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Rudisill KE, Mathur N, Kalyanpur A. A teleradiology network for the improvement of healthcare and patient management in the developing countries of the African continent. Clin Imaging 2024; 111:110188. [PMID: 38759600 DOI: 10.1016/j.clinimag.2024.110188] [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: 08/21/2023] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Africa is the second-largest continent on Earth in terms of both size and population. However, inaccessibility and shortfall of trained radiologists impede the delivery of adequate healthcare to such a large population. Teleradiology holds considerable potential in improving patient outcomes and healthcare delivery in African nations by furnishing timely interpretation of radiological examinations, particularly in those areas where there is a particular scarcity of radiologists. The aim of the present study was to assess the impact of teleradiology in the improvement of healthcare and patient management in the developing countries of the African continent. METHODS In this retrospective study, from January 2017 and December 2022, the scans of a cohort of patients from eight African countries were uploaded to the teleradiology cloud server and interpreted by board certified radiologists empanelled by a teleradiology service provider. RESULTS The telehealth model proposed in the study was seen to provide timely and quality reporting of 58,223 scans of 39,513 patients with a mean turn-around-time (TAT) of 2.46 h 95 % CI (2.44-2.48). DISCUSSION A dedicated teleradiology model designed in this study allowed the interpretation and analysis of the scans of the cohort of patients from hospitals in African countries by teleradiologists via high quality DICOM-image transfer over a cloud-based platform. The outcomes of our investigation reflect that teleradiology provides an effective solution for early diagnosis/interpretation of examinations performed in Africa. Further, the currently proposed teleradiology model may be used for other developing countries across the world to improve quality of care.
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Affiliation(s)
- Katelyn E Rudisill
- Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA.
| | - Neetika Mathur
- Image Core Lab, Plot No. 7G, Opposite Graphite India, Whitefield, Bengaluru, Karnataka 560048, India.
| | - Arjun Kalyanpur
- Teleradiology Solutions, Plot No. 7G, Opposite Graphite India, Whitefield, Bengaluru, Karnataka 560048, India.
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Chai Y, Boudali AM, Veltman ES, Farey JE, Walter WL. Evaluating pelvic tilt using the pelvic antero-posterior radiographs: A novel method. J Orthop Res 2024. [PMID: 38814154 DOI: 10.1002/jor.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/12/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
Pelvic tilt (PT) is an important parameter for orthopedic surgeries involving hip and spine, typically determined from sagittal pelvic radiographs. However, various challenges can compromise the feasibility of measurement from sagittal imaging, including obscured landmarks, anatomical variations, hardware interference, and limited medical resources. Addressing these challenges and with the aim of reducing radiation exposure to patients, our study developed a novel method to estimate PT from antero-posterior (AP) radiographs, using vertical distances from the pelvic outlet and obturator foramen. We correlated these measurements with PT, defined both anatomically (anterior pelvic plane, PTa) and mechanically (centers of femoral heads and sacral plate, PTm). The study explored creating linear, exponential, and multivariate regression models based on twelve 3D CT-derived pelvic models (six men, six women), simulating AP radiograph projections with controlled PTs. We then validated these models against 105 pairs of patient stereoradiographs. Statistical analysis revealed that combined exponential-linear models yielded the most accurate results, with Pearson correlation coefficients of 0.75 for PTa and 0.77 for PTm, and mean absolute errors of 3.7° ± 2.6° for PTa and 4.5° ± 3.4° for PTm, showing excellent measurement reliability (all ICCs > 0.9) without significant gender discrepancies. In conclusion, this study presents a validated, simple, and accessible method for estimating PT using AP radiograph parameters, supported by the Supporting Information S1: Excel Tool, showing great potential for clinical application in hip and spine procedures.
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Affiliation(s)
- Yuan Chai
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute of Future Health, South China University of Technology, Guangzhou, China
| | - A Mounir Boudali
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ewout S Veltman
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - John E Farey
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - William L Walter
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Munyangaju I, José B, Esmail R, Palmer M, Santiago B, Hernanz-Lobo A, Mutemba C, Perez P, Tlhapi LH, Mudaly V, Pitcher RD, Jahnen A, Carruana EV, López-Varela E, Thierry-Chef I. Evaluation of radiological capacity and usage in paediatric TB diagnosis: A mixed-method protocol of a comparative study in Mozambique, South Africa and Spain. PLoS One 2024; 19:e0299293. [PMID: 38635846 PMCID: PMC11025952 DOI: 10.1371/journal.pone.0299293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Tuberculosis remains one of the top ten causes of mortality globally. Children accounted for 12% of all TB cases and 18% of all TB deaths in 2022. Paediatric TB is difficult to diagnose with conventional laboratory tests, and chest radiographs remain crucial. However, in low-and middle-income countries with high TB burden, the capacity for radiological diagnosis of paediatric TB is rarely documented and data on the associated radiation exposure limited. METHODS A multicentre, mixed-methods study is proposed in three countries, Mozambique, South Africa and Spain. At the national level, official registry databases will be utilised to retrospectively compile an inventory of licensed imaging resources (mainly X-ray and Computed Tomography (CT) scan equipment) for the year 2021. At the selected health facility level, three descriptive cross-sectional standardised surveys will be conducted to assess radiology capacity, radiological imaging diagnostic use for paediatric TB diagnosis, and radiation protection optimization: a site survey, a clinician-targeted survey, and a radiology staff-targeted survey, respectively. At the patient level, potential dose optimisation will be assessed for children under 16 years of age who were diagnosed and treated for TB in selected sites in each country. For this component, a retrospective analysis of dosimetry will be performed on TB and radiology data routinely collected at the respective sites. National inventory data will be presented as the number of units per million people by modality, region and country. Descriptive analyses will be conducted on survey data, including the demographic, clinical and programmatic characteristics of children treated for TB who had imaging examinations (chest X-ray (CXR) and/or CT scan). Dose exposure analysis will be performed by children's age, gender and disease spectrum. DISCUSSION As far as we know, this is the first multicentre and multi-national study to compare radiological capacity, radiation protection optimization and practices between high and low TB burden settings in the context of childhood TB management. The planned comparative analyses will inform policy-makers of existing radiological capacity and deficiencies, allowing better resource prioritisation. It will inform clinicians and radiologists on best practices and means to optimise the use of radiological technology in paediatric TB management.
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Affiliation(s)
- Isabelle Munyangaju
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Benedita José
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Ridwaan Esmail
- Imaging Division, Ministry of Health, Maputo, Mozambique
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Begoña Santiago
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
| | - Alicia Hernanz-Lobo
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Crimenia Mutemba
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Patricia Perez
- National Paediatric TB Working Group, Maputo, Mozambique
| | | | - Vanessa Mudaly
- Service Priorities Coordination (SPC) Directorate, Department of Health, Western Cape, South Africa
| | - Richard D. Pitcher
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andreas Jahnen
- ITIS Department, Luxembourg Institute of Science and Technology, Luxembourg
| | - Eliseo Vañó Carruana
- Department of Radiology, Faculty of Medicine of the Complutense University, Madrid, Spain
| | - Elisa López-Varela
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Smith CB, Marapese KD, Charles AG. Management of acute appendicitis in low- and middle-income countries. Curr Probl Surg 2024; 61:101444. [PMID: 38548428 DOI: 10.1016/j.cpsurg.2024.101444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 04/02/2024]
Affiliation(s)
| | | | - Anthony G Charles
- School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Adjei ANA, Donkor A, Wiafe YA, Anyitey-Kokor IC, Hyde E. Elements of person-centred diagnostic imaging care in low-and middle-income countries: A systematic review. Radiography (Lond) 2024; 30:394-407. [PMID: 38176130 DOI: 10.1016/j.radi.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Diagnostic imaging professionals are trained to deliver safe and high-quality person-centred radiographic diagnostic imaging care. The term person-centred care has been described as a confused concept without a unified definition. This systematic review identified the elements that have been used to measure person-centred care in diagnostic imaging in low- and middle-income countries (LMICs). METHODS A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Embase, MEDLINE and Cochrane library were searched. Bias was assessed using the Critical Appraisal Skill Programme and Mixed Method Appraisal Tool. A narrative synthesis guided by the Picker Principles of person-centred care was undertaken. RESULTS Of the 4482 articles identified, 26 articles were included. The studies were from 12 LMICs. Synthesis of the literature generated six themes, namely access to high quality and safe diagnostic imaging care, effective communication and shared diagnostic imaging decision making, suitable diagnostic imaging environment for physical comfort, respectful and compassionate diagnostic radiographers, effective coordination of diagnostic imaging care process, and family and friends' involvement in diagnostic imaging care. CONCLUSION Medical imaging facilities in most LMICs continue to struggle with issues of access, safety, quality, and responsiveness to the needs of patients. The need for innovative person-centred diagnostic imaging care interventions in LMICs has become urgent. IMPLICATIONS FOR PRACTICE If diagnostic imaging services in LMICs are to move beyond the current models of limited person-centred access to care, a greater focus on systems thinking is required. It is imperative to involve all stakeholders, not only patients and radiographers, but also policymakers whose works impact on equitable access to diagnostic imaging services.
