Madrid. Specialists in internal medicine ask to integrate and standardize the use of multi -rge ultrasound at bed, since it enhances the profitability of traditional clinical exploration and optimizes decision making by modifying diagnostic suspicion and treatment in a considerable percentage of cases.
They also affect that multi -rgan ultrasound is a fast, safe, accessible and effective tool that allows the cardiorespiratory system and abdomen to be explored, providing key information and modifies the diagnosis and treatment approximately one in four to five patients. The specialists gathered in the XII Meeting of Clinical Ultrasound of the Spanish Society of Internal Medicine (SEMI) Recently held in Cádiz they ask that this technique be integrated and standardized in all areas of medical care to improve the quality of the service provided to patients.
Dr. Yale tung -chen
Dr. Yale Tung-Chen, coordinator of the Ultrasound group of the Spanish Society of Internal Medicine and the Internal Medicine Service of the Hospital “La Paz”, in Madrid, commented to Medscape in Spanish The main arguments to defend the need to provide these portable mini -cooks to specialists in internal medicine. “It represents an investment in care quality that helps faster, safe and effective diagnoses, adapting to the needs of an increasingly dynamic Health environment and with care challenges.” In turn, they allow an immediate diagnostic evaluation at the point of care, which optimizes decision making and improves patient management by complementing the traditional physical examination. “Its portability enables use in different environments (hospitable, primary care, address), reducing the need to transfer the patient for complementary tests, avoiding diagnostic delays.”
They also help detect unexpected findings and guide interventions safely, which translates into significant therapeutic changes in high percentage of cases.
In that line, their incorporation facilitates the continuous training of these specialists and promotes a more efficient care model based on standardized protocols that have proven to improve clinical results.
Regarding whether there has been any formal proposal to the health administrations, Dr. Tung-Chen indicated: “As far as I know, in internal medicine no. But other specialties, such as Family Medicine and Emergency, have managed to be provided with pocket equipment in the health centers of different autonomous communities, as is the case in the Community of Madrid.”
In Spain, the Ministry of Health has promoted a formal initiative that includes the endowment of ultraportable organizers in the framework of diagnostic modernization in the Amat-I Plan, which seeks to renew the technological park of the national Health System replacing obsolete equipment (many with analog technology and with more than ten years of use) by latest generation devices that improve diagnostic capacity. According to an official press release, 63.5 million euros have been allocated for the acquisition of more than 1,579 equipment distributed in different lots, among them, one for ultraportable equipment.[1] “Although I do not have national data, we have benefited to modernize several teams in our internal medicine service of the ‘La Paz’ hospital,” added the specialist.
Credentials of multi -rgan ultrasound
Dr. Tung-Chen added that a study published in Journal of Clinical Medicine In 2022 carried out in the working group, the usefulness of this technique consolidates. “The realization of a multi -rigan ultrasound screening detected unexpected relevant diagnoses in approximately 27.7 % of cases, modifying the therapeutic strategy in 19.3 %.”[2] Among these findings it is mentioned that at the heart level
Significant valve diseases and cardiac contractility problems were identified, which led to adjusting the treatment to optimize the management of heart failure.
As for pulmonary findings, complicated pneumonia or pleural spills were diagnosed that had not been evident in the initial clinical examination, which implied changes in antibiotic administration or the need for procedures such as pleural drainage.
Regarding the abdomen, acute urinary retention and aorta aneurysms were detected, conditions that require specific interventions, such as catheter placement or urgent reference for surgical interventions.
The doctor said that “orientates procedures, for example, in venous channeling, avoiding those that are complicated by thrombosis or in the decision to perform thoracic drains or abdominal ascites only when there is sufficient amount of liquid, which constitutes an essential element of safety for the patient.”
At the same time it benefits patients in external consultations and primary care, said another more recent article published in Journal of Clinical Ultrasonography In 2024, in which significant ultrasound findings were found in 37.5 % of patients.[3] Of all ultrasounds, the most clinically relevant were carried out in the cardiac region (almost 32 %), followed by the abdominal cavity (26 %).
In addition, these findings led to a change in general management in 27.5 % of patients. Through logistics regression a model was developed to estimate the presence of clinically relevant findings with an area under the 0.78 curve with a sensitivity of 80 % and specificity of 66 %.
