Longitudinal scan with an ultrasound probe showed that the kidney was broad bean-shaped, and the right kidney was lower than the left kidney; the left kidney showed a single hump because it was close to the spleen. The kidney can be divided into the renal parenchyma and the renal sinus; the renal sinus is hyperechoic on ultrasound imaging and the renal parenchyma is hypoechoic: this can be divided into an outer cortical area and an inner medullary area (cone echo). Between the medulla is the renal column.
Normal adult kidney ultrasound scan image: *renal column, **renal pyramid, ***renal cortex, ****renal sinus
Normal child kidney ultrasound scan image: *renal column, **renal pyramid, ***renal cortex, ****renal sinus
The normal adult kidney is about 10-12 cm long, and the right kidney is slightly longer than the left kidney. Kidney size correlates with individual size and age. The renal cortical thickness is measured from the base of the renal vertebral body and is typically 7-10 mm. If the renal vertebral body is poorly demarcated, the thickness of the renal parenchyma can be measured and is 15-20 mm.
Renal measurements: L=length; P=parenchymal thickness; C=cortical thickness.
Renal Doppler ultrasonography is widely used in clinical practice and can accurately assess vascular perfusion. Spectral Doppler examination of renal arteries and interlobular arteries can evaluate peak renal artery systolic blood flow, resistance index and blood flow velocity curve, such as renal artery systolic peak blood flow ≥ 180 cm/s, which is renal artery stenosis ≥ 60. % predictors, resistance index ≥ 0.70 indicates abnormal renal vascular resistance.
Doppler ultrasound image of a normal adult kidney. Red: blood flow into the transducer; blue: blood flow out of the transducer.
Most renal cysts are simple renal cysts that are round in shape and filled with fluid. The incidence of simple renal cysts in people over 50 years old is ≥50%. It is a benign lesion and no further evaluation is required.
Adult simple cyst, dashed distance: kidney length
Features of complex renal cysts: septation, calcification, and irregular thickening of the cyst wall. Doppler ultrasonography is feasible for further evaluation. Bosniak grading and follow-up of complex renal cysts can be performed with contrast-enhanced ultrasonography or enhanced CT. The Bosniak classification can be divided into grades I-IV, grade I: simple cyst, grade IV: cystic malignancy risk 85%–100%.
Adult complex renal cyst with wall thickening in the lower pole, +, dashed distance: kidney length and complex cyst
In patients with polycystic kidney disease, multiple cysts of varying sizes can be seen. In patients with advanced polycystic kidney disease, the kidneys are enlarged, with no obvious demarcation between cortex and medulla.
Advanced polycystic kidney disease with multiple renal cysts
The primary indication for renal ultrasound is to evaluate the renal collecting system. Dilation of the renal collecting system is often associated with obstruction of the urinary tract (including renal pelvis, calyces, and ureters). There is no echo in the hydronephrotic area, and renal sinus dilatation can be seen.
Hydronephrosis in children can be caused by obstruction of the ureteropelvic junction, ectopic ureteral orifice, primary megaureter, and posterior urethral valves (below). In adults, hydronephrosis can be caused by urolithiasis, obstruction of the renal pelvis or ureter, and ureteral compressions, such as pregnancy and retroperitoneal fibrosis. Urolithiasis is the most common cause of hydronephrosis in adults, with a prevalence of 10%-15%.
Hydronephrosis due to obstruction of the ureteropelvic junction in children
Normally, the ureter cannot be seen on ultrasound imaging. However, in the setting of urinary tract obstruction and vesicoureteral reflux with ureteral dilatation, the ureteropelvic junction can be seen, as well as the dilated ureter (below).
Bilateral ureteral dilatation due to vesicoureteral reflux in children
Hydronephrosis can be classified into five different grades from mild dilatation of the renal pelvis to thinning of the cortex based on macroscopic findings (Figure A). Hydronephrosis can also be assessed by measuring the level of the neck in the longitudinal section of the renal pelvis, the level of dilation in the transverse section, and cortical thickness (Figures B, C).
