Image Quality of Handheld Ultrasound Devices for Lung Ultrasound in Adult Patients with Pneumonia

Handheld ultrasound devices (HHUDs) have increased accessibility and convenience of ultrasonography, but also raised concern regarding image quality and sufficiency for clinical use. This explorative study aims to compare image quality between 3 commercially available HHUDs in patients with pneumonia, and to compare expert agreement on image quality and sonopathological findings.

Patients were scanned with 3 different HHUDs. Clips were stored, anonymized, duplicated, and randomized. Three blinded, experienced thoracic ultrasound operators independently rated the clips for image quality (1-5), sufficiency for clinical use (1-3), and presence of sonopathological findings.

Eleven patients were scanned, yielding 38 ultrasound clips and 76 ratings per rater. Overall image quality was 3.60 (95% CI 3.40-3.80) for Lumify, 3.32 (95% CI 3.11-3.53) for Vscan Air, and 2.78 (95% CI 2.55-3.01) for Butterfly iQ+. Overall agreement on image quality ratings was low (27.6%). Interrater agreement for specific sonopathological findings ranged from slight for air bronchograms (kappa 0.15-0.34) to substantial for pleural effusions (kappa 0.58-0.84).

This explorative study demonstrated a higher image quality in Vscan Air and Lumify compared to Butterfly iQ+ in patients with pneumonia. However, interrater agreement on image quality was low, while interrater agreement on sonopathological findings was moderate.