Table 4

The education and training goals for point-of-care lung ultrasound (LUS) following an Indication, Acquisition, Interpretation, and Medical decision-making framework

Lung ultrasound assessmentPreferred learning tool
Background knowledgeBasic physics of ultrasound
Basic knobology
B-mode, M-mode
Anatomy/sonoanatomy of the thoracoabdominal region
Didactics
IndicationIndications of LUS
Pneumothorax
Effusions/blood
Diaphragmatic paresis
Interstitial syndrome
Limitations and pitfalls
Previous thoracic surgery (pneumonectomy, pleurodesis)
Severe pre-existing lung disease (bullae, pulmonary fibrosis, septations, emphysema), lung contusion/consolidation
Small effusions, intraperitoneal fluid, loculated/complex collections
Mechanical ventilation, apnea, ascites, subphrenic fluid accumulation
Didactics
AcquisitionOptimize machine ergonomics
Transducer selection: resolution versus penetration
Recognize the effect of gravity on the location of air/fluid
Identify relevant anatomy (ribs, diaphragm, pleural line, liver, spine)
Hands on training
Pneumothorax
Linear probe
Least dependent part of the chest
Identify:
Superior and inferior ribs and their shadows
Pleural line
Effusion
Curvilinear probe
The posterior axillary line at the level of the xiphoid
Identify: diaphragm anterior chest wall
Lung parenchyma
Diaphragm
Linear/curvilinear probe
The mid-axillary line at the eighth–ninth ICS or Midclavicular/anterior axillary line at the subcostal region
Hands on training
InterpretationHighly likely
Lung point
Likely
Absence of lung sliding and A-line pattern
Barcode sign
Excluded
Vertical artifacts (B-lines, comet tail)
Lung sliding/pulse
Seashore sign
Confirmation
Anechoic collection cephalad to the diaphragm
Spine sign
Sinusoid sign
Excluded
Curtain sign
Confirmation
∆tdi <20%
Excursion less than 1.8 cm during quiet breathing or less than 4.8 cm during deep breathing
Paradoxical movement on inspiration (towards probe)
Hands on training
Clinical case discussions
Medical decision-makingAbility to integrate exam findings to patient management
Consider limitations and pitfalls
Consider the urgency and severity of the symptoms
Clinical case discussions
Needle decompression versus chest tube versus pigtailObservation versus chest-tube versus thoracotomySupportive measurements
NIMV versus intubation
Clinical case discussions
  • .B-Mode, brightness mode; ICS, intercostal space; LUS, Lung ultrasound; M-Mode, motion mode; NIMV, non-invasive mechanical ventilation; ∆tdi, change in diaphragm thickness between end-expiration and end-inspiration.