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Alhussein M. Use of Real-Time Remote Tele-mentored Ultrasound Echocardiography for Cardiovascular Disease Diagnosis in Adults: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:779-787. [PMID: 38448316 DOI: 10.1016/j.ultrasmedbio.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Cardiovascular diseases remain a major health challenge, leading to high rates of death and hospitalization globally. In the battle against these ailments, echocardiography stands as the frontline tool for diagnosis. Pioneering the charge in innovation, real-time remote tele-mentored ultrasound echocardiography (RTMUS echo) has emerged. This cutting-edge technique facilitates the instant transmission of cardiac imaging from the patient's side to experts in far-off locations, enabling prompt diagnosis and expert consultation. To bridge this gap, a systematic review was conducted to understand RTMUS echo's current applications in diagnosing heart diseases. Searches across six databases, guided by strict inclusion and exclusion criteria, yielded nine relevant articles. These studies assessed the feasibility of RTMUS echo and the technology behind it, confirming its potential for high-quality cardiac imaging. The findings reveal that RTMUS echo could notably improve care for cardiac patients, especially those in resource-constrained settings or in isolation because of infection risks. This technology enables quick access to diagnostic expertise, which is otherwise unavailable in such areas. Future research should aim to optimize the cost-effectiveness and application of RTMUS echo to enhance its benefits for global healthcare.
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Affiliation(s)
- Manal Alhussein
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, USA.
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Bui C, Parange N, Bezak E, Bidner A. The Role of Telehealth in Ultrasound Training for Remote Learners: A Systematic Review. Telemed J E Health 2024; 30:963-975. [PMID: 38052050 DOI: 10.1089/tmj.2023.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Introduction: Remote learners and educators face geographic, professional, and personal barriers that affect their access to quality ultrasound education. The integration of telehealth in ultrasound education enables learners performing ultrasound to receive real-time instruction from an educator at a distant or remote site. However, to date, there has been poor understanding of the efficacy, benefits, shortcomings, and economic impact of telehealth education in comparison to in-person ultrasound training. The aim of this research was to assess current literature on telehealth in ultrasound education and hands-on training, its outcomes and impact, and requirements for future development. Methods: This review examined international literature on telehealth in ultrasound training. The primary author and second investigator were involved in the research and reached consensus on the eligibility criteria, search strategy, included articles, data extraction, and quality assessment. Results: A total of 23 studies were obtained from Medline, Emcare and Scopus. Key themes identified: Most studies saw an equivalent improvement in knowledge and skills through pre and postassessments in both in-person and telehealth sessions. Generally, learners felt comfortable performing ultrasound guided by a remote educator and felt their skills had been advanced across all studies. Educators reported positive feedback, however compared with learners, educators expressed less satisfaction with the telehealth session. Conclusions: This study demonstrated the feasibility of telehealth in ultrasound training for remote learners with little to no experience. Quality studies with comparable outcomes are needed to ascertain the safe and effective application of telehealth in ultrasound training.
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Affiliation(s)
- Catthy Bui
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia
| | - Amber Bidner
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
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Zhang Z. Opinions on Remote and in-Person Breast Imaging Work: Survey Results from the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2024; 6:23-32. [PMID: 38243858 DOI: 10.1093/jbi/wbad082] [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: 08/01/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic accelerated trends in remote radiology work. We evaluated the opinions of Society of Breast Imaging (SBI) members regarding remote and in-person breast imaging work. METHODS An institutional review board-exempt anonymous survey was distributed to SBI members. Survey questions included demographics and opinions on remote and in-person work. RESULTS The response rate was 12% (307/2561). Overall, 79% of respondents preferred hybrid work, 16% preferred in-person work, and 5% preferred fully remote work. Only 34% of respondents had remote work in current practice. Screening mammograms (97%) and breast MRI (92%) were deemed most suitable for remote work. Most respondents believed barriers for remote work were inability to perform US (80%) and high monitor price (78%). Seventy-six percent of respondents believed remote work improves work-life balance and reduces burnout. Work model preferences were significantly associated with gender (P = .048) and perceived work-related impacts (P <.001). Women were more likely to prefer hybrid work than men (82% vs 73%). Compared to those who preferred in-person work, respondents who preferred hybrid work were more likely to believe remote work improves efficiency (89% vs 3%) and reduces burnout (88% vs 6%) while not negatively affecting career growth (88% vs 3%) or communication (87% vs 4%). CONCLUSION Hybrid work is the preferred model among SBI survey respondents. However, a minority have the option for remote work in current practice. Perceived benefits of remote work are efficiency and reduced burnout among breast imaging radiologists while not negatively affecting career growth or communication.
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Affiliation(s)
- Zi Zhang
- Department of Radiology, Jefferson Einstein Hospital, Philadelphia, PA, US
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Sultan LR, Haertter A, Al-Hasani M, Demiris G, Cary TW, Tung-Chen Y, Sehgal CM. Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound. AI 2023; 4:875-887. [PMID: 37929255 PMCID: PMC10623579 DOI: 10.3390/ai4040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.
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Affiliation(s)
- Laith R. Sultan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Allison Haertter
- Radiation Oncology Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - George Demiris
- Informatics Division of the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore W. Cary
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Yale Tung-Chen
- Emergency Medicine Department, La Madrida Hospital, 28006 Madrid, Spain
| | - Chandra M. Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
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Saati A, Au A, Joshi AU, Davis R, West FM, Lewiss RE. Can Untrained Patients Perform Their Own Skin and Soft Tissue Ultrasound Examination by Teleguidance? POCUS JOURNAL 2023; 8:159-164. [PMID: 38099176 PMCID: PMC10721299 DOI: 10.24908/pocus.v8i2.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Objectives: This pilot study aims to determine if patients untrained in performing ultrasound can self-scan to obtain images under remote clinician teleguidance during a simulated telehealth encounter. This study also seeks to describe the patients' comfort level and barriers to performing an ultrasound examination on themselves using a handheld ultrasound device. Methods: This was a single center prospective observational cohort study conducted over a 4-month period in 2021. Patients were eligible if they had no prior training in the use of ultrasound and in the use of teleguidance. They voluntarily consented to participate at a single ambulatory internal medicine clinic. Results: 20 participants were enrolled and underwent teleguidance to ultrasound their own skin and soft tissues at the antecubital fossae. Six second video clips were evaluated by 2 subject matter experts using the Point of Care Ultrasound Image Quality scale. A score >7 was considered adequate for diagnostic interpretation. The average score was 10.15/14, with a minimum score of 5/14, and maximum score of 14/14 and a standard deviation (SD) of 2.39 using a two tailed Z-score. Setting alpha at 0.05 the 95% CI was (5.47-14.83). Conclusion: In a pilot study of 20 participants with no ultrasound experience, untrained healthy volunteers were able to perform technically acceptable and interpretable ultrasound scans using teleguidance by a trained clinician.
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Affiliation(s)
- Ammar Saati
- Department of Cardiovascular Medicine Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic FoundationCleveland, OHUSA
| | - Arthur Au
- Department of Emergency Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Aditi U Joshi
- Digital Health Intelligence, MDisrupt, Founder, Nagamed LLC
| | - Rebecca Davis
- Department of Internal Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Frances Mae West
- Department of Internal Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Resa E Lewiss
- Department of Emergency Medicine, University of Alabama at BirminghamBirmingham, ALUSA
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Bidner A, Bezak E, Parange N. Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access. BMC Public Health 2023; 23:2268. [PMID: 37978505 PMCID: PMC10655468 DOI: 10.1186/s12889-023-17106-4] [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: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ultrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities. OBJECTIVE To perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians' interest in and access to ultrasound training opportunities. METHODS The survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components. RESULTS A total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating 'Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use. CONCLUSIONS Future efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.
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Affiliation(s)
- Amber Bidner
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia.
| | - Eva Bezak
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia
- Department of Physics, The University of Adelaide, North Terrace, Adelaide, SA, 5001, Australia
| | - Nayana Parange
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia
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Zhang Y, Zhang Y, Huang J, Dong L. Application of Internet hospitals for first-visit patients with COVID-19 during the pandemic in China. Eur J Public Health 2023; 33:789-795. [PMID: 37550253 PMCID: PMC10567245 DOI: 10.1093/eurpub/ckad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND There has been controversy over whether to carry out online medical inquiries and electronic prescription for first-visit patients. While Internet hospitals have become crucial to ensure providing online diagnosis and prescription needs for first-visit COVID-positive patients. OBJECTIVE We describe the results and advantages of online medical treatment during the coronavirus disease 2019 (COVID-19) outbreak and analyse the results and advantages of online medical treatment. METHODS Data were collected from the patients who received online medical inquiry services through the COVID-19 Special Section of our Internet hospital. The user demographic characteristics, user behaviour, clinical symptoms and medical records were collected. Baseline data of offline outpatient patients were also collected. RESULTS A total of 16 173 online medical inquiries were included. The daily online outpatient service volume reached a peak of 2446 person-times. The median age was 29.92 years (SD 15.59), ranging from 20-39 years (n = 8870, 54.84%). A total of 89.20% (n = 14 426/16 173) patients had epidemic-related symptoms. Moreover, 23.35% of the people were diagnosed as COVID-19-positive through antigen or nucleic acid testing. Furthermore, 86.61% (14 008/16 173) of the patients visited our hospital for the first time or had no offline physical outpatient service record within the past 3 months. The demand for medical inquiries was mainly for drug dispensing, followed by medication guidance and disease diagnosis. And 2.07% (334/16 173) of the patients needed to go to the offline hospital for further treatment. CONCLUSION The service model of the COVID-19 Special Section based on Internet hospitals provided the public with the necessary medical support during the COVID-19 outbreak. It provides a reference for future pandemics or public health emergencies.
