Abstract
Purpose of Review
Point-of-care imaging (POCI) has been defined as, “an imaging test carried out at or close to the point-of-care, at the time and place of care delivery.” The American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) strongly supports POCI to provide patients with timely and effective care. In this review, we demonstrate the value of POCI for all stakeholders including the patient, the otolaryngologist, and the healthcare system.
Recent Findings
In-office imaging has become more accessible to physician offices in recent years due to improved technology and reduced costs. Additionally, shifting imaging tests to physician offices is predicted to reduce healthcare spending in the United States. The history, cost-effectiveness, and usage options for POCI are important to consider. The primary modalities for POCI in otolaryngology include ultrasound (US), computed tomography (CT) imaging, and to a lesser extent, magnetic resonance imaging.
Summary
POCI has been largely embraced by clinicians and patients due to the ability to control access, timing, quality, and cost of imaging to improve patient experience and outcomes. In an era of value-based healthcare reform and price transparency, transitioning to lower-cost centers that are more affordable and accessible continues to drive demand (and preference) for POCI services, most commonly for US and CT imaging in otolaryngology.
Similar content being viewed by others
Data Availability
No datasets were generated or analyzed during the current study.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
• Frija G, Salama DH, Kawooya MG, Allen B. A paradigm shift in point-of-care imaging in low-income and middle-income countries. EClinicalMedicine. 2023;62:102114. https://doi.org/10.1016/j.eclinm.2023.102114. A review of point-of-care imaging uses including ultrasound, portable computed tomography, magnetic resonance imaging, and the of artificial intelligence software.
Position Statement: Point-of-Care Imaging in Otolaryngology. (2021). Retrieved date 27 Nov 2023, from https://www.entnet.org/resource/position-statement-point-of-care-imaging-in-otolaryngology/.
Smith-Bindman R, et al. Trends in use of medical imaging in US Health Care Systems and in Ontario, Canada, 2000–2016. JAMA. 2019;322:843–56. https://doi.org/10.1001/jama.2019.11456.
McCarthy M. US healthcare spending will reach 20% of GDP by 2024, says report. BMJ. 2015;351:h4204. https://doi.org/10.1136/bmj.h4204.
Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319:1024–39. https://doi.org/10.1001/jama.2018.1150.
New Research Reveals Savings Opportunities for Diagnostic Imaging. (2020). Retrieved date 27 Nov 2023, from https://www.unitedhealthgroup.com/newsroom/research-reports/posts/new-research-reveals-savings-opportunities-for-diagnostic-imaging-471266.html#:~:text=High%20Cost%20of%20Diagnostic%20Imaging,imaging%20centers%20or%20physician%20offices.
Gluckman JL, Mann W, Portugal LG, Welkoborsky HJ. Real-time ultrasonography in the otolaryngology office setting. Am J Otolaryngol. 1993;14:307–13. https://doi.org/10.1016/0196-0709(93)90088-o.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–57. https://doi.org/10.1056/NEJMra0909487.
Maw AM, Huebschmann AG, Mould-Millman NK, Dempsey AF, Soni NJ. Point-of-care ultrasound and modernization of the bedside assessment. J Grad Med Educ. 2020;12:661–5. https://doi.org/10.4300/jgme-d-20-00216.1.
Liao LJ, Wen MH, Yang TL. Point-of-care ultrasound in otolaryngology and head and neck surgery: a prospective survey study. J Formos Med Assoc. 2021;120:1547–53. https://doi.org/10.1016/j.jfma.2021.02.021.
Harb JL, Zaro C, Nassif SJ, Dhingra JK. Point-of-care ultrasound scan as the primary modality for evaluating parotid tumors. Laryngoscope Investig Otolaryngol. 2022;7:1402–6. https://doi.org/10.1002/lio2.887.
• Shires CB, Boughter JD Jr, Smith A, Sebelik ME. Head and neck ultrasound utilization rates: 2012 to 2019. OTO Open. 2023;7:e97. https://doi.org/10.1002/oto2.97. A comprehensive review of point-of-care ultrasound in the head and neck with recommended equipment and methods for various clinical situations.
Furukawa M, Hashimoto K, Kitani Y, Yoshida M. Point-of-care ultrasound in the head and neck region. J Med Ultrason. 2022;2001(49):593–600. https://doi.org/10.1007/s10396-022-01266-8.
