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Introduction: Ultrasound-based diagnosis requires great expertise for reliability and accuracy, thus practical training is vital. Digital training can offer students the possibility of practical training in their local setups. However, there are critical issues that remote educators must address, particularly in advanced ultrasound training. The present study was therefore aiming at developing a suitable technical setup for supervision and education in tele-ultrasound that can be applied to a variety of advanced diagnostic and therapeutic areas. Methods: Using an action research approach including four cycles of action, we tested four technical setups with different software and hardware components across four ultrasound courses. Based on evaluation forms, written reflections, and two focus group interviews from the four cycles of action, respectively, we modified the setups to improve the technical solution for the next cycle. Results: The initial set-up was using commercial video call apps via mobile phones. Although no additional equipment or expertise was required, it was precluded by the poor image quality and motion blur resulting from capturing the ultrasound image on the smartphone. Nevertheless, this solution is viable when quick clarifications are needed. Additional stabilization support in the second set-up did not provide satisfactory image quality. The best technical solution was found in the third set-up, using a frame grabber and Reacts, which allows simultaneous live streaming of the ultrasound screen image and two web cameras. However, the cumbersome software interface, the need for an expensive user license, and problems with the internet connection reduced the acceptability of this setup. The optimal setup in cycle four, was a reasonable frame grabber, and Zoom, which is free, has a simple user interface and can stream live audio-visual ultrasound data from the probe and user simultaneously. Its annotation function is also beneficial in supervision. Conclusion: Through an action research approach including four cycles of action and thorough, subsequent evaluations, we found that a videoconferencing platform, such as Zoom, a computer, and a frame grabber connected to the ultrasound scanner was the optimal solution as this set-up is simple and affordable and is facilitating a good video-transmitted learning situation for students and supervisors. This technical set-up could therefore be suitable for a wide range of remote ultrasound courses.