A: Late hydronephrosis with cortical thinning; +, dashed line distance: the dilated size of the renal pelvis
B: Renal pelvis, calyx dilation with cortical atrophy; +, dashed line distance: the width of the calyx in longitudinal section
C: Renal pelvis dilated size in transverse section
If abnormal echoes are seen in the collection system, clinical examination, blood analysis, and puncture or drainage should be performed to exclude pyonephrosis if necessary. Hydronephrosis can also be caused by non-obstructive diseases, such as taking diuretics, pregnant women, and children with vesicoureteral reflux.
Renal ultrasonography is an important method for diagnosing and treating kidney disease.
Ultrasound is an important method for diagnosing chronic kidney disease and judging prognosis. Whether it is glomerulosclerosis, tubular atrophy, interstitial fibrosis, or inflammation, echogenic cortical enhancement is seen on ultrasound imaging. Normal kidney echoes are similar to those of the liver or spleen. In addition, renal atrophy and cortical thinning are common, especially as the disease progresses. However, kidney size correlates with height, and patients with short stature have smaller kidneys; therefore, kidney size should not be used as the sole criterion.
Chronic kidney disease due to glomerulonephritis: thinning of the cortex and increased echogenicity. +, dotted line: kidney length
Nephrotic syndrome: echogenic demarcation of renal cortex and medulla
Chronic pyelonephritis: renal atrophy, focal cortical thinning. +, dotted line: kidney length
End-stage renal disease: echogenic, homogeneous structure, inability to distinguish renal parenchyma from renal sinus with the naked eye. +, dotted line: kidney length
Ultrasound is the method of choice for the detection of acute renal lesions; CT and magnetic resonance imaging (MRI) are options for evaluation when ultrasonography is difficult to detect. When evaluating acute renal lesions, renal echo, renal imaging, renal vascularity, renal size, and focal lesions should be observed.
Acute pyelonephritis: cortical echogenicity, ill-defined superior renal pole
Postoperative renal failure: increased cortical echo and enlarged kidneys. Kidney biopsy revealed acute tubular necrosis.
CT is the method of choice for evaluating renal trauma, and ultrasound is used for follow-up, especially in patients with suspected urethral tumors (below).
Renal trauma: Infrarenal pole laceration, subcapsular effusion.
Kidney biopsy, percutaneous nephrostomy, or abscess drainage can be performed under ultrasound guidance. In the past, thermal ablation of renal tumors was guided by CT, because ultrasound-guided intervention was difficult to clearly display the intestinal distribution, resulting in a higher risk of peripheral intestinal injury. However, the latest guidelines for renal interventional therapy recommend ultrasound guidance as the preferred choice for radiofrequency, microwave, and cryoablation.
(A) Percutaneous nephrostomy with a fistula placed through the renal calyx into the hydronephrosis at the lower pole of the kidney. (B) Pigtail catheter placed in the calyceal dilatation. White arrows: fistula and pigtail catheter.
Percutaneous nephrostomy and abscess drainage can be performed using the one-step or Seldinger technique. Clinicians can choose one-step or Seldinger techniques based on preference, experience, and equipment conditions.
Renal ultrasonography is simple, convenient, rapid, and low-cost, and is an important method for diagnosing renal disease and guiding treatment. However, it still has certain limitations, and CT and MRI can be used to assist evaluation.
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Masters of Ultrasound, an educational account on YouTube, focused mainly on Echo Cardiography, POCUS, and FOA Med. In his video, he showed the EagleView Ultrasound operation process, usage method, and image quality and compared it with other portable ultrasound products on the market, and also objectively enumerated their respective advantages and disadvantages. Read his article to learn more.
So this is how it came directly from the package, and as you can see, it somehow reminds me of an Apple product. So if we open it the first we see is the quick operation guide, which is a small book with instructions, then we find the probe in this translucent plastic bag. Then we find on the bottom of the box the cable which is a micro USB for the wireless charger, and finally, the wireless charger and a stand, to put the iPhone tablet or whatever or even the probe itself.
