The vision echOpen : "The ultraportable ultrasound scanner will become as indispensable as the stethoscope".

Making medical imaging accessible to all caregivers, at the patient's bedside: this is the ambition of a start-up incubated at AP-HP, echOpen. Its co-founder, Dr. Mehdi Benchoufi, talks about the revolution in medical diagnosis made possible by ultra-portable ultrasound. A new training challenge for general practitioners, in particular.

What is the added value of integrating imaging into primary care?

The challenge is access to so-called diagnostic imaging, which is first-line. Worldwide, two-thirds of humanity does not have access to it at all. For all others, this examination is possible in a hospital or radiology facility, but not at the patient's bedside. Our ambition is to generalize access to imaging to all populations, in all territories, thanks to ultraportable ultrasound. The abbreviation POCUS (Point-Of-Care Ultrasound) refers to the practice of trained medical professionals using ultrasound to diagnose patients anywhere, whether in modern hospitals, ambulances, or remote villages. 

By integrating it into the clinical examination, the ultrasound machine would become the stethoscope of the 21st century. This has a considerable impact on the rest of the patient's care. Our systematic review of the literature, including the pioneering work of a Frenchman, Daniel Lichtenstein, shows that 49.4% of diagnoses are corrected after a clinical ultrasound, and that treatment is changed in 26.5% of cases (source: British Medical Journal).

Can you give concrete examples of use for the general practitioner?

Here are two examples of common uses. In a patient who is coughing, has chest pain or dyspnea, lung ultrasound is easy to perform and can easily recognize signs of lung infection. The general practitioner can immediately refute or affirm his diagnostic hypothesis. The French-language Pneumology Society is also very interested in ultrasound as a first-line treatment for the diagnosis of infectious pneumonia. Another example, when faced with lower back pain, a portable ultrasound can formally rule out a urinary stone.

What about the training of health professionals in clinical ultrasound? 

The United States, where all medical students are trained in the integration of ultrasound into clinical practice, is ahead. In France, a course will start in September 2024 for externs in Paris. This is a real turning point in the way semiology is taught. The challenge is of course to develop this training from the day school throughout France, as well as in the general medicine curriculum. 

For practicing doctors, there are DUs and private training courses to train in the fundamentals of portable clinical ultrasound. We are going to participate in this major training effort via the Invivox platform, by creating content to raise awareness of the challenges of clinical ultrasound. 

At echOpen, we are also working on the development of artificial intelligence solutions to simplify the acquisition of the gesture by the professional user...

Does the clinical ultrasound act already exist in the nomenclature of medical acts? 

Yes, the act of transcutaneous ultrasound at the patient's bedside already exists. It is the role of professional organisations to ensure that these new practices are recognised by the Health Insurance, like the ECG, which has become more widespread in general practice.

What can you tell us about the ultrasound machine echOpen that you have developed? 

It was incubated at the AP-HP from 2015, in a fab lab at the Hôtel-Dieu hospital. With the conviction that first-line clinical ultrasound must be accessible to as many patients as possible, and inexpensive. We have therefore designed a personal ultraportable ultrasound probe, at a cost that allows each doctor to equip himself.

With a view to the industrialization of the tool, our partnership was extended to Altran, which became Capgemini Engineering, then in 2021 we created the company and AP-HP acquired a stake in its capital. The support of medical experts and in the biophysics of ultrasound has allowed us to properly configure the use for general ultrasound scans performed by emergency physicians, internists, general practitioners. The idea is to add an echo hit as simply as the stethoscope! Our ultrasound system is now CE certified.*

This year, the ultrasound probes echOpen O1 are used at AP-HP as part of a pre-deployment phase to assess all their impacts. We are also leading the Echo 93 project, selected and funded by the Ile-de-France Regional Health Agency, in order to improve the city-hospital care pathway by allowing an initial imaging diagnosis to be carried out during general clinical examinations at the Jean-Verdier Hospital (Bondy), in multi-professional health centres and in itinerant buses to meet disadvantaged populations.

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