Extreme musculo-skeletal ultrasound: training of non-physicians in the Arctic Circle
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ORIGINAL ARTICLE
Extreme musculo-skeletal ultrasound: training of non-physicians in the Arctic Circle Kathleen O’Connell • Antonio J. Bouffard • Andrew Vollman • Rosario Mercado-Young Ashot E. Sargsyan • Ilan Rubinfeld • Scott A. Dulchavsky
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Received: 4 November 2010 / Accepted: 3 February 2011 / Published online: 2 March 2011 Ó Springer-Verlag 2011
Abstract Objective The purpose of this study was to compare if non-physician, inexperienced ultrasound subjects can take quality diagnostic images after watching a brief educational video and using reference cue cards (autonomous group) versus taking ultrasound images with expert guidance using a satellite connection. Methods Six non-medical, inexperienced ultrasound subjects from a rural area (Arctic Circle) obtained ultrasound images of target anatomic regions using a portable ultrasound device after receiving expert-guided training or autonomous training (educational video and cue cards). Real-time expert guidance was provided using an audiovisual tele-ultrasound connection with direct ultrasound video compression which was relayed to a remote expert via a secure satellite connection. The resultant images from all studies were blindly reviewed by imaging experts for determination of diagnostic adequacy. Results All of the examinations were completed in \15 min. The blinded expert identified 85.1% of autonomously acquired images and 86.2% of the images obtained
K. O’Connell A. Vollman I. Rubinfeld S. A. Dulchavsky (&) Department of Surgery, CFP-1, Henry Ford Health Systems, 2799 West Grand Boulevard, Detroit, MI 48202, USA e-mail: [email protected] A. J. Bouffard Department of Radiology, Henry Ford Hospital, Detroit, MI, USA R. Mercado-Young A. E. Sargsyan Wyle Integrated Science and Engineering Group, Houston, TX, USA
by expert guidance to be of diagnostic quality; there was no statistical difference between the two groups (P = 0.6653). Conclusion Non-physician, inexperienced subjects can quickly educate themselves to retrieve diagnostic quality ultrasound images whether they are being expert-guided or trained autonomously. Keywords
Remote care Arctic Circle Ultrasound
Introduction The aboriginal communities of rural Northern Canada are faced with extremely limited access to health care. A shortage of physicians in Canada has lead to an ‘‘urbancentric’’ infrastructure, forcing many patients to travel great distances to obtain health care services. In 2002, the Society of Rural Physicians of Canada cited geography as a determinant of health, and partially attributed the poorer health outcomes of Northern inhabitants to the lack of health care services [1]. Undoubtedly, acute illness and injury in the high artic presents a significant challenge for both patients and health care providers. The diagnosis of injury is a dilemma in remote areas all over the world. In developed countries, ultrasound is routinely used in the initial evaluation of trauma patients to detect hemo-peritoneum. Ultrasound is also used in the assessment of traumatic musculoskelet
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