Original ArticleClinical Practice ManagementMapping 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
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.
Section snippets
Current State With Overlapping Classification
A PubMed search for the term “point-of-care” reveals the evolution of this term as it applies to ultrasound evaluations. Between 1946 and 1991, that search yields 33 citations, none of which are related to ultrasound, with the majority describing bedside laboratory testing or nonultrasound technology. The first reference in the National Library of Medicine database that is identified when searching for both “point-of-care” and “ultrasound” identifies one investigation published in 1992 [5].
Proposed Framework With Distinct Categories
We propose a simple way to broadly classify ultrasound evaluations that is more meaningful and consistent, taking the nomenclature beyond the idea of who performs the evaluation to the more important concept of what evaluation has been performed. Ultrasound evaluations can be divided into four nonoverlapping categories (Table 1). POCUS is one category, a term we reserve for sonographic evaluation of a patient performed and reported as part of a patient evaluation and management (E/M) encounter.
Practical Impact
The map we create is specialty agnostic and allows for progressive increase in ultrasound effort as needed; a reimbursable PC-DXUS or CC-DXUS examination could follow an NC-DXUS examination if indicated. Table 4 outlines one example of the possible interplay among POCUS, DXUS, and other imaging. Importantly, our map does not require that DXUS studies be done only by specialists who traditionally perform these studies. We do not presume that DXUS evaluations are performed in any particular
Conclusions
As members of the SRU Executive Board and the ACR Commission on Ultrasound, we have deep respect for the power of ultrasound to improve the evaluation, management, diagnosis, and care of patients. Profound developments in color Doppler capabilities, cine clip acquisition and storage, and handheld ultrasound technology have changed the ultrasound landscape; we need a new map. Defining POCUS simply as the sonographic evaluation of a patient performed and reported in a patient E/M encounter, and
Take-Home Points
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Ultrasound evaluations can be divided into four nonoverlapping categories. We advocate that the term “POCUS” be used to describe sonographic evaluation of a patient performed and reported as part of a patient E/M encounter. Three other categories of ultrasound are distinguished by comprehensiveness and completeness; we label these NC-DXUS, PC-DXUS, and CC-DXUS.
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In our framework, “comprehensive” means protocol-driven evaluation of all relevant anatomic and sonographic features of a structure or
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The authors state that they have no conflict of interest related to the material discussed in this article. Drs Patel, Horrow, Kamaya, Frates, Dahiya, Chong, Gerena, Ghate, Glanc, Goldbach, Gupta, Hill, Johnson, Kocher, Sohaey, Waltz, Wolfman, and Middleton are employees. Drs Golding and Rubin are partners.