Space: US exams come down to earth
Remote US examinations is not science-fiction; they are now available for real-time diagnostics.
The first hospital on Mars will be equipped with ultrasound. But the radiologist will be earth-bound, conducting the exam by using a robotic arm to move the ultrasound probe.
CT or MRI scanners are far to heavy to be launched into space, so medical imaging of astronauts and cosmonauts, whether orbiting the Earth in the International Space Station or exploring distant planets, will necessarily be performed using a lighter and far more portable ultrasound system.
The results of such exams are famously operator-dependent, so rather than sending radiologists into space, the European Space Agency (ESA) and the French National Centre for Space Studies have helped to fund the development of a robotically-controlled exam operated by an ultrasound imaging expert.
This is not science fiction. The Melody robotic tele-echography system received a CE mark in January 2013. In May, Melody captured the Innovation Trophy 2013 at the combined congresses for Health Information Technology and Hospital Expo in Paris.
Developed by AdEchoTech from Huisseau en Beauce, France, the company has down-to-earth commercial plans for the technology, offering the system to hospital imaging centres for patient examinations in remote facilities. Thus the system responds to the unmet medical need of patients in rural areas lacking expert diagnostic, and one can imagine other applications, such as for workers on oil drilling platforms in the North Sea, or guests on a cruise ship. So far the Melody remote diagnostic system has been used on hundreds of patients in France, Cyprus and Guyana.
The Melody technology is based on the pioneering research of Professor Philippe Arbeille MD, from the Trousseau Hospital, part of the University Hospital Centre-Tours (CHU-Tours), where he is the director for nuclear medicine and ultrasound.
Over 15 years, Prof. Arbeille worked on projects encouraged by, and at times financed by, ESA. He also was the physician who, for 520 days, followed the six astronauts in the Mars 500 programme to test endurance in space, capturing and analysing effects on the cardiovascular system of confinement and simulated space flight.
Eric Lefebvre MD, a colleague from CHU-Tours, who believes ‘the potential is colossal and we expect to sell thousands of systems’, founded the company in 2008. Using the Melody Patient system, a trained operator at the patient’s side in a remote centre places a frame over the anatomy of interest to the expert physician and applies gel to the targeted zone. The robotic arm can accept any ultrasound probe and plug into any ultrasound platform for the exam, according to Nicolas Lefebvre, business manager of AdEchoTech and son of Dr Lefebvre.
Connected by high-speed landline or satellite transmission, the Melody Expert system at a remote medical centre controls the movement of the probe.
The expert, who is simultaneously connected by video conferencing with the operator at the secondary centre, views the ultrasound exam in real-time.
One megabyte per second for both uploading and downloading is sufficient capacity for the transmission of the exam as well as for the video conferencing, according to the business manager.
Among the 400 monitored exams 15% were considered inconclusive due to an incomplete view of the targeted organ. Neither false positives nor false negatives have been reported among the completed exams.
A strong selling point for Melody is that the technology’s price is quickly offset by not needing to transport fragile patients during an emergency.
Initial interest has come from developing countries, with vast regions to cover with medical services and a pronounced lack of expertise, such as hospitals in Cyprus and Guyana that have purchased the Melody system.
Another selling point for Melody, according to Lefebvre the younger, is the real-time assessment of an ultrasound exam by the expert who performed the exam.
Whereas in teleradiology an expert reader can remotely assist in diagnosis by assessing the images from MRI or CT scanners, the quality of an ultrasound examination is highly operator-dependent. In other words, the physician must move the probe to know what is being seen.
‘Our goal is not to replace ultrasound experts with remote readers, which is sometimes the case in teleradiology,’ he said. ‘The goal is to make available ultrasound diagnosis for centres and facilities that do not have a 24/7 coverage or have no experts at all.’
The company is currently working with the Telemedicine Centre Aachen (Germany) to create an Advanced Robotic Tele-echography Integrated Service to provide a connecting centre for a satellite based tele-consulting network providing 24/7 support for diagnostic problems or challenging therapeutic decisions.
Meanwhile, AdEchoTech is continuing development of next-generation systems, including research that will ultimately support the ESA goal of equipping a hospital on Mars.
PROFILE
Specialising in ultrasound for more than 25 years, Eric Lefebvre MD estimates he has performed almost 200,000 examinations in nearly every practice area at the University Hospital Centre in Tours, France.
The author of four reference books and 15 articles in the field, he is a recognised expert in echography, participating regularly as a speaker at international congresses. In 2008 he founded AdEchoTech to apply the technology developed for robotic-assisted exams to advance the potential for remote diagnoses using the Melody robot.
02.07.2013
