McBeth Paul B, Crawford Innes, Blaivas Michael, Hamilton Trevor, Musselwhite Kimberly, Panebianco Nova, Melniker Lawrence, Ball Chad G, Gargani Luna, Gherdovich Carlotta, Kirkpatrick Andrew W
Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada.
J Trauma. 2011 Dec;71(6):1528-35. doi: 10.1097/TA.0b013e318232cca7.
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.
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.
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.
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.
呼吸暂停（APN）和气胸（PTX）是常见的直接危及生命的病症。超声是一种便携式工具，可将解剖结构和生理信息捕获为数字信息，便于通过电子手段轻松传输。通过观察脏层-壁层胸膜界面处的呼吸运动（即肺滑动，LS），并结合M型或彩色能量多普勒对LS的描绘，可简单排除APN和PTX。因此，我们评估了如何通过蜂窝网络远程经济且实际地获取这些信息。
使用iPhone在手持超声设备上获取超声图像，并将其传输到标准的免费互联网服务（Skype）。远程专家超声医师指导远程提供者（超声经验不一或无经验）通过查看传输的超声信号以及通过头戴式网络摄像头查看远程检查者来获取图像。检查在一系列远程站点和一个基站之间进行。远程站点包括两个偏远山区站点、一架飞行中的小型飞机以及卡尔加里的一户家庭，基站位于比萨、罗马、费城和卡尔加里。
在所有情况下的所有肺野（20/20）中，均可轻松快速地看到LS。通过捕获彩色能量多普勒和M型图像，可轻松证实并记录LS。还展示了其他超声应用，如创伤超声重点评估检查、血管解剖结构以及胎儿健康评估等。
通过蜂窝网络与几乎任何应答者进行经济连接的远程专家，可立即实现对APN - PTX的紧急排除。进一步的工作应探索可进行远程评估的其他生理功能和解剖结构的范围。
