The use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tablet facilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to perform diagnostic and interventional procedures in bedridden patients. The device is equipped with a battery-powered probe without cables that transmits images to a tablet (or a cell phone) through a dedicated App. We hypothesise in future to extend diagnostic and low-complexity interventional procedures from hospitalised patients to at-home patients who are not able to mobilise out of bed or are difficult to transport. This domiciliary service might also reduce the overhead of hospital accesses

Carcano G.

Coppola A.

Curti M.

Fontana F.

Ossola C.

Piacentino F.

Venturini M.

Zorzetto G.

English

Archivio istituzionale della ricerca - Università dell'Insubria

HYPOTHESIS Open AccessPocket-sized, wireless-Bluetooth ultrasoundsystem to perform diagnostic and low-complexity interventional procedures inbedridden patients during the COVID-19pandemic: from intensive care unit todomiciliary service?Christian Ossola1, Filippo Piacentino1, Federico Fontana1, Marco Curti1, Giada Zorzetto1, Andrea Coppola1,Giulio Carcano2 and Massimo Venturini1*AbstractThe use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tabletfacilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to performdiagnostic and interventional procedures in bedridden patients. The device is equipped with a battery-poweredprobe without cables that transmits images to a tablet (or a cell phone) through a dedicated App. We hypothesisein future to extend diagnostic and low-complexity interventional procedures from hospitalised patients to at-homepatients who are not able to mobilise out of bed or are difficult to transport. This domiciliary service might alsoreduce the overhead of hospital accesses.Keywords: Bedridden persons, COVID-19, Mobile applications, Ultrasonography, Wireless technologyKey points Pocket-sized, wireless-Bluetooth ultrasound systemscan allow bedside diagnostic and low-complexityinterventional procedures. Those bedside diagnostic and interventionalprocedures could be extended from hospitalised toat-home patients. This innovative domiciliary service might alsoreduce the overhead of hospital accesses.The increase in life expectancy over 80 years in indus-trialised countries has led to a higher and higher preva-lence of chronic diseases that often coexist in the sameindividual, making its management difficult, leading tonot always justified crowding of emergency rooms [1].This evidence has become more acute during the se-vere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, when the risk of clogging of emer-gency rooms has been added to the risk of contagion forpatients and health workers [2]. The introduction of sys-tems based on wireless, Bluetooth, and touchscreentechnologies has recently also included ultrasound im-aging [3]. Ultrasound has low cost, is radiation free,operator-dependent, easily repeatable, capable of real-time imaging, allowing rapid diagnosis for example incase of emerging diseases [3, 4]. Ultrasound is also© The Author(s) under exclusive licence to European Society of Radiology. 2022 Open Access This article is licensed under aCreative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproductionin any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to theCreative Commons licence, and indicate if changes were made. The images or other third party material in this article areincluded in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is notincluded in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceedsthe permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by/4.0/.* Correspondence: massimo.venturini@uninsubria.it1Department of Diagnostic and Interventional Radiology, Circolo Hospitaland Macchi Foundation, Insubria University, Varese, ItalyFull list of author information is available at the end of the articleEuropean RadiologyExperimentalOssola et al. European Radiology Experimental            (2022) 6:20 https://doi.org/10.1186/s41747-022-00273-1widely used as the main guidance system for variousinterventional procedures such as biopsies, drainageplacements, and ablations [1].An innovative pocked-sized, wireless-Bluetooth ultra-sound system (Clarius Mobile Health Corp, Vancouver,Canada) facilitated the work of radiologists during the firstwave of coronavirus disease 2019 (COVID-19) to performdiagnostic and interventional procedures in bedridden pa-tients. The device is