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Affiliation(s)
- A N A Adjei
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - A Donkor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; IMPACCT, Faculty of Health, University of Technology Sydney, Australia.
| | - Y A Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - I C Anyitey-Kokor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - E Hyde
- Provost for Learning & Teaching, University of Derby, United Kingdom.
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Khaledyan D, Marini TJ, M. Baran T, O’Connell A, Parker K. Enhancing breast ultrasound segmentation through fine-tuning and optimization techniques: Sharp attention UNet. PLoS One 2023; 18:e0289195. [PMID: 38091358 PMCID: PMC10718429 DOI: 10.1371/journal.pone.0289195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/03/2023] [Indexed: 12/18/2023] Open
Abstract
Segmentation of breast ultrasound images is a crucial and challenging task in computer-aided diagnosis systems. Accurately segmenting masses in benign and malignant cases and identifying regions with no mass is a primary objective in breast ultrasound image segmentation. Deep learning (DL) has emerged as a powerful tool in medical image segmentation, revolutionizing how medical professionals analyze and interpret complex imaging data. The UNet architecture is a highly regarded and widely used DL model in medical image segmentation. Its distinctive architectural design and exceptional performance have made it popular among researchers. With the increase in data and model complexity, optimization and fine-tuning models play a vital and more challenging role than before. This paper presents a comparative study evaluating the effect of image preprocessing and different optimization techniques and the importance of fine-tuning different UNet segmentation models for breast ultrasound images. Optimization and fine-tuning techniques have been applied to enhance the performance of UNet, Sharp UNet, and Attention UNet. Building upon this progress, we designed a novel approach by combining Sharp UNet and Attention UNet, known as Sharp Attention UNet. Our analysis yielded the following quantitative evaluation metrics for the Sharp Attention UNet: the Dice coefficient, specificity, sensitivity, and F1 score values obtained were 0.93, 0.99, 0.94, and 0.94, respectively. In addition, McNemar's statistical test was applied to assess significant differences between the approaches. Across a number of measures, our proposed model outperformed all other models, resulting in improved breast lesion segmentation.
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Affiliation(s)
- Donya Khaledyan
- Department of Electrical and Electronics Engineering, University of Rochester, Rochester, NY, United States of America
| | - Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Timothy M. Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Avice O’Connell
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Kevin Parker
- Department of Electrical and Electronics Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
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Miranda-Schaeubinger M, Venkatakrishna SSB, Otero HJ, Marais BJ, Goussard P, Frigati LJ, Zar HJ, Andronikou S. Evolving role of chest radiographs for diagnosis of pediatric pulmonary tuberculosis. Pediatr Radiol 2023; 53:1753-1764. [PMID: 37069395 DOI: 10.1007/s00247-023-05652-3] [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: 11/18/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
Chest radiographs (CXR) have played an important and evolving role in diagnosis, classification and management of pediatric pulmonary tuberculosis (TB). During the pre-chemotherapy era, CXR aided in determining infectiousness, mainly to guide isolation practices, by detecting calcified and non-calcified lymphadenopathy. The availability of TB chemotherapy from the mid-1900s increased the urgency to find accurate diagnostic tools for what had become a treatable disease. Chest radiographs provided the mainstay of diagnosis in children, despite high inter-reader variability limiting its accuracy. The development of cross-sectional imaging modalities, such as computed tomography, provided more accurate intra-thoracic lymph node assessment, but these modalities have major availability, cost and radiation exposure disadvantages. As a consequence, CXR remains the most widely used modality for childhood pulmonary TB diagnosis, given its relatively low cost and accessibility. Publication of the revised 2022 World Health Organization Consolidated TB guidelines added practical value to CXR interpretation in children, by allowing the selection of children for shorter TB treatment using radiological signs of severity of disease, that have high reliability. This article provides a review of the historical journey and evolving role of CXR in pediatric pulmonary TB.
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Affiliation(s)
- Monica Miranda-Schaeubinger
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | | | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ben J Marais
- The University of Sydney, Sydney, Australia
- Centre for Research Excellence in Tuberculosis (TB-CRE), Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Tygerberg Hospital, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lisa J Frigati
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Tygerberg Hospital, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross Children's Hospital and SA-MRC Unit On Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Khaledyan D, Marini TJ, O’Connell A, Parker K. Enhancing Breast Ultrasound Segmentation through Fine-tuning and Optimization Techniques: Sharp Attention UNet. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.14.549040. [PMID: 37503223 PMCID: PMC10370074 DOI: 10.1101/2023.07.14.549040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Segmentation of breast ultrasound images is a crucial and challenging task in computer-aided diagnosis systems. Accurately segmenting masses in benign and malignant cases and identifying regions with no mass is a primary objective in breast ultrasound image segmentation. Deep learning (DL) has emerged as a powerful tool in medical image segmentation, revolutionizing how medical professionals analyze and interpret complex imaging data. The UNet architecture is a highly regarded and widely used DL model in medical image segmentation. Its distinctive architectural design and exceptional performance have made it a popular choice among researchers in the medical image segmentation field. With the increase in data and model complexity, optimization and fine-tuning models play a vital and more challenging role than before. This paper presents a comparative study evaluating the effect of image preprocessing and different optimization techniques and the importance of fine-tuning different UNet segmentation models for breast ultrasound images. Optimization and fine-tuning techniques have been applied to enhance the performance of UNet, Sharp UNet, and Attention UNet. Building upon this progress, we designed a novel approach by combining Sharp UNet and Attention UNet, known as Sharp Attention UNet. Our analysis yielded the following quantitative evaluation metrics for the Sharp Attention UNet: the dice coefficient, specificity, sensitivity, and F1 score obtained values of 0.9283, 0.9936, 0.9426, and 0.9412, respectively. In addition, McNemar's statistical test was applied to assess significant differences between the approaches. Across a number of measures, our proposed model outperforms the earlier designed models and points towards improved breast lesion segmentation algorithms.
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Affiliation(s)
- Donya Khaledyan
- Department of Electrical and Electronics Engineering, University of Rochester, Rochester, NY, USA
| | - Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Avice O’Connell
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Parker
- Department of Electrical and Electronics Engineering, University of Rochester, Rochester, NY, USA
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Watermeyer G, Katsidzira L, Nsokolo B, Isaac Alatise O, Duduyemi BM, Kassianides C, Hodges P. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective. Therap Adv Gastroenterol 2023; 16:17562848231184986. [PMID: 37457138 PMCID: PMC10345935 DOI: 10.1177/17562848231184986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.
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Affiliation(s)
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bright Nsokolo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olusegun Isaac Alatise
- Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Babatunde M. Duduyemi
- Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Phoebe Hodges
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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Karamian BA, Schroeder GD, Lambrechts MJ, Canseco JA, Vialle EN, Kandziora F, Benneker LM, Shanmuganathan R, Öner FC, Schnake KJ, Kepler CK, Vaccaro AR. Validation of the Hierarchical Nature of the AO Spine Sacral Classification and the Development of the Sacral AO Spine Injury Score. Clin Spine Surg 2023; 36:E239-E246. [PMID: 36864585 PMCID: PMC10284127 DOI: 10.1097/bsd.0000000000001437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/01/2022] [Indexed: 03/04/2023]
Abstract
STUDY DESIGN Global cross-sectional survey. OBJECTIVE The objective of this study was to validate the hierarchical nature of the AO Spine Sacral Classification System and develop an injury scoring system. SUMMARY OF BACKGROUND DATA Although substantial interobserver and intraobserver reliability of the AO Spine Sacral Classification System has been established, the hierarchical nature of the classification has yet to be validated. METHODS Respondents numerically graded each variable within the classification system for severity. Based on the results, a Sacral AO Spine Injury Score (AOSIS) was developed. RESULTS A total of 142 responses were received. The classification exhibited a hierarchical Injury Severity Score (ISS) progression (A1: 8 to C3: 95) with few exceptions. Subtypes B1 and B2 fractures showed no significant difference in ISS (B1 43.9 vs. B2 43.4, P =0.362). In addition, the transitions A3→B1 and B3→C0 represent significant decreases in ISS (A3 66.3 vs. B1 43.9, P <0.001; B3 64.2 vs. C0 46.4, P <0.001). Accordingly, A1 injury was assigned a score of 0. A2 and A3 received scores of 1 and 3 points, respectively. Posterior pelvic injuries B1 and B2 both received a score of 2. B3 received a score of 3 points. C0, C1, C2, and C3 received scores of 2, 3, 5, and 6 points, respectively. The scores assigned to neurological modifiers N0, N1, N2, N3, and NX were 0, 1, 2, 4, and 3, respectively. Case-specific modifiers M1, M2, M3, and M4 received scores of 0, 0, 1, and 2 points, respectively. CONCLUSIONS The results of this study validate the hierarchical nature of the AO Spine Sacral Classification System. The Sacral AOSIS sets the foundation for further studies to develop a universally accepted treatment algorithm for the treatment of complex sacral injuries. LEVEL OF EVIDENCE Level IV-Diagnostic.