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Affiliation(s)
- Ye Zhang
- Department of General Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ye Zhang
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China
| | - Jie Huang
- Department of General Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Liang Dong
- Department of Information, Affiliated Hospital of Jiaxing University, Jiaxing, China
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Shi R, Rosario J. Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review. Prehosp Disaster Med 2023; 38:645-653. [PMID: 37622570 PMCID: PMC10548023 DOI: 10.1017/s1049023x23006234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
Ultrasound with remote assistance (tele-ultrasound) may have potential to improve accessibility of ultrasound for prehospital patients. A review of recent literature on this topic has not been done before, and the feasibility of prehospital tele-ultrasound performed by non-physician personnel is unclear. In an effort to address this, the literature was qualitatively analyzed from January 1, 2010 - December 31, 2021 in the MEDLINE, EMBASE, and Cochrane online databases on prehospital, paramedic-acquired tele-ultrasound, and ten articles were found. There was considerable heterogeneity in the study design, technologies used, and the amount of ultrasound training for the paramedics, preventing cross-comparisons of different studies. Tele-ultrasound has potential to improve ultrasound accessibility by leveraging skills of a remote ultrasound expert, but there are still technological barriers to overcome before determinations on feasibility can be made.
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Affiliation(s)
- Rachel Shi
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Javier Rosario
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Zhou YJ, Guo LH, Bo XW, Sun LP, Zhang YF, Chai HH, Ye RZ, Peng CZ, Qin C, Xu HX. Tele-Mentored Handheld Ultrasound System for General Practitioners: A Prospective, Descriptive Study in Remote and Rural Communities. Diagnostics (Basel) 2023; 13:2932. [PMID: 37761299 PMCID: PMC10530153 DOI: 10.3390/diagnostics13182932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. METHODS Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. RESULTS Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). CONCLUSIONS The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.
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Affiliation(s)
- Yu-Jing Zhou
- Department of Medical Ultrasound, Jinshan Hospital, Fudan University, Shanghai 201508, China;
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Hui-Hui Chai
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Rui-Zhong Ye
- Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China;
| | - Cheng-Zhong Peng
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Chuan Qin
- Department of Medical Ultrasound, Jinshan Hospital, Fudan University, Shanghai 201508, China;
- Department of Ultrasound, Karamay Central Hospital, Karamay 834000, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China;
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Kornelsen J, Ho H, Robinson V, Frenkel O. Rural family physician use of point-of-care ultrasonography: experiences of primary care providers in British Columbia, Canada. BMC PRIMARY CARE 2023; 24:183. [PMID: 37684568 PMCID: PMC10486031 DOI: 10.1186/s12875-023-02128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs' experience and use of PoCUS in their clinical practice. METHODS This qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants' motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken. RESULTS This study used Rogers' framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner. CONCLUSION This study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Hilary Ho
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Virginia Robinson
- Rural Coordination Centre of British Columbia, 1665 West Broadway, Vancouver, BC, V6J 1X1, Canada
| | - Oron Frenkel
- Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Grubic N, Belliveau DJ, Herr JE, Nihal S, Wong SWS, Lam J, Gauthier S, Montague SJ, Durbin J, Mulvagh SL, Johri AM. Training of Non-expert Users Using Remotely Delivered, Point-of-Care Tele-Ultrasound: A Proof-of-Concept Study in 2 Canadian Communities. Ultrasound Q 2023; 39:118-123. [PMID: 36197076 DOI: 10.1097/ruq.0000000000000622] [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: 02/04/2023]
Abstract
ABSTRACT Many physicians, particularly those practicing in remote regions, lack training opportunities to develop point-of-care ultrasound (POCUS) skills. This pretest-posttest study quantified the skill improvement of learners after participating in a virtual training program that used real-time, remotely delivered point-of-care tele-ultrasound (tele-POCUS) for teaching and learner feedback provision. Ten physicians practicing in an urban tertiary (Kingston, Ontario, Canada, n = 6) or remote care center (Moose Factory, Ontario, Canada, n = 4) completed a 3-week educational program that consisted of e-learning module review, independent image acquisition practice, and expert-guided tele-POCUS consultations. Pretraining and posttraining assessments were performed to evaluate skill enhancement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS using a 5-point Likert scale. A total of 76 tele-POCUS consultations were performed during the study period. Significant improvements in image quality were noted following remotely delivered mentorship and guidance (all P < 0.01). In cardiac POCUS, pretraining and posttraining comparisons noted significant improvements in image acquisition (means, 2.69-4.33; P < 0.02), quality (means, 2.40-4.03; P < 0.01), and interpretation (means, 2.50-4.40; P < 0.02). In lung/pleura POCUS, significant improvements in image acquisition (means, 3.00-4.43; P < 0.01), quality (means, 3.23-4.37; P < 0.01), and interpretation (means, 3.00-4.40; P < 0.01) were demonstrated. Introductory ultrasound can be taught to novice users using a virtual, live-streamed training format with tele-POCUS while demonstrating significant enhancement in imaging skills.
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Affiliation(s)
| | | | | | - Salwa Nihal
- Medicine, Queen's University, Kingston, Ontario
| | | | - Jeffrey Lam
- Medicine, Queen's University, Kingston, Ontario
| | | | | | | | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Shabir D, Anjum A, Hamza H, Padhan J, Al-Ansari A, Yaacoub E, Mohammed A, Navkar NV. Development and Evaluation of a Mixed-Reality Tele-ultrasound System. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1867-1874. [PMID: 37263893 DOI: 10.1016/j.ultrasmedbio.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/25/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objective of this feasibility study was to develop and assess a tele-ultrasound system that would enable an expert sonographer (situated at the remote site) to provide real-time guidance to an operator (situated at the imaging site) using a mixed-reality environment. METHODS An architecture along with the operational workflow of the system is designed and a prototype is developed that enables guidance in form of audiovisual cues. The visual cues comprise holograms (of the ultrasound images and ultrasound probe) and is rendered to the operator using a head-mounted display device. The position and orientation of the ultrasound probe's hologram are remotely controlled by the expert sonographer and guide the placement of a physical ultrasound probe at the imaging site. The developed prototype was evaluated for its performance on a network. In addition, a user study (with 12 participants) was conducted to assess the operator's ability to align the probe under different guidance modes. RESULTS The network performance revealed the view of the imaging site and ultrasound images were transferred to the remote site in 233 ± 42 and 158 ± 38 ms, respectively. The expert sonographer was able to transfer, to the imaging site, data related to position and orientation of the ultrasound probe's hologram in 78 ± 13 ms. The user study indicated that the audiovisual cues are sufficient for an operator to position and orient a physical probe for accurate depiction of the targeted tissue (p < 0.001). The probe's placement translational and rotational errors were 1.4 ± 0.6 mm and 5.4 ± 2.2º. CONCLUSION The work illustrates the feasibility of using a mixed-reality environment for effective communication between an expert sonographer (ultrasound physician) and an operator. Further studies are required to determine its applicability in a clinical setting during tele-ultrasound.
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Affiliation(s)
- Dehlela Shabir
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Arshak Anjum
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Hawa Hamza
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Elias Yaacoub
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Amr Mohammed
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
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Silvestre Sombrio M, Mai W, Buch D, Costa Grotti G, Gabriela Luciani M, Rodrigues Froes T. Accuracy and reliability of tele-ultrasonography in detecting gastrointestinal obstruction in dogs and cats. J Small Anim Pract 2023; 64:367-374. [PMID: 36973863 DOI: 10.1111/jsap.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/19/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To assess the accuracy and interobserver agreement of tele-ultrasonography for the diagnosis of gastrointestinal obstruction in small animals by radiologists with different levels of experience. MATERIALS AND METHODS A retrospective cross-sectional study including dogs and cats admitted with gastrointestinal signs, between 2017 and 2019, that had abdominal ultrasonographic (US) examination performed and images saved for review. Patients were classified into two categories based on final diagnosis: animals with or without complete or partial gastrointestinal obstruction. Observers with four experience levels interpreted the archived ultrasound examinations, simulating a tele-ultrasonography consultation. Analyses of accuracy, sensitivity, specificity, positive and negative predictive values were obtained for each observer for detection of gastrointestinal obstruction. Agreement between observers for the gastrointestinal obstruction diagnosis was assessed using Fleiss's Kappa statistics. RESULTS Ninety patients with gastrointestinal signs were included. Of these, 23 of 90 had partial or complete gastrointestinal obstruction. Interpretation of the images by observers via tele-ultrasonography showed intervals of accuracy, sensitivity, specificity, positive and negative predictive values, respectively, of 78.9% to 87.8%, 73.9% to 100%, 77.6% to 89.6%, 55.9% to 70.8% and 90.9% to 100% for diagnosis of gastrointestinal obstruction. Agreement for the gastrointestinal obstruction diagnosis across all reviewers was moderate (Kappa 0.6). CLINICAL SIGNIFICANCE Tele-ultrasonography had good accuracy for detection of gastrointestinal obstruction, however had a rather low positive predictive value and only moderate interobserver agreement. Therefore, this technique should be used with caution in this clinical context, given the potential surgical decision at hand.
