Abstract
Abstract Purpose Remote guidance techniques have been developed by NASA researchers to allow non-clinicians to perform complex ultrasound examinations on the International Space Station to increase clinical diagnostic capabilities. Real-time or near real-time communication will not be an option for missions beyond the Earth and Moon; non-experts will have to scan autonomously. We investigated the ability of non-experts to perform point-of-care ultrasound in a remote location using “virtual guidance”, consisting of a video-based training and troubleshooting guide to acquire cardiac ultrasound images. Methods Non-expert operators (n = 4) reviewed a short (<15 min) cardiac ultrasound examination training video using dedicated video glasses and an iPod. They then acquired echocardiography scansets on normal, volunteer subjects at Resolute Bay, Canada using a portable ultrasound device. Image quality was evaluated using a scoring system by two experts in echocardiography. Results Cardiac ultrasound examinations were autonomously completed by four non-expert operators using virtual guidance in under 30 min and judged to be adequate for clinical interpretation. Virtual guidance with the video glasses and streaming examination guide was accepted by all operators as an effective guidance technique for this purpose. Conclusions Virtual guidance is a novel technique that may allow data acquisition by non-expert operators autonomously when on-site expertise or real time support is not available. Further refinement of the technique should be explored to enhance autonomous medical capabilities in isolated or underserved settings, either on or off the planet.
Highlights
Evidence published in peer-reviewed literature is driving further expansion and broader recognition of point-of-care ultrasound
We investigated the ability of non-experts to perform point-of-care ultrasound in a remote location using ‘‘virtual guidance’’, consisting of a video-based training and troubleshooting guide to acquire cardiac ultrasound images
Cardiac ultrasound examinations were autonomously completed by four non-expert operators using virtual guidance in under 30 min and judged to be adequate for clinical interpretation
Summary
A battery-powered, compact ultrasound device (Zonare Medical systems, Inc., Mountain View, CA, USA) was used with a P 4-1C phased-array transducer was used for the echocardiographic examinations (Fig. 4). Parasternal long axis (PLAX) color Doppler, 3. Parasternal short axis (PSAX) at the mitral level, 4. Parasternal short axis (PSAX) at the papillary muscle level, 5. All four remote ultrasound operators were able to activate and use the ultrasound equipment, position the patient, hold the probe effectively, and obtain some cardiac images by following the virtual guidance instructions as determined by the quality of the study and post-study interviews with the participants (Fig. 5). All operators were able to obtain three images, which were judged to be diagnostically adequate (with a score greater than 15 points): PLAX with and without color Doppler, PSAX at the papillary muscle level and mitral level, apical four-chamber view with and without color Doppler and Mitral Valve Doppler (Table 1, Fig. 6). Some suggestions for improvement in the video program included: (1) creating a chapter for each image to allow the operator to view the instruction as long as they need before proceeding to the image, (2) maintaining the reference image in upper screen view while showing trouble shooting images in the middle of the screen, and (3) programming a short time delay with a persisting display of the target image after the instructional component is finished in order to increase image recognition
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