Veterinary telemedicine: A new era for animal welfare.

Telehealth is a rapidly developing field of veterinary medicine, particularly during and after the coronavirus 2019 (COVID-19) pandemic. The world and animal owners' expectations are changing to the point where veterinary practice will need to adapt due to information technology advancements. This narrative review describes the status, benefits, technology basics, applications, limitations, and legal aspects of veterinary telemedicine over the globe. Veterinary telemedicine is a service alongside other veterinary services that meets client needs, delivers quality medicine, and improves animal welfare. The most frequently utilized veterinary telemedicine applications include teleradiology, telesonography, teledentistry, telecardiology, telerehabilitation, anesthesia teleconsultation, telehospice and telepalliative care, telecytology, tele-endoscpy, teledermatology, tele-ophthalmology, tele-behavior therapy, and veterinary education and training. Veterinary telemedicine has a bright near future and will impact veterinary medicine and animal welfare due to its numerous advantages. These advantages include its low cost, availability, involvement in veterinary health care, online payment, and effectiveness in many clinical situations such as follow-up after an in-person examination, inspection of surgical sites, or mobility. Nevertheless, veterinary telemedicine should receive more attention from veterinary professional regulatory bodies in all countries. Moreover, it is necessary to conduct more studies to evaluate how telehealth is beginning to improve veterinary care, particularly for underserved regions.

Robotic ultrasound imaging: State-of-the-art and future perspectives.

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques. Additionally, we present the challenges that the scientific community needs to face in the coming years in order to achieve its ultimate goal of developing intelligent robotic sonographer colleagues. These colleagues are expected to be capable of collaborating with human sonographers in dynamic environments to enhance both diagnostic and intraoperative imaging.

Small Animal Teleultrasound.

Teleradiology is well established in many small animal practices, whereas teleultrasound is slowly gaining prominence. The demand for teleultrasound services in the veterinary profession has increased substantially because access to ultrasound to general practitioners increases faster than the number of imaging specialists and Point of Care Ultrasound (POCUS) becomes part of the standard of care. Two main methods of teleultrasound currently exist: asynchronous (eg, "store-and-forward") and synchronous (eg, real-time) interpretations. Few standardized protocols for teleultrasound in small animals are available. Similarly, there are no standardized training programs for sonographic examination acquisition and interpretation outside of the traditional diagnostic imaging residency under the purview of the American College of Veterinary Radiology. The success of a telesonographic evaluation largely depends on the relationship between the veterinarian requesting remote assistance and the expert providing support.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

A Telerobotic Ultrasound Clinic Model of Ultrasound Service Delivery to Improve Access to Imaging in Rural and Remote Communities.

OBJECTIVE: Patients living in many rural and remote areas do not have readily available access to ultrasound services because of a lack of sonographers and radiologists in these communities. The objective of this study was to determine the feasibility of using telerobotic ultrasound to establish a service delivery model to remotely provide access to diagnostic ultrasound in rural and remote communities. METHODS: Telerobotic ultrasound clinics were developed in three remote communities more than 500 km away from our academic medical center. Sonographers remotely performed all ultrasound examinations using telerobotic ultrasound systems, and examinations were subsequently interpreted by radiologists at an academic medical center. Diagnostic performance was assessed by each interpreting radiologist using a standardized reporting form. Patient experience was assessed through quantitative and qualitative analysis of survey responses. Operational challenges and solutions were identified. RESULTS: Eighty-seven telerobotic ultrasound examinations were remotely performed and included in this study, with the most frequent examination types being abdominal (n = 35), first-trimester obstetrical (n = 26), and second-trimester complete obstetrical (n = 12). Across all examination types, 70% of telerobotic ultrasound examinations were sufficient for diagnosis, minimizing travel or reducing wait times for these patients. Ninety-five percent of patients would be willing to have another telerobotic ultrasound examination in the future. Operational challenges were related to technical infrastructure, human resources, and coordination between clinic sites. CONCLUSION: Telerobotic ultrasound can provide access to diagnostic ultrasound services to underserved rural and remote communities without regular ultrasound services, thereby reducing disparities in access to care and improving health equity.