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Affiliation(s)
| | | | | | - Jose A. Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Emiliano N. Vialle
- Department of Orthopaedics, Catholic University of Parana, Curitiba, Brazil
| | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Lorin M. Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
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Khan SZ, Lengyel CG. Challenges in the management of colorectal cancer in low- and middle-income countries. Cancer Treat Res Commun 2023; 35:100705. [PMID: 37060879 DOI: 10.1016/j.ctarc.2023.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/05/2023] [Accepted: 04/01/2023] [Indexed: 04/17/2023]
Abstract
AIM This narrative review aims to describe colorectal cancer (CRC) management landscape in low- and middle-income countries (LMICs), presenting the most recent and relevant papers on the topic. As a secondary aim, the authors suggest new ways of improving CRC patient care in LMICs. BACKGROUND Several studies show that the incidence of colon cancer in low- and middle-income countries (LMICs) is rising. In addition to the increasing incidence, lack of early detection and impeded access to optimal multidisciplinary treatment may worsen survival outcomes. CONCLUSION Developing quality diagnostic services in the proper health context is crucial for early diagnosis and successful therapy of CRC patients, and applying a resource-sensitive approach to prioritize essential treatments based on effectiveness and cost-effectiveness is key to overcoming barriers in LMICs, with clinical research collaborations between high-income countries (HICs) and LMICs being a helpful strategy to improve health indicators and prevent the burnout of health workers.
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Affiliation(s)
- Shah Zeb Khan
- Department of Clinical Oncology, Bannu Institute of Nuclear Medicine Oncology and Radiotherapy (BINOR), Bannu, Khyber Pakhtunkhwa, Pakistan.
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Marini TJ, Castaneda B, Satheesh M, Zhao YT, Reátegui-Rivera CM, Sifuentes W, Baran TM, Kaproth-Joslin KA, Ambrosini R, Rios-Mayhua G, Dozier AM. Sustainable volume sweep imaging lung teleultrasound in Peru: Public health perspectives from a new frontier in expanding access to imaging. FRONTIERS IN HEALTH SERVICES 2023; 3:1002208. [PMID: 37077694 PMCID: PMC10106710 DOI: 10.3389/frhs.2023.1002208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
BackgroundPulmonary disease is a common cause of morbidity and mortality, but the majority of the people in the world lack access to diagnostic imaging for its assessment. We conducted an implementation assessment of a potentially sustainable and cost-effective model for delivery of volume sweep imaging (VSI) lung teleultrasound in Peru. This model allows image acquisition by individuals without prior ultrasound experience after only a few hours of training.MethodsLung teleultrasound was implemented at 5 sites in rural Peru after a few hours of installation and staff training. Patients were offered free lung VSI teleultrasound examination for concerns of respiratory illness or research purposes. After ultrasound examination, patients were surveyed regarding their experience. Health staff and members of the implementation team also participated in separate interviews detailing their views of the teleultrasound system which were systematically analyzed for key themes.ResultsPatients and staff rated their experience with lung teleultrasound as overwhelmingly positive. The lung teleultrasound system was viewed as a potential way to improve access to imaging and the health of rural communities. Detailed interviews with the implementation team revealed obstacles to implementation important for consideration such as gaps in lung ultrasound understanding.ConclusionsLung VSI teleultrasound was successfully deployed to 5 health centers in rural Peru. Implementation assessment revealed enthusiasm for the system among members of the community along with important areas of consideration for future teleultrasound deployment. This system offers a potential means to increase access to imaging for pulmonary illness and improve the health of the global community.
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Affiliation(s)
- Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Correspondence: Thomas J. Marini
| | - Benjamin Castaneda
- Departamento de Ingeniería, Laboratorio de Imágenes Médicas, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Malavika Satheesh
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Yu T. Zhao
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | | | | | - Timothy M. Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Robert Ambrosini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Ann M. Dozier
- Department of Public Health, University of Rochester Medical Center, Rochester, NY, United States
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Marini TJ, Castaneda B, Iyer R, Baran TM, Nemer O, Dozier AM, Parker KJ, Zhao Y, Serratelli W, Matos G, Ali S, Ghobryal B, Visca A, O'Connell A. Breast Ultrasound Volume Sweep Imaging: A New Horizon in Expanding Imaging Access for Breast Cancer Detection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:817-832. [PMID: 35802491 DOI: 10.1002/jum.16047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The majority of people in the world lack basic access to breast diagnostic imaging resulting in delay to diagnosis of breast cancer. In this study, we tested a volume sweep imaging (VSI) ultrasound protocol for evaluation of palpable breast lumps that can be performed by operators after minimal training without prior ultrasound experience as a means to increase accessibility to breast ultrasound. METHODS Medical students without prior ultrasound experience were trained for less than 2 hours on the VSI breast ultrasound protocol. Patients presenting with palpable breast lumps for standard of care ultrasound examination were scanned by a trained medical student with the VSI protocol using a Butterfly iQ handheld ultrasound probe. Video clips of the VSI scan imaging were later interpreted by an attending breast imager. Results of VSI scan interpretation were compared to the same-day standard of care ultrasound examination. RESULTS Medical students scanned 170 palpable lumps with the VSI protocol. There was 97% sensitivity and 100% specificity for a breast mass on VSI corresponding to 97.6% agreement with standard of care (Cohen's κ = 0.95, P < .0001). There was a detection rate of 100% for all cancer presenting as a sonographic mass. High agreement for mass characteristics between VSI and standard of care was observed, including 87% agreement on Breast Imaging-Reporting and Data System assessments (Cohen's κ = 0.82, P < .0001). CONCLUSIONS Breast ultrasound VSI for palpable lumps offers a promising means to increase access to diagnostic imaging in underserved areas. This approach could decrease delay to diagnosis for breast cancer, potentially improving morbidity and mortality.
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Affiliation(s)
| | | | - Radha Iyer
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Omar Nemer
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ann M Dozier
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin J Parker
- University of Rochester Medical Center, Rochester, NY, USA
| | - Yu Zhao
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gregory Matos
- University of Rochester Medical Center, Rochester, NY, USA
| | - Shania Ali
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Adam Visca
- University of Rochester Medical Center, Rochester, NY, USA
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Liu A, Ma Y, Yin L, Zhu Y, Lu H, Li H, Ye Z. Comparison of malignant calcification identification between breast cone-beam computed tomography and digital mammography. Acta Radiol 2023; 64:962-970. [PMID: 35815702 DOI: 10.1177/02841851221112562] [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: 11/15/2022]
Abstract
BACKGROUND Calcifications are important abnormal findings in breast imaging and help in the diagnosis of breast cancer. PURPOSE To compare breast cone-beam computed tomography (CBCT) with digital mammography (DM) in terms of the ability to identify malignant calcifications. MATERIAL AND METHODS In total, 115 paired examinations were performed utilizing breast CBCT and DM; 86 pathology-proven malignant lesions with calcifications detected on DM and 29 randomly selected breasts without calcifications were reviewed by three radiologists. The ability to detect calcifications was assessed on CBCT images. The characterization agreement of two imaging modalities was evaluated by the kappa coefficient. For breast CBCT images, the parameters for the display of calcifications were recorded. The Kruskal-Wallis test was used to compare the preferred slice thickness chosen by each of the three radiologists. The degree of calcification clarity was compared between two modalities using the Mann-Whitney U-test. RESULTS The combined sensitivity and specificity of three radiologists in 85 DM-detected calcifications detection on breast CBCT images were 98.43% (251/255) and 98.85% (86/87), respectively. CBCT images showed substantial agreement with mammograms in terms of the characterization of calcifications morphology (k = 0.703; P < 0.05) and distribution (k = 0.629; P < 0.05). CBCT images with a slice thickness of 0.273 mm and three-dimensional maximum-intensity projection (3D-MIP) were more beneficial for calcifications identification. No statistically significant difference was found between standard DM views and CBCT images for three radiologists on calcification display clarity. CONCLUSION CBCT images were comparable to mammograms in calcification identification and may be sufficient for malignant calcifications detection and characterization.
