Ultrasonography is an incredibly valuable diagnostic tool. Advantages include portability allowing it to be performed at the bedside, lack of ionizing radiation, and the dynamic nature of the information provided.
And with the decreasing price point of ultrasound devices that can practically be carried around in your pocket, some have gone so far as to argue that ultrasound devices will replace the stethoscope.
However, as anyone who was interpreted ultrasound studies knows, an enormous part of the utility of these studies depends on the sonographer. A trained sonographer can incorporate the clinical context to actively search out pathology and recognize abnormalities during the study that warrant further investigation. That being said, trained sonographers aren’t available everywhere. On the other hand, operators with less training can miss critical findings or overcall abnormalities.
A recent study in JACC Imaging sought to extend the reach of echocardiography performed by trained sonographers by using a robotic platform to enable remote performance of studies. That was paired with a tele-consultation performed by a cardiologist.
The basic methodology was simple. Patients referred for an echocardiogram and cardiology consultation by a primary care physician in rural Sweden were randomized to one of two arms. Usual care was referral to the nearest cardiology clinic approximately 140 miles away. The intervention arm received robotic echocardiogram performed by a remotely situated trained sonographer followed by a tele-consultation with a cardiologist in the presence of the primary care physician.
The metrics followed were basically process oriented, with the time required for the entire process dropping from a median of 114 days to 27 days. Ninety five percent of the patients in the remote consultation arm found that to be a superior method of evaluation because it saved them travel time, got them evaluated faster, and presumably would lead to faster intervention.
As noted in the accompanying editorial, there was no evaluation of image quality, outcomes, or safety endpoints. We can’t say whether the image quality of robotic sonography was equivalent or whether all pathology was captured. Similarly we don’t know whether any patients suffered adverse events due to the delayed evaluation in the usual care arm.
The application here is clearly to resource-limited situations, particularly if such platforms can perform a full range of ultrasound exams. The cost of this robotic ultrasound platform is not specified and we have to wonder whether a more cost effective approach would be remotely supervised ultrasound examinations where the operator has basic familiarity with the procedure but is counseled in real-time by a trained sonographer. Both strategies will likely have a place in helping extend the reach of this valuable diagnostic tool to appropriate patients in need.