Ultrasound Device No. 2 – The VScan by GE!

Pre-amble!

So here is Part 2 of the as promised portable ultrasound reviews. The aim, to un-muddy the water a bit for you all over choice and functionality. There are so many put there at the moment, we wanted to test them on the shop floor…are they the true ITU workhorses you need to keep in your pocket?

All reviews are clearly done by myself, unless stated otherwise, so you could argue are very subjective. I can’t disagree…but I will try to be as un-biased as I can and start with an open mind on it all. I own my own GE Vscan DP device as a declaration, but I am not receiving any money / sponsorship or anything else financial from the kind companies who have agreed to allow me to review their devices. All devices in my possession for testing go back to them.

 

1. VScan DP – GE

Seeing cardiologists walking around the hospital a number of years back with the original VScan roused my interest in these devices. So, starting to really get my teeth into POCUS in critical care fuelled my desire to acquire my own device.

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Original VScan

The GE Vscan was an obvious choice, and even better, the dual probe sister device to the one I had seen the cardiologists branding (with the single phased array probe on it).

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VScan DP – the one I own.

Anyway, it is in my possession and has been for well over a year now and it is down to this that I feel my practice had been revolutionised on ITU and on the wards when looking at sick patients. Does this then make me rather biased towards GE….in a word, yes, it does a bit. But I just wanted to state that from the start. That is not to say that I will not be giving the other devices fair trial on the back of now owning the GE Scan DP and being unable to acquire another different company’s device, (without winning the lottery anyway!).

Here is the promo vid direct from their site:

Another on LVH identification:

Final one on the device and an overview:

See Chris Fox talking Ted about POCUS:

So…you get the idea here!

What is it?

Take a look here at GE’s website promo for the DP:

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Vscan with Dual Probe product overview

GE Healthcare’s innovative pocket-sized ultrasound features the first of its kind dual probe that houses two transducers in one probe.

The Vscan with Dual Probe transforms physical exams that help enable efficient triage, fast workflow, and deepens patient connection.

This intuitive device provides a non-invasive look inside the body, with both shallow and deep views, that helps speed diagnostic decisions for a wide range of clinical applications.

With diagnostic information in the palm of your hand, this system may help you:

  • Have greater clinical confidence, with immediate visual validation of what you feel and hear
  • Reduce patient wait times for clinical information to guide appropriate course of care
  • Support efficient workflow across your health system for time and cost savings

The device comes with the 2 probes; flip it over and you interchange between ends (Linear and phased array). The probes are of course hot wired into the body housing and the probe can be detached should anything g go wrong. So this is NOT a wireless device folks!  The battery slips out easily to reveal the micro memory card onto which data / images can be stored and transferred. The device kind of resembles the old Motorolla Startac phone from the late 90’s and is a clamshell design. Panel at the base with cogwheel and microswitch touch interface, the top is the screen. It literally fits into your scrubs pocket, and with your jelly in your pocket (seemingly odd to members of the public and peers in the hospital!), you are good to go wherever you want!

What’s it like then – hands on?

So, what does the DP do and why do I like it (I own it, so reviewing it and slating it in the process is clearly not going to happen…otherwise I would not have bought it)!

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1) Take it out of it’s charging cradle / your pocket and simply open it up!
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2) After 40 seconds or so, its booted up and ready to scan!
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3) First scan screen defaults to your preferred initiator as set by you – mine is on linear lung. You can set this to whatever you wish.
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4) Simply press the main menu button and scroll on the jog-wheel across to the type of probe you want.
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5) Then the individual default settings for different anatomical scans appears as options for each of the probes, select, click and go. Easy!
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6) Linear selected, the end of the probe will illuminate to confirm.
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7) Phased array selected, the end of the probe will illuminate to confirm as well.

So, easy and swift, menu’s could be operated by my 9 and 7-year old (not sure about the 7-month old…but they are very intuitive).

The scans!

You may have seen many of my US images on Twitter…most are from this device.

Obviously I am used to the settings and it is like riding a bike for me using this machine, but others have revelled in the fact it is simple and the image quality quite unbelievable when you see the size of the device. I love seeing the faces of staff and juniors, particularly on the ward, when you explain you are here to scan a patient and you pull this device out! Most still can’t believe it!

I have used it in theatres, pre, intra and post-op. I have travelled the wards reviewing sick patients with it. It has been used to aid my ultrasound guided blocks during upper limb lists and has been used for vascular access. A work-horse really.