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Affiliation(s)
- M Silvestre Sombrio
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
- UniRadio, São Paulo, Brazil
| | - W Mai
- Department of Clinical Sciences and Advanced Medicine, Section of Radiology, School of Veterinary Medicine of the University of Pennsylvania, Philadelphia, USA
| | - D Buch
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
| | | | | | - T Rodrigues Froes
- Veterinary Medicine Department, Paraná Federal University, Curitiba, Brazil
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Arnold AC, Fleet R, Lim D. Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105821. [PMID: 37239548 DOI: 10.3390/ijerph20105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.
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Affiliation(s)
- Annie C Arnold
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Richard Fleet
- Family and Emergency Medicine, Universite Laval, Quebec City, QC G1V0A6, Canada
| | - David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Translational Health Research Institute, School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
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15
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Toscano M, Marini T, Lennon C, Erlick M, Silva H, Crofton K, Serratelli W, Rana N, Dozier AM, Castaneda B, Baran TM, Drennan K. Diagnosis of Pregnancy Complications Using Blind Ultrasound Sweeps Performed by Individuals Without Prior Formal Ultrasound Training. Obstet Gynecol 2023; 141:937-948. [PMID: 37103534 DOI: 10.1097/aog.0000000000005139] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/22/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To estimate the diagnostic accuracy of blind ultrasound sweeps performed with a low-cost, portable ultrasound system by individuals with no prior formal ultrasound training to diagnose common pregnancy complications. METHODS This is a single-center, prospective cohort study conducted from October 2020 to January 2022 among people with second- and third-trimester pregnancies. Nonspecialists with no prior formal ultrasound training underwent a brief training on a simple eight-step approach to performing a limited obstetric ultrasound examination that uses blind sweeps of a portable ultrasound probe based on external body landmarks. The sweeps were interpreted by five blinded maternal-fetal medicine subspecialists. Sensitivity, specificity, and positive and negative predictive values for blinded ultrasound sweep identification of pregnancy complications (fetal malpresentation, multiple gestations, placenta previa, and abnormal amniotic fluid volume) were compared with a reference standard ultrasonogram as the primary analysis. Kappa for agreement was also assessed. RESULTS Trainees performed 194 blinded ultrasound examinations on 168 unique pregnant people (248 fetuses) at a mean of 28±5.85 weeks of gestation for a total of 1,552 blinded sweep cine clips. There were 49 ultrasonograms with normal results (control group) and 145 ultrasonograms with abnormal results with known pregnancy complications. In this cohort, the sensitivity for detecting a prespecified pregnancy complication was 91.7% (95% CI 87.2-96.2%) overall, with the highest detection rate for multiple gestations (100%, 95% CI 100-100%) and noncephalic presentation (91.8%, 95% CI 86.4-97.3%). There was high negative predictive value for placenta previa (96.1%, 95% CI 93.5-98.8%) and abnormal amniotic fluid volume (89.5%, 95% CI 85.3-93.6%). There was also substantial to perfect mean agreement for these same outcomes (range 87-99.6% agreement, Cohen κ range 0.59-0.91, P<.001 for all). CONCLUSION Blind ultrasound sweeps of the gravid abdomen guided by an eight-step protocol using only external anatomic landmarks and performed by previously untrained operators with a low-cost, portable, battery-powered device had excellent sensitivity and specificity for high-risk pregnancy complications such as malpresentation, placenta previa, multiple gestations, and abnormal amniotic fluid volume, similar to results of a diagnostic ultrasound examination using a trained ultrasonographer and standard-of-care ultrasound machine. This approach has the potential to improve access to obstetric ultrasonography globally.
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Affiliation(s)
- Marika Toscano
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; the Department of Imaging Sciences, the Department of Public Health Sciences, and the Department of Obstetrics & Gynecology, University of Rochester Medical Center, and the University of Rochester School of Medicine and Dentistry, Rochester, New York; and the Division of Electric Engineering, Department of Academic Engineering, Pontificia Universidad Catolica del Peru, Lima, Peru
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16
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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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17
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Maita KC, Palmieri-Serrano L, Avila FR, Torres-Guzman RA, Garcia JP, S. Eldaly A, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Imaging evaluated remotely through telemedicine as a reliable alternative for accurate diagnosis: a systematic review. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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18
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Beldjerd M, Quarello E, Lafouge A, Giorgi R, Le Corroller Soriano AG. A cost minimization analysis comparing asynchronous tele-expertise with face-to-face consultation for prenatal diagnosis in France. J Telemed Telecare 2023:1357633X231151713. [PMID: 36755393 DOI: 10.1177/1357633x231151713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Timely detection of congenital anomalies using ultrasound improves neonatal care. As specialist sonographers are often geographically dispersed, they are sometimes requested to provide a second opinion via tele-expertise. The present study aimed to evaluate the economic impact of asynchronous tele-expertise in obstetric ultrasound care in private medical practice through a comparison with face-to-face consultations. We conducted a cost minimization analysis using decision tree modeling in order to determine whether asynchronous tele-expertise or face-to-face consultation had the lowest cost, under the assumption of equivalent effectiveness in terms of prenatal diagnosis. Costs were measured from the societal perspective. The data for the base case of our modeling came from a retrospective analysis of the clinical practice of an expert who had been conducting asynchronous tele-expertise for 4 years in France. The study included 260 patients for whom 322 requests for expert opinions were made by physicians/midwives from January 2016 to January 2020. The expected average total cost for tele-expertise for a patient was €74.45 (95% CI: €66.36-€82.54) compared to €195.02 (95% CI: €183.90-€206.14) for the conventional face-to-face strategy. Accordingly, using tele-expertise led to a statistically significant reduction of €120.57 in the average total cost per patient. A sensitivity analysis confirmed the robustness of the model produced. The results of the present study underline the efficiency of tele-expertise and highlight related economic benefits. Accordingly, they could inform public health policy on the dissemination of tele-expertise in the field of obstetric ultrasound care.
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Affiliation(s)
- M'hamed Beldjerd
- Inserm, Aix Marseille Univ, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Edwin Quarello
- Centre Image 2, 6 rue Rocca, Marseille, France
- Service de Gynécologie Obstétrique 26 Bd de Louvain, Hôpital Saint Joseph, Marseille, France
| | - Antoine Lafouge
- Cabinet de gynécologie et obstétrique Hyères, Hyères, France
| | - Roch Giorgi
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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19
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Timor‐Tritsch IE, Goldstein SR. Gynecologic Teleultrasound and COVID-19: Is There a Connection? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:255-260. [PMID: 35312092 PMCID: PMC9088465 DOI: 10.1002/jum.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Ilan E. Timor‐Tritsch
- Department of Obstetrics and GynecologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - Steven R. Goldstein
- Department of Obstetrics and GynecologyNew York University Grossman School of MedicineNew YorkNYUSA
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Dinh A, Tseng E, Yin AL, Estrin D, Greenwald P, Fortenko A. Perceptions of Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers (Preprint). JMIR Form Res 2022; 7:e45211. [PMID: 36976628 PMCID: PMC10131657 DOI: 10.2196/45211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. OBJECTIVE This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. METHODS Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding. RESULTS Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption. CONCLUSIONS AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.
