A Feasibility Study of Telementoring for Identifying the Appendix Using Smartphone-Based Telesonography

Abstract

We investigated the feasibility of the clinical application of novice-practitioner-performed/offsite-mentor-guided ultrasonography for identifying the appendix. A randomized crossover study was conducted using a telesonography system that can transmit the ultrasound images displayed on the ultrasound monitor (ultrasound sequence video) and images showing the practitioner's operations (background video) to a smartphone without any interruption in motion over a Long-Term Evolution (LTE) network. Thirty novice practitioners were randomly assigned to two groups. The subjects in group A (n = 15) performed ultrasonography for the identification of the appendix under mentoring by an onsite expert, whereas those in group B (n = 15) performed the same procedure under mentoring by an offsite expert. Each subject performed the procedure on three simulated patients. After a 4-week interval, they performed the procedure again under the other type of mentoring. A total of 90 ultrasound examinations were performed in each scenario. The primary outcomes were the success rate for identifying the appendix and the time required to identify the appendix. The success rates for identifying the appendix were 91.1 % (82/90) in onsite-mentored ultrasonography and 87.8 % (79/90) in offsite-mentored ultrasonography; both rates were high, and there was no significant difference (p = 0.468) between them. The time required in the case of offsite mentoring (median, 242.9 s; interquartile range (IQR), 238.2) was longer than that for onsite mentoring (median, 291.4 s; IQR, 200.9); however, the difference was not significant (p = 0.051). It appears that offsite mentoring can allow novice onsite practitioners to perform ultrasonography as effectively as they can under onsite mentoring, even for examinations that require proficiency in rather complex practices, such as identifying the appendix.

Telesonography in emergency medicine: A systematic review

“…A defining feature of emergency medicine is the need to minimise delays. The time taken for scanning ranged from 4 minutes for a scan which was tele-mentored [ 29 ] to 24 minutes for a scan using a robotic device [ 21 ]; most examinations took less than 10 minutes [ 20 , 23 , 29 , 30 , 42 ]. Transmission time or other related delays were infrequently reported.…”

“…Several articles separately reported on the clinical utility of the images using a range of measures from the proportion of anatomic features visualised to Likert scales of diagnostic confidence [ 16 , 22 , 30 , 31 , 34 , 36 ]. The judgements made concerning the clinical utility of images were generally positive with high proportions of images judged as sufficient for interpretation or identification of anatomic features [ 19 , 22 , 29 , 31 , 35 , 36 ].…”

“…Telesonography was considered as a teaching tool in several studies [ 17 , 18 , 20 , 22 , 27 , 29 , 30 , 38 ]. There is evidence that it is feasible to tele-mentor or remotely support novices with medical and non-medical backgrounds [ 15 , 17 , 18 , 20 , 22 , 27 , 28 , 29 , 30 , 31 , 35 , 36 , 37 ]. Evaluative work comparing tele-mentoring to onsite mentoring suggests that there is no significant difference between time taken and success rate of image acquisition between onsite and remote mentoring [ 29 ].…”

“…There is evidence that it is feasible to tele-mentor or remotely support novices with medical and non-medical backgrounds [ 15 , 17 , 18 , 20 , 22 , 27 , 28 , 29 , 30 , 31 , 35 , 36 , 37 ]. Evaluative work comparing tele-mentoring to onsite mentoring suggests that there is no significant difference between time taken and success rate of image acquisition between onsite and remote mentoring [ 29 ]. Two papers found that telesonography with remote mentors had almost equivalent sensitivity and specificity to conventional ultrasonography in a range of scenarios [ 25 , 42 ].…”

“…As a consequence studies may contain findings that cannot be replicated when the additional challenges of pure emergency medicine are imposed. Nonetheless, there was evidence from these articles that telesonography could be used to identify variety of abnormalities relevant to emergency medicine such as the presence of peritoneal fluid or pneumothorax [ 15 , 18 , 21 , 24 , 27 , 29 , 30 , 31 , 34 , 38 ]. Only one telesonography system was used in the setting of resuscitation and in this case it was reported that telesonography was a beneficial addition to the emergency department [ 17 , 22 ].…”