Point-of-care ultrasound (POCUS), which is performed by clinicians at the bedside, has been developed in emergency and critical care medicine in Western countries. In recent years, the concept of POCUS has also been accepted in other specialties. POCUS differs from comprehensive ultrasound in several aspects. POCUS exams focus on regions of interest in an organ system based on clinical reasoning. The regions are assessed qualitatively or semi-quantitatively. POCUS in acute care settings is used for anatomical evaluation in each part of the body and physiological evaluation in the circulatory system. On top of that, POCUS is performed for resuscitation, assessment of urgency and severity, monitoring, and guidance for various procedures. Collaboration between POCUS users and ultrasound specialists, implementation of high-quality clinical research, construction of the framework in each specialty, and development of educational systems are needed to develop POCUS and utilize it for improvement of patient care in Japan.

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Although clinical application of ultrasound to the heart has a history of about 80 years, its big turning point was the emergence of a portable ultrasound diagnostic machine. As a result, the place where echocardiography is performed widely spread outside the examination room, and the people who perform echocardiography have also greatly increased. Emergency physicians, anesthesiologists and primary care physicians became interested in echocardiography and started using it. Such ultrasonic examinations performed by a doctor for assessment of disease condition, management or guidance of treatment at bedside has been called point-of-care ultrasound (POCUS). Echocardiography in POCUS is divided into a focused cardiac ultrasound examination (FoCUS) performed by non-experts in echocardiography such as emergency physicians and anesthesiologists, and limited echocardiography performed by cardiologists who are experts in echocardiography. FoCUS has an established protocol and evaluation method, and evidence to prove its effect is mounting. Although FoCUS is becoming popular in Japan, an educational program for FoCUS has not been established, and discussion on how to educate medical students and interns will be necessary. Even if POCUS in cardiovascular medicine becomes widespread, auscultation will still be necessary. Rather, adding echocardiography to inspection, palpation and auscultation in the flow of physical examinations will benefit the patient greatly.

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In this paper, point-of-care ultrasound (POCUS) for the initial diagnosis and the management of acute abdomen is discussed. POCUS is supposed to be executed mainly by doctors other than ultrasound specialists anytime and anywhere such as in the emergency room or the intensive care unit. Although it seems rather difficult to cover the wide spectrum of organs as well as diseases causing acute abdominal pain, the author advocates a “six approach” for the diagnosis and triage of acute abdomen, which consists of scanning at eight points in less than 5 minutes. With this method, the attending doctor can diagnose most of the diseases frequently encountered in patients with acute abdomen, which can help patients avoid unnecessary examinations or admissions. However, users of POCUS should be aware of the limitations of POCUS, especially when they are using pocket-sized ultrasound equipment. Therefore, users should be careful when ruling out a disease even when they cannot find any pathological findings, and consider the need for further examinations such as US done by specialists with high-end equipment or CT. Since there has been no standard curriculum in Japan for POCUS training that should deal with basic physics and techniques for US, normal abdominal anatomy, typical pathological US findings, and interventional US, the establishment of a learning program for doctors and training of experts as instructors of POCUS are needed.

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The concept of point-of-care ultrasound (POCUS) is spreading worldwide, including Japan. However, there are several problems with chest POCUS. The current problems and future position of chest POCUS are discussed.

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Use of point-of-care ultrasound (POCUS) has become widespread in management of the critically ill. About two decades ago, sonographic evaluation in intensive care was limited to a small number of intensivists. However, with recent advances in ultrasound equipment, POCUS can now be easily used by intensivists. POCUS has become an indispensable diagnostic method for the respiratory, abdominal, vascular, and also central nervous system in the intensive care unit (ICU). ICU patients benefit greatly from POCUS, which can be done at the bedside, because it is often difficult to transport patients to the CT examination room during artificial respiration, renal replacement therapy, and so forth. It is also available for urgent examinations. I am convinced that use of POCUS will continue to spread as a diagnostic method in the ICU going forward. Education of doctors on POCUS techniques will also be very important. I think adding ultrasound diagnosis to the curriculum of medical students or residents should be considered. In this review article, I discuss the POCUS examinations now carried out, the future potential of POCUS, and also the education of intensivists on POCUS.

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The term point-of-care ultrasound (POCUS) has attracted attention recently in other clinical societies, especially in critical care medicine, because of its usefulness, but not so in the Japan Society of Ultrasonics in Medicine (JSUM). With an increase in the need for POCUS, we are seeing more and more training and hands-on sessions being hosted by the Society of Point-of-Care Ultrasound, emergency medicine-related societies, intensive care unit-related societies, internal medicine-related societies, and so on. These programs vary from society to society, which is not ideal. JSUM can contribute to establishing a standard program. And having some kind of certification may help to increase the motivation of participants.

