THE ROLE OF ARTIFICIAL INTELLIGENCE IN GUIDING POINT-OF-CARE ULTRASOUND FOR DEEP VEIN THROMBOSIS DIAGNOSIS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.18623/rvd.v23.8046Keywords:
Artificial Intelligence, Point-of-Care Systems, Venous Thrombosis, Hybrid Models, Workflow, RadiologistsAbstract
Deep vein thrombosis (DVT) is a significant global health burden. Point-of-care ultrasound (POCUS) enhances diagnostic access but is dependent on the operator. Artificial intelligence (AI) has been proposed to guide novices and standardize image acquisition, often within a hybrid model incorporating remote clinician review. This systematic review aimed to synthesize the diagnostic accuracy, clinical feasibility, and health economic impact of AI-guided POCUS for DVT diagnosis within AI-human hybrid models. This systematic review was conducted in accordance with PRISMA guidelines, searching databases (PubMed/Medline, Scopus, Web of Science, IEEE, and Google Scholar) for studies published between 2021 and 2025. Four studies met the eligibility criteria, assessing AI-guided POCUS systems for DVT diagnosis. These studies demonstrated that the hybrid AI-human model achieved high diagnostic performance for ruling out proximal DVT, with a sensitivity of 90-100% and a negative predictive value (NVP) of 87.5-100%. Reviewer expertise significantly impacted accuracy; emergency medicine POCUS-trained physicians outperformed general radiologists. The model was feasible for non-expert operators (e.g., nurses) with minimal training and showed potential to reduce unnecessary duplex ultrasound referrals by 29–58%, with associated workflow efficiency. AI-guided POCUS combined with mandatory clinician review forms an effective hybrid model that enhances access, standardizes quality, and safely rules out DVT. Successful real-world implementation requires targeted reviewer training, workflow integration, and further health economic and independent pragmatic evaluation.
References
Avgerinos, E., Spiliopoulos, S., Psachoulia, F., Yfantis, A., Plakas, G., Grigoriadis, S., Speranza, G., & Kakisis, Y. (2025). Novel AI Guided Non-Expert Compression Ultrasound DVT Diagnostic Pathway May Reduce Vascular Laboratory Venous Testing. European Journal of Vascular and Endovascular Surgery.
Bernardi, E., & Camporese, G. (2018). Diagnosis of deep-vein thrombosis. Thrombosis Research, 163, 201–206. https://doi.org/https://doi.org/10.1016/j.thromres.2017.10.006
Bhatt, M., Braun, C., Patel, P., Patel, P., Begum, H., Wiercioch, W., Varghese, J., Wooldridge, D., Alturkmani, H. J., & Thomas, M. (2020). Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy. Blood advances, 4(7), 1250–1264.
CDC. (2025a). Data and Statistics on Venous Thromboembolism.
CDC. (2025b). Deep Vein Thrombosis and Pulmonary Embolism. https://www.cdc.gov/yellow-book/hcp/travel-air-sea/deep-vein-thrombosis-and-pulmonary-embolism.html
Checa, A. (2018). Ultrasonography, an operator-dependent modality versus dual-energy computed tomography (DECT) in the detection of chondrocalcinosis: with regard to Tanikawa et al.’s study. Journal of Orthopaedic Surgery and Research, 13(1), 255. https://doi.org/10.1186/s13018-018-0953-4
D'Oria, M., Girardi, L., Amgad, A., Sherif, M., Piffaretti, G., Ruaro, B., Calvagna, C., Dueppers, P., Lepidi, S., & Donadini, M. P. (2025). Expert-Based Narrative Review on Compression UltraSonography (CUS) for Diagnosis and Follow-Up of Deep Venous Thrombosis (DVT). Diagnostics (Basel), 15(1). https://doi.org/10.3390/diagnostics15010082
East, S. A., Wang, Y., Yanamala, N., Maganti, K., & Sengupta, P. P. (2025). Artificial Intelligence-Enabled Point-of-Care Echocardiography: Bringing Precision Imaging to the Bedside. Curr Atheroscler Rep, 27(1), 70. https://doi.org/10.1007/s11883-025-01316-9
Eini, P., Eini, P., Serpoush, H., Rezayee, M., & Tremblay, J. (2025). Machine learning-based classification of carotid plaques via ultrasound: a systematic review and meta-analysis of diagnostic performance. Int J Emerg Med, 18(1), 247. https://doi.org/10.1186/s12245-025-01065-1
Grosse, S. D., Nelson, R. E., Nyarko, K. A., Richardson, L. C., & Raskob, G. E. (2016). The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thrombosis Research, 137, 3–10. https://doi.org/https://doi.org/10.1016/j.thromres.2015.11.033
Haematology, T. L. (2015). Thromboembolism: an under appreciated cause of death. In (Vol. 2, pp. e393).
Johnson, G. G., Kirkpatrick, A. W., & Gillman, L. M. (2019). Ultrasound in the surgical ICU: uses, abuses, and pitfalls. Current Opinion in Critical Care, 25(6), 675–687.
