Performance and development trends of ultrasound diagnostic systems in military settings: a review
Keywords:
Battlefield ultrasound, Point-of-care ultrasound (POCUS), Military medical systems, Military medicine, Combat casualty care, Artificial intelligence, Military telemedicine, Tactical medicineAbstract
With the evolving challenges of modern warfare, battlefield medical support systems are often required to enhance capabilities in rapid response, flexible deployment, and modular integration. Ultrasound diagnostic systems, appreciated for their portability and ability to provide real-time imaging without ionizing radiation, have been investigated for potential use in early injury screening and rapid assessment in combat and pre-hospital settings. This review provides an overview of representative battlefield-adapted ultrasound systems, such as the Sonosite M-Turbo, Edge II, and GE Vscan Extend, and discusses their reported limitations, including issues with deployment reliability, image quality, operational complexity, and telecommunication capability. Emerging technological directions are explored, including artificial intelligence-assisted diagnosis, multimodal integration, adaptation to extreme environments, and integration with unmanned platforms. Furthermore, a conceptual framework is proposed, focusing on areas such as research and development, standardization, deployment at combat nodes, and training infrastructure, which may contribute to future advancements. The goal is to provide insights that could guide the future development and strategic planning of next-generation tactical medical imaging systems.
References
1. Kulahin K, Nos I, Solonets O, Kvitkin K (2024) Implementation of the emerging and disruptive technologies as the key to technological superiority in modern warfare. МНЖ Military Sci 2(1):177–199
2. Wither JK (2023) Hybrid warfare revisited: abattle of ‘Buzzwords’. Connections: Q J 22(1):7–27
3. Preparing for the Future of Combat Casualty Care (2021) Opportunities to refine the military health system’s alignment with the National defense strategy. RAND Corporation
4. Nayak G, Bolla V, Balivada SK (2022) Technological evolution of ultrasound devices: a review. Int J Health Technol Innov 1(03):24–32
5. Alwagdani YM, Alshamrani MA, Felempan WH, Alsulami NK, Bali AS, Alyami HS et al (2024) Impact of portable Pre-Hospital ultrasound on patients’ outcomes: a narrative review. J Int Crisis Risk Communication Res 7(S8):1601
6. Gao X, Lv Q, Hou S (2023) Progress in the application of portable ultrasound combined with artificial intelligence in Pre-Hospital emergency and disaster sites. Diagnostics 13(21):3388
7. Anderson A, Theophanous RG (2024) Point-of-care ultrasound use in austere environments: a scoping review. PLoS ONE 19(12):e0312017
8. Savell SC, Baldwin DS, Blessing A, Medelllin KL, Savell CB, Maddry JK (2021) Military use of point of care ultrasound (POCUS). J Spec Oper Med 21(2):35–42
9. Blenkinsop G, Heller RA, Carter NJ, Burkett A, Ballard M, Tai N (2023) Remote ultrasound diagnostics disrupting traditional military frontline healthcare delivery. BMJ Mil Health 169(5):456–458
10. Goldberg BB, Gramiak R, Freimanis AK (1993) Early history of diagnostic ultrasound: the role of American radiologists. AJR Am J Roentgenol 160(1):189–194
11. Rozanski TA, Edmondson JM, Jones SB (2005) Ultrasonography in a forward-deployed military hospital. Mil Med 170(2):99–102
12. Brooks AJ, Price V, Simms M (2005) FAST on operational military deployment. Emerg Med J 22(4):263–265
13. Stamilio DM, McReynolds T, Endrizzi J, Lyons RC (2004) Diagnosis and treatment of a ruptured ectopic pregnancy in a combat support hospital during operation Iraqi freedom: case report and critique of a field-ready sonographic device. Mil Med 169(9):681–683
14. Ahern BJ, Monti JD, Naylor JF, Cronin AJ, Perreault MD (2020) U.S. Army combat medic eFAST performance with a novel versus conventional transducers: a randomized, crossover trial. Mil Med 185(Supplement1):19–24