A toolkit for haptic force feedback in a telerobotic ultrasound system.

OBJECTIVE: To develop a collision engine (haptic force feedback simulator) compatible with a 5-degrees-of-freedom (DOF) haptic wand. This has broad applications such as telerobotic ultrasound systems. Integrating force feedback into systems is critical to optimize remote scanning. A collision engine compatible with a 5-DOF haptic wand was developed based on the Gilbert-Johnson-Keerthi algorithm. The collision engine calculated force during collision between the wand and a virtual object based on code developed using MATLAB. A proportional force was subsequently returned to a user via the haptic wand, thereby simulating the collision force for the user. Three experiments were conducted to assess the accuracy of the collision engine on curved and flat surfaces. RESULTS: The average errors in calculation of distances between the wand and virtual object were 2.1 cm, 3.4 cm, and 4.2 cm for the model of the human hand, cylinder, and cuboid, respectively. The collision engine accurately simulated forces on a flat surface, though was less accurate on curved surfaces. Future work will incorporate haptic force feedback into a telerobotic ultrasound system. The haptic force simulator presented here may also be used in the development of ultrasound simulators for training and education.

Medical Robotics for Ultrasound Imaging: Current Systems and Future Trends.

PURPOSE OF REVIEW: This review provides an overview of the most recent robotic ultrasound systems that have contemporary emerged over the past five years, highlighting their status and future directions. The systems are categorized based on their level of robot autonomy (LORA). RECENT FINDINGS: Teleoperating systems show the highest level of technical maturity. Collaborative assisting and autonomous systems are still in the research phase, with a focus on ultrasound image processing and force adaptation strategies. However, missing key factors are clinical studies and appropriate safety strategies. Future research will likely focus on artificial intelligence and virtual/augmented reality to improve image understanding and ergonomics. SUMMARY: A review on robotic ultrasound systems is presented in which first technical specifications are outlined. Hereafter, the literature of the past five years is subdivided into teleoperation, collaborative assistance, or autonomous systems based on LORA. Finally, future trends for robotic ultrasound systems are reviewed with a focus on artificial intelligence and virtual/augmented reality.

An evaluation of the awareness, perceptions, and practice of ultrasound and the use of telesonography among obstetrics and gynecologic sonologists in the Philippines during COVID-19 pandemic / Philippine Journal of Obstetrics and Gynecology

Background@#Major changes in the practice of medicine have been adopted due to the COVID-19 pandemic and have not spared the practice of ultrasound among obstetrician–gynecologists, considered to have higher risk due to unique attributes of an ultrasound examination. @*Objectives@#This study evaluated the awareness, attitudes, perceptions, and practices of the obstetric–gynecologic sonologists in the country during the pandemic, including the use of telesonography.@*Methodology@#A descriptive, cross-sectional survey was conducted through a self-administered, structured questionnaire using an online survey software. @*Results@#There were 120 respondents with postresidency training in ultrasound (54.2%) or in maternal and fetal medicine (43.3%), practicing in different regions, and mostly with teaching affiliations (56.7%). Most are aware of the guidelines on the practice of ultrasound this pandemic and they perceived themselves to be especially vulnerable to the infection. They admitted having feelings of stress, sadness, and depression, and their concerns centered on being infected and potentially transmitting it to their family. These perceptions translated to specific practices that include use of level 3 personal protective equipment, patient screening, triaging, and use of physical barriers to minimize environmental and contamination. While most are consistent with guidelines, some practices are neither based on sound scientific evidence nor correctly adhered to, including noncompliance with appropriate ultrasound transducer cleaning and disinfection. Regarding telesonography, only half of the respondents had good knowledge, with most having informal sources of information on the technology. Although the respondents have a good attitude toward it, only a few (15.8%) admitted to using it, mainly to confer with an expert or colleague (38.3%), and for teaching purposes (11.7%). @*Conclusions@#Obstetric–gynecologic sonologists in the Philippines are aware of the risks and have the same attitudes and perspective on COVID-19 infection as other health-care providers. Specific practices have been modified; however, the use of telesonography is not among the changes adopted.