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Affiliation(s)
- Alana Dinh
- Medical College, Weill Cornell Medicine, New York, NY, United States
| | - Emily Tseng
- Department of Information Science, Cornell Tech, New York, NY, United States
| | - Andrew Lukas Yin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Deborah Estrin
- Department of Computer Science, Cornell Tech, New York, NY, United States
| | - Peter Greenwald
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Alexander Fortenko
- Emergency Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
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21
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Drukker L, Sharma H, Karim JN, Droste R, Noble JA, Papageorghiou AT. Clinical workflow of sonographers performing fetal anomaly ultrasound scans: deep-learning-based analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:759-765. [PMID: 35726505 PMCID: PMC10107110 DOI: 10.1002/uog.24975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Despite decades of obstetric scanning, the field of sonographer workflow remains largely unexplored. In the second trimester, sonographers use scan guidelines to guide their acquisition of standard planes and structures; however, the scan-acquisition order is not prescribed. Using deep-learning-based video analysis, the aim of this study was to develop a deeper understanding of the clinical workflow undertaken by sonographers during second-trimester anomaly scans. METHODS We collected prospectively full-length video recordings of routine second-trimester anomaly scans. Important scan events in the videos were identified by detecting automatically image freeze and image/clip save. The video immediately preceding and following the important event was extracted and labeled as one of 11 commonly acquired anatomical structures. We developed and used a purposely trained and tested deep-learning annotation model to label automatically the large number of scan events. Thus, anomaly scans were partitioned as a sequence of anatomical planes or fetal structures obtained over time. RESULTS A total of 496 anomaly scans performed by 14 sonographers were available for analysis. UK guidelines specify that an image or videoclip of five different anatomical regions must be stored and these were detected in the majority of scans: head/brain was detected in 97.2% of scans, coronal face view (nose/lips) in 86.1%, abdomen in 93.1%, spine in 95.0% and femur in 92.3%. Analyzing the clinical workflow, we observed that sonographers were most likely to begin their scan by capturing the head/brain (in 24.4% of scans), spine (in 23.2%) or thorax/heart (in 22.8%). The most commonly identified two-structure transitions were: placenta/amniotic fluid to maternal anatomy, occurring in 44.5% of scans; head/brain to coronal face (nose/lips) in 42.7%; abdomen to thorax/heart in 26.1%; and three-dimensional/four-dimensional face to sagittal face (profile) in 23.7%. Transitions between three or more consecutive structures in sequence were uncommon (up to 13% of scans). None of the captured anomaly scans shared an entirely identical sequence. CONCLUSIONS We present a novel evaluation of the anomaly scan acquisition process using a deep-learning-based analysis of ultrasound video. We note wide variation in the number and sequence of structures obtained during routine second-trimester anomaly scans. Overall, each anomaly scan was found to be unique in its scanning sequence, suggesting that sonographers take advantage of the fetal position and acquire the standard planes according to their visibility rather than following a strict acquisition order. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. Drukker
- Nuffield Department of Women's and Reproductive HealthJohn Radcliffe Hospital, University of OxfordOxfordUK
- Women's Ultrasound, Department of Obstetrics and GynecologyBeilinson Medical Center, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - H. Sharma
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
| | - J. N. Karim
- Nuffield Department of Women's and Reproductive HealthJohn Radcliffe Hospital, University of OxfordOxfordUK
| | - R. Droste
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
| | - J. A. Noble
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's and Reproductive HealthJohn Radcliffe Hospital, University of OxfordOxfordUK
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Morel B, Hellec C, Fievet A, Taveau CS, Abimelech M, Dujardin PA, Brunereau L, Patat F. Reliability of 3-D Virtual Abdominal Tele-ultrasonography in Pediatric Emergency: Comparison with Standard-of-Care Ultrasound Examination. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2310-2321. [PMID: 36055859 DOI: 10.1016/j.ultrasmedbio.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/01/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
Ultrasound is currently recommended as the first-line examination for abdominal symptoms in children. However, a pediatric radiologist is not always available on site, especially during on-call duty. This study was aimed at evaluating the reliability of an innovative 3-D virtual abdominal tele-ultrasonography in this context. A prospective study was conducted between December 2020 and May 2021 that recruited 103 children undergoing ultrasound for abdominal pain. Trauma cases were excluded. Four tridimensional acquisitions were performed with a Smart Sensor 3D device (Canon Medical Systems, Otawara, Japan). Each tele-ultrasonography was secondarily blindly reviewed by two radiologists (one senior and one resident) with Fusion software (Canon Medical Systems). Acceptance and quality of the acquisitions were evaluated on a Likert scale. Inter-rater reliability was quantified using Cohen's κ coefficient and intraclass correlation coefficient. The ultrasound examination was normal in 66 cases (64%), abnormal in 36 cases (35%) and inconclusive in 1 case (1%). The acquisitions were obtained without objections from the children, their parents or the operators in more than 95% of cases. The quality of the acquisitions was considered good to excellent in 84% and 70% of cases. The sensitivity of the senior radiologist and the resident was 86% and 84%, respectively; specificity was 95% and 92%, positive predictive value 92% and 86% and negative predictive value 92 and 91% when comparing the conclusions of the standard and the tele-ultrasound examinations. Cohen's κ coefficients of the diagnosis obtained with the standard and the tele-ultrasound examinations were 0.82 and 0.71, respectively. The inter-rater Cohen's κ coefficient was 0.84. The intraclass correlation coefficient between the standard abdominal examination and the 3-D tele-ultrasound reformatted images for the following quantitative variables on pathological cases was 0.99 (confidence interval: 0.98-0.99). Virtual abdominal tele-ultrasonography is a promising method in pediatric emergencies.
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Affiliation(s)
- Baptiste Morel
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; Pediatric Radiology Department, Clocheville Hospital, CHRU de Tours, Tours, France.
| | - Corentin Hellec
- Pediatric Radiology Department, Clocheville Hospital, CHRU de Tours, Tours, France
| | - Adèle Fievet
- Pediatric Radiology Department, Clocheville Hospital, CHRU de Tours, Tours, France
| | | | - Martine Abimelech
- Pediatric Radiology Department, Regional Hospital of Orleans, Orleans, France
| | | | | | - Frédéric Patat
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France
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Marini TJ, Kaproth-Joslin K, Ambrosini R, Baran TM, Dozier AM, Zhao YT, Satheesh M, Mahony Reátegui-Rivera C, Sifuentes W, Rios-Mayhua G, Castaneda B. Volume sweep imaging lung teleultrasound for detection of COVID-19 in Peru: a multicentre pilot study. BMJ Open 2022; 12:e061332. [PMID: 36192102 PMCID: PMC9534786 DOI: 10.1136/bmjopen-2022-061332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Pulmonary disease is a significant cause of morbidity and mortality in adults and children, but most of the world lacks diagnostic imaging for its assessment. Lung ultrasound is a portable, low-cost, and highly accurate imaging modality for assessment of pulmonary pathology including pneumonia, but its deployment is limited secondary to a lack of trained sonographers. In this study, we piloted a low-cost lung teleultrasound system in rural Peru during the COVID-19 pandemic using lung ultrasound volume sweep imaging (VSI) that can be operated by an individual without prior ultrasound training circumventing many obstacles to ultrasound deployment. DESIGN Pilot study. SETTING Study activities took place in five health centres in rural Peru. PARTICIPANTS There were 213 participants presenting to rural health clinics. INTERVENTIONS Individuals without prior ultrasound experience in rural Peru underwent brief training on how to use the teleultrasound system and perform lung ultrasound VSI. Subsequently, patients attending clinic were scanned by these previously ultrasound-naïve operators with the teleultrasound system. PRIMARY AND SECONDARY OUTCOME MEASURES Radiologists examined the ultrasound imaging to assess its diagnostic value and identify any pathology. A random subset of 20% of the scans were analysed for inter-reader reliability. RESULTS Lung VSI teleultrasound examinations underwent detailed analysis by two cardiothoracic attending radiologists. Of the examinations, 202 were rated of diagnostic image quality (94.8%, 95% CI 90.9% to 97.4%). There was 91% agreement between radiologists on lung ultrasound interpretation among a 20% sample of all examinations (κ=0.76, 95% CI 0.53 to 0.98). Radiologists were able to identify sequelae of COVID-19 with the predominant finding being B-lines. CONCLUSION Lung VSI teleultrasound performed by individuals without prior training allowed diagnostic imaging of the lungs and identification of sequelae of COVID-19 infection. Deployment of lung VSI teleultrasound holds potential as a low-cost means to improve access to imaging around the world.
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Affiliation(s)
- Thomas J Marini
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Robert Ambrosini
- University of Rochester Medical Center, Rochester, New York, USA
| | - Timothy M Baran
- University of Rochester Medical Center, Rochester, New York, USA
| | - Ann M Dozier
- University of Rochester Medical Center, Rochester, New York, USA
| | - Yu T Zhao
- University of Rochester Medical Center, Rochester, New York, USA
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24
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Small Animal Teleultrasound. Vet Clin North Am Small Anim Pract 2022; 52:1141-1151. [PMID: 36150791 DOI: 10.1016/j.cvsm.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Teleradiology is well established in many small animal practices, whereas teleultrasound is slowly gaining prominence. The demand for teleultrasound services in the veterinary profession has increased substantially because access to ultrasound to general practitioners increases faster than the number of imaging specialists and Point of Care Ultrasound (POCUS) becomes part of the standard of care. Two main methods of teleultrasound currently exist: asynchronous (eg, "store-and-forward") and synchronous (eg, real-time) interpretations. Few standardized protocols for teleultrasound in small animals are available. Similarly, there are no standardized training programs for sonographic examination acquisition and interpretation outside of the traditional diagnostic imaging residency under the purview of the American College of Veterinary Radiology. The success of a telesonographic evaluation largely depends on the relationship between the veterinarian requesting remote assistance and the expert providing support.
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25
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Zhang YQ, Yin HH, He T, Guo LH, Zhao CK, Xu HX. Clinical application of a 5G-based telerobotic ultrasound system for thyroid examination on a rural island: a prospective study. Endocrine 2022; 76:620-634. [PMID: 35182363 PMCID: PMC8857403 DOI: 10.1007/s12020-022-03011-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/29/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the feasibility of a 5G-based telerobotic ultrasound (US) system for thyroid examination on a rural island. METHODS From September 2020 to March 2021, this prospectively study enrolled a total of 139 patients (average age, 58.6 ± 12.7 years) included 33 males and 106 females, who underwent 5G-based telerobotic thyroid US examination by a tele-doctor at Shanghai Tenth People's Hospital and a conventional thyroid US examination at Chongming Second People's Hospital 84 km away. The clinical feasibility of 5G-based telerobotic US for thyroid examination were evaluated in terms of safety, duration, US image quality, diagnostic results, and questionnaire survey. RESULTS 92.8% of patients had no examination-related complaints. The average duration of the 5G-based telerobotic US examination was similar as that of conventional US examination (5.57 ± 2.20 min vs. 5.23 ± 2.1 min, P = 0.164). The image quality of telerobotic US correlated well with that of conventional US (4.63 ± 0.60 vs. 4.65 ± 0.61, P = 0.102). There was no significant difference between two types of US examination methods for the diameter measurement of the thyroid, cervical lymph nodes, and thyroid nodules. Two lymphadenopathies and 20 diffuse thyroid diseases were detected in two types of US methods. 124 thyroid nodules were detected by telerobotic US and 127 thyroid nodules were detected by conventional US. Among them, 122 were the same thyroid nodules. In addition, there were good consistency in the US features (component, echogenicity, shape, and calcification) and ACR TI-RADS category of the same thyroid nodules between telerobotic and conventional US examinations (ICC = 0.788-0.863). 85.6% of patients accepted the telerobotic US, and 87.1% were willing to pay extra fee for the telerobotic US. CONCLUSION The 5G-based telerobotic US system can be a routine diagnostic tool for thyroid examination for patients on a rural island.
