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Koyasu N, Hyodo F, Iwasaki R, Elhelaly AE, Mori T, Noda Y, Kato H, Krishna MC, Kishimoto S, Matsuo M. Quantitative spatial visualization of X-ray irradiation via redox reaction by dynamic nuclear polarization magnetic resonance imaging. Free Radic Biol Med 2024:S0891-5849(24)00980-8. [PMID: 39396582 DOI: 10.1016/j.freeradbiomed.2024.10.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 09/12/2024] [Accepted: 10/10/2024] [Indexed: 10/15/2024]
Abstract
The dose of X-ray irradiation is commonly measured by point assessment with an ionization chamber dosimeter. However, to achieve spatially accurate delivery of X-ray to avoid the exposure to normal tissues, an accurate imaging method for spatially and quantitatively detecting exposure is required. Herein, we present a novel method to visualize X-ray exposure using low-field dynamic nuclear polarization magnetic resonance imaging (DNP-MRI) with nitroxyl radical tempol as the chemical dosimeter. In this system, gel phantoms containing glutathione (GSH) and the paramagnetic tempol radical were used to monitor the deposited X-ray-irradiation via the redox reaction. The tempol radical level was evaluated by DNP-MRI whose signal intensity was linearly correlated with the radical concentration. The radical level in the presence of GSH decreased in proportion to the dose of X-irradiation deposited. In an imaging experiment simulating clinical radiotherapy, we used a clinical linear accelerator with a radiotherapy planning software to confirm the utility of the exposure imaging. The X-ray exposure and its distribution were clearly visualized on the gel phantom image acquired by DNP-MRI. The results were consistent with those specified in the radiotherapy plan where the intensity of the radiation beam was modulated. This exposure estimation will be useful for determining an accurate irradiation field and reducing off-target exposure in clinical settings.
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Affiliation(s)
- Norikazu Koyasu
- Department of Radiology, Gifu University, Gifu, Japan; Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Fuminori Hyodo
- Department of Pharmacology, Graduate School of Medicine, Gifu University, Gifu, Japan; Center for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Japan; Innovation Research Center for Quantum Medicine, Gifu University, Gifu, Japan.
| | - Ryota Iwasaki
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan; Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Abdelazim Elsayed Elhelaly
- Department of Radiology, Frontier Science for Imaging, School of Medicine, Gifu University, Gifu, Japan; Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Takashi Mori
- Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, Gifu, Japan; Department of Radiology, Frontier Science for Imaging, School of Medicine, Gifu University, Gifu, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Murali C Krishna
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Shun Kishimoto
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA; Urologic Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, Gifu, Japan; Innovation Research Center for Quantum Medicine, Gifu University, Gifu, Japan; Department of Radiology, Frontier Science for Imaging, School of Medicine, Gifu University, Gifu, Japan
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2
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Grover S, Court L, Amoo-Mitchual S, Longo J, Rodin D, Scott AA, Lievens Y, Yap ML, Abdel-Wahab M, Lee P, Harsdorf E, Khader J, Jia X, Dosanjh M, Elzawawy A, Ige T, Pomper M, Pistenmaa D, Hardenbergh P, Petereit DG, Sargent M, Cina K, Li B, Anacak Y, Mayo C, Prattipati S, Lasebikan N, Rendle K, O'Brien D, Wendling E, Coleman CN. Global Workforce and Access: Demand, Education, Quality. Semin Radiat Oncol 2024; 34:477-493. [PMID: 39271284 DOI: 10.1016/j.semradonc.2024.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
There has long existed a substantial disparity in access to radiotherapy globally. This issue has only been exacerbated as the growing disparity of cancer incidence between high-income countries (HIC) and low and middle-income countries (LMICs) widens, with a pronounced increase in cancer cases in LMICs. Even within HICs, iniquities within local communities may lead to a lack of access to care. Due to these trends, it is imperative to find solutions to narrow global disparities. This requires the engagement of a diverse cohort of stakeholders, including working professionals, non-governmental organizations, nonprofits, professional societies, academic and training institutions, and industry. This review brings together a diverse group of experts to highlight critical areas that could help reduce the current global disparities in radiation oncology. Advancements in technology and treatment, such as artificial intelligence, brachytherapy, hypofractionation, and digital networks, in combination with implementation science and novel funding mechanisms, offer means for increasing access to care and education globally. Common themes across sections reveal how utilizing these new innovations and strengthening collaborative efforts among stakeholders can help improve access to care globally while setting the framework for the next generation of innovations.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center
| | - Sheldon Amoo-Mitchual
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John Longo
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Global Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Belgium; Ghent University, Ghent, Belgium
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; The George Institute for Global Health, UNSW Sydney, Barangaroo, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, NSW, Australia
