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Jemal K, Ayana D, Tadesse F, Adefris M, Awol M, Tesema M, Dagne B, Abeje S, Bantie A, Butler M, Nwoke C, Kanyuka Z, Adams SJ, Mendez I. Implementation and evaluation of a pilot antenatal ultrasound imaging programme using tele-ultrasound in Ethiopia. J Telemed Telecare 2024; 30:1005-1016. [PMID: 35912493 PMCID: PMC11367800 DOI: 10.1177/1357633x221115746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. METHODS Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. RESULTS 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. CONCLUSION Healthcare provider-performed antenatal ultrasound - supported by obstetricians via tele-ultrasound - showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging.
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Affiliation(s)
- Kemal Jemal
- Department of Nursing, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Dereje Ayana
- Department of Medicine, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Felagot Tadesse
- Department of Obstetrics and Gynecology, St Paul’s Hospital Millennium College, Addis Ababa, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, University of Gondar, Gondar, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mengistu Tesema
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Bewunetu Dagne
- Department of Computer Science, College of Natural Sciences, Salale University, Fitche, Ethiopia
| | - Sandra Abeje
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | - Alehegn Bantie
- Canadian Physicians for Aid and Relief, Addis Ababa, Ethiopia
| | - Megan Butler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Chikezirim Nwoke
- Department of Sociology and Anthropology, Carleton University, Ottawa, Canada
| | - Zakhar Kanyuka
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Ivar Mendez
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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2
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Leo MM, Potter IY, Zahiri M, Vaziri A, Jung CF, Feldman JA. Using Deep Learning to Detect the Presence and Location of Hemoperitoneum on the Focused Assessment with Sonography in Trauma (FAST) Examination in Adults. J Digit Imaging 2023; 36:2035-2050. [PMID: 37286904 PMCID: PMC10501965 DOI: 10.1007/s10278-023-00845-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Abdominal ultrasonography has become an integral component of the evaluation of trauma patients. Internal hemorrhage can be rapidly diagnosed by finding free fluid with point-of-care ultrasound (POCUS) and expedite decisions to perform lifesaving interventions. However, the widespread clinical application of ultrasound is limited by the expertise required for image interpretation. This study aimed to develop a deep learning algorithm to identify the presence and location of hemoperitoneum on POCUS to assist novice clinicians in accurate interpretation of the Focused Assessment with Sonography in Trauma (FAST) exam. We analyzed right upper quadrant (RUQ) FAST exams obtained from 94 adult patients (44 confirmed hemoperitoneum) using the YoloV3 object detection algorithm. Exams were partitioned via fivefold stratified sampling for training, validation, and hold-out testing. We assessed each exam image-by-image using YoloV3 and determined hemoperitoneum presence for the exam using the detection with highest confidence score. We determined the detection threshold as the score that maximizes the geometric mean of sensitivity and specificity over the validation set. The algorithm had 95% sensitivity, 94% specificity, 95% accuracy, and 97% AUC over the test set, significantly outperforming three recent methods. The algorithm also exhibited strength in localization, while the detected box sizes varied with a 56% IOU averaged over positive cases. Image processing demonstrated only 57-ms latency, which is adequate for real-time use at the bedside. These results suggest that a deep learning algorithm can rapidly and accurately identify the presence and location of free fluid in the RUQ of the FAST exam in adult patients with hemoperitoneum.
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Affiliation(s)
- Megan M Leo
- Boston University School of Medicine, Boston, MA, USA.