"From the technology came the idea": safe implementation and operation of a high quality teleradiology model increasing access to timely breast cancer assessment services for women in rural Australia.

Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate experience in breast work to attend onsite assessment clinics, limits capacity of services to offer assessment appointments to women in some regional centres. In response to identified need, local service staff developed the remote radiology assessment model for service delivery. This study investigated important factors for establishing the model, the challenges and enablers of successful implementation and operation of the model, and factors important in the provision of a model considered safe and acceptable by service providers. METHODS: Semi-structured interviews were conducted with service providers at four assessment services, across three jurisdictions in Australia. Service providers involved in implementation and operation of the model at the service and jurisdictional level were invited to participate. A social constructivist approach informed the analysis. Deductive analysis was initially undertaken, using the interview questions as a classifying framework. Subsequently, inductive thematic analysis was employed by the research team. Together, the coding team aggregated the codes into overarching themes. RESULTS: 55 service providers participated in interviews. Consistently reported enablers for the safe implementation and operation of a remote radiology assessment clinic included: clinical governance support; ability to adapt; strong teamwork, trust and communication; and, adequate technical support and equipment. Challenges mostly related to technology and internet (speed/bandwidth), and maintenance of relationships within the group. CONCLUSIONS: Understanding the key factors for supporting innovation, and implementing new and safe models of service delivery that incorporate telemedicine, will become increasingly important as technology evolves and becomes more accessible. It is possible to take proposed telemedicine solutions initiated by frontline workers and operationalise them safely and successfully: (i) through strong collaborative relationships that are inclusive of key experts; (ii) with clear guidance from overarching bodies with some flexibility for adapting to local contexts; (iii) through establishment of robust teamwork, trust and communication; and, (iv) with appropriate equipment and technical support.

A Crossover Comparison of Standard and Telerobotic Approaches to Prenatal Sonography.

OBJECTIVES: To determine the feasibility of a telerobotic approach to remotely perform prenatal sonographic examinations. METHODS: Thirty participants were prospectively recruited. Participants underwent a limited examination (assessing biometry, placental location, and amniotic fluid; n = 20) or a detailed examination (biometry, placental location, amniotic fluid, and fetal anatomic survey; n = 10) performed with a conventional ultrasound system. This examination was followed by an equivalent examination performed with a telerobotic ultrasound system, which enabled sonographers to remotely control all ultrasound settings and fine movements of the ultrasound transducer from a distance. Telerobotic images were read independently from conventional images. RESULTS: The mean gestational age ± SD of the 30 participants was 22.9 ± 5.3 weeks. Paired-sample t tests showed no statistically significant difference between conventional and telerobotic measurements of fetal head circumference, biparietal diameter, or single deepest vertical pocket of amniotic fluid; however, a small but statistically significant difference was observed in measurements of abdominal circumference and femur length (P < .05). Intraclass correlations showed excellent agreement (>0.90) between telerobotic and conventional measurements of all 4 biometric parameters. Of 21 fetal structures included in the anatomic survey, 80% of the structures attempted across all patients were sufficiently visualized by the telerobotic system (range, 57%-100% per patient). Ninety-seven percent of patients strongly or somewhat agreed that they would be willing to have another telerobotic examination in the future. CONCLUSIONS: A telerobotic approach is feasible for remotely performing prenatal sonographic examinations. Telerobotic sonography (robotic telesonography) may allow for the development of satellite ultrasound clinics in rural, remote, or low-volume communities, thereby increasing access to prenatal imaging in underserved communities.

Telepresent Focused Assessment With Sonography for Trauma Examination Training Versus Traditional Training for Medical Students: A Simulation-Based Pilot Study.