I have also dropped it, the cable has been trodden upon and it stays in my work bag..enduring cycling into work and various other bag thuds! Still fine.

Phased array views

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LV apical view on PSAX
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LV Papillary level on PSAX
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PLAX  view in a congenital heart disease patient at Pap level demonstrating RV overload and septal D’ing in LV systole
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Congenital heart disease patient with RV dilatation and dominance with LV failure and high PAP
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PLAX view in a patient with severe congenital (operated), heart disease. Massive over-riding RV and kissing failing LV
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R base PLAPS view demonstrating pleural effusion not visible on CXR
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Another pleural effusion on PLAPS view demonstrating the spine sign

Linear views

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Lung US upper L showing A-line profile and pleura clearly visible
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Upper R zone on US demonstrating B line profile in a pneumonia patient. A-lines also visible

 

The verdict!

Below, is the review template we came up with in order to fairly assess portable devices (mainly credit to Adrian Wong for this).

Criteria for the perfect handheld POCUS device

General

Portability

  • Undoubtedly, one of the best. Small enough to pull out of your pocket and functional enough to scan with! What more could you want?

Number of probes

  • Its a dual probe, so there is no switching and fiddling about disconnecting one to connect another wirelessly. A mere click of the jog-wheel and its done
  • Phased array great for cardiac / abdominal / chest and the rest, linear for vascular access, blocks etc etc.

Screen – dedicated or linked to tablet/phone

  • The device is all in one. The screen, I guess, could be a little bigger, but then you compromise on size increase and non-pocket POCUS!
  • Resolution is perfect and settings easily adjusted.
  • A fabulous feature is that you can put it down and angle the screen to wherever you want. This gives the advantage of not having to worry about placing a flatscreen monitor down and cocking you head over it to see it. Also, you don’t end up dirtying the screen as you run your fingers over not to perform different functions, only to not be able to see for a gel skid-mark or bit of blood on there!

Battery life

  • A full charge from nothing takes under 1 hour and run time, when scanning like a radiologist on ecstasy is around 45 minutes before you see the red warning indicator.
  • It doesn’t get too hot either; a problem with many of these devices.

Interface logistics and ergonomics – touchscreen, user-friendly software

  • The device is intuitive and lacks over complexity.
  • The screen is not touchscreen, but personally; I like this as there is a certain comfort on physical dials / buttons. The jog wheel acts as a sensitive gain control when whizzed over with your finger and the click points act as good depth adjusters.
  • It comes with software, BUT…it’s windows…aaaargh! This will retrospectively perform M-mode on your B-mode images and you can perform various calculations etc after scanning with it. Where is the Mac interface GE?!!😳
  • Colour mode is swift and does not visibly slow the refresh rate down when triggered. Measurement is also easy with accurate usage of the jog-wheel and buttons.
  • Switching between probes and modes is a sinch!
  • One drawback, it doesn’t have wifi capability. Thus, for me, getting images off it involves battery out, remove memory card, insert into Mac card reader and drag the files across. Not so bad after 1-2 goes and easy after a while.

Cost

  • Here we go!
  • I paid around £4500 or so for mine as an ex-dem model. Which, when you consider wireless probes and their combined costs (once you have enough of them to do all you want with), tots up big-time!
  • I believe the DP retails or did retail, at about £5000 or so brand spankers!

Warranty

  • GE aftercare has been flawless. Warranty is a couple of years, but they always deal with problems swiftly. Another reason I perhaps like the company so much.

Echo probe

  • Accurate, small and easy to get it to where you want it. Certainly in no way bulky.

Curvilinear probe

  • N/A – the phased array seems to do all this one can…just perhaps not at curvi depth resolution with lower frequency.

Linear array probe

Ergonomics – weight, feel

  • Small footprint, but packs a good scan and depth is enough.
  • The one disadvantage is that you can’t seem to drop the depth on the linear to below 3.5cm. Somewhat irritating when you may want less depth in order to enhance the image of very superficial tissues.

Image quality

  • Crisp and clear. In fact, clear enough to perform US guided blocks with. The clarity of the images is not that of a laptop sized or larger unit, but what do you expect for what it is.
  • Vascular access with hot is fabulous, as it can be placed on the bed, the screen cocked and off you pop.

Features

Video’s of the device in action

All above for you

 

Score and conclusion

This device scored 8/10 for me. And this was downgraded by the Extend (see the review to follow)!

