140 Patient Performed Thoracic Lung Ultrasound

Abstract

Given expanding utilization of telemedicine for remote patient monitoring and improving portable ultrasound technology, a situation in which patients perform their own ultrasound may not be far in the future. In this study we aimed to evaluate the ability of patients to self-perform lung ultrasound (LUS) with minimal guidance. We hypothesized that with brief instruction, patients could obtain diagnostic ultrasound images of similar quality as those obtained by ultrasound experts. This was a prospective observational study of patients ≥18 years old presenting to a tertiary care emergency department. Patients watched a 5-minute instructional video describing a four-zone LUS protocol (right superior anterior, left superior anterior, right hemidiaphragm, left hemidiaphragm). Patients were surveyed on their comfort and willingness to independently perform the study protocol. Study sonographers repeated the scans using the same scanning protocol. Images were blindly reviewed and independently scored by two ultrasound fellowship-trained attending physicians who rated image quality on a Likert scale from 1-5; a score of 3 or more was deemed interpretable. Inter-rater reliability between the two raters was estimated using intraclass correlation coefficient (ICC). Group differences were compared using Wilcoxon-Mann-Whitney tests and chi- square tests. 32 English-speaking patients (50% female) of mean age 52.9 were enrolled. 94% were right-handed. 75% had prior computer experience or used technology regularly, and 94% had access to smart phones. The proportion of interpretable images were similar between the two groups except for the left hemidiaphragm (90% of provider-obtained images were interpretable vs. 45% of patient-performed images, P=0.002). Overall, the majority of patient-performed images were interpretable (66%). The mean of image scores was significantly higher for provider-obtained images, compared to patient-obtained images (P<0.05), except for images in the right hemidiaphragm, where the quality was similar (P=0.08). Inter-rater reliability was good (ICC = 0.78, 95% CI 0.72-0.83). Overall, patients reported high comfort with performing LUS [median score 4, interquartile range (IQR)4-5] and high willingness to perform LUS in the future (median score 4, IQR 4-5). With limited video-based instruction, patients can independently and comfortably obtain interpretable LUS images. However, patients had more difficulty in obtaining interpretable images in the left hemidiaphragm. With advents in telemedicine and portable ultrasound, patient-performed ultrasound could be explored as a means of home monitoring or remote diagnosis, but further research is needed.