Diku Mandavia, M.D., Chief Medical Officer for Fujifilm Sonosite, discusses how Sonosite’s newest ultrasound system, Sonosite PX, can help frontline military and civilian healthcare workers combat the pandemic and why Sonosite PX is uniquely-suited for this global health crisis.
What role does point-of-care ultrasound (POCUS) play in diagnosing and monitoring COVID-19 patients?
Dr. Mandavia: One of the things to understand about COVID-19 is that we learn more and more every week about this devastating disease. And we’re learning how you can use POCUS in the beginning to assess a lung injury, progression into cytokine storm, and for hemodynamic assessments. So, ultrasound plays a crucial role in the continuum of COVID-19, where a patient initially presents with respiratory symptoms, but also if they develop complications such as shock, thromboembolism, or renal failure. I look at ultrasound as a tool from the initial ER assessment all the way through to an ICU admission and then, recovery.
The entire Fujifilm Sonosite POCUS portfolio recently received 510(k) Clearance from the U.S. Food & Drug Administration (FDA) to support healthcare providers in performing accurate lung and cardiac imaging in COVID-19 patients. Being able to provide support to frontline healthcare workers in the battle to save lives is important to all of us.
That’s why we created a downloadable COVID-19 Point-of-Care Ultrasound Guide to help with performing accurate lung and cardiac imaging in COVID-19 patients, and cleaning and disinfecting Sonosite ultrasound machines.
Why launch a new point-of-care ultrasound system, in the middle of a global pandemic? Can Sonosite PX contribute to the care of COVID-19 patients?
Dr. Mandavia: POCUS has risen in importance in this pandemic. In a very short time, it has proven to be extremely valuable in the care of COVID-19 patients. We learned from experiences in China, Italy, UK, and New York City how extensive a disease COVID-19 is, with multi-organ system involvement. POCUS really contributes in the assessment and monitoring of these patients.
The two most important organs for COVID-19 assessment are the lungs and heart. Those are the most commonly performed applications. When you’re performing your shock assessment, you’re going to look at the lungs, heart, and the IVC. Sonosite PX is optimized for all of this.
Sonosite PX has dedicated lung presets with a new lung exam type on the new C5-1 transducer. And, we’ve made significant improvements in image quality. The system has our next-generation 2D cardiac and color flow imaging, which is going to be really important for hemodynamic assessments in COVID-19.
Of course, the image improvements are across the board for all parts of the body. So whether you’re talking about lung scanning, DVT scanning, or any other part of the body, Sonosite PX image clarity will help clinicians get to the answer quicker, faster
The all new Sonosite PX point-of-care ultrasound solution. (Image Source: FUJIFILM Sonosite, Inc.)
Can you speak to how Sonosite PX can play a role in military hospitals facing a surge?
Dr. Mandavia: Most COVID-19 cases are seen in the ER and the ICU. And this is where Sonosite PX’s small footprint is extremely valuable. It is an optimal size, especially in the ICU where you have a lot of equipment surrounding the bed. The form, size, and shape are ideally suited for crowded spaces. You have a large enough screen so the care team can see what’s happening with the patient, yet it can be easily moved in and out of ICUs.
In fact, physicians who are using Sonosite PX have commented on it. The system is more accessible at the bedside. And the more accessible the system is, the more patients are going to get access to that imaging.
How big of a role does advanced image clarity play in providing physicians confidence in their clinical diagnoses, particularly when caring for COVID-19 patients?
Dr. Mandavia: Ultrasound imaging is a very user-dependent technology. Image acquisition and image interpretation are completely dependent upon the clinician using the device. And in point of care, specifically, many users tend to be less experienced. They may be in the learning phases when having better image quality helps them understand, identify, and learn. Having higher resolution and clear definition of the anatomy is extremely important.
Ultimately you’re looking inside the body. The clearer the anatomy, the clearer the answer. It’s about having confidence in the answer to take care of the patient.
I think Dr. Theoret said it very well when he tried Sonosite PX:
Every study in point-of care-ultrasound will have to be redone because this completely changes everything. I mean, you can see individual muscle fibers! You can see the layers of the nerve sheath! – Dr. Jonathan Theoret, emergency physician, Australia
Let’s talk a little bit more about the form factor and adaptability of Sonosite PX.
Dr. Mandavia: Sonosite PX is a hybrid system with the ability to adapt from a horizontal to a vertical work surface position. This helps clinicians treat their patients by positioning the system closer to the bed. Clinicians are either performing a diagnostic scan or an ultrasound-guided procedure. And depending on where the device is and what type of scan they’re doing, the clinician may prefer the device in a standard configuration versus a vertical approach, whether it’s vascular access or a nerve block. This flexibility is really important for the specific types of patients they are treating.
Interscalene Nerve, scanned with the L15-4 transducer on Sonosite PX. (Image Source: FUJIFILM Sonosite, Inc.)
How can Sonosite PX play a role in surgery?
Dr. Mandavia: We know that with COVID-19, intubation is an extremely high-risk procedure for the anesthesiologist, as well as the other surgical staff in the operating room. It’s a procedure with a risk of aerosols, so everyone is in danger of being exposed to COVID-19 viral particles. Both American Society of Regional Anesthesia (ASRA) and European Society of Regional Anesthesia (ESRA) recommend regional anesthesia, if possible. Depending on the scenario, regional anesthesia may be a very effective and very safe option, for the patient and surgical staff.
Sonosite PX image clarity is critical for ultrasound-guided nerve blocks. When you’re guiding a needle all the way to the neurovascular bundle, where an artery and a nerve are adjacent, you want to get the anesthetic precisely adjacent to the nerve, but not inside the nerve, without hitting the artery. When you have to be anatomically certain, image clarity is crucial. This is where Sonosite PX with our most advanced image clarity, ever, excels.
