Frequently described in medical literature as the “visual stethoscope,” point-of-care ultrasound (POCUS) continues to redefine bedside care by empowering surgeons to make high-stakes decisions quickly and safely—whether in a busy trauma bay or in remote environments, including space-based missions.1
While the traditional stethoscope relies on the evaluation of sound, POCUS provides real-time imaging within seconds, allowing clinicians an enhanced ability to assess the heart, lungs, and abdominal organs. Although this technology is typically employed in emergency and critical care settings, POCUS is shifting from a frontline emergency tool to a standard, noninvasive diagnostic device used in daily practice.
Specifically, POCUS—which augments clinical expertise rather than replacing it—can help guide critical procedures related to trauma assessment, vascular access planning, preoperative evaluation, and more.
The principles of ultrasound were first identified in the 1790s by Italian physiologist Lazzaro Spallanzani, who studied how bats use inaudible, high-frequency sounds to navigate in the darkness.2 His research was the basis for what would later become diagnostic ultrasound technology.
Ultrasounds were first used for medical purposes in the 1940s to help detect brain tumors. At that time, the machinery was inconveniently large, and patients had to be submerged in water where ultrasound waves move more quickly. By the 1990s, enhancements to this technology resulted in a portable ultrasound probe that allowed for rapid assessment of patients at the bedside rather than in a bathtub.3
By the early 2000s, widespread use of POCUS to guide central venous access (CVA) began to emerge, establishing this technique as one of the original and fundamental applications for POCUS, along with the Focused Assessment with Sonography for Trauma (FAST) exam.
“POCUS was built out of the need to evaluate patients in real time for specific procedures, most notably, the placement of central line access into a vein or artery,” said Luis E. Llerena, MD, FACS, medical director of the University of South Florida (USF) Health Center for Advanced Medical Learning and Simulation (CAMLS) in Tampa. “The old way of doing it was by feel. We used anatomy because, as surgeons, we know anatomy very well—that’s our fallback.”
Today, POCUS-guided CVA (sometimes referred to as central venous catheter [CVC]) is the standard of care for these patients. In 2001, the Agency for Healthcare Research and Quality recommended ultrasound-guided CVC placement as a key practice, and in 2011, the ACS released the “Revised Statement on Recommendations for Use of Real-Time Ultrasound Guidance for Placement of Central Venous Catheters,” noting that “Several prospective, randomized trials, as well as two meta-analyses, document that the use of ultrasound has been associated with a reduction in complication rate and an improved first-pass success when placing catheters in the internal jugular vein and the subclavian vein.”4
“No one in 2026 should be putting in an essential line without an ultrasound,” asserted Dr. Llerena, surgical director of the ACS Accredited Education Institute at USF.
With the real-time imaging provided by POCUS, anatomical variations may be detected, and complications such as arterial puncture, hematoma, and pneumothorax may be significantly reduced.
Despite these benefits, incorporating POCUS into daily bedside care continues to meet some resistance from surgeons and other healthcare providers.
“In the beginning, there was a lot of pushback, including my own resistance,” admitted Dr. Llerena, a trauma surgeon and surgeon educator overseeing a series of critical care courses at CAMLS.
During an especially hectic night in the ICU, a critically ill patient required central line placement. Although ultrasound was readily available, Dr. Llerena initially hesitated to use it despite teaching POCUS. The ultrasound immediately provided more than just vessel visualization; it revealed vessel compression and movement characteristics that exposed an unsuspected blood clot. Using a traditional technique would likely have located the vessel, but without real-time imaging, the clot could have been missed, potentially causing unnecessary pain and complications for the patient.
POCUS in the Trauma Bay and Beyond
POCUS started to gain momentum as a diagnostic tool in the emergency department in the 1990s, when the diagnostic peritoneal lavage procedure was superseded by the FAST exam, which was introduced and adopted to quickly identify hemodynamically unstable trauma patients.
In 1997, the FAST exam was incorporated into ACS Advanced Trauma Life Support® guidelines—a key milestone in caring for the injured patient because it marked a shift from invasive, time-consuming assessments to a swift, noninvasive bedside approach. In 2004, Extended FAST (commonly known as eFAST) was developed, which features thoracic imaging and helps clinicians identify free fluid or air in the chest, abdomen, or around the heart.
“No one should be resuscitating a patient in the trauma department or in the ICU without quickly going to your ultrasound to see what’s going on,” said Dr. Llerena. “POCUS causes no radiation damage, so it is a process that is repeatable. And the images can quickly be exported to send to other medical experts.”
