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Cal EM, Gunnell E, Olinger K, Benefield T, Nelson J, Maggioncalda E, McGinty K. Utility of tele-guidance for point-of-care ultrasound: a single center prospective diagnostic study. J Ultrasound 2024; 27:519-525. [PMID: 38340216 PMCID: PMC11333636 DOI: 10.1007/s40477-023-00860-x] [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: 09/30/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Point-of-care-ultrasound (POCUS) improves diagnostic accuracy and expedites lifesaving procedures. Remote areas disproportionately underuse ultrasound (US) due to a dearth of US trained professionals, imaging tools, and lack of quality assurance. Handheld US probes have been approved for diagnostic imaging but there have been limited studies examining their tele-guidance features. This study investigates whether physician tele-guidance improved ultrasound image acquisition by untrained scanners. METHODS To determine the effectiveness of tele-guidance for ultrasound image acquisition, 30 participants (15 in each study arm: experimental and control) with no ultrasound or medical experience gathered images of the heart, right kidney, and gallbladder of a standardized patient using a handheld ultrasound probe (Butterfly iQ +). All participants watched a standardized ultrasound tutorial video and were randomized into the control or experimental group. A physician assisted the experimental group using ultrasound probe's tele-guidance feature while the control group received no assistance. Time to image acquisition was recorded for both groups, and the images were graded by 3 blinded radiologists using the RACE tool to determine image and diagnostic quality. RESULTS There was evidence that mean imaging time was greater in the control group for the heart, right kidney, and gallbladder (p < 0.0001, all; Cohen's DL: 2.0, 1.7, 3.0, respectively). Similarly, there was evidence that the predicted mean image quality for the heart, right kidney, and gallbladder was higher for the experimental group compared to the control group (3.46 versus 1.86, 4.49 versus 1.58, and 3.93 versus 1.5, respectively; p < 0.0001, all). There was also evidence that the diagnostic quality of images had a statistically higher predicted probability of meaningful interpretation for the experimental group for pericardial fluid, intraperitoneal fluid, and acute cholecystitis (p = 0.003, p < 0.0001, p < 0.0001, respectively). CONCLUSIONS Tele-guidance improves time to image acquisition and clinical applicability of ultrasound images obtained by untrained scanners.
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Affiliation(s)
- Eric M Cal
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA.
| | - Elias Gunnell
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Kristen Olinger
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Thad Benefield
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Jacob Nelson
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Elise Maggioncalda
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Katrina McGinty
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
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Munyangaju I, José B, Esmail R, Palmer M, Santiago B, Hernanz-Lobo A, Mutemba C, Perez P, Tlhapi LH, Mudaly V, Pitcher RD, Jahnen A, Carruana EV, López-Varela E, Thierry-Chef I. Evaluation of radiological capacity and usage in paediatric TB diagnosis: A mixed-method protocol of a comparative study in Mozambique, South Africa and Spain. PLoS One 2024; 19:e0299293. [PMID: 38635846 PMCID: PMC11025952 DOI: 10.1371/journal.pone.0299293] [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: 07/06/2023] [Accepted: 02/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Tuberculosis remains one of the top ten causes of mortality globally. Children accounted for 12% of all TB cases and 18% of all TB deaths in 2022. Paediatric TB is difficult to diagnose with conventional laboratory tests, and chest radiographs remain crucial. However, in low-and middle-income countries with high TB burden, the capacity for radiological diagnosis of paediatric TB is rarely documented and data on the associated radiation exposure limited. METHODS A multicentre, mixed-methods study is proposed in three countries, Mozambique, South Africa and Spain. At the national level, official registry databases will be utilised to retrospectively compile an inventory of licensed imaging resources (mainly X-ray and Computed Tomography (CT) scan equipment) for the year 2021. At the selected health facility level, three descriptive cross-sectional standardised surveys will be conducted to assess radiology capacity, radiological imaging diagnostic use for paediatric TB diagnosis, and radiation protection optimization: a site survey, a clinician-targeted survey, and a radiology staff-targeted survey, respectively. At the patient level, potential dose optimisation will be assessed for children under 16 years of age who were diagnosed and treated for TB in selected sites in each country. For this component, a retrospective analysis of dosimetry will be performed on TB and radiology data routinely collected at the respective sites. National inventory data will be presented as the number of units per million people by modality, region and country. Descriptive analyses will be conducted on survey data, including the demographic, clinical and programmatic characteristics of children treated for TB who had imaging examinations (chest X-ray (CXR) and/or CT scan). Dose exposure analysis will be performed by children's age, gender and disease spectrum. DISCUSSION As far as we know, this is the first multicentre and multi-national study to compare radiological capacity, radiation protection optimization and practices between high and low TB burden settings in the context of childhood TB management. The planned comparative analyses will inform policy-makers of existing radiological capacity and deficiencies, allowing better resource prioritisation. It will inform clinicians and radiologists on best practices and means to optimise the use of radiological technology in paediatric TB management.