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave1St Floor, Boston, MA, 02118, USA.
| | | | | | | | - Christine F Jung
- Division of Emergency Ultrasound, Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
- Department of Emergency Medicine, Chicago Medical School of Rosalind, Franklin University of Medical Sciences, Chicago, IL, USA
- Department of Emergency Medicine, Rush Medical College, Chicago, IL, USA
| | - James A Feldman
- Boston University School of Medicine, Boston, MA, USA
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave1St Floor, Boston, MA, 02118, USA
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3
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Russell FM, Herbert A, Lobo D, Ferre R, Nti BK. Evaluation of Point-of-Care Ultrasound Training for Family Physicians Using Teleultrasound. Fam Med 2023; 55:263-266. [PMID: 37043188 PMCID: PMC10622021 DOI: 10.22454/fammed.2023.469019] [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: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The goal of this study was to assess family physicians' change in knowledge and ability to perform abdominal aorta ultrasound after implementation of a novel teleultrasound curriculum. METHODS This was a prospective, observational study conducted at a single academic institution. Family physicians completed a preassessment, test, and objective structured clinical evaluation (OSCE). Physicians then individually completed a standard curriculum consisting of online content and an hour-long, hands-on training session on abdominal aorta ultrasound using teleultrasound technology. Physicians then performed a minimum of 10 independent examinations over a period of 8 weeks. After physicians completed the training curriculum and 10 independent scans, we administered a postassessment, test, and OSCE. We analyzed differences between pre- and postcurriculum responses using Fisher exact and Wilcoxon signed rank tests. RESULTS Thirteen family physicians completed the curriculum. Comparing pre- to postcurriculum responses, we found significant reductions in barriers to using aorta POCUS and improved confidence in using, obtaining, and interpreting aorta POCUS (P<0.01). Knowledge improved from a median score of 70% to 90% (P<0.01), and OSCE scores improved from a median of 80% to 100% (P=0.012). Overall, 211 aorta ultrasound examinations were independently acquired with a median image quality of 4 (scale 1 to 4). CONCLUSIONS After an 8-week teleultrasound curriculum, family physicians with minimal experience with POCUS showed improved knowledge and psychomotor skill in abdominal aorta POCUS.
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Affiliation(s)
- Frances M. Russell
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Audrey Herbert
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Daniela Lobo
- Department of Family Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Robinson Ferre
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Benjamin K. Nti
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
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4
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Lipsitz M, Levin L, Sharma V, Herrala J, Rimawi A, Bernier D, Kimberly H, Thomson A, Soucy Z, Henwood P. The State of Point-of-Care Teleultrasound Use for Educational Purposes: A Scoping Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1889-1906. [PMID: 34825718 DOI: 10.1002/jum.15885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/24/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Bedside ultrasound has been shown to change and direct patient management in the emergent setting. Demand, use, and diagnostic potential of point-of-care ultrasound (POCUS) has continually increased throughout the years. The ongoing COVID-19 pandemic and physical distancing have necessitated further POCUS innovation. With the advent of affordable portable ultrasound devices, teleultrasound teaching has become a more viable method of POCUS education, especially in resource-limited settings. Here, we provide a scoping review of the current state of teleultrasound, specifically its use for educational purposes.
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Affiliation(s)
- Mindy Lipsitz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Vinay Sharma
- Froedtert Hospital Menomonee Falls Family Medicine Program, Menomonee Falls, WI, USA
| | - Jeffrey Herrala
- Alameda Health System - Highland Hospital, Emergency Medicine Program, Oakland, CA, USA
| | | | - Denie Bernier
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heidi Kimberly
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Thomson
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Zach Soucy
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Patricia Henwood
- Department of Emergency Medicine, Jefferson Medical College, Philadelphia, PA, USA
