Lung Ultrasound

for COVID-19
Lung Ultrasound for COVID-19
Healthcare providers have been challenged to find effective Clinical examples of lung ultrasound images from healthy
strategies to manage patients with COVID-19 during the patients and COVID-19 patients are shown on the following
global pandemic. The recent guidance from the World Health page to demonstrate B-lines, thickened and irregular pleura,
Organization (WHO) entitled, “Clinical Management of COVID-19”, and subpleural consolidations.
suggests that chest imaging, including lung ultrasound, may be
helpful in diagnosing and identifying or excluding pulmonary
complication in COVID-19 patients with moderate to severe 6 3
disease.1 Specifically, lung ultrasound has been proposed
12 14
as a clinical tool in emergency rooms for triaging COVID-19
patients symptomatic for pneumonia before hospital admission, 8 10
5 2
monitoring patients with pneumonia-related lung findings,
managing ventilation and weaning for intensive care unit
11 13
patients, and evaluating the effects of antiviral medications.2
4 1 7 9
As a real-time diagnostic tool that can be performed bedside,
lung ultrasound can be effective for detection of interstitial
lung disease, subpleural consolidations, and acute respiratory
distress syndrome.3 Specific ultrasound findings for COVID-19
patients include2-6: Various anatomical scanning protocols have been reported
for lung ultrasound examination including the Bedside Lung
• Thickened pleural line 1 Ultrasound in Emergency (BLUE)7-9 protocol for assessment of
acute respiratory failure and the Fluid Administration Limited
• B-lines (multifocal, discrete 2 , or confluent 3 ) by Lung Sonography (FALLS)7 protocol for management
of acute circulatory failure. A specific scanning protocol for
• Small consolidations 4 evaluation of COVID-19 patients has also been reported
including the 14 views (3 posterior, 2 lateral, 2 anterior) listed
• Both non-translobar and translobar consolidations below for patients able to maintain a seated position3:
• Pleural effusion (rare) 5 • R ight 1
and Left 4 basal on the paravertebral line above
the curtain sign10;
• Early stage findings: Focal B-lines and pleural line thickening
 rogressive and late stage findings: Confluent B-lines,
•P • R ight2 and Left 5 middle on the paravertebral line at the
inferior angle of the shoulder blade;
pleural line thickening then small consolidations which
progress to lobar consolidation. • R ight 3
and Left 6 upper on the paravertebral line at the
spine of the shoulder blade;

5 • R ight
7 and Left 9 basal on the midaxillary line below the
1 internipple line;

4 • R ight 8
and Left 10 upper on the midaxillary line above the
internipple line;
2
• R ight
11 and Left 13 basal on the midclavicular line below
the internipple line;

3 • R ight 12
and Left 14 upper on the midclavicular line above
the internipple line
Posterior views may be difficult to assess if the seated position
is not feasible. However, acquiring at least a partial view of
posterior basal area is recommended when performing lung
ultrasound exams on COVID-19 patients.3
Source: Dr. Kylie Baker https://www.youtube.com/watch?v=Y_a_h8FyH7c
Scan Examples:
A convex transducer (e. g. abdominal, 2–5 MHz) or a linear transducer (e. g. vascular, 4–9 MHz) is recommended for scanning.

Thickened and irregular pleural line

Thin and sharp pleural line

1
Rib

A Line Acoustic shadow

2

Normal – COVID-19: Pleural thickening, irregular pleura

craniocaudal orientation, anterior and diffuse B lines

Subpleural consolidations (possibly air infiltrations)

Thin and sharp pleural line

A Lines Liver

3
Lung

4
Normal – COVID-19: Small subpleural consolidation
lateral orientation

Larger consolidation

B Lines
6

Normal – COVID-19: Irregular pleural line with thickened B

posterior orientation lines and subpleural consolidation

Clinical images courtesy of Dr Norbert Jung, Managing Senior Physician, Endoscopy Center, Kliniken Landkreis Heidenheim gGmbH
Recommended settings for lung ultrasound scanning 3,9

Based on patient body habitus

• Convex array (e.g. 2-5 MHz)
Transducer Type
• Linear array (e.g. 4-9 MHz)
• Sector array (e.g. 2-5 MHz)
• Convex array: Abdomen
Starting Preset • Linear array: Arterial
• Sector array: Adult Heart
Transmit Focus Single focal zone set at the depth of the pleural line
• Aplio i-series & a-series: GEN or non-harmonic
Frequency Type
• Xario g-series: Non-harmonic
ApliPure Setting 0 (off )
Precision Setting 0 (off )
Gain Set appropriately to avoid saturation
MI < 1.4
QuickScan Off
Depth 7 – 15 cm for easy visualization below the pleura
Frame Rate Setting 1
Cine clip length At least 3-5 second clips should be stored for each view