15. FUJIFILM SonoSite (2025) Military medicine ultrasound. https://www.sonosite.com/specialties/military-medicine-ultrasound. Accessed June 13
16. Nations JA, Browning RF (2011) Battlefield applications for handheld ultrasound. Ultrasound Q 27(3):171–176
17. Hsieh A, Baker MB, Phalen JM, Mejias-Garcia J, Hsieh A, Hsieh A et al (2022) Handheld Point-of-Care ultrasound: safety considerations for creating guidelines. J Intensive Care Med 37(9):1146–1151
18. Salazar RF, Monti JD, Cronin AJ, Ahern BJ, Gendron BC, Perreault MD et al (2021) Combat medic eFAST with novel and conventional portable ultrasound devices: A Prospective, Randomized, crossover trial. Medical Journal, US Army Medical Center of Excellence (MEDCoE)
19. Gharahbaghian L, Anderson KL, Lobo V, Huang RW, Poffenberger CM, Nguyen PD (2017) Point-of-Care ultrasound in austere environments. Emerg Med Clin North Am 35(2):409–441
20. Hata R, Hart A, Tin D, Issa F, Ciottone G (2023) Terrorist attacks on Refugees, internally displaced Peoples, and asylum seekers. Prehosp Disaster Med 38(S1):S7
21. Hernandez-Torres SI, Bedolla C, Berard D, Snider EJ (2023) An extended focused assessment with sonography in trauma ultrasound tissue-mimicking Phantom for developing automated diagnostic technologies. Front Bioeng Biotechnol 11:1244616
22. Hile DC, Morgan AR, Laselle BT, Bothwell JD (2012) Is Point-of-Care ultrasound accurate and useful in the hands of military medical technicians? A review of the literature. Mil Med 177(8):983–987
23. Renard A, Martinet C, Cungi PJ, Combes E, Gasperini G, Cazes N et al (2019) Is E-FAST possible and useful on the battlefield? A feasibility study during medical courses in hostile environment (MEDICHOS): preliminary results. BMJ Military Health 165(5):338–341
24. Butterfly Network Inc Butterfly iQ + product specifications and white paper. https://www.butterflynetwork.com/iq. Accessed 30 June 2025
25. Graham RNJ (2012) Battlefield radiology. Br J Radiol 85(1018):1556–1565
26. Cirlan S, Marfin A, Dumitras V (2023) Risc management: the medical support system in contemporary armed conflict. One Health Risk Manage 4(4):13–18
27. FUJIFILM SonoSite M-Turbo ultrasound system: user guide (P07662-09 C). https://www.sonosite.com/support/userdocs/M-Turbo_UG_ENG_P07662-09C_e.pdf. Accessed 12 June 2025
28. FUJIFILM SonoSite M-Turbo ultrasound system: product brochure. https://www.sonosite.com/sites/default/files/M-Turbo_brochure_v14.pdf. Accessed 24 June 2025
29. FUJIFILM SonoSite Edge II ultrasound system: user guide (P20516-08B). https://www.sonosite.com/support/userdocs/EdgeII_UG_ENG_P20516-08B_e.pdf. Accessed 24 June 2025
30. SonoSolutions SonoSite Edge II review. https://sonosolutions.com/sonosite-edge-ii-review/. Accessed 24 June 2025
31. FUJIFILM Corporation (2025) SonoSite Edge II. https://www.fujifilm.com/br/en/healthcare/ultrasound/devices/edge2. Accessed 12 June
32. Vega R, Dehghan M, Nagdev A, Buchanan B, Kapur J, Jaremko JL et al (2025) Overcoming barriers in the use of artificial intelligence in point of care ultrasound. Npj Digit Med 8(1):213
33. GE Healthcare Vscan Extend user manual. https://www.gehealthcare.com/-/media/fdbbc3f456914f5dbc3cc44cb866ffb5.pdf. Accessed 17 June 2025
34. The Medical Futurist. Threshold of a new era in diagnostics: Philips Lumify portable ultrasound review. Published (2018) August https://medicalfuturist.com/threshold-of-a-new-era-in-diagnostics-philips-lumify-portable-ultrasound-review/. Accessed 12 June 2025
35. Van De Voort JC, Stark PW, Van Dongen TT, Van Der Borger BL, Hoencamp R (2025) Ultrasound guided arterial access for combat medics: a blinded proof-of-concept study using echogenic needles. J Vasc Access 26(3):1016–1023
36. Philips Healthcare (2023) https://www.documents.philips.com/doclib/enc/18539384/453561942121a_-_user_manual_t-chinese.pdf. Accessed 23 June 2025
37. Brown SA, Carius BM, Monti JD, Robeck RS, Fritz DK (2024) Combat medic-performed auscultation versus thoracic ultrasound image interpretation for pneumothorax detection: look or listen? Cureus 16(9):e68657