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Chai HH, Ye RZ, Xiong LF, Xu ZN, Chen X, Xu LJ, Hu X, Jiang LF, Peng CZ. Successful Use of a 5G-Based Robot-Assisted Remote Ultrasound System in a Care Center for Disabled Patients in Rural China. Front Public Health 2022; 10:915071. [PMID: 35923952 PMCID: PMC9339711 DOI: 10.3389/fpubh.2022.915071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 12/07/2022] Open
Abstract
Background Disability has become a global population health challenge. Due to difficulties in self-care or independent living, patients with disability mainly live in community-based care centers or institutions for long-term care. Nonetheless, these settings often lack basic medical resources, such as ultrasonography. Thus, remote ultrasonic robot technology for clinical applications across wide regions is imperative. To date, few experiences of remote diagnostic systems in rural care centers have been reported. Objective To assess the feasibility of a fifth-generation cellular technology (5G)-based robot-assisted remote ultrasound system in a care center for disabled patients in rural China. Methods Patients underwent remote robot-assisted and bedside ultrasound examinations of the liver, gallbladder, spleen, and kidneys. We compared the diagnostic consistency and differences between the two modalities and evaluated the examination duration, image quality, and safety. Results Forty-nine patients were included (21 men; mean age: 61.0 ± 19.0 [range: 19-91] years). Thirty-nine and ten had positive and negative results, respectively; 67 lesions were detected. Comparing the methods, 41 and 8 patients had consistent and inconsistent diagnoses, respectively. The McNemar and kappa values were 0.727 and 0.601, respectively. The mean duration of remote and bedside examinations was 12.2 ± 4.5 (range: 5-26) min and 7.5 ± 1.8 (range: 5-13) min (p < 0.001), respectively. The median image score for original images on the patient side and transmitted images on the doctor side was 5 points (interquartile range: [IQR]: 4.7-5.0) and 4.7 points (IQR: 4.5-5.0) (p = 0.176), respectively. No obvious complications from the examination were reported. Conclusions A 5G-based robot-assisted remote ultrasound system is feasible and has comparable diagnostic efficiency to traditional bedside ultrasound. This system may provide a unique solution for basic ultrasound diagnostic services in primary healthcare settings.
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Affiliation(s)
- Hui-hui Chai
- Department of Medical Ultrasound, Shanghai Tenth People' Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui-zhong Ye
- Emergency and Critical Care Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lin-fei Xiong
- Department of Engineering, BGI Life Science Research Institution, Shenzhen, China
| | - Zi-ning Xu
- Emergency and Critical Care Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xuan Chen
- Department of Engineering, BGI Life Science Research Institution, Shenzhen, China
| | - Li-juan Xu
- Department of General Practice, Yuanshu Disabled Care Center, Huzhou, China
| | - Xin Hu
- Department of General Practice, Yuanshu Disabled Care Center, Huzhou, China
| | - Lian-feng Jiang
- Department of General Practice, Yuanshu Disabled Care Center, Huzhou, China
| | - Cheng-zhong Peng
- Department of Medical Ultrasound, Shanghai Tenth People' Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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Abouzid MR, Elshafei SM, Elkhawas I, Elbana MK. Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced. Cureus 2022; 14:e26611. [PMID: 35936169 PMCID: PMC9355518 DOI: 10.7759/cureus.26611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Information and communication technology has left a print on all fields of life, including medicine and the health care system. Telemedicine is the perfect way to ensure adequate healthcare delivery to all people at any time, particularly during pandemics, regardless of any geographic or economic considerations. This article investigates the different types, categories, and benefits in addition to the barriers to telemedicine implementation, especially in the Middle East and North Africa (MENA) region. After a thorough review of medical literature related to telemedicine using PubMed, Google Scholar, and some other gray literature, it has been found that telemedicine has been involved in almost all medical specialties with a positive influence on healthcare delivery and medical education and research. It had a major role during the COVID-19 pandemic. However, many obstacles prevent its proper application and need to be addressed carefully by the government and relevant authorities. Due to the rapidly growing population, unequal distribution of healthcare services, and social distancing of the COVID-19 pandemic, the role of telemedicine has become increasingly essential. Regarding medical education and research, telemedicine facilitates the exchange of information and ideas between physicians and professionals from all over the world, bringing these various minds together on a single platform.