Sonosite got its start with a DARPA* grant for an ultrasound system that could be taken to the battlefield. Does Sonosite PX follow that history?
Dr. Mandavia: Absolutely. In 1996, the company that became Sonosite secured funding from DARPA to develop from the ground up, a digital ultrasound machine specifically for frontline physicians. From that the Sonosite 180 ultrasound system was born.
Sonosite PX has that same reliability and durability built into it. But not just the ultrasound system, the transducers, too. We design, test, and manufacture our transducers which allows us to make them incredibly durable.
- Sonosite ultrasound systems are dropped, shaken, baked, and frozen
- Every Sonosite system under goes up to ten hours of quality assurance before shipping
- Sonosite PX system and transducers are drop-tested to 1 meter
- Sonosite PX transducers are IPX7 rated for immersion**
- Sonosite transducers are designed to endure 50,000 major flex and twist cycles on the transducer end
- Sonosite ultrasound systems require no preventive maintenance
Every Sonosite system under goes up to ten hours of quality assurance before shipping. The Sonosite PX system and transducers are drop-tested to 1 meter. The transducers are IPX7 rated for immersion*, and are designed to endure 50,000 major flex and twist cycles on the transducer end. As an added benefit Sonosite systems require no preventive maintenance.
Given how contagious COVID-19 can be on surfaces, tell me about cleaning and disinfecting Sonosite PX.
Dr. Mandavia: We designed Sonosite PX based on input from hundreds of physicians. And we got the message loud and clear that cleaning, disinfecting, and liquid ingress were at the top of the list, even before the COVID-19 pandemic appeared.
Sonosite PX has a user interface that is a blend of touch and tactile, but also retains the quality of being more easily cleaned with all the buttons being one piece. The surfaces are sealed edge-to-edge, preventing liquid ingress. This means that you can be confident that you can clean and disinfect both the system and transducers before you see the patient and after you’re finished. The ease of cleaning helps save time. The transducer holder cups that were on previous Sonosite systems are gone because those were harder to clean. That was a direct result of clinician input.
When Sonosite PX is used in a highly-contagious environment, such as a COVID-19 ward, it can be used with a clear, sterile drape. That makes cleaning much easier. Even with the drape over Sonosite PX, you can still see the images extremely well and control the entire system via the touchscreen and buttons.
Will Sonosite and Sonosite PX play a role in COVID-19 research?
Dr. Mandavia: Absolutely. We’ve launched a research collaboration with American College of Emergency Physicians (ACEP), Emergency Medicine Foundation (EMF), and the American College of Chest Physicians (CHEST Foundation) to study point-of-care ultrasound in the care of COVID-19 patients. Based on the early reports, we believe that even more ultrasound care pathways will be developed. We’re deploying Sonosite PX to the front lines for both clinical care and COVID-19 research.
Sonosite created a downloadable point-of-care ultrasound guide to help clinicians care for COVID-19 patients. (Image Source: FUJIFILM Sonosite, Inc.)
How does Sonosite PX facilitate ultrasound education, and how does this impact COVID-19?
Dr. Mandavia: In the pandemic, physicians in other specialties are being redeployed into the ER or the ICU. They may be an internal medicine physician, gastroenterologist, or an OB-GYN, but they may be deployed as a COVID-19 clinical physician. As a result, many clinicians are still learning ultrasound.
POCUS exams aren’t difficult, but they do require some education. Having access to educational resources is one of the most important elements of the ultrasound learning phase. This is where Sonosite PX really shines. It has more than 150 onboard 3D scan-along tutorials on how to perform point-of-care ultrasound. So it’s a device that helps you learn to scan well.
Our customers also have access to Sonosite Institute, a full learning management system, available in six languages. Within the medical imaging industry, there’s no other source as comprehensive. We developed and aggregated educational content for POCUS applications and made it accessible from a phone, laptop, desktop, or tablet. Learning pathways enable clinicians to complete courses in the major applications within emergency medicine, critical care, anesthesia, MSK specialties, and more. Students can learn at their own pace. When they pass a course, they receive a certificate from Sonosite. This holistic solution is really important for point of care.
We also provide the free SonoAccess app for iPhone and Android, which contains how-to videos, clinical images, reference guides, and other educational content.
We’re the market leader in POCUS education. Last year, we taught over 37,000 clinicians at workshops in the U.S. alone. We have more than 600 training videos with 18 million views. Sonosite Institute has 27,000 active users, while our SonoAccess app has over 270,000 users around the world.
Many medical schools are now giving students exposure to ultrasound. These students will enter different specialties, which will further expand the use of POCUS. And it’s not just physicians. Nurses, paramedics, physician assistants, veterinarians, and athletic trainers are using POCUS. They will do more and more.
Any final thoughts on the role of POCUS and Sonosite PX in the pandemic?
Dr. Mandavia: As we battle the COVID-19 pandemic, Sonosite PX is going to advance the power of POCUS even further. To me, it’s is about solving problems. My journey into POCUS was to solve a problem in the early 1990s, when I found myself overwhelmed with trauma patients in at LAC+USC Medical Centre in Los Angeles. POCUS helped solve that problem by detecting internal bleeding at the bedside. Now every trauma center in the U.S. is using POCUS.
Today, it’s a privilege to help civilian and military medical professionals fight COVID-19 worldwide. I know Sonosite PX can be part of the global effort to save lives from the ravages of this terrible pandemic. We’ve seen time and time again that point-of-care ultrasound is a key component in managing COVID-19 patients.
And Sonosite PX is ready for the job.
* DARPA did not select or approve this advertiser and does not endorse and is not responsible for the views or statements contained in this advertisement. ** Protected against water immersion for 30 minutes at a depth of up to 1 meter.