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.
"Please cite this article as: Levine AR, et al, Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images, J Crit Care (2015), http://dx.doi.org/10.1016/j.jcrc.2015.05.030 on ultrasound to enhance the physical examination when diagnosing patients with abdominal pain . Outside of the hospital setting, the National Aeronautics and Space Administration originally designed remote telementored ultrasound (RTMUS) to help diagnose and care for astronauts aboard the space station  . Remote telementored ultrasound consists of a geographically separated expert providing real-time guidance and interpreting ultrasound images that are captured and electronically transmitted by an inexperienced ultrasonographer. "
"Remote telementored ultrasound (RTMUS) consists of the use of informatics technologies to facilitate the real-time guidance by a remote expert of an on-site less-experienced ultrasound user to generate and interpret in real-time, meaningful images that guide the care of the patient . This paradigm was initiated and pioneered by investigators from the National Aeronautics and Space Administration as the only practical solution to provide emergency medical imaging onboard the International Space Station . In these studies, novice non-medical users were guided from the ground to generate diagnostic quality images of multiple body regions by ultrasound experts. "
[Show abstract][Hide abstract] ABSTRACT: Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic 'off-the-shelf' technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal.
The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted.
Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination.
Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
"ese efforts were largely initiated by the National Aeronautics and Space Administration (NASA) to allow nonphysician astronauts onboard the International Space Station to conduct ultrasound examinations with realtime guidance from terrestrial experts. us, in the absence of any other diagnostic imaging resources, accurate diagnosis can still be made for most of the medical conditions that might arise in low Earth's orbit    . While these initial efforts were supported by all the technical infrastructure of NASA, advances in connectivity, accessibility, and availability of hand-held computing and communication devices are making real-time mentored tele-ultrasound (RTMTUS) a service that can be brought to R/UR settings in a back pack or even a pocket and potentially used by any nontraditional care provider on any patient   . "
[Show abstract][Hide abstract] ABSTRACT: Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, "nontraditional" providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.
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