Again, I am biased as it has become more a part of me than any stethoscope and goes almost everywhere with me. It has got me out of trouble at times, been to arrests, been used to cannulate, block, echo and assist in diagnosis negating trips off the unit to have other tests done etc. It is easy to cart about in your pocket…almost to the point you forget its there!

If I could improve…a bit of a larger screen, Wifi capability, some funkier software patches that might allow some other things to be done. These would all be nice…but for me, it’s difficult to polish this device any more. You get a lot of ‘bang for your buck’!

If you can get one…do! I am sure GE can see what they can do as bare in mind…the newer Scan Extend is out…which funnily enough, follows from here! 👍



 

2. VSCan Extend – GE

Now, how can you better what I considered to be the best handheld scanner? As Mentioned, there is unfortunately some bias to this set of reviews, as I have always been a GE ‘scan-er’!

As you have seen from the above..the DP will be hard to beat. So when GE announced the Extend some time back, I gave it a go before purchasing my DP.

At the time, I wasn’t completely sold on the Extend. The touch screen interface wasn’t as crisp as buttons and palpable jog-wheels. There just wasn’t that tactility you got from the DP. I found the interface with screen / gains etc a little irritating, particularly if you weren’t careful with gel getting everywhere etc. So, I said to GE, ‘thanks but no thanks’, and went for the DP….saving I think a few grand at the time.

But; they have returned to us for the review series and they have come back with the brand new Extend and it’s new software upgrades. What is all this about…as I was told I was one of the first to test this new platform!

With a privileged grin, off I went with it.

What is it?

It’s the touchscreen upgrade, slightly bigger screened version of the DP. More memory, longer battery life, apps to integrate with it, Wifi and more!

Here are some promo vids for you to look at from GE:

Screenshot 2018-08-18 13.19.02.png

From the site:

Vscan Extend is designed to be easy to use, much like your smartphone with a minimized number of keys. Just swipe through the interface with your right or left thumb to access powerful portable ultrasound and clear images. It’s also easy to adjust in one hand while holding the probe with the other.

Vscan Extend seamlessly integrates handheld ultrasound imaging with your hospitals’ wireless networks and DICOM®-based documentation and reporting1. Review images at the bedside or use wireless DICOM data transfer to connect to your standard imaging workflow.1 With a special emphasis on data security, you can easily and securely send images wirelessly to the PACS.

Screenshot 2018-08-18 13.30.40.png

Customize your Vscan Extend with apps to expand your diagnostic capabilities and fit the care areas you serve. It’s the first GE ultrasound system to leverage the GE Marketplace to enrich your diagnostic power. Available over the Internet, Vscan Extend apps are downloadable for installation on the device. The GE Marketplace is the host of Vscan Extend apps – providing access to available apps with screenshots and additional information before download. The user can be notified of new or updated apps through email to the customer account. Updates can be easily initiated directly from the Vscan Extend device1.

So….let’s get on with the test!

 

What’s it like then – hands on

As above…it’s a case of squeeze the power button and wait around 30 seconds. It boots up and is ready for the off!

IMG_5175

Things get a little different now….if you swipe left, a series of new menus appear for you. Within these are the opportunity to switch between scan modalities, as with the DP. But, there is also a new section offering the opportunity to use protocols. There are only 2, but to be honest, this shows what software upgrades can do and the potential for further exciting upgrades once you own one of these.

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Let’s start with the scan coach FATE.

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Here are all of the components, click on each and it effectively tells you which view to capture.

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Once you have worked through each one on a patient, there’s your series and each goes green for you. It will then compile an effective report.

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That’s cardiac…then there is chest. For all of us CUSIC fans…

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Much the same again for us. We are guided through the different views on the upper chest and lower chest; left and right. Once you have completed all exams, the report appears and you are asked to grade each segment. It won’t do auto B-line calculation like the big Venue, but asks you to be the judge.

Here is what it comes up with as options for each segment:

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And here is your report…

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All rather nice!

Now, I know I said I had moved on from cardiac, but not quite! It also has this icon option as you scan the heart! What’s this ‘LVivo EF all about then?!

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This intrigued me….was this small machine going to be able to calculate my EF? How does it do this? It appears it does so via a form of modified speckle tracking!!

And mine….

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Reassuringly normal and it took all of 10 seconds or less to do on the fly. It will do this when it gets a decent view on PSAX LV / apical and subcostal views. I was impressed!

 

The Scans

The machine has not altered chip / probe / interface software or indeed hardware on the probe. So the images are much the same as the DP in resolution. It’s the added Gizmos that are the impressive part to this kit.

