Optimizing B-lines on lung ultrasound: an in-vitro to in-vivo pilot study with clinical implications.

B-lines on lung ultrasound (US) are the hallmark of pulmonary edema. It is unknown if ultrasound machine settings or probe type matter. We created an in-vitro gelatin model. Using lung presets as baseline, five blinded investigators assessed the impact of 32 distinct settings on B-line visibility ba...

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Publicado en:Journal of Clinical Monitoring & Computing Vol. 34; no. 2; pp. 277 - 285
Autores principales: Schmickl, Christopher N., Menon, Aravind Ajakumar, Dhokarh, Rajanigandha, Seth, Bhavna, Schembri, Frank
Formato: Journal Article
Publicado: Springer Nature Apr2020
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Apr2020
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      pub: Springer Nature
      place: New York, New York
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        atl: Optimizing B-lines on lung ultrasound: an in-vitro to in-vivo pilot study with clinical implications.
      aug:
        au:
          Schmickl, Christopher N.
          Menon, Aravind Ajakumar
          Dhokarh, Rajanigandha
          Seth, Bhavna
          Schembri, Frank
        affil: University of California San Diego, 5210 Fiore Ter L414, 92122, San Diego, CA, USA
      sug:
        subj:
          Ultrasonography Methods
          Pulmonary Edema
          Lung
          Regression
          Ultrasonography Statistics and Numerical Data
          Phantoms, Imaging
          Multivariate Analysis
          Proteins
          False Positive Results
          Pilot Studies
          In Vitro Studies
          Linear Regression
          Clinical Assessment Tools
          Impact of Events Scale
          Scales
      ab: B-lines on lung ultrasound (US) are the hallmark of pulmonary edema. It is unknown if ultrasound machine settings or probe type matter. We created an in-vitro gelatin model. Using lung presets as baseline, five blinded investigators assessed the impact of 32 distinct settings on B-line visibility based on a Likert-Scale (LS) from 0 to10 (< 5 worse, > 5 better) separately for two probes. The experiment was then repeated in-vivo in a patient with known pulmonary edema. Based on a multivariable regression LS-ratings were similar when comparing the in-vitro versus in-vivo experiment (P = 0.16; partial R2 = 0.2%) and when using the curvilinear versus linear probe (P = 0.69; partial R2 = 0.02%) but significantly different across machine settings (P < 0.0001; partial R2 = 34.4%). Limited by its pilot character, our study suggests that (1) certain US-machine settings heavily impact B-line visibility, with no clear difference between probes; (2) in-vitro models are a valid and practical alternative to more challenging patient-based research; (3) there is significant potential to improve B-line visibility and thus diagnostic yield in the clinical setting by using lung presets, centering the focal zone at the pleural line and increasing the distal time gain compensation, most of which are (in our experience) rarely done.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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