Wireless versus cart-based ultrasound in musculoskeletal and superficial soft-tissue imaging: a prospective blinded cross-over study

Aim: Wireless ultrasound probes are increasingly used in point-of-care settings, but their performance in musculoskeletal and superficial soft-tissue imaging remains incompletely defined. This study compared image quality and clinical-pragmatic performance of a wireless ultrasound probe with a high-end cart-based ultrasound system. Methods: This prospective blinded cross-over study included 41 musculoskeletal or superficial soft-tissue anatomical regions examined in routine clinical practice. Each region was assessed with both the Mindray Resona I9 Elite Edition cart-based system and the Mindray TE-Air e5M wireless probe. Device order was randomized. Images were acquired by one experienced operator, anonymized, coded, and reviewed offline by an experienced reviewer blinded to device type. Image quality, anatomical margin definition, tissue contrast, speckle noise, diagnostic confidence, interpretability, diagnosis possibility, pathological finding detection, clinical decision sufficiency, and the need for further imaging were assessed. Results: The cart-based system showed superior image quality. Median global image quality was 5 versus 3, anatomical margin definition 5 versus 3 and tissue contrast 5 versus 4. Diagnostic confidence was higher with the cart-based system, 97.95 ± 5.32 versus 69.10 ± 16.05. Clinical-pragmatic endpoints showed a less pronounced reduction: examination interpretability was 97.6% versus 90.2%, diagnosis was considered possible in 73.2% versus 61.0%, and images were sufficient for clinical decision-making in 70.7% versus 58.5%. Conclusions: The wireless probe provided lower image quality and confidence but retained clinically useful performance in selected cases. It should be considered complementary rather than a substitute for high-end cart-based ultrasound.