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Affiliation(s)
- Isabelle Munyangaju
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Benedita José
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Ridwaan Esmail
- Imaging Division, Ministry of Health, Maputo, Mozambique
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Begoña Santiago
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
| | - Alicia Hernanz-Lobo
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Crimenia Mutemba
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Patricia Perez
- National Paediatric TB Working Group, Maputo, Mozambique
| | | | - Vanessa Mudaly
- Service Priorities Coordination (SPC) Directorate, Department of Health, Western Cape, South Africa
| | - Richard D. Pitcher
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andreas Jahnen
- ITIS Department, Luxembourg Institute of Science and Technology, Luxembourg
| | - Eliseo Vañó Carruana
- Department of Radiology, Faculty of Medicine of the Complutense University, Madrid, Spain
| | - Elisa López-Varela
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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3
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Adjei ANA, Donkor A, Wiafe YA, Anyitey-Kokor IC, Hyde E. Elements of person-centred diagnostic imaging care in low-and middle-income countries: A systematic review. Radiography (Lond) 2024; 30:394-407. [PMID: 38176130 DOI: 10.1016/j.radi.2023.12.016] [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: 08/20/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Diagnostic imaging professionals are trained to deliver safe and high-quality person-centred radiographic diagnostic imaging care. The term person-centred care has been described as a confused concept without a unified definition. This systematic review identified the elements that have been used to measure person-centred care in diagnostic imaging in low- and middle-income countries (LMICs). METHODS A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Embase, MEDLINE and Cochrane library were searched. Bias was assessed using the Critical Appraisal Skill Programme and Mixed Method Appraisal Tool. A narrative synthesis guided by the Picker Principles of person-centred care was undertaken. RESULTS Of the 4482 articles identified, 26 articles were included. The studies were from 12 LMICs. Synthesis of the literature generated six themes, namely access to high quality and safe diagnostic imaging care, effective communication and shared diagnostic imaging decision making, suitable diagnostic imaging environment for physical comfort, respectful and compassionate diagnostic radiographers, effective coordination of diagnostic imaging care process, and family and friends' involvement in diagnostic imaging care. CONCLUSION Medical imaging facilities in most LMICs continue to struggle with issues of access, safety, quality, and responsiveness to the needs of patients. The need for innovative person-centred diagnostic imaging care interventions in LMICs has become urgent. IMPLICATIONS FOR PRACTICE If diagnostic imaging services in LMICs are to move beyond the current models of limited person-centred access to care, a greater focus on systems thinking is required. It is imperative to involve all stakeholders, not only patients and radiographers, but also policymakers whose works impact on equitable access to diagnostic imaging services.
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Affiliation(s)
- A N A Adjei
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - A Donkor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; IMPACCT, Faculty of Health, University of Technology Sydney, Australia.
| | - Y A Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - I C Anyitey-Kokor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - E Hyde
- Provost for Learning & Teaching, University of Derby, United Kingdom.
