Construct Validity and Reproducibility of Handheld Ultrasound Devices in Carotid Artery Diameter Measurement

Loes Willems*, Jenske Vermeulen, Anouk Wiegerinck, Stein Fekkes, Michel Reijnen, Michiel Warlé, Chris De Korte, Dick Thijssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The construct validity and reproducibility of three commonly used handheld ultrasound (US) devices in measuring carotid arterial diameter was evaluated: Telemed MicrUs EXT-1H (Telemed, Vilnius, Lithuania), Butterfly iQ (Butterfly Network, Inc., Guilford, CT, USA) and Philips Lumify (Philips Healthcare, Best, The Netherlands). An in vitro setup was built to evaluate construct validity, compared with high-end US, and intra-observer variability of handheld US devices. Handheld devices showed a mean difference of 0.023 ± 0.030 cm, 0.012 ± 0.037 cm and 0.009 ± 0.046 cm for, respectively, Telemed, Butterfly and Lumify in comparison with high-end US devices. Intraclass agreement with the high-end system as well as intra-observer variability for handheld US devices was classified as excellent, with all values greater than 0.95. Subsequently, inter-observer variability of handheld US devices was investigated in an in vivo setup with 20 healthy volunteers. Inter-observer variability was classified as excellent for Telemed (0.901), good for Lumify (0.827) and moderate for Butterfly (0.684) with a difference of, respectively, 0.005 ± 0.031 cm, 0.020 ± 0.050 cm and –0.003 ± 0.033 cm. In conclusion, handheld US devices demonstrated an excellent construct validity and intra-observer variability. Additionally, excellent-to-good inter-observer variability for Telemed and Lumify was observed, and Butterfly demonstrated a moderate inter-observer agreement. These results indicate that handheld US devices are effective for measuring carotid arterial diameter.

Original languageEnglish
Pages (from-to)866-874
Number of pages9
JournalUltrasound in medicine and biology
Issue number3
Publication statusPublished - Mar 2023


  • Carotid arteries
  • Diameter
  • Handheld ultrasound
  • Ultrasonography

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