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Peter Lee
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ekaterina Harsdorf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jamal Khader
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Xun Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - Manjit Dosanjh
- ICEC, CERN, Geneva, Switzerland; University of Oxford, Oxford, UK
| | - Ahmed Elzawawy
- Department of Clinical Oncology, Suez Canal University, Ismailia, Egypt; Alsoliman Clinical and Radiation Oncology Center, Port Said, Egypt
| | | | - Miles Pomper
- James Martin Center for Nonproliferation Studies, Washington, DC; ICEC, International Cancer Expert Corps, Washington, DC
| | | | | | - Daniel G Petereit
- Monument Health Cancer Care Institute Rapid City, South Dakota; Avera Research Institute, Sioux Falls, SD
| | | | | | - Benjamin Li
- University of Washington, Seattle, WA; Fred Hutch Cancer Center, Seattle, WA
| | - Yavuz Anacak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Chuck Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Nwamaka Lasebikan
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Katharine Rendle
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Donna O'Brien
- ICEC, International Cancer Expert Corps, Washington, DC
| | | | - C Norman Coleman
- ICEC, International Cancer Expert Corps, Washington, DC; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
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3
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). J Thorac Cardiovasc Surg 2024; 168:e104-e116. [PMID: 38864805 DOI: 10.1016/j.jtcvs.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 02/15/2024] [Indexed: 06/13/2024]
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of "assisting only." In Rwanda, Team Heart, a US and Rwanda-based nongovernmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its "Seal of Approval" for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pa
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, and Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria; Department of Cardiothoracic Surgery, University Clinic St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women's Hosp. and Mass General Hospital, Harvard University, Boston, Mass
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4
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a Difference: 5 Years of Cardiac Surgery Intersociety Alliance (CSIA). Ann Thorac Surg 2024; 118:338-351. [PMID: 38864803 DOI: 10.1016/j.athoracsur.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 06/13/2024]
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of "assisting only." In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its "Seal of Approval" for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, New York
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria; Department of Cardiothoracic Surgery, University Hospital St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women's Hospital and Mass General Hospital, Harvard University, Boston, Massachusetts
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5
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Mumuni AN, Eyre K, Montalba C, Harrison A, Maharjan S, Botwe F, Garcia MF, Zeraii A, Friedrich MG, Fatade A, Ntusi NAB, Lim T, Garg R, Umair M, Ninalowo HA, Adeleke S, Anosike C, Dako F, Anazodo UC. Scan With Me: A Train-the-Trainer Program to Upskill MRI Personnel in Low- and Middle-Income Countries. J Am Coll Radiol 2024; 21:1222-1234. [PMID: 38763442 DOI: 10.1016/j.jacr.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/29/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Access to MRI in low- and middle-income countries (LMICs) remains among the poorest in the world. The lack of skilled MRI personnel exacerbates access gaps, reinforcing long-standing health disparities. The Scan With Me (SWiM) program aims to sustainably create a network of highly skilled MRI technologists in LMICs who will facilitate the transfer of MRI knowledge and skills to their peers and contribute to the implementation of highly valuable imaging protocols for effective clinical and research use. METHODS The program introduces a case-based curriculum designed using a novel train-the-trainer approach, integrated with peer-collaborative learning to upskill practicing MRI technologists in LMICs. The 6-week curriculum uses the teach-try-use approach, which combines self-paced didactic lectures covering the basics of MR image acquisition (teach) with hands-on expert-guided scanning experience (try) and the implementation of protocols tailored to provide the best possible images on their infrastructures (use). Each program includes research translation skills training using an established advanced MRI technique relevant to LMICs. A pilot program focused on cardiac MRI (CMR) was conducted to assess the program's curriculum, delivery, and evaluation methods. RESULTS Forty-three MRI technologists from 16 LMICs participated in the pilot CMR program and, over the course of the training, implemented optimized CMR protocols that reduced acquisition times while improving image quality. The training resources and scanner-specific standardized protocols are published openly for public use in an online repository. In general, at the end of the program, learners reported considerable improvements in CMR knowledge and skills. All respondents to the program evaluation survey agreed to recommend the program to their colleagues, while 87% indicated interest in returning to help train others. CONCLUSIONS The SWiM program is the first master class in MRI acquisition for practicing imaging technologists in LMICs. The program holds the potential to help reduce disparities in MRI expertise and access. The support of the MRI community, imaging societies, and funding agencies will increase its reach and further its impact in democratizing MRI.