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Affiliation(s)
- Ya-Qin Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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
| | - Hao-Hao Yin
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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
| | - Tian He
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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.
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, 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.
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
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26
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Uschnig C, Recker F, Blaivas M, Dong Y, Dietrich CF. Tele-ultrasound in the Era of COVID-19: A Practical Guide. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:965-974. [PMID: 35317949 PMCID: PMC8743597 DOI: 10.1016/j.ultrasmedbio.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Telemedicine has evolved over the past 50 years, with video consultations and telehealth (TH) mobile apps that are now widely used to support care in the management of chronic conditions, but are infrequently used in acute conditions such as emergencies. In the wake of the COVID-19 pandemic, demand is growing for video consultations as they minimize health provider-patient interactions and thereby the risk of infection. Advanced applications such as tele-ultrasound (TUS) have not yet gained a foothold despite their achieving technical maturity and the availability of software from numerous companies for TUS for their respective portable ultrasound devices. However, ultrasound is indispensable for triage in emergencies and also offers distinct advantages in the diagnosis of COVID-19 pneumonia for certain patient populations such as pregnant women, children and immobilized patients. Additionally, recent work suggests lung ultrasound can accurately risk stratify patients for likely infection when immediate polymerase chain reaction (PCR) testing is not available and has prognostic utility for positive patients with respect to the need for admission and intensive care unit (ICU) treatment. Though currently underutilized, a wider implementation of TUS in TH applications and processes may be an important stepping-stone for telemedicine. The addition of ultrasound to TH may allow it to cross the barrier from being an application used mainly for primary care and chronic conditions to an indispensable tool used in emergency care, disaster situations, remote areas and low-income countries where it is difficult to obtain high-quality diagnostic imaging. The objective of this review was to provide an overview of the current state of telemedicine, insights into current and future use scenarios, its practical application as well as current TUS uses and their potential value with an overview of currently available portable and handheld ultrasound devices. In the wake of the COVID-19 pandemic we point out an unmet need and use case of TUS as a supportive tool for health care providers and organizations in the management of affected patients.
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Affiliation(s)
- Christopher Uschnig
- Department of Internal Medicine, Clinics Beau-Site, Salem and Permanence, Bern, Switzerland.
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus, Germany
| | - Michael Blaivas
- Department of Emergency Medicine, St. Francis Hospital, University of South Carolina School of Medicine, Columbus, Georgia, USA
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department of Internal Medicine, Clinics Beau-Site, Salem and Permanence, Bern, Switzerland
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Peterman NJ, Yeo E, Kaptur B, Smith EJ, Christensen A, Huang E, Rasheed M. Analysis of Rural Disparities in Ultrasound Access. Cureus 2022; 14:e25425. [PMID: 35774712 PMCID: PMC9236672 DOI: 10.7759/cureus.25425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This work aims to conduct a geospatial analysis of recent ultrasound access and usage within the United States, with a particular focus on disparities between rural and urban areas. Methods/Materials Multiple public datasets were merged on a county level, including US Department of Agriculture economic metrics and Centers for Medicare Services data using the most recent years available (2015-2019). From these databases, 39 total variables encompassing the socioeconomic, health, and ultrasound characteristics of each county were obtained. Current Procedural Terminology (CPT) codes incorporated included ultrasound-guided procedures and diagnostic exams. Three thousand eleven counties were included. The combined dataset was then exported to GeoDa for network-based analysis and to produce map visualizations. To identify statistically significant (p < 0.05) hotspots and coldspots in point-of-care ultrasound (POCUS) prevalence, Moran’s I was used. Choropleth maps were created for visualization. ANOVA was run across the four Moran’s I groups for each of 39 variables of interest. Results A total of 30,135,085 ultrasound-related CPT codes were billed to Medicare over 2015-2019, with 26.55% of codes being ultrasound-guided procedures and 73.45% being diagnostic exams. 38.84% of rural counties had access to POC ultrasound compared to 88.56% of metropolitan counties and 74.19% of counties overall. Hotspots of POCUS were in Southern California and the Eastern US (average of 1,441 per 10,000 Medicare members per year). Coldspot areas were seen in the Great Plains and Midwest (average of 7.43 per 10k Medicare members per year). Hotspot clusters, when compared to coldspot clusters, were significantly (p < 0.001) more dense (703.6 to 14.9 people per square mile), more urbanized (3.5 to 7.1 Rural-Urban Continuum (RUC)), more college-educated (25.1% to 20.0%), more likely to have an Emergency Department (ED) visit (725.8 to 616.9 visits per 1,000 Medicare members), more likely to be obese (19.0% to 12.9%), less likely to be uninsured (10.1% to 13.0%), had more Black representation (8.5% to 3.4%), and less Hispanic representation (2.6% to 5.5%). Conclusions Ultrasound access and usage demonstrate significant geospatial trends across the United States. Hotspot and coldspot counties differ on several key sociodemographic and economic variables.
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Mazzuca D, Borselli M, Gratteri S, Zampogna G, Feola A, Della Corte M, Guarna F, Scorcia V, Giannaccare G. Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095614. [PMID: 35565003 PMCID: PMC9101177 DOI: 10.3390/ijerph19095614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.
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Affiliation(s)
- Daniela Mazzuca
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Santo Gratteri
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Giovanna Zampogna
- Department of Law, Economics and Human Sciences (DIGIES), Mediterranea University of Reggio Calabria, Via dell’Università 25, 89124 Reggio Calabria, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Via Luciano Armanni 5, 80138 Naples, Italy;
| | - Marcello Della Corte
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Francesca Guarna
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
- Correspondence: ; Tel.: +39-0961-3647-041; Fax: +39-0961-3647-094
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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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Shaddock L, Smith T. Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review. J Multidiscip Healthc 2022; 15:605-625. [PMID: 35378744 PMCID: PMC8976575 DOI: 10.2147/jmdh.s359084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Liam Shaddock
- Medical Radiation Science, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tony Smith
- The University of Newcastle Department of Rural Health & School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
- Correspondence: Tony Smith, The University of Newcastle Department of Rural Health, C/- 69A High Street, Taree, Newcastle, NSW, Australia, Tel +61 466 440 037, Email
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Abstract
The delivery of healthcare from a distance, also known as telemedicine, has evolved over the past 50 years, changing the way healthcare is delivered globally. Its integration into numerous domains has permitted high-quality care that transcends the obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine has advanced substantially in recent years, particularly in high-income settings and low-resource areas. The literature in Pubmed from 1960–2020 was assessed with the keywords “ultrasound”, “telemedicine”, “ultrasound remote”, and “tele-ultrasound” to conduct a SWOT analysis (strengths, weaknesses, opportunities, and threats). In addressing strengths and opportunities, we emphasized practical aspects, such as the usefulness of tele-ultrasound and the cost efficiency of it. Furthermore, aspects of medical education in tele-ultrasound were considered. When it came to weaknesses and threats, we focused on issues that may not be solved immediately, and that require careful consideration or further development, such as new software that is not yet available commercially.
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Duarte ML, Dos Santos LR, Iared W, Peccin MS. Telementored ultrasonography: a narrative review. SAO PAULO MED J 2022; 140:310-319. [PMID: 35293938 PMCID: PMC9610246 DOI: 10.1590/1516-3180.2020.0607.r2.15092021] [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: 10/10/2020] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.
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Affiliation(s)
- Marcio Luis Duarte
- MD, MSc. Musculoskeletal Radiologist, WEBIMAGEM, São Paulo (SP), Brazil; and Doctoral Student, Postgraduate Program on Evidence-Based Health, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Lucas Ribeiro Dos Santos
- MD, MSc. Endocrinologist and Professor, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil; and Doctoral Student, Postgraduate Program on Evidence-Based Health, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Wagner Iared
- MD, PhD. Supervisor Professor, Postgraduate Program on Evidence-Based Health, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Maria Stella Peccin
- PT, PhD. Associate Professor, Department of Human Movement Sciences, and Advisor, Postgraduate Program on Evidence-Based Health, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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33
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Marini TJ, Weiss SL, Gupta A, Zhao YT, Baran TM, Garra B, Shafiq I, Oppenheimer DC, Egoavil MS, Ortega RL, Quinn RA, Kan J, Dozier AM, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas. J Endocrinol Invest 2021; 44:2699-2708. [PMID: 33970434 PMCID: PMC8572222 DOI: 10.1007/s40618-021-01584-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
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Affiliation(s)
- T J Marini
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - S L Weiss
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A Gupta
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Y T Zhao
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - T M Baran
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - B Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - I Shafiq
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - D C Oppenheimer
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - M S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - R L Ortega
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - R A Quinn
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - J Kan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A M Dozier
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - L Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - C Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - B Castaneda
- Pontifica Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru.
