High Quality Ultrasound Images Can Be Acquired by Nonphysicians in Developing Countries Instructed by Tele-Intensivists Using Commercially Available Video-Chat Technology

Abstract

Rationale Bedside ultrasound is a valuable diagnostic tool in the intensive care unit (ICU). We have demonstrated that geographically separated intensivists can guide non-physicians to obtain high-quality ultrasound images via Philips VISICU e-ICU technology with image quality comparable to those acquired directly from the ultrasound machine (Levine et al., High Quality Ultrasound Images Can Be Acquired By Non-Physicians Instructed By Tele-Intensivists, abstract submitted to ATS International Conference, San Diego, California 2014). Unfortunately, proprietary software is prohibitively expensive for many hospitals that could benefit from real-time tele-intensivist interpretation of ultrasound images. We conducted an educational pilot to determine: 1) if high quality ultrasound images can be captured and transmitted using commercially available video-chat software and 2) if the quality of these images are comparable to those obtained directly from the ultrasound machine. Methods Non-physicians viewed a brief instructional slideshow on using the SonoSite SICU ultrasound machine. A geographically separated tele-intensivist used a tele-ICU Philips VISICU two-way camera to provide real-time instruction to the "ultrasonographer" to acquire each image. The acquired images included the right internal jugular vein, bilateral lung apices and bases, heart (subxiphoid view), and bladder. When the "ultrasonographer" acquired an optimal target image, as determined by the tele-intensivist, a bedside still image of the ultrasound screen was captured with an iPad2 using Apple FaceTime video-chat software. This image was simultaneously saved on the ultrasound machine. The tele-intensivist later used a five-point Likert scale to compare the quality of the FaceTime images to the ultrasound machine images. Results Eleven non-physicians participated in the educational pilot. Two intensivists, averaging six years of bedside ultrasound experience and greater than five years of eICU experience, remotely directed image acquisition and interpretation. Seventy-seven total images were obtained. The intensivists agreed (defined as "agree" or "strongly agree" on five-point-Likert scale) that 90% (69/77) of the images captured via FaceTime were high quality. For 97% of images (75/77), the intensivist indicated there was no difference in image quality between the FaceTime acquired and direct ultrasound acquired images. The intensivist felt comfortable making clinical decisions based on the real-time ultrasound images obtained using the FaceTime technology 96% (74/77) of the time. Conclusion High-quality ultrasound images can be captured using commercially available video-chat software by minimally trained non-physician "ultrasonographers" guided remotely by tele-intensivists. The image quality does not differ when comparing the images obtained directly from the ultrasound to those obtained using Apple's video-chat FaceTime software. (Figure Presented).