Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

Abstract

COVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

Smartphone-based point-of-care testing of the SARS-CoV-2: A systematic review

“…RNA was eluted out in molecular-grade water SARS- CoV-2 cDNA and RNA based on the viral N-gene 3.9 × 10 3 RNA copies/ml 81.66% 15 iPhone cameras The quantification of LFA test and control lines was performed by using a smartphone-based in vitro diagnostics (IVD) device [52] Fluorescent, colorimetric, or electrochemical Saliva diluted 10-fold Isothermal incubation at 65°C for 35 min viral RNA less than 35 × 10 4 viral particles /mL NR 35 min iPhone6 A smartphone device is used to image the samples containing fluorescent beads post-RT-LAMP and correlates decreased diffusivity to positive sample [53] Thermal Thermal images of the participants’ exposed upper backs NO sample lungs 92% 62% up to 3 min FLIR ONE thermal camera device (both iOS- and Android) image processing using a portable thermal camera connected to the phone [54] Thermal droplets Thermal exposure detection of SARS-CoV-2 RNA 30 fM of target ssRNA NR 20min NR application to avoid user errors in readout [55] Ultrasound No sample - Lung imaging lung ultrasound for COVID has demonstrated an extremely high sensitivity for detecting such abnormalities Depend on the lung expert. - Samsung Galaxy Tablet A portable smartphone support ultrasound probes for communicating with a remote expert using Zoom Teleconferencing (telemedicine) [56] Ultrasound lung ultrasound NR Lung imaging a minimum 720p video Depends on a remote clinical ultrasound expert NR NR smartphone-supported tele-ultrasound system using online video conferencing [57] Flow-meter Saliva viruses were cultured and the cell lysates were collected and centrifuged antigen antibody reaction …”

“…Kirkpatrick et al. [ 56 , 57 ] developed a novel method called tele-mentored self-performed ultrasound was created to perform medical imaging on the International Space Station, with remote guidance and supervision by medical experts. The examination is more thorough than routine examinations that concentrate solely on the front and side of the chest since it encompasses 14 different places.…”

Teleguidance for Patient Self‐Imaging of Hemophilic Joints Using Mobile Ultrasound Devices

“…27 This provided the concept and basis for selfimaging studies to diagnose and monitor COVID-19 progression at home. Subsequently, case reports 28,29 and increasing advocacy efforts from the medical community to accelerate remote diagnosis and alleviate monitoring of COVID-19 to optimize triage for hospitalization 30,31 paved the way for several feasibility studies recruiting patients and/or volunteers for lung and pleura imaging. 32,33 Results from these studies are encouraging and mirror our own findings and experience.…”

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

“…When the person holding the probe is less experienced and is being mentored this concept is designated Remote Telementored Ultrasonography (or sonography) (RTMUS) [ 5 , 6 , 7 ]. When the novel person is being remotely mentored to generate images of themself, we have designated this as Remote Telementored Self-Performed Ultrasound (RTMSPUS) [ 8 , 9 , 10 ].…”

“…Sanitized lightweight telemedical smart phone supported ultrasound probes can be quickly couriered or even drone delivered to completely obviate human to human contact ( Figure 3 a,b) [ 54 , 55 ]. In the group of previously asymptomatic patients at risk for COVID, one subject later caught COVID, with his initial pre-infectious study serving as a baseline for repeated examinations by the same remote mentor providing longitudinal follow-up to detect deterioration at the earliest possible time [ 10 ].…”