Remote real‐time supervision via tele‐ultrasound in focused cardiac ultrasound: A single‐blinded cluster randomized controlled trial

Abstract

BackgroundSupervision via tele‐ultrasound presents a remedy for lacking on‐site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele‐supervised physicians’ cine‐loop quality compared to that of non‐supervised physicians and compared to that of experts.MethodsWe conducted a single‐blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non‐supervised, and the second was non‐supervised (control) or tele‐supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine‐loops recorded from all scans on a 1–5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed‐effects model.ResultsIn each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non‐supervised scan grading was 10.9 (95% CI 10.2‐11.7), whereas the tele‐supervised grading was 12.6 (95% CI: 11.8‐13.3). From the first to the second scan, tele‐supervised physicians moved 9% (1.09; 95% CI: 1.00‐1.19; P = 0.041) closer to the experts’ quality than the non‐supervised physicians.ConclusionTele‐supervised physicians performed scans of better quality than non‐supervised physicians. The present study supports the use of tele‐supervision for physicians with basic focused ultrasound competence in a setting where on‐site supervision is unavailable.

The Use of Handheld Ultrasound Devices in Emergency Medicine

“…Remotely guided US, or “tele-ultrasound,” improves image quality and scanning confidence among novice users and will be critical for improving safety as HHU becomes more widespread [ 5 , 15 , 53 , 54 ]. AI algorithms have been developed that automatically show users the movements necessary to obtain high quality images [ 5 , 55 ].…”

Improving the quality of breast ultrasound examination performed by inexperienced ultrasound doctors with synchronous tele-ultrasound: a prospective, parallel controlled trial

“…In the past few decades, an increasing number of studies have focused on synchronous tele-US [8,[17][18][19][20][21][22][23]. However, due to the limitations in image processing technology and communication technology, most of the synchronous transmissions in these studies come at the expense of lower resolution.…”

“…Jensen et al [ 23 ] proved that the guidance of experts using synchronous tele-US could improve the image quality of focused cardiac US. Their results were consistent with the results of this trial.…”

Synchronous tele-ultrasonography is helpful for a naive operator to perform high-quality thyroid ultrasound examinations

“…Teleultrasound (TUS), as a new sub-type of telemedicine, could provide US examination without side-by-side and get accurate diagnoses. It might be a good solution to the scenarios with insufficient US medical resources [14,15]. In 2005, National Aeronautics and Space Administration (NASA)…”