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Watermeyer G, Katsidzira L, Nsokolo B, Isaac Alatise O, Duduyemi BM, Kassianides C, Hodges P. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective. Therap Adv Gastroenterol 2023; 16:17562848231184986. [PMID: 37457138 PMCID: PMC10345935 DOI: 10.1177/17562848231184986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.
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Affiliation(s)
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bright Nsokolo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olusegun Isaac Alatise
- Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Babatunde M. Duduyemi
- Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Phoebe Hodges
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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5
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Pyrros A, Chen A, Rodríguez-Fernández JM, Borstelmann SM, Cole PA, Horowitz J, Chung J, Nikolaidis P, Boddipalli V, Siddiqui N, Willis M, Flanders AE, Koyejo S. Deep Learning-Based Digitally Reconstructed Tomography of the Chest in the Evaluation of Solitary Pulmonary Nodules: A Feasibility Study. Acad Radiol 2023; 30:739-748. [PMID: 35690536 PMCID: PMC9732145 DOI: 10.1016/j.acra.2022.05.005] [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: 03/30/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Computed tomography (CT) is preferred for evaluating solitary pulmonary nodules (SPNs) but access or availability may be lacking, in addition, overlapping anatomy can hinder detection of SPNs on chest radiographs. We developed and evaluated the clinical feasibility of a deep learning algorithm to generate digitally reconstructed tomography (DRT) images of the chest from digitally reconstructed frontal and lateral radiographs (DRRs) and use them to detect SPNs. METHODS This single-institution retrospective study included 637 patients with noncontrast helical CT of the chest (mean age 68 years, median age 69 years, standard deviation 11.7 years; 355 women) between 11/2012 and 12/2020, with SPNs measuring 10-30 mm. A deep learning model was trained on 562 patients, validated on 60 patients, and tested on the remaining 15 patients. Diagnostic performance (SPN detection) from planar radiography (DRRs and CT scanograms, PR) alone or with DRT was evaluated by two radiologists in an independent blinded fashion. The quality of the DRT SPN image in terms of nodule size and location, morphology, and opacity was also evaluated, and compared to the ground-truth CT images RESULTS: Diagnostic performance was higher from DRT plus PR than from PR alone (area under the receiver operating characteristic curve 0.95-0.98 versus 0.80-0.85; p < 0.05). DRT plus PR enabled diagnosis of SPNs in 11 more patients than PR alone. Interobserver agreement was 0.82 for DRT plus PR and 0.89 for PR alone; and interobserver agreement for size and location, morphology, and opacity of the DRT SPN was 0.94, 0.68, and 0.38, respectively. CONCLUSION For SPN detection, DRT plus PR showed better diagnostic performance than PR alone. Deep learning can be used to generate DRT images and improve detection of SPNs.
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Affiliation(s)
- Ayis Pyrros
- Department of Radiology, Duly Health and Care, Hinsdale, IL.