38. Kim S, Fischetti C, Guy M, Hsu E, Fox J, Young SD (2024) Artificial intelligence (AI) applications for point of care ultrasound (POCUS) in Low-Resource settings: a scoping review. Diagnostics 14(15):1669
39. Butterfly Network Inc. Butterfly iQ user manual: Rev AC, Published (2023) https://manual.butterflynetwork.com/butterfly-iq-user-manual_rev-ac-en.pdf. Accessed 23 June 2025
40. FUJIFILM SonoSite SonoSite M-Turbo. https://www.sonositeinstitute.com/cn/product/sonosite-m-turbo. Accessed 17 June 2025
41. Philips Lumify C5-2 curved array transducer. https://www.philips.com.sg/healthcare/product/HC989605450382/lumify-c5-2-curved-array-transducer. Accessed 18 June 2025
42. Razom for Ukraine Hospitals aid. https://www.razomforukraine.org/category/current-emergency-response/hospitals-aid/. Accessed 18 June 2025
43. Cazes N, Desmots F, Geffroy Y, Renard A, Leyral J, Chaumoître K (2013) Emergency ultrasound: a prospective study on sufficient adequate training for military Doctors. Diagn Interv Imaging 94(11):1109–1115
44. Perrier P, Leyral J, Thabouillot O, Papeix D, Comat G, Renard A, Cazes N (2020) Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents. BMJ Mil Health 166(4):236–239
45. Dubecq C, Dubourg O, Morand G, Montagnon R, Travers S, Mahe P (2021) Point-of-care ultrasound for treatment and triage in austere military environments. J Trauma Acute Care Surg 91(2S Suppl 2):S124–S129
46. Beck-Razi N, Fischer D, Michaelson M, Engel A, Gaitini D (2007) The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war. J Ultrasound Med 26(9):1149–1156
47. Zhao J, Zhou Y, Wang J, Zhang C, Cai Z (2022) Portable ultrasonography onboard deployment in the PLA(N) peace Ark hospital ship in mission harmony 2018. Disaster Med Public Health Prep 16(2):835–839
48. Sullivan JF, do Brasil M, Roman JW, Milder EA, Carter E, Lennon RP (eds) (2021) Utility of Point of Care Ultrasound in Humanitarian Assistance Missions. Mil Med. ;186(Suppl 1):789–794
49. Shorter M, Macias DJ (2012) Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehosp Disaster Med 27(2):172–177
50. Aziz S, Edmunds CT, Barratt J (2024) Implementation of a point-of-care ultrasound archiving system and governance framework in a UK physician-paramedic staffed helicopter emergency medical service. Scand J Trauma Resusc Emerg Med 32(1):49
51. Garrone M Prehospital ultrasound as the evolution of the Franco-German model of prehospital EMS. Crit Ultrasound J, (2011) ;3(3):141–147
52. Wydo SM, Seamon MJ, Melanson SW, Thomas P, Bahner DP, Stawicki SP (2016) Portable ultrasound in disaster triage: a focused review. Eur J Trauma Emerg Surg 42(2):151–159
53. Gao B, Han J, Shao Q, Wang Y (2020) Investigative analysis of training injuries in the crew undergoing escort mission in Gulf of aden. Chin J Nautical Med Hyperbaric Med 27(2):172–174
54. Feletti F, Mucci V, Aliverti A (2018) Chest ultrasonography in modern day extreme settings: from military setting and natural disasters to space flights and extreme sports. Can Respir J 2018(1):8739704
55. Heiner JD, Chin EJ Use of ultrasound in war zones. In: Critical Care Ultrasound. Expert Consult Site. ClinicalGate. https://clinicalgate.com/use-of-ultrasound-in-war-zones/. Accessed 23 June 2025
56. Howard JT, Kotwal RS, Santos-Lazada AR, Martin MJ, Stockinger ZT (2018) Reexamination of a battlefield trauma golden hour policy. J Trauma Acute Care Surg 84(1):11–18
57. Nelson BP, Melnick ER, Li J (2011) Portable ultrasound for remote environments, part I: feasibility of field deployment. J Emerg Med 40(2):190–197
58. Shi R, Rosario J (2023) Paramedic-Performed prehospital Tele-Ultrasound: a powerful technology or an impractical endeavor? A scoping review. Prehosp Disaster Med 38(5):645–653
59. Breunig M, Hanson A, Huckabee M (2023) Learning curves for point-of-care ultrasound image acquisition for novice learners in a longitudinal curriculum. Ultrasound J 15(1):31