This thing almost feels like a mini GE Venue in your pocket! And we all love the versatility and simplicity of this ITU workhorse (the Venue that is). We have been praising it all over the world as we run courses etc! We have one on loan from GE at the moment too….as well as owning our fabulous Logiq P9.

These images are from GE and are not mine, but I can vouch for the quality, having used it on my ITU.

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Bladder still, capturing bladder volume being calculated.
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Another of the fabulous software options on this thing – calculation of bladder volume in action!
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PLAX view
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IVC view

The verdict!

Same review template we came up with in order to fairly assess portable devices (credit to Adrian Wong for this).

Criteria for the perfect handheld POCUS device

General

Portability

  • Still pocketable…so so important. Yes, a bigger screen, but it still fits into the scrubs!

Number of probes

  • Its a dual probe, so there is no switching and fiddling about disconnecting one to connect another wirelessly. A mere click of the jog-wheel and its done
  • Phased array great for cardiac / abdominal / chest and the rest, linear for vascular access, blocks etc etc.

Screen – dedicated or linked to tablet/phone

  • It’s touchscreen! This annoyed me a tad in the past. But, give it a few minutes and things are tight! The screen is large and clear.
  • Resolution is perfect and settings are easily adjusted, even when you lie the device flatter on the bed than you would with the DP.
  • Its all hard wired in with the probe, as with the DP. Again, I think, a pre-requisite…no wireless faffing!

Battery life

  • A full charge takes a little longer than it does with the DP, but battery life is possibly another 10 minutes or so on mine?
  • This one heats up a little more than the DP when working. But it’s nothing to take you to a burns unit over!

Interface logistics and ergonomics – touchscreen, user-friendly software

  • So simple to use and the menus take you through what to do. You could pick it all up in under 1 hour IMHO.
  • The screen is touchscreen, and the image adjustments work fine. Dragging and zooming etc are as intuitive as using an iPhone.
  • Again…windows based after image software!!! Why not Mac? You can also get this thing to do all sorts with app’s you can download from GE. So many options and exciting new things appearing.
  • Colour mode is swift and does not visibly slow the refresh rate down when triggered. Measurement is also easy with accurate usage of the jog-wheel and buttons and you have the added capability to do volumes / EF’s and more with this machine. Amazing really!
  • EF calculation, various protocols and scores, bladder volume calculation, colour modes and more on this thing. Brilliant App Store and you can label your images on the fly as well.
  • Switching between probes and modes is a sinch!
  • It has Wifi capability, so image transfer is a cinch. You can upload to GE’s cloud, to PACS, via DICOM or just hook up with your home network. Easy as pie!! We have seen and are continuously debating governance / quality control and recall of images…this is made simple here! Software upgrades are also possible…all via Wifi!!

Cost

  • A little more than the DP
  • I think, and will change this if I am wrong, the Extend will set you back around £7500. There are ex-dem options with GE as always. I also believe they will ‘throw one in’ with purchases of their bigger machines if you buy 3 or more Venues, for example!
  • Again, considering what you will see over subsequent reviews on the wireless probes, this is cheap!

Warranty

  • 2 or more years

Echo probe

  • Accurate, small and easy to get it to where you want it. Certainly in no way bulky.

Curvilinear probe

  • N/A – the phased array seems to do all this one can…just perhaps not at curvi depth resolution with lower frequency.

Linear array probe

Ergonomics – weight, feel

  • Small footprint, but packs a good scan and depth is enough.
  • The one disadvantage is that you can’t seem to drop the depth on the linear to below 3.5cm. Somewhat irritating when you may want less depth in order to enhance the image of very superficial tissues.

Image quality

  • As with the DP. The images are easy to acquire, adjust and modify.

 

Score and conclusion

Wow! Yes…and I keep batting on about this, I am a little GE biased. But this is a serious and affordable piece of portable pout for your money.

The software options are exciting and they work. There is the opportunity for more in the future too. We would love spectral doppler and a few other cheeky options…but my eyes are a little too big here.

I am seriously considering an upgrade and even though I sit on the ever length increasing Butterfly waiting list, I am unsure that that device will match this one. I had placed the DP at 9/10, but I am sorry my faithful friend, you get downgraded by the Extend, purely on the added extras it offers. So…the Extend gets a shiny 9/10 from me. Why the drop of 1 point? Well, if I gave it 10/10, you would suspect me of being a GE employee!

I must thank GE for all of their support over the years and for allowing me to review this device, as well as being one of the first to see the new software upgrade.



 

Next: The Clarius!

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