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- Discrepancies between Screening Sonography and Ultrasound in Emergency Department - A case reportPublication . Miravent, Sérgio; Figueiredo, Teresa; Donchenko, Inna; Duarte Lobo, Manuel; Cruz, Gualter; Almeida, RuiIntroduction: This case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care. Case Presentation: A patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam. Conclusion: The differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.
- Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency servicePublication . Miravent, Sérgio; Lobo, Manuel; Figueiredo, Teresa; Jiménez, Carmen; Almeida, RuiBackground and Aims: The use of ultrasound screening is primarily facilitated by point‐of‐care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal. Methods: Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH. Results: In our sample, 60% of cases were related to biliary pathology, 20% were liver‐related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables “Sonographic Murphy sign” (V = 0.859; p = 0.001), “Cholelithiasis/Gallbladder sludge” (V = 0.840; p = 0.001), and “Intrahepatic biliary tract dilatation” (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the “Sonographic Murphy sign” (k = 0.664; p = 0.001) and the presence of “Cholelithiasis/Gallbladder sludge” (k = 0.712; p = 0.000). Conclusion: Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.
- Renal screening sonography—a comparative study in a portuguese basic emergency servicePublication . Jiménez, Carmen; Barbancho, Narciso; Lobo, Manuel Duarte; João Mário Gonçalves; Corina Hasnas; Miravent, Sérgio; Figueiredo, Teresa; Almeida, Rui; Gomes, Carla Marisa; Ratusneac, IonRenal Point-of-Care Ultrasound (POCUS) is a screening modality that aids in clinical decision-making for patients with suspected renal colic. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). Methods: Thirty-one patients suspected of having renal pathology underwent initial sonography screening with POCUS at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. Results: In our sample, the majority of patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) patients presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables ‘Dilatation of pyelocaliceal system’ (V = 0.895; P = 0.00), ‘Simple cystic formation’ (V = 0.878; P = 0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables, respectively (k = 0.890; P = 0.000) and (k = 0.870; P = 0.000). There was also a strong statistically significant correlation in the ultrasonographic findings between BES and RH performers (k = 0.890; P = 0.000 and k = 0.870; P = 0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. Conclusion: Renal POCUS screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic findings at the BES had a good correlation with the complementary imaging results obtained at the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.
- Pre-hospital ultrasonography screening for biliary disease in remote settingsPublication . Miravent, Sérgio; Jimenez, Cármen; Lobo, Manuel; Figueiredo, Teresa; Almeida, RuiScreening ultrasound, including Point of Care Ultrasonography (POCUS), is widely utilized for rapid clinical guidance in diverse healthcare settings. In this case report, a 34-year-old male with recurrent biliary colic symptoms underwent a Basic Emergency Service ultrasound, revealing a 13 mm gallbladder calculus and signs of inflammation, and was promptly referred to the hospital for further evaluation and treatment. Medical specialist confirmation at the hospital underscored the significance of early detection through POCUS. Despite inconclusive laboratory results, the detailed ultrasound assessment provided a comprehensive understanding, emphasizing the tool's value in averting complications. Thus, screening ultrasound played a pivotal role in justifying the hospital referral, showcasing its vital role in healthcare, especially in resource-limited settings. The judicious use of POCUS can lead to superior outcomes, avoiding unnecessary referrals for non-emergent cases.
- Pre-hospital detection of intrahepatic biliary duct dilatation: Recognizing the abundance of vessels in the liverPublication . Miravent, Sérgio; Lobo, Manuel Duarte; Almeida, RuiDiagnosing and confirming intrahepatic biliary duct dilation (IHBDD) involves a coordinated effort across multiple medical spe cialties, often relying on comprehensive blood analysis. However, the utility of screening ultrasound in detecting intrahepatic biliary dilation becomes particularly valuable in pre-hospital settings like our Basic Emergency Service, especially when access to alternative imaging techniques or detailed blood analyses are unavailable. Detecting the intrahepatic biliary dilation pattern through ultrasound is notably straightforward for a skilled sonographer. The presence of IHBDD can be efficiently identified during a screening ultrasound, allowing identifi cation of imaging findings that help differentiate simple biliary colic from clinical cases that should be prompt referral to the reference hos pital and without unnecessary delays or resource expenditure. The eti ology of IHBDD is multifactorial1 , and while its presentations may vary, the characteristic ultrasound pattern often involves the visualization of “extra vessels within the liver,” related to the distinctive “shotgun” sign2 . This sign translates into the observation of dilated bile ducts exhibiting no flow on Doppler imaging.
