Comparison of image quality in healthy dogs across 3 handheld ultrasound devices: Butterfly IQ+, Clarius C7HD3VET, and VScan Air.

Comparison of image quality in healthy dogs across 3 handheld ultrasound devices: Butterfly IQ+, Clarius C7HD3VET, and VScan Air - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Can Vet J . 2026 Mar 1;67(3):318–327. Show available content in en fr Comparison of image quality in healthy dogs across 3 handheld ultrasound devices: Butterfly IQ+, Clarius C7HD3VET, and VScan Air Seth T Colby 1, ✉ , Daniel Pang 1 , Serge Chalhoub 1 , Amy Larkin 1 , Soren Boysen 1 Author information Article notes Copyright and License information 1 Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta (Colby, Pang, Chalhoub, Boysen); VetCT, Toronto, Ontario (Larkin). ✉ Address all correspondence to Seth T. Colby; email: sethcolby@hotmail.ca . ✉ Corresponding author. Collection date 2026 Mar. Copyright and/or publishing rights held by the Canadian Veterinary Medical Association PMC Copyright notice PMCID: PMC12990006  PMID: 41847500 Abstract Objective, animals, and procedure Handheld ultrasound devices (HUDs), a cost-effective alternative to cart-based ultrasound in humans, are not well studied in veterinary medicine. Twelve healthy dogs underwent point-of-care ultrasound (POCUS) examinations [abdomen, pleural space and lung (PLUS), cardiovascular] using 3 HUDs. Twelve views were recorded (6 abdominal, 2 PLUS, and 4 cardiovascular) and retrospectively assessed by 2 expert reviewers (1 for thoracic and 1 for abdominal) who were blinded to the HUD used. Reviewers assessed overall image quality (Likert scale) and ability to answer clinically relevant POCUS binary choice questions. Results Image quality varied among HUDs for lung sliding ( P = 0.001), curtain signs ( P = 0.032), cardiac subxiphoid ( P = 0.002), stomach ( P < 0.001), short- and long-axis kidney views, gallbladder ( P = 0.003), and caudal vena cava ( P = 0.002). There were no differences among devices in answering key POCUS questions: subxiphoid heart ( P = 0.332), stomach ( P = 0.294), short-axis kidney ( P = 0.308), caudal vena cava ( P = 0.037 for group comparison; IQ versus VScan: P = 0.214, IQ versus Clarius: P = 0.03, VScan versus Clarius: P = 0.584), 4-chamber heart ( P = 0.092), 5-chamber heart, long-axis kidney, mushroom, gallbladder, PLUS, and left atrium to aortic ratio ( P > 0.999). Conclusion and clinical relevance Results of the current study suggest that, although image quality varied among HUDs, all 3 HUDs answered key abdominal, PLUS, and cardiac POCUS questions. INTRODUCTION Point-of-care ultrasound (POCUS) is a commonly used diagnostic tool in veterinary medicine ( 1 , 2 ). The goal of POCUS is to rapidly answer specific clinical questions through focused, rather than comprehensive, examinations of the abdomen, pleural space and lung (PLUS), and cardiovascular system ( 3 ). There are numerous ultrasonographic modes used in POCUS, including B-mode, M-mode, and color Doppler. B-mode (“brightness”) ultrasound is most often used in POCUS and is the standard, 2-dimensional view. M-mode (“motion”) and color Doppler may be used in combination with B-mode ultrasound to gather additional information, such as blood flow with Doppler or certain PLUS examinations with M-mode ( e.g. , lung pulse assessment). Other ultrasound modes, such as A-mode, have been described but have little utility in POCUS ( 2 ). Historically, POCUS was most often done using portable ultrasound machines ( 4 ). Recently, handheld ultrasound devices (HUDs) have been used as an ultra-portable and cost-effective alternative to cart-based models ( 5 ). In human medicine, some studies suggest that HUDs have image quality similar to that of portable ultrasound ( 6 , 7 ). However, other studies suggest HUDs have inferior image quality compared to portable ultrasound, depending on structures of interest, but can still provide diagnostic images ( 8 – 10 ). By contrast, few studies have directly compared image quality across various HUDs ( 4 , 11 , 12 ). Some human studies suggest differences in overall image quality exist between HUD devices ( 4 ). In addition, there is considerable variation among commercially available HUDs regarding viewing angle, scan depth, frequency range, and transducer types. In animals, further challenges in obtaining ultrasound images exist due to noncompliant patients; long or dense hair coats; and animal species, size, patient positioning, and anatomical differences. Given these challenges, there