Ultrasound in the Age of Telehealth, Telemonitoring, Telemedicine, Robots, and Kimonos

Today, there is online access to almost everything; groceries, a video chat with your grandmother across the globe, step-by-step instructions on how to fix your lawnmower, and a virtual doctor to help with pain in your abdomen. The healthcare applications of the internet have exploded in recent years with digital health and telemedicine assuming one of the highest growth areas for start-up entrepreneurs. The expansion of telehealth resources (IT infrastructure/capabilities) has allowed telemedicine to extend to isolated, inaccessible, remote spaces (maybe even your living room). And telehealth has gone beyond just a video chat with incorporation of sensing technologies including cameras, digital stethoscopes, and ultrasound.
Kat and Scott

Ultrasound imaging in austere locations is not just about access to an ultrasound system; it requires both the ultrasound operator, and the interpreter, to have specific knowledge, competency, and ultimately accountability about the quality of the examination, and the diagnosis it helps to provide. Our NASA-sponsored research team has shown that novice ultrasound operators can acquire diagnostic quality ultrasound images after a short training period with remote tele-ultrasound guidance in a space medicine environment. The astronaut operators were able to perform terrestrial standard abdominal, cardiovascular, and musculoskeletal ultrasound examinations with modest remote guidance oversight; zero gravity specific exams of the eyes, spine, and sinus were also completed. Importantly, the astronaut crewmembers quickly became more autonomous during their 6-month mission in space and were able to self-direct image acquisition.

But a major challenge with tele-ultrasound is operator training. William R. Buras, Sr, Director, Life Sciences at Tietronix Software Inc, and his team are making an augmented reality user interface for ultrasound scanning using a wearable heads-up display with imbedded guidance to improve ultrasound competency. This innovative Houston team is being funded by a NASA grant.

Unfortunately, when it gets to real-world practicality, neither the ultrasound machine nor the examination is intuitive. A team in Canada led by Dr Andy Kirkpatrick are working on a sustainable ultrasound solution using both remote ultrasound system operation and telemonitoring. They investigated the ability of non-trained firefighters to perform ultrasound in Edmonton being guided from Calgary. “We found that by using just-in-time–training with motivated firefighters, the remote examiner guiding the firefighters was 97% correct in determining the presence of a simulated hemo-peritoneum. Ironically, while this trial design also attempted to examine the utility of remote ultrasound knobology control, the firefighters were so good at the task that the remote knobology control became less of a relevant problem” said Dr Kirkpatrick.

To reduce the challenges of novice ultrasound operators, at team in France, led by Dr Phillipe Arbelle, linked a robot-coupled ultrasound device with a remote operator. The distant clinician can move the ultrasound probe with a joystick to acquire the ultrasound images. His concept has been implemented in a French ultrasound device, SonoScanner, that the European Space Agency will begin investigating on the International Space Station.

Similar work in robotic ultrasound is being done in Australia, where a team is building a robotic ultrasound machine that can perform abdominal ultrasound.

Have you seen the guy in a kimono buying a car? Online resourcing is indeed pants-optional. But if you plan on telemonitoring be suitably dressed.

Alien

What other areas have come a long way when it comes to ultrasound? What areas are poised to be next? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Kathleen M Rosendahl-Garcia, BS, RDMS, RVT, RDCS, is a NASA contractor working for KBRWyle and is a senior scientist and clinical sonographer in the Space Medicine division working under the Human Health and Performance Contract. Scott Dulchavsky, MD, PhD, is the Roy D. McClure Chairman of Surgery and Surgeon-in-Chief at Henry Ford Hospital in Detroit, and Professor of Surgery, Molecular Biology and Genetics at the Wayne State University School of Medicine. He is also a principal investigator for NASA and heads a project teaching astronauts how to use medical ultrasound in space.