Available transducers for lung ultrasound scanning

• PLI-705BX • PLT-705BT
Linear • PLU-704BT
• PLT-705BT • PLT-704SBT
array • PLU-1005BT
• PLT-1005BT • PLT-1005BT

• PVI-475BX • PVI-482BX
• PVT-475BT • PVT-482BT • PVU-375BT
Convex • PVI-475BT • PVT-482BT
• PVT-375BT • PVT-382BT • PVU-382BT
array • PVT-375BT • PVI-574BX
• PVT-375SC • PVT-574BT • PVU-674BT
• PVT-375SC • PVT-574BT

• PST-28BT
• PSI-30BX • PSU-25BT
Sector • PST-50BT • PST-25BT
• PST-25BT • PSU-30BT
array • PST-65BT • PST-30BT
• PST-30BT • PSU-50BT
• PST-50BT

For System Disinfection Guides and Guidelines for Cleaning, Disinfection, and Sterilization of Transducers, please
visit the Canon COVID-19 Resources website at: https://us.medical.canon/service-and-support/covid-19/.
If an User Preset for Lung scanning is not available on your system, a custom User Preset can be
created by following the steps below.
Creating a New User Preset on
Aplio i-series /Aplio a-series
1  Start a new exam with the desired exam type.
2 Select a different transducer, if necessary.
3  Adjust the imaging settings as desired.
4  Select Preset button.
5  Select Save.
• Enter new Preset name.
• Select Probe.
• Select Measurement package.
• Select Annotation/Body Mark.
6  Select User Preset Save.
Creating a New User Preset on
Xario g-series
1  Press the Transducer hard key.
2  Select the PROBE EXAM tab.
• Press the Probe button.
3  Select the starting User Preset.
4  Adjust the imaging settings as desired.
5  Select Preset tab.
6 Select Save.
• Enter new Preset name.
• Select anatomical Region.
• Select Application (annotation, body mark).
• Select Probe.
• Select Measurement package.
7  Select User Preset Save.
To start a new patient exam, please follow the instructions below:

Starting a New Patient Exam— Starting a New Patient Exam—

Aplio i-series /Aplio a-series Xario g-series
1C
 lick on the 1  Press the Exam button on the left side on the
Exam icon control panel.
from the left
column on 2  If the patient
the touch information is
screen. not available,
click on
“Emergency ID”
and then click
2  I f the patient information is not available, click on “Start” to
on “Emergency ID” and then click on “Start” to begin the exam.
begin the exam.
3 T o end the exam, press the Exam button on the
left side of the control panel and then click on
“End Exam”.

3  To end the exam, click on the Exam

icon from the left column of the 4  T o edit the patient information:
touch screen. • Select the “Patient Browser” from the “PIMS” tab
located on the top row on the touch screen.
• Highlight the exam to correct patient information
and click on “Patient Info” from the bottom row.
• Click on “Correct”.
4  T o edit the patient information: • Edit patient information, as needed. Click on
• Select the “Patient Browser” from the right-hand “Ok” and then “Confirm” to accept the changes.
column of the touch screen.
• Highlight the exam to correct patient
information.
• Select “Pat Info Edit”.
• Edit patient information, as needed. Click on
“Ok” and then “Confirm” to accept the changes.
 References
1. World Health Organization. https://www.who.int/publications/i/item/clinical-management-of-covid-19
2. Sultan LR et al. https://www.umbjournal.org/article/S0301-5629(20)30221-0/fulltext
3. Soldati G et al. https://onlinelibrary.wiley.com/doi/full/10.1002/jum.15285
4. Peng QY et al. https://link.springer.com/article/10.1007/s00134-020-05996-6
5. Poggiali E et al. https://pubs.rsna.org/doi/10.1148/radiol.2020200847
6. Huang Y et al. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544750
7. Lichtenstein DA. https://journal.chestnet.org/article/S0012-3692(15)37223-8/fulltext
8. Lichtenstein DA et al. https://journal.chestnet.org/article/S0012-3692(08)60155-5/fulltext
9. Miller A. https://academic.oup.com/bjaed/article/16/2/39/2897763
10. Lee FCY. https://www.sciencedirect.com/science/article/pii/S0929644117300413

For additional information on COVID-19

• CDC Coronavirus (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/index.html
• WHO Coronavirus Disease (COVID-19) Pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
コンポジットロゴ_CANON MEDICAL SYSTEMS USA,INC_英語表記 2017.7.21

• ACR COVID-19 Resources. https://www.acr.org/Coronavirus-Covid-19-Resources

• RSNA COVID-19 Resources. https://www.rsna.org/covid-19
• AIUM COVID-19 Resources. https://www.aium.org/soundWaves/article.aspx?aId=1120
• ASE Coronavirus (COVID-19) Resources. https://www.asecho.org/covid-19-resources/

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