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Affiliation(s)
- Aidi Liu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yue Ma
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Lu Yin
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yueqiang Zhu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Hong Lu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Haijie Li
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Zhaoxiang Ye
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
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Marini TJ, Castaneda B, Parker K, Baran TM, Romero S, Iyer R, Zhao YT, Hah Z, Park MH, Brennan G, Kan J, Meng S, Dozier A, O’Connell A. No sonographer, no radiologist: Assessing accuracy of artificial intelligence on breast ultrasound volume sweep imaging scans. PLOS DIGITAL HEALTH 2022; 1:e0000148. [PMID: 36812553 PMCID: PMC9931251 DOI: 10.1371/journal.pdig.0000148] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/21/2022] [Indexed: 05/12/2023]
Abstract
Breast ultrasound provides a first-line evaluation for breast masses, but the majority of the world lacks access to any form of diagnostic imaging. In this pilot study, we assessed the combination of artificial intelligence (Samsung S-Detect for Breast) with volume sweep imaging (VSI) ultrasound scans to evaluate the possibility of inexpensive, fully automated breast ultrasound acquisition and preliminary interpretation without an experienced sonographer or radiologist. This study was conducted using examinations from a curated data set from a previously published clinical study of breast VSI. Examinations in this data set were obtained by medical students without prior ultrasound experience who performed VSI using a portable Butterfly iQ ultrasound probe. Standard of care ultrasound exams were performed concurrently by an experienced sonographer using a high-end ultrasound machine. Expert-selected VSI images and standard of care images were input into S-Detect which output mass features and classification as "possibly benign" and "possibly malignant." Subsequent comparison of the S-Detect VSI report was made between 1) the standard of care ultrasound report by an expert radiologist, 2) the standard of care ultrasound S-Detect report, 3) the VSI report by an expert radiologist, and 4) the pathological diagnosis. There were 115 masses analyzed by S-Detect from the curated data set. There was substantial agreement of the S-Detect interpretation of VSI among cancers, cysts, fibroadenomas, and lipomas to the expert standard of care ultrasound report (Cohen's κ = 0.73 (0.57-0.9 95% CI), p<0.0001), the standard of care ultrasound S-Detect interpretation (Cohen's κ = 0.79 (0.65-0.94 95% CI), p<0.0001), the expert VSI ultrasound report (Cohen's κ = 0.73 (0.57-0.9 95% CI), p<0.0001), and the pathological diagnosis (Cohen's κ = 0.80 (0.64-0.95 95% CI), p<0.0001). All pathologically proven cancers (n = 20) were designated as "possibly malignant" by S-Detect with a sensitivity of 100% and specificity of 86%. Integration of artificial intelligence and VSI could allow both acquisition and interpretation of ultrasound images without a sonographer and radiologist. This approach holds potential for increasing access to ultrasound imaging and therefore improving outcomes related to breast cancer in low- and middle- income countries.
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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
- * E-mail:
| | - Benjamin Castaneda
- Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Kevin Parker
- 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
| | - Stefano Romero
- Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Radha Iyer
- 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
| | - Zaegyoo Hah
- Samsung Medison Co., Ltd., Seoul, Republic of Korea
| | - Moon Ho Park
- Samsung Electronics Co., Ltd., Seoul, Republic of Korea
| | - Galen Brennan
- 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
| | - Steven Meng
- 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
| | - Avice O’Connell
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
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16
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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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Baloescu C, Parhar A, Liu R, Wanjiku GW. Effect of Point-of-Care Ultrasound on Clinical Outcomes in Low-Resource Settings: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1711-1719. [PMID: 35786524 DOI: 10.1016/j.ultrasmedbio.2022.04.221] [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: 10/28/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Despite the potential for improved patient care, little is known of the true effect of point-of-care ultrasound (POCUS) on patient outcomes in resource-limited settings. Electronic databases were searched using medical subject heading and free text terms related to POCUS and resource-limited settings through August 2020. Two authors independently selected studies, assessed methodological quality using the Downs and Black scale and extracted data. Twenty observational studies were included in the final review. All studies had moderate to high risk of bias. No studies exhibited an effect on the pre-specified primary outcome of mortality. Varying degrees of change in differential diagnosis and management were reported, but definitions varied widely among studies. Estimates for change in diagnosis as a result of POCUS ranged from 15% to 52%, and those for change in management, from 17% to 87%. Articles on POCUS clinical utility represent a small part (4.6%) of the scholastic literature dedicated to POCUS in low-resource settings. POCUS is a valuable intervention to consider in resource-limited settings, with the potential to change diagnosis and patient management. The exact magnitude of effect remains unknown. There is a continued need for large-scale experimental studies to investigate the effect of POCUS on patient diagnosis, management and mortality.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Arya Parhar
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Rachel Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace W Wanjiku
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Dunning H, Zadutsa B, Kainja E, Colbourn T, McCollum ED, Makwenda C, Wells J, Grijalva-Eternod CS, King C. Bioelectrical impedance vector analysis as an indicator of malnutrition in children under five years with and without pneumonia in Mchinji District, Malawi: An exploratory mixed-methods analysis. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13655.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Bioelectrical impedance vector analysis (BIVA) is a non-invasive assessment of body composition and cellular health, which may improve the assessment of nutritional status in sick children. We explored the reliability, clinical utility, and acceptability of BIVA, as an indicator of nutritional status for children under five years with and without pneumonia, in Malawi. Methods: We conducted a parallel convergent mixed-methods exploratory study in Mchinji District Hospital, Malawi, in 2017. We planned to recruit a convenience sample of children aged 0-59 months with clinical pneumonia, and without an acute illness. Children had duplicate anthropometric and BIVA measurements taken. BIVA measurements of phase angle (PA) were taken of the whole body, and trunk and arm segments. Reliability was assessed by comparing the variability in the two measures, and clinical utility by estimating the association between anthropometry and PA using linear regression. Focus group discussions with healthcare workers who had not previously used BIVA instrumentation were conducted to explore acceptability. Results: A total of 52 children (24 with pneumonia and 28 healthy) were analysed. The reliability of sequential PA measurements was lower than anthropometric measurements, but trunk and arm segments performed better. The largest associations with PA were a negative relationship with weight-for-age z-score (WAZ) and PA in children with pneumonia in the trunk segment, and a positive association with WAZ in the full body measurement in healthy children. Healthcare workers in focus group discussions expressed trust in BIVA technology and that it would enable more accurate diagnosis of malnutrition; however, they raised concerns about the sustainability and necessary resources to implement BIVA. Conclusions: While healthcare workers were positive towards BIVA as a novel technology, implementation challenges should be expected. The differential direction of association between anthropometry and PA for children with pneumonia warrants further investigation.
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19
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Machine learning models to prognose 30-Day Mortality in Postoperative Disseminated Cancer Patients. Surg Oncol 2022; 44:101810. [DOI: 10.1016/j.suronc.2022.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
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Artificial Intelligence Accurately Detects Traumatic Thoracolumbar Fractures on Sagittal Radiographs. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080998. [PMID: 35893113 PMCID: PMC9330443 DOI: 10.3390/medicina58080998] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Commonly being the first step in trauma routine imaging, up to 67% fractures are missed on plain radiographs of the thoracolumbar (TL) spine. The aim of this study was to develop a deep learning model that detects traumatic fractures on sagittal radiographs of the TL spine. Identifying vertebral fractures in simple radiographic projections would have a significant clinical and financial impact, especially for low- and middle-income countries where computed tomography (CT) and magnetic resonance imaging (MRI) are not readily available and could help select patients that need second level imaging, thus improving the cost-effectiveness. Materials and Methods: Imaging studies (radiographs, CT, and/or MRI) of 151 patients were used. An expert group of three spinal surgeons reviewed all available images to confirm presence and type of fractures. In total, 630 single vertebra images were extracted from the sagittal radiographs of the 151 patients—302 exhibiting a vertebral body fracture, and 328 exhibiting no fracture. Following augmentation, these single vertebra images were used to train, validate, and comparatively test two deep learning convolutional neural network models, namely ResNet18 and VGG16. A heatmap analysis was then conducted to better understand the predictions of each model. Results: ResNet18 demonstrated a better performance, achieving higher sensitivity (91%), specificity (89%), and accuracy (88%) compared to VGG16 (90%, 83%, 86%). In 81% of the cases, the “warm zone” in the heatmaps correlated with the findings, suggestive of fracture within the vertebral body seen in the imaging studies. Vertebras T12 to L2 were the most frequently involved, accounting for 48% of the fractures. A4, A3, and A1 were the most frequent fracture types according to the AO Spine Classification. Conclusions: ResNet18 could accurately identify the traumatic vertebral fractures on the TL sagittal radiographs. In most cases, the model based its prediction on the same areas that human expert classifiers used to determine the presence of a fracture.