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Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study. J Clin Med 2021; 10:jcm10225353. [PMID: 34830635 PMCID: PMC8617747 DOI: 10.3390/jcm10225353] [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: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
Continuous Intrathecal Drug Delivery through an implanted pump is a well-known therapeutic option for the management of chronic pain and severe disabling spasticity. To have a successful therapy, pump refills need to be performed at regular time intervals after implantation. In line with the increased applications of Hospital at Home, these refill procedures might be performed at the patient’s home. The aim of this pilot study is to evaluate the feasibility, safety, and effectiveness of intrathecal pump refill procedures at home. Twenty patients were included whereby pump refill procedures were conducted at the patient’s home. To enable contact with the hospital, a video connection was set-up. Tele-ultrasound was used as post-refill verification. All procedures were successfully performed with complete patient satisfaction. Ninety-five percent of the patients felt safe during the procedure, and 95% of the procedures felt safe according to the physician. All patients indicated that they preferred their next refill at home. The median time consumption for the physician/nurse at the patient’s home was 26 min and for the researcher at the hospital 15 min. In light of quality enhancement programs and personalized care, it is important to continue urgent pain management procedures in a safe way, even during a pandemic.
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Marini TJ, Weis JM, Baran TM, Kan J, Meng S, Yeo A, Zhao YT, Ambrosini R, Cleary S, Rubens D, Chess M, Castaneda B, Dozier A, O'Connor T, Garra B, Kaproth-Joslin K. Lung ultrasound volume sweep imaging for respiratory illness: a new horizon in expanding imaging access. BMJ Open Respir Res 2021; 8:8/1/e000919. [PMID: 34772730 PMCID: PMC8593737 DOI: 10.1136/bmjresp-2021-000919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Respiratory illness is a leading cause of morbidity in adults and the number one cause of mortality in children, yet billions of people lack access to medical imaging to assist in its diagnosis. Although ultrasound is highly sensitive and specific for respiratory illness such as pneumonia, its deployment is limited by a lack of sonographers. As a solution, we tested a standardised lung ultrasound volume sweep imaging (VSI) protocol based solely on external body landmarks performed by individuals without prior ultrasound experience after brief training. Each step in the VSI protocol is saved as a video clip for later interpretation by a specialist. Methods Dyspneic hospitalised patients were scanned by ultrasound naive operators after 2 hours of training using the lung ultrasound VSI protocol. Separate blinded readers interpreted both lung ultrasound VSI examinations and standard of care chest radiographs to ascertain the diagnostic value of lung VSI considering chest X-ray as the reference standard. Comparison to clinical diagnosis as documented in the medical record and CT (when available) were also performed. Readers offered a final interpretation of normal, abnormal, or indeterminate/borderline for each VSI examination, chest X-ray, and CT. Results Operators scanned 102 subjects (0–89 years old) for analysis. Lung VSI showed a sensitivity of 93% and a specificity of 91% for an abnormal chest X-ray and a sensitivity of 100% and a specificity of 93% for a clinical diagnosis of pneumonia. When any cases with an indeterminate rating on chest X-ray or ultrasound were excluded (n=38), VSI lung ultrasound showed 92% agreement with chest X-ray (Cohen’s κ 0.83 (0.68 to 0.97, p<0.0001)). Among cases with CT (n=21), when any ultrasound with an indeterminate rating was excluded (n=3), there was 100% agreement with VSI. Conclusion Lung VSI performed by previously inexperienced ultrasound operators after brief training showed excellent agreement with chest X-ray and high sensitivity and specificity for a clinical diagnosis of pneumonia. Blinded readers were able to identify other respiratory diseases including pulmonary oedema and pleural effusion. Deployment of lung VSI could benefit the health of the global community.
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Affiliation(s)
| | | | | | - Jonah Kan
- University of Rochester School of Medicine and Dentistry, URMC, Rochester, NY, USA
| | - Steven Meng
- University of Rochester School of Medicine and Dentistry, URMC, Rochester, NY, USA
| | - Alex Yeo
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Yu T Zhao
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | | | - Sean Cleary
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Deborah Rubens
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Mitchell Chess
- Department of Imaging Sciences, URMC, Rochester, NY, USA
| | - Benjamin Castaneda
- Departmento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Ann Dozier
- Department of Public Health Sciences, URMC, Rochester, NY, USA
| | | | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, FL, USA
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Sheppard G, Devasahayam AJ, Campbell C, Najafizada M, Yi Y, Power A. The prevalence and patterns of use of point-of-care ultrasound in Newfoundland and Labrador. CANADIAN JOURNAL OF RURAL MEDICINE 2021; 26:160-168. [PMID: 34643555 DOI: 10.4103/cjrm.cjrm_61_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Point-of-care ultrasound (POCUS) is used for diagnostic and procedural guidance by physicians in Newfoundland and Labrador (NL). POCUS use is largely limited to urban locations and the training is variable amongst physicians. The primary aim of this study was to determine the prevalence of POCUS devices in NL and the secondary aim was to characterise the patterns of POCUS use amongst physicians in NL. Methods This is a mixed-methods cross-sectional study. We determined the prevalence of POCUS devices from purchase records and the patterns of POCUS use through theme-based interviews. The interviews were transcribed, coded and analysed using standardised qualitative methods. Results Ten physicians (3 females, 5 rural) participated in the interviews. The overall prevalence of POCUS devices in NL was 12.5/100,000 population. Participants in urban areas had more access to POCUS training and devices. Participants used POCUS on a daily or weekly basis to rule in or out life-threatening conditions and improve access to specialist care. The benefits of POCUS included expedited investigations, decreased radiation and increased patient satisfaction. The barriers to using POCUS were lack of training, time, devices, image archiving software, difficulty generating and interpreting images and patient body habitus. Conclusion This is the first study to our knowledge to report the prevalence of POCUS devices in Canada. Physicians who practise in rural NL have limited access to POCUS devices and have identified barriers to POCUS training. Connecting physicians in rural areas with POCUS experts through a province-wide POCUS network may address these barriers and improve healthcare access.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Faculty of Medicine Memorial University, Canada
| | | | - Craig Campbell
- Medical Student with the Faculty of Medicine at Memorial Univeristy, Canada
| | - Maisam Najafizada
- Division of Community Health and Humanities, Faculty of Medicine Memorial University, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine Memorial University, Canada
| | - Amanda Power
- Discipline of Emergency Medicine, Faculty of Medicine Memorial University, Canada
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Soni NJ, Boyd JS, Mints G, Proud KC, Jensen TP, Liu G, Mathews BK, Schott CK, Kurian L, LoPresti CM, Andrus P, Nathanson R, Smith N, Haro EK, Mader MJ, Pugh J, Restrepo MI, Lucas BP. Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic. Ultrasound J 2021; 13:39. [PMID: 34487262 PMCID: PMC8419826 DOI: 10.1186/s13089-021-00242-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-19 pandemic. Results Pre- and post-course knowledge test scores of learners from the in-person (n = 88) and tele-ultrasound course (n = 52) were compared. Though mean pre-course knowledge test scores were higher among learners of the tele-ultrasound versus in-person course (78% vs. 71%; p = 0.001), there was no significant difference in the post-course test scores between learners of the two course formats (89% vs. 87%; p = 0.069). Both learners and faculty rated the tele-ultrasound course highly (4.6–5.0 on a 5-point scale) for effectiveness of virtual lectures, tele-ultrasound hands-on scanning sessions, and course administration. Faculty generally expressed less satisfaction with their ability to engage with learners, troubleshoot image acquisition, and provide feedback during the tele-ultrasound course but felt learners completed the tele-ultrasound course with a better basic POCUS skillset. Conclusions Compared to a traditional in-person course, tele-ultrasound POCUS CME courses appeared to be as effective for improving POCUS knowledge post-course and fulfilling learning objectives. Our findings can serve as a roadmap for educators seeking guidance on development of a tele-ultrasound POCUS training course whose demand will likely persist beyond the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00242-6.
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Affiliation(s)
- Nilam J Soni
- South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA. .,University of Texas Health San Antonio, South Texas Veterans Health Care System, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Jeremy S Boyd
- Department of Emergency Medicine, Veterans Affairs - Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory Mints
- Division of Hospital Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kevin C Proud
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, CA, USA
| | - Gigi Liu
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Benji K Mathews
- Department of Hospital Medicine, Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Christopher K Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care System, Pittsburgh, PA, USA.,Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Kurian
- Division of Hospital Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Charles M LoPresti
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Phil Andrus
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Robert Nathanson
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Natalie Smith
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Michael J Mader
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Marcos I Restrepo
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, VT, USA.,Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH, USA
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Huang LY, McKenty N, Alvarez A, Gober J, Irwin R, Molinares D, Price C, Sherman A, Tiu T, Gater DR. Virtually Possible: Medical Student Rehabilitation Rotations During a Pandemic. Am J Phys Med Rehabil 2021; 100:831-836. [PMID: 34173775 PMCID: PMC8366514 DOI: 10.1097/phm.0000000000001831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The novel coronavirus 2019 pandemic has led to new dilemmas in medical education because of an initial shortage of personal protective equipment, uncertainty regarding disease transmission and treatments, travel restrictions, and social distancing guidelines. These new problems further compound the already existing problem of limited medical student exposure to the field of physical medicine and rehabilitation, particularly for students in medical schools lacking a department of physical medicine and rehabilitation, approximately 50% of medical schools. A virtual medical student physical medicine and rehabilitation rotation was created to mitigate coronavirus 2019-related limitations and impact on medical education. Using audiovisual technology, students had the opportunity to participate in clinical inpatient and outpatient care, live-streamed procedures, and virtual didactics, develop and showcase their clinical knowledge and reasoning skills, and become familiar with the culture of the physical medicine and rehabilitation residency program. Adaptive educational approaches, including integration of the flipped classroom model, success, pitfalls, and areas for improvement will be described and discussed. Providing nontraditional methods for physical medicine and rehabilitation education and exposure to medical students is crucial to maintain and promote growth of the field in this unprecedented and increasingly virtual era.