Pynnonen MA, et al. Clinical practice guideline: evaluation of the neck mass in adults. Otolaryngol Head Neck Surg. 2017;157:S1–s30. https://doi.org/10.1177/0194599817722550.
Feier J, Self Q, Karabachev A, Brundage W, Sajisevi M. Assessing the role of ultrasound for the evaluation of adult neck masses. Laryngoscope Investig Otolaryngol. 2023;8:135–9. https://doi.org/10.1002/lio2.995.
Horvath L, Kraft M. Evaluation of ultrasound and fine-needle aspiration in the assessment of head and neck lesions. Eur Arch Otorhinolaryngol. 2019;276:2903–11. https://doi.org/10.1007/s00405-019-05552-z.
Untch BR, et al. Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years. J Am Coll Surg. 2011;212:522–9. https://doi.org/10.1016/j.jamcollsurg.2010.12.038. discussion 529–531.
Abou Shaar B, Meteb M, Awad El-Karim G, Almalki Y. Reducing the number of unnecessary thyroid nodule biopsies with the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Cureus. 2022;14:e23118. https://doi.org/10.7759/cureus.23118.
Hawkins SP, Jamieson SG, Coomarasamy CN, Low IC. The global epidemic of thyroid cancer overdiagnosis illustrated using 18 months of consecutive nodule biopsy correlating clinical priority, ACR-TIRADS and Bethesda scoring. J Med Imaging Radiat Oncol. 2021;65:309–16. https://doi.org/10.1111/1754-9485.13161.
Hamill C, Ellis PK, Johnston PC. Point of care thyroid ultrasound (POCUS) in endocrine outpatients: a pilot study. Ulster Med J. 2020;89:21–4.
Haugen BR, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. https://doi.org/10.1089/thy.2015.0020.
Na DG, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012;13:117–25. https://doi.org/10.3348/kjr.2012.13.2.117.
Ding J, Wang D, Zhang W, Xu D, Wang W. Ultrasound-guided radiofrequency and microwave ablation for the management of patients with benign thyroid nodules: systematic review and meta-analysis. Ultrasound Q. 2023;39:61–8. https://doi.org/10.1097/ruq.0000000000000636.
Kandil E, et al. Efficacy and safety of radiofrequency ablation of thyroid nodules: a multi-institutional prospective cohort study. Ann Surg. 2022;276:589–96. https://doi.org/10.1097/sla.0000000000005594.
Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine. 2021;72:619–32. https://doi.org/10.1007/s12020-020-02598-6.
Lim JY, Kuo JH. Thyroid nodule radiofrequency ablation: complications and clinical follow up. Tech Vasc Interv Radiol. 2022;25:100824. https://doi.org/10.1016/j.tvir.2022.100824.
Onkar PM, Ratnaparkhi C, Mitra K. High-frequency ultrasound in parotid gland disease. Ultrasound Q. 2013;29:313–21. https://doi.org/10.1097/RUQ.0b013e3182a0abe0.
Alyas F, et al. Diseases of the submandibular gland as demonstrated using high resolution ultrasound. Br J Radiol. 2005;78:362–9. https://doi.org/10.1259/bjr/93120352.
Afzelius P, Nielsen MY, Ewertsen C, Bloch KP. Imaging of the major salivary glands. Clin Physiol Funct Imaging. 2016;36:1–10. https://doi.org/10.1111/cpf.12199.
Ungari C, Paparo F, Colangeli W, Iannetti G. Parotid glands tumours: overview of a 10-year experience with 282 patients, focusing on 231 benign epithelial neoplasms. Eur Rev Med Pharmacol Sci. 2008;12:321–5.
Harb JL, Bakar D, Dhingra JK. Diagnostic accuracy of fine-needle biopsy for salivary gland neoplasms in a community otolaryngology practice. OTO Open. 2020;4:2473974x20949184. https://doi.org/10.1177/2473974x20949184.
Reilly JS, Hotaling AJ, Chiponis D, Wald ER. Use of ultrasound in detection of sinus disease in children. Int J Pediatr Otorhinolaryngol. 1989;17:225–30. https://doi.org/10.1016/0165-5876(89)90049-9.