Jørgensen, H., Horváth-Puhó, E., Laugesen, K., Braekkan, S. K., Hansen, J. B., & Sørensen, H. T. (2022). The Interaction Between Venous Thromboembolism and Socioeconomic Status on the Risk of Disability Pension. Clin Epidemiol, 14, 489–500. https://doi.org/10.2147/clep.S361840
Medicine, A. S. f. U. i. (2017). Minimum education & training requirements for ultrasound practitioners. Australas J Ultrasound Med, 20(3), 132–135. https://doi.org/10.1002/ajum.12061
Munro, R. (2021). Human-in-the-Loop Machine Learning: Active learning and annotation for human-centered AI. Manning.
Nothnagel, K., & Aslam, M. F. (2024). Evaluating the benefits of machine learning for diagnosing deep vein thrombosis compared with gold standard ultrasound: a feasibility study. BJGP Open, 8(4). https://doi.org/10.3399/bjgpo.2024.0057
Oppenheimer, J., Mandegaran, R., Staabs, F., Adler, A., Singöhl, S., Kainz, B., Heinrich, M., Geroulakos, G., Spiliopoulos, S., & Avgerinos, E. (2024). Remote Expert DVT Triaging of Novice-User Compression Sonography with AI-Guidance. Annals of Vascular Surgery, 99, 272–279. https://doi.org/https://doi.org/10.1016/j.avsg.2023.08.022
Peterman, N. J., Yeo, E., Kaptur, B., Smith, E. J., Christensen, A., Huang, E., & Rasheed, M. (2022). Analysis of Rural Disparities in Ultrasound Access. Cureus, 14(5), e25425. https://doi.org/10.7759/cureus.25425
Pomero, F., Dentali, F., Borretta, V., Bonzini, M., Melchio, R., Douketis, J. D., & Fenoglio, L. M. (2013). Accuracy of emergency physician–performed ultrasonography in the diagnosis of deep-vein thrombosis. Thrombosis and haemostasis, 109(01), 137–145.
Puttarak, K., Angchaisuksiri, P., & Boonyawat, K. (2025). Delayed diagnosis and treatment of deep vein thrombosis - an underrecognized factor for its related outcomes? Thromb J, 23(1), 85. https://doi.org/10.1186/s12959-025-00769-x
Speranza, G., Mischkewitz, S., Al-Noor, F., & Kainz, B. (2025). Value of clinical review for AI-guided deep vein thrombosis diagnosis with ultrasound imaging by non-expert operators. npj Digital Medicine, 8(1), 135. https://doi.org/10.1038/s41746-025-01518-0
Varrias, D., Palaiodimos, L., Balasubramanian, P., Barrera, C. A., Nauka, P., Melainis, A. A., Zamora, C., Zavras, P., Napolitano, M., Gulani, P., Ntaios, G., Faillace, R. T., & Galen, B. (2021). The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med, 10(17). https://doi.org/10.3390/jcm10173903
Visonà, A., Quere, I., Mazzolai, L., Amitrano, M., Lugli, M., Madaric, J., & Prandoni, P. (2021). Post-thrombotic syndrome. Vasa, 50(5), 331–340. https://doi.org/10.1024/0301-1526/a000946
Waheed, S. M., Kudaravalli, P., & Hotwagner, D. T. (2018). Deep vein thrombosis.
Wong, J., Montague, S., Wallace, P., Negishi, K., Liteplo, A., Ringrose, J., Dversdal, R., Buchanan, B., Desy, J., & Ma, I. W. (2020). Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. The Ultrasound Journal, 12(1), 19.
Yan, L., Li, Q., Fu, K., Zhou, X., & Zhang, K. (2025). Progress in the Application of Artificial Intelligence in Ultrasound-Assisted Medical Diagnosis. Bioengineering (Basel), 12(3). https://doi.org/10.3390/bioengineering12030288
Yoshida, T., Yoshida, T., Noma, H., Nomura, T., Suzuki, A., & Mihara, T. (2023). Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis. Critical care, 27(1), 1–11.
Zhou, A., Chen, K., Wei, Y., Ye, Q., Xiao, Y., Shi, R., Wang, J., & Li, W.-D. (2025). Machine learning-based prediction of carotid intima–media thickness progression: a three-year prospective cohort study [Original Research]. Frontiers in Medicine, Volume 12 - 2025. https://doi.org/10.3389/fmed.2025.1593662
Downloads
Published
How to Cite
Issue
Section
License
I (we) submit this article which is original and unpublished, of my (our) own authorship, to the evaluation of the Veredas do Direito Journal, and agree that the related copyrights will become exclusive property of the Journal, being prohibited any partial or total copy in any other part or other printed or online communication vehicle dissociated from the Veredas do Direito Journal, without the necessary and prior authorization that should be requested in writing to Editor in Chief. I (we) also declare that there is no conflict of interest between the articles theme, the author (s) and enterprises, institutions or individuals.
I (we) recognize that the Veredas do Direito Journal is licensed under a CREATIVE COMMONS LICENSE.
Licença Creative Commons Attribution 3.0