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Fagni F, Knitza J, Krusche M, Kleyer A, Tascilar K, Simon D. Digital Approaches for a Reliable Early Diagnosis of Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:718922. [PMID: 34458293 PMCID: PMC8385754 DOI: 10.3389/fmed.2021.718922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that develops in up to 30% of patients with psoriasis. In the vast majority of cases, cutaneous symptoms precede musculoskeletal complaints. Progression from psoriasis to PsA is characterized by subclinical synovio-entheseal inflammation and often non-specific musculoskeletal symptoms that are frequently unreported or overlooked. With the development of increasingly effective therapies and a broad drug armamentarium, prevention of arthritis development through careful clinical monitoring has become priority. Identifying high-risk psoriasis patients before PsA onset would ensure early diagnosis, increased treatment efficacy, and ultimately better outcomes; ideally, PsA development could even be averted. However, the current model of care for PsA offers only limited possibilities of early intervention. This is attributable to the large pool of patients to be monitored and the limited resources of the health care system in comparison. The use of digital technologies for health (eHealth) could help close this gap in care by enabling faster, more targeted and more streamlined access to rheumatological care for patients with psoriasis. eHealth solutions particularly include telemedicine, mobile technologies, and symptom checkers. Telemedicine enables rheumatological visits and consultations at a distance while mobile technologies can improve monitoring by allowing patients to self-report symptoms and disease-related parameters continuously. Symptom checkers have the potential to direct patients to medical attention at an earlier point of their disease and therefore minimizing diagnostic delay. Overall, these interventions could lead to earlier diagnoses of arthritis, improved monitoring, and better disease control while simultaneously increasing the capacity of referral centers.
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Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Efficacy of Antenatal Ultrasound Examination in Diagnosis of Congenital Cardiac Anomalies in an Unselected Population: Retrospective Study from a Tertiary Centre. J Obstet Gynaecol India 2021; 71:277-284. [PMID: 34408347 DOI: 10.1007/s13224-020-01424-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/29/2020] [Indexed: 01/28/2023] Open
Abstract
Background In Low- and Middle-Income Countries like India, where the services and surgical care for Congenital Heart Disease (CHD) are available only in selected centres with geographical variations, it is important to detect Heart defects early and give the parents an opportunity to plan ahead for seeking appropriate care at the earliest. Several developments in recent years such as improvement of quality of ultrasound machines, sonographer's experience, skills and better description of cardiac views have contributed to improve detection rate. Methods A retrospective study was done between March 2016 and December 2019, and showed ultrasound evidence of CHD was included. Results The total number of morphology scans done during study period was 50,435. The number of congenital anomalies detected was 1482, out of which CHD was detected in 334 (22.5%). Outcome of 50 pregnancies were not available while the rest (284) were available for follow up in post-natal period. There were 51 cases of CHD, missed on routine antenatal morphological screening, which were diagnosed in the post-natal period. There were 18 cases of over-diagnosed CHD on antenatal scan, but were found to have normal echo findings after birth. Conclusion A systematic approach is crucial for practitioner to determine the patterns of associated defects. Use of step wise strategy helps in determining the correct diagnosis of isolated cardiac defect, associated with other system or a part of syndrome. Systematic audit of morphological scans could play an important role in improving the diagnostic accuracy, which in turn will lead to early detection.
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Sun YK, Li XL, Wang Q, Zhou BY, Zhu AQ, Qin C, Guo LH, Xu HX. Improving the quality of breast ultrasound examination performed by inexperienced ultrasound doctors with synchronous tele-ultrasound: a prospective, parallel controlled trial. Ultrasonography 2021; 41:307-316. [PMID: 34794212 PMCID: PMC8942725 DOI: 10.14366/usg.21081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This prospective study explored the value of synchronous tele-ultrasound (US) to aid doctors inexperienced in US with breast US examinations. METHODS In total, 99 patients were enrolled. Two trainee doctors who were inexperienced in US (trainee A [TA] and trainee B [TB]) and one doctor who was an expert in US completed the US examinations sequentially. TA completed the US examinations independently, while TB was instructed by the expert using synchronous tele-US. Subsequently, the expert performed on-site US examinations in person. Separately, they selected the most clinically significant nodule as the target nodule. Consistency with the expert and image quality were compared between TA and TB to evaluate tele-US. Furthermore, TB and the patients evaluated tele-US through questionnaires. RESULTS TB demonstrated higher consistency with the expert in terms of target nodule selection than TA (93.3% vs. 63.3%, P<0.001). TB achieved good inter-observer agreement (>0.75) with the expert on five US features (5/9, 55.6%), while TA only did so for one (1/9, 11.1%) (P=0.046). TB's image quality was higher than TA's in gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (P=0.018, P<0.001, P<0.001, P=0.033, and P=0.006, respectively). The comprehensive assessment score was higher for TB than for TA (3.96±0.82 vs. 3.09±0.87, P<0.001). Tele-US was helpful in 69.7% of US examinations and had a training effect in 68.0%. Furthermore, 63.6% of patients accepted tele-US and 60.6% were willing to pay. CONCLUSION Tele-US can help doctors inexperienced in US to perform breast US examinations.
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Affiliation(s)
- 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
| | - 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.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qiao Wang
- 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
| | - Bo-Yang Zhou
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - An-Qi Zhu
- 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
| | - Chuan Qin
- Department of Ultrasound, Karamay Center Hospital, Karamay, China
| | - Le-Hang Guo
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Xiong Xu
- 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.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Marini TJ, Oppenheimer DC, Baran TM, Rubens DJ, Dozier A, Garra B, Egoavil MS, Quinn RA, Kan J, Ortega RL, Zhao YT, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic right upper quadrant abdominal ultrasound in Peru: A new horizon in expanding access to imaging in rural and underserved areas. PLoS One 2021; 16:e0255919. [PMID: 34379679 PMCID: PMC8357175 DOI: 10.1371/journal.pone.0255919] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/26/2021] [Indexed: 01/11/2023] Open
Abstract
Background Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas. Methods The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist. Results Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated “poor” on 36.8% of exams, “acceptable” on 38.9% of exams, and “excellent” on 24.3% of exams. Among telemedicine exams of “acceptable” or “excellent” image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen’s kappa of 0.84 (95% CI 0.7–0.98, p <0.0001). Finally, among these teleultrasound exams of “acceptable” or “excellent” image quality, the sensitivity for cholelithiasis was 93% (95% CI 68.1%-99.8%), and the specificity was 97% (95% CI 89.5%-99.6%). Conclusion This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.
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Affiliation(s)
- Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Daniel C. Oppenheimer
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Timothy M. Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Deborah J. Rubens
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Ann Dozier
- Department of Public Health, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, United States of America
| | | | - Rosemary A. Quinn
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Jonah Kan
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Rafael L. Ortega
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yu T. Zhao
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Lorena Tamayo
- Medical Innovation and Technology, San Isidro, Lima, Peru
| | | | - Benjamin Castaneda
- Department of Engineering, Pontifica Universidad Catolica del Peru, San Miguel, Lima, Peru
- * E-mail:
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Kaneko T, Kagiyama N, Nakamura Y, Hirasawa T, Murata A, Morimoto R, Miyazaki S, Minamino T. Effectiveness of real-time tele-ultrasound for echocardiography in resource-limited medical teams. J Echocardiogr 2021; 20:16-23. [PMID: 34347261 PMCID: PMC8335714 DOI: 10.1007/s12574-021-00542-9] [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: 05/01/2021] [Revised: 06/25/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Echocardiography is a first-line tool for the screening of patients with cardiac dysfunction. However, the mastery of echocardiography requires significant training, and not all medical teams involve an echocardiography specialist. Telemedicine approaches can potentially improve the quality of echocardiography in resource-limited situations. METHODS We used a novel tablet-based hand-held ultrasound device that enables tele-ultrasound- a real-time video telecommunication with remote control for ultrasound images. A trainee scanned patients with various cardiovascular diseases and interpreted the images. Subsequently, the same trainee re-scanned the same patients and re-interpreted the same images using tele-ultrasound with an echocardiography specialist. An examination on the same patients by a blinded specialist was considered the gold standard. RESULTS We included 31 patients (median 77 [interquartile range 68-84] years old, 42% women). Mean absolute errors in left ventricular (LV) end-diastolic and end-systolic diameters, visual LV ejection fraction, and tricuspid annular plane systolic excursion decreased significantly after tele-ultrasound advice (5.9 mm, 5.8 mm, 8.6%, and 4.5 to 1.6 mm, 2.8 mm, 0.7%, and 1.8 mm, respectively, all p < 0.001), and intra-class correlation coefficients improved (0.76, 0.84, 0.68, and 0.44 to 0.96, 0.93, 0.99, and 0.90, respectively). Notably, with tele-advice, the trainee's examination showed perfect agreement with that of the specialist in classifying LV ejection fraction (> 50%, 50-35%, or > 35%) and identifying significant valvular heart diseases. CONCLUSION Real-time tele-ultrasound improved a trainee's echocardiography results to those of a specialist-level examination. This approach might be helpful in resource-limited medical teams where echocardiographic specialists are not readily available.
