Doctors have one of the noblest professions. They take care of us when we’re sick, exuding empathy and genuine worry for our health. We may think that at times they’re cold and uncaring, but what many people don’t know is that doctors are under extreme stress. There are few professions where one simple mistake can cause someone their life, so don’t hold it against them if they ask concise, detailed questions.

What would happen if a doctor didn’t have all the tools necessary to diagnose an illness? Could it cost a person their life if a critical decision was based on insufficient evidence? Doctors and healthcare professionals in countries where medical facilities are scarce are consistently troubled with making proper diagnoses. An emerging trend in healthcare is remote diagnostics, also known as telemedicine, which can be used to get doctors and patients the best professional opinion with the help of leading institutions from around the world.

We’re going to explore the use of remote desktop applications, mobile apps on smartphones and tablets, webcams and even robots. We’ll also delve into remote diagnostics programs implemented by NASA, WINFOCUS and RAFT among others.

Robot-assisted medical procedures coming to a hospital near you

Almost 100 years ago, a brave pilot by the name of Charles Lindbergh was able to overcome the odds by becoming the first person to fly solo across the Atlantic Ocean from New York to France. On September 7th, 2001 with the help of high-tech fiberoptic internet technology and ZEUS robot surgical system, a French surgeon in New York remotely performed a cholecystectomy (removal of gallbladder) on a patient in France, dubbed the “Lindbergh Operation.”         

 Last year, Dr. Partho P. Sengupta, MD, of Icahn School of Medicine at Mount Sinai, while in Munich, Germany performed a carotid artery examination with a lightweight robotic arm with an ultrasound probe stationed in Boston, Massachusetts. The exam took only four minutes and was successful, proving that remote diagnostics using a low-bandwidth internet connection is possible.

Image courtesy of Mount Sinai Medical Center

Is it possible to tap into an ultrasound machine remotely?

By connecting a host computer to another (client) computer through remote desktop applications, IT experts can diagnose and fix computer problems.

Using software products like LogMeIn, which has secure 256 bit SSL/TLS encryption and multiple layers of authentication, expert ultrasound centers can effectively take control of the computer at the patient center with a click of the mouse. Experts can then transfer and share the images or video through Skype or other available means. LogMeIn is also available for iOS and Android, so even if the expert is out of the office, he/she can open the LogMeIn app and have instant access to the patient.

More sophisticated systems use a series of wireless network cameras for video conferencing and a video server connected to an ultrasound machine to transfer high quality video, granted internet speeds are sufficient.

 Possibly the most intriguing offering from the company Remote Medical Technologies, their iMedHD2 Tele-Ultrasound System, is a big step-up from remote desktop apps. Not only does it capture images, audio and HD (1920 x 1080 pixels) video, it offers unmatched security, which includes token passing and video encryption. This unique package also includes annotation features on an intuitive user interface which multiple doctors and radiologists can access simultaneously to compare and comment on the results of the examination. The iMedHD2 is also compatible with iOS and Android.

A short demonstration of the iMedHD2 Tele-Ultrasound System

On Earth as it is in space

 Ultrasound imaging is the sole diagnostic method available to astronauts in space. The ISS (International Space Station) has recently upgraded their ultrasound system to a modified General Electric Vivid q (an improvement on the Vivid i), which has a slew of features. By partnering with the World Interactive Network Focused on Critical Ultrasound (WINFOCUS), NASA was able to develop a system for training inexperienced personnel on the use of the Vivid q and its transducers. With some guidance from doctors on Earth, astronauts captured images and video that was later reviewed by experts. Traumatic injuries can occur in space where medical care is extremely limited and if there was no way to diagnose a suspected injury; lives could potentially be in danger.

 Astronaut Kevin Ford (right) trains with the Ultrasound 2 for the Integrated Cardiovascular experiment. Sonographer David Martin (left) guides the crewmember in obtaining the desired images for the experiment while Ariel Rodriguez (center) serves as the subject.

During the course of preparing and outlining the guidelines for ultrasound imaging in space, WINFOCUS took it upon themselves to expand the boundaries of ultrasound to reach remote areas of the Earth. Their methodology can give patients in the “golden hour” of traumatic injury, a period of around an hour during which proper management and care can prevent death, access to high-quality diagnostics.  

A life RAFT for countries with limited resources

In a perfect world, there would be experts in every city and village with high-end equipment, which would be accessible to the average citizen. Even if money wasn’t a factor, it is ultimately impossible to have highly qualified local experts that wouldn’t have trouble with the most difficult cases. The Réseau en Afrique Francophone pour la Télémédecine (Telemedicine network of French-speaking African countries - RAFT) network has been offering important educational, clinical and public health activities for the past decade.

RAFT developed a neat piece of software called Bogou, which allows doctors, post-graduates and medical students to collaborate and discuss cases. The software connects experts to patient centers and vice-versa, reaching countries where there are few specialists, providing pertinent diagnoses and suggestions. RAFT is expanding to the Middle East and South America, but of course more developed countries can also benefit from these pioneering ideas.

Whatsapp and smartphone probes

Mobile applications have recently seen tremendous growth with prices falling for smartphones and more and a record number of apps being downloaded. Seeing patients suffer without proper medical care, doctors in Nigeria decided to take an initiative to come up with a way to send patient data to experts for second opinions. Because almost everybody nowadays has a smartphone and most people use Whatsapp to communicate, it was a no-brainer to start using these mobile tools for quick, accurate interpretations of clinical cases. Researchers from Nigeria took a scientific approach to determining the accuracy of Whatsapp consultations and showed a 93% agreement between remote experts and on-site operators.

Another way to have an extremely mobile platform for imaging, especially in emergency medicine, is by using mobile smartphone probes. We previously demonstrated what the Philips Lumify is capable of. These types of app-based platforms could also be useful as a tool for imaging patients that can’t physically get to a patient center. Using mobile Internet and the cloud integrated app, doctors can then share images securely.

No patient left behind – Adopting new strategies

Telemedicine is a promising new direction that will benefit patients by saving them money, time and hassles, and of course doctors will have supreme confidence in their decisions. These innovations could also pave the way for a new form of medical tourism - virtual medical tourism, where you won’t have to travel to get specialized medical care, only your clinical images sent over the Internet.

Adambounou K, Adjenou V, Salam AP, et al. A Low-Cost Tele-Imaging Platform for Developing Countries. Frontiers in Public Health. 2014;2:135. doi:10.3389/fpubh.2014.00135.

Bediang G, Perrin C, Ruiz de Castañeda R, et al. The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries. Frontiers in Public Health. 2014;2:180. doi:10.3389/fpubh.2014.00180.

By Dr. Yuriy Sarkisov, BiMedis staff writer