Covid-19 Lung Ultrasound Guidance

This lung ultrasound document has been put together using available resources and up-to-date literature that is emerging due to the worldwide COVID-19 pandemic. It’s focus during the current crisis is to facilitate ultrasound practitioners who have experience in chest ultrasound (or who may wish to develop the necessary skills required) to provide diagnostic assistance if required. Whilst CXR and Computed Tomography (CT) remain the mainstay in diagnosing the pulmonary manifestations of COVID -19 infection, it is expected that pressure on these modalities is likely to escalate. Point of Care Ultrasound Scanning (POCUS) may be of assistance, particularly in clinical triage. There is current literature stating that there are comparable results to CT in some aspects of lung assessment in COVID patients. We are particularly grateful to Mrs Catherine Kirkpatrick, the BMUS Development Officer and Professional Standards Chair, for her lead in writing and collating the material within this document.

Ultrasound Practitioners and Ultrasound Departments should not feel under pressure to train or provide lung ultrasound where they do not feel they have the required level of skill, training, knowledge or manpower in order to do so safely. Given the potential for lack of adequate training in the current situation, this is highly relevant. Sonographers in particular may be put under pressure to provide this service given the lack of Radiology cover either secondary to Radiology workload pressures, a lack of numbers or the fact that Radiological cover is being provided remotely. Governance remains a priority to ensure high quality services are maintained for all patients in our care. Any pathway development for lung assessment and the associated training in lung ultrasound should be done with the support of Radiology Departments and in conjunction with Intensivists / Emergency physicians etc. Appropriate delegation and supervision and safety provision for practitioners all need to be adequately addressed when instigating such a service development.

 We hope that the lung ultrasound document will be useful in this context and also to Sonographers in general who may be identifying lung abnormalities as part of their general abdominal ultrasound examinations.

It is worth noting that many centres have now changed their abdominal CT protocols to include the lower chest (scanning from carina down) as initial experience has shown that significant numbers of COVID patients are presenting with an acute abdomen. (The detection on CT of multiple segmental pneumonitis being regarded as suggestive of COVID).

It is also the time to urge ultrasound departments to reassess how ultrasound practitioners’ / sonographers’ skills are best utilised during these challenging times. Discussions are being held in radiology departments up and down the U.K. as contingency plans are being developed and enacted. We are hearing innovative and changing ways of working to support our colleagues elsewhere within the hospital setting. For example, re-directing sonographers to work alongside physicians within Emergency Departments. Expert ultrasound input at the front door may reduce need for admission and reduce subsequent pressure on CT by allowing rapid streaming of non-COVID-19 patients away from high risk areas. Now is the time to have these conversations and make it count.

All changes in working practices must be supported by the individual trusts and/or radiology departments. Utilising skills and resource to the best of our abilities is encouraged whilst ensuring patient and staff safety is paramount. Safety for Sonographers and Ultrasound practitioners is particularly important as initial evidence is now emerging from China and Europe as to the increased time spent in contact with patients by Sonographers in particular. We commend you to read the latest ISUOG document with respect to triage of patients, limiting scan times and personal protection guidelines. We are very grateful to Prof Adrian Lim, the BMUS Hon Secretary, for his work and input into this document. It is vitally important that we reduce and mitigate risk when providing the care that our patients need and that it is delivered as safely as possible.

BMUS acknowledges the expert skills and knowledge in our multi-disciplinary membership and know that it will be increasingly useful in the fight against COVID-19. We wish you all good luck and good health in the weeks and months ahead in your efforts to help care for our patients in overcoming the COVID-19 pandemic.

Prof Rhodri Evans
BMUS President

30th March 2020