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Affiliation(s)
- Mohamed R Abouzid
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Shorouk M Elshafei
- Internal Medicine, Mansoura University Faculty of Medicine, Mansoura, EGY
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7
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DePhilip RM, Quinn MM. Adaptation of an anatomy graduate course in ultrasound imaging from in-person to live, remote instruction during the Covid-19 pandemic. ANATOMICAL SCIENCES EDUCATION 2022; 15:493-507. [PMID: 35271761 PMCID: PMC9082486 DOI: 10.1002/ase.2177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 05/28/2023]
Abstract
Health concerns during the Covid-19 pandemic required the adaptation of a lecture-laboratory course in ultrasound imaging for graduate students from an in-person to a live, remote learning format. The adaptation of in-person lectures to live, remote delivery was achieved by using videoconferencing. The adaptation of in-person laboratory sessions to live, remote instruction was achieved in the first half of the course by providing a hand-held ultrasound instrument to each student who performed self-scanning at their remote locations, while the instructor provided live instruction using videoconferencing. In the second half of the course, the students transitioned to using cart-based, hospital-type instruments and self-scanning in the ultrasound laboratory on campus. The aim of this study was to measure the success of this adaptation to the course by comparing assessment scores of students in the live, remote course with assessment scores of students in the in-person course offered in the previous year. There were no statistically significant differences in the assessment scores of students in the two courses. The adaptation of a course in ultrasound imaging from an in-person to a live, remote learning format during the Covid-19 pandemic described here suggests that contrary to the prevailing view, ultrasound imaging can be taught to students without in-person instruction. The adapted course can serve as a model for teaching ultrasound where instructors and learners are physically separated by constraints other than health concerns during a pandemic.
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Affiliation(s)
- Robert M. DePhilip
- Division of AnatomyDepartment of Biomedical Education and AnatomyThe Ohio State University College of MedicineColumbusOhioUSA
| | - Melissa M. Quinn
- Division of AnatomyDepartment of Biomedical Education and AnatomyThe Ohio State University College of MedicineColumbusOhioUSA
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8
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Li XL, Sun YK, Wang Q, Chen ZT, Qian ZB, Guo LH, Xu HX. Synchronous tele-ultrasonography is helpful for a naive operator to perform high-quality thyroid ultrasound examinations. Ultrasonography 2022; 41:650-660. [PMID: 35773182 PMCID: PMC9532195 DOI: 10.14366/usg.21204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/05/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose This study investigated the value of synchronous tele-ultrasonography (TUS) for naive operators in thyroid ultrasonography (US) examinations. Methods Ninety-seven patients were included in this prospective, parallel-controlled trial. Thyroid scanning and diagnosis were completed by resident A independently, resident B with guidance from a US expert through synchronous TUS, and an on-site US expert. The on-site expert’s findings constituted the reference standard. Two other off-site US experts analyzed all data in a blind manner. Inter-operator consistency between the two residents and the on-site US expert for thyroid size measurements, nodule measurements, nodule features, American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) categories, and image quality was compared. Two questionnaires were completed to evaluate the clinical benefit. Results Resident B detected more nodules consistent with the on-site expert than resident A did (89.4% vs. 56.5%, P<0.001). Resident B achieved excellent consistency with the on-site expert in terms of ACR TI-RADS categories, nodule composition, shape, echogenic foci, and vascularity (all intra-class correlation coefficients [ICCs] >0.75), while resident A achieved lower consistency in ACR TI-RADS categories, composition, echogenicity, margin, echogenic foci, and vascularity (all ICCs 0.40-0.75). Residents A and B had excellent consistency in target nodule measurements (all ICCs >0.75). Resident B achieved better performance than resident A for gray values, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (all P<0.05). Furthermore, 61.9% (60/97) of patients accepted synchronous TUS, and 59.8% (58/97) patients were willing to pay for it. Conclusion Synchronous TUS can help inexperienced residents achieve comparable thyroid diagnostic capability to a US expert.
