Sonography in remote areas are often affected by access limitations. Sonograms taken from sonography examinations are typically interpreted after the patient has already left the facility by off-site radiologists. If additional images are required by the radiologist to make a definitive diagnosis, another examination will have to be arranged, causing repeat visits for the patient and further delays in diagnosis.
Remote sonography would be able to overcome some of these limitations, but a certain level of skill and training is required for taking the appropriate images, and this additional complication makes remote sonography challenging. Nonetheless, McBeth et al have previously shown that handheld ultrasounds can be used to collect sonograms remotely to rule out life-threatening lung conditions including apnea (APN) and pneumothorax (PTX). Boman et al have also demonstrated the benefits of remote echocardiography for areas with limited access, although cost and image quality were not emphasized. A recent feasibility test on a new telerobotic ultrasound system at the University of Saskatchewan has provided some additional insights.
The telerobotic system tested consisted of a robotic arm (MELODY System, AdEchoTech) and an ultrasound system (SonixTablet, BK Ultrasound), used in conjunction with a teleconferencing system (TE30 All-in-One, HD Videoconferencing Endpoint) to conduct remote abdominal examinations on 19 patients at a local imaging clinic 2.75 km away from the radiologist/sonographer hub. The radiologist/sonographer conducting the test was able to control every part of the telerobotic system including the ultrasound using a remote probe and electronic control box. The TC system allowed them to communicate with the patient and the assistant at the local center during the test to request any physical re-positioning.
Compared to the gold standard using the EPIQ 5 (Philips) or LOGIQ E9 (GE Healthcare) for a conventional sonography examination, no significant difference was observed in measurements for the liver, spleen, and diameter of the proximal aorta. However, telerobotic assessments overestimated distal aorta and common bile duct diameters and underestimated kidney lengths. Amongst all sonograms, 5 pathological findings were identified by both methods (2 renal cysts, enlarged common bile duct, hepatic cyst, and a hyperechoic focus in the spleen), 3 were identified using only conventional sonography (a hepatic cyst, focal fatty sparing of the liver, and a small renal cyst), and 2 were identified using only telerobotic sonography (a small renal cyst and gallbladder wall polyp).
Although the telerobotic sonography system did find pathological sites that were not identified by conventional sonography, the fact that it missed some cases identified by conventional sonography makes relying solely on this technology somewhat questionable from a clinical perspective. Although patients were pleased with the experience and have voiced that they would be open to remote examinations again, the technical aspect needs to be improved. For example, sonographers noted that it was difficult to precisely place the calipers on the touchscreen when using the remote system and images obtained using the remote system generally appeared to be more hyperechoic compared to those obtained using the conventional system.
In addition, from an economic and resource perspective, the remote system used in the study costs as much as high-end ultrasound systems, thus unfortunately there were no immediate savings in hardware costs. Although this remote system saves patients from commuting and has the benefit of allowing non-specialized staff to execute the examination by taking remote instructions from the sonographer through the teleconferencing system, these two factors may not be enough to offset the cost of the system itself and the cost of the staff involved, and detailed cost-benefit analysis is needed to assess the economic impact of the system.
All points considered, remote sonography still has a ways to go before widespread adoption.