Minimal Criteria for Lung Ultrasonography in Internal Medicine

Main Article Content

Janeve Desy
Vicki E. Noble
Andrew S. Liteplo
Paul Olszynski
Brian Buchanan
Renee Dversdal
Shane Arishenkoff
Gigi Liu
Elaine Dumoulin
Irene W. Y. Ma

Point of care ultrasound, Lung ultrasound, Minimal criteria


Point-of-care lung ultrasound (LUS) examination is increasingly utilized in Internal Medicine. To improve the standardization of LUS education and clinical use, explicit minimal criteria for defining what is an acceptable and clinically useful image are needed.
A 97-item online survey of potential minimal criteria for common uses of LUS in Internal Medicine was developed and sent to 10 international point-of-care ultrasound experts. Their opinion on the inclusion of each item was sought and items not achieving consensus (defined as agreement by at least 70% of the experts) were reassessed in subsequent rounds. A total of three rounds were conducted.
Seventy-four minimal criteria were agreed upon for inclusion, 24 were agreed upon for exclusion, and two did not reach consensus.
Experts agreed on 74 minimal criteria for Internal Medicine LUS. The use of these minimal criteria during teaching and clinical use is strongly recommended.

L’échographie pulmonaire au point d’intervention est de plus en plus utilisée en médecine interne. Pour améliorer l’uniformisation de la formation sur l’échographie pulmonaire et de son utilisation clinique, il faut des critères minimaux explicites pour définir ce qu’est une image acceptable et utile sur le plan clinique.
Un sondage en ligne de 97 éléments portant sur des critères minimaux possibles dans l’utilisation courante de l’échographie pulmonaire en médecine interne a été élaboré et soumis à 10 experts internationaux en échographie au point d’intervention. Leur avis sur l’inclusion de chaque élément a été sondé, et les éléments pour lesquels il n’y avait pas de consensus (défini par l’accord d’au moins 70 % des experts) ont été réévalués lors de tours suivants. Au total, trois tours ont été effectués.
Soixante-quatorze critères minimaux ont été acceptés, 24 ont été exclus et deux n’ont pas fait consensus.
Les experts se sont entendus sur 74 critères minimaux relatifs à l’échographie pulmonaire en médecine interne. L’utilisation de ces critères minimaux au cours de l’enseignement et de l’utilisation clinique est fortement recommandée.

Abstract 458 | pdf Downloads 157 HTML Downloads 182


1. American College of Physicians. ACP statement in support of point-of-care ultrasound in Internal Medicine
[Internet]. 2018. Available from:
2. Soni NJ, Schnobrich D, Matthews BK, et al. Point-of-care ultrasound for hospitalists: A position statement of the Society of Hospital Medicine. J Hosp Med. 2019;14:E1–6. | 10.12788/ jhm.3079
3. Ma IWY, Arishenkoff S, Wiseman J, et al. Internal Medicine point-of-care ultrasound curriculum: Consensus recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) group. J Gen Intern Med.
4. Gargani L, Volpicelli G. How I do it: Lung ultrasound. Cardiovasc Ultrasound. 2014;12:25.
5. Perrone T, Maggi A, Sgarlata C, et al. Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea. Eur J Intern Med. 2017;46:61–5.
6. Filopei J, Siedenburg H, Rattner P, Fukaya E, Kory P. Impact of pocket ultrasound use by internal medicine housestaff in the diagnosis of dyspnea. J Hosp Med. 2014;9:594–7.
7. Vitturi N, Soattin M, Allemand E, Simoni F, Realdi G. Thoracic ultrasonography: A new method for the work-up of patients with dyspnea. J Ultrasound. 2011;14:147–51.
8. Ma IWY, Hussain A, Wagner M, et al. Canadian Internal Medicine Ultrasound (CIMUS) expert consensus statement on the use of lung ultrasound for the assessment of medical inpatients with known or suspected coronavirus disease 2019. J Ultrasound Med. 2020. jum.15571
9. Ma IWY, Desy J, Woo MY, Kirkpatrick AW, Noble VE. Consensus-based expert development of critical items for direct observation of point-of-care ultrasound skills. J Grad Med Educ. 2020;2:176–84.
10. Ambasta A, Balan M, Mayette M, et al. Education indicators for internal medicine point-of-care ultrasound: A consensus report from the Canadian Internal Medicine Ultrasound (CIMUS) group. J Gen Intern Med. 2019;34:2123–9.
11. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intens Care Med. 2012;38:577–91.
12. Buda N, Kosiak W, Wełnicki M, et al. Recommendations for lung ultrasound in internal medicine. Diagnostics (Basel). 2020;10:597.
13. Noble VE, Nelson BP. Manual of emergency and critical care ultrasound. New York: Cambridge University Press; 2011.
14. Soni NJ, Arntfield R, Kory P. Point-of-care ultrasound. Philadelphia, PA: Saunders; 2015.
15. Lichtenstein DA. Whole body ultrasonography in the critically ill. New York, NY: Springer-Verlag; 2010.
16. Lichtenstein D, Meziere G, Biderman P. The comet-tail artifact. an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640–6.
17. Lichtenstein D, Meziere G, Biderman P, Gepner A. The “lung point”: An ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434–40.
18. Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram: A lung ultrasound sign of alveolar consolidation ruling out atelectasis. CHEST J. 2009;135:1421–5.
19. Lichtenstein DA, Lascols N, Prin S, Mezière G. The “lung pulse”: An early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29:2187–92.
20. Carmody KA, Moore CL, Feller-Kopman D. Handbook of critical care and emergency ultrasound. The McGraw-Hill Companies; 2011.
21. Levitov A, Dallas A, Slonim A. Bedside ultrasonography in clinical medicine. The McGraw-Hill Companies; 2011.
22. Levitov A, Mayo PH, Slonim AD. Critical care ultrasonography. New York, NY: The McGraw-Hill Companies; 2009.
23. Humphrey-Murto S, Varpio L, Gonsalves C, Wood TJ. Using consensus group methods such as Delphi and Nominal Group in medical education research. Med Teach. 2017;39:14–19. 59X.2017.1245856
24. Lichtenstein DA. Current misconceptions in lung ultrasound: A short guide for experts. CHEST. 2019;156:21–5. chest.2019.02.332

Similar Articles

You may also start an advanced similarity search for this article.