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Affiliation(s)
- Xiao-Long Li
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Kang Sun
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qiao Wang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zi-Tong Chen
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhe-Bin Qian
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Le-Hang Guo
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Unar B, Rolak SC, Zhong C, Rokey R. Implementation of Process Improvements to Facilitate Cardiac CT Re-Credentialing in a Rural Healthcare System. Clin Med Res 2022; 20:9-15. [PMID: 35022198 PMCID: PMC9390853 DOI: 10.3121/cmr.2021.1650] [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: 12/03/2020] [Accepted: 10/04/2021] [Indexed: 11/18/2022]
Abstract
Background: Because rural providers may experience barriers in achieving the necessary components to successfully re-credential in cardiac computed tomography (Cardiac CT), we evaluated the current system for re-credentialing at our organization and implemented processes to facilitate Cardiac CT re-credentialing for our providers.Methods: Institutional opportunities for Cardiac CT quality assurance (QA) conference attendance, Cardiac CT imaging evaluation, and Cardiac CT continuing medical education (CME) acquisition were assessed in 2009 and 2013. Process improvement strategies were implemented in 2014 including adding electronic media hosting sites, a "hands-on" image interpretation course, and more options for CME acquisition. Pre- and post-educational improvements were evaluated over a 10-year period. The number and type of events hosted, attendees, image review opportunities, and CME credits awarded were assessed and compared at the provider level.Results: Attendance at Cardiac CT QA conferences increased substantially following implemented changes despite fewer certified Cardiac CT providers. Electronic attendance accounted for 26% of this increased attendance, while the "hands on" course provided 43 images for review per year. The number of Cardiac CT CME credits awarded increased substantially, paralleling increased QA and "hands-on" attendance.Conclusion: In rural healthcare systems, institutional strategies can increase provider access to components necessary for Cardiac CT level II re-credentialing. In the COVID-19 era, rural and urban health organizations may find considerable provider benefit and engagement by using similar process improvement methods to help providers meet local and national requirements for certification.
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Affiliation(s)
- Bilal Unar
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Stacey C Rolak
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Current affiliation: Mayo Clinic School of Graduate Medical Education, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, Wisconsin, USA
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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10
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Berlet M, Vogel T, Gharba M, Eichinger J, Schulz E, Friess H, Wilhelm D, Ostler D, Kranzfelder M. 5G enabled emergency telemedicine application mobile ultrasound: Development and Usability Study (Preprint). JMIR Form Res 2022; 6:e36824. [PMID: 35617009 PMCID: PMC9185330 DOI: 10.2196/36824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications. Objective The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. Methods A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. Results Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. Conclusions Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Thomas Vogel
- Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Mohamed Gharba
- German Research Center, Munich Office, Huawei Technologies Düsseldorf GmbH, Munich, Germany
| | - Joseph Eichinger
- German Research Center, Munich Office, Huawei Technologies Düsseldorf GmbH, Munich, Germany
| | - Egon Schulz
- German Research Center, Munich Office, Huawei Technologies Düsseldorf GmbH, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Daniel Ostler
- Researchgroup Minimally-Invasive Therapy and Intervention, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
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Duan S, Liu L, Chen Y, Yang L, Zhang Y, Wang S, Hao L, Zhang L. A 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:134. [PMID: 33827638 PMCID: PMC8025902 DOI: 10.1186/s13054-021-03563-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
Background Teleultrasound provides an effective solution to problems that arise from limited medical resources, a lack of local expertise, and scenarios where the risk of infection is high. This study aims to explore the feasibility of the application of a 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit. Methods In this study, the robot-assisted teleultrasound diagnostic system MGIUS-R3 was used. Using 5G network technology, the doctor manipulates the robotic arm to perform teleultrasound examination. The doctor can adjust parameters via the teleultrasound control panel, and real-time transmission of audio, video and ultrasound images can facilitate simultaneous communication between both parties. All patients underwent robot-assisted teleultrasound examination and bedside ultrasound examination of the liver, gallbladder, pancreas, spleen, kidney, as well as assessment for pleural effusion and abdominal effusion. We evaluated the feasibility of the application of the robot-assisted teleultrasound diagnosis system in the intensive care unit in terms of consultation duration, image quality, and safety. We also compared diagnostic consistency and differences. Results Apart from one patient who was excluded due to severe intestinal gas interference and poor image quality, a total of 32 patients were included in this study. Every patient completed all relevant examinations. Among them, 20 patients were male; 12 were female. The average age of the patients was 61 ± 20 years. The average duration of teleultrasound diagnosis was 17 ± 7 min. Of the 32 patients, 26 had positive results, 6 had negative results, and 5 had inconsistent diagnoses. The overall diagnostic results were basically the same, and there were no differences in diagnostic levels between the two. The overall average image quality score was 4.73 points, which represented a high-quality image. After robot-assisted teleultrasound examination, no significant changes were observed in the vital signs of patients as compared to before examination, and no examination-related complications were found. Conclusion The 5G-powered robot-assisted teleultrasound diagnostic system was associated with the benefits of clear images, simple operation, relatively high levels of consistency in terms of diagnostic results, higher levels of safety, and has considerable application value in the intensive care unit.
