PMID- 30478478
OWN - NLM
STAT- MEDLINE
DCOM- 20201116
LR  - 20201116
IS  - 1618-727X (Electronic)
IS  - 0897-1889 (Print)
IS  - 0897-1889 (Linking)
VI  - 32
IP  - 5
DP  - 2019 Oct
TI  - Remote Real-Time Ultrasound Supervision via Commercially Available and Low-Cost 
      Tele-Ultrasound: a Mixed Methods Study of the Practical Feasibility and Users' 
      Acceptability in an Emergency Department.
PG  - 841-848
LID - 10.1007/s10278-018-0157-9 [doi]
AB  - Minor emergency departments (ED) struggle to access sufficient expertise to 
      supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using 
      tele-ultrasound (tele-US) for remote supervision may remedy this situation. We 
      aimed to evaluate the feasibility of real-time supervision via tele-US when 
      applied to an everyday ED clinic. We conducted a mixed methods study that 
      assessed practical feasibility, determined performance, and explored users' 
      acceptability of supervision via tele-US. Technical performance was assessed 
      quantitatively by the ratio in mean gray value between images on site and as 
      received by the supervisor, and by after-compression frame rate. Qualitatively, 
      12 exploratory semi-structured interviews were conducted with exposed junior 
      doctors and supervisors. Remote supervision via tele-US was performed with 10 
      junior doctors scanning 45 included patients. During performance assessment, 
      neither alternating internet connection nor software significantly changed the 
      mean gray value ratio. The lowest median frame rate of 4.6 (interquartile range 
      [IQR]: 3.1-5.0) was found by using a 4G internet connection; the highest of 28.5 
      (IQR: 28.5-29.0) was found with alternative computer and local area network 
      internet connection. In interviews, supervisors stressed the importance of 
      preserving frame rate, and junior doctors emphasized a need for shared ultrasound 
      terminology. In the qualitative analysis, setup mobility, accessibility, and time 
      consumption were emphasized as being of key importance for future clinical 
      implementations. Remote supervision via a commercially available and low-cost 
      tele-US setup is operational for both junior doctors and supervisors when applied 
      to lung and cardiac POCUS scans of hospitalized patients.
FAU - Jensen, Stig Holm
AU  - Jensen SH
AUID- ORCID: 0000-0003-3815-2141
AD  - Emergency Department, Regional Hospital West Jutland, Herning, Denmark. 
      stig.holm.jensen@post.au.dk.
AD  - Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus 
      University, Palle Juul-Jensens Boulevard 99, Building J, Level 1 (J103), 8200, 
      Aarhus N, Denmark. stig.holm.jensen@post.au.dk.
FAU - Duvald, Iben
AU  - Duvald I
AD  - Interdisciplinary Centre for Organizational Architecture (ICOA), Business and 
      Social Sciences, Aarhus University, Aarhus, Denmark.
AD  - Department of Business Development and Technology, Business and Social Sciences, 
      Aarhus University, Herning, Denmark.
FAU - Aagaard, Rasmus
AU  - Aagaard R
AD  - Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus 
      University, Palle Juul-Jensens Boulevard 99, Building J, Level 1 (J103), 8200, 
      Aarhus N, Denmark.
AD  - Department of Internal Medicine, Regional Hospital Randers, Randers, Denmark.
FAU - Primdahl, Stine Catharina
AU  - Primdahl SC
AD  - Emergency Department, Regional Hospital West Jutland, Herning, Denmark.
FAU - Petersen, Poul
AU  - Petersen P
AD  - Emergency Department, Regional Hospital West Jutland, Herning, Denmark.
FAU - Kirkegaard, Hans
AU  - Kirkegaard H
AD  - Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus 
      University, Palle Juul-Jensens Boulevard 99, Building J, Level 1 (J103), 8200, 
      Aarhus N, Denmark.
FAU - Weile, Jesper
AU  - Weile J
AD  - Emergency Department, Regional Hospital West Jutland, Herning, Denmark.
AD  - Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus 
      University, Palle Juul-Jensens Boulevard 99, Building J, Level 1 (J103), 8200, 
      Aarhus N, Denmark.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Digit Imaging
JT  - Journal of digital imaging
JID - 9100529
SB  - IM
MH  - *Emergency Service, Hospital
MH  - Feasibility Studies
MH  - Female
MH  - Heart Diseases/*diagnostic imaging
MH  - Humans
MH  - Lung Diseases/*diagnostic imaging
MH  - Male
MH  - *Point-of-Care Systems
MH  - Telemedicine/*methods
MH  - Ultrasonography/*methods
PMC - PMC6737136
OTO - NOTNLM
OT  - Point-of-care ultrasound
OT  - Tele-ultrasound
COIS- The authors declare that there are no conflicts of interest. This research was 
      not sponsored by any company. None of the authors have any financial relationship 
      with Apple; Lenovo; MM Vision; Visicom Media; Logitech; GE Healthcare; Marshall; 
      Epiphan Video; Skype; National Institutes of Health, USA; Ookla; or any of their 
      products. The authors have full control of data.
EDAT- 2018/11/28 06:00
MHDA- 2020/11/18 06:00
PMCR- 2020/10/01
CRDT- 2018/11/28 06:00
PHST- 2018/11/28 06:00 [pubmed]
PHST- 2020/11/18 06:00 [medline]
PHST- 2018/11/28 06:00 [entrez]
PHST- 2020/10/01 00:00 [pmc-release]
AID - 10.1007/s10278-018-0157-9 [pii]
AID - 157 [pii]
AID - 10.1007/s10278-018-0157-9 [doi]
PST - ppublish
SO  - J Digit Imaging. 2019 Oct;32(5):841-848. doi: 10.1007/s10278-018-0157-9.