In reality, the right question is not which device category is universally better, but which one best serves the intended clinical task. Handheld systems have expanded access dramatically, while cart-based systems still offer advantages in some workflows.
Recent prospective evidence found similar overall diagnostic accuracy between a handheld device and a cart-based system across selected POCUS applications. In many clinical environments, a device that is immediately available can be more useful than a more powerful machine that is not nearby when the decision needs to be made.
Cart-based systems still hold advantages in ergonomics for prolonged scanning, larger displays, some advanced Doppler options, workflow in dedicated imaging spaces, and complex or comprehensive examinations.
For procedural guidance, ward rounds, emergency review, outreach work, theatre, and point-of-care decision-making, handheld ultrasound can be extremely compelling. Many services will ultimately benefit from both: handheld for access and speed, cart-based for depth and breadth.
Handheld ultrasound is not a toy, and cart-based ultrasound is not obsolete. Each has strengths. The best choice depends on scope, workflow, training, and the level of diagnostic detail required.
Dr Yahya Docrat is an anaesthetist based in Johannesburg, South Africa, with clinical experience in perioperative medicine and point-of-care ultrasound applications in anaesthesia, emergency medicine and critical care.