may be greater differences in the abilities of HUDs to produce diagnostic images in animals. The aim of this study was to compare the image quality of 3 HUDs used in veterinary medicine: Butterfly IQ+ (IQ), Clarius C7HD3Vet (Clarius), and VScan Air (VScan). From a search of the literature, the 3 devices listed have never been directly compared. It was hypothesized that these 3 HUDs have different image quality. However, each would produce an image that could be interpreted to answer key clinically driven POCUS questions regarding the thorax and abdomen. MATERIALS AND METHODS Handheld ultrasound device specifications All HUDs were connected to a tablet computer (4th generation Apple iPad Air; Apple, Cupertino, California, USA). The Butterfly IQ+ Vet (Butterfly Network, Burlington, Massachusetts, USA) was connected via a USB-C cable. The Clarius C7HD3VET (Clarius Mobile Health, Vancouver, British Columbia) and VScan Air (General Electric Company, Horten, Norway) were both connected via local wireless network. In all cases, interface with the tablet was through HUD-specific applications. Although the VScan has curved and linear array transducers available on the same HUD, only the curved array transducer option and settings were used for all 3 HUDs. Study design and setting A prospective, randomized, blinded crossover study was conducted at the University of Calgary Faculty of Veterinary Medicine (Calgary, Alberta). Data were collected on a single day by a Board-certified veterinary radiologist (A.L.). Cineloops of 12 standardized thoracic and abdominal POCUS views were collected with each HUD. Cineloops were exported and saved via the individual HUD software’s default settings. The IQ and VScan cineloops were saved as MPEG-4 format; Clarius cineloops were saved as AVI movie format. Animals A convenience sample of 13 dogs, presumed healthy based on physical examination and history, was recruited from among student- and faculty-owned animals following ethics review and approval of the study protocol (AC23-0056). Owners provided written informed consent for the study. Data from 1 dog were used as a pilot for assessment of optimal HUD and dog positioning, standardization of cineloops across the HUDs, and familiarization with HUD recording software. Pilot data were not included in the analyzed data. The remaining 12 dogs were included in the study (2 females, 10 males; all neutered). Dogs were categorized as having long hair (fur needing to be parted before ultrasound) or short hair (fur not needing to be parted). Study protocol Each of the 12 dogs underwent 3 POCUS examinations, 1 with each HUD. The order of HUD use was randomized via online random number-generation software (RANDOM. ORG; Randomness and Integrity Services, Dublin, Ireland). Each examination included 4 ultrasound windows with a total of 12 views recorded. The POCUS windows and normal sonoanatomy visualized included the following: i) Right transthoracic window midway up the thorax, caudal to the front limb, to identify the “bat sign” and lung sliding. The right transthoracic window midway up the thorax, over the caudolateral margin of the lung, to assess the abdominal curtain sign ( 13 , 14 ). ii) Right parasternal short axis cardiac window to identify the left atrium to aortic ratio (LA:Ao) and left ventricular papillary muscle views. The right parasternal long axis cardiac window to identify the 4- and 5-chamber views ( 3 ). iii) Abdominal subxiphoid window to obtain views of the heart, caudal vena cava (CVC) ( 15 ), stomach, and gallbladder. iv) Abdominal left paralumbar window to identify long- and short-axis kidney views at the level of the renal pelvis ( 2 ). Dogs were scanned in 2 positions: i) standing, to assess the right transthoracic, abdominal subxiphoid, and left paralumbar windows; and ii) right lateral recumbency, to assess right parasternal cardiac windows. Dogs were manually restrained to minimize movement artifact during scanning. Acoustic conductive media (ultrasound transmission gel and isopropyl alcohol) were applied to each scan location. Probe location was standardized based on common sites used in canine thoracic and abdominal POCUS ( 2 ). For the purpose of our study, thoracic POCUS included PLUS and cardiovascular views. Matching HUD presets were chosen for each device, based on the structure of interest: i) right transthoracic windows, lung preset; ii) right parasternal cardiac windows, cardiac preset; iii) abdominal subxiphoid and paralumbar windows, abdominal preset. Gain and depth