In addition to assessing acute trauma cases, POCUS can be used in the emergency department to identify a variety of conditions, including kidney stones, appendicitis, gallstones, bowel obstructions, gout, and rheumatoid arthritis.
Perhaps most notably, these “grab-and-go” POCUS devices (as they are sometimes referred to in the mainstream media) are used in one of the most critical, high-stakes presentations in the emergency department—cardiac.5 This technology aids clinicians in detecting serious medical conditions such as tamponade and ventricular thrombus, ultimately optimizing emergency resuscitation efforts.
“Someone described the ultrasound as the modern-day equivalent of the stethoscope, and I think that is an accurate statement,” said Dr. Llerena, noting that while the stethoscope has functioned as a bedside cardiac and pulmonary assessment tool for more than 2 centuries, its effectiveness is contingent on the clinician’s interpretation of auditory data. POCUS, on the other hand, provides visuals of cardiac function in real time. When used in tandem, both tools can help optimize diagnostic precision.
“Where you used to get a stethoscope as a gift from your family for getting into medical school—now I could see them getting you a commercially available ultrasound device,” added Dr. Llerena.
A cross-sectional study of US Veterans Affairs medical centers published in 2025 examined POCUS usage in five clinical domains, including surgery, hospital medicine, anesthesiology, emergency medicine, and critical care.6
Researchers found that approximately 54% to more than 90% of surgeons and emergency physicians use POCUS, depending on the specific specialty, setting (academic versus community), and geographical region. The most common application was in trauma bays, specifically the FAST exam, which is used in 73%–89% of cases, according to survey.
The study authors noted that “past studies have focused on POCUS use in individual specialties, primarily emergency medicine and critical care, but comparative studies of different specialties are needed to guide investment” in POCUS implementation.
Barriers to POCUS implementation, according to survey respondents, include lack of training (53%–80%), access to ultrasound equipment (25%–57%), and POCUS infrastructure (36%–65%).
NASA-Inspired Training Drives POCUS Education on Earth
In 2006, the Wayne State University School of Medicine (WSUSOM) in Detroit, Michigan, became a pioneer in medical education by integrating an ultrasound curriculum into its basic science courses and clinical clerkships, positioning it as one of the first US institutions to adopt this training.7
The program featured six organ-system-based sessions covering ultrasound physics, anatomy, and procedural applications. The inaugural class achieved a mean score of 87% in technical performance. Student engagement scores also were high, with 91% supporting longitudinal integration across 4 years.
The WSUSOM ultrasound curriculum was informed by educational training developed by the ACS and National Aeronautics and Space Administration (NASA) protocols. Scott Dulchavsky, MD, PhD, FACS, a principal investigator for NASA and the International Space Station, was funded by the agency to lead a team from 1998 to 2014 that trained astronauts on how to use POCUS to obtain diagnostic-quality medical images that could be transmitted via satellite to radiologists on earth for medical evaluation.8
“While we developed this program for astronaut and cosmonaut crews to be used off the planet, we thought it’d be very applicable to bring back home to Earth in one of the largest medical schools in the US,” explained Dr. Dulchavsky, the Roy D. McClure Chair of Surgery and surgeon-in-chief of Henry Ford Health in Detroit, Michigan. “When we were originally doing this, it was quite novel, and in fact, Wayne State actually had the program in the recruitment brochure. But now, you’re at the point of being left behind if you don’t offer ultrasound training. It’s an expectation that all our surgical residents are exposed to surgeon-performed ultrasound in their training and that many will take it into their practice.”
A survey of nearly 200 accredited US medical schools in 2001 revealed that 72.6% of respondents had an integrated ultrasound curriculum; that number has likely increased due to increased portability of handheld devices, reduced costs, user-friendly artificial intelligence (AI)-assisted systems, and increased student demand.9 In fact, today some medical schools even provide a handheld ultrasound device to every first-year medical student.
“This kind of training is becoming standard at many universities due to the many demonstrated benefits—cost savings, decreased complications, improved patient comfort, and the fact that it allows the resident to feel more confident in what they’re doing,” said Dr. Llerena.
At USF, administrators incorporate POCUS training into its medical and physician assistant curricula via its CAMLS program, which emphasizes a hands-on approach to ultrasound training.
“Ultrasound is used from the minute the students arrive at USF. During the same course where they’re looking at anatomical cadavers, they also rotate through different stations where they look at imaging and scans, and then they rotate through another station where they’re doing actual ultrasound training,” added Dr. Llerena.
