IEEE Systems, Man and Cybernetics Magazine - April 2023 - 50

We investigate the early diagnosis of DVT based on the
characteristics of POCT equipment. We present the current
state, benefits, and drawbacks of POCT diagnostic
equipment, including POC D-dimer, POC US (POCUS), and
photoplethysmography (PPG). In addition, we analyze performance
measures from research methods, such as sensitivity
and specificity. Finally, we outline the developing
trends of DVT detection methods and propose several
issues that need to be addressed.
Introduction
DVT is a vascular disease resulting from abnormal blood
clotting in the deep veins. It often occurs in the upper femoral,
popliteal, posterior tibial, and peroneal veins of the
lower extremities [1]. The main causes of DVT are damage
to the vein wall, blood coagulation, and slow blood flow
[2]. DVT is typically present in patients undergoing major
surgery, pregnant women, and orthopedic patients. The
main manifestations of acute lower-limb DVT are edema,
warming, and sensitivity of the affected limb [3]. However,
the symptoms of some patients are not obvious and may
not be considered in the management of DVT diagnosis.
Once blood transports a dislodged thrombus from the
veins to the lungs, it can cause a PE and even lead to
sequelae and death of the patient. The annual incidence of
DVT is approximately one in 1,000, and nearly a third of the
patients will deteriorate [4]. Therefore, improving early
diagnostic methods for DVT has a positive effect on reducing
morbidity.
In 1942, X-ray venography was initially used by Jacob
et al. as an effective adjunct diagnostic tool for DVT [5].
Venography is the gold standard for the diagnosis of DVT.
However, venography has many undesirable effects, such
as an invasive character, hypersensitivity, and nephrotoxicity.
In the meantime, venography is difficult to use extensively
in early diagnosis due to its high cost and
inadequate detection. Subsequently, medical US was
applied in clinical diagnosis, and its noninvasivity was its
major benefit. In 1967, Tandness et al. confirmed that US
could effectively assess peripheral vessel disease [6]. Since
Evans et al. confirmed the first ultrasonic DVT detection
experiment, in 1969, US has been used extensively in clinical
diagnosis [7]. In 1978, impedance plethysmography was
first applied as wearable equipment to DVT diagnosis [8].
Subsequently, in 1989, PPG expanded the use of portable
equipment for diagnosing DVT based on plethysmographic
theory [9]. In 1989, in the area of biomarkers, Bounameaux
demonstrated the powerful role of D-dimer in positive DVT
detection [10]. So far, D-dimer remains the main method
for positive screening. However, its specificity is low and
cannot be used outside a central lab. As a result, rapid DVT
diagnosis and home surveillance are not possible. In the
21st century, miniaturization has become a trend in the
development of diagnostic equipment. In 2003, Torbicki
et al. used POCUS to detect DVT [11]. In 2021, some studies
suggested portable equipment based on PPG and POC
D-dimer detectors [12]. D-dimer is inexpensive and has
excellent capacity for widespread positive primary detection.
Equipment such as POCT is cheap, convenient, and
fast in diagnosis [13].
A systematic search on Web of Science generated 2,641
relevant articles. Through the selection of paper titles and
Likelihood
Assessment
With Significant
Precipitating Factors and
Typical Presenting Signs
US
Without Significant
Precipitating Factors and
Typical Presenting Signs
D-Dimer
Positive
Negative
Diagnosed
Exclusion
Positive
Diagnosed
Figure 1. Clinical diagnostic management.
50 IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE April 2023
Positive
US
Negative
Exclusion
Negative
Exclusion
IEEE Systems, Man and Cybernetics Magazine - April 2023

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