adjustments to optimize image quality were made at the discretion of the radiologist. For each dog, the first HUD used provided baseline depth settings, which were then held constant for the 2 subsequent HUDs. All POCUS studies were conducted using B-mode. Once each target image was obtained, 6- to 10-second cineloops were recorded (based on HUD software capability) and stored using each HUD’s software. Image review Collected cineloops were divided into 2 groups: thoracic and abdominal. Cineloops were randomized for each dog and HUD via random number generation, then imported into software (Microsoft PowerPoint, Microsoft 365; Microsoft Corporation, Redmond, Washington, USA) for viewing and anonymized by removing HUD identifiers ( e.g. , image indicator symbol, depth indicator). In each case, the size of the structure of interest was increased using the viewing software. All cineloops > 6 s were cropped to 6 s, prioritizing the video segment that best imaged the structure of interest. The individual doing the cineloop edits (S.T.C.) was blinded to the HUD used following anonymization. Cineloops were first presented individually (1 per slide), and then as a series of slides with all 3 HUD cineloops positioned side by side (in random order) to facilitate image quality comparison ( Figure 1 ). Previously anonymized cineloops were labeled 1 to 12 and A to C, based on the dog and HUD used, respectively, with cineloops set to play on loop. Cineloops were sent to 2 reviewers with expertise in POCUS: 1 reviewer for the thoracic images (S.B.), who has > 20 y of veterinary POCUS experience and is Board-certified in veterinary emergency and critical care; and 1 for the abdominal images (S.C.), who has > 20 y of experience in abdominal ultrasound and > 10 y of experience in veterinary POCUS and is Board-certified in veterinary internal medicine (small animal). Both reviewers were blinded to the HUD used to collect each cineloop and the dog being scanned. FIGURE 1. Open in a new tab Still images, captured from cineloops, of the anonymized gallbladder side-by-side review. The number “10” represents the dog and the letters “A,” “B,” and “C” represent the handheld ultrasound device used (VScan, Clarius, and IQ, respectively). Reviewers were given the following 2 criteria for assessing data: i) A set of 4 to 9 binary (yes/no) POCUS questions related to the sonoanatomy of interest ( Table S1 , available online from: Supplementary Materials ). After review, 1 POCUS question from each sonoanatomical structure was selected to be the most clinically relevant based on ultrasound expertise and clinical practice experiences ( Table 1 ). A positive response to the binary POCUS questions was determined to be a “yes,” meaning the question posed could be answered based on the image acquired. Data analyzed and ability to answer POCUS questions were based on the total number of positive responses for each HUD at a given window. ii) A 5-point Likert scale to assess the overall image quality (1, uninterpretable; 2, poor; 3, fair; 4, good; 5, excellent). TABLE 1. Key binary point-of-care ultrasound (POCUS) questions asked for each site within the thoracic [cardiovascular, pleural space and lung (PLUS)] and abdominal windows. Visualized POCUS structure Key binary POCUS question asked 4-chamber heart Is the image of sufficient quality to determine if right-sided heart failure is present? 5-chamber heart Is the image of sufficient quality to assess the left ventricular outflow tract? Left atrium to aortic ratio (LA:Ao) Is the image of sufficient quality to determine left atrial enlargement? Mushroom Can volume status and contractility be assessed from these images? Lung sliding Is the image of sufficient quality throughout the entire field of view to assess lung sliding? Abdominal curtain Is the interface between the thorax and abdomen clearly distinguishable and fully visualized? Subxiphoid heart Is the image of sufficient quality to rule out pericardial effusion? Caudal vena cava Is the image of sufficient quality to assess caudal vena cava intravascular volume? Stomach Is the image of sufficient quality to assess gastrointestinal motility? Gallbladder Is the image of sufficient quality to assess the presence of gallbladder wall edema? Short- and long-axis kidney Is the image of sufficient quality to assess for the presence of free fluid? Open in a new tab For the purposes of the present study, image quality was defined and assessed based on the following criteria: contrast, defined by the American National