Role of diagnostic point-of-care ultrasound in preoperative optimization: a narrative review

Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing

“…TTE uses grayscale ultrasound, has the capability to use advanced imaging modes (eg, color/spectral Doppler and EKG gating), and is performed/interpreted by providers with comprehensive training in cardiac ultrasound image acquisition and interpretation (ie, board certification or equivalent). [8][9][10]12 The definitions above have implications for the oft-misused term: "limited echocardiogram" (aka "limited echo"). A "limited echocardiogram" is an abbreviated exam, but one that nevertheless upholds the high standards that define the term "echocardiography" (quantitative assessment, advanced imaging modalities, and performed/interpreted by providers with comprehensive training in surface cardiac ultrasound).…”

“…(2) include advanced imaging modes (eg, color and/or spectral Doppler); and (3) answer questions quantitatively. 2,[8][9][10]12 In contrast, FoCUS exams require less intensive training, utilize grayscale imaging only, and address questions qualitatively. In the examples above, a FoCUS exam would identify the presence of severe ventricular dysfunction or severe aortic stenosis as "yes," "no," or "indeterminate.…”

“…So, while it is certainly possible for a patient's primary treating provider to perform a "comprehensive point-of-care TTE," in our experience, this is not usually practical. This is because a primary treating provider is inherently tasked with answering a targeted list of context-specific clinical questions, whereas a comprehensive TTE is designed to obtain a full set of cardiac measurements to screen for a broad list of possible 12 with permission from Wolters Kluwer Health Inc. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”

“…In contrast, TTE is a quantitative examination capable of identifying and quantifying the severity of all sonographically detectable cardiac pathologies. TTE uses grayscale ultrasound, has the capability to use advanced imaging modes (eg, color/spectral Doppler and EKG gating), and is performed/interpreted by providers with comprehensive training in cardiac ultrasound image acquisition and interpretation (ie, board certification or equivalent) 8–10,12…”

“…CCE indicates critical care echocardiogram; FoCUS, Focused Assessment with Sonography in Trauma; PTTE, perioperative transthoracic echocardiography; TTE, transthoracic echocardiography. Adapted from Krishnan and Bronshteyn12 with permission from Wolters Kluwer Health Inc. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”