Feasibility of Remote Real-Time Guidance of a Cardiac Examination Performed by Novices Using a Pocket-Sized Ultrasound Device

Abstract EN

Background.

The potential of pocket-sized ultrasound devices (PUDs) to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users.

Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE) through wireless guidance of novice users.

Methods.

Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD), LA enlargement (LAE), ultrasound lung comets (ULC+), and elevated CVP (eCVP).

Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc.) attached to the PUD and transmitted data wirelessly.

Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds.

Results.

Novice versus sonographer imaging yielded technically adequate views in 122/135 (90%) versus 130/135 (96%) (P<0.05).

CLUE’s combined SN, SP, and ACC were 0.67, 0.96, and 0.90.

Technical adequacy (%) and accuracy for each abnormality (n) were LVSD (85%, 0.93, n=5), LAE (89%, 0.74, n=16), ULC+ (100%, 0.94, n=5), and eCVP (78%, 0.91, n=1).

Conclusion.

A novice can perform the CLUE using PUD when wirelessly guided by an expert.

This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.