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Table 1 Indicative imaging performed and how this information is used pertaining to point of care LUS by respiratory physiotherapists

From: A proposed framework for point of care lung ultrasound by respiratory physiotherapists: scope of practice, education and governance

aIndicative imaging performed

Role of the imaging of these structures

Role within physiotherapy and wider MDT patient management

∆Recognition of normal thoracic structures and adjacent organs as landmarks

• Subcutaneous tissues, ribs, pleura and diaphragm

• Heart, liver, spleen and kidneys

• Aorta and vena cava

Awareness of spectrum of ‘normal’ presentations. Landmark identification serves as mechanism to enhance accuracy of imaging; integral aspect of protocol-based imaging

Recognition of ‘normal’ as part of sonographic and clinical differential diagnosis process. Standardised approach to imaging as quality assurance mechanism

â—ŠIdentification of ultrasound appearances of normal aerated lung including

• Pleural line and lung sliding (in 2D/B mode and M mode)

• Normal aerated lung (including A-line and B-line artefacts)

Awareness of ‘normal’ presentations

Recognition of ‘normal’ as part of sonographic and clinical differential diagnosis process

Recognition of pleural fluid:

• Appearances of pleural fluid and pleural thickening

• Estimation of pleural effusion volume

• Demonstration of sinusoid sign on M mode

• Distinguishing between pleural and abdominal fluid collection

Building upon ∆ and ◊, sonographic differential diagnosis, description and (where appropriate) estimation of pleural effusion

Feeds into clinical differential diagnosis process; also monitoring of severity and response to treatment/intervention

Recognition of consolidation/atelectasis:

• Ultrasound appearances of consolidated/atelectatic lung

• Ultrasound appearances of air and fluid bronchograms

Building upon ∆ and ◊, sonographic differential diagnosis and description of consolidation/atelectasis and types of bronchograms

Feeds into clinical differential diagnosis process; also monitoring of severity and response to treatment/intervention

Recognition of interstitial syndrome:

• Recognition of B-lines

• Differentiating between normal and pathological B-lines

Building upon ∆ and ◊, sonographic differential diagnosis and description of interstitial syndrome

Feeds into clinical differential diagnosis process; also monitoring of severity and response to treatment

Use of ultrasound to exclude pneumothorax:

• Recognition of signs of pneumothorax (B mode and M mode)

• Absence of lung sliding, B-lines and lung pulse

• Presence of lung point

Building upon ∆ and ◊, exclusion of pneumothorax

Feeds into clinical differential diagnosis process

  1. aThis column draws upon the focused ultrasound intensive care (FUSIC) Lung Ultrasound accreditation written by Dr Ashley Miller (Co-Chair FUSIC Committee; Consultant Intensivist Shrewsbury Telford Hospital); https://www.ics.ac.uk/Society/Learning/FUSIC_Accreditation