Premium Portable Ultrasound Becomes a Reality at Columbus Children’s Hospital Brian D. Coley, M.D. Assistant Director, Department of Radiology Section Chief, Ultrasound Columbus Children’s Hospital The last 20 years have seen dramatic progress in the quality of diagnostic ultrasound equipment. The level of detail and resolution allows for more conﬁdent diagnoses and has improved the quality of care in diagnostic imaging. Over the last 5 to 10 years, hardware and software advances have allowed machines to become smaller and lighter, providing potential advantages for those performing portable examinations, to scan in crowded environments such as intensive care units. However, the trade-off for embracing compact ultrasound has been image quality. While adequate for detection of free ﬂuid or guiding needle access procedures, compact units have generally been more limited in diagnostic quality. Many radiologists, myself included, have been uninterested in these compact machines for diagnostic work, especially portable studies on ill neonates. This is the situation where I need excellent sonographic imaging, and I have been unwilling to consider lesser units, no matter how convenient and appealing they may appear. At Columbus Children’s Hospital, we have had the opportunity to utilize ZONARE Medical System’s z.one ultrasound system, and assess the capabilities of their new P10-4 neonatal neurosonography transducer. While still a work in progress, my initial response is very enthusiastic from the standard of image quality, workﬂow and sonographer productivity, and sonographer stress and comfort. The goal of any ultrasound examination is to acquire diagnostic quality images. We used the z.one ultrasound system during portable studies in our neonatal intensive care unit side-by-side with our premium ultrasound units. As illustrated by the ﬁgures, the image quality of the z.one system was felt to rival those produced by the traditional equipment that have been the mainstays of our department. Abdominal imaging in the NICU also showed the z.one system to be of equivalent diagnostic quality. Existing ultrasound system at Columbus Children’s Hospital Zonare Medical Systems, Inc. – z.one ultrasound system Normal coronal view of the anterior aspect in a neonatal brain Existing ultrasound system z.one ultrasound system Sagittal view of a dilated lateral ventricle with hemorrhage in a neonatal brain An unanticipated beneﬁt during portable scanning is the ability to move from patient to patient without having to shut down and restart the ultrasound unit for each patient. Whether using the SuperCart or the portable 5.5 pound scan engine, the z.one system can be moved to the next patient without having to shut down. For our premium systems, the shutdown and restart process takes about 5 minutes between each patient. While this doesn’t sound like much, during a typical portable session in the ICU this can easily add 15 to 30 minutes of additional time that the sonographer is away from the main department, time not spent to scan more carefully, or to examine additional patients. Additionally, the SuperCart with the scan engine docked is one-third the weight of conventional premium systems giving our sonographers relief when taking the z.one system on a portable. In one case during our trial evaluation, a critically ill neonate needed an examination. The child’s room was packed with life-support apparatus and concerned family members. It would truly have been difﬁcult to bring in a conventional ultrasound unit without rearranging both people and equipment. Removing the scan engine from the SuperCart allowed the sonographer to easily move into the room and efﬁciently perform the examination (since there was no startup time) with minimal disruption to the medical staff and family. The z.one ultrasound system that we are using has provided me with the premium imaging performance that has been lacking in the conventional compact systems we have previously evaluated. Existing ultrasound system z.one ultrasound system Transmastoidal view of a neonatal cerebellum Existing ultrasound system z.one ultrasound system Sagittal view of a dilated lateral ventricle with hemorrhage in a neonatal brain Existing ultrasound system z.one ultrasound system Right sagittal view of liver, gallbladder in a neonatal abdomen with massive ascites Neonatal abdomen with massive ascites using the z.one ultrasound system’s L10-5 transducer