FAST at MACH 20: clinical ultrasound aboard the International Space Station.
ABSTRACT Focused assessment with sonography for trauma (FAST) examination has been proved accurate for diagnosing trauma when performed by nonradiologist physicians. Recent reports have suggested that nonphysicians also may be able to perform the FAST examination reliably. A multipurpose ultrasound system is installed on the International Space Station as a component of the Human Research Facility. Nonphysician crew members aboard the International Space Station receive modest training in hardware operation, sonographic techniques, and remotely guided scanning. This report documents the first FAST examination conducted in space, as part of the sustained effort to maintain the highest possible level of available medical care during long-duration space flight.
An International Space Station crew member with minimal sonography training was remotely guided through a FAST examination by an ultrasound imaging expert from Mission Control Center using private real-time two-way audio and a private space-to-ground video downlink (7.5 frames/second). There was a 2-second satellite delay for both video and audio. To facilitate the real-time telemedical ultrasound examination, identical reference cards showing topologic reference points and hardware controls were available to both the crew member and the ground-based expert.
A FAST examination, including four standard abdominal windows, was completed in approximately 5.5 minutes. Following commands from the Mission Control Center-based expert, the crew member acquired all target images without difficulty. The anatomic content and fidelity of the ultrasound video were excellent and would allow clinical decision making.
It is possible to conduct a remotely guided FAST examination with excellent clinical results and speed, even with a significantly reduced video frame rate and a 2-second communication latency. A wider application of trauma ultrasound applications for remote medicine on earth appears to be possible and warranted.
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ABSTRACT: Ultrasound has become a major diagnostic tool in many parts of the world, with broad clinical applications. Ultrasound provides a noninvasive, painless mode of diagnostics that produces instant results. Disseminating ultrasound skills to remote and rural communities has become a challenge for many medical schools, particularly those where distances are great and the density of population is low. The University of California, Irvine School of Medicine and the University of New England School of Rural Medicine in Australia piloted the use of dual video feeds in two scenarios: (1) to display the instructor's ultrasound feed and the instructor's transducer placement to provide guidance for remote students; and (2) to display side-by-side views of the instructor's and the remote student's ultrasound feeds to allow the instructor to guide the remote student in his or her transducer placement. Using high-speed broadband connections, the two schools demonstrated the feasibility of remote, synchronous, practical, and hands-on ultrasound training and instruction over international distances. This opens up a broad range of possibilities for future remote ultrasound education.Telemedicine and e-Health 03/2015; DOI:10.1089/tmj.2014.0050 · 1.54 Impact Factor
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ABSTRACT: Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25-50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.Critical care research and practice 11/2014; 2014:934796. DOI:10.1155/2014/934796
Article: Wilderness medicine.[Show abstract] [Hide abstract]
ABSTRACT: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.01/2014; 5(1):5-15. DOI:10.5847/wjem.j.1920-8642.2014.01.001