equipped with a battery-poweredprobe without cables and can transmit images to a tabletor cell phone through a dedicated app [2, 5].In our hospital, many patients affected by SARS-CoV-2 developed biliary sludge and subsequently acute chole-cystitis. In this inauspicious context, the placement of apercutaneous cholecystostomy in the angiographicroom—as usually performed—added three additional is-sues to an already strained hospital management frame-work [6]. The first was the transport of patientsthroughout the hospital, increasing the risk of infectionspread. The second was the occupation of an angio-graphic room which then must be sterilised. The thirdwas the necessity to provide personal protection equip-ment for the whole team involved in the procedure [1].To solve these problems, we thought to perform bedsidecholecystostomy in COVID-19 patients in the intensivecare unit. Transhepatic gallbladder drainage wasperformed by two interventional radiologists with appro-priate personal protection equipment for standard, con-tact, and airway precautions (Fig. 1) according to theWorld Health Organization recommendations [7]. Sev-eral diagnostic ultrasound examinations and ultrasound-guided interventional procedures such as pleural or peri-toneal drainage (Fig. 2) were performed in bedridden pa-tients in the intensive care unit [8]. Typically, pre-pandemic bedside procedures were performed in pa-tients admitted to intensive care units or in patients withmedical issues that did not allow their transfer to theinterventional radiology room [8].All these cases were conducted using the pocket-sized,wireless-Bluetooth ultrasound system, with appropriatesterile probe cover and protection system of the coolingfan. The tablet on which the images have been transmittedwas also adequately protected. Images were transferred tothe local Picture Archiving and Communicating System,permitting the full legal archiving of the images and thepossibility of making comparisons over time duringproper follow-up [9].We hypothesise a future scenario where diagnosticand low-complexity interventional procedures (thora-centesis, paracentesis, peritoneal, and pleural drainages)based on pocket-sized ultrasound systems not only inhospitalised but also at-home patients, creating a newFig. 1 Percutaneous transhepatic ultrasound-guided cholecystostomy through an intercostal approach in a coronavirus disease 2019, COVID-19,patient with acute cholecystitis. The guidewire (A), the “railway sign” of the gallbladder wall (arrow), and the presence of sludge and microlithiasis(asterisk) are shown in a. The interventional radiology team performing percutaneous gallbladder drainage at the bedside in intensive care unit isshown in bOssola et al. European Radiology Experimental            (2022) 6:20 Page 2 of 4domiciliary service [1, 2]. Many elderly, fragile, onco-logic, and bedridden patients could benefit from thisperspective [2]. This diagnostic and interventionalhomecare setting leads to a reduced risk of infection forcompromised patients, less stress for hospitalisation andbetter follow-up options.In the case of an interventional procedure, an inter-ventional radiologist and an experienced nurse shouldbe involved, making the whole procedure easilymanageable. These procedures are safe, with life-threatening complications (e.g., haemoperitoneum,bowel perforation, accidental puncture of an arterialvessel along the drainage pathway with progressive as-piration of bright red blood) occurring in very rarecases [1, 10]. At any rate, at the end of the procedure,the patient will remain under observation for at least 30min. In the case of major complications, the interven-tional team can alert emergency physicians and transferimmediately the patient to the emergency room of thenearest hospital, possibly that where the interventionalteam is based.This innovative domiciliary service might also reducethe overhead of hospital accesses particularly ofemergency departments, overloaded with COVID-19 pa-tients during the high waves of the recent pandemic[11]. Moreover, the angiographic room would be avail-able to perform more complex interventions, optimisingthe resources of the hospital and also of the surroundingterritory. In the end, the expected advantages are thoseof minimising the pressure on emergency rooms, guar-anteeing diagnostic and therapeutic procedures to pa-tients who can be transported with difficulty and toimplement new guidelines that push towards territorialmedicine.AbbreviationsCOVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratorysyndrome coronavirus 2Authors’ contributionsAll the authors directly participated in the design of this article. All authorsread and approved the final manuscript.FundingNo funding was received.Availability of data and materialsNot applicableFig. 