OBJECTIVES: Telepresent education is becoming an important modality in medical education, as it provides a means for instructors to lead education sessions via videoconferencing technologies. This study aimed to compare the effectiveness of telepresent ultrasound training versus traditional in-person ultrasound training. METHODS: Medical student cohorts were educated by either traditional in-person instruction or telementoring on how to perform a focused assessment with sonography for trauma (FAST) examination. Effectiveness was evaluated by pre- and post-multiple-choice tests (knowledge), confidence surveys, and summative simulation scenarios (hands-on FAST simulation). Formative simulation scenario debriefings were evaluated by each student using the Debriefing Assessment for Simulation in Healthcare student version (DASH-SV). RESULTS: Each method of instruction had significant increases in knowledge, confidence, and hands-on FAST simulation performance (P < .05). The collective increase in knowledge was greater for the in-person group, whereas the improvement in FAST examination performance during simulations was greater for the telementored group. Confidence gains were comparable between the groups. The DASH-SV scores were significantly higher for the in-person group for each criterion; however, both methods were deemed effective via median scoring. CONCLUSIONS: Telepresent education is a viable option for teaching the FAST examination to medical students.

Can an Offsite Expert Remotely Evaluate the Visual Estimation of Ejection Fraction via a Social Network Video Call?

We aimed to investigate whether an offsite expert could effectively evaluate visually estimated ejection fraction (EF) while watching and guiding the echocardiographic procedure of an onsite novice practitioner using a social network video call. Sixty patients presenting to the intensive care unit and requiring echocardiography between October and November 2016 were included. Sixty novice sonographers without any previous experience of echocardiography participated. Prior to the procedure, the onsite cardiologist completed the echocardiography and determined the EF using the modified Simpson's method (reference value). Then, the novice practitioner performed the echocardiography again with the offsite expert's guidance via a social network video call. The EF was visually estimated by the offsite expert while watching the ultrasound video on the smartphone display. Spearman's rank correlation and Bland-Altman plot analysis were conducted to assess the agreement between the two methods. There was excellent agreement between the two methods, with a correlation coefficient of 0.94 (p < 0.001). The Bland-Altman plot showed that the average bias was -3.05, and the limit of agreement (-10.3 to 4.2) was narrow. The offsite expert was able to perform an accurate visual estimation of ejection fraction remotely via a social network video call by mentoring the onsite novice sonographer. ClinicalTrials.gov Identifier: NCT02960685.

Initial Experience Using a Telerobotic Ultrasound System for Adult Abdominal Sonography.

PURPOSE: The study sought to assess the feasibility of performing adult abdominal examinations using a telerobotic ultrasound system in which radiologists or sonographers can control fine movements of a transducer and all ultrasound settings from a remote location. METHODS: Eighteen patients prospectively underwent a conventional sonography examination (using EPIQ 5 [Philips] or LOGIQ E9 [GE Healthcare]) followed by a telerobotic sonography examination (using the MELODY System [AdEchoTech] and SonixTablet [BK Ultrasound]) according to a standardized abdominal imaging protocol. For telerobotic examinations, patients were scanned remotely by a sonographer 2.75 km away. Conventional examinations were read independently from telerobotic examinations. Image quality and acceptability to patients and sonographers was assessed. RESULTS: Ninety-two percent of organs visualized on conventional examinations were sufficiently visualized on telerobotic examinations. Five pathological findings were identified on both telerobotic and conventional examinations, 3 findings were identified using only conventional sonography, and 2 findings were identified using only telerobotic sonography. A paired sample t test showed no significant difference between the 2 modalities in measurements of the liver, spleen, and diameter of the proximal aorta; however, telerobotic assessments overestimated distal aorta and common bile duct diameters and underestimated kidney lengths (P values < .05). All patients responded that they would be willing to have another telerobotic examination. CONCLUSIONS: A telerobotic ultrasound system is feasible for performing abdominal ultrasound examinations at a distant location with minimal training and setup requirements and a moderate learning curve. Telerobotic sonography (robotic telesonography) may open up the possibility of remote ultrasound clinics for communities that lack skilled sonographers and radiologists, thereby improving access to care.

Robotic Arm-Assisted Sonography: Review of Technical Developments and Potential Clinical Applications.

