Background
Ultrasound has been proven to help medical decision-making in remote locations. Use of cell phones in medical care has become a popular trend given their availability, and 85% of the world has access to a 3G network.
Objective
To evaluate live-stream video for interpretation of ultrasound using a 3G network.
Methods
We evaluated the inter-rater reliability of assessment of ultrasound scans for abdominal free fluid, intussusception, and hip effusions. Deidentified 6-second video clips in .mp4 format were downloaded to a laptop: 58 focused assessment with sonography in trauma (FAST) scans, 44 scans evaluating for intussusception, and 28 scans evaluating for hip effusions. A bedside ultrasound expert evaluated each scan and marked it positive or negative for pathology. Using an iPhone 3G for remote “telesound” consultation, we used Skype to connect to our second ultrasound expert located in Ethiopia, who repeated the process over a live-stream video connection. When the remote expert returned from Ethiopia, evaluation of the scans was repeated as a bedside reviewer. Inter-rater reliability analysis using the Kappa statistic and percent agreement were performed to determine consistency among raters.
Results
The Kappa values between the bedside and remote evaluators for FAST, intussusception, and hip effusion were 0.748 (95% CI 0.576–0.92), 0.816 (95% CI 0.648–0.984), and 0.764 (95% CI 0.519–1.0), respectively. The percent agreements after adjusting for chance were 86%, 80%, and 88%, respectively. The Kappa values between the bedside assessments by each evaluator were 0.851 (95% CI 0.71–0.992), 0.8 (95% CI 0.616–0.984), and 0.747 (95% CI 0.479–0.884), respectively. The percent agreements after adjusting for chance were 92%, 81%, and 88%, respectively.
Conclusion
Live-stream video conference using 2 cellphones over a 3G network is a feasible and accurate method for consultation of ultrasound scans from a remote location.