The objective of the study was to evaluate different probes for Vet BLUE® lung ultrasound.  The study design was something that Dr. Jessica Ward and I had discussed several years ago.  The clinical importance and relevance was founded on the premise that many veterinary cardiologists would be tempted to use the phased-array probe immediately after or before their echocardiogram evaluation for Vet BLUE® lung evaluation.  Thus, would the cardiac probe, the phased-array probe be effective and accurate?

There are 2 major fundamental objectives to accurately perform Vet BLUE®:

  1. To accurately be able to identify the Gator Sign orientation.  The Gator Sign term was published in Vet Radiol and Ultrasound in 2014 (Lisciandro, Fosgate and Fulton).  It represents the intercostal space bordered by a rib cranially and a rib caudally likened to a partially submerged alligator peering at you.
  2. To accurately be able to count B-lines.  Our B-line scoring system was first published in Vet Radiol and Ultrasound 2014 (Lisciandro, Fosgate and Fulton) as the Gator Sign and thereafter in several studies by Ward and Lisciandro.

Gator Sign

The Vet BLUE® B-line Scoring System

The Vet BLUE® B-line scoring system is composed of “weak” and “strong” positives.  The “strong” positive model was used for the rapid screening for left-sided congestive heart failure in dogs and cats and published in J Am Vet Med Assoc in 2017 (Ward, Lisciandro, Ware et al.); however, it is important to know that “weak” multiple positives are not expected during Vet BLUE®.  Learn Vet BLUE® Online in its 7-hour course.  The use of Vet BLUE® is cutting edge and has clear advantages over other formats being regional, pattern-based, with B-line scoring and a simple visual lung language (Shred, Tissue, Nodule, and Wedge Signs).  We were the first in the world to use proactive lung ultrasound on a daily basis (since 2005).  Click here for more Online Course information.

A list of our Publications and LINKS to Pubmed and Open Access is available by clicking here.  This LINK is available to BOTH members and non-members.

Furthermore, the reader can determine what probe is being used in ultrasound images by looking at the shape of the near field.  A phased-array probe is a sharp point, a convex probe is a curve, and a linear probe is squared off.

This is a slide from our 8-hour RACE-approved Global FAST® Course that may be taken remotely or in-person.  Note the near field of each shape representing different probe types. Click here for more Online Course information.

So let’s look at some images from our Am Jr of Vet Research study published in 2021 (Ward, Murphy and Lisciandro, et al. 2021).  Ask the following 3 questions – 1) what probe is being used? and 2) can you accurately see the Gator Sign orientation?  and 3) can you accurately count B-lines?

Example 1

Example 2

Example 3 

This is a slide from our 8-hour RACE-approved Global FAST® Course that may be taken remotely or in-person.  Note the near field of each shape representing different probe types. Click here for more Online Course information.

The conclusion of the AJVR study was that experience can overcome the deficiencies of the phased-array probe.

Our recommendation would be to maximum Vet BLUE® success and use a convex probe that is effective for Vet BLUE® and all of Global FAST®.  The linear probe performs well but cannot be used for the entire Global FAST® and is better left for a radiologist than sonographers performing Global FAST®.

Send any comments to Dr. Greg Lisciandro, DVM, DABVP, DACVECC at [email protected]

Order our Point-of-care Ultrasound Techniques for the Small Animal Practitioner textbook’s 2nd edition from Amazon at the LINK here.

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