Standards Institute as “the absolute difference in luminance between the peak white and black levels, where white and black luminance is displayed simultaneously;” image brightness, in which brightness was considered as normal, too-bright, or too-dark; graininess, as determined by the noise ratio or signal-to-noise ratio subjectively assessed by “speckling” within the image; and resolution, dictated by the sharpness and detail, primarily determined by the number of visible pixels. In addition, a second 5-point Likert scale was used to assess lung sliding presence and quality across the entire field of view (1, unable to assess lung sliding; 2, partially visible with poor shimmer; 3, easily visible but partially present across the pleural line; 4, easily visible across most of the pleural line; 5, shimmer easily visible along the entire pleural line). This second Likert scale was primarily used to assess overall image quality of lung sliding, given the clinical importance of lung sliding assessment across the entire pleural line, along with the inherent differences of lung sliding as a strictly dynamic observation. Although the first Likert scale was reported ( Table S2 , available online from: Supplementary Materials ), this was not used for direct image quality interpretation. Statistical analysis A sample size of 9 dogs was estimated, using a 2-tailed parametric approach, from predicted values for median image quality, to identify a difference in Likert scale score of 1 (scale range: 1 to 5) between the IQ (median) (3.17) and VScan (4.33) with α = 0.05 and 80% power. To account for data being treated as nonparametric, the sample size estimate was increased by 30%, resulting in a sample size target of 12 dogs. Image quality predictions and median values were based on the current human literature ( 4 ). Binary-choice POCUS questions were assessed using a 2-step process. First, a X 2 -square test was done for a group-level evaluation (3 HUDs). If the resultant P -value was < 0.05, then differences between pairs of HUDs were evaluated using a Yates continuity corrected X 2 -square test. Similarly, for evaluating the most clinically relevant POCUS question(s) for a given abdominal or thoracic window, a 2-step process was followed: a Fisher exact test for group-level evaluation, followed by a Yates continuity corrected X 2 -square test if the group-level result was significant. P -values from HUD pair comparisons were considered significant if < 0.017, to correct for multiple comparisons. Likert scale data were compared across the 3 HUDs for each structure of interest using a Friedman test, followed by the Dunn multiple comparison test when Friedman test results were significant. P -values < 0.05 were considered significant. Statistical analysis was done using commercial software (GraphPad Prism 10; GraphPad Software, Boston, Massachusetts, USA). RESULTS A total of 432 cineloops were collected for review. Demographic data for dogs were as follows: median age = 6.5 y (range: 1.5 to 14 y), median body mass = 22.3 kg (range: 7.9 to 42 kg), median body condition score = 5.5/9 (range: 3 to 7/9). Fur length was distributed as follows: short ( n = 5) and long ( n = 7). Breeds included were Australian cattle dog ( n = 1), beagle ( n = 1), French bulldog ( n = 1), German shepherd ( n = 3), Jack Russel terrier ( n = 2), and mixed breed ( n = 4). When comparing overall image quality for thoracic windows, the Clarius scored better than the VScan for lung sliding and abdominal curtain signs ( Figure 2 ; Table S2 , available online from: Supplementary Materials ). For lung sliding, IQ versus Clarius: P = 0.554 and IQ versus VScan: P = 0.074. For abdominal curtain, IQ versus Clarius: P = 0.124 and IQ versus VScan: P > 0.999. In contrast, other comparisons between HUDs for thoracic window views did not reveal significant differences ( Table S2 , available online from: Supplementary Materials ). There were no overall statistical differences for the cardiac views, so comparisons between individual HUDs were not made ( Table S2 , available online from: Supplementary Materials ). P-values were as follows: 4-chamber view: P = 0.460, 5-chamber view: P = 0.837, mushroom view: P = 0.206, and LA:Ao: P = 0.607. FIGURE 2. Open in a new tab Box and whisker plots of overall image quality ratings with each handheld ultrasound device (VScan, Clarius, IQ) for sonoanatomy of the lung sliding (A) and abdominal curtain signs (B). On each plot, middle line is median, box limits are interquartile range, and whiskers