Economic Evaluation of Telerobotic Ultrasound Technology to Remotely Provide Ultrasound Services in Rural and Remote Communities.

INTRODUCTION: Telerobotic ultrasound technology allows radiologists and sonographers to remotely provide ultrasound services in underserved areas. This study aimed to compare costs associated with using telerobotic ultrasound to provide ultrasound services in rural and remote communities to costs associated with alternate models. METHODS: A cost-minimization approach was used to compare four ultrasound service delivery models: telerobotic ultrasound (Model 1), telerobotic ultrasound and an itinerant sonographer (Model 2), itinerant sonographer without telerobotic ultrasound (Model 3), and travel to another community for all exams (Model 4). In Models 1-3, travel was assumed when exams could not be successfully performed telerobotically or by an itinerant sonographer. A publicly funded healthcare payer perspective was used for the reference case and a societal perspective was used for a secondary non-reference case. Costs were based on the literature and experience using telerobotic ultrasound in Saskatchewan, Canada. Costs were expressed in 2020 Canadian dollars. RESULTS: Average cost per ultrasound exam was $342, $323, $368, and $478 for Models 1, 2, 3, and 4, respectively, from a publicly funded healthcare payer perspective, and $461, $355, $447, and $849, respectively, from a societal perspective. In one-way sensitivity analyses, Model 2 was the lowest cost from a payer perspective for communities with population >2075 people, distance >350 km from the nearest ultrasound facility, or >47% of the population eligible for publicly funded medical transportation. CONCLUSION: Health systems may wish to consider solutions such as telerobotic ultrasound and itinerant sonographers to reduce healthcare costs and improve access to ultrasound in rural and remote communities.

Early Detection of First Carpometacarpal Joint Osteoarthritis Using Magnetic Resonance Imaging Assessment in Women With High Hypermobility Scores.

OBJECTIVE: The aim of this study was to explore association between hypermobility and osteoarthritis (OA) at the first carpometacarpal (CMC) joint, using magnetic resonance imaging (MRI) to identify early change in women at high risk of developing OA but without yet established diagnoses. METHODS: For this observational study, 33 women (aged 30-50 years) with self-reported history of maternal hand OA but without personal diagnoses of OA were recruited. Participants completed a 5-point hypermobility questionnaire. The 20 participants with 2 or more positive responses were categorized with "high hypermobility scores." The remaining 13 were categorized with "low hypermobility scores." Data collection included functional index, hand pain measure, parity, smoking status, and body mass index. Each participant underwent dominant hand radiographic and MRI examination. Imaging studies were interpreted by assessors blinded to hypermobility score categorization. RESULTS: No significant differences in age, body mass index, parity, functional index, or pain scores were observed between higher and lower hypermobility score groups. Similarly, there were no significant differences between groups for radiographic changes. However, significantly higher proportions of women with higher hypermobility scores were observed on MRI to have abnormalities of trapezium cartilage (75% vs. 38%), metacarpal cartilage (80% vs. 38%), and trapezium bone (70% vs. 31%); p < 0.05 for all. CONCLUSIONS: First CMC joint structural abnormalities were more frequently observed in women with higher hypermobility scores. Identification of early preradiographic changes in this group supports the concept that early-life joint laxity may contribute to future OA predisposition. Magnetic resonance imaging may be a preferred imaging test for detection of early cartilage changes in people at high risk of CMC joint OA.

Development and assessment of a telesonography system for musculoskeletal imaging.

BACKGROUND: Telesonography systems have been developed to overcome barriers to accessing diagnostic ultrasound for patients in rural and remote communities. However, most previous telesonography systems have been designed for performing only abdominal and obstetrical exams. In this paper, we describe the development and assessment of a musculoskeletal (MSK) telesonography system. METHODS: We developed a 4-degrees-of-freedom (DOF) robot to manipulate an ultrasound probe. The robot was remotely controlled by a radiologist operating a joystick at the master site. The telesonography system was used to scan participants' forearms, and all participants were conventionally scanned for comparison. Participants and radiologists were surveyed regarding their experience. Images from both scanning methods were independently assessed by an MSK radiologist. RESULTS: All ten ultrasound exams were successfully performed using our developed MSK telesonography system, with no significant delay in movement. The duration (mean ± standard deviation) of telerobotic and conventional exams was 4.6 ± 0.9 and 1.4 ± 0.5 min, respectively (p = 0.039). An MSK radiologist rated quality of real-time ultrasound images transmitted over an internet connection as "very good" for all telesonography exams, and participants rated communication with the radiologist as "very good" or "good" for all exams. Visualisation of anatomic structures was similar between telerobotic and conventional methods, with no statistically significant differences. CONCLUSIONS: The MSK telesonography system developed in this study is feasible for performing soft tissue ultrasound exams. The advancement of this system may allow MSK ultrasound exams to be performed over long distances, increasing access to ultrasound for patients in rural and remote communities.

Development of a risk assessment model to differentiate malignant and benign musculoskeletal soft-tissue masses on magnetic resonance imaging.

INTRODUCTION: This study aimed to develop a risk stratification model to differentiate benign and malignant MRI-imaged musculoskeletal soft-tissue tumours, informing decisions surrounding biopsy and follow-up imaging. METHODS: Imaging of patients who underwent MRI and subsequent biopsy to evaluate a soft-tissue mass was retrospectively reviewed. Features analysed included patient age; tumour size; shape; margins; enhancement pattern; signal intensity pattern; deep fascia, neurovascular bundle, bone and joint involvement; and the presence of necrosis, haemorrhage, oedema and intralesional fat. Univariate comparisons, by final histopathological status, employed t-tests and chi-square tests, followed by simple and multiple logistic regressions. Variables included in the final multiple regression model were used to define a three-level risk stratification strategy. RESULTS: One-hundred and ten patients were included in the analysis. Univariate relationships were identified between malignancy and age, tumour size, deep fascia involvement, neurovascular involvement, necrosis, haemorrhage, oedema and heterogeneous enhancement (all P < 0.01). Final multiple regression modelling included size, enhancement and oedema. Thirty of 40 (75%) tumours >5 cm with surrounding oedema ('high risk') were malignant, 13 of 47 (28%) tumours with one or more of tumour size >5 cm, surrounding oedema or heterogeneous enhancement ('moderate risk') were malignant, and none of the 16 tumours ≤5 cm with the absence of surrounding oedema and heterogeneous enhancement ('low risk') were malignant. CONCLUSIONS: A model including tumour size, enhancement and oedema has potential to stratify soft-tissue tumours into high-, intermediate- and low-risk categories; this may inform decisions surrounding biopsy and follow-up imaging.