‘A service that they really wanted’
Remote presence technology improves access to ultrasound
Nadine Kanigan’s hand guides an imitation ultrasound probe across her desk in her dimly lit Stonebridge office. She doesn’t need to look at the video feed to her right to know her motions are being perfectly replicated more than 1,000 kilometres away. Instead, she gazes at the screen to her left, inspecting the inner workings of the abdomen of a woman in Stony Rapids.
“With the ability of technology and the speed of the Internet, we’re really able to scan as if we are really there,” Kanigan says.
“The image quality is amazing. We are able to — once we get the hang of it — scan through just as we would in a conventional system.”
Kanigan, a sonographer and owner of The Ultrasound Centre, is among the pioneers of a new remote technology ultrasound system that may one day make it possible for people in Saskatchewan’s remote and isolated communities to have the same access to the diagnostic tool as people in larger centres.
The technology, developed to be used by astronauts in space by a French company working for the European Space Agency, made its way to Saskatchewan a little over a year ago after the French company contacted the U of S and asked if staff there would be able to use the system.
Dr. Ivar Mendez, unified head of the department of surgery at the University of Saskatchewan’s College of Medicine, said such opportunities are not uncommon given the international reputation the U of S has developed around remote presence technology.
“Programs and companies around the world contact us on a routine basis because they want us to see if their systems can be used for health care delivery in remote locations,” Mendez said.
The remote ultrasound system consists of three parts: A cage with an ultrasound probe that is placed over a patient, an imitation probe that is controlled by an ultrasonographer and a video conferencing system that connects the two, allowing the ultrasonographer to see and talk with the patient and whoever is holding the cage.
Mendez and his team spent a year testing the remote technology system in Saskatoon and comparing how reliable remote ultrasounds are compared to conventional ones. They found remote ultrasounds to be just as effective and, in early 2018, remote presence ultrasound systems were installed at health centres in Stony Rapids and La Loche — something made possible by a $300,000 donation from the Leslie and Irene Dube Foundation.
Prior to the systems being set up in the remote communities, people there who needed ultrasounds could only get them when ultrasonographers visited the communities — which happened roughly once a month — or they would travel south for appointments.
“The access to ultrasounds in many of our communities is very difficult,” said Veronica Mckinney, director of Northern Medical Services. “It’s not uncommon that people would have to be sent out of their community in order to access this diagnostic care.”
And that can be a challenge. Small aircraft that serve northern communities can sometimes be delayed because of weather, causing people to miss appointments. And many people who travel south for appointments have to spend a night away from home, separated from family and culture.
Mckinney said the need for ultrasounds in remote communities is so great that when she told people in Stony Rapids that remote ultrasounds would be offered there, some started crying with relief.
“People were very teary because they said, ‘We’ve wanted to have services in our community, this is what we’ve been asking for for years’ ... It was emotional for people because they really felt like they were being heard and this was a service that they really wanted and needed in their community.”
Dr. Bert Neethling, a fly-in physician who works at the La Loche Health Centre, says the difficulty in getting ultrasounds in northern communities often means people — especially pregnant women — don’t get the ultrasounds they need.
“Most of our patients don’t go, just because it’s back and forth, back and forth,” he said. He said he’s seen women come in for their first ultrasound 38 weeks into their pregnancy because they haven’t wanted to deal with the hassle of booking ultrasounds earlier or they don’t want to worry about followup appointments.
Neethling said prenatal ultrasounds are important because they allow physicians to monitor the health and development of a baby and put physicians in the position to offer the best prenatal care possible. He said he hopes more pregnant women get prenatal ultrasounds once the service is offered at the La Loche Health Centre.
By mid-july, roughly 12 people in Stony Rapids had received remote ultrasounds since the service started being offered there in March, Mendez said. The system is not yet operational in La Loche.
Mendez said his goal is to eventually offer regular weekly or twice-weekly ultrasound clinics in both communities for scheduled ultrasounds — such as prenatal ultrasounds — and develop capacity to offer emergency ultrasounds. He said it’s not clear yet how many remote ultrasounds could be performed annually in each community.
Even as those plans develop, there has been no talk about cancelling trips north by ultrasonographers.
“The reality is the backlog is so long that we need to shorten that list for sure,” Mckinney said.
Mendez said he is looking forward to seeing how remote presence technology can assist with whittling down that list.
“One of the things we’re very interested in is narrowing the gap of inequity or inequality on health care delivery,” he said. “We hope that this will serve the most needed populations and the most vulnerable populations.”