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Affiliation(s)
| | - Katerina Eyre
- Courtois CMR Research Group at the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Cristian Montalba
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aduluwa Harrison
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Surendra Maharjan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Francis Botwe
- Clinical Imaging Sciences Centre, University of Sussex, Brighton, United Kingdom
| | - Marina Fernandez Garcia
- Institute for Molecular Imaging and Instrumentation, Universitat Politenica de Valencia, Valencia, Spain
| | - Abderrazek Zeraii
- Biophysics Department, Higher Institute of Medical Technologies of Tunis, Tunis, Tunisia
| | - Matthias G Friedrich
- Courtois CMR Research Group at the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada; Departments of Cardiology and Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Tchoyoson Lim
- National Neuroscience Institute, Singapore, Singapore
| | - Ria Garg
- Department of Internal Medicine, Geisinger Wyoming Valley Hospital, Wilkes-Barre, Pennsylvania
| | | | | | - Sola Adeleke
- Department of Oncology, Guy's & St. Thomas' Hospital, London, United Kingdom
| | - Chinedum Anosike
- Accuread Radiology Nigeria, Lagos, Nigeria; Warrington and Halton Hospitals National Health Service Foundation Trust, Warrington, United Kingdom
| | - Farouk Dako
- RAD-AID International, Chevy Chase, Maryland; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Udunna C Anazodo
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Dako F, Omofoye TS, Scheel J. Radiologists' Role in Decolonizing Global Health. J Am Coll Radiol 2024; 21:1172-1179. [PMID: 38461914 DOI: 10.1016/j.jacr.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 03/12/2024]
Abstract
The colonial origins and power imbalances between Western high-income countries and low- and middle-income countries (LMICs) are barriers to self-reliance and sustained structural improvements to health care systems. Radiologists working in global health (global radiologists) are tasked with improving the state of imaging in LMICs while mitigating the effects of colonial structures and processes. To accomplish this, we need to be aware of factors such as colonialism, neocolonialism, parachute research, and brain drain that contribute to global health inequities. Potential solutions to decolonizing global radiology include commitment to understanding local context; strengthening local capacity for technology advancement, research, and development; and policies and educational programs to combat medical brain drain from LMICs. In this article, we describe how the legacies of colonialism can interfere with improving health in LMICS, despite the best intentions, and provide a call to action for decolonizing our field with intentional approaches and equitable partnerships that emphasize investments in sustainable infrastructure, robust training of personnel, and policies that support self-reliance to match true health system strengthening with our passion for addressing health equity.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Director of the Center for Global and Population Health Research in Radiology.
| | - Toma S Omofoye
- Strategic Director of Education, Department of Breast Imaging, Department of Clinical Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee. https://twitter.com/TomaOmofoyeMD
| | - John Scheel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Vice Chair of Global and Planetary Health. https://twitter.com/JohnRScheel
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7
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Omofoye TS, Refinetti APC, Kizub D, Bond M. Value-Based Care in Low- to Middle-Income Countries: Low-Cost, Context-Specific Imaging Technologies to Meet Population Health Needs. J Am Coll Radiol 2024; 21:1162-1165. [PMID: 38599360 DOI: 10.1016/j.jacr.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Toma S Omofoye
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast Imaging, Global Oncology Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Ana Paula Correa Refinetti
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast Surgical Oncology, Global Oncology Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, Texas. https://twitter.com/Drefinetti
| | - Darya Kizub
- Department of Breast Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas. https://twitter.com/DKizub
| | - Meaghan Bond
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas
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8
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Li L, He Q, Wei S, Wang H, Wang Z, Wei Z, He H, Xiang C, Yang W. Fast, high-quality, and unshielded 0.2 T low-field mobile MRI using minimal hardware resources. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01184-5. [PMID: 38967865 DOI: 10.1007/s10334-024-01184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To propose a deep learning-based low-field mobile MRI strategy for fast, high-quality, unshielded imaging using minimal hardware resources. METHODS Firstly, we analyze the correlation of EMI signals between the sensing coil and the MRI coil to preliminarily verify the feasibility of active EMI shielding using a single sensing coil. Then, a powerful deep learning EMI elimination model is proposed, which can accurately predict the EMI components in the MRI coil signals using EMI signals from at least one sensing coil. Further, deep learning models with different task objectives (super-resolution and denoising) are strategically stacked for multi-level post-processing to enable fast and high-quality low-field MRI. Finally, extensive phantom and brain experiments were conducted on a home-built 0.2 T mobile brain scanner for the evaluation of the proposed strategy. RESULTS 20 healthy volunteers were recruited to participate in the experiment. The results show that the proposed strategy enables the 0.2 T scanner to generate images with sufficient anatomical information and diagnostic value under unshielded conditions using a single sensing coil. In particular, the EMI elimination outperforms the state-of-the-art deep learning methods and numerical computation methods. In addition, 2 × super-resolution (DDSRNet) and denoising (SwinIR) techniques enable further improvements in imaging speed and quality. DISCUSSION The proposed strategy enables low-field mobile MRI scanners to achieve fast, high-quality imaging under unshielded conditions using minimal hardware resources, which has great significance for the widespread deployment of low-field mobile MRI scanners.
