In a small room in the Alice Springs Hospital, Rhonda O'Keefe is giving a man an ultrasound on his heart, despite having no formal training to do so.
Ms O'Keefe is not a sonographer, she's an Aboriginal health practitioner.
She has some medical training, but not the two years of post-graduate study it takes to become a qualified sonographer.
Instead, Ms O'Keefe is being guided by artificial intelligence as she performs the echocardiogram, the ultrasound of the heart.
The AI software prompts Ms O'Keefe on where she needs to hold the ultrasound probe, and how much pressure to apply, depending on what the echocardiogram is looking for.
"It's hard to get a good picture of the heart," she said.
"[I'm] trying to get the best technique using my hand to rotate where the heart is."
Her first attempt at performing the procedure was just two weeks ago, but already she is obtaining pictures that cardiologists can use for diagnosis.
It's a remarkable achievement, according to Dr Angus Baumann, the only full-time cardiologist at the Alice Springs Hospital.
Dr Baumann, who has been observing Ms O'Keefe's training, said when he learned to conduct echocardiograms it took him months of practice to get usable images — despite already working as a specialist in the field after years of medical school.
"With this technology, someone's able to get usable images on their first go," he said.
"As they use the machine more, they become more comfortable and more familiar, and it becomes easier for them.
"But we're able to get some basic diagnostic images within the first couple of attempts, which is really unheard of."
The images are uploaded to a cloud-based server,and then downloaded and analysed by cardiologists. who may be hundreds of kilometres away from the patient.
A lifeline for remote communities
The new technology is being trialled by the Baker Heart and Diabetes Institute at five sites across Australia in cooperation with Aboriginal community health groups.
The other sites where the technology is being tested are: Walgett in New South Wales; the Wheatbelt in Western Australia, starting at Merredin; southern Tasmania, starting at Huonville; and in Queensland at outreach clinics in Kingaroy, Cherbourg and Cunnamulla.
First Nations Australians are three times more likely than the general population to die from a heart condition, and the rate is even higher for people living in remote parts of the country.
Dr Baumann said he could see an enormous potential for the technology to be used in remote Indigenous clinics to try to screen more people and catch heart ailments earlier.
"We don't know how bad the prevalence of heart failure is," he said.
"We're not able to diagnose everybody because we can't get them echo images to have a look at their heart function."
Ms O'Keefe said allowing Indigenous health workers to offer echocardiograms could help improve health outcomes for people and could be more culturally appropriate.
"I feel good, maybe it'll be of benefit for my people, out in the communities or wherever they need help," she said.
"Sometimes it's hard for them to get into the hospital.
"Sometimes they have transport problems and sometimes Aboriginal people don't want to leave their community."
AI a 'helper' not a replacement
Professor Tom Marwick from the Baker Institute said so far the results from the trial had shown that the AI technology was working to get good quality ultrasound images.
"The computer knows what the image should look like and it also knows how to get to the appropriate image, so it's able to prompt the person that's doing the test to get to where they should be," he said.
Professor Marwick said that the technology could also be adapted to allow for scans on other parts of the body, broadening its potential uses in remote locations.
In the future, AI software could also be taught to analyse the pictures and help diagnose health issues, he said.
"Fundamentally, I don't think it's going to replace a human," he said.
"I think that it means that the process of interpreting the images will be more consistent, and probably more reliable.
"But it's still going to require some human judgement about what's important and what's not."
He said the technology aimed to assist trained sonographers and cardiologists, not to replace them.
"If you think about the patients that are having these scans at the moment, the normal pathway for them would be either to travel to a city to have the test done, or to wait until the visiting group come by perhaps once a month," he said.
"That produces problems with timeliness of diagnosis and then people getting lost in the system."
Professor Marwick said the trial was examining whether the images gathered using the AI technology were of the same quality as traditionally gathered pictures, and if they were failing to identify any health problems.
"If there's uncertainty about the result, because the image is inadequate, then that patient will go through the normal pathway, so I don't see a downside," he said.
AI eases sonographer shortage
Australia has a shortage of sonographers, and the profession has been on the national skills shortage list for more than a decade, according to the Australasian Sonographers Association chief executive Jodie Long.
"Having done a recent survey of the major employers across Australia, probably about 20 per cent of rooms are being closed or not filled because they can't get sonographers," she said.
Ms Long said part of the shortage was due in part to a lack of clinical placements for sonographers in training, with employers being unable to dedicate resources to the training due to an increase in demand for ultrasounds.
She said there was a role for technology like that being trialled by the Baker Institute, but cautioned it would not and should not completely replace human sonographers who were able to investigate further if they saw a problem.
"They are performing the scan in real time, so they're moving the patient, getting the patient to breathe in, putting different pressure on the probe, turning the probe a different way to be able to get a different image, it's very much individualised to the patient's type," Ms Long said.
"That can be quite challenging for something like AI where it's not reproducible."
But Ms Long said the AI technology could be useful in remote places, where patients had few options if they needed an echocardiogram.
"If you're comparing it to nothing, then obviously having something is better than nothing, absolutely," she said.
"For really remote Indigenous communities, where sonographers aren't even going out there, then anything to help them and support them absolutely we encourage.
"In an ideal world, you would be able to have them access the best possible scan that they possibly can but I do understand the limitations of geography."
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