Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology

Abstract

Objectives This study aimed to validate dermatologic ultrasound as a complementary teledermatologic imaging modality in primary and tertiary care centers. Methods Six primary care centers and 1 tertiary care dermatology department collaborated in the program. Images were sent through the institutional teledermatologic platform to the tertiary care dermatology department. At the reference hospital, ultrasound images and clinical data were received and registered by a physician trained in dermatologic ultrasound. An in‐person consultation was scheduled to confirm the teleultrasound diagnosis. The time of response by the tertiary center, quality and size of the teledermatologic image, and concordance with the in‐person diagnosis were assessed for each dermatologic lesion. Results A total of 147 teleultrasound consultations with 143 patients (93 women and 50 men; mean age ± SD, 47 ± 23 years) were evaluated between June 2018 and January 2019. Nine teleultrasound consultations (6.1%) were not valid. Discordance between teleultrasound and the in‐person diagnosis was evident in 6 of 138 cases (4.3%). Most cases corresponded to benign skin tumors (66.7%), followed by inflammatory skin lesions (15.9%), nonmelanoma skin lesions (13%), and other skin lesions (4.3%). All malignant tumors were detected (sensitivity, 100%), although 2 cases of benign lesions were telediagnosed as malignant (specificity, 97.8%). The positive and negative predictive values of a teleultrasound diagnosis of cutaneous malignancy were 90% and 100%, respectively. Conclusions Asynchronous primary care teleultrasound combined with dermatologic ultrasound training at tertiary centers is an effective teledermatologic modality.

Synchronous tele-ultrasonography is helpful for a naive operator to perform high-quality thyroid ultrasound examinations

“…The asynchronous mode means that the transmission of TUS images and related communication cannot be performed in real time. As previously reported by Alfageme et al [ 18 ], the mean response time using asynchronous TUS for evaluating dermatologic diseases was 52.3±2.2 hours. As a result, this mode may lead to delay in diagnoses and further treatment.…”

Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review

“…23,24 The concept of tele-ultrasound in the prehospital setting was initially devised in 2008 by Robosoft Inc. (Udupi, India) who developed a portable robot remotely controlled by physicians in France to conduct paramedic-assisted prehospital ultrasound examinations on remote patients in the Mediterranean Sea. 25 Since then, teleultrasound has been evaluated for the assessment or diagnosis of numerous clinical indications, including fetal structural abnormalities, [26][27][28] cardiac dysfunction, [29][30][31] acute trauma, 32,33 coronavirus disease 2019/COVID-19, 34 hepatic and biliary diseases, 35 thyroid nodules, 36 breast abnormalities, 37 dermatologic lesions, 38 and spinal alterations. 39 In addition, tele-ultrasound has primarily been studied in low-income rural communities 35,36 and resourceconstrained settings, 30,[39][40][41][42][43][44] but also in the intensive care unit (ICU) 45,46 and emergency department (ED).…”