In cardiology, the vast majority of patients require an effective cardiac visualization tool, yet the preferred method of cardiac imaging – an echocardiogram – is rarely available during an initial exam. Thus, patients and their physicians have traditionally had to wait to obtain a high quality visual image of the heart’s anatomy and function.Much like the echocardiogram changed cardiac evaluation, developments that put ultrasound technology at cardiologists’ fingertips are transforming the way doctors image the heart during initial exams. New developments allow cardiologists to look inside the body in real time, to visualize the pathology and help assess diseases of the heart valves. The use of ultrasound technology in the evaluation of patients in cardiology is not a new concept. Cardiac specialists have been using ultrasound and echocardiograms to visualize the heart since the 1950s using single dimensional B mode. But the utility of echocardiography came into its own only with the emergence of clinical use of 2D echo, in the late ’70s, and Cardiac Color Doppler in the late ’80s. More recently, with miniaturization of electronics and leaps in the power of microprocessors, ever smaller and more powerful ultrasound has become available. Portable ultrasound has been groundbreaking for the convenience it provides to doctor and patient. Portable ultrasound technology can address nearly every challenge that cardiologists struggle with regarding point-of-care screening, including difficulties with accurately visualizing the heart and delays in the diagnostic process. Portable ultrasound technology is particularly useful to help assess the motion of the heart wall, which can give information regarding the presence and severity of coronary artery disease. GE Healthcare’s Vscan, a pocket-sized visualization tool released earlier this year, takes this a step further. Roughly the size of a smartphone, it fits right into the coat pocket and enables cardiologists to obtain high quality images neatly and efficiently, right in the examining room. Vscan provides the ability to assess blood flow and to diagnose ventricular systolic dysfunction, all during the initial exam. Patients are fascinated with Vscan, which can make the initial exam informational, interactive and reassuring. While most patients are familiar only with traditional ultrasound as a concept, they have welcomed portable ultrasound as an intriguing aspect of their cardiac exam. Patients are equally impressed by Vscan’s size and accessibility. Beyond its novelty factor, Vscan has proven useful in the day-to-day clinic setting. A patient referred for a nuclear stress test presenting with an abnormal ECG may be scanned at the point-of-care to help assess for underlying pathology. Recently we scanned such a patient whose rest ECG was suggestive but not diagnostic for previous infarction. Advance knowledge that he did not suffer a previous antroseptal MI allowed us a measure of comfort in the setting of a provocative test, such as a treadmill test. Yes, we did manage somehow before Vscan became a reality, but so we did before 2D Echo and Doppler. While cardiologists have been using Vscan in private practice, the accessibility and transportability of this device makes it well-suited for the hospital setting. Its size and image quality make it practical in helping evaluate acute chest pain. In such a setting, acute echo imaging can be helpful in assessing wall motion abnormalities associated with acute MI, pericardial fluid, and cardiac changes associated with pulmonary hypertension. In the fast-paced Emergency Department environment, the use of portable echo can accelerate treatment decisions without sacrificing quality of care. Pocket-sized visualization tools like Vscan have the potential to revolutionize how doctors examine their patients at the initial point-of-care. Not only does its usage facilitate immediate and effective treatment, but it can do so in a variety of settings – from the private practice to the ICU of any major hospital. I believe it won’t be long before many physicians carry a Vscan in their pocket.