Calgary surgeons develop early diagnosis tool that anyone could be trained to use

You’ve just been struck by an avalanche. You’re buried and you’re not breathing. You have two broken ribs and a ruptured artery. It might take hours before you even see the emergency room, and by then you’ll likely be dead.

 But what if there was a way for the ski patrollers to diagnose you on the spot, and speed up your journey to the operating room?

University of Calgary medical resident Dr. Paul McBeth, says he has the answer.Dr. Paul McBeth performs a guided ultrasound on a volunteer at Sunshine Village during one of his earlier remote ultrasound tests.

Photo: Courtesy of Paul McBeth

“Typically when you come to the hospital you go to the emergency room, where the surgical staff diagnosis the problem and then you’re transferred to the operating room for surgery,” he said. “But if we could diagnose the patient in the field, then we could speed up this process.”

McBeth and fellow trauma surgeon, Dr. Andrew Kirkpatrick, have developed a new technology called “remote telementored ultrasound.” This technology can assist in the early diagnosis of potentially fatal injuries before a patient reaches the hospital.

The twist is that a doctor doesn’t need to perform the ultrasound.

The whole concept, according to Dr. McBeth, is that somebody who is untrained, like a businessperson, carpenter or school teacher, known as the end-user, could operate a portable ultrasound machine with directions from a trained surgeon over Skype.

Early diagnosis saves lives

Christine Vis, trauma services manager at the Foothills Medical Centre, says that ultrasound technology is an extremely important tool for diagnosing patients.

“Ultrasound is a fairly new technology so it’s not widely used,” she said. “But in terms of how it can benefit a patient, it’s very fast and it’s very accurate. The surgeons get a much better picture of the condition the patient is in when they roll into the trauma bay that they would by completing a formal patient diagnosis.”

Dr. Paul McBeth sets up his ultrasound equipment on the slopes of Sunshine Village during one of his earlier remote ultrasound tests.

Photo courtesy of: Dr. Paul McBethVis, along with Dr. Kirkpatrick and Dr. McBeth, believes that the diagnosis of a patient prior to being transported to the hospital, or while in transport, could save the surgical team time and resources. This in turn could lead to more lives being saved.

“In trauma care we use a rule called ‘the golden hour,’” she continued. “From the time a patient gets injured, say in a car crash, we have a one hour window to start operating on them before things could take a turn for the worse. If the paramedics had access to an ultrasound machine, they could communicate with an available surgeon, who could recommend immediate treatment, and would be aware of the patient’s condition before they arrive to hospital.”

Vis says that a remote ultrasound system also opens up the possibility for a surgeon to perform a quick diagnosis or follow-up diagnosis from another location.Dr. Andrew Kirkpatrick pilots a Cessna 182 aircraft while Dr. Paul McBeth performs a guided ultrasound on nurse, Nancy Biegler, in the back of the plane.

Photo courtesy of: Dr. Paul McBeth

“Say a physician is in his office at the other side of the hospital and a patient comes off the ambulance in critical condition,” she said. “The physician could still diagnose the patient remotely by having a nurse perform the ultrasound and he could see exactly what is going on with the patient before he arrives in the operating room. However, remote ultrasound diagnosis will never replace that face-to-face interaction between the doctor and patient.”

Cost effective and easy to use

The initial stages of the project were funded by the Canadian Space Agency so that the two doctors could examine the implications of the technology in Canada’s Far North. The rest of the project was funded by the doctors themselves.

“Apart from the (portable) ultrasound machine (which costs about $10, 000,) the technology is relatively inexpensive,” Dr. McBeth said. “The only other technology we use is a typical laptop with internet and Skype as well as a webcam.”

Through a wireless Skype session, the surgeon back at the hospital can see the images from the ultrasound probe as well as a live video from a head-mounted camera on the operator. Because of this, a surgeon can guide someone with no medical experience to successfully perform an ultrasound, and gather meaningful data for the surgical team back at the hospital.

“To prove that the technology could be used by anyone, I had my six-year-old daughter perform an ultrasound on me in my basement,” Dr. Kirkpatrick said. “She was being guided by a surgeon at the Foothills Medical Centre, and she did a pretty good job. There were some communication issues between the surgeon and my daughter — she was only six, so she didn’t understand some of the terminology — but we ended up getting information we could use from that trial.”

Dr. McBeth said that communication was an issue he hadn’t thought of until that particular test.