As you can see, it’s a wireless, dual-head probe, that connects to iOS 9 or later and Android 10 or later smartphones and tablets. Given it is multipurpose and has the ability to scan both very superficial structures with the linear probe and deeper ones with the curved, I will compare at the end of the video some of its most remarkable features versus the Butterfly IQ+ and Vscan Air, the two most popular multipurpose out there in the market. It doesn’t make sense to compare them with specific ones, since they are usually tailored towards a specific target and therefore they usually have higher performance in that narrower specter of situations, whereas these probes are able to handle a wider range of circumstances.
It measures 156 x 60 x 20mm (equivalent to 6.1 x 2.4 x 0.8 inches), has a glossy finish, and weights 260g equivalent to 0.6lbs, which lies in between the Butterfly which is heavier with 309g, and the Vscan Air which is lighter with 205g. It has an integrated battery of 4200 mili Amperes hour and in my case, it allowed approximately 30 minutes of continued use until it overheats, and almost 3.5 hours of total scan time before recharging it.
Bear in mind this time can vary substantially based on the scan mode you use and how long the image is frozen (their official webpage states between 3 and 5 hours of total scan time). Color doppler drains the battery more quickly, then the remaining imaging modes, and finally a frozen screen while doing measurements or entering patient info and so on. As I’ve been testing it intensely I must admit I have used color doppler for quite long periods.
Simply placing your EagleView portable doppler ultrasound over the wireless charger that comes in the same box will recharge the battery. In my case, it required approximately 2:30h for a full charge and it cannot be used while charging. It doesn’t have any port so everything is wireless (including charging and exporting). As mentioned initially, it has two probes integrated with the same device, with the linear end tailored towards shallow exams, such as MSK, vascular, thyroid, lung, breast, nerves, aesthetic medicine and interventionism in general and the curved end towards deeper exams such as the cardiac, abdomen, ob/GYN and urology. The footprints are the usual ones of linear and curved probes, same as Vscan but contrary to Butterfly.
The only button it has, which switches on and off the device and freezes the image, also changes between both probes and the light indicates which one is being used currently. It is not fully waterproof, only 1-2cm from the footprint, video speed is 18 frames per second, the linear probe is 128 elements. Probes frequencies are: 3.5MHz and 5MHz for the curved one, 7.5MHz and 10MHz for the linear one. Scan depth: arriving up to 30cm for the curved one, arriving up to 10cm for the linear one.
Bear in mind the cardiac preset concentrates all the ultrasound beams in the center to be able to go through the ribs and obtain an image. Because it’s bigger than usual PA cart machine probes, it can be tricky sometimes to obtain some views (such as apical 4 chambers for example), because of the lack of space between the bed and the patient.
Now you’ll see the bootup and pairing process. It connects via WiFi network in less than 17 seconds from pressing the power button to being ready for the scan. It has 15 presets for the different organs, 5 imaging modes (B, M, color doppler, power Doppler and pulsed wave doppler), and several advanced image settings such as TGC, DYN, Focus, Harmonic, and Denoise, as well as the typical depth and gain. It stores the images directly in your device as a .jpg or .avi and it can also use DICOM. This has some pros, such as not needing any cloud service to store your info nor pay any annual subscription as well as cons such as only having the images in the device they were taken, although you can always share them via your favorite apps, such as Whatsapp, messages, telegram, email, AirDrop and so on.
Now you’re gonna see some recorded clips with the device and live demos because I could say it’s really good or bad but I prefer you assess it by yourself and obtain your own conclusions.
And, as usual, to sum up, let’s put the pros and cons all together and compare them with the Butterfly and Vscan.
On the pros column, we have:
– Lowest price in the market. The main one. It provides comparable results to more expensive options, and here lies its greatest value.
– Great image quality and advanced imaging settings
– Several imaging modes (B, M, color doppler, PDI, PWD).
– Aesthetic, somehow light and not clunky.
– Long battery duration and fast charging.
On the other hand, on the cons column, we find:
– Color doppler scale up to 40cm/s only, suboptimal for cardiac velocities.
– Gain adjustment is made by buttons, not with a left or right slide, which would be easier.
