How to set up a low cost tele-ultrasound capable videoconferencing system with wide applicability

Abstract

BackgroundWorldwide ultrasound equipment accessibility is at an all-time high, as technology improves and costs decrease. Ensuring that patients benefit from more accurate resuscitation and diagnoses from a user-dependent technology, such as ultrasound, requires accurate examination, typically entailing significant training. Remote tele-mentored ultrasound (RTUS) examination is, however, a technique pioneered in space medicine that has increased applicability on earth. We, thus, sought to create and demonstrate a cost-minimal approach and system with potentially global applicability.MethodsThe cost-minimal RTUS system was constructed by utilizing a standard off-the-shelf laptop computer that connected to the internet through an internal wireless receiver and/or was tethered through a smartphone. A number of portable hand-held ultrasound devices were digitally streamed into the laptop utilizing a video converter. Both the ultrasound video and the output of a head-mounted video camera were transmitted over freely available Voice Over Internet Protocol (VOIP) software to remote experts who could receive and communicate using any mobile device (computer, tablet, or smartphone) that could access secure VOIP transmissions from the internet.ResultsThe RTUS system allowed real-time mentored tele-ultrasound to be conducted from a variety of settings that were inside buildings, outside on mountainsides, and even within aircraft in flight all unified by the simple capability of receiving and transmitting VOIP transmissions. . Numerous types of ultrasound examinations were conducted such as abdominal and thoracic examinations with a variety of users mentored who had previous skills ranging from none to expert. Internet connectivity was rarely a limiting factor, with competing logistical and scheduling demands of the participants predominating.ConclusionsRTUS examinations can educate and guide point of care clinical providers to enhance their use of ultrasound. The scope of the examinations conducted is limited only by the time available and the criticality of the subject being examined. As internet connectivity will only improve worldwide, future developments need to focus on the human factors to optimize tele-sonographic interactions.

Help Is in Your Pocket: The Potential Accuracy of Smartphone- and Laptop-Based Remotely Guided Resuscitative Telesonography

“…17 The analog video output of a NanoMaxx Ò US machine (Sonosite Corp., Bothell, WA) was digitized using an analog-to-digital converter (Monoprice, Rancho Cucamonga, CA). A head-mounted 1.3-megapixel Web camera (Microsoft, Redmond, WA) provided a regional view of the examination.…”

Barriers to point-of-care ultrasound use in rural emergency departments

“…32 Assuming instant availability of a trained physician at any time to "tele-mentor," this method could be both accurate and feasible. [33][34][35][36][37][38][39] However, limitations include mentor availability, a need for high-bandwidth Internet or cellular connections to maintain image quality, and technical problems such as image freezing. 39,40 Its effectiveness in clinical use has not yet been studied in rural Canada.…”

Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings

“…In the early years of tele-ultrasound initiatives it was considered a technologically demanding field, requiring high data transfer rates for the direct involvement of experts in real time relative to the internet capabilities of the time [23]. This is changing.…”

“…This use of the internet in place of the public-switched telephone network (PSTN; normal telephone) potentially makes tele-ultrasound available in any R/UR setting in which a smartphone has connectivity. The particular system constructed in Calgary utilized a freely accessible internet service (Skype) that currently provides low cost videoconferencing services to millions of people and businesses worldwide [23]. Using such a system, McBeth et al conducted a series of trials with the assistance of healthy volunteers at a variety of remote sites to demonstrate the feasibility and applicability of these techniques conducted primarily over a smartphone [18, 19].…”