Oct 2026· Journal of the American College of Emergency Physicians Open· Vol 7 5, pp.
100491
· 0 citations· 35 references
Medicine
TL;DR
To improve integration, stakeholders should begin any new POCUS AI development project by first examining the different domains where POCUS AI applications are most needed, including education, clinical practice, workflow, research, and administration.
Abstract
The use of artificial intelligence (AI) within medicine has increased dramatically in the past few years, and applications for point-of-care ultrasound (POCUS) have followed a similar trend. Although physicians believe that POCUS AI applications have the potential to improve clinical practice, adoption of current applications remains limited. A lack of outcomes-based evidence, bias within datasets, poor assimilation within current workflows, and regulatory uncertainty are some of the major barriers that lead to poor adoption rates. To improve integration, stakeholders (physician leaders, researchers, health care executives, and industry partners) should begin any new POCUS AI development project by first examining the different domains where POCUS AI applications are most needed, including education, clinical practice, workflow, research, and administration. A gap analysis with clearly defined outcomes should come next, followed by an examination of how the new POCUS AI application will integrate into existing workflows. Training data sets that are reflective of real-world scenarios, including limitations encountered by end users, are essential. POCUS AI applications that integrate with existing workflows, have explainable outputs, and have been codeveloped with end users will improve adoption. Although regulatory pathways are evolving, engaging regulators early in the process and identifying viable reimbursement pathways are key strategies that will improve both the development and adoption of POCUS AI applications in the future.
Digital twins (DTs) are rapidly emerging as foundational enablers of 6G smart cities, offering real time monitoring, predictive analytics, and autonomous control across transportation, energy, healthcare, and industrial domains. Large scale DT adoption faces critical barriers including cybersecurity vulnerabilities, privacy risks, and the absence of standardized orchestration frameworks. This article presents Fed-DTOrch, a comprehensive end to end architecture that integrates federated intelligence, blockchain based audit trails, and AI governance to achieve secure and privacy preserving DT management. The proposed three tier architecture spans IoT and edge devices, domain specific twins, and a city level orchestrator, employing secure federated learning for model updates, lightweight cryptographic authentication, and tamper proof logging. We quantify the DT threat landscape, perform a standards gap analysis across ISO/IEC 27001, 3GPP TS 33.501, ITU-T IoT risk frameworks, and NIST AI RMF, and introduce a 6G ready security framework incorporating federated AI trust metrics, secure synchronization, and explainable AI audits. Cross domain evaluation across five smart city sectors demonstrates 35-60% privacy gain, 40-55% attack mitigation, 28-40% reliability uplift, 26-30% latency reduction, and >85% compliance readiness with <10% overhead. These results provide the first integrated blueprint that combines federated intelligence, blockchain-based auditability, and standards gap analysis to enable secure, standardized, and interoperable DT orchestration for trustworthy 6G ecosystems.
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