August 31st, 2014

Entrusting Imaging to Robotic Hands: The Potential of Remote Echocardiography and Tele-Consultation

CardioExchange’s Harlan M. Krumholz interviews Dr. Jagat Narula about his two collaborative, remote, robot-assisted echocardiographic technology studies and the potential applications worldwide. The study is published in the August issue of JACC-Imaging.

Krumholz: Could you please briefly tell us the highlights of your paper?

Narula: Two studies were published as the iConcepts in the August issue of JACC-Imaging. The iConcepts section publishes pilot reports of the technology that is on the verge of clinical translation. In the first study, the Mount Sinai-based investigators performed a robot-assisted, trans-Atlantic ultrasound examination on a person in Boston. A small, lightweight robotic-arm with built-in ultrasound technology was stationed in Boston from Munich. The robotic ultrasound exam of the patient’s carotid artery was completed in just four minutes. This feasibility and time-efficiency of long-distance, telerobotic ultrasound may help expand the role of imagers to care for patients online, virtually lending a true ‘helping hand’ remotely and providing a patient’s care with team expert guidance. The second study in collaboration with Umeå University in Sweden showed how a cardiologist’s video e-consultation, coupled with a remote, robot-assisted echocardiogram test, could dramatically reduce the waiting time for a diagnosis faced by heart failure patients who live in a rural communities far from the hospital. Remote consultation and the robotic echocardiogram exam were conducted on the same day of a patient’s visit to their local Primary Healthcare Center located more than 100 miles away from the hospital. Study results show the total diagnostic process time was significantly reduced from 114 to 27 days in those patients receiving remote consultation. Also, the patient’s wait time until obtaining a specialist consultation was reduced from 86 to 12 days, with 95 percent of remote consult patients claiming remote consult to be a superior strategy.

Krumholz: How much does this machinery cost?

Narula: These are experimental systems under development; no realistic cost is available at this time.

Krumholz: Why not just teach people to scan and then send images?

Narula: Yes… a very logical suggestion. We have recently submitted a research proposal for the training of high school students who desire voluntary service in low- and middle-income countries (LMIC). They could record requisite views and beam them to a central station for interpretation. This would allow triage of patients who need to be transported to the hospital. Such trainees could be designated as Hubots or Human Robots.

Krumholz:  Is this going to be a way that we get such technology to LMICs?

Narula: The two studies give us a glimpse of what to expect in the near future, and may serve as a model for use of e-consults and robotic imaging in far flung areas to improve global access to specialists and the latest diagnostic technology. This technology is more for developed nations and can provide convenient service in distant areas to selective patient groups such as the senior citizens. Furthermore, such on-demand, virtual robotic ultrasound could be used in a wide variety of clinical settings ranging from timely in-hospital or emergency room patient imaging studies, community screenings, or even within more demanding locations such as war zones.

Join the discussion: How could this technology benefit your practice, if it were made readily available? Does the future of medical imaging technology lie in the field of robotics?

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