Druce HM. The use of ultrasound as an imaging technique in the diagnosis of sinusitis. N Engl Reg Allergy Proc. 1988;9:109–12. https://doi.org/10.2500/108854188778994995.
Varonen H, Mäkelä M, Savolainen S, Läärä E, Hilden J. Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol. 2000;53:940–8. https://doi.org/10.1016/s0895-4356(99)00213-9.
Hsu CC, Sheng C, Ho CY. Efficacy of sinus ultrasound in diagnosis of acute and subacute maxillary sinusitis. J Chin Med Assoc. 2018;81:898–904. https://doi.org/10.1016/j.jcma.2018.03.005.
O’Rourke K, Kibbee N, Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections. Mo Med. 2015;112:202–5.
Beam G, Check R, Denne N, Minardi J, End B. Point-of-care ultrasound findings in a case of orbital cellulitis: a case report. J Emerg Med. 2021;61:157–60. https://doi.org/10.1016/j.jemermed.2021.03.033.
Acuña J, Shockey D, Adhikari S. The use of point-of-care ultrasound in the diagnosis of Pott’s puffy tumor: a case report. Clin Pract Cases Emerg Med. 2021;5:422–4. https://doi.org/10.5811/cpcem.2021.6.52726.
Wang LM, et al. Value of ultrasonography in diagnosis of pediatric vocal fold paralysis. Int J Pediatr Otorhinolaryngol. 2011;75:1186–90. https://doi.org/10.1016/j.ijporl.2011.06.017.
Deshpande A, et al. The utility of handheld ultrasound as a point-of-care screening tool to assess vocal fold impairment following congenital heart surgery. Int J Pediatr Otorhinolaryngol. 2021;148:110825. https://doi.org/10.1016/j.ijporl.2021.110825.
Zhang WQ, Lambert EM, Ongkasuwan J. Point of care, clinician-performed laryngeal ultrasound and pediatric vocal fold movement impairment. Int J Pediatr Otorhinolaryngol. 2020;129:109773. https://doi.org/10.1016/j.ijporl.2019.109773.
Su E, et al. Laryngeal ultrasound detects vocal fold immobility in adults: a systematic review. J Ultrasound Med. 2022;41:1873–88. https://doi.org/10.1002/jum.15884.
Eliason MJ, Wang AS, Lim J, Beegle RD, Seidman MD. Are computed tomography scans necessary for the diagnosis of peritonsillar abscess? Cureus. 2023;15:e34820. https://doi.org/10.7759/cureus.34820.
Costantino TG, Satz WA, Dehnkamp W, Goett H. Randomized trial comparing intraoral ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar abscess. Acad Emerg Med. 2012;19:626–31. https://doi.org/10.1111/j.1553-2712.2012.01380.x.
Gibbons RC, Costantino TG. Evidence-based medicine improves the emergent management of peritonsillar abscesses using point-of-care ultrasound. J Emerg Med. 2020;59:693–8. https://doi.org/10.1016/j.jemermed.2020.06.030.
Simard RD, Socransky S, Chenkin J. Transoral point-of-care ultrasound in the diagnosis of parapharyngeal space abscess. J Emerg Med. 2019;56:70–3. https://doi.org/10.1016/j.jemermed.2018.09.034.
Margalit I, Berant R. Point-of-care ultrasound to diagnose a simple ranula. West J Emerg Med. 2016;17:827–8. https://doi.org/10.5811/westjem.2016.9.30890.
Zollinger R. Psychotherapy with a boy with depression following the death of his 2 brothers. Prax Kinderpsychol Kinderpsychiatr. 1997;46:727–31.
Bhattacharyya N. Trends in otolaryngologic utilization of computed tomography for sinonasal disorders. Laryngoscope. 2013;123:1837–9. https://doi.org/10.1002/lary.24001.
• Batra PS, Setzen M, Li Y, Han JK, Setzen G. Computed tomography imaging practice patterns in adult chronic rhinosinusitis: survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society membership. Int Forum Allergy Rhinol. 2015;5:506–12. https://doi.org/10.1002/alr.21483. A retrospective study evaluating Medicare billing trends for in-office computerized tomography among otolaryngologists.
Patel RA, Torabi SJ, Kasle DA, Narwani V, Manes RP. Billing patterns for in-office computerized tomography scans of the face/sinus by otolaryngologists. Am J Otolaryngol. 2021;42:103140. https://doi.org/10.1016/j.amjoto.2021.103140.
