Cardiac Point-of-Care Ultrasound Orientation Conventions in Emergency Medicine Practice

Cardiac point-of-care ultrasound (POCUS) has been used by emergency physicians for decades; however, the position of the indicator marker on the screen and probe is not standardized. We surveyed emergency ultrasound fellowship directors in the United States to characterize their preferences and practices regarding cardiac POCUS conventions.

We surveyed all Emergency Ultrasound Fellowship Accreditation Council accredited program directors regarding the cardiac POCUS conventions taught at their institutions. The survey was distributed through from 3/18/2024 – 9/16/2025 with follow-up invitations every two weeks. Respondents anonymously answered three questions addressing their program’s typical parasternal long axis (PSLA) convention, its frequency of use, and their preferred standard for emergency medicine with an option to explain their choice. Convention options were the a) cardiology convention, defined as screen indicator on the right and probe indicator to the patient’s right shoulder; b) general convention, defined as screen indicator on the left and probe indicator to the patient’s right shoulder; c) cardiology congruent convention, defined as screen indicator on the left and probe indicator to the patient’s left hip; and d) other conventions, defined as any convention not listed.

Of 132 program directors, 120 (90.9%) completed the survey. The most common approach was the cardiology convention (performed: 76/120, 63.3%; preferred: 79/120, 65.8%), followed by the general convention (performed: 23/120, 19.2%; preferred: 25/120, 20.8%) and the cardiology congruent convention (performed: 21/120, 17.5%; preferred: 14/120, 11.7%). Institutional consistency with directors’ reported convention was high. Eleven (9.2%) directors preferred conventions different from those used at their institution. The most cited reason for preferring the cardiology convention was congruency with other specialty conventions to facilitate communication and trust. The most cited reason for preferring the general and cardiology congruent conventions was maintaining consistency across all POCUS applications.

Cardiac POCUS conventions across emergency medicine ultrasound fellowship programs in the United States are not standardized. This data provides a foundation for informed dialogue and future efforts to standardize cardiac POCUS within emergency medicine.