The use of small personal ultrasound devices by internists without formal training in echocardiography

Eur J Echocardiogr. 2003 Jun;4(2):141-7. doi: 10.1053/euje.2002.0617.


Aims: Hand-held ultrasound devices will probably be used for bedside cardiac diagnoses by internists without formal training in echocardiography. We compared the accuracy of hand-held ultrasound devices studies performed by expert echocardiographers vs internal medicine residents with brief training in echocardiography.

Methods and results: Three internal medicine residents participated in an organized training program in echocardiographic principles, image acquisition, and interpretation. Subsequently, these residents and three echocardiographers imaged 300 patients with a hand-held ultrasound device. Sensitivity, specificity, positive and negative predictive values for internist- and echocardiographer-performed studies for the detection of cardiac abnormalities were compared using a full-featured exam as the gold standard. Resident- and echocardiographer-performed scans had similar overall sensitivity and specificity. There was a higher positive predictive value for the echocardiographer-performed scans. For clinically important findings (likely to affect patient care), sensitivity was slightly but significantly higher for the echocardiographer-performed scans. Clinically important findings most often missed by residents included regional wall motion abnormalities, intra-cardiac thrombus, right ventricular dysfunction and non-trivial pericardial effusions.

Conclusion: Hand-held ultrasound devices provide useful screening tools for cardiac disease but should not replace a standard platform study. Training guidelines and competency evaluation are needed if these devices are to be used by non-echocardiographers for clinical decision-making.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Aortic Valve Stenosis / diagnosis
  • Cardiovascular Abnormalities / diagnosis
  • Echocardiography / instrumentation*
  • Heart Atria / diagnostic imaging
  • Heart Atria / pathology
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Humans
  • Hypertrophy, Left Ventricular / diagnosis
  • Inservice Training*
  • Internship and Residency*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Ventricular Dysfunction, Right / diagnosis