OBJECTIVE: Ultrasound imaging requires trained personnel. Advances in robotics and data transmission create the possibility of telesonography. This review introduces clinicians to current technical work in and potential applications of this developing capability. CONCLUSION: Telesonography offers advantages in hazardous or remote environments. Robotically assisted ultrasound can reduce stress injuries in sonographers and has potential utility during robotic surgery and interventional procedures.

A Feasibility Study of Telementoring for Identifying the Appendix Using Smartphone-Based Telesonography.

We investigated the feasibility of the clinical application of novice-practitioner-performed/offsite-mentor-guided ultrasonography for identifying the appendix. A randomized crossover study was conducted using a telesonography system that can transmit the ultrasound images displayed on the ultrasound monitor (ultrasound sequence video) and images showing the practitioner's operations (background video) to a smartphone without any interruption in motion over a Long-Term Evolution (LTE) network. Thirty novice practitioners were randomly assigned to two groups. The subjects in group A (n = 15) performed ultrasonography for the identification of the appendix under mentoring by an onsite expert, whereas those in group B (n = 15) performed the same procedure under mentoring by an offsite expert. Each subject performed the procedure on three simulated patients. After a 4-week interval, they performed the procedure again under the other type of mentoring. A total of 90 ultrasound examinations were performed in each scenario. The primary outcomes were the success rate for identifying the appendix and the time required to identify the appendix. The success rates for identifying the appendix were 91.1 % (82/90) in onsite-mentored ultrasonography and 87.8 % (79/90) in offsite-mentored ultrasonography; both rates were high, and there was no significant difference (p = 0.468) between them. The time required in the case of offsite mentoring (median, 242.9 s; interquartile range (IQR), 238.2) was longer than that for onsite mentoring (median, 291.4 s; IQR, 200.9); however, the difference was not significant (p = 0.051). It appears that offsite mentoring can allow novice onsite practitioners to perform ultrasonography as effectively as they can under onsite mentoring, even for examinations that require proficiency in rather complex practices, such as identifying the appendix.

Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display.

BACKGROUND: Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities. METHODS: Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK-). RESULTS: Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK-). There were no statistical test performance differences in either group (GUIK+ and GUIK-). CONCLUSIONS: Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.

A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos.

Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.

Trans-Pacific tele-ultrasound image transmission of fetal central nervous system structures.

OBJECTIVE: To assess the quality of images and video clips of fetal central nervous (CNS) structures obtained by ultrasound and transmitted via tele-ultrasound from Brazil to Australia. METHODS: In this cross-sectional study, 15 normal singleton pregnant women between 20 and 26 weeks were selected. Fetal CNS structures were obtained by images and video clips. The exams were transmitted in real-time using a broadband internet and an inexpensive video streaming device. Four blinded examiners evaluated the quality of the exams using the Likert scale. We calculated the mean, standard deviation, mean difference, and p values were obtained from paired t tests. RESULTS: The quality of the original video clips was slightly better than that observed by the transmitted video clips; mean difference considering all observers = 0.23 points. In 47/60 comparisons (78.3%; 95% CI = 66.4-86.9%) the quality of the video clips were judged to be the same. In 182/240 still images (75.8%; 95% CI = 70.0-80.8%) the scores of transmitted image were considered the same as the original. CONCLUSION: We demonstrated that long distance tele-ultrasound transmission of fetal CNS structures using an inexpensive video streaming device provided images of subjective good quality.

Ultrasound: from Earth to space.

Ultrasonography is a versatile imaging modality that offers many advantages over radiography, computed tomography, and magnetic resonance imaging. On Earth, the use of ultrasound has become standard in many areas of medicine including diagnosis of medical and surgical diseases, management of obstetric and gynecologic conditions, assessment of critically ill patients, and procedural guidance. Advances in telecommunications have enabled remotely-guided ultrasonography for both geographically isolated populations and astronauts aboard the International Space Station. While ultrasound has traditionally been used in spaceflight to study anatomical and physiological adaptations to microgravity and evaluate countermeasures, recent years have seen a growth of applications adapted from terrestrial techniques. Terrestrial, remote, and space applications for ultrasound are reviewed in this paper.