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.
- SourceAvailable from: Alfred Papali
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- "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. "
ABSTRACT: Intensive care unit telemedicine (tele-ICU) uses audiovisual systems to remotely monitor and manage patients. Intensive care unit ultrasound can augment an otherwise limited bedside evaluation. To date, no studies have utilized tele-ICU technology to assess the quality and clinical use of real-time ultrasound images. We assessed whether tele-intensivists can instruct nonphysicians to obtain high-quality, clinically useful ultrasound images. This prospective pilot evaluated the effectiveness of a brief educational session of nonphysician "ultrasonographers" on their ability to obtain ultrasound images (right internal jugular vein, bilateral lung apices and bases, cardiac subxiphoid view, bladder) with real-time tele-intensivist guidance. All ultrasound screen images were simultaneously photographed with a 2-way camera and saved on the ultrasound machine. The tele-intensivist assessed image quality, and an independent ultrasound expert rated their use in guiding clinical decisions. The intensivist rated the tele-ICU camera images as high quality (70/77, 91%) and suitable for guiding clinical decisions (74/77, 96%). Only bilateral lung apices demonstrated differences in quality and clinical use. All other images were rated noninferior and clinically useful. Tele-intensivists can guide minimally trained nonphysicians to obtain high-quality, clinically useful ultrasound images. For most anatomic sites, tele-ICU images are of similar quality to those acquired directly by ultrasound. Copyright © 2015. Published by Elsevier Inc.Journal of Critical Care 06/2015; DOI:10.1016/j.jcrc.2015.05.030 · 2.19 Impact Factor
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- "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   . "
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.01/2013; 2013:986160. DOI:10.1155/2013/986160
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- "Disposition of 7/25 patients was altered by ultrasound, including four who avoided evacuation when acute pathology was excluded Sargsyan et al., 2005 (19) Chiao et al., 2005 (20) Fincke et al., 2005 (21) "
ABSTRACT: In field medical operations, rapid diagnosis and triage of seriously injured patients is critical. With significant bulk and cost constraints placed on all equipment, it is important that any medical devices deployed in the field demonstrate high utility, durability, and ease of use. When medical ultrasound was first used in patient care, machine cost, bulk, and steep learning curves prevented use outside of the radiology department. Now, lightweight portable ultrasound is widely employed at the bedside by emergency physicians. The techniques and equipment have recently been extrapolated out of the hospital setting in a wide variety of environments in an effort to increase diagnostic accuracy in the field. In this review, deployment of lightweight portable ultrasound in the field (by emergency medical services, military operations, disaster relief, medical missions, and expeditions to austere environments) is examined. The feasibility of field deployment and experiences of clinicians using ultrasound in a host of environments are detailed. In addition, special technological considerations such as telemedicine and machine characteristics are reviewed. The use of lightweight portable ultrasound shows great promise in augmenting clinical assessment for field medical operations. Although the feasibility of the technology has been demonstrated in certain medical and trauma applications, further research is needed to determine the utility of ultrasound use for medical illness in the field.Journal of Emergency Medicine 02/2011; 40(2):190-7. DOI:10.1016/j.jemermed.2009.09.006 · 1.18 Impact Factor