Cost-Effective Remotely Guided Resuscitative Tele-Sonography
Remote Ultrasound Technology
Pleural and lung ultrasound (PLUS) is increasingly used in the bedside management of pulmonary pathology such as with the EFAST and BLUE protocols. As ultrasound is operator-dependant however, there are challenges to ensure that clinicians have adequate training. With a current explosion in the availability of ultrasound machines we believe there is an need to optimize ultrasound availability to patients, yet ensure quality and avoidance of misinformation from erroneous exams. The National Aeronautics and Space Administration has addressed this challenge by examining the concept of remote telementored telesonography (RTMTS), wherein just-in-time users onboard the International Space Station are guided by to capture meaningful images by remote terrestrial experts using elaborate informatics. The World Health Organization also recognizes that communication technologies have potential to address challenges in both developed and developing countries in providing accesible, cost-effective, high-quality health care services, especially for rural and underserved communities in developing countries. Thus, we endeavoured to provide RTMTS using markedly simpler informatics.
We thus investigated the provision of RTMS by allowing remote experts in Aberdeen to view real-time PLUS images displayed on a smartphone. A portable ultrasound (Sonosite 180, Sonosite, Bothell, WA) in Calgary was interfaced to a laptop computer (Aspire 5741, Acer, Kuala Lumpur) via an analogue-to-digital converter (VC-211V, ActionStar LinXcel, Taiwan). Xsplit Broadcaster (SplitMedialLabs ltd, Hong Kong) allowed video-streaming of both an inexpensive head-mounted webcam (LifeCam VX-2000, Microsoft, Washington) and ultrasound over Skype (Skype, Luxembourg), easily viewed on any smartphone. The remote experts were thereafter able to easily view both the Calgary examiners hands and probe and resultant ultrasound images and to audibily bi-directionally communicate during the conducting of PLUS, with the iphone images deemed of diagnostic quality demonstrating clear evidence of real-time lung sliding. While best appreciated real-time, the colour-power Doppler function also documented this movement as the "Power-slide", confirming and documenting respiration and pneumothorax absence.
While ultrasound images have been previously viewed over smartphones, we believe this is the first utilization of this ever more-prevalent technology to allow cost-minimal telementoring in telesonography. Therefore despite the myriad of challenges for global health-improvements, we believe that as the globe is shrunk by informatics remote experts in developed nations could increasingly assist with education and clinical care delivery using affordable technologies that are likely to be already in our coat pockets.
