Compact Ecocardiography Revolution: from bedside to interventional Lab ultrasound anywhere? Fausto Rigo FESC Dipartimento Cardiovascolare Ospedale di Mestre-Venezia Milano 20/06/ 2008
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Evidence for evolution: ultrasound. 1951 Cattle Tank Scanner - Dr. Howry & Dr Herz M-Mode 70 3-D 2003 3
Evidence for evolution: ultrasound.
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Portable echo
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Portable machine ranging from small system containing imaging and colour mapping alone to miniaturised quite full system Comparing the same type of study, high accuracy is obtainable with portable system Focused echocardiography speeds decision-making in many emergency clinical situations Screening echocardiography reduces the need for standard echocardiography in patients with suspected heart disease, even if sometimes further investigation is needed. 2003
Portable echo: ultrasound stethoscope Portable ultrasound devices in clinical cardiology: lights and shadows M Penco Ital Heart J Suppl 2003 Hand-carried ultrasound devices may be considered as a "visual stethoscope" which provides an extension of the physical examination, but not as a potential alternative to standard transthoracic echocardiography. Vignon P Arch Mal Coeur Vaiss 2003 11
Portable echo: ultrasound stethoscope Introdotto 10 anni fa come ultrasound stethoscope first sight Funzione diagnostica limitata, spesso non esaustiva La nanotecnologia ha rivoluzionato l elettronica applicata agli ultrasuoni riducendo il gap con macchine tradizionali Ecografo portatile: - flessibile d uso (trasportabilità) - facilita l esecuzione dell esame al letto del malato - costi contenuti - elevati standard tecnologici e diagnostici
Portable echo: latest technology
Premium Compact Ultrasound
The need for ultrasound use growing Ultrasound anytime & anywhere Anesthesiology Interventional labs Surgical suites Office environments Pain management clinics Screening / Wellness clinics Sports injury clinics Emergency department Remote location care Disaster site triage?
Portable echo: latest technology Diagnostic confidence : -leverage image processing from superior machines -broadband digital beam and pure wave transducer Mobility: -easily carried to bedside in each department -wide monitor - flexible conettivity (Dicom-wireless) Efficency of examination - I-scan for 2D-Dopper investigation - Anatomical M-mode - Full Doppler investigation ( TDI,Strain rate,speckle) - Dicom images (exporting ) Transducers equipment: TT, TE and Cw-dedicated
Real world: Surgical arena? 17
Real world: Interventional-Lab? 18
Real world: ICU
Real world: Cardiac surgery 20
Portable echo: Mestre Distribuzione Esami: 69 pz Rep.Cardiologia 12 pz UTIC 8 pz CCH 10 pz Rianimazione CCH 6 pz Rianimazione Gen 6 pz P.S. 8 pz Rep. Medicina 6 pz Amb. Esterni 8 pz Stress-Echo 3 pz Personal data 2008
vs 100 100 99,8 100 99,8 66 consecutive patients + 3 stress-echo 80 60 40 Ie33 0,2 portable 0,2 feasibility diagnostic accuracy inconclusive Personal data 2008
Clinical case Real world ICU Male 65 years Intermediate risk Chest pain 30 m Trop. (h 3:40 )
Clinical case Real world Female 74 years Hypertension Chest pain (30-40 m ) Troponin T
Clinical case Real world ICU
Clinical case Real world ICU
Clinical case Real world Division of Cardiac Surgery Female 72 years Mitral Bioprosthesis 1 year earlier Fever, dyspnea, weakness.; Blood examination.negative
Clinical case Real world
Clinical case Real world
Clinical case Real world
Compact echo: ETE
ETE: 3D
Digital-Lab: Multi- cardiac Imaging UO Cardiologia Sede distaccata Reparto / UTIC Client generici ECG Workstation di Refertazione Ambulatori visite/esami Workstation Produzione CD-Paziente Ecocardiografia Medici di base Strutture convenzionate, MMG, etc. Emodinamica Workstation di Refertazione Archiviazione legale 100Mb 54 Mb wireless 1 Mb 640/256 ADSL Router/firewall
Take home message. Compact Echo (latest generation): - small size= notebook - Flexible and suitable for any pts and operator (I-scan) -Higher and complete techonology: (atomicalm-mode,volume,ef,pw,cw,color- Dop, TDI speckle tracking, CFR, etc) - Allowing to export each examination in Dicom format ( visible at any PC) - It can be employed anywhere and particularly in emergency room or in inteventional arena - At present, we can consider it no more as first ultrasound approach...!
Final remarks Auri sacra fames Technology in medicine is frequently untested scientifically, often applied without data relating to cost benefit, and driven by market forces rather than by patient needs Bernard Lown, 2004
Thank You
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Clinical case Real world Departement of Medicine Male 64 years Old A.M.I. Stroke
Clinical case Real world Stress-Echo Stress-echo Male 67 yrs old Low risk
Clinical case Real world Stress-Echo