Telementoring for Emergency Ultrasonography Performed by Emergency Physicians With Low Experience.

Telementoring for Emergency Ultrasonography Performed by Emergency Physicians

1. Purpose

   • This study aims to evaluate the feasibility of iPhone based telementoring for the ultrasonography.

2. Methods

   • Study Design: Prospective observational study
   • Study Setting: Urban academic ED of tertiary care teaching hospital
   • Study period: July, 2014 ~ December, 2014 (six months)
   • Study participants: Of the patients who need to undergo ultrasonography in the ED, those who are agreed to participate in this study are enrolled.
3. We hypothesize that the iPhone based real time tele-diagnosis by remote expert would not be different from the diagnosis via his/her direct ultrasound examination.

Study Overview

• Status: Completed
• Conditions: Teleradiology, Ultrasonography
• Intervention / Treatment: Device: IPhone based realtime remote ultrasound interpretation

Detailed Description

• Teleultrasound system

  1. We already developed the telesystem for viewing the ultrasound examinations performed in the emergency department (ED) by using the iPhone display simultaneously at the out of ED.
  2. Remote mentors can view the patient and examiner's hand holding the ultrasound probe while simultaneously viewing the ultrasound image in the same field of ultrasound display
  3. The examiner and the mentor can communicate with each other.

• Procedures:

  1. The residents perform the ultrasonography and the out of ED expert observe the practice by using the iPhone.
  2. While viewing the practice, the mentor can guide the examiner (resident) to manipulate the probe to get the best ultrasound image.
  3. After finishing the practice, the mentor measures the speed of used mobile network using the application of 'BENCHBEE' and records the predesigned registry.
  4. The registry includes the patients' information, the time and date of examination, the type of mobile network (3G, LTE, WiFi and etc.) and the speed of mobile network, used tele-displayer (iPhone, iPad, iPad mini), used probe, performed body organ (cardiac, lung, Hepatobiliary, vascular, genital organ, appendix and intestine including suspected intussusception), the examiner's level of training and the ultrasound experience of the examiner and the mentor.
  5. The mentor records the patient's diagnosis and the problems during this procedure.
  6. The mentor goes to the patient, perform the ultrasonography directly and confirm the patients' diagnosis.
  7. We will investigate the diagnostic accuracy for iPhone-based tele-ultrasonography comparing these diagnoses.

• Study Type: Observational
• Enrollment (Actual): 103

Contacts and Locations

Study Locations

• Korea, Republic of
  • GyeongGi-do
    • Guri, GyeongGi-do, Korea, Republic of, 471-701
      • Hanyang University Guri Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

The patients who undergo the ultrasonography in the emergency department

Description

Inclusion Criteria:

• the patients who undergo the emergency physician-performed ultrasonography

Exclusion Criteria:

• the failure of examination due to such as patients' severe obesity, a large amount of gas and etc.
• the patients who refuse to participate in this study.
• the patients who need emergency ultrasonography.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
- The patients who undergo ultrasonography in the ED	Device: IPhone based realtime remote ultrasound interpretation; Other Names: Application name: cubeview

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diagnostic accuracy by using Receiver Operating Characteristics (area under the curve)	Comparing sensitivity and specificity between the iPhone and LCD monitor of the ultrasound machine.	up to 6 months

Collaborators and Investigators

• Sponsor: Hanyang University
• Investigators: Study Chair: Bo Seung Kang, MD, Emergency Department of Hanyang University

Publications and helpful links

General Publications

• Kim C, Kang BS, Choi HJ, Lee YJ, Kang GH, Choi WJ, Kwon IH. Nationwide online social networking for cardiovascular care in Korea using Facebook. J Am Med Inform Assoc. 2014 Jan-Feb;21(1):17-22. doi: 10.1136/amiajnl-2012-001465. Epub 2013 May 23.
• Park JB, Choi HJ, Lee JH, Kang BS. An assessment of the iPad 2 as a CT teleradiology tool using brain CT with subtle intracranial hemorrhage under conventional illumination. J Digit Imaging. 2013 Aug;26(4):683-90. doi: 10.1007/s10278-013-9580-0.
• Lim TH, Choi HJ, Kang BS. Feasibility of dynamic cardiac ultrasound transmission via mobile phone for basic emergency teleconsultation. J Telemed Telecare. 2010;16(5):281-5. doi: 10.1258/jtt.2010.091109. Epub 2010 Jun 24.
• Choi HJ, Lee JH, Kang BS. Remote CT reading using an ultramobile PC and web-based remote viewing over a wireless network. J Telemed Telecare. 2012 Jan;18(1):26-31. doi: 10.1258/jtt.2011.110412. Epub 2011 Nov 8.
• Biegler N, McBeth PB, Tiruta C, Hamilton DR, Xiao Z, Crawford I, Tevez-Molina M, Miletic N, Ball CG, Pian L, Kirkpatrick AW. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - 'a remote virtual mentor'. Crit Ultrasound J. 2013 Jun 27;5(1):5. doi: 10.1186/2036-7902-5-5.
• McBeth P, Crawford I, Tiruta C, Xiao Z, Zhu GQ, Shuster M, Sewell L, Panebianco N, Lautner D, Nicolaou S, Ball CG, Blaivas M, Dente CJ, Wyrzykowski AD, Kirkpatrick AW. Help is in your pocket: the potential accuracy of smartphone- and laptop-based remotely guided resuscitative telesonography. Telemed J E Health. 2013 Dec;19(12):924-30. doi: 10.1089/tmj.2013.0034. Epub 2013 Oct 19.

Study record dates

Study Major Dates

• Study Start: June 1, 2014
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): April 1, 2015

Study Registration Dates

• First Submitted: June 5, 2014
• First Submitted That Met QC Criteria: June 8, 2014
• First Posted (Estimate): June 10, 2014

Study Record Updates

• Last Update Posted (Estimate): April 17, 2015
• Last Update Submitted That Met QC Criteria: April 16, 2015
• Last Verified: April 1, 2015

More Information

Terms related to this study

• Keywords: real time, ultrasonography, handheld
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2014-01