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Affiliation(s)
- Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Luwen Liu
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Yongqing Chen
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Long Yang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shuaiyang Wang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Liuwei Hao
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Lianzhong Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China. .,Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
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12
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Jones L, Callaghan T, Campbell P, Jones PR, Taylor DJ, Asfaw DS, Edgar DF, Crabb DP. Acceptability of a home-based visual field test (Eyecatcher) for glaucoma home monitoring: a qualitative study of patients' views and experiences. BMJ Open 2021; 11:e043130. [PMID: 33820785 PMCID: PMC8030466 DOI: 10.1136/bmjopen-2020-043130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.
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Affiliation(s)
- Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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13
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Vatsvåg V, Todnem K, Næsheim T, Cathcart J, Kerr D, Oveland NP. Offshore telementored ultrasound: a quality assessment study. Ultrasound J 2020; 12:33. [PMID: 32613261 PMCID: PMC7329972 DOI: 10.1186/s13089-020-00180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Telementored ultrasound (US) connects experts to novices through various types of communication and network technologies with the overall aim to bridge the medical imaging gap between patients’ diagnostic needs and on-site user experience. The recurrent theme in previous research on remote telementored US is the limited access to US machines and experienced users. This study was conducted to determine whether telementored US was feasible in a remote offshore setting. The aim was to assess if an onshore US expert can guide an offshore nurse through focused US scanning protocols by connecting an US machine to existing videoconference units at the offshore hospitals and to evaluate the diagnostic quality of the images and cineloops procured. Results The diagnostic quality of cineloops was scored on a five-point scale. The percentage of cineloops suitable for interpretation (score 3 ≥) for the FATE and e-FAST protocols was 96.4 and 79.1. Lung sliding and seashore sign could be identified in all volunteers. The scan time for the FAST protocol (n = four scanning positions), FATE protocol (n = six scanning positions) and both lungs (n = two scanning positions) was 1 min 20 s, 4 min 15 s and 32 s, respectively. Conclusion A novice US user can be guided by a remote expert through focused US protocols within an acceptable time frame and with good diagnostic quality using existing communication and network systems found onboard offshore oil rigs.
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Affiliation(s)
- Victoria Vatsvåg
- School Health Sciences, Ulster University, Co., Antrim, UK. .,Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
| | - Kjetil Todnem
- Department of Health and Working Environment, Global Business Support, Equinor ASA, Stavanger, Norway
| | - Torvind Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Anaesthesiology, University Hospital North Norway, Tromsø, Norway
| | - John Cathcart
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Daniel Kerr
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Nils Petter Oveland
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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14
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Shengzheng WMD, Keyan LMD, Ruizhong YMD, Yuehua LMD, Jufen XMD, Linfei XMD, Ailin CMD, Yaqing LMD, Chengzhong PMD, Faqin LMD. Robot-assisted Teleultrasound Assessment of Cardiopulmonary Function on a Patient with Confirmed COVID-19 in a Cabin Hospital. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Sheehan FH, McConnaughey S, Freeman R, Zierler RE. Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics. Mil Med 2019; 184:386-391. [PMID: 30901403 PMCID: PMC6433213 DOI: 10.1093/milmed/usy388] [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: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. METHODS Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from measurements of blood flow velocity, parameter settings, and diagnosis. The validity of the vascular simulator was assessed from the accuracy with which experts can measure peak systolic blood flow velocity (PSV). RESULTS In the TTE simulator, the skill metric enabled immediate feedback, formative assessment of curriculum efficacy, and comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback, and experts' measurements of PSV deviated from actual PSV in the model by <10%. CONCLUSIONS Skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Current applications are provision of feedback to learners to enable training without direct faculty oversight and formative assessment of curricula. Simulator-based metrics could also be applied for summative assessment.
