Sharing a Point-of-Care Ultrasound System

Dr Mandy Masters purchased a Sonosite iViz in 2018 while attending a Rural Hospital Conference trade show where Sonosite was exhibiting. Intrigued by this new compact ultrasound device, her husband, Dr Jonathan Masters, began to borrow the iViz for his own clinical work at a private practice.

They now have a weekly iViz ‘sharing’ system in place.

We asked both doctors how they use point-of-care ultrasound in their respective jobs.

What kind of medicine do you practice?

Dr Mandy Masters: I work as a Rural Hospital Specialist on New Zealand’s North Island. I previously worked as a GP in the UK.

Dr Jonathan Masters: I have worked as a urologist for over 30 years, mainly with male patients. I work in both the public hospitals and clinics and a private practice in Auckland.

I conduct radical prostatectomies for prostate cancer, and major pelvic and reconstructive surgery for bladder cancer. I also perform open and endoscopic laser surgery for kidney and ureteric stones, shock wave lithotripsy, and transurethral resection of prostate for benign prostate disease.

How long have you been using point-of-care ultrasound as part of your patient practice?

Dr Mandy Masters: Back in 2013, I worked at the Middlemore Hospital Emergency Department, and I always had access to ultrasound equipment. At the University of Otago, I took a year-long course to obtain a certificate in Clinician-Performed Ultrasound that’s specifically designed for clinicians working in rural practice. The course is excellent, and teaches the physics of ultrasound, as well as cardiac and general scanning and POCUS techniques. I bought the iViz after taking the course.

Dr Jonathan Masters: I have had access to ultrasound throughout my career, and have used it since earning my medical degree. However, I’ve only been using the iViz since Mandy purchased it!

Has using point-of-care ultrasound changed anything about your work?

Dr Mandy Masters: Lung scanning! It is not always possible to get access to a radiographer to do an X-ray. Portable ultrasound is a great tool and you can use it to diagnose most acute presentations of lung disease, and if a physician is skilled enough with ultrasound diagnostics, one could even dispense with a chest X-ray.

Dr Jonathan Masters: I take an iViz to every clinic I go to and use it for all my scanning work. I use it when looking for bladder tumours, checking the size and shape of prostrates, checking for tumours, and residual volume.

The device is so light that when I’m performing a scan, I can hand the screen to my patient to show them what’s going on in real time. This really helps them understand what I am talking when I find a problem – they get to ‘eyeball the enemy’ as I manoeuvre the probe.

If I use a standard ultrasound machine, the process is much more difficult as they have to turn their head to see the screen – this can then interrupt the scan image as their body is moving.

Live imaging provides a better understanding of what they are facing. Even if they haven’t been given a formal education in, say, prostate cancer, just being able to see a live scan of a tumour in their own body as I’m scanning it helps patients feel like they have a bit more control.

With POCUS, it’s less common for me to have to send patients off for an ordered ultrasound scan in Radiology. For my patients, outside referrals mean another appointment, delay in treatment, and added costs. So being able to use ultrasound in my office can avoid all that.

What sort of features are important in a POCUS system?

Dr Mandy Masters: Being able to get a really good cardiac view while still having a system that’s easy to carry around—I was surprised that something as small as the iViz could get good views like that.

Being able to scan for DVTs, and to assess undifferentiated abdominal pain is really handy. The phased array transducer works for most people, but we also just purchased a curvilinear transducer, which will offer better penetration in patients with a larger physique.

Dr Jonathan Masters: Ergonomics and automated settings. In the iViz, the controls are intuitive and there are auto-adjustments. For instance, when depth is wrong, you don’t have to press a whole lot of buttons to get the correct setting – it does it automatically. The menus are easy-peasy and I really like the Doppler.

You both travel abroad to conduct medical volunteer work. Do you use point-of-care ultrasound on these missions?

Dr Mandy Masters: I often travel to far-flung areas like Nepal and Tonga. I actually bought the iViz specifically for when I travel overseas, and it has been really great! Having a small diagnostic tool that can give you quick answers in remote locations is invaluable. Because the machine is so lightweight, the patient can hold the screen while I scan them—say, when checking for pregnancy. They love that!

I use it to conduct imaging of the heart, lungs, and abdomen, and also for venepuncture, locating foreign bodies, evaluating pregnancies, identifying fractures, and assessing soft tissue infections.

Dr Jonathan Masters: I also perform voluntary service overseas, usually in Vanuatu and Samoa. I work with the Pacific Island Medical Development, which is part of Ministry of Foreign Development and Trade for New Zealand government. I have been using the iViz today in Vanuatu and it has been really useful. Both the patients and the local doctors have loved it.

Would you recommend the use of POCUS to other physicians?

Dr Mandy Masters: I’ve already recommended it to my rural hospital colleagues. One day, I envisage that we will all be walking around with an iViz looking at hearts. Also, being able to send our images via email, and save and store images to the cloud, is really cool. This is really valuable if we need a second opinion and for learning and teaching purposes.

Dr Jonathan Masters: I regularly recommend the iViz to other urologists.