Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound

Abstract

Current descriptions of ultrasound evaluations, including use of the term “point-of-care ultrasound” (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness. Details of this classification scheme are elaborated, including important clarifications regarding what ensures comprehensiveness and completeness. Practical implications of this framework for future research and reimbursement paradigms are highlighted.

Introduction

Point-of-care ultrasound (POCUS) has been heralded as a disruptive innovation [1], akin to deployment of the stethoscope in the 19th century. Proponents argue that insonation be added to inspection, palpation, percussion, and auscultation as a fifth pillar of clinical bedside medicine [2]. However, the terminology regarding the use of handheld ultrasound units has been inconsistent and imprecise. Some define POCUS as “ultrasound performed and interpreted by the clinician at the bedside” [3], a definition based only on who and where the examination is performed. Others focus on a difference in the scope of the examination to differentiate POCUS; for these advocates, POCUS is different because it is focused on only some organs in an anatomic region or, somewhat paradoxically, not limited to organs in a single anatomic region [4].

The absence of a precise definition of POCUS impairs discussion and analysis of research, reimbursement, and accreditation efforts. This article, a collaborative endeavor from the Society of Radiologists in Ultrasound (SRU) and the members of the American College of Radiology Ultrasound Commission, addresses the absence of a unique POCUS definition by describing a metaphorical map depicting the ultrasound landscape as simply as possible. We intentionally take an approach that is specialty agnostic, applicable to ultrasound studies regardless of who performs the evaluation. We define four unique ultrasound evaluations, including one we label as POCUS, that we believe represent distinct, nonoverlapping categories of ultrasound as applied in the evaluation of patients. This framework has implications for future efforts regarding research and reimbursement.