PoCUS Image Archiving

Emergency Medicine Saint John PoCUS Quality Assurance

In line with recommendations from CAEP and ACEP, our PoCUS program has minimum image archiving requirements. These archiving requirements are aligned to the Minimum archiving requirements for emergency medicine point-of-care ultrasound: a modified Delphi-derived national consensus – CAEP position statement.

General Principles

  • All PoCUS patient encounters must be recorded on q-path
  • Use the table below for minimum image archiving requirements
  • Additional images and clips can be saved to demonstrate important findings but avoid saving repeated clips that essentially show the same thing (choose the best examples and delete the rest on q-path)
  • Use q-path to correctly classify the PoCUS study (multiple studies on the same patient can be split in q-path)

 

Short demonstration on logging a scan on the machine (see video: Machine Archiving )

Short demonstration on how to use the Q-path (see video: Q-Path Guide )

Minimum Image Archiving Requirements

Click on application name link to view examples of required clips/images

APPLICATION IMAGES CINE-CLIPS

AORTA

 – Transverse images of the

  • proximal
  • mid
  • distal
  • bifurcation of the aorta

 -If Positive AAA single transverse image is sufficient

  3-4 sec 1-2 clips demonstrating Aorta from Xiphoid to Umbilicus

(Proximal Abdominal Aorta to bifurcation)

CARDIAC

CORE

 N/A
  • Cardiac Arrest: Single Best Available view
  • LV function: Parasternal Long Axis
  • RV function: Apical Four Chamber view
  • Pericardial effusion: Single Best Available view (Sub-Xiphoid)

CARDIAC

ADVANCED

 N/A Multiple views as Possible to maximize accuracy

E-FAST

 – RUQ:

  • Entire hepato-renal interface to the tip of the liver (Morison’s pouch)
  • Diaphragm–liver interface up to the 9 o’clock position (including R pleural effusion)

– LUQ:

  • Entire spleno-renal interface including the caudal tip of spleen
  • Diaphragm–Spleen interface up to the 9 o’clock position (including L pleural effusion)

– Pelvic:

  • Transverse view

– Sub-Xiphoid:

  • Best possible view demonstrating continuity of the right ventricular wall with septum

Same interfaces of RUQ, LUQ, Pelvic and sub-xiphoid while sweeping through the area of interest

 

 

– Pneumothorax:

  • clip or M-Mode
  • Bilateral sagittal scans at the mid-clavicular line, third intercostal space

LUNG

(Pulmonary edema)

 N/A Minimum of two representative zones, bilaterally

OBSTETRIC

 – Longitudinal and transverse view demonstrating if present

  • Juxtaposition of Bladder and uterus
  • Gestational sac
  • Yolk sac
  • Fetal pole (Heart rate documentation in M-mode)
  • Myometrial mantle measurement if looks abnormal (at least 5mm)
 All still images can be demonstrated in clips including fetal heart rate documentation

GALLBLADDER
  • Long-axis view
  • Short-axis view
  • In the context of cholecystitis, measurement of the anterior wall of the gallbladder (>3mm)
 Can be documented as clips to sweep through gallbladder

RENAL

  

  • Long-axis view of bilateral kidneys
  • Transverse view of the bladder

 

 All still images can be demonstrated in clips

DVT

 N/A – Demonstrated with and without compression

Zone 1:

  • Common–femoral vein.
  • Saphenous–femoral junction.
  • Femoral vein beyond the deep femoral branch.

Zone 2:

  • Distal femoral vein.
  • Popliteal vein.
  • Popliteal vein trifurcation.