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As the clinical significance of point-of-care ultrasound had been widely recognized, dissemination and education of point-of-care ultrasound became increasingly viewed as an important future issue. For dissemination and education, it is recommended that a training program including three core components be established: didactic education, hands-on image acquisition, and image interpretation experience. When working with a multidisciplinary team consisting of members from different departments in each hospital, and when medical institutions in the region collaborate on developing the educational program, it is deemed desirable to make effective use of online communication tools. I will outline a prototype online educational system we recently developed, in which lectures, representative ultrasound images, frequently encountered cases, and a question and answer site with bidirectional video transmission will be provided, and discuss the possibilities of online communication tools for dissemination and education of point-of-care ultrasound.

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Purpose: The breast after breast conservation therapy (BCT) presents characteristic ultrasound findings, but the course of the change in findings varies from patient to patient. The purpose of this study was to investigate factors affecting the protraction of image findings after BCT. Subjects and Methods: Between 2010 and 2014, we identified 101 breast cancer patients (103 breasts) after BCT. Based on breast ultrasonography performed 18 months after completion of radiotherapy, we evaluated the presence of interstitial fluid collection and skin edema of the diseased side. Furthermore, we evaluated the relationship between those findings and age, BMI, breast size, breast composition, operation method, the extent of resection, and tumor location. Results and Discussion: Twenty-nine cases (28%) showed interstitial fluid collection and 60 cases (58%) showed skin thickening at 18 months after radiation therapy. Skin thickening tended to remain in fatty breast (p=0.041), and also skin thickening tended to remain when the longer axes of resection were 40 mm or more (p=0.041). Interstitial fluid collection tended to remain when the tumor location was the lower region (p=0.006), and skin thickening tended to remain when the tumor location was the outside region (p=0.027). Conclusion: Our data suggested that tumor location affected the protraction of interstitial fluid collection and skin thickening after BCT. Skin thickening tended to remain in fatty breast and when the extent of resection was large.

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A 58-year-old Japanese man underwent colonoscopy. We identified a protruding submucosal tumor covered with normal mucosa to the level of the rectal ampullary lesion. The patient underwent convex endoscopic ultrasonography (EUS) and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS showed a hypoechoic mass with homogeneous internal echoes and regular margins. The lesion was contiguous with the fourth layer of the rectal wall. The histological specimen from EUS-FNA identified spindle cells. The immunohistochemical profile of the spindle cell tumor was as follows: c-kit+, s-100-, desmin-, and smooth muscle antigen-. We completed surgical resection using the transanal route. The final diagnosis was rectal gastrointestinal stromal tumor.

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A 39-year-old mother was referred to us at 20 gestational weeks owing to a large fetal left lung multilocular mass (macrocystic CPAM) and minimal ascites. The overall size of the mass lesion corresponded to a CPAM volume ratio (CVR) of 1.61. Placentomegaly was also noted. On admission at 22 weeks’ gestation, the fetus exhibited skin edema, and hydrops fetalis was diagnosed. The patient demonstrated fairly stable vital signs, but complained of emesis and vomiting that had developed over the last several days. Upon physical examination, she exhibited edema of the face and legs. Moreover, the patient’s laboratory values showed anemia, low platelet counts, and hypoproteinemia. The serum β-hCG concentration was 178,077 mIU/ml. Based on the above results, mirror syndrome was diagnosed. The mother underwent thoracoamniotic shunting at 22⁺⁵ gestational weeks, with successful drainage of the largest cyst. However, a fair-sized mass composed of multiple small cysts persisted, and the CVR was calculated as 1.20. Fetal pleural skin edema became somewhat less severe, but neither fetal ascites nor placentomegaly improved. At 23⁺⁵ gestational weeks, the mother complained of breathing difficulties. Chest X-ray demonstrated bilateral pleural effusion and cardiomegaly. Maternal hypoproteinemia and edema had gradually worsened, and the patient showed a decrease in urinary volume. We determined that continuation of the pregnancy was not ideal, and induced labor under administration of albumin and diuretics. At 24⁺² gestational weeks, a female infant weighing 860 g was delivered and died immediately after birth. The edematous placenta weighed 725 g. After delivery, the mother’s condition improved. Based on this experience, we have re-affirmed that successful drainage of the largest cyst does not necessarily improve the hydropic state of fetuses with multilocular macrocystic CPAM. The fetal and maternal condition should both be treated with caution via physical examination, hematological examination, and chest radiography.

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