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Big Brother Could Actually Help Quite Easily: Telementored “Just-in-Time” Telesonography of the FAST Over a Smartphone

2011; Elsevier BV; Volume: 58; Issue: 3 Linguagem: Inglês

10.1016/j.annemergmed.2011.04.020

1097-6760

Innes Crawford, Corina Tiruta, Andrew W. Kirkpatrick, Mark Mitchelson, James Ferguson,

Trauma Management and Diagnosis

Trauma remains an ever-increasing cause of preventable years of life lost worldwide. Although prevention is paramount, the earliest identification of injuries and deranged physiology is critical. Ultrasonography is a noninvasive technology that can increasingly assist nearly every facet of resuscitation and diagnosis.1Kirkpatrick A.W. Clinician-performed focused sonography for the re resuscitation of trauma.Crit Care Med. 2007; 35: S162-S172Crossref PubMed Scopus (60) Google Scholar With technical developments, machines are becoming cheaper, more portable, and more user friendly, and thus available to care providers. Nonetheless, ultrasonography is a user-dependent technical skill, meaning that machines may now frequently be available beside the patient, without a skilled user. Just such a situation led NASA to champion the use of advanced communications and informatics to allow terrestrial mentors to remotely guide space providers to gain clinically useful ultrasonographic information using a “just-in-time” educational philosophy2Sargsyan A.E. Hamilton D.R. Jones J.A. et al.FAST at MACH 20: clinical ultrasound aboard the International Space Station.J Trauma. 2005; 58: 35-39Crossref PubMed Scopus (131) Google Scholar in a technique known as telementored telesonography. The University of Calgary has further evaluated a complex emergency department (ED)–to-ED link, with good results.3Dyer D. Cusden J. Turner C. et al.The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.J Trauma. 2008; 65: 1209Crossref PubMed Scopus (56) Google Scholar Both these systems, however, were logistically complex and require mentors to respond to a fixed geographic location, complicating the provision of a continuous immediate response.We thus examined whether telementored telesonography can be radically simplified and conducted over a Smartphone (Iphone-4; Apple, Cupertino, CA). Two experienced clinical sonographers in Aberdeen guided a nonclinical researcher with no previous ultrasonographic experience in Calgary to obtain diagnostic quality images, following a standard focused assessment with sonography for trauma approach, viewing and guiding the examination over their Smartphones. A head-mounted Web camera (LifeCam VX-2000; Microsoft, Redmond, WA) and an ultrasonographic machine through an inexpensive analogue-to-digital converter (VC-211V; ActionStarLinXcel, Taipei, Taiwan) were connected to a laptop computer (Aspire 5741; Acer, Taipei, Taiwan). Xsplit Broadcaster (SplitMediaLabs, Hong Kong) software displayed both the ultrasonographic image and the novice examiner's probe manipulations in real time, which could be selected as a virtual Web camera by Skype (Skype Limited, Luxembourg). A video call was initiated by Skype from Calgary to Aberdeen, allowing bidirectional video and audio communication. The Aberdeen mentors then guided the novice to examine first an ultrasonographic phantom (ER/FASTFAN, Kyoto Kagaku) and afterward a volunteer (Figure). The images were all deemed of diagnostic quality by the remote experts.Although others have investigated viewing images, improving subspecialist access, and allowing instant treatment decisions over Smartphones,4Drnasin I. Grgic M. The use of mobile phones in radiology.http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=5606074&isnumber=5606063Google Scholar, 5Parker A. Rubinfeld I. Azuh O. et al.What ring tone should be used for patient safety? early results with a Blackberry-based telementoring safety solution.Am J Surg. 2010; 199: 336-341Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar we believe this is the first example of real-time telementored telesonography being conducted over a Smartphone. With the development of ever more powerful processors and faster global Internet connections, any less experienced emergency responder can theoretically be mentored through simple infrastructure by anybody appropriate who has a Smartphone, a device becoming the Swiss Army knife of medicine. Trauma remains an ever-increasing cause of preventable years of life lost worldwide. Although prevention is paramount, the earliest identification of injuries and deranged physiology is critical. Ultrasonography is a noninvasive technology that can increasingly assist nearly every facet of resuscitation and diagnosis.1Kirkpatrick A.W. Clinician-performed focused sonography for the re resuscitation of trauma.Crit Care Med. 2007; 35: S162-S172Crossref PubMed Scopus (60) Google Scholar With technical developments, machines are becoming cheaper, more portable, and more user friendly, and thus available to care providers. Nonetheless, ultrasonography is a user-dependent technical skill, meaning that machines may now frequently be available beside the patient, without a skilled user. Just such a situation led NASA to champion the use of advanced communications and informatics to allow terrestrial mentors to remotely guide space providers to gain clinically useful ultrasonographic information using a “just-in-time” educational philosophy2Sargsyan A.E. Hamilton D.R. Jones J.A. et al.FAST at MACH 20: clinical ultrasound aboard the International Space Station.J Trauma. 2005; 58: 35-39Crossref PubMed Scopus (131) Google Scholar in a technique known as telementored telesonography. The University of Calgary has further evaluated a complex emergency department (ED)–to-ED link, with good results.3Dyer D. Cusden J. Turner C. et al.The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.J Trauma. 2008; 65: 1209Crossref PubMed Scopus (56) Google Scholar Both these systems, however, were logistically complex and require mentors to respond to a fixed geographic location, complicating the provision of a continuous immediate response. We thus examined whether telementored telesonography can be radically simplified and conducted over a Smartphone (Iphone-4; Apple, Cupertino, CA). Two experienced clinical sonographers in Aberdeen guided a nonclinical researcher with no previous ultrasonographic experience in Calgary to obtain diagnostic quality images, following a standard focused assessment with sonography for trauma approach, viewing and guiding the examination over their Smartphones. A head-mounted Web camera (LifeCam VX-2000; Microsoft, Redmond, WA) and an ultrasonographic machine through an inexpensive analogue-to-digital converter (VC-211V; ActionStarLinXcel, Taipei, Taiwan) were connected to a laptop computer (Aspire 5741; Acer, Taipei, Taiwan). Xsplit Broadcaster (SplitMediaLabs, Hong Kong) software displayed both the ultrasonographic image and the novice examiner's probe manipulations in real time, which could be selected as a virtual Web camera by Skype (Skype Limited, Luxembourg). A video call was initiated by Skype from Calgary to Aberdeen, allowing bidirectional video and audio communication. The Aberdeen mentors then guided the novice to examine first an ultrasonographic phantom (ER/FASTFAN, Kyoto Kagaku) and afterward a volunteer (Figure). The images were all deemed of diagnostic quality by the remote experts. Although others have investigated viewing images, improving subspecialist access, and allowing instant treatment decisions over Smartphones,4Drnasin I. Grgic M. The use of mobile phones in radiology.http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=5606074&isnumber=5606063Google Scholar, 5Parker A. Rubinfeld I. Azuh O. et al.What ring tone should be used for patient safety? early results with a Blackberry-based telementoring safety solution.Am J Surg. 2010; 199: 336-341Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar we believe this is the first example of real-time telementored telesonography being conducted over a Smartphone. With the development of ever more powerful processors and faster global Internet connections, any less experienced emergency responder can theoretically be mentored through simple infrastructure by anybody appropriate who has a Smartphone, a device becoming the Swiss Army knife of medicine.