| | - Andrew Chen
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | | | | | - Patrick A Cole
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Jeanne Horowitz
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
| | - Jonathan Chung
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Paul Nikolaidis
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
| | | | - Nasir Siddiqui
- Department of Radiology, Duly Health and Care, Hinsdale, IL
| | - Melinda Willis
- Department of Radiology, Duly Health and Care, Hinsdale, IL
| | - Adam Eugene Flanders
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sanmi Koyejo
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois
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6
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Liu YYM, O'Hagan S, Holdt FC, Lahri S, Pitcher RD. After-hour trauma-radiograph interpretation in the emergency centre of a District Hospital. Afr J Emerg Med 2022; 12:199-207. [PMID: 35702139 PMCID: PMC9178478 DOI: 10.1016/j.afjem.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Plain radiographs remain a first-line trauma investigation. Most trauma radiographs worldwide are reported by junior doctors. This study assesses the accuracy of after-hour acute trauma radiograph reporting by emergency centre (EC) doctors in an African district hospital. Methods An institutional review board approved retrospective descriptive study over two consecutive weekends in February 2020. The radiologist report on the admission radiographs of adult trauma patients was compared with the initial EC interpretation. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for EC interpretation were calculated with 95% confidence intervals (95%CI). The association between reporting accuracy and anatomical region, mechanism of injury, time of investigation, and the number of abnormalities per radiograph was assessed. Results 140 radiographs were included, of which 49 (35%) were abnormal. EC doctors recorded (95%CI) 77% (69-84%) accuracy, 38% (25-54%) sensitivity, 97% (91-99%) specificity, 86% (65-95%) PPV and 76% (71-80%) NPV. Performance was associated with the anatomical region (p=0.02), mechanism of injury (p=<0.01) time of day (p=0.04) and the number of abnormalities on the film (p=<0.01). The highest sensitivity was achieved in reports of the appendicular skeleton (42%) and in the setting of simple blunt trauma (62%). Overall accuracy was in line with the range (44%-99%) reported in the international literature. Discussion Accurate reporting of acute trauma radiographs is challenging. Key factors impact performance. Further training of junior doctors in this area of clinical practice is recommended. Future work should focus on assessing the impact of such training on reporting performance.
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Affiliation(s)
- Yi-Ying Melissa Liu
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Suzanne O'Hagan
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frederik Carl Holdt
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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7
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Navarro SM, Shaikh H, Abdi H, Keil EJ, Odusanya S, Stewart KA, Tuyishime E, Mazingi D, Tuttle TM. Surgical applications of ultrasound use in low‐ and
middle‐income
countries: A systematic review. Australas J Ultrasound Med 2022; 25:80-97. [DOI: 10.1002/ajum.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Hashim Shaikh
- Department of Orthopaedics University of Rochester 601 Elmwood Avenue Rochester NY 14642 USA
| | - Hodan Abdi
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Evan J. Keil
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Simisola Odusanya
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Kelsey A. Stewart
- Department of Anaesthesia, Critical Care, and Emergency Medicine University of Rwanda KN 4 Ave Kigali Rwanda
| | - Eugene Tuyishime
- Department of Anaesthesia University of Toronto 123 Edward Street Toronto ON M5G 1E2 Canada
- Department of Obstetrics and Gyenecology University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Dennis Mazingi
- Department of Surgery University of Zimbabwe Mazowe Street A168 Harare Zimbabwe
| | - Todd M. Tuttle
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, India
- Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King’s College London, Queen Square, London WC1N 3BG, UK
- High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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9
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Watermeyer G, Katsidzira L, Setshedi M, Devani S, Mudombi W, Kassianides C. Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis. Lancet Gastroenterol Hepatol 2022; 7:952-961. [DOI: 10.1016/s2468-1253(22)00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
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10
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Ng'andwe E, Bwanga O. Factors affecting the ability of radiographers to deliver imaging services in rural parts of Zambia. Radiography (Lond) 2022; 28:758-765. [DOI: 10.1016/j.radi.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
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11
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van Wijk M, Barnard MM, Fernandez A, Cloete K, Mukosi M, Pitcher RD. Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009-2019. SA J Radiol 2021; 25:2251. [PMID: 34917410 PMCID: PMC8661274 DOI: 10.4102/sajr.v25i1.2251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs). Objectives To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country. Method A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40–70 years. Results The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas. Conclusion Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.