Integrated artificial intelligence, luxury assistant
As for the most outstanding characteristics of these devices, Dr. Tung-chen explained that artificial intelligence is integrated directly into the software of portable ultrasound devices to assist in several phases of the diagnostic process: “During the acquisition and processing of images, artificial intelligence algorithms help to optimize data capture reducing errors and improving the quality of the image.” In real -time interpretation, this tool identifies and quantifies relevant clinical parameters, as function and contractility of the ventricle, detection of specific patterns in the lungs, measurement of diameters and volumes in abdominal structures such as the bladder or lower vein cava. “These calculations help, with a shorter learning curve, to standardize the interpretation, reduce the dependence of the operator and allow faster and more precise decision making, improving the safety and effectiveness in the patient’s care,” said the doctor.
On the other hand, “thanks to the miniaturization of the equipment and the increasing quality, these devices have reduced their cost significantly; their price can range between 1,000 and 10,000 euros, usually below 5,000 in most equipment.”
We must not forget “that specific training is indispensable to guarantee the quality in the use of these devices.” However, there are basic applications (such as bladder measurement, lower cava evaluation or even vein thrombosis detection in lower limbs) in which the learning curve is relatively short and the necessary competition can be acquired after approximately twenty supervised ultrasound. In contrast, “other more complex procedures, such as echocardioscopy, require more extensive formation, with approximately one hundred supervised ultrasounds to achieve an adequate level of domain,” added the expert.
But not everything is benefits and these teams also have some inconveniences linked to that miniaturization, since 2D image quality and color doppler can vary depending on the device. Before buying them, battery, loading time, continuous scanning time, weight, connectivity, operating system and related to the storage of the images (cloud, PACS-Decom format) should be considered.
Decision making in different scenarios
These devices “enhance clinical decision making in various contexts, adapting to the needs of multiple specialties and care environments,” said Dr. Tung-Chen.
In primary care these devices allow a more complete and rapid clinical evaluation facilitating the early diagnosis of pathologies such as vascular diseases, abdominal infections or musculoskeletal alterations. “This helps reduce unnecessary referrals and prioritize attention based on gravity,” he added.
In household care and palliative care “allow monitors and evaluations to be carried out in the patient’s environment, improving the management of chronic diseases and palliative care,” he said.
Also in pediatrics they facilitate the evaluation of respiratory, abdominal or cardiac problems in children, “offering a rapid and non -invasive diagnosis, also without ionizing radiation, so sensitive in this population.”
Without forgetting their role in sports medicine and rehabilitation, where “they are useful for the evaluation of musculoskeletal lesions and monitoring patient recovery.”
Dr. Tung-Chen said “that virtually any specialty is in contact with ultrasound, so in medical faculties these portable devices become a fundamental didactic tool.” They allow grade students to integrate theoretical knowledge with clinical practice early facilitating the learning of anatomy, physiology and exploration techniques. “This not only reinforces the integral formation of future doctors, but also improves their ability to perform precise diagnoses and understand the correlation between clinical and image findings.”
The tool of the future internal medicine specialist
The Spanish Society of Internal Medicine, supported by other institutions, defends in the consensus document the realization of clinical ultrasound, the effective integration of ultrasound in medical care, its standardization and the fact of guaranteeing quality and its systematic application in clinical practice, education and research, to ensure that professionals are properly trained and that ultrasound evaluations are carried out with a standard of excellence.[4] The purpose is the homogenization of its use to offer a higher quality service.
“We are faced with a technological revolution that results in a more resolutive, efficient and patient -centered medicine due Professionals, “said Dr. Daniel García Gil, a member of the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine in a press release of the Scientific Society.[5]
In that line, “in internal medicine, multi-rgan ultrasound has become the perfect complement to traditional physical examination. The physical-ecography exploration binomial, with adequate standardization, can be done in less than 15 minutes and substantially increases the profitability of traditional physical examination,” said Dr. Gonzalo García Casasola Sánchez, advisory member of the Working Group of Clinical Ultrasound of the Spanish Society of Internal Medicine. “The integration of traditional physical exploration-multi-rgan ecography will be the physical examination of the future and should be adopted by any specialist in internal medicine.”
Dr. Tung-Chen has declared no conflict of relevant economic interest.
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