Research

Our faculty and investigators, along with a national network of point-of-care ultrasound experts, are teaming up with the VA National Center for Patient Safety to develop certification pathways and best practices in point-of-care ultrasound use for the VA system. The VA’s Point-of-care Ultrasound Patient Safety Center will be established at the South Texas Veterans Health Care System in San Antonio.

Evaluation of Implementation of a National Point-of-care Ultrasound Training Program

Since 2016, our point-of-care ultrasound faculty have served as national core faculty of the Department of Veterans Affairs’ Point-of-care Ultrasound Training program and are leading the quality improvement project evaluating the impact of training frontline clinicians in procedural and diagnostic POCUS applications on educational and clinical outcomes. This quality improvement project is funded by the VA’s Quality Enhancement Research Initiative (QUERI).

Clinical Evaluation of Personal Ultrasound System

In recent years, we have seen an explosion of personal handheld ultrasound devices used in clinical care as more clinicians have received point-of-care ultrasound training. We have partnered with various industry sponsors to fine tune ultrasound technology of handheld devices.  Currently, we have an ongoing product evaluation project with Vave Health.

This novel translational science project focused on development of a non-human primate model to assess cardiac changes from pneumococcal sepsis. A multi-system point-of-care ultrasound exam was performed, and we demonstrated that lung ultrasonography accurately detected the consolidated lobes with pneumonia compared to the gold standard post-mortem pathological analysis.  This project was funded by the UT Health San Antonio Institute for Integration of Medicine and Science.

Pleural Fluid Echogenicity by Ultrasound Imaging and Computer Based Pixilation to Determine Transudative vs. Exudative Effusions

Artificial intelligence and computer-aided diagnosis are being integrated increasingly into point-of-care ultrasound technology.  This innovative protect compared qualitative versus quantitative assessments of pleural fluid echogenicity to differentiate transudative versus exudative effusions. We demonstrated that exudative effusions had higher pleural fluid echogenicity using computer-based pixel density and a pleural fluid ultrasound score can help differentiate exudative versus transudative pleural effusions.

National Survey of Point-of-care Ultrasound Use in VA Facilities

In collaboration with the VA Health Analysis and Information Group (HAIG), we conducted a large national survey of all VA medical centers to better understand the training needs, current use, and barriers to point-of-care ultrasound use. A key finding of this national survey was facilities that currently use point-of-care ultrasound had greater desire for additional training, and the greatest barriers to use were lack of training and limited access to ultrasound equipment. The initial survey was conducted in 2015 followed by a follow-up survey in 2020.

Pleural Ultrasonography to Rule out Post-bronchoscopy Pneumothorax

Although point-of-care pleural ultrasound can accurately rule out pneumothorax, we conducted this study to determine whether pleural ultrasound can accurately rule out pneumothorax in lung transplant recipients immediately post-bronchoscopy. We found that an immediate post-bronchoscopy pleural ultrasound exam can detect large pneumothoraces in lung transplant recipients that require prompt tube thoracostomy, but relatively slow air leaks leading to delayed pneumothoraces may be missed.

Use of Ultrasound for Central Venous Catheterization (US-CVC): A Multidisciplinary Survey of Physician Practices

Use of ultrasound guidance for central lines has been recommended by national patient safety organizations since the early 2000’s, but it has not been universally adopted into practice.  Our expert faculty group conducted a national survey of intensivists and hospitalists to assess the frequency of ultrasound use to guide insertion of central lines and explore the various provider, educational, and system barriers to use of ultrasound. We found that physicians least frequently used real-time ultrasound guidance to insert subclavian central lines, and limited access to an ultrasound machine and lack of training were the most significant barriers.