First-time use of novel teleultrasound technologies guided virtually by an expert, with potential benefits for remote community access to health care.
Remote medicine is entering into the realm of human-enhancing applications that can enable experts to provide patient care from afar. A pilot study led by Vancouver Coastal Health Research Institute (VCHRI) researcher Dr. Tim Salcudean is the first to record volunteers’ ability to follow the virtual guidance of specialists to complete tasks using an ultrasound-like device.
“A human-teleoperated ultrasound could enhance access to ultrasounds in rural and remote communities, sparing patients from the need to travel by bus, plane, train or whatever it takes to get to a hospital or clinic in a major city center like Vancouver,” states Salcudean.
Additionally, this technology could further optimize the workload of sonographers and radiologists, saving time spent travelling across the province to visit patients, along with the associated costs to the health care system.
As a diagnostic tool, ultrasounds provide real-time images of internal organs that clinicians can use to assess, diagnose and treat patients. However, the radiologists and sonographers trained to operate these technologies are often few and far between. These specialists are typically concentrated in large, urban centres where additional diagnostic tools, such as computer tomography (CT) and magnetic resonance imaging (MRI) scanners, are housed.
The new handheld technology being explored by Salcudean — together with David Black, a PhD candidate in the Department of Electrical and Computer Engineering at UBC — could offer an alternative solution to connect communities with scarce and often time-strapped experts.
Enhancing humans with advanced technology for remote ultrasounds
Salcudean’s research — published in the International Journal of Computer Assisted Radiology and Surgery — involved the use of mixed reality teleultrasound devices that could be operated by patients, family members or friends, with remote support from sonographers or radiologists.
“To perform an ultrasound requires quite a bit of training, along with skill and dexterity,” notes Salcudean.
“Enabling a non-expert to perform this task remotely under the guidance of an expert is no trivial exercise.”
Eleven volunteers were recruited to participate in testing a prototype teleultrasound unit. Each participant used a handheld ultrasound-like transducer device and wore a mixed reality headset (Microsoft HoloLens 2). Mixed reality combines elements of both virtual and augmented reality, superimposing images and additional virtual elements onto the wearer’s real-world environment.
On the other end of the experiment, an expert used a tablet to guide a superimposed virtual probe that traced a path participants could see in their headset and attempted to follow with the hand-held transducer on a mannequin. An error bar in the corner of the participants’ headset also showed them how much pressure to apply and if the pressure they were exerting stayed within a target amount of force.
The study results showed a high enough degree of accuracy — within millimetres and fractions of a second of the expert — for the research team to launch the next phase of testing on their novel technology.
“We have developed a system that experts feel is very workable, but we need to quantify how much time they take to perform remote, mixed-reality ultrasound imaging of human subjects, and the accuracy of the readings compared to conventional ultrasound,” notes Salcudean.
The research team is presently engaged in a follow-up study led by VCHRI researcher Dr. Silvia Chang, which was supported by a 2023 VCHRI Innovation and Translational Research Award. Chang’s study is evaluating the efficacy of the teleultrasound technology in a clinical environment, with the first results expected in 2024.
