Telemedicine and point-of-care ultrasound have merged to create a field known as teleultrasound (TUS). Real-time TUS involves the transmission of bedside ultrasound (US) images with direct feedback from an US expert. In this review, we summarize the current uses of real-time TUS and discuss its potential future uses.
Methods:
We performed a literature search (PubMed and EMBase) to assess articles related to real-time TUS. Data were extracted using a standardized collection form, and relevant articles were separated into feasibility or clinical studies.
Results:
Our search yielded 45 articles, with most of the reports taking place in resource-constrained settings. A large portion of the studies discussed the use of the focused assessment with sonography in trauma exam. Others included musculoskeletal, vascular, and echocardiography.
Conclusion:
Real-time TUS allows for rapid access to diagnostic imaging in various clinical settings. This technology is poised to expand with many uses on the horizon.
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References
1.
FerreiraAC, O'MahonyE, OlianiAH, et al.Teleultrasound: Historical perspective and clinical application. Int J Telemed Appl, 2015; 2015:306259.
2.
LevineAR, McCurdyMT, ZubrowMT, et al.Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care, 2015; 30:871–875.
3.
RobertsonTE, LevineAR, VercelesAC, et al.Remote tele-mentored ultrasound for non-physician learners using FaceTime: A feasibility study in a low-income country. J Crit Care, 2017; 40:145–148.
4.
LevineAR, RobertsonTE, PapaliA, et al.Tele-medicine and point-of-care ultrasound. Chest, 2016; 149:1580–1581.
5.
OlivieriPP, VercelesAC, HurleyJM, et al.A pilot study of ultrasonography-naïve operators' ability to use tele-ultrasonography to assess the heart and lung. J Intensive Care Med, 2018. [Epub ahead of print]; DOI: 10.1177/0885066618777187.
6.
DouglasTM, LevineAR, OlivieriPP, et al.Brief training increases nurses' comfort using tele-ultrasound: A feasibility study. Intensive Crit Care Nurs, 2010; 51:45–49.
7.
PanayidesA, EleftheriouI, PantziarisM. Open-source telemedicine platform for wireless medical video communication. Int J Telemed Appl, 2013; 2013:457491.
8.
AdambounouK, AdjenouV, SalamAP, et al.A low-cost tele-imaging platform for developing countries. Front Public Health, 2014; 2:135.
9.
PaulusYM, ThompsonNP. Inexpensive, realtime tele-ultrasound using a commercial, web-based video streaming device. J Telemed Telecare, 2012; 18:185–188.
10.
MiyashitaT, TakizawaM, NakaiK, et al.Telemedicine of the heart: Real-time telescreening of echocardiography using satellite telecommunication. Circ J, 2003; 67:562–564.
11.
MiyashitaT, TakizawaM, NakaiK, et al.Realtime ultrasound screening by satellite telecommunication. J Telemed Telecare, 2003; 9:S60–S61.
12.
BalestriR, CavinaE, AliferisA, et al.Telemedicine on a small island. J Telemed Telecare, 1999; 5:S50–S52.
13.
OttoCA, ShemenskiR, DrudiL. Real-time tele-echocardiography: Diagnosis and management of a pericardial effusion secondary to pericarditis at an Antarctic research station. Telemed J E Health, 2012; 18:521–524.
14.
OttoC, ShemenskiR, ScottJM, et al.Evaluation of tele-ultrasound as a tool in remote diagnosis and clinical management at the Amundsen-Scott South Pole Station and the McMurdo Research Station. Telemed J E Health, 2013; 19:186–191.
15.
KolbeN, KilluK, CobaV, et al.Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management. J Ultrasound, 2015; 18:179–185.
HellerT, WallrauchC, GoblirschS, et al.Focused assessment with sonography for HIV-associated tuberculosis (FASH): A short protocol and a pictorial review. Crit Ultrasound J, 2012; 4:21.
18.
CarboneM, FerrariV, MarconiM, et al.A tele-ultrasonographic platform to collect specialist second opinion in less specialized hospitals. Updates Surg, 2018; 70:407.
19.
RubinMN, BarrettKM, FreemanWD, et al.Teleneurosonology: A novel application of transcranial and carotid ultrasound. J Stroke Cerebrovasc Dis, 2015; 24:562–565.
20.
MikulikR, AlexandrovAV, RiboM, et al.Telemedicine-guided carotid and transcranial ultrasound: A pilot feasibility study. Stroke, 2006; 37:229–230.
21.
BeckerC, FusaroM, PatelD, et al.The utility of teleultrasound to guide acute patient management. Cardiol Rev, 2017; 25:97–101.
22.
LawJ, MacBethPB. Ultrasound: From earth to space. Mcgill J Med, 2011; 13:59.
23.
ChiaoL, SharipovS, SargsyanAE, et al.Ocular examination for trauma; clinical ultrasound aboard the International Space Station. J Trauma, 2005; 58:885–889.
