Can POCUS Reduce the Ordering of Formal Radiology Studies?
- Nov 11
- 2 min read
EMUGs Journal Club Summary - November 2025
Hosted and Summarised by Dr Brian Doyle, FACEM FACEP
The current evidence to answer this question is limited and mixed. In fact, some worry that
POCUS might increase radiology use due to suboptimal interpretation or those pesky
incidental findings. Hmm…
They identified POCUS scans via their EMR, which included a built-in POCUS reporting
template used for every accredited or directly supervised study. Scan types included lung,
cardiac, urinary tract, DVT, and a few MSK studies.
In total, 572 POCUS scans were recorded. The most common were lung (44%) and cardiac
(23%).
Main result: After POCUS, only 27% of patients had further radiology or echo studies. When
excluding lung ultrasound, this rose to 43%.
The authors concluded that “…an internal medicine POCUS service will significantly reduce
the demand [on radiology services].”
During our EMUGs journal club discussion, we agreed the study’s methodology wasn’t really
designed to answer that question — which might explain why it wasn’t published in a higher-
impact journal. It’s unrealistic to expect every POCUS study to require follow-up imaging. A
“before-and-after” design might have been more appropriate (though still messy).
We also noted several limitations: this was a single-centre internal medicine study (limiting
external validity); “phantom scans” weren’t accounted for; only 2–3 unblinded accredited
sonologists performed or supervised the scans; and diagnostic accuracy wasn’t evaluated.
Other reflections: If we genuinely want to reduce formal radiology imaging, robust
credentialing and archiving of POCUS studies are essential. This is the first step in building
confidence and accountability. There was plenty of lively discussion about local experiences
and how different sites are tackling this.
In summary: It’s a tricky research question, but one definitely worth pursuing.
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