title: Simple, almost anywhere, with almost anyone: remote low-cost telementored resuscitative lung ultrasound.
abstract: BACKGROUND
  Apnea (APN) and pneumothorax (PTX) are common immediately life-threatening conditions. Ultrasound is a portable tool that captures anatomy and physiology as digital information allowing it to be readily transferred by electronic means. Both APN and PTX are simply ruled out by visualizing respiratory motion at the visceral-parietal pleural interface known as lung sliding (LS), corroborated by either the M-mode or color-power Doppler depiction of LS. We thus assessed how economically and practically this information could be obtained remotely over a cellular network.
  
  
  METHODS
  Ultrasound images were obtained on handheld ultrasound machines streamed to a standard free internet service (Skype) using an iPhone. Remote expert sonographers directed remote providers (with variable to no ultrasound experience) to obtain images by viewing the transmitted ultrasound signal and by viewing the remote examiner over a head-mounted webcam. Examinations were conducted between a series of remote sites and a base station. Remote sites included two remote on-mountain sites, a small airplane in flight, and a Calgary household, with base sites located in Pisa, Rome, Philadelphia, and Calgary.
  
  
  RESULTS
  In all lung fields (20/20) on all occasions, LS could easily and quickly be seen. LS was easily corroborated and documented through capture of color-power Doppler and M-mode images. Other ultrasound applications such as the Focused Assessment with Sonography for Trauma examination, vascular anatomy, and a fetal wellness assessment were also demonstrated.
  
  
  CONCLUSIONS
  The emergent exclusion of APN-PTX can be immediately accomplished by a remote expert economically linked to almost any responder over cellular networks. Further work should explore the range of other physiologic functions and anatomy that could be so remotely assessed.
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Paul B
authors.initials: PB
authors.lastname: McBeth
authors.forename: Innes
authors.initials: I
authors.lastname: Crawford
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Trevor
authors.initials: T
authors.lastname: Hamilton
authors.forename: Kimberly
authors.initials: K
authors.lastname: Musselwhite
authors.forename: Nova
authors.initials: N
authors.lastname: Panebianco
authors.forename: Lawrence
authors.initials: L
authors.lastname: Melniker
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.forename: Carlotta
authors.initials: C
authors.lastname: Gherdovich
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
mesh_terms: D000416:Alberta; D001049:Apnea / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D040421:Cell Phone / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D004630:Emergencies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D019095:Point-of-Care Systems; D019114:Remote Consultation / Q000191:economics / Q000379:methods*; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging* / Q000628:therapy; D012151:Resuscitation / Q000379:methods; D012680:Sensitivity and Specificity; D012984:Software; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D014741:Video Recording