- Pre-hospital Identification of a Giant Bladder Calculus through Screening Sonography: A Case ReportPublication . Miravent, Sérgio; Gomes, Carla Marisa; Simãozinho, Paula; Vaz, Bruna; Lobo, Manuel Duarte; Almeida, RuiIntroduction: Screening ultrasound proves to be remarkably beneficial in pre-hospital settings, particularly in geographically remote areas with technological constraints and no medical specialties. Urological pathology has a high frequency of occurrence in the emergency department and is part of the wide range of occurrences that can benefit from this ultrasound screening as a clinical guide for patients. Case Presentation: In this case, a patient experiencing lower abdominal pain and symptoms of renal colic sought assistance at a basic emergency service facility. Utilizing a renal screening ultrasound executed by a sonographer, the clinical team identified images indicative of a significant bladder calculus. Subsequently, the patient was referred to a referral hospital for a comprehensive evaluation by medical specialties. Conclusion: The images obtained in both health units exhibited congruence, indicating that the screening ultrasound, while not intended to replace the specialized orthodox ultrasound executed by a radiologist, served as a crucial tool for diagnostic presumption, providing consistency in clinical decision-making for referring patients. This capability allowed emergency physicians to promptly transfer a patient requiring urgent further investigation to a referral hospital with compelling and substantiated data. This shift in the approach to patient triage in a remote setting could enhance patient safety.
- Emerging trends in ultrasound education and healthcare clinical applicationsPublication . Manuel Duarte Lobo; Miravent, Sérgio; Almeida, RuiIn this chapter, the authors explore the transformation of ultrasound training in the digital era of higher education. As the digital landscape redefines access to information and learning modalities, this chapter critically examines the integration of innovative digital tools in ultrasound education. The authors focus on leveraging technologies like extended realities and simulations, alongside the practicality of mobile applications, to enhance the learning experience. The chapter underscores the importance of evolving educational systems to actively engage students in these advanced learning frameworks. It aims to stimulate a comprehensive discussion on effectively incorporating these technologies at the undergraduate level, evaluating their impact on student learning outcomes, and preparing future healthcare professionals for a technology-driven medical landscape. This review offers a forward-looking perspective on integrating cutting-edge digital tools in ultrasound education, signifying a shift towards more interactive, immersive, and effective learning experiences.
- Pre-hospital ultrasonography screening for biliary disease in remote settingsPublication . Miravent, Sérgio; Cármen Jimenez; Manuel Lobo; Figueiredo, Teresa; Almeida, RuiScreening ultrasound, including Point of Care Ultrasonography (POCUS), is widely utilized for rapid clinical guidance in diverse healthcare settings. In this case report, a 34-year-old male with recurrent biliary colic symptoms underwent a Basic Emergency Service ultrasound, revealing a 13 mm gallbladder calculus and signs of inflammation, and was promptly referred to the hospital for further evaluation and treatment. Medical specialist confirmation at the hospital underscored the significance of early detection through POCUS. Despite inconclusive laboratory results, the detailed ultrasound assessment provided a comprehensive understanding, emphasizing the tool's value in averting complications. Thus, screening ultrasound played a pivotal role in justifying the hospital referral, showcasing its vital role in healthcare, especially in resource-limited settings. The judicious use of POCUS can lead to superior outcomes, avoiding unnecessary referrals for non-emergent cases.