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Sellergren AB, Chen C, Nabulsi Z, Li Y, Maschinot A, Sarna A, Huang J, Lau C, Kalidindi SR, Etemadi M, Garcia-Vicente F, Melnick D, Liu Y, Eswaran K, Tse D, Beladia N, Krishnan D, Shetty S. Simplified Transfer Learning for Chest Radiography Models Using Less Data. Radiology 2022; 305:454-465. [DOI: 10.1148/radiol.212482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew B. Sellergren
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Christina Chen
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Zaid Nabulsi
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Yuanzhen Li
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Aaron Maschinot
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Aaron Sarna
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Jenny Huang
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Charles Lau
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Sreenivasa Raju Kalidindi
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Mozziyar Etemadi
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Florencia Garcia-Vicente
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - David Melnick
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Yun Liu
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Krish Eswaran
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Daniel Tse
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Neeral Beladia
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Dilip Krishnan
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
| | - Shravya Shetty
- From Google Health, Google, 3400 Hillview Ave, Palo Alto, CA 94304 (A.B.S., C.C., Z.N., Y. Liu, K.E., D.T., N.B., S.S.); Google Research, Cambridge, Mass (Y. Li, A.M., A.S., J.H., D.K.); Google via Advanced Clinical, Deerfield, Ill (C.L.); Apollo Radiology International, Hyderabad, India (S.R.K.); and Northwestern Medicine, Chicago, Ill (M.E., F.G.V., D.M.)
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22
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Manoyana A, Angkurawaranon S, Katib S, Wiwattanadittakul N, Sirikul W, Angkurawaranon C. Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches. CHILDREN 2022; 9:children9060863. [PMID: 35740800 PMCID: PMC9221978 DOI: 10.3390/children9060863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 01/23/2023]
Abstract
Introduction: Diagnosis of emergent intracranial lesions that require emergency treatment either medically or surgically in non-traumatic pediatric headaches is important. Red-flag signs and symptoms are commonly used as justification for neuroimaging; however, evidence on its diagnostic values is limited. The study aims to identify diagnostic values of red-flags and develop a clinical prediction score to help improve the diagnostic yield of neuroimaging. Methods: A retrospective review of 109 pediatric patients from 2006 to 2020 who presented with a non-traumatic headache was conducted. A clinical prediction score from red flags was developed using multivariate logistic regression. Discriminatory ability was examined using the area under the receiver operating characteristic curve. Results: A total of 51 patients were diagnosed with emergent intracranial lesions. Four potential clinical red flag predictors were identified: (1) acute onset (less than 3 months), (2) altered conscious state, (3) focal motor abnormality, and (4) and ocular/pupillary abnormality or squint. A clinical prediction score was developed with good discriminatory properties (0.84). Conclusions: Clinical predictor scores from these four red flags may play an important role in maximizing neuroimaging and proper management for pediatric patients with non-traumatic headaches. Future validation studies are needed and could guide referrals and optimize the use of neuroimaging for these patients.
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Affiliation(s)
- Atipat Manoyana
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (A.M.); (S.K.)
| | - Salita Angkurawaranon
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (A.M.); (S.K.)
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand;
- Correspondence:
| | - Sumintra Katib
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (A.M.); (S.K.)
| | | | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Chaisiri Angkurawaranon
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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23
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Navarro SM, Shaikh H, Abdi H, Keil EJ, Odusanya S, Stewart KA, Tuyishime E, Mazingi D, Tuttle TM. Surgical applications of ultrasound use in low‐ and
middle‐income
countries: A systematic review. Australas J Ultrasound Med 2022; 25:80-97. [DOI: 10.1002/ajum.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Hashim Shaikh
- Department of Orthopaedics University of Rochester 601 Elmwood Avenue Rochester NY 14642 USA
| | - Hodan Abdi
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Evan J. Keil
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Simisola Odusanya
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Kelsey A. Stewart
- Department of Anaesthesia, Critical Care, and Emergency Medicine University of Rwanda KN 4 Ave Kigali Rwanda
| | - Eugene Tuyishime
- Department of Anaesthesia University of Toronto 123 Edward Street Toronto ON M5G 1E2 Canada
- Department of Obstetrics and Gyenecology University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Dennis Mazingi
- Department of Surgery University of Zimbabwe Mazowe Street A168 Harare Zimbabwe
| | - Todd M. Tuttle
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
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24
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Watermeyer G, Katsidzira L, Setshedi M, Devani S, Mudombi W, Kassianides C. Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis. Lancet Gastroenterol Hepatol 2022; 7:952-961. [DOI: 10.1016/s2468-1253(22)00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
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25
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Urva M, Challa ST, Haonga BT, Eliezer E, Working ZM, El Naga A, Morshed S, Shearer DW. Reliability of Modified Radiographic Union Score for Tibia Scores in the Evaluation of Femoral Shaft Fractures in a Low-resource Setting. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00011. [PMID: 35605095 PMCID: PMC9126518 DOI: 10.5435/jaaosglobal-d-21-00211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/15/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The modified Radiographic Union Score for Tibia (RUST) fractures was developed to better describe fracture healing, but its utility in resource-limited settings is poorly understood. This study aimed to determine the validity of mRUST scores in evaluating fracture healing in diaphyseal femur fractures treated operatively at a single tertiary referral hospital in Tanzania. METHODS Radiographs of 297 fractures were evaluated using the mRUST score and compared with outcomes including revision surgery and EuroQol five dimensions questionnaire (EQ-5D) and visual analog scale (VAS) quality-of-life measures. Convergent validity was assessed by correlating mRUST scores with EQ-5D and VAS scores. Divergent validity was assessed by comparing mRUST scores in patients based on revision surgery status. RESULTS The mRUST score had moderate correlation (Spearman correlation coefficient 0.40) with EQ-5D scores and weak correlation (Spearman correlation coefficient 0.320) with VAS scores. Compared with patients who required revision surgery, patients who did not require revision surgery had higher RUST scores at all time points, with statistically significant differences at 3 months (2.02, P < 0.05). DISCUSSION These results demonstrate that the mRUST score is a valid method of evaluating the healing of femoral shaft fractures in resource-limited settings, with high interrater reliability, correlation with widely used quality of life measures (EQ-5D and VAS), and expected divergence in the setting of complications requiring revision surgery.
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26
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Meidani Z, Atoof F, Mobarak Z, Nabovati E, Daneshvar Kakhki R, Kouchaki E, Fakharian E, Nickfarjam AM, Holl F. Development of clinical-guideline-based mobile application and its effect on head CT scan utilization in neurology and neurosurgery departments. BMC Med Inform Decis Mak 2022; 22:106. [PMID: 35443649 PMCID: PMC9020029 DOI: 10.1186/s12911-022-01844-3] [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: 11/09/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is little evidence regarding the adoption and intention of using mobile apps by health care professionals (HCP) and the effectiveness of using mobile apps among physicians is still unclear. To address this challenge, the current study seeks two objectives: developing and implementing a head CT scan appropriateness criteria mobile app (HAC app), and investigating the effect of HAC app on CT scan order.
Methods A one arm intervention quasi experimental study with before/after analysis was conducted in neurology & neurosurgery (N&N) departments at the academic hospital. We recruited all residents' encounters to N&N departments with head CT scan to examine the effect of HAC app on residents' CT scan utilization. The main outcome measure was CT scan order per patient for seven months at three points, before the intervention, during the intervention, after cessation of the intervention -post-intervention follow-up. Data for CT scan utilization were collected by reviewing medical records and then analyzed using descriptive statistics, Kruskal-Wallis, and Mann-Whitney tests. A focus group discussion with residents was performed to review and digest residents' experiences during interaction with the HAC app. Results Sixteen residents participated in this study; a total of 415 N&N encounters with CT scan order, pre-intervention 127 (30.6%), intervention phase 187 (45.1%), and 101 (24.3%) in the post-intervention follow-up phase were included in this study. Although total CT scan utilization was statistically significant during three-time points of the study (P = 0.027), no significant differences were found for CT utilization after cessation of the intervention (P = 1). Conclusion The effect of mobile devices on residents' CT scan ordering behavior remains open to debate since the changes were not long-lasting. Further studies based on real interactive experiences with mobile devices is advisable before it can be recommended for widespread use by HCP.
