One day, the ultrasound equipment that healthcare professionals use for essential diagnostic imaging may no longer be confined to the clinic and may be operated by patients from the comfort of their homes. New research marks an important step toward that future.
During the throes of the COVID-19 pandemic, where U.S. hospitals were frequently facing overcrowding, researchers at Brigham and Women’s Hospital set out to learn whether patients could perform ultrasounds themselves. In a study published in Scientific Reportscompared images acquired by ultrasound experts with those taken by inexperienced adult volunteers who were given minimal guidance and found little difference in the image quality of the two groups. The results point to ultrasound as a potential home diagnostic tool, which could increase the safety and accessibility of care for patients and relieve pressure on healthcare facilities in difficult times.
“COVID-19 forced everyone to look for unconventional solutions like this, but what we learned could be beneficial far beyond the context of the pandemic,” said lead author Tina Kapur, Ph.D., assistant professor of radiology at Harvard Medical School and executive director of Image-Guided Therapy at Brigham and Women’s Hospital.
Ultrasound, which transmits and receives sound waves to obtain images of our organs and tissues, is cheaper and more portable than other imaging techniques and has recently demonstrated greater accuracy in detecting certain types of respiratory disease and heart failure.
Previous investigations has explored the value of portable point-of-care ultrasound (POCUS) for emergency medical technicians (EMTs) in the field; However, during the COVID-19 pandemic, another potential use came to light.
“We started seeing these groups of doctors, who were diagnosed with COVID-19 and had access to portable ultrasounds, doing self-examinations. That was the first way we saw POCUS being used regularly at home,” said lead author Nicole Duggan, MD, director of Emergency Ultrasound Research at Brigham and Women’s Hospital.
Duggan and his colleagues set out to discover whether patients without medical training could also obtain diagnostic-quality ultrasound images remotely. In this study, they evaluated the feasibility of at-home POCUS among a group of 30 volunteers who had no prior experience handling ultrasound devices.
The researchers developed and provided the group with a 28-slide tutorial explaining how to use POCUS to obtain quality images of one’s own lungs.
At home, participants used portable POCUS probes, which were connected to smart devices, to scan eight areas on the surface of their chests and sides. The emergency medicine faculty at Brigham and Women’s Hospital then repeated the imaging procedure and produced images of the same group of volunteers.
A separate pair of experts, not knowing who took which images, rated them all from zero to three based on their diagnostic quality. When evaluating the scores of images acquired by both novices and experts, the researchers found no significant differences.
“We carefully crafted instructions to help volunteers obtain adequate images without us at their side, and the data suggests they could do so,” Duggan said. “As long as you communicate clearly, you can often successfully guide patients through simple protocols.”
Even if the ultrasound images were taken outside the clinic, professionals would need to evaluate them to reach conclusions.
But still, there are clear benefits at a time when emergency rooms and hospitals are crowded, Kapur said. And effective POCUS at home would always be good news for patients with reduced mobility, compromised immune systems, or who live in regions with limited healthcare resources.
“I think this study is an eye-opener on how versatile ultrasound technology is. If optimally implemented, it could be a game-changer for telehealth applications,” said Qi Duan, Ph.D., director of the biomedical informatics program in the Division of Health Informatics and Technologies at the National Institute of Biomedical Imaging and Bioengineering (NIBIB).
The study focused on images taken from healthy participants, but the authors plan to test POCUS in patients with specific diseases to find out how well the quality of images obtained by patients is maintained.
This research was funded by an emergency supplement to an existing NIBIB grant (R01EB027134) in response to the COVID-19 pandemic.
Study reference: Nicole Duggan et al. Point-of-care ultrasound performed by beginners for imaging at home. Scientific Reports (2022). DOI: 10.1038/s41598-022-24513-x.