Woolen S, et al. Waiting for radiology test results: patient expectations and emotional disutility. J Am Coll Radiol. 2018;15:274–81. https://doi.org/10.1016/j.jacr.2017.09.017.
Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat. 2014;10:1–161.
Setzen G, et al. Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease. Otolaryngol Head Neck Surg. 2012;147:808–16. https://doi.org/10.1177/0194599812463848.
Rosenfeld RM, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152:S1–s39. https://doi.org/10.1177/0194599815572097.
Tan BK, Chandra RK, Conley DB, Tudor RS, Kern RC. A randomized trial examining the effect of pretreatment point-of-care computed tomography imaging on the management of patients with chronic rhinosinusitis symptoms. Int Forum Allergy Rhinol. 2011;1:229–34. https://doi.org/10.1002/alr.20044.
Leung R, et al. Upfront computed tomography scanning is more cost-beneficial than empiric medical therapy in the initial management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2011;1:471–80. https://doi.org/10.1002/alr.20084.
Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 2: clinical applications. AJNR Am J Neuroradiol. 2009;30:1285–92. https://doi.org/10.3174/ajnr.A1654.
Leung R, Chaung K, Kelly JL, Chandra RK. Advancements in computed tomography management of chronic rhinosinusitis. Am J Rhinol Allergy. 2011;25:299–302. https://doi.org/10.2500/ajra.2011.25.3641.
Albu S. Chronic rhinosinusitis-an update on epidemiology, pathogenesis and management. J Clin Med. 2020. https://doi.org/10.3390/jcm9072285.
Rudmik L. Economics of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2017;17:20. https://doi.org/10.1007/s11882-017-0690-5.
Truitt KN, Brown T, Lee JY, Linder JA. Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study. Clin Infect Dis. 2021;72:311–4. https://doi.org/10.1093/cid/ciaa736.
Han M, Kim HJ, Choi JW, Park DY, Han JG. Diagnostic usefulness of cone-beam computed tomography versus multi-detector computed tomography for sinonasal structure evaluation. Laryngoscope Investig Otolaryngol. 2022;7:662–70. https://doi.org/10.1002/lio2.792.
Alam-Eldeen MH, Rashad UM, Ali AHA. Radiological requirements for surgical planning in cochlear implant candidates. Indian J Radiol Imaging. 2017;27:274–81. https://doi.org/10.4103/ijri.IJRI_55_17.
Nateghifard K, et al. Cone beam CT for perioperative imaging in hearing preservation cochlear implantation - a human cadaveric study. J Otolaryngol Head Neck Surg. 2019;48:65. https://doi.org/10.1186/s40463-019-0388-x.
Wu Q, et al. Advances in image-based artificial intelligence in Otorhinolaryngology-Head And Neck Surgery: a systematic review. Otolaryngol Head Neck Surg. 2023;169:1132–42. https://doi.org/10.1002/ohn.391.
Massey CJ, Asokan A, Tietbohl C, Morris M, Ramakrishnan VR. Otolaryngologist perceptions of AI-based sinus CT interpretation. Am J Otolaryngol. 2023;44:103932. https://doi.org/10.1016/j.amjoto.2023.103932.
Majid Khan JS, James Zinreich S, Nafi Aygun. Cummings Otolaryngology-Head and Neck Surgery. 7th ed. 2021.
Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend. J Am Coll Radiol. 2008;5:105–9. https://doi.org/10.1016/j.jacr.2007.09.017.
Islam KT, et al. Improving portable low-field MRI image quality through image-to-image translation using paired low- and high-field images. Sci Rep. 2023;13:21183. https://doi.org/10.1038/s41598-023-48438-1.
Author information
Authors and Affiliations
Contributions
JP wrote the main manuscript text including the “Abstract,” “Introduction,” “Ultrasound,” and “Magnetic Resonance Imaging” sections. JP also reviewed and collaborated on the “Computed Tomography” section. SS and GS wrote the main text within the “Computed Tomography” section. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The author declares no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Preece, J., Setzen, S.A. & Setzen, G. Point-of-Care Imaging in Otolaryngology. Curr Otorhinolaryngol Rep 12, 30–38 (2024). https://doi.org/10.1007/s40136-024-00499-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40136-024-00499-0