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Affiliation(s)
- Zahra Meidani
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran. .,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Fatemeh Atoof
- Department of Biostatistics & Epidemiology, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohre Mobarak
- Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Daneshvar Kakhki
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ebrahim Kouchaki
- Department of Neurology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, University of Munich, Munich, Germany
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27
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Medical physics services in radiology and nuclear medicine in Africa: challenges and opportunities identified through workforce and infrastructure surveys. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00663-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractThe International Atomic Energy Agency (IAEA) developed a staffing model to estimate the number of clinically qualified medical physicists (CQMP) that are required in an imaging facility, including diagnostic radiology and nuclear medicine. For the first time this staffing model was applied on a large scale across Africa. Within the framework of the IAEA African Regional Agreement (AFRA) Technical Cooperation (TC) project RAF6/053 entitled “Enhancing Capacity Building of Medical Physics to Improve Safety and Effectiveness of Medical Imaging (AFRA)”, a survey based on the IAEA staffing model was used to investigate the current CQMP workforce needs in imaging and radionuclide therapy in Africa in order to establish a baseline, identify gaps and suggest steps for improvement. The survey was open for five months, after which data verification was performed. 82 responses were received from 21 countries, including data from 97 diagnostic radiology and 40 nuclear medicine departments, as well as 75 interventional radiology departments and/or catheterization laboratories. Only 26·8% of centres employed an adequate number of CQMPs. The staffing model indicated that 134·3 CQMPs were required for these centres, but only 63 are currently employed in medical imaging and/or nuclear medicine at these centres. At least 11 countries do not have a single institution with an adequate number of CQMPs. Data analysis indicated that the number of radiology and nuclear medicine CQMPs is largely inadequate, at least by a factor of 20 in almost all countries in the region.
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28
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Arroyo J, Marini TJ, Saavedra AC, Toscano M, Baran TM, Drennan K, Dozier A, Zhao YT, Egoavil M, Tamayo L, Ramos B, Castaneda B. No sonographer, no radiologist: New system for automatic prenatal detection of fetal biometry, fetal presentation, and placental location. PLoS One 2022; 17:e0262107. [PMID: 35139093 PMCID: PMC8827457 DOI: 10.1371/journal.pone.0262107] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023] Open
Abstract
Ultrasound imaging is a vital component of high-quality Obstetric care. In rural and under-resourced communities, the scarcity of ultrasound imaging results in a considerable gap in the healthcare of pregnant mothers. To increase access to ultrasound in these communities, we developed a new automated diagnostic framework operated without an experienced sonographer or interpreting provider for assessment of fetal biometric measurements, fetal presentation, and placental position. This approach involves the use of a standardized volume sweep imaging (VSI) protocol based solely on external body landmarks to obtain imaging without an experienced sonographer and application of a deep learning algorithm (U-Net) for diagnostic assessment without a radiologist. Obstetric VSI ultrasound examinations were performed in Peru by an ultrasound operator with no previous ultrasound experience who underwent 8 hours of training on a standard protocol. The U-Net was trained to automatically segment the fetal head and placental location from the VSI ultrasound acquisitions to subsequently evaluate fetal biometry, fetal presentation, and placental position. In comparison to diagnostic interpretation of VSI acquisitions by a specialist, the U-Net model showed 100% agreement for fetal presentation (Cohen’s κ 1 (p<0.0001)) and 76.7% agreement for placental location (Cohen’s κ 0.59 (p<0.0001)). This corresponded to 100% sensitivity and specificity for fetal presentation and 87.5% sensitivity and 85.7% specificity for anterior placental location. The method also achieved a low relative error of 5.6% for biparietal diameter and 7.9% for head circumference. Biometry measurements corresponded to estimated gestational age within 2 weeks of those assigned by standard of care examination with up to 89% accuracy. This system could be deployed in rural and underserved areas to provide vital information about a pregnancy without a trained sonographer or interpreting provider. The resulting increased access to ultrasound imaging and diagnosis could improve disparities in healthcare delivery in under-resourced areas.
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Affiliation(s)
- Junior Arroyo
- Laboratorio de Imágenes Médicas, Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Thomas J. Marini
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Ana C. Saavedra
- Laboratorio de Imágenes Médicas, Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Marika Toscano
- Department of Obstetrics and Gynecology, 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
| | - Kathryn Drennan
- Department of Obstetrics and Gynecology, 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
| | - Yu Tina Zhao
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Miguel Egoavil
- Research & Development, Medical Innovation & Technology, Lima, Perú
| | - Lorena Tamayo
- Research & Development, Medical Innovation & Technology, Lima, Perú
| | - Berta Ramos
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Benjamin Castaneda
- Laboratorio de Imágenes Médicas, Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima, Peru
- * E-mail:
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29
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Ganguli R, Franklin J, Yu X, Lin A, Heffernan DS. Machine learning methods to predict presence of residual cancer following hysterectomy. Sci Rep 2022; 12:2738. [PMID: 35177700 PMCID: PMC8854708 DOI: 10.1038/s41598-022-06585-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Abstract
Surgical management for gynecologic malignancies often involves hysterectomy, often constituting the most common gynecologic surgery worldwide. Despite maximal surgical and medical care, gynecologic malignancies have a high rate of recurrence following surgery. Current machine learning models use advanced pathology data that is often inaccessible within low-resource settings and are specific to singular cancer types. There is currently a need for machine learning models to predict non-clinically evident residual disease using only clinically available health data. Here we developed and tested multiple machine learning models to assess the risk of residual disease post-hysterectomy based on clinical and operative parameters. Data from 3656 hysterectomy patients from the NSQIP dataset over 14 years were used to develop models with a training set of 2925 patients and a validation set of 731 patients. Our models revealed the top postoperative predictors of residual disease were the initial presence of gross abdominal disease on the diaphragm, disease located on the bowel mesentery, located on the bowel serosa, and disease located within the adjacent pelvis prior to resection. There were no statistically significant differences in performances of the top three models. Extreme gradient Boosting, Random Forest, and Logistic Regression models had comparable AUC ROC (0.90) and accuracy metrics (87–88%). Using these models, physicians can identify gynecologic cancer patients post-hysterectomy that may benefit from additional treatment. For patients at high risk for disease recurrence despite adequate surgical intervention, machine learning models may lay the basis for potential prospective trials with prophylactic/adjuvant therapy for non-clinically evident residual disease, particularly in under-resourced settings.
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Affiliation(s)
- Reetam Ganguli
- Brown University, Providence, USA.,Department of Surgery, Rhode Island Hospital, Brown University, Providence, USA
| | - Jordan Franklin
- Department of Computer Sciences, Georgia Institute of Technology, Atlanta, USA
| | - Xiaotian Yu
- Department of Mathematics, University of Virginia, Charlottesville, USA
| | - Alice Lin
- Warren Alpert Medical School, Providence, USA.,Department of Surgery, Rhode Island Hospital, Brown University, Providence, USA
| | - Daithi S Heffernan
- Brown University, Providence, USA. .,Warren Alpert Medical School, Providence, USA. .,Department of Surgery, Rhode Island Hospital, Brown University, Providence, USA. .,Division of Trauma/Surgical Critical Care, Division of Surgical Research, Department of Surgery, Rhode Island Hospital, Brown University, Room 207, Aldrich Building, 593 Eddy Street, Providence, RI, 02903, USA.
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30
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK.,Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India.,Department of Radiology, Sri Ramachandra University Medical College, Chennai, India.,Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK.,High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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31
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Yokoyama T, Nakahara S, Kondo H, Miyake Y, Sakamoto T. Novel score for predicting early emergency endovascular therapy in trauma care using logistic
LASSO
regression. Acute Med Surg 2022; 9:e774. [PMID: 35928218 PMCID: PMC9345292 DOI: 10.1002/ams2.774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Aim To support decision‐making for early interventional radiology, this study aimed to derive and validate a novel and simple scoring system for predicting the necessity of interventional radiology therapies in trauma patients. Methods This retrospective study used data derived from the medical records of patients with severe traumatic injuries treated at a tertiary‐level emergency institution. The score was derived from 168 patients treated between April 2015 and October 2016 and validated using data from 68 patients treated between November 2016 and July 2017. Logistic “least absolute shrinkage and selection operator (LASSO)” regression was used to select predictors. In order to compose the score, odds ratios derived from the logistic model were simplified to integer score coefficients. The score was evaluated using the area under the receiver operating characteristic curve. The best cut‐off point for the score was determined using Youden’s index, and sensitivity and specificity were calculated. Results The derived score comprised three predictors (systolic blood pressure, positive findings in abdominal ultrasound assessment, and pelvic fracture) and ranged from 0 to 30. On validation, the area under the receiver operating characteristic curve for the score was 0.86 (95% confidence interval, 0.64–1.00). The sensitivity and specificity were 80% and 89%, respectively, with a cut‐off point of 3. Conclusion This simple score, requiring variables obtainable immediately after hospital arrival, could aid in facilitating early interventional radiology team activation.
