Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

Abstract

Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.

Keywords: community out-reach (Min. 5–Max. 8); informatics; patient self-care; point-of-care ultrasound; telementoring.

Figure 1

Example of Ultrasound Naïve Volunteer being guided to image their own chest. Figure Legend: Screenshot of the Mentors computer in Calgary viewing the completely novice self-isolating volunteer image their upper right anterior lung field depicting the visceral and parietal pleural interface with movement emphasized with Color Power-Doppler the “Power-Slide” Sign (seen in Supplementary Materials). Note: Lung ultrasound is a dynamic science much better appreciated with real time imaging. The videorecording of the entire mentored Lung examination ca be viewed in Supplementary File S1.

Figure 2

Example of the “Spleen Point” Sign confirming imaging of the Lung Base. Legend: When the ultrasound probe is correctly positioned at the bung base, the image will review the visceral-parietal interface (left) alternating with the parenchyma of the spleen on the left or liver on the right with no probe movement due to the respiratory movement of the diaphragm. Note: Lung ultrasound is a dynamic science much better appreciated with real time imaging. The videorecording of the entire mentored Lung examination ca be viewed in Supplementary File S2.

Figure 3

(a) Sanitized Home Ultrasound Delivery Package. Legendz: Sanitized package for home-delivery to patients containing a Philips Lumify Ultrasound probe and dedicated smart phone to support the ultrasound, gloves, masks, and ultrasound jelly. (b) Sanitized Home Ultrasound Delivery Package. Figure Legend: Sanitized package ready for home-delivery to self-isolating patients.