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Affiliation(s)
- Lei Li
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qingyuan He
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Shufeng Wei
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
| | - Huixian Wang
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
| | - Zheng Wang
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
| | - Zhao Wei
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
| | - Hongyan He
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
| | - Ce Xiang
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wenhui Yang
- Institute of Electrical Engineering Chinese Academy of Sciences, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
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9
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Zhao Y, Xiao L, Hu J, Wu EX. Robust EMI elimination for RF shielding-free MRI through deep learning direct MR signal prediction. Magn Reson Med 2024; 92:112-127. [PMID: 38376455 DOI: 10.1002/mrm.30046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To develop a new electromagnetic interference (EMI) elimination strategy for RF shielding-free MRI via active EMI sensing and deep learning direct MR signal prediction (Deep-DSP). METHODS Deep-DSP is proposed to directly predict EMI-free MR signals. During scanning, MRI receive coil and EMI sensing coils simultaneously sample data within two windows (i.e., for MR data and EMI characterization data acquisition, respectively). Afterward, a residual U-Net model is trained using synthetic MRI receive coil data and EMI sensing coil data acquired during EMI signal characterization window, to predict EMI-free MR signals from signals acquired by MRI receive and EMI sensing coils. The trained model is then used to directly predict EMI-free MR signals from data acquired by MRI receive and sensing coils during the MR signal-acquisition window. This strategy was evaluated on an ultralow-field 0.055T brain MRI scanner without any RF shielding and a 1.5T whole-body scanner with incomplete RF shielding. RESULTS Deep-DSP accurately predicted EMI-free MR signals in presence of strong EMI. It outperformed recently developed EDITER and convolutional neural network methods, yielding better EMI elimination and enabling use of few EMI sensing coils. Furthermore, it could work well without dedicated EMI characterization data. CONCLUSION Deep-DSP presents an effective EMI elimination strategy that outperforms existing methods, advancing toward truly portable and patient-friendly MRI. It exploits electromagnetic coupling between MRI receive and EMI sensing coils as well as typical MR signal characteristics. Despite its deep learning nature, Deep-DSP framework is computationally simple and efficient.
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Affiliation(s)
- Yujiao Zhao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, People's Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Linfang Xiao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, People's Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Jiahao Hu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, People's Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, People's Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, People's Republic of China
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10
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). Eur J Cardiothorac Surg 2024; 65:ezae048. [PMID: 38856237 PMCID: PMC11163458 DOI: 10.1093/ejcts/ezae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 02/15/2024] [Indexed: 06/11/2024] Open
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, PA, USA
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria
- Department of Cardiothoracic Surgery, University Hospital St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women’s Hosp. and Mass General Hospital, Harvard University, Boston, MA, USA
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11
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Bolman R, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele J, Enumah Z, Podesser B, Farkas E, Kofidis T, Zühlke L, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). Asian Cardiovasc Thorac Ann 2024; 32:271-284. [PMID: 38872357 PMCID: PMC11370180 DOI: 10.1177/02184923241259191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
SUMMARY Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, it's 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R.M. Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, USA
| | - P. Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - F. Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P. Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - J. Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, PA, USA
| | - J. Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - J. Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S. Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T. Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K. Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J.l. Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z. Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B. Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria
- Department of Cardiothoracic Surgery, University Clinic St. Pölten, Austria
| | - E.A. Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T. Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L.J. Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R. Higgins
- Brigham and Women’s Hosp. and Mass General Hospital, Harvard University, Boston, MA, USA
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12
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Zhao Y, Ding Y, Lau V, Man C, Su S, Xiao L, Leong ATL, Wu EX. Whole-body magnetic resonance imaging at 0.05 Tesla. Science 2024; 384:eadm7168. [PMID: 38723062 DOI: 10.1126/science.adm7168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 05/31/2024]
Abstract
Despite a half-century of advancements, global magnetic resonance imaging (MRI) accessibility remains limited and uneven, hindering its full potential in health care. Initially, MRI development focused on low fields around 0.05 Tesla, but progress halted after the introduction of the 1.5 Tesla whole-body superconducting scanner in 1983. Using a permanent 0.05 Tesla magnet and deep learning for electromagnetic interference elimination, we developed a whole-body scanner that operates using a standard wall power outlet and without radiofrequency and magnetic shielding. We demonstrated its wide-ranging applicability for imaging various anatomical structures. Furthermore, we developed three-dimensional deep learning reconstruction to boost image quality by harnessing extensive high-field MRI data. These advances pave the way for affordable deep learning-powered ultra-low-field MRI scanners, addressing unmet clinical needs in diverse health care settings worldwide.
