title: Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine.
abstract: Remote telementored ultrasound (RTMUS) systems can deliver ultrasound (US) expertise to regions lacking highly trained bedside ultrasonographers and US interpreters. To date, no studies have evaluated the quality and clinical utility of US images transmitted using commercially available RTMUS systems.
  
  
  
  This prospective pilot evaluated the quality of US images (right internal jugular vein, lung apices and bases, cardiac subxiphoid view, bladder) obtained using a commercially available iPad operating FaceTime software. A bedside non-physician obtained images and a tele-intensivist interpreted them. All US screen images were simultaneously saved on the US machine and captured via a FaceTime screen shot. The tele-intensivist and an independent US expert rated image quality and utility in guiding clinical decisions.
  
  
  
  The tele-intensivist rated FaceTime images as high quality (90% [69/77]) and could comfortably make clinical decisions using these images (96% [74/77]). Image quality did not differ between FaceTime and US images (97% (75/77). Strong inter-rater reliability existed between tele-intensivist and US expert evaluations (Spearman's rho 0.43; P<.001).
  
  
  
  An RTMUS system using commercially available two-way audiovisual technology can transmit US images without quality degradation. For most anatomic sites assessed, US images acquired using FaceTime are not inferior to those obtained directly with the US machine.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA, 15213, United States. Electronic address: levinar@upmc.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. Electronic address: buchneja@gmail.com.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Buchner
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
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; 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: University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States. Electronic address: haney.mallemat@gmail.com.
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: apapali@medicine.umaryland.edu.
authors.forename: Alfred
authors.initials: A
authors.lastname: Papali
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; University of Maryland School of Medicine, Department of Emergency 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
mesh_terms: D000328:Adult; D034201:Computers, Handheld; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D063731:Mobile Applications; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D013685:Telecommunications; D017216:Telemedicine; D014463:Ultrasonography / Q000379:methods; D001743:Urinary Bladder / Q000000981:diagnostic imaging*
keywords: FaceTime; RTMUS; remote telementored ultrasound systems; tele-ICU; tele-intensivist; tele-ultrasound