“A simple word like ‘parallel’ might make sense to you or me, but to a six-year-old — it’s not in her vocabulary,” he explained. “That’s one thing we learned from this test — we need to work on our communication with the user and develop simpler terminology that can be understood by everyone.”


Remote Telementored Ultrasound

Working out the kinks

Dr. McBeth said he would like to work on the technology more to make it as user-friendly as possible.

“I would like to see the technology simplified quite a bit more so that it’s just a few buttons for the user to work with. Right now it’s a bit too complicated for an average person to use.”

Dr. Kirkpatrick agrees though the technology has a promising future, right now it’s better to be used as a clinical teaching tool.

“Everything works in theory, but theory isn’t real life,” he said.

“There would be times where I wasn’t in the emergency department and I would be called at home from Banff. I would have to run over to the emergency department here at Foothills, log into the system, get it all hooked up and communicate with the people in Banff.

“To be honest, it’s a great test project and it worked well in theory, but in real life things have to be instantaneous. If there was an emergency halfway around the world and I wasn’t connected to the system, the time it took to connect could be fatal.”

According to Dr. Kirkpatrick, there are only a handful of people who are trained to guide others through an ultrasound exam.

“That’s why it’s just as good a teaching tool as it is a clinical tool,” he said. ‘If we can educate people how to use the equipment, then we’ll have more people who are familiar with it, and can use it.”

Training with the technology

In April 2011, the two tested the signal strength and usability of their equipment at 5,000 ft in a small aircraft. They brought along adult trauma nurse practitioner, Nancy Biegler, who had no previous ultrasound experience, to perform the diagnosis and prove that even in a confined space, in turbulence, and at 5,000 ft, an ultrasound can be successfully done.

“It’s amazing to see that we can even do these things,” Biegler said. “I never would have imagined that I would be operating an ultrasound probe in the air, and I normally don’t travel very well.”

Dr. McBeth said there were a few signal drops while they were in the air.

“We lost the signal a few times, but the whole point of the test was to see if we could carry out an ultrasound exam in the air. We were able to provide an ultrasound expert in Georgia with enough information that he could provide a correct diagnosis.”

Biegler is currently being trained to use the ultrasound technology. To date, she has performed six guided ultrasounds in the trauma unit at the Foothills Medical Centre.

“I’m still a beginner, but the technology is very easy to use,” she said. “I’ve had very limited experience using the machine, but I can see its importance.”

Biegler, with the remote guidance of Dr. Kirkpatrick, was able to correctly diagnose the condition of a patient prior to an X-ray. The X-ray confirmed the diagnosis from the ultrasound.

“It wouldn’t be far off to think that this could become an alternative to an X-ray,” Biegler said. “It’s very accurate, and when you have a set of trained eyes watching your every move, and guiding you through the process, it makes sense as an early diagnosis tool.”

Dr. McBeth said: “There are so many possibilities with this technology. We could see it used in African villages, at research stations in the Arctic, in small towns, oil rigs, ski hills, you name it – as long as we have internet.”

Dr. Kirkpatrick sees this technology playing a huge role in the third world.

“Did you know that the most common cause of death in the third world is childbirth?” Dr. Kirkpatrick asked. “More women die each year from complications in childbirth than anything else. A simple ultrasound test could guide doctors how to proceed on a case-by-case basis. I can say with certainty that the number of deaths in the third world would drastically decrease if ultrasound technologies were better utilized.”

However, one problem with implementing this technology in such remote locations is the lack of a steady internet connection.

“The technology is essentially useless without internet,” Dr. Kirkpatrick said. “But with the internet expanding to the far reaches of the globe, it’s not too far off for us to think that we could get the technology into third-world countries.”

Though the cost of the ultrasound technology is on the decline, Dr. McBeth says the portable ultrasound machine alone costs upwards of $10,000.

“As the technology develops, it will become a lot cheaper, but it’s still quite pricy at the moment,” he said. “It could be quite difficult for a research station or African village to purchase the equipment if they don’t have the funds.”

Both doctors will continue to work on making the remote ultrasound technology more user-friendly in the hopes that the technology could one day be as common as a defibrillator in a shopping mall.

“If the human mind can imagine it, we can do it,” Dr. Kirkpatrick said. “There are endless possibilities with this technology, and we’re just at the beginning.”

“When this technology goes through a few more tweaks, it’ll drastically improve healthcare around the world.”

mhayhurst@cjournal.ca