Handheld Ultrasound Is Battle-Ready

March 28, 2003 -- A technology widely used for a glimpse at the soon-to-be-born has now been turned into a battlefield unit that may help keep soldiers from dying in Iraq.

Ultrasound gear, in new handheld form, relies on the same technology used to give expectant parents a first look at their unborn. But it comes in a much smaller package.

Compared to conventional cart-based ultrasound machines that can weigh in at 400 pounds, these portable devices weigh less than 6 pounds and can easily be transported in a backpack or even a jacket pocket.

The gear gives emergency room physicians a fast, internal look at trauma victims. In another situation where every second counts — on the battlefield — it can be used to help military medical personnel determine the best course of treatment for wounded soldiers.

One firm that makes the handheld units is Bothell, Wash.-based SonoSite. So far 300 of its portable ultrasounds have been sold to the Department of Defense, with 150 being deployed with the U.S. military.

"There are systems … all over the world, but there are a significant amount of them in the Middle East with all three branches of the military," says Ron Dickson, SonoSite's chief officer of business development.

An Important Imaging Tool

The systems were developed in the mid-1990s at the request of the military, which was looking for a rugged, portable system that could bring the benefits of ultrasound imaging to the battlefield.

Ultrasound has a variety of uses in the initial evaluation of a trauma patient, explains Maj. Craig Manifold, an emergency medicine physician at Wilford Hall Medical Center at the Lackland Air Force Base in San Antonio. Manifold says portable ultrasounds are used almost daily in Texas, and they have been used in Afghanistan to assess wounded soldiers.

"What [ultrasound] allows us to do is have an imaging capability to look at the chest and the abdomen in order to identify any injuries," he adds. "And more particularly, to identify those patients who may need an urgent operation."

Ultrasound is primarily used to identify internal bleeding in the chest and the abdomen, which physicians say is not easy to identify without an inside look.

"[A] person may be unconscious — they may not be able to tell you that their abdomen hurts," says Dr. Daniel Price, an emergency flight physician and director of the emergency ultrasound fellowship at the Alameda County Medical Center in California. "And even when they are able to tell you … there are studies that show that almost half the time they are incorrect."

Aside from internal bleeding, ultrasound can be used to detect the presence of shrapnel or foreign matter, collapsed lungs, the presence of a heartbeat, and to locate veins for the insertion of intravenous lines.

And it may also play an important role in determining who is in most need of advanced medical attention when resources are limited.

"As we have seen [with the Iraq war] over the past couple of days, there may be several casualties at one time," says Dr. Michael Blaivas, director of emergency ultrasound at the Medical College of Georgia in Augusta. "You can pick the most [injured] soldier — the man or woman with blood in their belly and fly them out."

Power and Speed With Minimal Compromise

Dr. Chris Merritt, radiology professor at Thomas Jefferson University in Philadelphia, which has tested a number of portable ultrasound devices in industry consultations, says one of the concerns that arises with the miniaturization of any technology is there will be significant trade-offs.

Yet he's satisfied with the development and performance of portable ultrasound devices.

"These things have been truly amazing in that there has been very little compromise in terms of the quality of diagnostic data they provide," says Merritt. "I think the important thing is that a 3- to 5-pound machine can provide probably 95 percent of the performance of a hospital-based piece of equipment."

And others who work with portable ultrasound also praise their speed and utility. "In under a minute, you can examine the essential portions of the patient's abdomen and identify any injuries and immediately make your decision," says Manifold.

This fast treatment and immediate decision-making better equips the U.S. military to save lives on the front lines, and some say this capability may someday move even closer to where injuries occur — and right into the hands of medics and corpsmen.

Adds Manifold, "I certainly think that's a future use of the ultrasound technology as we get more experienced and more training with them."