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Affiliation(s)
- Taro Yokoyama
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Shinji Nakahara
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
- Graduate School of Health Innovation Kanagawa University of Human Services Kawasaki Japan
| | - Hiroshi Kondo
- Department of Radiology Teikyo University School of Medicine Tokyo Japan
| | - Yasufumi Miyake
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
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Gathuru LM, Elias GDO, Pitcher RD. Analysis of registered radiological equipment in Kenya. Pan Afr Med J 2021; 40:205. [PMID: 35136468 PMCID: PMC8783305 DOI: 10.11604/pamj.2021.40.205.29570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/30/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION diagnostic radiology plays a key role in healthcare. Proper planning of healthcare requires accurate and robust data. There´s, however, paucity of comprehensive figures on radiological equipment in the African setting. The goal of this study was to carry out an in-depth analysis of the registered radiological equipment in Kenya, a lower middle-income African country, and compare the findings to published international data. METHODS data on radiological equipment were obtained from the Kenya Nuclear Regulatory Authority and analyzed as units/million of the population by imaging modality, health service sector and administrative units. The findings were then compared to published international data. RESULTS there has been an overall increase in the number of radiological equipment in comparison to data published in 2013, with a relatively uniform distribution of resources across all eight regions. General radiography is the most available modality at 24.5 units/million with the majority of the equipment owned privately, while the public sector (9.6 units/million) has less than a half of the WHO recommendation of 20 units/million. Accessibility to computerized tomography (CT) scan, fluoroscopy and mammography in the public sector closely mirrors that of South Africa. On the contrary, positron emission tomography-computerized tomography (PET-CT) is the least-resourced modality and is currently only available in the private sector. CONCLUSION the increased number and homogenous distribution of radiological resources can largely be attributed to the Managed Equipment Services project launched by the national government in 2016. More needs to be done with regards to availability of PET/CT scanners and general radiography equipment in the public sector.
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Affiliation(s)
- Lynne Muthoni Gathuru
- Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya,,Corresponding author: Lynne Muthoni Gathuru, Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya.
| | | | - Richard Denys Pitcher
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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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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Validation of the AO Spine Sacral Classification System: Reliability Among Surgeons Worldwide. J Orthop Trauma 2021; 35:e496-e501. [PMID: 34387567 PMCID: PMC8788941 DOI: 10.1097/bot.0000000000002110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) demonstrate that the AO Spine Sacral Classification System can be reliably applied by general orthopaedic surgeons and subspecialists universally around the world and (2) delineate those injury subtypes that are most difficult to classify reliably to refine the classification before evaluating clinical outcomes. DESIGN Agreement study. SETTING All-level trauma centers, worldwide. PARTICIPANTS One hundred seventy-two members of the AO Trauma and AO Spine community. INTERVENTION The AO Sacral Classification System was applied by each surgeon to 26 cases in 2 independent assessments performed 3 weeks apart. MAIN OUTCOME MEASUREMENTS Interobserver reliability and intraobserver reproducibility. RESULTS A total of 8097 case assessments were performed. The kappa coefficient for interobserver agreement for all cases was 0.72/0.75 (assessment 1/assessment 2), representing substantial reliability. When comparing classification grading (A/B/C) regardless of subtype, the kappa coefficient was 0.84/0.85, corresponding to excellent reliability. The kappa coefficients for interobserver reliability were 0.95/0.93 for type A fractures, 0.78/0.79 for type B fractures, and 0.80/0.83 for type C fractures. The overall kappa statistic for intraobserver reliability was 0.82 (range 0.18-1.00), representing excellent reproducibility. When only evaluating morphology type (A/B/C), the average kappa value was 0.87 (range 0.18-1.00), representing excellent reproducibility. CONCLUSION The AO Spine Sacral Classification System is universally reliable among general orthopaedic surgeons and subspecialists worldwide, with substantial interobserver and excellent intraobserver reliability.
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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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O’Connell AM, Marini TJ, Kawakyu-O’Connor DT. Cone-Beam Breast Computed Tomography: Time for a New Paradigm in Breast Imaging. J Clin Med 2021; 10:jcm10215135. [PMID: 34768656 PMCID: PMC8584471 DOI: 10.3390/jcm10215135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 01/02/2023] Open
Abstract
It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.
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Shanthakumar D, Payne A, Leitch T, Alfa-Wali M. Trauma Care in Low- and Middle-Income Countries. Surg J (N Y) 2021; 7:e281-e285. [PMID: 34703885 PMCID: PMC8536645 DOI: 10.1055/s-0041-1732351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Trauma-related injury causes higher mortality than a combination of prevalent infectious diseases. Mortality secondary to trauma is higher in low- and middle-income countries (LMICs) than high-income countries. This review outlines common issues, and potential solutions for those issues, identified in trauma care in LMICs that contribute to poorer outcomes.
Methods
A literature search was performed on PubMed and Google Scholar using the search terms “trauma,” “injuries,” and “developing countries.” Articles conducted in a trauma setting in low-income countries (according to the World Bank classification) that discussed problems with management of trauma or consolidated treatment and educational solutions regarding trauma care were included.
Results
Forty-five studies were included. The problem areas broadly identified with trauma care in LMICs were infrastructure, education, and operational measures. We provided some solutions to these areas including algorithm-driven patient management and use of technology that can be adopted in LMICs.
Conclusion
Sustainable methods for the provision of trauma care are essential in LMICs. Improvements in infrastructure and education and training would produce a more robust health care system and likely a reduction in mortality in trauma-related injuries.
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Affiliation(s)
| | - Anna Payne
- Department of Surgery, Royal London Hospital, London, United Kingdom
| | - Trish Leitch
- Department of Surgery, St George's Hospital, London, United Kingdom
| | - Maryam Alfa-Wali
- Department of Surgery, Royal London Hospital, London, United Kingdom
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van Zyl BC, Barnard MM, Cloete K, Fernandez A, Mukosi M, Pitcher RD. Towards equity: a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017. BMC Health Serv Res 2021; 21:991. [PMID: 34544402 PMCID: PMC8454129 DOI: 10.1186/s12913-021-06997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.
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Affiliation(s)
- Beulah Christina van Zyl
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl, Avenue, Tygerberg, Cape Town, 7505, South Africa.
| | - Michelle Monique Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, 1st Floor North Block, Bellville Health Park, c/o Mike Pienaar Boulevard & Frans Conradie Drive, Bellville, Cape Town, 7500, South Africa
| | - Keith Cloete
- Department of Health, Western Cape Government, Cape Town, South Africa
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, 1st Floor North Block, Bellville Health Park, c/o Mike Pienaar Boulevard & Frans Conradie Drive, Bellville, Cape Town, 7500, South Africa
| | - Matodzi Mukosi
- Department of Health, Western Cape Government, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl, Avenue, Tygerberg, Cape Town, 7505, South Africa
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Shah DR, Leslie A, Destigter K, van de Broek-Altenburg E, Horton S, Dahn B. Medical Imaging: The Missing Element of National Health Plans. JOURNAL OF GLOBAL RADIOLOGY 2021. [DOI: 10.7191/jgr.2021.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges.
Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix.
Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties.
Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future.
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Mapuranga H, Pitcher RD, Jakanani GC, Banhwa J. An audit of Zimbabwean public sector diagnostic ultrasound services. Pan Afr Med J 2021; 39:99. [PMID: 34466201 PMCID: PMC8379399 DOI: 10.11604/pamj.2021.39.99.28342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.
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Affiliation(s)
- Humphrey Mapuranga
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Josephat Banhwa
- Department of Medical Physics and Imaging Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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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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Möbius D, Fitzek A, Hammer N, Heinemann A, Ron A, Schädler J, Zwirner J, Ondruschka B. Ultrasound in legal medicine-a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts. Int J Legal Med 2021; 135:2363-2383. [PMID: 34292383 PMCID: PMC8295453 DOI: 10.1007/s00414-021-02661-5] [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: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.
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Affiliation(s)
- Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Austria.,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Dokponou YCH, Kotecha J, Bandyopadhyay S, Erhabor J, Ooi SZY, Egiz A, Boutarbouch M, Dalle DU, Higginbotham G, Thioub M, Sichimba D, Bankole NDA, Kanmounye US. Continental Survey of Access to Diagnostic Tools and Endovascular Management of Aneurysmal Subarachnoid Hemorrhage in Africa. Front Surg 2021; 8:690714. [PMID: 34355014 PMCID: PMC8329527 DOI: 10.3389/fsurg.2021.690714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Rationale: Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa. Methodology: A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable. Results: Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist. Conclusion: This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.