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Affiliation(s)
- Monica van Wijk
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Michelle M Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
| | - Keith Cloete
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
| | - Matodzi Mukosi
- Tygerberg Hospital, Department of Health, Western Cape Government, Cape Town, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Gathuru LM, Elias GDO, Pitcher RD. Analysis of registered radiological equipment in Kenya. Pan Afr Med J 2021; 40:205. [PMID: 35136468 PMCID: PMC8783305 DOI: 10.11604/pamj.2021.40.205.29570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/30/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION diagnostic radiology plays a key role in healthcare. Proper planning of healthcare requires accurate and robust data. There´s, however, paucity of comprehensive figures on radiological equipment in the African setting. The goal of this study was to carry out an in-depth analysis of the registered radiological equipment in Kenya, a lower middle-income African country, and compare the findings to published international data. METHODS data on radiological equipment were obtained from the Kenya Nuclear Regulatory Authority and analyzed as units/million of the population by imaging modality, health service sector and administrative units. The findings were then compared to published international data. RESULTS there has been an overall increase in the number of radiological equipment in comparison to data published in 2013, with a relatively uniform distribution of resources across all eight regions. General radiography is the most available modality at 24.5 units/million with the majority of the equipment owned privately, while the public sector (9.6 units/million) has less than a half of the WHO recommendation of 20 units/million. Accessibility to computerized tomography (CT) scan, fluoroscopy and mammography in the public sector closely mirrors that of South Africa. On the contrary, positron emission tomography-computerized tomography (PET-CT) is the least-resourced modality and is currently only available in the private sector. CONCLUSION the increased number and homogenous distribution of radiological resources can largely be attributed to the Managed Equipment Services project launched by the national government in 2016. More needs to be done with regards to availability of PET/CT scanners and general radiography equipment in the public sector.
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Affiliation(s)
- Lynne Muthoni Gathuru
- Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya,,Corresponding author: Lynne Muthoni Gathuru, Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya.
| | | | - Richard Denys Pitcher
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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van Zyl BC, Barnard MM, Cloete K, Fernandez A, Mukosi M, Pitcher RD. Towards equity: a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017. BMC Health Serv Res 2021; 21:991. [PMID: 34544402 PMCID: PMC8454129 DOI: 10.1186/s12913-021-06997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.
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Affiliation(s)
- Beulah Christina van Zyl
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl, Avenue, Tygerberg, Cape Town, 7505, South Africa.
| | - Michelle Monique Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, 1st Floor North Block, Bellville Health Park, c/o Mike Pienaar Boulevard & Frans Conradie Drive, Bellville, Cape Town, 7500, South Africa
| | - Keith Cloete
- Department of Health, Western Cape Government, Cape Town, South Africa
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, 1st Floor North Block, Bellville Health Park, c/o Mike Pienaar Boulevard & Frans Conradie Drive, Bellville, Cape Town, 7500, South Africa
| | - Matodzi Mukosi
- Department of Health, Western Cape Government, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl, Avenue, Tygerberg, Cape Town, 7505, South Africa
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Mapuranga H, Pitcher RD, Jakanani GC, Banhwa J. An audit of Zimbabwean public sector diagnostic ultrasound services. Pan Afr Med J 2021; 39:99. [PMID: 34466201 PMCID: PMC8379399 DOI: 10.11604/pamj.2021.39.99.28342] [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] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.
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Affiliation(s)
- Humphrey Mapuranga
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Josephat Banhwa
- Department of Medical Physics and Imaging Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Kiguli-Malwadde E, Byanyima R, Kawooya MG, Mubuuke AG, Basiimwa RC, Pitcher R. An audit of registered radiology equipment resources in Uganda. Pan Afr Med J 2021; 37:295. [PMID: 33654516 PMCID: PMC7881928 DOI: 10.11604/pamj.2020.37.295.22046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction the third Sustainable Development Goal (SDG) relates to Universal Health Coverage (UHC) and provision of quality essential health services. The Government of Uganda has operationalized this through the National Health Policy which stresses the importance of availability of functioning medical equipment in health facilities. There have been efforts by the Ministry of Health and Atomic Energy Council in Uganda to compile an inventory of imaging equipment in the country, however, this information has not been widely published. The purpose of this study was to conduct an audit of registered radiology equipment in Uganda and establish their functional status. Methods a cross-sectional descriptive study that involved a desktop review of the equipment registry at the Uganda Atomic Energy Council was conducted. Data was collected on a number of variables including type of equipment, location, functional status, modality and density per million people. Results the audit revealed 625 pieces of equipment spread over 354 health facilities. The majority (397) were plain X-ray machines followed by dental X-ray machines at 120. There were only 3 Radiotherapy machines. Most were recorded as being functional with only 0.1% of the equipment non-functional. Most of the equipment was in the central region which has the third highest population density. The majority of the equipment belonged to private health facilities. Conclusion Uganda lags behind the WHO recommended ratio of equipment versus the population (20 per million population). Most of the equipment is the plain X-ray machine with a few more advanced technologies in both public and private health facilities.