are full range. For abdominal sonoanatomy, the IQ produced 2 uninterpretable images (Likert score: 1), 1 CVC view, and 1 gallbladder view. The other HUDs had no uninterpretable images. The Clarius scored better on overall image quality than both the IQ and VScan for the cardiac subxiphoid view, and better on overall image quality than both the IQ and VScan for image quality of the stomach view ( Figure 3 ; Table S2 , available online from: Supplementary Materials ). Compared to the IQ, the Clarius scored better for the CVC, gallbladder, stomach, and kidney long- and short-axis views ( Figure 3 ). Otherwise, there were no statistical differences between HUDs for the remaining abdominal views ( Figure 3 ). FIGURE 3. Open in a new tab Box and whisker plots of overall image quality ratings with each handheld ultrasound device (VScan, Clarius, IQ) for cardiac subxiphoid (A), caudal vena cava (B), gallbladder (C), stomach (D), long-axis kidney (E), and short-axis kidney (F) abdominal views. On each plot, middle line is median, box limits are interquartile range, and whiskers are full range. There was no observed difference in reviewers’ interpretation to positively answer clinical POCUS questions for the cardiac and transthoracic PLUS views when all posed POCUS questions were collectively analyzed between the VScan and Clarius or VScan and IQ ( Table S3 , available online from: Supplementary Materials ). However, the Clarius provided more positive responses when compared to the IQ ( Figure 4 A ). When looking at each transthoracic PLUS and cardiac view individually, the only sonoanatomical finding with an observed difference between HUDs was the 4-chamber cardiac view, in which the VScan and Clarius both resulted in more positive responses than the IQ ( P < 0.001, P = 0.002, respectively) ( Table S3 , available online from: Supplementary Materials ). When analyzing the POCUS question(s) of each view within the cardiac and PLUS windows, there were no observed differences among any of the HUDs ( Table S3 , available online from: Supplementary Materials ). Regarding the remaining views, the 5-chamber heart, LA:Ao, mushroom, and abdominal curtain did not meet the threshold for significance for the X 2 -square test; therefore, Yates corrections were not done ( Table S3 , available online from: Supplementary Materials ). FIGURE 4. Open in a new tab Total binary point-of-care ultrasound questions for all 6 thoracic views, which include the cardiac (A) and abdominal (B) views visualized with each of the 3 handheld ultrasound devices (IQ, VScan, Clarius). Black bars represent positive (“Yes”) responses to binary questions and white bars represent negative (“No”) responses. For total binary POCUS questions of the abdomen, the Clarius provided more frequent positive responses than both the VScan and the IQ ( Figure 4 B ). The VScan provided more positive responses than the IQ ( Figure 4 B ). Similarly, for the 6 individual abdominal views, the Clarius gave more positive responses than the IQ ( P = 0.006 for the long-axis kidney and P < 0.001 for the 5 other abdominal views; Table S3 , available online from: Supplementary Materials ). The Clarius provided more positive responses than the VScan for the cardiac subxiphoid ( P < 0.001), stomach ( P < 0.001), and short- ( P = 0.003) and long-axis ( P = 0.015) kidney views, with no differences for the CVC or gallbladder ( Table S3 , available online from: Supplementary Materials ). The VScan had more positive responses than the IQ for the CVC ( P < 0.001) and gallbladder ( P = 0.009) views, with no differences for the other 4 abdominal views: heart, stomach, long-axis kidney, and short-axis kidney ( Table S3 , available online from: Supplementary Materials ). When comparing the most clinically relevant POCUS question for a given thoracic or abdominal window, there was no difference in the reviewers’ interpretations to positively answer with each HUD ( Table S3 , available online from: Supplementary Materials ). DISCUSSION Our study focused on assessment of overall image quality produced by 3 commercially available HUDs — the Butterfly IQ+, Clarius C7HD3Vet, and VScan Air — along with their abilities to positively answer a key, clinically relevant POCUS question in dogs. Although many additional POCUS questions regarding normal sonoanatomy were recorded for each HUD, the purpose of these questions was to further guide the reviewer’s interpretation of each cineloop and standardize features on which to focus ( Table S1 , available online from: Supplementary Materials ). These additional questions were not considered critical to assess the most common clinically asked POCUS questions at each site, but rather a tool to distinguish image quality differences among HUDs. In general, the Clarius provided the most consistently high image quality scores for PLUS and abdominal windows, with most cineloops providing a fair to excellent image quality according to reviewers ( Figures 2 , 3 ). The IQ tended to score lower when compared to the VScan and Clarius within the abdominal windows, in addition to providing 2 uninterpretable images. Regarding the IQ scoring lower than the Clarius and VScan, similar findings have been detailed in human pediatric POCUS. However, contrary to results of our study, the VScan scored higher than the Clarius ( 16 ). The causes of uninterpretable images for a given HUD, window, and dog may have been many, ranging from HUD ergonomics, HUD type, and footprint size to dog compliance during the serial ultrasound examinations, fur coat length/density, and patient size differences. Although occasional uninterpretable images occurred using the IQ within the abdomen, the IQ still provided images of a diagnostic quality, based on assessment of their ability to answer common, clinically driven POCUS questions. Based on our data, no single HUD outperformed the others in image quality across all assessed views (cardiovascular, PLUS, abdominal), though image quality varied among HUDs and the windows assessed. Other studies reported similar findings for a range of HUDs used in human medicine ( 4 , 8 – 10 ). Similarly, although there were differences between the total positive binary POCUS questions answered across all windows for each HUD ( Figure 4 ), there was no difference in HUD ability to answer key POCUS questions at each window. In POCUS, adequate use of acoustic coupling media is imperative, as lack of contact between the HUD transducer and skin can directly affect the acoustic interface and resulting image quality. To obtain the greatest contact between HUD and skin, acoustic conductive gel and 70% isopropyl alcohol were used concurrently, as coupling media. Notably, the use of alcohol may be contraindicated, such as when there exists the possibility of performing electrical defibrillation. Examining the effect of coupling media on image quality was outside the scope of this study but is worthy of investigation. Multiple studies have investigated alternative and homemade coupling agents that can provide image quality relative to that of commercially available agents ( 17 – 19 ). Whereas a veterinary radiologist obtained all images for our study, many reports described the minimal training required for clinicians and veterinary students to become proficient conducting POCUS examinations to gather diagnostic images ( 20 – 23 ). In those studies, duration of training ranged from a single-day course for clinicians ( 22 ) to a 3-week, self-directed learning period for veterinary students ( 20 ). An additional study detailing the confidence level of veterinarians following a 2-day course of abdominal, PLUS, and cardiovascular POCUS reported improved clinician POCUS confidence with a short course of lecture and hands-on training ( 23 ). Additional studies should be done to investigate the ability of novices to collect high-quality images from animals using these and other HUDs. To reduce variation, a single transducer of each HUD type was used. The Clarius and IQ each come with a single transducer, whereas the VScan has a curved and a linear array transducer at either pole of the device. Only the curved array transducer was used, and we acknowledge that the linear array transducer may have produced images of different quality. The IQ manufacturer describes their single probe as a 3-in-1 combined curved, linear, and phased array transducer, with automatic selection based on the application software setting used to acquire images. The 3 HUDs further vary in probe type, with the IQ employing a 2D array of 9000 capacitive micro-machined ultrasound transducers and the Clarius and VScan using piezoelectric ceramics. All features of each HUD could be further studied to understand if differences exist depending on the transducer or setting used. Image quality is affected by factors such as lossy (compression with loss of original data) and lossless (compression without loss of original data) image compression. Assessing compression effects was outside the scope of our study, which was limited to assessing