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Affiliation(s)
- Yao Christian Hugues Dokponou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Mohammed V University, Rabat, Morocco
| | - Jay Kotecha
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Abdullah Egiz
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - George Higginbotham
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Mbaye Thioub
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nourou Dine Adeniran Bankole
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Mohammed V University, Rabat, Morocco
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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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Xu L, He B, Zhang Y, Chen L, Fan D, Zhan S, Wang S. Prognostic models for amyotrophic lateral sclerosis: a systematic review. J Neurol 2021; 268:3361-3370. [PMID: 33694050 DOI: 10.1007/s00415-021-10508-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing prognostic models for amyotrophic lateral sclerosis (ALS) have been developed. However, no comprehensive evaluation of these models has been done. The purpose of this study was to map the prognostic models for ALS to assess their potential contribution and suggest future improvements on modeling strategy. METHODS Databases including Medline, Embase, Web of Science, and Cochrane library were searched from inception to 20 February 2021. All studies developing and/or validating prognostic models for ALS were selected. Information regarding modelling method and methodological quality was extracted. RESULTS A total of 28 studies describing the development of 34 models and the external validation of 19 models were included. The outcomes concerned were ALS progression (n = 12; 35%), change in weight (n = 1; 3%), respiratory insufficiency (n = 2; 6%), and survival (n = 19; 56%). Among the models predicting ALS progression or survival, the most frequently used predictors were age, ALS Functional Rating Scale/ALS Functional Rating Scale-Revised, site of onset, and disease duration. The modelling method adopted most was machine learning (n = 16; 47%). Most of the models (n = 25; 74%) were not presented. Discrimination and calibration were assessed in 12 (35%) and 2 (6%) models, respectively. Only one model by Westeneng et al. (Lancet Neurol 17:423-433, 2018) was assessed with overall low risk of bias and it performed well in both discrimination and calibration, suggesting a relatively reliable model for practice. CONCLUSIONS This study systematically reviewed the prognostic models for ALS. Their usefulness is questionable due to several methodological pitfalls and the lack of external validation done by fully independent researchers. Future research should pay more attention to the addition of novel promising predictors, external validation, and head-to-head comparisons of existing models.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Bingjie He
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yunjing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Kiguli-Malwadde E, Byanyima R, Kawooya MG, Mubuuke AG, Basiimwa RC, Pitcher R. An audit of registered radiology equipment resources in Uganda. Pan Afr Med J 2021; 37:295. [PMID: 33654516 PMCID: PMC7881928 DOI: 10.11604/pamj.2020.37.295.22046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction the third Sustainable Development Goal (SDG) relates to Universal Health Coverage (UHC) and provision of quality essential health services. The Government of Uganda has operationalized this through the National Health Policy which stresses the importance of availability of functioning medical equipment in health facilities. There have been efforts by the Ministry of Health and Atomic Energy Council in Uganda to compile an inventory of imaging equipment in the country, however, this information has not been widely published. The purpose of this study was to conduct an audit of registered radiology equipment in Uganda and establish their functional status. Methods a cross-sectional descriptive study that involved a desktop review of the equipment registry at the Uganda Atomic Energy Council was conducted. Data was collected on a number of variables including type of equipment, location, functional status, modality and density per million people. Results the audit revealed 625 pieces of equipment spread over 354 health facilities. The majority (397) were plain X-ray machines followed by dental X-ray machines at 120. There were only 3 Radiotherapy machines. Most were recorded as being functional with only 0.1% of the equipment non-functional. Most of the equipment was in the central region which has the third highest population density. The majority of the equipment belonged to private health facilities. Conclusion Uganda lags behind the WHO recommended ratio of equipment versus the population (20 per million population). Most of the equipment is the plain X-ray machine with a few more advanced technologies in both public and private health facilities.
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Affiliation(s)
- Elsie Kiguli-Malwadde
- Health Workforce Education and Development, African Centre for Global Health and Social Development, Plo13B, Acacia Avenue, Kampala, Uganda.,Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosemary Byanyima
- Department of Radiology, School of Medicine, Mulago Hospital, Kampala, Uganda
| | - Michael Grace Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - Aloysius Gonzaga Mubuuke
- Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Marini TJ, Oppenheimer DC, Baran TM, Rubens DJ, Toscano M, Drennan K, Garra B, Miele FR, Garra G, Noone SJ, Tamayo L, Carlotto C, Trujillo L, Waks E, Garra K, Egoavil MS, Berrospi J, Castaneda B. New Ultrasound Telediagnostic System for Low-Resource Areas: Pilot Results From Peru. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:583-595. [PMID: 32798267 DOI: 10.1002/jum.15420] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 05/26/2023]
Abstract
Billions of people around the world lack access to diagnostic imaging. To address this issue, we piloted a comprehensive ultrasound telediagnostic system, which uses ultrasound volume sweep imaging (VSI) acquisitions capable of being performed by operators without prior traditional ultrasound training and new telemedicine software capable of sending imaging acquisitions asynchronously over low Internet bandwidth for remote interpretation. The telediagnostic system was tested with obstetric, right upper quadrant abdominal, and thyroid volume sweep imaging protocols in Peru. Scans obtained by operators without prior ultrasound experience were sent for remote interpretation by specialists using the telemedicine platform. Scans obtained allowed visualization of the target region in 96% of cases with diagnostic imaging quality. This telediagnostic system shows promise in improving health care disparities in the developing world.
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Affiliation(s)
- Thomas J Marini
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Daniel C Oppenheimer
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Deborah J Rubens
- Department of Imaging Sciences, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Marika Toscano
- Department of Obstetrics and Gynecology, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Kathryn Drennan
- Department of Obstetrics and Gynecology, University of Rochester, and University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Frank R Miele
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Gail Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | | | | | | | | | - Erin Waks
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
| | - Katie Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, USA
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Operative costs associated with arthroscopic assisted open reduction and internal fixation of acute ankle fractures. Foot (Edinb) 2021; 46:101765. [PMID: 33453610 DOI: 10.1016/j.foot.2020.101765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fractures are a common orthopedic injury that frequently involves associated cartilage lesions, soft tissue damage, and a significant inflammatory burden. Despite studies revealing intra-articular pathology in up to 79% of ankle fractures, only 1% of open reduction and internal fixation (ORIF) procedures undergo arthroscopic evaluation. The primary purpose of this study was to determine the cost effectiveness of ankle arthroscopy performed at time of ORIF for ankle fracture. METHODS An IRB approved retrospective review of patients who sustained ankle fractures and underwent ORIF with and without concomitant arthroscopic surgery between 2015 and 2020 were investigated. Patient demographics, fracture characteristics, outcomes, and cost data were collected and analyzed. RESULTS There were 567 total ORIF and 28 ORIF and scope included for cost analysis purposes. Total surgical costs averaged $6,537.62 and $6,886.46 for the ORIF only and ORIF and scope procedures respectively. Total direct costs, including operating room time, for the same procedures were found to average $6,212.34 and $7,312.10 for the ORIF only and ORIF and scope procedures respectively. The cost difference between the ORIF only and with arthroscopy was not statistically significant (p = 0.1174). Twelve of the 28 arthroscopic patients (42.86%) had grade 3 or full thickness chondral lesions, and 11/28 (39.28%) arthroscopic patients were found to have grade 1-2 cartilage changes. CONCLUSION In the acute treatment of ankle fractures, concurrent arthroscopic evaluation does not add a significant cost to the procedure and may result in improved short and long term benefits for the patient. With improved arthroscopic efficiency, the cost differential can be further reduced. LOE: IV.
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Management of infective complications of otitis media in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2021; 28:174-181. [PMID: 32332206 DOI: 10.1097/moo.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. RECENT FINDINGS Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. SUMMARY Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
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50
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Tan BS, Dunnick NR, Gangi A, Goergen S, Jin ZY, Neri E, Nomura CH, Pitcher RD, Yee J, Mahmood U. RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020. Radiology 2020; 299:E193-E203. [PMID: 33289616 PMCID: PMC7734846 DOI: 10.1148/radiol.2020204267] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 pandemic has challenged and changed health care systems around the world. There has been a heterogeneity of disease burden, health care resources, and nonimaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. In this report, radiology experts in representative countries from around the world share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides.
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Affiliation(s)
- Bien Soo Tan
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - N Reed Dunnick
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Afshin Gangi
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Stacy Goergen
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Zheng-Yu Jin
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Emanuele Neri
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Cesar Higa Nomura
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - R D Pitcher
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Judy Yee
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Umar Mahmood
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
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