– Relative: (Manual image quality settings. Good for experienced people, but this can be daunting for inexperienced ones, that might prefer that an algorithm adjusted the image by itself)
Overall, EagleView portable doppler ultrasound got 3 golds in this product competition with multiple imaging modes and powerful battery life.
Now let’s compare the EagleView ultrasound with Butterfly iQ+ vs GE Vscan Air.
We’re gonna compare the size and weight, battery, imaging modes, image quality, advanced image settings, and price, which are the most important features for most of you. If someone wants any further detail, please let me know in the comments.
1. Size and Weight: It lies between the Vscan Air and the Butterfly IQ+ both in size and weight. 235g for the EagleView vs 205g for the VscanAir and 309g for the ButterflyIQ+.
2. Battery: This extra weight and size vs Vscan Air allow it to have a bigger battery (4200mAh). It has better than the Butterfly IQ+.
3. Imaging modes: Neither the Vscan Air nor the Butterfly IQ+ has the same amount of modes outside of the US, with Vscan Air only having B mode and color doppler, and Butterfly having B, M, color doppler, power doppler and, only in the US, pulsed wave doppler. It also has additional tools such as the auto calculator, bladder volume calculator, needle enhancer, and bi-plane tool for interventionism, that any other hand-held device has.
4. Image quality: IMHO, the Vscan Air has the best B-mode image quality, then I would say the EagleView and then the Butterfly. This applies especially to the heart, which is what I scanned the most but can relate to the rest of the body.
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In the rapidly advancing field of healthcare, the portability and versatility of medical equipment have become essential. Mobile ultrasounds, with their capability to provide on-the-go imaging solutions, have gained significant popularity. Choosing the right mobile ultrasound is a crucial decision that healthcare professionals need to make to ensure accurate diagnoses and efficient patient care. In this article, we will explore the key considerations to guide you in selecting the optimal mobile ultrasound for your clinical needs.
When considering a mobile ultrasound, the first and foremost factor to ponder upon is its portability. Assess the weight, size, and ease of transportation of the device. Opt for a system that allows for seamless mobility between different healthcare settings, such as clinics, hospitals, or even remote locations.
The primary purpose of any ultrasound is to produce high-quality images for diagnostic purposes. Evaluate the image quality, resolution, and clarity of the mobile ultrasound. Ensure that it meets the standards required for your specific clinical applications, be it abdominal, cardiac, obstetric, or vascular imaging.
Healthcare professionals encounter diverse clinical scenarios, each requiring a specific transducer. Choose a mobile ultrasound system that offers a range of transducer options to accommodate different imaging needs. This flexibility ensures that the device is versatile enough to address a variety of medical cases.
A user-friendly interface is essential for efficient operation, especially in dynamic healthcare environments. Consider the intuitiveness of the controls, touchscreen capabilities, and overall ease of use. A well-designed interface enhances workflow, reducing the learning curve for users.
Given the mobile nature of these devices, battery life is a critical consideration. A longer battery life ensures extended usability without the need for frequent recharging. This feature is particularly valuable in settings where immediate access to power outlets may be limited.
Evaluate the connectivity options of the mobile ultrasound. Seamless integration with existing healthcare systems and wireless connectivity for data transfer and storage are essential features. Ensure that the device aligns with the technological infrastructure of your healthcare facility.
Mobile ultrasounds may be subjected to various environments, including travel and different clinical settings. Assess the durability and build quality of the device to ensure it can withstand regular use and transportation without compromising functionality.
Consider how well the mobile ultrasound integrates into existing workflow processes. Compatibility with clinical software, ease of data management, and efficient reporting capabilities contribute to streamlined workflows in healthcare settings.
Evaluate the overall cost of ownership, including the initial purchase price, maintenance costs, and additional accessories or software licenses. While it's essential to stay within budget constraints, prioritize features that align with your clinical requirements.
Selecting the right mobile ultrasound involves a comprehensive evaluation of various factors to ensure it aligns with your clinical needs and enhances diagnostic capabilities. By prioritizing portability, image quality, versatility, and seamless integration into existing workflows, healthcare professionals can make an informed decision that positively impacts patient care and overall efficiency in healthcare settings.
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