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Affiliation(s)
- Yujiao Zhao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ye Ding
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Vick Lau
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Christopher Man
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shi Su
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Linfang Xiao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Alex T L Leong
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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13
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Anazodo UC, Plessis SD. Imaging without barriers. Science 2024; 384:623-624. [PMID: 38723100 DOI: 10.1126/science.adp0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Low-field magnetic resonance imaging can be engineered for widespread point-of-care diagnostics.
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Affiliation(s)
- Udunna C Anazodo
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Insitute, McGill University, Montreal, QC, Canada
- Medical Artificial Intelligence Laboratory, Crestview Radiology Ltd., Lagos, Nigeria
| | - Stefan du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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14
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Ren Q, Lang Y, Jia Y, Xiao X, Liu Y, Kong X, Jin R, He Y, Zhang J, You JW, Sha WEI, Pang Y. High-Q metasurface signal isolator for 1.5T surface coil magnetic resonance imaging on the go. OPTICS EXPRESS 2024; 32:8751-8762. [PMID: 38571125 DOI: 10.1364/oe.514806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/24/2024] [Indexed: 04/05/2024]
Abstract
The combination of surface coils and metamaterials remarkably enhance magnetic resonance imaging (MRI) performance for significant local staging flexibility. However, due to the coupling in between, impeded signal-to-noise ratio (SNR) and low-contrast resolution, further hamper the future growth in clinical MRI. In this paper, we propose a high-Q metasurface decoupling isolator fueled by topological LC loops for 1.5T surface coil MRI system, increasing the magnetic field up to fivefold at 63.8 MHz. We have employed a polarization conversion mechanism to effectively eliminate the coupling between the MRI metamaterial and the radio frequency (RF) surface transmitter-receiver coils. Furthermore, a high-Q metasurface isolator was achieved by taking advantage of bound states in the continuum (BIC) for extremely high-resolution MRI and spectroscopy. An equivalent physical model of the miniaturized metasurface design was put forward through LC circuit analysis. This study opens up a promising route for the easy-to-use and portable surface coil MRI scanners.
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15
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Goyal MS, Vidal L, Chetcuti K, Chilingulo C, Ibrahim K, Zhang J, Small DS, Seydel KB, O'Brien N, Taylor TE, Postels DG. MRI-Based Brain Volume Scoring in Cerebral Malaria Is Externally Valid and Applicable to Lower-Resolution Images. AJNR Am J Neuroradiol 2024; 45:205-210. [PMID: 38216302 DOI: 10.3174/ajnr.a8098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND PURPOSE Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs. MATERIALS AND METHODS To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs. RESULTS Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P < .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients > 0.86). CONCLUSIONS Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.
