POCUS in Simulation

A lot of great things have come out of Sweden – Ikea, Abba, Vikings, Stefan Edberg… Awesome Ultrasound Simulator is the brainchild of Per Östergren who incidentally is also from Sweden. Awesome Ultrasound Simulator allows for real-time ultrasound images of normal scans and pathology to be shown as scenario participants scan a particular area of a mannikin or a simulated patient.

Why is it useful?

I have been experimenting using the Awesome Ultrasound Simulator in both my POCUS teaching sessions and also in in-situ simulation. It can simulate a number of POCUS pathologies such as pneumothorax, pericardial effusions, aortic aneurysms and intra-abdominal free fluid.

Prior to using the app I was only able to show a still image of the eFAST scan or just verbally tell the team what the eFAST demonstrated. Using the Awesome Ultrasound Simulator you can now set up complex POCUS findings and project them onto a monitor for your team to see & interpret when they actively simulate performing the POCUS exam.  These can be tailored to the scenario you are running.

Recently at POCUS GEELONG we ran an eFAST workshop for our registrar training.  One of the stations incorporated the ultrasound simulator. We ran some simple trauma scenarios where the focus was on the primary survey and interpretation of eFAST images.  Participants were asked to talk through the surface anatomy of probe placement and were then asked to identify structures and pathology on the Awesome Ultrasound Simulator generated images. We then discussed ongoing management of the patient depending on the vital signs, pathology identified and trauma protocols. It was a great learning experience for participants and much better than the standard didactic lecture.

How do I use it? 

  • Awesome Ultrasound Simulator comes in an app which can be purchased from Apple Store  for AU$22.99
  • You require and iPhone & an iPAD or new generation Apple TV
  • The case can be setup on the fly, prior to the simulation starting or evolve as the scenario proceeds.  The iPhone is the remote and the iPAD is the monitor projecting the image
  • It’s as easy as selecting the area being imaged and choosing the pathology required. Once the participants simulates scanning this area you activate that region which then projects onto the monitor for participant to interpret the scan.

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What do we think of it?

I have been using the app now for over a year. These are the things I like about it:

  • I find it intuitive to use and easy to navigate through the menus
  • Usually connects seamlessly between devices
  • Cases are simple to set up using the user-friendly interface and was easily used by a colleague who had never used the app before with minimal training.
  • Can be used in both stand alone teaching of ultrasound or in a simulation scenarios
  • Good selection of medical and trauma images.

What improvements/additions we would like to see?

  • Ability to upload your own images to the library
  • Occasionally there is drop out between the remote and monitor but usually easily fixed by restarting apps.
  • Currently only compatible with apple products, would be nice to see developed for the android market as well
  • It would be great to create a bank of #FOAMED simulations scenarios where the Awesome Ultrasound Simulator app has been used for sharing amongst users

We contacted Per the Awesome Ultrasound Simulator Developer and asked him to discuss his App with us.

Hi, and thanks for a great review!

I built this simulator because the diagnostics in simulations scenarios often were left out or only included as highly modified versions (ultrasound images printed on standard office paper, anyone?). This app is not supposed to be a tool for training hand-eye coordination, but rather a tool for interpreting images of actual pathology. If used together with other tools for simulating patient vital signs (SimMon, iSimulate), there’s a great potential for highly immersive and true to reality scenarios.

Unfortunately, the app is only available on the iOS platform due to my very limited experience as a programmer (I’m an anaesthesiologist by trade, remember). Maybe there will be an Android version some day, but work on that haven’t begun yet. Some things are in pipeline though:

  • Future versions should definitely have the option for pro users to use their own clips instead of the bundled ones.
  • Integration with hardware sensors and the iOS device that will let the examiner trigger the appropriate clips by doing their exam. This will eliminate the need for the simulation facilitator to do this, and will potentially create an even more immersive experience. Adding hardware should be optional, and should be able to retrofit on existing mannequins. This development is in progress right now.

So far, the goal has been to make an app that people can use without much hassle, that work anywhere (be it in situ, the simlab or prehospital), and that can be customized to work with most possible scenarios.

Pro tip: All mid line views have alternate clips that the examiner can change between by touching the screen (think of it as a simulated 90 degree rotation of the probe). Change between parasternal view(PLAX) and short axis (PSAX), between subcostal view and IVC, between the the aorta and pelvic view in short axis and long axis.

If anyone have experiences to share, feel free to contact me, and I can publish scenarios and other use cases on the Awesome Ultrasound Blog.

Happy simulations, y’all!



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