Wednesday, April 1, 2020

GLOBAL MEDICAL ALLIES SHARE LUNG ULTRASOUND SOLUTION FOR COVID-19 TRIAGE


Additional contributors: Dr. K. Lessnau (NYC) and Dr. D. Buonsenso, (Rome)

April 1, 2020- Dr. Robert L. Bard, recognized cancer imaging specialist manages an international network of medical allies who have presented recent insight on the use of Lung Ultrasound in identifying respiratory disorders that may be associated with Covid-19.  One of Dr. Bard’s collaborators, Dr. Danilo Buonsenso of Rome, Italy recently published applied uses of ultrasound equipment as an “effective replacement of the stethoscope” for high exposure areas of the Coronavirus.

Front line physicians in Italy and Spain are reportedly currently triaging with portable ultrasound units that reduce logistical problems of a chaotic environment and healthcare worker exposure. Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic overwhelming medical providers.  Dr. Buonsenso, at the viral epicenter in Rome, uses sonograms to decide who requires a CT scan.

The use of CT lung imaging for COVID-19 has been the diagnostic standard for the last few months of the current epidemic.  CT has the disadvantage of logistics (staff, patients, transport) and radiation exposure. Respiratory distress creates motion artifacts on images that may simulate pulmonary inflammation. Since the disease mutates often, frequent imaging may be required. Viral pneumonia is not diagnostically distinguishable from other viral inflammations in the lung so the argument for a screening modality is useful to separate the critically ill from those needing outpatient treatment.  Dr. Klaus Lessnau, author of CHEST ULTRASOUND (Springer 2003), employs both CT and ultrasound imaging in clinical practice.

Dr. Bard reviews international healthcare updates including recent reports by Dr. Buonsenso about the Covid crisis. As a community of assumed carriers and not clinically affected, Dr. Buonsenso is also actively investigating the pediatric population with the expanded use of lung ultrasound.  “The global pandemic demands effective answers toward a cure as well as protection of healthcare workers on duty. I have the highest regard for the European approach to problem solving both clinically and technologically… applying Dr. Buonsenso’s concept makes perfect sense and carries great value in our war against Covid-19.”

According to Dr. Bard, Lung ultrasound has been used in emergency rooms since it was introduced to the Mt Sinai Medical School in 2014 and is now used nationwide to diagnose pneumonia (viral or bacterial) in children which spares them unnecessary x-rays since it is so accurate. “It is like an electronic stethoscope since lung disease and heart failure producing pulmonary fluid buildup are diagnosed or confirmed with portable ultrasound units at the bedside. This is considered the best imaging tool to diagnose a collapsed lung in seconds which has proven lifesaving as a time saver for on the spot detection.”

In a recent telehealth conference, Dr. Bard explains how ultrasound probes study the lungs between the ribs to read the lung surface where most Covid pathology is situated.   The virus has known cardiac toxicity so the same sonogram unit may image the heart for fluid buildup and weakened contraction. This may differentiate heart failure from pulmonary infection in some cases which may have similar clinical presentations.

Ultrasound probes study the lungs via the ribs showing the lung surface (where most Covid pathology is situated) and adjacent lung tissue. The abdominal scan with the curved transducer has a larger field of view and affords a rapid assessment of B lines (Fig 1), pleural effusion and frank pneumonia (Fig 2).  Portable units have the advantage of containment within a sterile sleeve preventing accidental viral spread to imaging equipment necessitating full decontamination procedures.  

Some infected European physicians are monitoring their disease at home via the B line count-few B lines suggest low grade inflamed lung tissue-increasing B line count calls for more aggressive treatment. All clinical imaging was correlated with the patient’s oxygen saturation and clinical setting.  The virus has potential cardiac toxicity so the same sonogram unit may image the heart for fluid buildup and weakened contraction. This may differentiate heart failure from pulmonary infection in some cases which may have similar clinical presentations.


Dr. Bard currently runs a private imaging center in NYC specializing in advanced 3-D sonography to detect cancers and other health disorders.  He lectures in medical conferences worldwide, runs a volunteer cancer awareness program for first responders and is also a publisher of countless educational books and articles about cancer imaging and other health/wellness related materials. Additional info. on this topic may be found in Dr. Bard’s newsletter (prevention101.org).  For interviews, call our media director: Grace Dellavalle @ 631-920-5757 or email: nycralliance@gmail.com

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