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Affiliation(s)
- Manu S Goyal
- From the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri
| | - Lorenna Vidal
- Children's Hospital of Philadelphia (L.V.), Philadelphia, Pennsylvania
| | - Karen Chetcuti
- Department of Radiology (K.C.), Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Cowles Chilingulo
- Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Khalid Ibrahim
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
| | - Jeffrey Zhang
- Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dylan S Small
- Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl B Seydel
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicole O'Brien
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
- Nationwide Children's Hospital (N.O.), Division of Pediatric Critical Care, Columbus, Ohio
| | - Terrie E Taylor
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Douglas G Postels
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
- Division of Neurology (D.G.P.), The George Washington University, Children's National Medical Center, Washington, DC
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16
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Zalcman M, Barth RA, Rubesova E. Real-time ultrasound-derived fat fraction in pediatric population: feasibility validation with MR-PDFF. Pediatr Radiol 2023; 53:2466-2475. [PMID: 37667050 DOI: 10.1007/s00247-023-05752-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. To avoid limitations of liver biopsy and MRI, quantitative ultrasound has become a research focus. Ultrasound-derived fat fraction (UDFF) is based on a combination of backscatter coefficient and attenuation parameter. OBJECTIVE The objectives of the study were to determine (1) agreement between UDFF/MRI proton density fat fraction (MR-PDFF) and (2) whether BMI and age are predictive for UDFF. MATERIALS AND METHODS This cross-sectional prospective study included a convenience sample of 46 children referred for clinically indicated abdominal MRI. MR-PDFF and five acquisitions of UDFF were collected. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between MR-PDFF and UDFF. Receiver operating characteristic curves were calculated for UDFF prediction of liver steatosis (MR-PDFF ≥ 6%). Multivariable regression was performed to assess BMI and age as predictors for UDFF. RESULTS Twenty-two participants were male, 24 were female, and the mean age was 14 ± 3 (range: 7-18) years. Thirty-six out of 46 participants had normal liver fat fraction <6%, and 10/46 had liver steatosis. UDFF was positively associated with MR-PDFF (ICC 0.92 (95% CI, 0.89-0.96). The mean bias between UDFF and MR-PDFF was 0.64% (95% LOA, -5.3-6.6%). AUROC of UDFF for steatosis was of 0.95 (95% CI, 0.89-0.99). UDFF cutoff of 6% had a sensitivity of 90% (95% CI, 55-99%) and a specificity of 94% (95% CI, 81-0.99%). BMI was an independent predictor of UDFF (correlation: 0.55 (95% CI, 0.35-0.95)). CONCLUSIONS UDFF shows strong agreement with MR-PDFF in children. A UDFF cutoff of 6% provides good sensitivity and specificity for detection of MR-PDFF of ≥ 6%.
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Affiliation(s)
- Max Zalcman
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
| | - Richard A Barth
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Erika Rubesova
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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17
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Man C, Lau V, Su S, Zhao Y, Xiao L, Ding Y, Leung GK, Leong AT, Wu EX. Deep learning enabled fast 3D brain MRI at 0.055 tesla. SCIENCE ADVANCES 2023; 9:eadi9327. [PMID: 37738341 PMCID: PMC10516503 DOI: 10.1126/sciadv.adi9327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023]
Abstract
In recent years, there has been an intensive development of portable ultralow-field magnetic resonance imaging (MRI) for low-cost, shielding-free, and point-of-care applications. However, its quality is poor and scan time is long. We propose a fast acquisition and deep learning reconstruction framework to accelerate brain MRI at 0.055 tesla. The acquisition consists of a single average three-dimensional (3D) encoding with 2D partial Fourier sampling, reducing the scan time of T1- and T2-weighted imaging protocols to 2.5 and 3.2 minutes, respectively. The 3D deep learning leverages the homogeneous brain anatomy available in high-field human brain data to enhance image quality, reduce artifacts and noise, and improve spatial resolution to synthetic 1.5-mm isotropic resolution. Our method successfully overcomes low-signal barrier, reconstructing fine anatomical structures that are reproducible within subjects and consistent across two protocols. It enables fast and quality whole-brain MRI at 0.055 tesla, with potential for widespread biomedical applications.
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Affiliation(s)
- Christopher Man
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Vick Lau
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Shi Su
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Yujiao Zhao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Linfang Xiao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Ye Ding
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Gilberto K. K. Leung
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Alex T. L. Leong
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Ed X. Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
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Nathoo N, Zeydan B, Neyal N, Chelf C, Okuda DT, Kantarci OH. Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities? Front Neurol 2023; 14:1215774. [PMID: 37448745 PMCID: PMC10338060 DOI: 10.3389/fneur.2023.1215774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences.
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Affiliation(s)
- Nabeela Nathoo
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Burcu Zeydan
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Nur Neyal
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Cynthia Chelf
- Mayo Clinic College of Medicine and Science, Library-Public Services, Mayo Clinic, Rochester, MN, United States
| | - Darin T. Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Orhun H. Kantarci
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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