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Affiliation(s)
- Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - Shannon McConnaughey
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - Rosario Freeman
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - R Eugene Zierler
- Department of Surgery, Division of Vascular Surgery, University of Washington, Campus Box 356410, Seattle, WA
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16
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Remote Training and Oversight of Sonography for Human Immunodeficiency Virus-Associated Tuberculosis in Malawi. J Am Coll Radiol 2018; 16:228-232. [PMID: 30268776 DOI: 10.1016/j.jacr.2018.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 11/22/2022]
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17
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Abstract
Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.
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Affiliation(s)
| | - Leila Eadie
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
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18
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Recent Developments in Tele-Ultrasonography. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:101-106. [PMID: 30687527 PMCID: PMC6320468 DOI: 10.12865/chsj.44.02.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 12/19/2022]
Abstract
A long-standing trend that will continue to grow in healthcare is providing high quality services for all the patient, no matter the distance and no matter the place. One approach currently being used to increase population access to healthcare services is telemedicine. This narrative review presents one branch of e-health, in particular the use of teleultrasonography (TUS) in clinical practice, the challenges and barriers encountered. Current advances in ultrasound technology, including the growth of portable and small ultrasound devices have increased the range of applications of TUS, from traumatic patients in emergency medicine, maternal ultrasound and even for monitoring and screening for chronic illnesses. Even though some barriers are still looking for a solution, like standardized training and protocols, errors in data acquisition, the lack of trained professionals to operate in remote areas, TUS has the potential to redesign future health care systems.
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19
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Loh BCS, Then PHH. Deep learning for cardiac computer-aided diagnosis: benefits, issues & solutions. Mhealth 2017; 3:45. [PMID: 29184897 PMCID: PMC5682365 DOI: 10.21037/mhealth.2017.09.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/28/2017] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular diseases are one of the top causes of deaths worldwide. In developing nations and rural areas, difficulties with diagnosis and treatment are made worse due to the deficiency of healthcare facilities. A viable solution to this issue is telemedicine, which involves delivering health care and sharing medical knowledge at a distance. Additionally, mHealth, the utilization of mobile devices for medical care, has also proven to be a feasible choice. The integration of telemedicine, mHealth and computer-aided diagnosis systems with the fields of machine and deep learning has enabled the creation of effective services that are adaptable to a multitude of scenarios. The objective of this review is to provide an overview of heart disease diagnosis and management, especially within the context of rural healthcare, as well as discuss the benefits, issues and solutions of implementing deep learning algorithms to improve the efficacy of relevant medical applications.
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Affiliation(s)
- Brian C S Loh
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
| | - Patrick H H Then
- Swinburne University of Technology Sarawak Campus, Kuching, Sarawak, Malaysia
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20
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Galván P, Velázquez M, Benítez G, Ortellado J, Rivas R, Barrios A, Hilario E. [Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]. Rev Panam Salud Publica 2017. [PMID: 28614483 PMCID: PMC6645396 DOI: 10.26633/rpsp.2017.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objetivo. Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay. Métodos. El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud. Resultados. Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037. Conclusión. Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.