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Affiliation(s)
- Elsie Kiguli-Malwadde
- Health Workforce Education and Development, African Centre for Global Health and Social Development, Plo13B, Acacia Avenue, Kampala, Uganda.,Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosemary Byanyima
- Department of Radiology, School of Medicine, Mulago Hospital, Kampala, Uganda
| | - Michael Grace Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - Aloysius Gonzaga Mubuuke
- Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Management of infective complications of otitis media in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2021; 28:174-181. [PMID: 32332206 DOI: 10.1097/moo.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. RECENT FINDINGS Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. SUMMARY Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
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Tan BS, Dunnick NR, Gangi A, Goergen S, Jin ZY, Neri E, Nomura CH, Pitcher RD, Yee J, Mahmood U. RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020. Radiology 2020; 299:E193-E203. [PMID: 33289616 PMCID: PMC7734846 DOI: 10.1148/radiol.2020204267] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 pandemic has challenged and changed health care systems around the world. There has been a heterogeneity of disease burden, health care resources, and nonimaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. In this report, radiology experts in representative countries from around the world share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides.
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Affiliation(s)
- Bien Soo Tan
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - N Reed Dunnick
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Afshin Gangi
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Stacy Goergen
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Zheng-Yu Jin
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Emanuele Neri
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Cesar Higa Nomura
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - R D Pitcher
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Judy Yee
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Umar Mahmood
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
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Alramdan MHA, Yakar D, IJpma FFA, Kasalak Ö, Kwee TC. Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury. Insights Imaging 2020; 11:102. [PMID: 32965600 PMCID: PMC7511496 DOI: 10.1186/s13244-020-00911-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate if patients with confirmed traumatic abdominal injury and a false-negative focused abdominal sonography for trauma (FAST) examination have a more favorable prognosis than those with a true-positive FAST. Methods This study included 97 consecutive patients with confirmed traumatic abdominal injury (based on computed tomography [CT] and/or surgical findings) who underwent FAST. Results FAST was false-negative in 40 patients (41.2%) and true-positive in 57 patients (58.8%). Twenty-two patients (22.7%) had an unfavorable outcome (defined as the need for an interventional radiologic procedure, laparotomy, or death due to abdominal injury). Univariately, a false-negative FAST (odds ratio [OR] 0.24; p = 0.017) and a higher systolic blood pressure (OR, 0.97 per mmHg increase; p = 0.034) were significantly associated with a favorable outcome, whereas contrast extravasation on CT (OR, 7.17; p = 0.001) and shock index classification (OR, 1.89 for each higher class; p = 0.046) were significantly associated with an unfavorable outcome. Multivariately, only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016). When excluding contrast extravasation on CT from multivariate analysis, only a false-negative FAST result was predictive of a favorable outcome (OR, 0.28; p = 0.038). Conclusion Trauma patients with confirmed abdominal injury and a false-negative FAST have a better outcome than those with a positive FAST. FAST may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when CT has not been performed yet or when CT is not available.
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Affiliation(s)
- Mohammed H A Alramdan
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ömer Kasalak
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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