Will PoCUS replace bedside x-ray in ICUs?

Khalid Azzam

Do you believe that point-of-care ultrasonography (PoCUS) will ever make bedside chest x-ray obsolete in the intensive care unit (ICU) setting?

Khalid Azzam, MD: In terms of the relationship between chest x-ray and PoCUS, we know for certain now, with multiple studies looking at the specificity and sensitivity of both modalities, that ultrasound is superior in picking up pneumothorax, pneumonia, interstitial patterns, and pleural effusion, for which it is the gold standard.

So ultrasound has a good potential to make chest x-ray obsolete. However, we are dealing with 2 things here: changing old habits, which is difficult. It the near future I do not think that is going to make chest x-ray obsolete, but it absolutely can reduce the use of chest x-ray. When you have a patient with heart failure, initially everyone gets a chest x-ray, you assess them with PoCUS and see that they are volume overloaded, they are having a significant interstitial pattern on a lung ultrasound, and you do not need to do a daily chest x-ray then. We see that in some ICUs: chest x-rays rounds and daily chest x-rays. That is not required, because you can assess their volume and lung status by ultrasound on a daily basis. There is no exposure to radiation, literally no cost to the system, because the ultrasound machine is there and the physician time is there, so absolutely PoCUS will and should reduce the use of chest x-ray in the ICU.

When is it going to make it obsolete? It is going to be a while, and maybe we will still need x-rays in certain patients, especially to see some deep-seated masses or abnormalities in the lung that ultrasound may not pick. But for your usual pneumothorax, pleural effusion, pneumonia, interstitial patterns, or heart failure, PoCUS is definitely superior to chest x-ray and should make it obsolete.

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