60. Milletari F, Birodkar V, Sofka M (2019) Straight to the point: reinforcement learning for user guidance in ultrasound. In: Smart Ultrasound Imaging and Perinatal, Preterm and Paediatric Image Analysis: In: Proceedings of the first international workshop susi 2019 and the 4th international workshop PIPPI 2019; October 13 and 17, 2019; Shenzhen, China. Vol 4. Springer International Publishing, pp 3–10
61. Baugher KM, Euerle BD, Sommerkamp SK, Witting MD (2014) Image quality evaluation of a portable handheld ultrasound machine for the focused assessment with sonography for trauma examination. Am J Emerg Med 32(4):389–391
62. Merkel D, Züllich TF, Schneider C, Yousefzada M, Beer D, Ludwig M et al (2023) Prospective comparison of handheld ultrasound devices from different manufacturers with respect to B-Scan quality and clinical significance for various abdominal sonography questions. Diagnostics 13(24):3622
63. Lucas VS, Burk RS, Creehan S, Grap MJ (2014) Utility of high-frequency ultrasound: moving beyond the surface to detect changes in skin integrity. Plast Surg Nurs 34(1):34–38
64. Souppaya M, Scarfone K (2025) Guidelines for Securing Wireless Local Area Networks (WLANs), NIST Special Publication 800 -53; February 2012.https://nvlpubs.nist.gov/nistpubs/Legacy/SP/nistspecialpublication800-153.pdf. Accessed 11 Sept
65. Oeselg V, Šalaševičius R, Ploom H, Palm A, Kuusik A, Lawrence T, Peeters K (2025) Military movement: risks from 5G networks. NATO Cooperative Cyber Defence Centre of Excellence. Published June 2022. https://ccdcoe.org/uploads/2022/06/Report_Military-Movement-Risks-from-5G-Networks.pdf. Accessed 11 Sept 2025
66. Rosser JC, Bell RL, Harnett B, Rodas E, Murayama M, Merrell R (1999) Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications. J Am Coll Surg 189(4):397–404
67. Cermack M (2006) Monitoring and telemedicine support in remote environments and in human space flight. Br J Anaesth 97(1):107–114
68. Stawicki SP (2010) Portable ultrasonography in mass casualty incidents: the CAVEAT examination. World J Orthop 1(1):10
69. Liu S, Wang Y, Yang X, Lei B, Liu L, Li SX et al (2019) Deep learning in medical ultrasound analysis: a review. Engineering 5(2):261–275
70. Fiedler HC, Prager R, Smith D, Wu D, Dave C, Tschirhart J et al (2024) Automated real-time detection of lung sliding using artificial intelligence. Chest 166(2):362–370
71. Levy BE, Castle JT, Virodov A, Wilt WS, Bumgardner C, Brim T et al (2023) Artificial intelligence evaluation of focused assessment with sonography in trauma. J Trauma Acute Care Surg 95(5):706–712
72. Dias D, Paulo Silva Cunha J (2018) Wearable health devices—vital sign monitoring, systems and technologies. Sensors 18(8):2414
73. Spicher N, Klingenberg A, Purrucker V, Deserno TM (2021) Edge computing in 5G cellular networks for real-time analysis of electrocardiography recorded with wearable textile sensors. In: 2021 43rd annual international conference of the IEEE engineering in medicine & biology society (EMBC). IEEE, pp 1735–1739
74. Speicher D, Grün T, Weber S, Hewener H, Klesy S, Schabo R et al (2025) Wearable 256-element MUX-based linear array transducer for monitoring of deep abdominal muscles. Appl Sci 15(7):3600
75. Russell TC, Crawford PF (2013) Ultrasound in the austere environment: a review of the history, indications, and specifications. Mil Med 178(1):21–28
76. Perez-Sanchez A, Johnson G, Pucks N, Soni RN, Lund TJS, Andrade AJ et al (2024) Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: a cross-sectional study. Ultrasound J 16(1):45
77. Shadvar S, Rahman A (2024) Performance evaluation of off-grid solar systems for critical medical instruments in remote regions. J Emerg Sci Eng 2(2):e22
78. Sohail A, Ali A, Shaukat H, Bhatti FM, Ali S, Kouritem SA et al (2024) Integrating self-powered medical devices with advanced energy harvesting: a review. Energy Strategy Reviews 52:101328
79. Peterson PG, Pak SK, Nguyen B, Jacobs G, Folio L (2012) Extreme compression for extreme conditions: pilot study to identify optimal compression of CT images using MPEG-4 video compression. J Digit Imaging 25(6):764–770
80. Votel JL, Cleveland CT, Connett CT, Irwin W (2016) Unconventional warfare in the Gray zone. Joint Forces Q 80(1):101–109
