Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine

Levine, Andrea; Buchner, Jessica; Verceles, Avelino C.; Zubrow, Marc T.; Mallemat, Haney; Papali, Alfred; McCurdy, Michael T.

doi:10.1016/j.jcrc.2016.02.019

Cited by 29 publications

(32 citation statements)

References 21 publications

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“…One particularly valuable potential use of point‐of‐care ocular ultrasound would be in resource‐limited settings where telemedicine could be used to help identify the diagnosis where access to ophthalmology may be more limited. This has been previously found to be successful with cardiac and lung ultrasound . Further studies should assess the utility of ocular ultrasound in this area.…”

Section: Discussionmentioning

confidence: 74%

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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Background: Ocular complaints are common presentations to the emergency department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment.Methods: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO CRD42018097288. There was no funding for this review.Results: Eleven studies (n = 844 patients) were identified. Overall, ultrasound was 94.2% (95% confidence interval [CI] = 78.4% to 98.6%) sensitive and 96.3% (95% CI = 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a positive likelihood ratio of 25.2 (95% CI = 8.1 to 78.0) and a negative likelihood ratio of 0.06 (95% CI = 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers.Conclusions: Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment.Future studies should determine the ideal training protocol and the influence of color Doppler and contrastenhanced ultrasound on diagnostic accuracy. O cular complaints are common emergency department (ED) presentations, accounting for approximately 3.4% of all ED visits over a 5-year period. 1 The differential diagnosis of flashes and floaters includes posterior vitreous detachment, retinal detachment, posterior uveitis, vitreous hemorrhage, oculodigital stimulation, rapid eye movements, neovascular age-related macular degeneration, migraine with aura, occipital lobe disorders, and postural hypotension. 2 While most patients will have a benign etiology, up to 10% to 26% of patients presenting with acute onset of flashes or floaters will be diagnosed with a

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Section: Discussionmentioning

confidence: 74%

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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“…Both asynchronous [ 15 , 19 , 24 , 27 , 34 , 38 , 41 ] and synchronous transmission with real time interaction between the operator and image interpreter [ 15 – 18 , 20 – 22 , 24 – 31 , 34 – 37 , 39 , 40 , 42 ] were reported. Several articles in a clinical setting used a combination of these approaches based on expert and operator availability [ 15 , 34 ], or in cases where asynchronous scans were deemed of insufficient quality therefore a second tele-mentored scan was conducted [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…The bandwidth available ranged from 0.132Kbps [ 19 ] to 59Mbps [ 25 ]. Several papers compared multiple telecommunications systems [ 26 , 31 , 33 , 41 ]. Despite the importance of compression algorithms (which facilitate the packaging and reduction of data volume from original the file format) to successful telesonography these were not described in in the majority of studies [ 16 , 17 , 19 , 20 , 22 , 26 , 30 , 34 , 37 , 39 , 42 ]…”

Section: Resultsmentioning

confidence: 99%

Telesonography in emergency medicine: A systematic review

2018

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Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.

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“…Multiple studies have demonstrated the utility of smartphone-based video conferencing platforms to remotely instruct POCUS examinations [10,16,29]. Images obtained from these platforms are noninferior to those obtained directly from the ultrasound device [18]. In addition, wearable video conferencing devices, such as GG, have also been applied to POCUS applications.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence has demonstrated the ability of a POCUS expert physician to guide a nonphysician hospital staff member to perform a POCUS exam via consumer-available teleconference equipment [9]. This same research group also demonstrated the ability of FT technology to transfer ultrasound images without clinically significant quality degradation [18]. Moreover, the use of FT communication between an intensivist team at a tertiary care center and nonphysician healthcare providers in a low-income country demonstrated the ability to successfully educate about POCUS image acquisition techniques as well allow appropriate image quality for remote clinical interpretation [10].…”

Section: Introductionmentioning

confidence: 94%

Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination

Ramsingh

et al. 2019

Diagnostics

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Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated.

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Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine

Cited by 29 publications

References 21 publications

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Telesonography in emergency medicine: A systematic review

Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination

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