Physicians in Scotland use iPhone 4 and Skype to remotely manage lung and pleural ultrasound

In a letter published in the Journal of Emergencies, Trauma, and Shock, physicians in Scotland described the use of a webcam, Skype, and an iPhone 4 to connect a provider in Calgary to an expert over 200 miles away in Aberdeen for assistance in performing a pulmonary ultrasound (full reference below).

As the authors point out, pulmonary ultrasound is becoming an increasingly valuable technique to look for a pneumothorax, evaluate the size of a pleural effusion, and more.

However, even for those that have some experience in this imaging technique, or for that matter, others like ECHO or abdominal ultrasound, its not always easy to tell what you are looking at or whether some finding is actually significant.

Even having put in plenty of central lines at this point in my training, there are still times where I seek a second set of eyes as I ultrasound the internal jugular vein for a suitable insertion site. For a physician in a remote location, whether a small Scottish town or a rural Indian village, a low-cost, simple way to get that kind of help could provide both welcome relief and improved care.

As described in their letter to the editor, system seems to have been relatively easy to set up,

A portable ultrasound (Sonosite 180, Sonosite, Bothell, WA) in Calgary was interfaced to a laptop computer (Aspire 5741, Acer, Kuala Lumpur, Malaysia) via an analogue-to-digital converter (VC-211V, ActionStar LinXcel, Taiwan) [Figure on-line supplement]. Xsplit Broadcaster (SplitMediaLabs ltd, Hong Kong) allowed video-streaming of both an inexpensive head-mounted webcam (LifeCam VX-2000, Microsoft, Washington) and ultrasound over Skype (Skype, Luxembourg), easily viewed on any smartphone.

The pessimist in me notes that HIPAA lawyers would probably be all over this in the United States, as viewing radiology images in Skype falls a little short of FDA approval.

That being said, those are solvable problems in the USA and somewhat irrelevant in the developing world, where the benefits could be substantial.

Image and quotation text from Crawford et al, “Telementorable “just-in-time” lung ultrasound on an iPhone.” J Emerg Trauma Shock. 2011 Oct;4(4):526-7.


Satish Misra, MD

Satish is a Cardiology Fellow at the Johns Hopkins Hospital. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology can change the way healthcare is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.

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7 Responses to Physicians in Scotland use iPhone 4 and Skype to remotely manage lung and pleural ultrasound

  1. Adan June 6, 2012 at 2:41 pm #

    Excelent.very exciting particularly for bridging quality healthcare delivery in countries like kenya.

    • Adan June 6, 2012 at 2:44 pm #

      I have an optimistic feeling about this technology in third world countries.can you imagine assisting a colleague who is in a remote locality..absolutely exciting

  2. vinay March 28, 2013 at 11:25 am #

    Surely the NHS already has better ways or transmitting high quality radiology imaging to other hospitals. Can’t see why they didn’t user those existing methods rather than have to use Skype with their downgrading the video quality and trying to view a ‘picture in picture’ of the procedure on a 3.7″ screen for supervising a pleural and lung scan looking for sliding sign. Surely the radiologists or A&E or some anaesthetists at that hospital have the ability to look for sliding sign than have to depend on Skype images on a 3.7″ screen PIP image for training for an emergency FAST scan. Guess they were just transmitting the images of a volunteer in a course rather than an actual patient going by the person smiling on the image in the article published.

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