title: Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: Alevine1@umm.edu.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Levine
authors.affiliation: Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States. Electronic address: drmccurdy@gmail.com.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McCurdy
authors.affiliation: Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States. Electronic address: mzubrow@umm.edu.
authors.forename: Marc T
authors.initials: MT
authors.lastname: Zubrow
authors.affiliation: Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States. Electronic address: apapali@umm.edu.
authors.forename: Alfred
authors.initials: A
authors.lastname: Papali
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States. Electronic address: hmallemat@umm.edu.
authors.forename: Haney A
authors.initials: HA
authors.lastname: Mallemat
authors.affiliation: Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States. Electronic address: avercele@medicine.umaryland.edu.
authors.forename: Avelino C
authors.initials: AC
authors.lastname: Verceles
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D013663:Teaching / Q000379:methods; D017216:Telemedicine / Q000379:methods*; D014465:Ultrasonics / Q000193:education* / Q000592:standards; D014463:Ultrasonography / Q000592:standards*
keywords: RTMUS; Remote telementored ultrasound systems; Tele-ICU; Tele-intensivist; Tele-ultrasound