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.