contrast, image brightness, signal-to-noise ratio, graininess, and resolution ( 23 ). The Clarius cineloop digital imaging and communications in medicine files were compressed into AVI movie format, whereas those for the IQ and VScan were compressed into MPEG-4 format. Video quality is variably affected by compression type, with potentially different effects on video quality and resultant image quality score. Limited information is available on the effects these video formats may have had on image quality, and formats used were determined by the HUD default when exporting cineloops. Both AVI movie and MPEG-4 formats can have lossy or lossless compression, depending on the video codec used for compression. This information was unavailable. A notable limitation of our study was the fact that having 1 expert review the thoracic/cardiac cineloops and a 2nd review the abdominal cineloops prevented the assessment of inter-reviewer reliability. In addition, the expert reviewers had varying degrees of experience with the HUDs used (Clarius and IQ probes were used more often than the VScan). Although cineloops were anonymized and reviewers blinded to dog and transducer used, there may have been an unconscious bias toward transducers with which the reviewers were more familiar. This bias was not present during image collection, as the veterinary radiologist had equivalent, brief (~1 h) experience with each of the 3 HUDs before the study. Investigating only normal sonoanatomy in healthy dogs was another limitation of our study. In many cases, POCUS is used when there is a suspicion of underlying pathology, such as effusion (pleural, pericardial, peritoneal), pulmonary contusions, increased numbers of B-lines, or atelectasis. Potential effects of pathology on image quality require further study. A few publications described the diagnostic capabilities of the VScan for thoracic and abdominal pathology in human medicine and reported high agreement with a traditional portable ultrasound machine ( 9 , 24 ). Further studies are required to determine if these findings are similar for other HUDs (Clarius, IQ) and in veterinary species. Considering the many factors contributing to diagnostic image acquisition in POCUS, animal size and species may also be important and were not explored in this study. Consequently, our results should be extrapolated cautiously to other species and patient sizes. There is limited literature describing image quality variation among specific breeds or species in veterinary medicine. For example, higher body condition score in dogs can degrade image quality, especially when assessing deep structures ( 25 ). In addition, some features, such as gastrointestinal wall thickness, may vary among patients of different sizes (small versus large breeds), leading to ambiguity between normal and pathological findings ( 26 ). In conclusion, the Butterfly IQ+, Clarius C7HD3Vet, and VScan Air HUDs all provided images that were of sufficient quality to answer key POCUS questions of the thorax and abdomen. Although there were differences in overall image quality for the 3 HUDs within sonoanatomical views, no single HUD was deemed better than the others across all examined structures. However, when examining abdominal views, our results suggest the Clarius may provide image quality superior to that of the IQ. Additional studies should be done to further quantify differences in image quality using all available HUD features and to compare other commercially available devices. CVJ Supplementary Information cvj_03_318_s_tables1-3.pdf (171.3KB, pdf) Footnotes Unpublished supplementary material (Tables S1 to S3) is available online from: Supplementary Materials . Copyright is held by the Canadian Veterinary Medical Association. Individuals interested in obtaining reproductions of this article or permission to use this material elsewhere should contact permissions@cvma-acmv.org . REFERENCES 1. Pelchat J, Chalhoub S, Boysen SR. The use of veterinary point-of-care ultrasound by veterinarians: A nationwide Canadian survey. Can Vet J. 2020;61:1278–1282. [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Lisciandro GR. Point-of-care Ultrasound Techniques for the Small Animal Practitioner. 2nd ed. Hoboken, New Jersey: Wiley-Blackwell; 2021. [ Google Scholar ] 3. Ward JL, DeFrancesco TC. The role of point-of-care ultrasound in managing cardiac emergencies. Vet Clin North Am Small Anim Pract. 2023;53:713–728. doi: 10.1016/j.cvsm.2023.05.017. 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