How Does Ultrasonic Scanner Help COVID-19?
The global pandemic of COVID-19 has put to challenge every sector, be that business sector, economic sector, or health sector. On March 11, 2020, COVID-19 was declared a global pandemic. The diagnosis and risk stratification of patients with symptoms of COVID has been a challenge for healthcare systems all around the world. When the virus was getting out of hand, health professionals did everything to get it back under control. They used different medical methodologies and tools to diagnose it and to find a plausible antidote. One such machine that was very helpful during the pandemic was Ultrasound Scanner. This article will tell you how does Ultrasonic scanner helps COVID-19?
Pulmonary ultrasonography in patients with COVID-19 VS Ultrasound of normal Lungs
The tests available to diagnose COVID-19 include Molecular tests (Which has low sensitivity and results are not readily available), chest X-ray (CXR), which is considered to be a poor diagnostic test for COVID-19, polymerase chain reaction (PCR)(the test also has low sensitivity, i.e., 72%). And Computed Tomography (CT), whose sensitivity is pretty fair (88-97%), but it is an impractical test for all COVID-19 patients—leaving us with the one option, i.e., Pulmonary ultrasonography.
Ultrasonography of Lungs is a fairly new test, as we cannot imagine the Lung using ultrasound due to high acoustic mismatch between the air and the soft tissues of the organ. But recently, clinicians have discovered that due to the presence of health conditions, ultrasound artifacts can be made. Ultrasonography is, therefore, very helpful in diagnosing different lung pathologies and especially against COVID-19.
Interpreting any pulmonary ultrasonography requires high operator skills, sometimes due to the lack of which makes it a less adaptable method for COVID detection. As little as 4 hours of training is required to able to detect the B-lines from lung ultrasonography.
When we compare pulmonary ultrasonography images of a normal lung and the one with COVID-19, we can see that the ultrasonography of a normal Lung shows a sharp and smooth Pleural line. And it lay inferior to and bordered on each side by dark rib shadows. A-line appears as bright-line inferior to the pleural line, and they are equidistant from the transducer. It is shown in figure 1.
The person with the Coronavirus can show irregularities in the pleural line, A-line and B-lines. The following figures show pulmonary ultrasonography of Covid-19 patients. Figure 2 shows an image that has small, peripheral localized consolidation and irregular Pleural line appearances.
Figure 2: Red arrows showing Pleural line irregularities in COVID-19 patient
Figure 3 shows an ultrasonographic image that shows discrete B-lines arising from a thin pleural line (Left), Confluent B-lines (Right).
Figure 4 shows an image that has larger consolidation stippled with an air bronchogram.
How does an ultrasonic scanner help COVID-19?
Studies have confirmed that pulmonary ultrasonography has a sensitivity, which is around 78.6%. So Ultrasonic scanner offers a cost-effective, sensitive, fast and reliable method of COVID-19 detection, which can be a lifesaver. Pulmonary ultrasonography could be a relevant alternative to chest CT.
COVID-19 attacks the terminal alveoli in the peripheral area of the Lung, and lesions tend to be close to the pleura, which is where ultrasound works perfectly. The ultrasonic scanner detects those lesions by sending high-frequency sound waves and recording the reflected waves from the lesions, thus confirming the presence of COVID-19. The test is very simple to conduct, and usually, it can be carried out at the bedside.
The main signs of lung ultrasound in COVID-19 patients are as follows:
1.Thickening of pleural line with the irregular shape of pleural line；
2. Multiple types of B-line patterns, including focal type, multiple discrete types, and fusion types;
3. Various types of lung consolidation, including small multifocal flakes, non-lobe types, and lobar types, occasionally accompanied by movable air bronchial signs；
4. Line A appears in the recovery phase;
5. Pleural effusion is rare.
The lesions of early or mild COVID-19 patients can be focal pulmonary interstitial infiltration. Ultrasound can find local pleural thickening at the lesion site, with discrete B-line at the back, indicating pulmonary interstitial inflammation.
In the progressive stage of COVID-19, multiple lobes of lung interstitial and alveolar infiltration can be seen. Ultrasound shows multiple focal B-lines, where discrete B-line indicates lung interstitial infiltration, and fusion B-line indicates alveolar infiltration. In the latter case, the sliding of the pleura was further weakened, suggesting that the lung ventilation in this area became worse.
Severe or critically ill patients may have different degrees of lung consolidation, with tissue-like echoes in the lung lobes, accompanied by fragmentation or bronchial signs, suggesting that the alveoli are collapsed, and ventilation is further reduced.
In light, severe and critically ill patients, the lung ultrasound score showed a significant gradient. It shows that the lung ultrasound score can be used to assess the severity of COVID-19. Lung ultrasound helps to perform repeated screenings many times a day, compare the patient's lung disease before and after, and fully understand the worsening or improvement of lung disease.
At the same time, it can reduce the shortcomings of transport risks and radiation of critically ill patients who are transported to the imaging department for examination.
Pulmonary ultrasound can complete the titration regulation of positive end-expiratory pressure (PEEP) in mechanical ventilation, select the best ventilator index, and guide lung recruitment.
Application scenarios of Ultrasonic scanner
The ultrasonic scanner is a device that is used to examine internal body structures. The first sonographic test of the Lung was carried out more than 50 years ago. Apart from the application of pulmonary ultrasonography, ultrasonic scanners are helpful against many other health concerns, such as abdominal scans, pelvic scans, pregnancy scans, musculoskeletal scans, etc. Ultrasonic scanners are extensively used by healthcare systems. Some of the departments that use ultrasonic scanners include:
1.Anaesthesiology
The visualization examination equipment and diagnosis and treatment technology represented by ultrasound examination has highlighted its significant clinical application value in anesthesia and perioperative department clinical work. Ultrasound can be called the anesthesiologist's third eye. In addition, ultrasound also plays a vital role in monitoring patients' perioperative safety and surgical effect.
2.Cardiology
Intracardiac ultrasound can provide a clearer real-time image of the heart structure, which can assist doctors in accurately identifying thrombosis in the auricle, guide the ablation catheter to accurately reach the predetermined anatomical position, and significantly reduce perioperative complications.