2 A low-complexity interventional radiology procedure performed at the patient's bedside using a pocket-sized, wireless-Bluetooth ultrasoundsystem. Images show the diagnostic ultrasound of the right pleural cavity displayed on the tablet (a) and the placement of the pleural drainage (b, c)Ossola et al. European Radiology Experimental            (2022) 6:20 Page 3 of 4DeclarationsEthics approval and consent to participateNot applicableConsent for publicationNot applicableCompeting interestsThe authors declare that they have no competing interests.Author details1Department of Diagnostic and Interventional Radiology, Circolo Hospitaland Macchi Foundation, Insubria University, Varese, Italy. 2Department ofGeneral, Emergency and Transplants Surgery, Circolo Hospital and MacchiFoundation, Insubria University, Varese, Italy.Received: 3 January 2022 Accepted: 25 March 2022References1. Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB (2013) Clinicaloutcomes after bedside and interventional radiology paracentesisprocedures. Am J Med 126:349–356. https://doi.org/10.1016/j.amjmed.2012.09.0162. Zanardo M, Schiaffino S, Sardanelli F (2020) Bringing radiology to patient’shome using mobile equipment: A weapon to fight COVID-19 pandemic.Clin Imaging 68:99–101. https://doi.org/10.1016/j.clinimag.2020.06.0313. Nicolaou S, Talsky A, Khashoggi K, Venu V (2007) Ultrasound-guidedinterventional radiology in critical care. Crit Care Med 35:S186–S197. https://doi.org/10.1097/01.CCM.0000260630.68855.DF4. Guillory RK, Gunter OL (2008) Ultrasound in the surgical intensive care unit.Curr Opin Crit Care 14:415–422. https://doi.org/10.1097/MCC.0b013e3283060a275. Moussaoui G, Zakaria AS, Negrean C, et al (2021) Accuracy of Clarius,handheld wireless point-of-care ultrasound, in evaluating prostatemorphology and volume compared to radical prostatectomy specimenweight: is there a difference between transabdominal vs transrectalapproach? J Endourol 35:1300–1306. https://doi.org/10.1089/end.2020.08746. Peckham-Cooper A, Coe PO, Clarke RW, Burke J, Lee MJ (2020) The role ofcholecystostomy drains in the management of acute cholecystitis duringthe SARS-CoV-2 pandemic. What can we expect? Br J Surg 107:e447. https://doi.org/10.1002/bjs.119077. Best S, Williams SJ (2021) What have we learnt about the sourcing ofpersonal protective equipment during pandemics? Leadership andmanagement in healthcare supply chain management: a scoping review.Front Public Health 9:765501. https://doi.org/10.3389/fpubh.2021.7655018. Lichtenstein DA (2007) Point-of-care ultrasound: infection control in theintensive care unit. Crit Care Med 35:S262–S267. https://doi.org/10.1097/01.CCM.0000260675.45549.129. Wallin MKEB, Wajntraub S (2004) Evaluation of Bluetooth as a replacementfor cables in intensive care and surgery. Anesth Analg 98:763–767, table ofcontents. https://doi.org/10.1213/01.ane.0000097186.99167.ba10. Fontana F, Piacentino F, Ossola C, et al (2021) Transcatheter arterialembolization in acute non-variceal gastrointestinal bleedings: a ten-yearsingle-center experience in 91 patients and review of the literature. J ClinMed 10:4979. https://doi.org/10.3390/jcm1021497911. Bein KJ, Berendsen Russell S, Ní Bhraonáin S, Seimon RV, Dinh MM (2021)Does volume or occupancy influence emergency access block? Amultivariate time series analysis from a single emergency department inSydney, Australia during the COVID-19 pandemic. Emerg Med Australas 33:343–348. https://doi.org/10.1111/1742-6723.13717Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Ossola et al. European Radiology Experimental            (2022) 6:20 Page 4 of 4

Pocket-sized, wireless-Bluetooth ultrasound system to perform diagnostic and low-complexity interventional procedures in bedridden patients during the COVID-19 pandemic: from intensive care unit to domiciliary service?

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Pocket-sized, wireless-Bluetooth ultrasound system to perform diagnostic and low-complexity interventional procedures in bedridden patients during the COVID-19 pandemic: from intensive care unit to domiciliary service?

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