While POCUS skills are not specifically outlined as an Accreditation Council for Graduate Medical Education (ACGME) milestone for general surgery residents, this skill set is generally required within the broader framework of procedural and critical care competence. For other specialties, such as emergency medicine residents, ACGME mandates a minimum of 150 POCUS examinations in order to fulfill residency requirements.10
Space Station Tech Boosts ER Care
While Dr. Dulchavsky’s collaboration with NASA played a role in shaping the educational framework of POCUS, his work with astronauts has had other terrestrial applications as well. Specifically, his team developed techniques for crew members aboard the International Space Station to use POCUS to check for thoracic issues such as pneumothorax.
“One of the challenges we had early on was how to diagnose a collapsed lung because we worry about that when you’re getting in and out of a spacesuit—you get depressurized and that’s a problem,” said Dr. Dulchavsky. “Because it’s loud in space, stethoscopes don’t work well, and because the crew officer might be a geophysicist and not a physician, we investigated using ultrasound to diagnose a lung collapse, an approach that was eventually confirmed by a large clinical study.”
Researchers for this study, published in 2001, examined retrospective data for a 3-year period at a Level I trauma center and found that POCUS outperformed supine chest x-ray in finding pneumothorax, whether used by a fellowship-trained provider or general practitioner.11
“So, if you’re in an ER anywhere in the US, more likely than not, somebody is going to a put a probe on your chest to see whether your lung is collapsed—and that came from NASA,” said Dr. Dulchavsky. “We did the same thing with musculoskeletal care and looking at intracranial pressure. These assessments would normally entail using a lot of devices and expenses here on planet Earth—but you can do all of that with POCUS.”
AI Enhances Clinical Decision-Making, Patient Engagement
Probe placement and image optimization can now be augmented by built-in AI guidance systems that provide users with real-time prompts for correctly positioning the device. For residents and trainees, this capability—combined with AI overlays that provide auto-labeling of anatomical features—delivers immediate feedback that accelerates learning and enhances user confidence levels.
“We work with ultrasound mannequins that allow learners to practice POCUS-specific maneuvers,” said Dr. Llerena. “There is a monitor beside the student that shows them where their hand is, with correcting capabilities in real time. At the same time, it’s telling you where to move your arm, almost like a golf swing simulator.”
Both AI POCUS simulators and AI-enabled golf swing simulators provide data-driven coaching.
A golf simulator displays information related to club path, face angle, and swing speed immediately after a shot, while a POCUS simulator provides instant feedback on probe positioning, angle, and image acquisition.
“When we first started working with the astronaut crews, it was interesting because these were not medical people; it would be a fighter pilot, geophysicist, engineer of some variety,” said Dr. Dulchavsky. “We would almost have to devise our own nomenclature for how to get the crew to appropriately place the probe to obtain the target image. And, so, we came up with some clever ways to do that, and it became part of what was incorporated into the early ACS resident ultrasound courses. Today, with AI, the devices have that capability built into them. They can be your bedside assistant telling you to push the device a little to the right.”
In addition to providing optimal probe positioning, AI-enhanced POCUS uses data acquired from deep learning algorithms to automatically adjust settings that improve clarity, reduce image “noise,” and improve tissue boundary visualization.
“This is where the real magic of AI comes in,” explained Dr. Dulchavsky. “AI-powered POCUS looks at a bank of millions of images and makes an incredibly good first guess. Much like the EKGs that spit out a presumptive diagnosis, these devices can do the same thing.”
AI-enabled POCUS can examine patterns and offer suggested findings such as “left ventricular hypertrophy,” a diagnosis that would need to be confirmed by a trained clinician.
“The black doctor’s bag of the future will have an ultrasound probe in it rather than a stethoscope,” Dr. Dulchavsky said. “I can tell you that 100% of my residents are completely comfortable with an ultrasound probe in their hand, much like I was decades ago with a stethoscope. Our surgeon’s bellwether has always been patient focused, and if we can use POCUS to get critical information, we can make faster, more accurate decisions at the bedside.”
While the stethoscope continues to be an iconic tool that fosters physician-patient relationships through its hands-on applications, POCUS also can support a personal and collaborative exchange with a patient through its real-time “point-and-display” capabilities.
“Ultimately, I need to figure out what is going on with the patient,” added Dr. Llerena. “If I have access to labs, x-rays, POCUS—all of these tools that help with my diagnosis and help get the patient better—why wouldn’t I take advantage of all of it?”
