrasound to assess the degree of lung involvement in patients suspected of having COVID-19...

1. Sensible Solutions for Refurbished Radiology
Ultrasound Protocols Used To Triage
COVID-19
By: Vikki Harmonay

2. Sensible Solutions for Refurbished Radiology
A group of Italian experts has published the first protocol for the use of lung ultrasound to
quantitively and reproducibly assess the degree of lung involvement in patients suspected of
having COVID-19 infection.
Libertario Demi, PhD, head of the ultrasound laboratory, University of Trento, Italy, and
colleagues have developed a protocol to standardize practice, which was published online on
March 30 in the Journal of Ultrasound Medicine, to standardize practice. Their research offers
broad agreement with industry-led algorithms and emphasizes the use of wireless, handheld
ultrasound devices, ideally consisting of a separate probe and tablet, to make sterilization easy.
Butterfly Network, Phillips, Clarius, GE Healthcare and Siemens are among numerous companies
that produce one or more such devices, including some that are completely integrated.

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While lung ultrasound is not universally accepted for diagnosing pneumonia in the context of
COVID-19 and triaging patients, Giovanni Volpicelli, MD, University Hospital San Luigi Gonzaga,
Turin, Italy says many COVID-19 patients that presented with a negative chest x-ray were found
to have interstitial pneumonia on lung ultrasound. And when patients don’t have to be
transported to the radiology department but can remain in the emergency room and undergo
lung ultrasound there, the risk of nosocomial infection is more easily controlled.
The goal of publishing the protocol was “to share our experience and to propose a
standardization with respect to the use of lung ultrasound in the management of COVID-19
patients.”
Approximately 60,000 ultrasound images of confirmed COVID-19 cases were reviewed without
access to the patients’ clinical backgrounds.

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The authors recommend scanning 14 areas in each patient for 10 seconds, making the scans
intercoastal to cover the widest possible surface area. They also advise the use of a single focal
point on the pleural line which optimizes the beam shape for observing the lung surface.
Cosmetic filters and modalities like harmonic imaging, doppler, contrast and compounding
should be avoided and the mechanical index should be kept low.
Volpicelli said, “There are situations where lung ultrasound can be considered definitive. For
instance, if I see a patient with mild signs of the disease, just fever, and I perform lung
ultrasound and see nothing,
lung ultrasound rules out pneumonia." He said, "This patient may have COVID-19 of course, but
they do not have pneumonia, and they can be treated at home, awaiting the result of the swab
test. And this is useful because you can reduce the burden in the emergency department."

5. Sensible Solutions for Refurbished Radiology
He continued, "On the other hand, there are patients with acute respiratory failure in
respiratory distress. If the lung ultrasound is normal, you can rule out COVID-19 and you need to
use other diagnostic procedures to understand the problem. This is also very important for us
because it's crucial to be able to remove the patient from the isolation area and perform CT
scan, chest radiography, and all the other diagnostic tools that we need.“
The Italian team said, “in the setting of COVID-19, wireless probes and tablets represent the
most appropriate ultrasound equipment," as they can "easily be wrapped in single-use plastic
covers, reducing the risk of contamination," and making sterilization easy.

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Volpicelli doesn't like what he sees as undue focus on wireless devices for lung ultrasound in the
COVID-19 protocols. For him, the issue of cross-contamination with standard lung ultrasound
machines is "nonexistent. Cleaning the machine is quite easy and I do it hundreds of times per
week." However, if the lung ultrasound is performed when a patient is using a continuous
positive airway pressure (CPAP) machine, the risk of contamination is much higher and a more
intensive cleaning procedure is warranted.
"Not all centers have wireless machines, whereas a normal machine is usually in all hospitals,”
he said. “The advantages of using lung ultrasound [in COVID-19] are too great to be limited by
something that is not important in my opinion.”

7. Sensible Solutions for Refurbished Radiology
The team at Atlantis Worldwide continues to monitor the role of medical imaging devices during
the COVID-19 crisis. If you are in the market for medical imaging equipment for your practice,
hospital, clinic or urgent care facility, remember that refurbished or used equipment can often
deliver the performance you want, the warranty you need and a price that helps your bottom
line.

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You can read this on our website
https://info.atlantisworldwide.com/blog/ultrasound-
protocols-used-to-triage-covid-19

9. Sensible Solutions for Refurbished Radiology
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