Point-of-Care Lung Ultrasound in Adults: Image Acquisition

Point-of-care ultrasound (POCUS) of the lungs provides quick answers in rapidly changing clinical scenarios. We present an efficient and informative protocol for image acquisition for use in acute care settings.

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs' air-filled nature normally prevents direct visualization of the lung parenchyma. When showing the lung parenchyma, ultrasound typically generates a number of non-anatomic artifacts. However, over the past several decades, these artifacts have been studied by diagnostic point-of-care ultrasound (POCUS) practitioners, who have identified findings that have value in narrowing the differential diagnoses of cardiopulmonary dysfunction. For instance, in patients presenting with dyspnea, lung POCUS is superior to chest radiography (CXR) for the diagnosis of pneumothorax, pulmonary edema, lung consolidations, and pleural effusions. Despite its known diagnostic value, the utilization of lung POCUS in clinical medicine remains variable, in part because training in this modality across hospitals remains inconsistent. To address this educational gap, this narrative review describes lung POCUS image acquisition in adults, including patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization.

Over the past several decades, bedside decision-making and treatment have increasingly been augmented by point-of-care ultrasound (POCUS). POCUS is the use of ultrasound for diagnostic or procedural guidance by a patient's primary treatment provider. This is in contrast to consultative ultrasound, where the ultrasound exam is requested by a patient's primary treatment provider but is performed by a separate specialist team¹.

This narrative review focuses on diagnostic POCUS of a specific organ system: the lungs. Diagnostic POCUS of the lungs has proven useful in the acute care setting, allowing the diagnosis ....

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

1. Instrument settings and probe selection

NOTE: Lung POCUS can be performed with a multitude of transducers depending on what question needs to be answered.

1. Superficial lung in.......

Normal lung ultrasound findings (Video 1, Video 2, Video 3, Video 4, Video 5, Video 6, and Supplementary File 1)
Due to the marked discrepancy in acoustic impedance between the air in the lungs and the superficial tissues, normally all the ultrasound energy that reaches the interface of the parietal and visceral pleurae is immediately reflected back to the ultrasound transducer. As a result, at the depth of the lung parenchyma, the image seen on the screen of an ultrasound machine normally sho.......

Diagnostic POCUS is the use of ultrasound at the bedside by a patient's primary treatment provider to answer clinical questions. The questions most amenable to diagnostic POCUS are those that are qualitative or binary in nature and that need to be answered faster than would be possible or practical with consultative ultrasound services.

A few steps are critical for image acquisition. The first one is probe selection. The authors recommend that the initial assessment be performed using the .......

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