Identifying Frailty Using Point-of-Care Ultrasonography: Image Acquisition and Assessment

Our research aims to assess frailty in surgical patients using point-of-care ultrasound measurements of the quadricep muscle. We seek to determine the accuracy of these measurements in predicting postoperative adverse events and their potential utility in clinical decision making. Recent advancements in our field include the utilization of point of care ultrasound for bedside assessment of muscle mass and quality.

This approach offers a non-invasive and expeditious alternative to traditional imaging techniques enhancing perioperative risk evaluation in surgical patients. Experimental challenges include optimizing image acquisition techniques for consistent and accurate measurement of quadriceps muscle thickness, as well as ensuring reproducibility across different operators and patient populations. Compared to other techniques such as the freed frailty assessment and CT imaging, this protocol offers the advantage of enhancing the efficiency in the preoperative area for identifying those patients at potentially higher surgical risk secondary to frailty.

In the future, our team will focus on further validating the use of point-of-care ultrasound and frailty assessment across different surgical populations and investigating interventions to improve outcomes and frail surgical patients. To begin, place a patient in a supine position on a surgical bed with their legs extended. Set the preset on the probe scanner to the musculoskeletal setting.

Place the probe transversely on the anterior thigh at about 60%the length from the anterior superior iliac spine to the superior border of the patella. The quadriceps will appear deep to the subcutaneous tissue and superficial to the femur. To prevent the overestimation of the muscle thickness due to superficial edema, apply firm pressure to the ultrasound probe.

If the rectus femoris is difficult to identify, ask the patient to contract their thigh muscles or extend their knee. Next, press distance, then measure on the ultrasound machine and activate the caliper function With the cursor, measure the anterior to posterior distance between the deep border of the vastus intermedius and the most superficial fascia of the rectus femoris. Click on acquire to capture the sonographic view.

Repeat the measurement three times, then average the values to minimize the variability. For the measurement of the rectus femoris, adjust the depth with the vertical ruler. Then use the horizontal slide bar to adjust the gain until the rectus femoris muscle is centered in the ultrasound frame with clear visibility of its boundaries and the underlying femur.

The rectus femoris muscle should be visible as a hypoechoic structure within the anterior thigh compartment with a central echogenic line. Now activate the caliper function and trace around the periphery of the rectus femoris muscle carefully. The circumference of the cross-section should be displayed automatically.

Click on acquire to capture the sonographic view. Average the values of three to minimize the variability. The measurements of a healthy subject showed well-defined muscle with uniform echo texture and clear continuous fascial planes consistent with non-frail status.

A scan of an elderly frail individual showed less defined muscles, a heterogeneous echo texture, and interrupted fascial planes.