HANDHELD AND POCKET-SIZED ULTRASOUND FOR ABDOMINAL AORTIC ANEURYSM SCREENING BEYOND THE RADIOLOGY SUITE: ACCESS, TASK-SHIFTING, AND REGULATORY CONSIDERATIONS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6051Keywords:
Abdominal Aortic Aneurysm, Point-of-Care Ultrasound, Handheld Ultrasound, Task-Shifting, Primary Care Screening, Health Technology AssessmentAbstract
Handheld and pocket-sized ultrasound devices enable accurate abdominal aortic aneurysm (AAA) screening across a wide range of non-radiology settings and operator types. This review synthesizes evidence from 26 sources spanning emergency departments, primary care offices, prehospital ambulances, and rural clinics across 12 countries. Non-radiologist operators, including family physicians, emergency physicians, paramedics, medical residents, complete novices, and nurses, achieved sensitivities of 96 to 100% and specificities of 94 to 100% for AAA detection when using focused, protocol-driven scanning. Training requirements ranged from 15 minutes for deep learning-guided nurses to 15 to 25 hours for unassisted clinicians, with measurement accuracy generally within 0.2 to 0.5 cm of reference standards. AI-guided systems reduced training to minutes while maintaining physician-comparable accuracy (100% sensitivity, 94 to 98% specificity, mean absolute error 2.8 mm), though this evidence derives from a single research group and requires broader validation. Obesity consistently reduced diagnostic accuracy, with sensitivity improving from 86% to 96% when large body habitus patients were excluded. Screening costs of $30 to $53 per examination, with devices costing approximately 10% of standard ultrasound machines, support economic viability; cost-utility modeling found opportunistic primary care scanning to be cost-saving for medium and large aneurysms. The principal barriers to broader implementation are not diagnostic accuracy but structural: the absence of standardized credentialing and training requirements across jurisdictions, unresolved coding and reimbursement pathways for non-radiologist point-of-care ultrasound (POCUS) screening, low screening uptake even with decision support, and additional regulatory complexity for AI-guided devices. Successful programs combined institutional endorsement, focused scanning protocols, short dedicated training, workflow adaptations such as nurse-directed ordering, and clear referral pathways for positive cases. Countries with centralized screening programs appear better positioned to integrate POCUS-based AAA screening than fragmented systems requiring individual practitioner navigation of reimbursement.
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Copyright (c) 2026 Michał Dyś, Jerzy Buszko, Adrianna Buż, Damian Danilczuk, Marta Bajkowska-Piterak, Monika Szlachta-Gubernat, Nicol Baran, Przemysław Piterak, Wiktor Adamiec
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