The Novel Concept of Patient Self-Imaging: Success in COVID-19 and Cardiopulmonary Disorders

Resnikoff, Pamela M.; Shi, Rui; Bagsic, Samantha R. Spierling; Kimura, Bruce J.

doi:10.1016/j.amjmed.2021.01.010

Cited by 7 publications

(12 citation statements)

References 4 publications

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“…Although prevalent in inpatients, B-lines were also reported by infected health care providers who imaged themselves during their own home isolation. [15][16][17] The presence of three B-lines in the lung apex alone, a site specifically shown to be feasible for patient selfimaging, 18 was observed by our group in a significant proportion, 33%, of hospitalized patients, who remarkably had only mild to moderate disease and lacked hypoxemia. 19 Given these observations, the concept of incorporating simplified lung self-imaging into a telehealth appointment was envisioned to help identify and allocate resources to those outpatients who may develop worsening disease while in isolation.…”

supporting

confidence: 53%

“…44 Telehealth and artificial intelligence methods demonstrated 84% to 92% accuracy using currently available smartphone and Internet technologies, which was similar to the 88% accuracy found in our prior study of patient self-imaging. 18 These observations underscore the potential of a simple imaging technique, which does not require undressing, to be applied by patients, household members, or individuals in the community using a smartphone. But despite telehealth accuracy, we noted that even the simplest of point-of-care ultrasound techniques is still best when applied by a physician.…”

Section: Discussionmentioning

confidence: 93%

“…One of four physicians, blinded to the patient's vaccination and clinical status, performed the apical lung imaging for the ultrasound lung comet (ULC) sign, defined as the presence or coalescence of three or more vertical ring-down linear B-line artifacts in a single image in the region of the second intercostal space in the midclavicular line (Figure 1). 18,19,23,24 All imaging physicians had previously completed an established point-of-care ultrasound training program 25 and had used the Lumify device in clinical practice. Patients were considered ULC+ if either lung showed a comet sign as just defined.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

Kimura¹,

Resnikoff²,

Tran³

et al. 2022

Journal of the American Society of Echocardiography

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supporting

confidence: 53%

Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

Kimura¹,

Resnikoff²,

Tran³

et al. 2022

Journal of the American Society of Echocardiography

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“…In a recent feasibility study using a single page of patient instruction, the same lung imaging technique employed in the current study was successfully taught to patients with cardiac disease, unexplained dyspnea, and COVID-19 pneumonia. 20 Over 85% of patients under 78 years of age obtained adequate images on themselves and overall accuracy was 88% compared to expert imaging. In conjunction with the current findings, our data would project the superiority of ultrasound to self-monitor initial COVID-19 infection over other methods, as SpO2 assessment would identify a later, more severe stage of disease and chest X-ray, which is less sensitive than ultrasound, 36 would require transport to a medical facility.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of Simplified Lung Ultrasound Exam in COVID‐19: Implications for Self‐Imaging

Kimura

Shi

Tran

et al. 2021

J of Ultrasound Medicine

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Objectives-Lung ultrasound B-lines represent interstitial thickening or edema and relate to mortality in COVID-19. As B-lines can be detected with minimal training using point-of-care ultrasound (POCUS), we examined the frequency, clinical associations, and outcomes of B-lines when found using a simplified POCUS method in acutely ill patients with COVID-19.Methods-In this retrospective cohort study, hospital data from COVID-19 patients who had undergone lung imaging during standard echocardiography or POCUS were reviewed for an ultrasound lung comet (ULC) sign, defined as the presence of ≥3 B-lines from images of only the antero-apex of either lung (ULC +). Clinical risk factors, oximetry and radiographic results, and disease severity were analyzed for associations with ULC+. Clinical risk factors and ULC+ were analyzed for associations with hospital mortality or the need for intensive care in multivariable models.Results-Of N = 160 patients, age (mean AE standard deviation) was 64.8 AE 15.5 years, and 46 (29%) died. ULC+ was present in 100/160 (62%) of patients overall, in 81/103 (79%) of severe-or-greater disease versus 19/57 (33%) of moderate-or-less disease (P < .0001) and was associated with mortality (odds ratio [OR] = 2.4 [95% confidence interval [CI]: 1.1-5.4], P = .02) and the need for intensive care (OR = 5.23 [95% CI: 2.42-12.40], P < .0001). In the multivariable models, symptom duration and severe-or-greater disease were associated with ULC+, and ULC+, diabetes, and symptom duration were associated with the need for intensive care.Conclusions-B-lines in the upper chest were common and related to disease severity, intensive care, and hospital mortality in COVID-19. Validation of a simplified lung POCUS exam could provide the evidence basis for a self-imaging application during the pandemic.

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“…Resnikoff also recently reported a mixed cohort of 80 COVID confirmed, dyspneic, or cardiology patients who were able to self-image the anterior second intercostal space bilaterally with a 67% sensitivity, 94% specificity, and 88% accuracy for standard lung ultrasound landmarks, with the participants being guided only by a instruction sheet [ 53 ]. They also noted that those younger than 80 who used the internet daily were more likely to obtain diagnostic lung images, while being acutely dyspneic was associated with reduced success [ 53 ].…”

Section: Remote Telementored Self-performed Ultrasound (Rtmspus) As M...mentioning

confidence: 99%

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

Kirkpatrick

McKee²,

Couperus³

et al. 2022

Diagnostics

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Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.

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The Novel Concept of Patient Self-Imaging: Success in COVID-19 and Cardiopulmonary Disorders

Cited by 7 publications

References 4 publications

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

Outcomes of Simplified Lung Ultrasound Exam in COVID‐19: Implications for Self‐Imaging

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

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