Help Is in Your Pocket

The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography

Paul McBeth, Innes Crawford, Corina Tiruta, Zhengwen Xiao, George Qiaohao Zhu, Michael Shuster, Les Sewell, Nova Panebianco, David Lautner, Savvas Nicolaou, Chad G. Ball, Michael Blaivas, Christopher J. Dente, Amy D. Wyrzykowski, Andrew W. Kirkpatrick*

*Corresponding author for this work

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. Materials and Methods: A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone((R)) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the patient, derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. Results: All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97%), with 100% of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70% of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70% of the ERs felt the EFAST exam was clinically useful. Conclusions: UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.

Original languageEnglish
Pages (from-to)924-930
Number of pages7
JournalTelemedicine Journal and E-Health
Volume19
Issue number12
Early online date4 Dec 2013
DOIs
Publication statusPublished - Dec 2013

Keywords

  • ultrasound
  • telemedicine
  • education
  • injury
  • remote medicine
  • prehospital care
  • Level V: hypothesis-generating study

Cite this

Help Is in Your Pocket : The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography. / McBeth, Paul; Crawford, Innes; Tiruta, Corina; Xiao, Zhengwen; Zhu, George Qiaohao; Shuster, Michael; Sewell, Les; Panebianco, Nova; Lautner, David; Nicolaou, Savvas; Ball, Chad G.; Blaivas, Michael; Dente, Christopher J.; Wyrzykowski, Amy D.; Kirkpatrick, Andrew W.

In: Telemedicine Journal and E-Health, Vol. 19, No. 12, 12.2013, p. 924-930.

Research output: Contribution to journalArticle

McBeth, P, Crawford, I, Tiruta, C, Xiao, Z, Zhu, GQ, Shuster, M, Sewell, L, Panebianco, N, Lautner, D, Nicolaou, S, Ball, CG, Blaivas, M, Dente, CJ, Wyrzykowski, AD & Kirkpatrick, AW 2013, 'Help Is in Your Pocket: The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography', Telemedicine Journal and E-Health, vol. 19, no. 12, pp. 924-930. https://doi.org/10.1089/tmj.2013.0034
McBeth, Paul ; Crawford, Innes ; Tiruta, Corina ; Xiao, Zhengwen ; Zhu, George Qiaohao ; Shuster, Michael ; Sewell, Les ; Panebianco, Nova ; Lautner, David ; Nicolaou, Savvas ; Ball, Chad G. ; Blaivas, Michael ; Dente, Christopher J. ; Wyrzykowski, Amy D. ; Kirkpatrick, Andrew W. / Help Is in Your Pocket : The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography. In: Telemedicine Journal and E-Health. 2013 ; Vol. 19, No. 12. pp. 924-930.
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abstract = "Background: Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. Materials and Methods: A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone((R)) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the patient, derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. Results: All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97{\%}), with 100{\%} of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70{\%} of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70{\%} of the ERs felt the EFAST exam was clinically useful. Conclusions: UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.",
keywords = "ultrasound, telemedicine, education, injury, remote medicine, prehospital care, Level V: hypothesis-generating study",
author = "Paul McBeth and Innes Crawford and Corina Tiruta and Zhengwen Xiao and Zhu, {George Qiaohao} and Michael Shuster and Les Sewell and Nova Panebianco and David Lautner and Savvas Nicolaou and Ball, {Chad G.} and Michael Blaivas and Dente, {Christopher J.} and Wyrzykowski, {Amy D.} and Kirkpatrick, {Andrew W.}",
note = "The Kyoto Kagaku Company (Kyoto, Japan) and the Sonosite Corporation (Bothell, WA) provided unrestricted use of a FAST/ER FAN ultrasonographic simulator and a NannoMaxx ultrasonographic unit, respectively, for research purposes. Michelle Mercado and Alma Radosfor are thanked for Web hosting, and Jessica McKee is thanked for review of the manuscript. Kevin Champagne, Martin Spriggs, Tim Bantle, Karen Janz, the Ski-Patrol of Sunshine Mountain, and the City of Calgary tactical emergency medical technicians are thanked for research assistance.",
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T2 - The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography

AU - McBeth, Paul

AU - Crawford, Innes

AU - Tiruta, Corina

AU - Xiao, Zhengwen

AU - Zhu, George Qiaohao

AU - Shuster, Michael

AU - Sewell, Les

AU - Panebianco, Nova

AU - Lautner, David

AU - Nicolaou, Savvas

AU - Ball, Chad G.

AU - Blaivas, Michael

AU - Dente, Christopher J.

AU - Wyrzykowski, Amy D.

AU - Kirkpatrick, Andrew W.

N1 - The Kyoto Kagaku Company (Kyoto, Japan) and the Sonosite Corporation (Bothell, WA) provided unrestricted use of a FAST/ER FAN ultrasonographic simulator and a NannoMaxx ultrasonographic unit, respectively, for research purposes. Michelle Mercado and Alma Radosfor are thanked for Web hosting, and Jessica McKee is thanked for review of the manuscript. Kevin Champagne, Martin Spriggs, Tim Bantle, Karen Janz, the Ski-Patrol of Sunshine Mountain, and the City of Calgary tactical emergency medical technicians are thanked for research assistance.

PY - 2013/12

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N2 - Background: Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. Materials and Methods: A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone((R)) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the patient, derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. Results: All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97%), with 100% of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70% of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70% of the ERs felt the EFAST exam was clinically useful. Conclusions: UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.

AB - Background: Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. Materials and Methods: A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone((R)) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the patient, derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. Results: All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97%), with 100% of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70% of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70% of the ERs felt the EFAST exam was clinically useful. Conclusions: UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.

KW - ultrasound

KW - telemedicine

KW - education

KW - injury

KW - remote medicine

KW - prehospital care

KW - Level V: hypothesis-generating study

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