The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - ‘a remote virtual mentor’

Abstract

BackgroundPoint-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal.MethodsThe simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted.ResultsThirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination.ConclusionsRemotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.

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.…”

Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED

“…Informatics technology facilitates the real-time interpretation by remote experts of transferred ultrasound videos acquired by a less-experienced onsite ultrasound user [6][7][8][9]. Several studies have demonstrated the possibilities of real-time tele-mentored ultrasonography in various emergency clinical settings, such as for pneumothorax or fluid collection in trauma patients [7][8][9].…”

“…Several studies have demonstrated the possibilities of real-time tele-mentored ultrasonography in various emergency clinical settings, such as for pneumothorax or fluid collection in trauma patients [7][8][9]. However, these have mostly been limited to simple ultrasound examinations, such as the extended Focused Assessment with Sonography for Trauma (e-FAST), which do not require high-resolution images or detailed mentor guidance.…”

A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos

“…Several studies have investigated the use of telesonography, in which ultrasound images are transferred to a remote display in real time to remedy a lack of on-site expert interpreters in under-resourced settings [3][4][5][6][7][8][9][10][11][12][13][14][15]. The term Btelesonographyŵ as first used in 1992 by Mendlowitz [3].…”

“…However, in the process of analog-to-digital conversion, the data must be compressed, and thus, the resolution of both video and still images is degraded. Today, although images remain digital during every step of image transmission, systems that transmit compressed data at a degraded resolution have been actively investigated because the available bandwidth is often limited [4][5][6][7][8][9][10][11][12][13]. These studies have demonstrated that the perception of the image quality is not significantly affected by the degraded resolution because the resolution required for the perception of image quality and smoothness is low [4].…”