81. Talley MJ, Gurney JM, Pamplin JC, Polk TM, Rosser SL, Schmidt PM et al (2024) Automating the survival chain and revolutionizing combat casualty care: human-technology teaming on the future battlefield. Military Rev 188:994–1003
82. Butterfly Network (2020) https://www.butterflynetwork.com/press-releases/butterfly-network-announces-the-worlds-first-augmented-reality-telemedicine-technology. Accessed 23 May 2025
83. Radin A, Holynska K, Tretter C, Van Bibber T (2025) Lessons from the war in Ukraine for space: challenges and opportunities for future conflicts. RAND Corporation; https://www.rand.org/pubs/research_reports/RRA2950-1.html. Accessed 2 July 2025
84. Reuters (2025) Ukraine says Starlink’s global outage hit its military communications. Published July 25. https://www.reuters.com/business/media-telecom/ukraine-says-starlinks-global-outage-hit-its-military-communications-2025-07-25/?utm_source=chatgpt.com. Accessed 13 Sept 2025
85. National Institute of Standards and Technology (NIST) (2021) https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-121r2.pdf?utm_source=Securitylab.ru. Accessed 13 Sept 2025
86. National Institute of Standards and Technology (NIST) (2020) https://nvlpubs.nist.gov/nistpubs/specialpublications/NIST.SP.800-207.pdf?utm_source=chatgpt.com. Accessed 13 Sept 2025
87. U.S. Department of Defense. 5G telemedicine trade article. Published (2020) https://media.defense.gov/2021/Apr/28/2002629569/-1/-1/1/5G%20TELEMEDICINE%20TRADE%20ARTICLE%2012-10-20.PDF?utm_source=chatgpt.com. Accessed 13 Sept 2025
88. TrellisWare Technologies, Waveform Datasheet TSM. Published 2023. https://www.trellisware.com/wp-content/uploads/2023/09/TSM-Waveform-Datasheet.pdf?utm_source=chatgpt.com. Accessed 13 Sept 2025
89. DICOM Standards Committee (2025) https://www.dicomstandard.org/using/dicomweb?utm_source=chatgpt.com. Accessed 13 Sept 2025
90. HL7 International. FHIR R4 (2025) https://hl7.org/fhir/R4/?utm_source=chatgpt.com. Accessed 13 Sept 2025
91. Monfaredi R, Wilson E, Koutenaei BA, LaBrecque B, LeRoy K, Goldie J et al (2015) Robot-assisted ultrasound imaging: overview and development of a parallel telerobotic system. Minim Invasive Therapy Allied Technol 24(1):54–62
92. Ye R, Zhou X, Shao F, Xiong L, Hong J, Huang H et al (2021) Feasibility of a 5G-based robot-assisted remote ultrasound system for cardiopulmonary assessment of patients with coronavirus disease 2019. Chest 159(1):270–281
93. Pamplin JC, Remondelli MH, Thota D, Trapier J, Davis WT, Fisher N et al (2025) Revolutionizing combat casualty care: the power of digital twins in optimizing casualty care through passive data collection. Mil Med 190(1–2):27–32
94. Topol EJ (2019) High-performance medicine: the convergence of human and artificial intelligence. Nat Med 25(1):44–56
95. Shrestha B. Enhancing joint medical training and interoperability: a path toward integrated care across NATO and U.S. forces. Pulse of Army Medicine. Published 2024 November 22. https://www.lineofdeparture.army.mil/Journals/Pulse-of-Army-Medicine/Archive/November-2024-Issue/Enhancing-Joint-Care/. Accessed 23 June 2025
96. U.S. Army (2024) https://www.army.mil/article/277437/army_tests_capability_of_portable_ultrasound_devices. Accessed 23 May 2025
97. NATO AMedP-9.1: modular approach multinational MTF STANAG. No date. https://tccc.org.ua/en/guide/amedp-91-modular-approach-multinational-mtf-stanag. Accessed 23 May 2025
98. DARPA (2021) https://www.darpa.mil/news/2021/point-care-ultrasound. Accessed 23 May 2025
99. Army US (2024) Automating the survival chain and revolutionizing combat casualty care. Military Review. Published. https://www.armyupress.army.mil/Journals/Military-Review/English-Edition-Archives/May-June-2024/MJ-24-Combat-Casualty-Care/. Accessed 23 May 2025
100. Wikipedia Standardization agreement (STANAG). No date. https://en.wikipedia.org/wiki/Standardization_agreement. Accessed 23 May 2025
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Chang Lu, He-Jing Huang (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.






