Lung ultrasound and telemedicine: new requirements for medical technologies in the era COVID-19

Pandemic COVID-19 was not only a challenge for health care, business and every person, and presented to the society valuable lessons. Technologies, which previously seemed to be known everything, today revealed a new side. Director, it cluster, a precision diagnostics company Philips in Russia and the CIS Mikhail Goncharov told about the method, opened in 2008, but became especially valuable and important in 2020 – about ultrasound of the lungs.

Three main methods of radiological diagnostics at COVID-19

In addition to the specific laboratory diagnosis COVID-19 (PCR test) during the spread of the virus a great importance was given to instrumental methods. The recommendations of the Ministry of health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection mentioned and described some of them: pulse oximetry, radiography, computed tomography and ultrasonography. The last three techniques are to radiodiagnostics. They have become indispensable in hospitals where they take patients with COVID-19.

The main method of diagnosis of lung lesions is computed tomography (CT). It’s a fast and informative method to detect pathology. In combination with the clinical picture it allows doctors to identify viral pneumonia caused COVID-19, with a probability of 98%. CT is the preferred study of the lungs even at the earliest stages of pneumonia.

Unlike CT, x-rays can be used in ward conditions, so it is well suited to monitor the dynamics of the patients in serious condition. However, this research has a significant disadvantage: it shows a high accuracy only in the later stages of the disease.

Before the pandemic COVID-19 ultrasonography of the lungs and the pleural cavity was not used for the diagnosis of pneumonia. Now, in view of the special situation, in particular, with the increasing flow of patients, views on this method have been revised.

New in the sphere of ultrasonic diagnostics

Today ultrasound is used as an additional method for diagnosing lesions of lungs at COVID-19. Obviously, this study cannot be a substitute for CT in the diagnosis of pneumonia and monitoring the patients with coronavirus. However, it is suitable for the dynamic evaluation of patients, including those in the departments of reanimation and intensive therapy, where ultrasound carried out in patients in a serious condition, which is difficult to deliver to the CT Cabinet. In casualty departments of hospitals the method is used to sort patients. With the help of ultrasound can also diagnose pregnant women whom CT is contraindicated. In addition, patients with COVID-19 frequent cardiovascular complications, including thrombosis, with subsequent pulmonary embolism (PE). In such situations, ultrasound of the heart is a necessity.

In Russia, lung ultrasonography in patients infected with COVID-19, approved by the three major professional bodies, including the Ministry of health of Russia. The first method is recommended by the experts of the Scientific centre for diagnostics and telemedicine Department of Health of Moscow, then joined the Association of ultrasonic diagnosis of READM. There is international experience of creating such recommendations.

Ultrasonic examination of the lungs based on the artifacts. The air the lungs can not see their structure, it is possible to evaluate only the line of the pleura. This allows to generate a certain ultrasound picture of healthy lung. The inflammatory process contributes to the appearance of fluid in the lung tissue, which changes their structure and conductivity of ULTRASONIC rays. In this case, we see another typical picture and can make an unambiguous conclusion about the developments.

Stationary or portable

During a pandemic, many hospitals will shift to assist patients with COVID-19, their territory is divided into “green” and “red” zones. In such conditions increasingly require a portable solution. Major stationary diagnostic equipment and difficult to disinfect, it is difficult to deliver patients who are in intensive care on a ventilator. When redevelopment of the hospitals inpatient ULTRASOUND machines may remain outside the “red” zones, thus to move people with coronavirus difficult.

Easy to handle portable device after the procedure much easier. Adherence to disinfection significantly reduces the risk of cross-infection in hospitals. It is important that, thanks to portable solutions, doctors can save time by moving devices, conduct diagnostic tool in the ICU and in any place where it is needed.

Telemedicine and COVID-19

Pandemic COVID-19 was for the heads of medical institutions and of officials in charge of health care, further proof of the importance of the availability of telemedicine functionalities in devices. We are talking about telemedicine in the format of “doctor-doctor”, when experts remotely support each other, provide expert comments and a second opinion. This is especially true for physicians who work in the red zones. Thus, for example, with a mobile ULTRASOUND machine procedure can conduct operator who is not a professional in the field of ultrasonic diagnosis. Thus a subject matter expert may be in a “clean” area to see the image and the position of the sensor, to give a colleague advice and assess what is happening.

The next level of analysis of the results of ultrasound – the use of a workstation for management of images and data. Complete solution (ultraportable ULTRASOUND device in the “red” zone + intelligent platform in the “clean” area) is already used in some medical institutions that provide assistance to patients with COVID – 19.

We asked the head of the Department of functional and ultrasound diagnostics fgbu “SMRC them. V. A. Almazov”, doctor of ultrasonic diagnostics, PhD Kid A.V., share impressions about this kind of solution:

“From the middle of may our center provides care for patients with COVID-19. Our experts record the necessary ULTRASOUND images directly at the bedside, and the doctor analyses the data gathered on the workstation IntelliSpace Cardiovascular, in a comfortable and safe environment “clean” zone. Thus the diagnostic process is accelerated, it becomes more secure and less labor-intensive for physicians. The system interface is intuitive and requires no lengthy training, therefore, the procedure itself may carry out the linear or intensive care physician infectious disease office.

The range of purposes in an infectious hospital with a wide popular in all sections of the ultrasound. When processing the data of echocardiography in some cases you can do without ECG-synchronization, but at the same time to perform routine morphometric analysis. In addition, you can use an automated algorithm for estimating myocardial deformation in gray-scale mode, which allows you to evaluate sokratitelnuju function of the left ventricle to changes in ejection fraction.

However, it should be noted the absence of Lumify technology impulsurilor Doppler, with which it would be possible to calculate the pressure in the pulmonary artery, to conduct transcranial duplex scanning to assess the hemodynamic significance of the stenosis and diastolic myocardial function. The research is now available, but the manufacturer promises to complete functionality of the device”.

Telemedicine and opportunities for research, who discovered its potential during COVID-19, have the potential to become the new reality of healthcare. Ultrasound is just one of the examples. Development is underway also in the field of magnetic resonance imaging and other technologies. Knowledge and experience obtained during the pandemic, will help you to cope better with global challenges.

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