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Affiliation(s)
- Pedro Galván
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Miguel Velázquez
- Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | | | - José Ortellado
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Ronald Rivas
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Antonio Barrios
- Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
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Swanson JO, Plotner D, Franklin HL, Swanson DL, Lokomba Bolamba V, Lokangaka A, Sayury Pineda I, Figueroa L, Garces A, Muyodi D, Esamai F, Kanaiza N, Mirza W, Naqvi F, Saleem S, Mwenechanya M, Chiwila M, Hamsumonde D, McClure EM, Goldenberg RL, Nathan RO. Web-Based Quality Assurance Process Drives Improvements in Obstetric Ultrasound in 5 Low- and Middle-Income Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:675-683. [PMID: 28031304 PMCID: PMC5199182 DOI: 10.9745/ghsp-d-16-00156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/01/2016] [Indexed: 11/15/2022]
Abstract
High quality is important in medical imaging, yet in many geographic areas, highly skilled sonographers are in short supply. Advances in Internet capacity along with the development of reliable portable ultrasounds have created an opportunity to provide centralized remote quality assurance (QA) for ultrasound exams performed at rural sites worldwide. We sought to harness these advances by developing a web-based tool to facilitate QA activities for newly trained sonographers who were taking part in a cluster randomized trial investigating the role of limited obstetric ultrasound to improve pregnancy outcomes in 5 low- and middle-income countries. We were challenged by connectivity issues, by country-specific needs for website usability, and by the overall need for a high-throughput system. After systematically addressing these needs, the resulting QA website helped drive ultrasound quality improvement across all 5 countries. It now offers the potential for adoption by future ultrasound- or imaging-based global health initiatives.
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Affiliation(s)
| | | | | | | | | | - Adrien Lokangaka
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Irma Sayury Pineda
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - David Muyodi
- Moi University School of Medicine, Eldoret, Kenya
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Sjogren AR, Leo MM, Feldman J, Gwin JT. Image Segmentation and Machine Learning for Detection of Abdominal Free Fluid in Focused Assessment With Sonography for Trauma Examinations: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2501-2509. [PMID: 27738293 PMCID: PMC7929643 DOI: 10.7863/ultra.15.11017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/04/2016] [Indexed: 06/06/2023]
Abstract
The objective of this pilot study was to test the feasibility of automating the detection of abdominal free fluid in focused assessment with sonography for trauma (FAST) examinations. Perihepatic views from 10 FAST examinations with positive results and 10 FAST examinations with negative results were used. The sensitivity and specificity compared to manual classification by trained physicians was evaluated. The sensitivity and specificity (95% confidence interval) were 100% (69.2%-100%) and 90.0% (55.5%-99.8%), respectively. These findings suggest that computerized detection of free fluid on abdominal ultrasound images may be sensitive and specific enough to aid clinicians in their interpretation of a FAST examination.
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Affiliation(s)
| | - Megan M Leo
- Boston Medical Center, Boston, Massachusetts USA
- Boston University School of Medicine, Boston, Massachusetts USA
| | - James Feldman
- Boston Medical Center, Boston, Massachusetts USA
- Boston University School of Medicine, Boston, Massachusetts USA
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23
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Continuing Medical Education via Telemedicine and Sustainable Improvements to Health. Int J Telemed Appl 2016; 2016:2424709. [PMID: 27660637 PMCID: PMC5021889 DOI: 10.1155/2016/2424709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 07/09/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995–2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine.
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Ahmadi M, Gross WJ, Kadoury S. A real-time remote video streaming platform for ultrasound imaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:4383-4386. [PMID: 28269249 DOI: 10.1109/embc.2016.7591698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ultrasound is a viable imaging technology in remote and resources-limited areas. Ultrasonography is a user-dependent skill which depends on a high degree of training and hands-on experience. However, there is a limited number of skillful sonographers located in remote areas. In this work, we aim to develop a real-time video streaming platform which allows specialist physicians to remotely monitor ultrasound exams. To this end, an ultrasound stream is captured and transmitted through a wireless network into remote computers, smart-phones and tablets. In addition, the system is equipped with a camera to track the position of the ultrasound probe. The main advantage of our work is using an open source platform for video streaming which gives us more control over streaming parameters than the available commercial products. The transmission delays of the system are evaluated for several ultrasound video resolutions and the results show that ultrasound videos close to the high-definition (HD) resolution can be received and displayed on an Android tablet with the delay of 0.5 seconds which is acceptable for accurate real-time diagnosis.
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