title: Telemedicine-guided carotid and transcranial ultrasound: a pilot feasibility study.
abstract: OBJECTIVE
  Transcranial Doppler (TCD) and carotid duplex (CD) provide rapid and safe screening for stroke patients but are highly operator dependent. We explored the feasibility of telemedicine (TM)-guided TCD/CD administered by a health care provider inexperienced with ultrasound.
  
  
  METHODS
  Dual video screens transmitted real-time TCD/CD images and sound to a neurosonographer. TM TCD/CD characteristics were compared with an in-person (IP) examination independently obtained on the same patient. We compared carotid stenosis, thrombolysis in brain ischemia (TIBI) flow grades, and the time spent on testing.
  
  
  RESULTS
  We examined 8 subjects with a median age of 51 (31 to 63 range). IP and TM successfully examined 100% of internal carotid and middle cerebral arteries, 50% versus 44% of anterior cerebral artery, and 100% versus 88% of the basilar arteries, respectively. The median time in minutes IP versus TM was 15 (range 10 to 35) and 30 (15 to 50) for CD (P=0.07) and 18 (15 to 30) and 45 (30 to 55) for TCD (P=0.002), respectively. TM correctly identified all normal CD/TCD examinations in 7 subjects. In 1 patient, TM identified carotid occlusion but misread TIBI flow grades in both middle cerebral arteries.
  
  
  CONCLUSIONS
  Our pilot study showed the feasibility of TCD/CD by an inexperienced health professional guided by a sonographer via TM. Tests were completed within times comparable to outpatient setting in a vascular laboratory.
authors.affiliation: Department of Neurology, University of Texas Health Science Center, Houston, TX 77030, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulik
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Garami
authors.forename: Nichole A
authors.initials: NA
authors.lastname: Porche
authors.forename: Eva
authors.initials: E
authors.lastname: Fulep
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Anne W
authors.initials: AW
authors.lastname: Wojner-Alexandrov
authors.forename: John Y
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology; D017216:Telemedicine / Q000379:methods*; D013927:Thrombosis; D013997:Time Factors; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation* / Q000379:methods*