The COVID-19 pandemic is driving an increase in the use of lung ultrasonography among physicians in Italy, according to the results of a small survey published in the Journal of Ultrasound in Medicine.
More physicians said they're using ultrasound equipment now than before the pandemic, and experienced physicians are performing more lung ultrasound scans than ever before. The findings support anecdotal evidence that COVID-19 has increased interest in ultrasound, including among clinicians with no prior ultrasound experience.
"Thanks to online resources, many operators could e-learn and apply the technique," wrote the authors, Dr. Allessandro Zanforlin and Dr. Francesco Tursi, who are both members of the Italian thoracic ultrasound academy behind the survey (July 16, 2020, Journal of Ultrasound in Medicine).
The informal, one-week-long survey was conducted by Italian ultrasound society Academia di Ecografia Thoracia after the group noticed its membership spiked from 1,700 members in February to 4,000 members in May. The academy promoted its survey on social media and received 123 responses.
Survey respondents worked in a variety of settings, including on COVID-19 floors (34%), in intensive care units (31%), and in the emergency department (20%). The majority said they used lung ultrasound to monitor pneumonia (63%) and screen for COVID-19 (60%).
A total of 14% of respondents started using lung ultrasound exclusively because of the COVID-19 pandemic. Among these respondents, 81% said they learned how to perform lung ultrasound scans by following video tutorials or participating in webinars. The remaining 19% of respondents gained experience through expert mentoring or local courses.
As the number of patients with COVID-19 surged at hospitals in Italy, so too did the number of lung ultrasound exams. Respondents said the number of daily chest scans increased from an average of three per day before the pandemic to seven per day during the outbreak. For so-called "expert operators" with at least five years of lung ultrasound experience, the number of exams rose from five per day to nine per day.
The majority of respondents also said their lung ultrasound exams had increased in quality (58%) and accuracy (66%) during the pandemic. These percentages were even higher for participants who took an online course or webinar, with 83% of these respondents saying their exams increased in both quality and accuracy.
One factor driving the increase in lung ultrasound exams could be the availability of additional equipment thanks to donations and emergency purchase approvals. More than half of respondents said they acquired new ultrasound equipment during the pandemic, namely portable wheeled systems (37%) or handheld/wireless systems (19%).
The survey adds to the evidence that ultrasound is becoming an invaluable tool for care teams, especially those in Italy, who are treating patients with the novel coronavirus. However, the increase in skilled operators and new equipment may mean the modality will remain prominent for lung imaging even after the pandemic is over.
"What we are learning from this pandemic is the importance of [lung ultrasound] in the diagnosis, evaluations, and monitoring of pneumonia, which, in the hands of many physicians ... could improve the quality of the treatment of respiratory patients," the authors concluded.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