24.
SargsyanAE, HamiltonDR, JonesJA, et al.FAST at MACH 20: Clinical ultrasound aboard the International Space Station. J Trauma, 2005; 58:35–39.
25.
MarshburnTH, HadfieldCA, SargsyanAE, et al.New heights in ultrasound: First report of spinal ultrasound from the International Space Station. J Emerg Med, 2014; 46:61–70.
26.
Silva-MartinezJP, Sorice GenaroA, WenHA, et al.Remotely guided breast sonography for long-term space missions: A case report and discussion. Telemed J E Health, 2017; 23:1016–1022.
27.
JonesJA, SargsyanAE, BarrYR, et al.Diagnostic ultrasound at MACH 20: Retroperitoneal and pelvic imaging in space. Ultrasound Med Biol, 2009; 35:1059–1067.
28.
OttoC, ComtoisJ-M, SargsyanA, et al.The Martian chronicles: Remotely guided diagnosis and treatment in the Arctic Circle. Surg Endosc, 2010; 24:2170–2177.
29.
OttoC, HamiltonDR, LevineBD, et al.Into thin air: Extreme ultrasound on Mt Everest. Wilderness Environ Med, 2009; 20:283–289.
30.
McBethPB, CrawfordI, BlaivasM, et al.Simple, almost anywhere, with almost anyone: Remote low-cost telementored resuscitative lung ultrasound. J Trauma, 2011; 71:1528–1535.
31.
Al-KadiA, DyerD, BallCG, et al.User's perceptions of remote trauma telesonography. J Telemed Telecare, 2009; 15:251–254.
32.
BonifaceKS, ShokoohiH, SmithER, et al.Tele-ultrasound and paramedics: Real-time remote physician guidance of the Focused Assessment With Sonography for Trauma examination. Am J Emerg Med, 2011; 29:477–481.
33.
SongKJ, Shin SDo, HongKJ, et al.Clinical applicability of real-time, prehospital image transmission for FAST (Focused Assessment with Sonography for Trauma). J Telemed Telecare, 2013; 19:450–455.
34.
McBethP, CrawfordI, TirutaC, et al.Help is in your pocket: The potential accuracy of smartphone- and laptop-based remotely guided resuscitative telesonography. Telemed J E Health, 2013; 19:924–930.
35.
KirkpatrickAW, McKeeI, McKeeJL, et al.Remote just-in-time telementored trauma ultrasound: A double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display. Am J Surg, 2016; 211:894–902.
36.
KwonD, BouffardJA, van HolsbeeckM, et al.Battling fire and ice: Remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink. Am J Surg, 2007; 193:417–420.
37.
KirkpatrickAW, BlaivasM, SargsyanAE, et al.Enabling the mission through trans-atlantic remote mentored musculoskeletal ultrasound: Case report of a portable hand-carried tele-ultrasound system for medical relief missions. Telemed J E Health, 2013; 19:530–534.
38.
KimC, ChaH, KangBS, ChoiHJ, et al.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. J Digit Imaging, 2016; 29:347–356.
39.
MelansonSW, McCarthyJ, StromskiCJ, et al.Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp Emerg Car, 2001; 5:399–402.
40.
HeegaardW, PlummerD, DriesD, et al.Ultrasound for the air medical clinician. Air Med J, 2004; 23:20–23.
41.
RolineCE, HeegaardWG, MooreJC, et al.Feasibility of bedside thoracic ultrasound in the helicopter emergency medical services setting. Air Med J, 2013; 32:153–157.
42.
MazurSM, PearceA, AlfredS, et al. The F.A.S.T.E.R. trial. Injury, 2008; 39:512–518.
43.
HamptonK, VasiosW, LoosP. SOLCUS: Update on point-of-care ultrasound in special operations medicine. J Spec Oper Med, 2016; 16:58–61.
44.
AdamsSJ, BurbridgeBE, BadeaA, et al.A crossover comparison of standard and telerobotic approaches to prenatal sonography. J Ultrasound Med, 2018; 37:2603–2612.
45.
GeorgescuM, SacccomandiA, BaudronB, ArbeillePL. Remote sonography in routine clinical practice between two isolated medical centers and the university hospital using a robotic arm: a 1-year study. Telemed J E Health, 2016; 22:276–281.
46.
SwerdlowDR, ClearyK, WilsonE, et al.Robotic arm-assisted sonography: review of technical developments and potential clinical applications. AJR Am J Roentgenol, 2017; 208:733–738.
47.
ThrallJH, LiX, LiQ, et al.Artificial intelligence and machine learning in radiology: opportunities, challenges, pitfalls, and criteria for success. J Am Coll Radiol, 2018; 15:504–508.
48.
EstevaA, KuprelB, NovoaRA, et al.Dermatologist-level classification of skin cancer with deep neural networks. Nature, 2017; 542:115–118.
