Integrating clinical ultrasound into general practice

Clinical ultrasound is a diagnostic tool that has revolutionized medical practice in recent decades. In addition to the recommendations of the World Health Organization (WHO) and the International Society of Ultrasound in Emergency Medicine (ISUEM), a Danish study published in the British Medical Journal in 2020 claims that the use of Point-of-Care Ultrasound (POCUS) in general practice can modify provisional diagnoses in almost half (49.4%) of consultations. This proves its significant impact on diagnostic processes, and the value of integrating this imaging technique into daily practice.

Clinical ultrasound differs from the traditional ultrasound examination performed by a radiologist. While the latter involves an in-depth, detailed examination of a specific area of the body, often requested by a general practitioner, clinical ultrasound is an extension of the physical examination. It is performed by the general practitioner himself, during the consultation, to answer a precise clinical question and guide the patient's care.

Clinical ultrasound is of particular interest to general practitioners. They are often the patient's first point of contact in the care process. As such, they are called upon to make rapid, well-informed decisions regarding patient orientation and management. By providing immediate diagnostic information, clinical ultrasound can make all the difference in his or her day-to-day practice.

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Echoing like a stethoist

Clinical ultrasound can be particularly useful in many clinical situations encountered in general practice.

Firstly, it can help to clarify non-specific symptoms, such as abdominal or chest pain, which can be a sign of many different pathologies. By enabling direct visualization of the organs concerned, clinical ultrasound helps to orientate the diagnosis and avoid unnecessary complementary examinations.

Secondly, it can help confirm or refute a suspected diagnosis based on the patient's history and clinical examination. For example, if pneumonia is suspected, clinical ultrasonography may reveal the presence of pleural effusion or ultrasound signs of pulmonary inflammation, thus increasing the likelihood of diagnosis.

Finally, it can help determine the severity of a pathology and direct the patient to a service offering the most appropriate treatment. For example, in the case of acute abdominal pain, clinical ultrasound may reveal signs of peritoneal irritation, acute appendicitis or intestinal obstruction, requiring urgent surgical management.

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Clinical pictures where clinical ultrasound can make all the difference

Clinical ultrasound in general practice can be used to diagnose a wide range of pathologies: 

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• Effusions : whether pleural, peritoneal or pericardial, effusions are easily visualized on ultrasound and may point to an underlying pathology.

• Dilation of the pyelocalic cavities: in cases of suspected renal colic, clinical ultrasound may reveal dilation of the pyelocalic cavities, a sign of obstruction of the upper urinary tract between the kidney(s) and the bladder.
• Phlebitis : by assessing the compressibility of veins in the lower limbs, clinical ultrasound can diagnose phlebitis and guide therapeutic management.
• Diagnosis of a bladder globe: in cases of acute urinary retention, clinical ultrasound can directly measure bladder volume and guide therapeutic management.
• Abdominal aortic aneurysm : in the event of a suspected abdominal aortic aneurysm, clinical ultrasound can confirm the diagnosis, assess the size of the aneurysm, and direct the practitioner to the appropriate treatment (surveillance or surgery).
• The sign of cholecystitis: in the event of acute abdominal pain, clinical ultrasound may reveal the presence of acute cholecystitis, requiring medical or surgical management.
• Confirmation of an intrauterine pregnancy : if pregnancy is suspected, clinical ultrasound can confirm the presence of an intrauterine gestational sac, or even date the pregnancy (depending on the finesse and functionality of the ultrasound machine).
• Thyroid nodules : if thyroid pathology is suspected, clinical ultrasound may reveal the presence of thyroid nodules, requiring specific management.

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Clinical ultrasound training for general practitioners

Training in clinical ultrasonography is an investment, but it can be extremely beneficial to the GP's day-to-day practice.

A wide range of clinical ultrasound training courses are available, from online courses to face-to-face training and practical courses. It's important to choose a course that suits your needs and availability.

The duration of training in clinical ultrasonography can vary considerably according to individual level, from a few hours to several weeks. However, it is generally accepted that basic training comprises a relatively short theoretical session, followed by practical sessions over several weeks. During these sessions, the doctor is invited to make cuts on himself or a peer (co-learner), and then integrate the technique into the practice, initially in test mode. Generally, after a few weeks of regular practice, practitioners feel confident enough to adopt it as a diagnostic tool.

Finally, it may be worth investing in an ultra-portable ultrasound scanner that covers all the essential requirements for efficient diagnostic referrals. echOpen O1, for example, is an ultra-portable ultrasound scanner developed by AP-HP to enable general practitioners to learn clinical ultrasound directly in the doctor's office, without having to invest in a bulky and expensive device. As well as being practical and easy to use, this tool can also be used as a training and self-assessment aid.

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Conclusion

Clinical ultrasound is a diagnostic tool increasingly used in general practice, and one that can make all the difference to your day-to-day practice. By providing immediate information and guiding therapeutic management right from the first appointment, it can significantly improve your patients' satisfaction and understanding of their condition.

Training in clinical ultrasound is certainly an investment, but it can prove extremely beneficial in the long term. By choosing the right training and investing in an ultraportable ultrasound scanner, any general practitioner can integrate clinical ultrasound into their daily practice and improve the quality of the care they provide.

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