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Affiliation(s)
- Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan. .,Department of Digital Health and Telemedicine R&D, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tomomi Hirasawa
- Department of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Morimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Safadi S, Murthi S, Kashani KB. Use of Ultrasound to Assess Hemodynamics in Acutely Ill Patients. KIDNEY360 2021; 2:1349-1359. [PMID: 35369668 PMCID: PMC8676393 DOI: 10.34067/kid.0002322021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 02/04/2023]
Abstract
Early diagnosis of AKI and preventive measures can likely decrease the severity of the injury and improve patient outcomes. Current hemodynamic monitoring variables, including BP, heart and respiratory rates, temperature, and oxygenation status, have been used to identify patients at high risk for AKI. Despite the widespread use of such variables, their ability to accurately and timely detect patients who are high risk has been questioned. Therefore, there is a critical need to develop and validate tools that can measure new and more kidney-specific hemodynamic and laboratory variables, potentially assisting with AKI risk stratification, implementing appropriate and timely preventive measures, and hopefully improved outcomes. The new ultrasonography techniques provide novel insights into kidney hemodynamics and potential management and/or therapeutic targets. Contrast-enhanced ultrasonography; Doppler flow patterns of hepatic veins, portal vein, and intrakidney veins; and ultrasound elastography are among approaches that may provide such information, particularly related to vascular changes in AKI, venous volume excess or congestion, and fluid tolerance. This review summarizes the current state of these techniques and their relevance to kidney hemodynamic management.
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Affiliation(s)
- Sami Safadi
- Division of Critical Care Medicine, Alteon Health, Carroll Hospital, Westminster, Maryland
| | - Sarah Murthi
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Toscano M, Marini TJ, Drennan K, Baran TM, Kan J, Garra B, Dozier AM, Ortega RL, Quinn RA, Zhao YT, Egoavil MS, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound. BMC Pregnancy Childbirth 2021; 21:328. [PMID: 33902496 PMCID: PMC8074497 DOI: 10.1186/s12884-021-03720-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03720-w.
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Affiliation(s)
- Marika Toscano
- Department of Obstetrics & Gynecology, Division of Maternal/Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA.
| | - Thomas J Marini
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Kathryn Drennan
- Department of Obstetrics & Gynecology, Division of Maternal/Fetal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 668, Rochester, NY, 14642, USA
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Jonah Kan
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Brian Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - Ann M Dozier
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Rafael L Ortega
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Rosemary A Quinn
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Yu T Zhao
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 607, Rochester, NY, 14642, USA
| | - Miguel S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Lorena Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Claudia Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - Benjamin Castaneda
- Departament of Academic Engineering, Division of Electric Engineering, Pontificia Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru
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Onweni CL, Venegas-Borsellino CP, Treece J, Turnbull MT, Ritchie C, Freeman WD. The Power of Mobile Health: The Girl With the Gadgets in Uganda. Mayo Clin Proc Innov Qual Outcomes 2021; 5:486-494. [PMID: 33997644 PMCID: PMC8105515 DOI: 10.1016/j.mayocpiqo.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Medical-grade ultrasound devices are now pocket sized and can be easily transported to underserved parts of the world, allowing health care providers to have the tools to optimize diagnoses, inform management plans, and improve patient outcomes in remote locations. Other great advances in technology have recently occurred, such as artificial intelligence applied to mobile health devices and cloud computing, as augmented reality instructions make these devices more user friendly and readily applicable across health care encounters. However, broader awareness of the impact of these mobile health technologies is needed among health care providers, along with training on how to use them in valid and reproducible environments, for accurate diagnosis and treatment. This article provides a summary of a Mayo International Health Program journey to Bwindi, Uganda, with a portable mobile health unit. This article shows how point-of-care ultrasonography and other technologies can benefit remote clinical diagnosis and management in underserved areas around the world.
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Affiliation(s)
| | | | - Jennifer Treece
- Internal Medicine Department, East Tennessee State University, Johnson City, TN
| | | | | | - William D Freeman
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.,Department of Neurology, Mayo Clinic, Jacksonville, FL.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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Luu HM, van Walsum T, Franklin D, Pham PC, Vu LD, Moelker A, Staring M, VanHoang X, Niessen W, Trung NL. Efficiently compressing 3D medical images for teleinterventions via CNNs and anisotropic diffusion. Med Phys 2021; 48:2877-2890. [PMID: 33656213 DOI: 10.1002/mp.14814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 02/14/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Efficient compression of images while preserving image quality has the potential to be a major enabler of effective remote clinical diagnosis and treatment, since poor Internet connection conditions are often the primary constraint in such services. This paper presents a framework for organ-specific image compression for teleinterventions based on a deep learning approach and anisotropic diffusion filter. METHODS The proposed method, deep learning and anisotropic diffusion (DLAD), uses a convolutional neural network architecture to extract a probability map for the organ of interest; this probability map guides an anisotropic diffusion filter that smooths the image except at the location of the organ of interest. Subsequently, a compression method, such as BZ2 and HEVC-visually lossless, is applied to compress the image. We demonstrate the proposed method on three-dimensional (3D) CT images acquired for radio frequency ablation (RFA) of liver lesions. We quantitatively evaluate the proposed method on 151 CT images using peak-signal-to-noise ratio ( PSNR ), structural similarity ( SSIM ), and compression ratio ( CR ) metrics. Finally, we compare the assessments of two radiologists on the liver lesion detection and the liver lesion center annotation using 33 sets of the original images and the compressed images. RESULTS The results show that the method can significantly improve CR of most well-known compression methods. DLAD combined with HEVC-visually lossless achieves the highest average CR of 6.45, which is 36% higher than that of the original HEVC and outperforms other state-of-the-art lossless medical image compression methods. The means of PSNR and SSIM are 70 dB and 0.95, respectively. In addition, the compression effects do not statistically significantly affect the assessments of the radiologists on the liver lesion detection and the lesion center annotation. CONCLUSIONS We thus conclude that the method has a high potential to be applied in teleintervention applications.
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Affiliation(s)
- Ha Manh Luu
- AVITECH, University of Engineering and Technology, VNU, Hanoi, Vietnam.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.,FET, University of Engineering and Technology, VNU, Hanoi, Vietnam
| | - Theo van Walsum
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Daniel Franklin
- School of Electrical and Data Engineering, University of Technology Sydney, Sydney, Australia
| | - Phuong Cam Pham
- Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Luu Dang Vu
- Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Marius Staring
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xiem VanHoang
- FET, University of Engineering and Technology, VNU, Hanoi, Vietnam
| | - Wiro Niessen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Nguyen Linh Trung
- AVITECH, University of Engineering and Technology, VNU, Hanoi, Vietnam
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Marini TJ, Rubens DJ, Zhao YT, Weis J, O’Connor TP, Novak WH, Kaproth-Joslin KA. Lung Ultrasound: The Essentials. Radiol Cardiothorac Imaging 2021; 3:e200564. [PMID: 33969313 PMCID: PMC8098095 DOI: 10.1148/ryct.2021200564] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/16/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
Although US of the lungs is increasingly used clinically, diagnostic radiologists are not routinely trained in its use and interpretation. Lung US is a highly sensitive and specific modality that aids in the evaluation of the lungs for many different abnormalities, including pneumonia, pleural effusion, pulmonary edema, and pneumothorax. This review provides an overview of lung US to equip the diagnostic radiologist with knowledge needed to interpret this increasingly used modality. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Thomas J. Marini
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Deborah J. Rubens
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Yu T. Zhao
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Justin Weis
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Timothy P. O’Connor
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - William H. Novak
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
| | - Katherine A. Kaproth-Joslin
- From the Departments of Imaging Sciences (T.J.M., D.J.R., Y.T.Z., K.A.K.J.), Medicine (J.W., W.H.N.), and Emergency Medicine (T.P.O.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642
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Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong PL, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AM. Medical imaging and nuclear medicine: a Lancet Oncology Commission. Lancet Oncol 2021; 22:e136-e172. [PMID: 33676609 PMCID: PMC8444235 DOI: 10.1016/s1470-2045(20)30751-8] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.
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Affiliation(s)
- Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria; Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Diana Paez
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason S Lewis
- Department of Radiology and Molecular Pharmacology Programme, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Pharmacology and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Geraldine McGinty
- Departments of Radiology and Population Science, Weill Cornell Medical College, New York, NY, USA; American College of Radiology, Reston, VA, USA
| | - Wim J G Oyen
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lawrence N Shulman
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Merton DA, Nair S, Gaev JA. Remote Evaluation of a Wireless Ultrasound Probe. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320982892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether an evaluation of a wireless ultrasound transducer could be completed remotely. Materials and Methods: Video conferencing was used for communication between a sonographer and a minimally trained operator to allow evaluation of a flat linear array transducer that communicated via Wi-Fi with a smartphone and the probe vendor’s software. A tissue-mimicking phantom was used for quantitative testing, while scanning human models allowed qualitative assessments. Video conferencing using a tablet camera directed at the smartphone screen or transducer allowed the sonographer to view images, and guide the operator on probe positioning, and image optimization techniques. Results: All tests were completed during three 60-minute video conferences. Assessments of models were more challenging than tests using the phantom. The glare from ambient lighting sometimes made it difficult to view the smartphone screen. A connectivity limitation, which has since been resolved, prevented simultaneous use of video conferencing and the transducer software on the smartphone. Conclusion: This study confirmed that an evaluation of a wireless ultrasound transducer can be successfully performed remotely.
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