The slides below outline key steps for getting a POCUS program off the ground. First and foremost, faculty need to build confidence and skill in common POCUS applications. This comes with regular hands-on scanning regardless of the type of introductory course they have taken. A great way to start is by performing educational scans and comparing them with formal imaging or reports. Once comfortable, faculty can begin billing for studies. Billing plays an important role not just in supporting and sustaining the program, but also in reinforcing accountability. Moving away from unsaved or “phantom scans” toward saving and documenting images helps promote a culture of quality and responsibility. This also strengthens the credibility of nephrologist-performed POCUS in the eyes of other physicians and consultants.

POCUS faculty should be mindful that it’s easy to gain an ‘expert’ label with only minimal skills, especially when few others in the department have even that. But settling at the peak of Mt. Stupid on the Dunning-Kruger curve can hinder the journey toward true expertise.

Handheld ultrasound devices are generating a lot of excitement thanks to their affordability and portability. However, their image quality often falls short for advanced applications or comprehensive studies. It is quite easy to miss subtle but important findings like a small stone, cyst, renal mass, or intracardiac thrombus. That said, if the primary goal is to introduce trainees to basic uses such as assessing extravascular lung water, they can be a great starting point. Some of the more expensive high-end handhelds do offer better image quality and added features such as spectral Doppler. Below is a helpful comparison of various hand held devices, though this landscape continues to evolve.

In a 2024 study, a panel of internal medicine POCUS experts including myself evaluated six commonly used handheld ultrasound devices for overall satisfaction. Interestingly, no single device stood out as the best in image quality across all views. The chart below shows how each device was rated. Keep in mind that real-world image quality can vary depending on patient body habitus, practice environment, and other factors. For consistency, we used healthy volunteers, not actual patients, for this comparison.