Teleradiology and technology innovations in radiology: status in India and its role in increasing access to primary health care.

Background: There is an inequitable distribution of radiology facilities in India. This scoping review aimed at mapping the available technology instruments to improve access to imaging at primary health care; to identify the facilitators and barriers, and the knowledge gaps for widespread adaptation of technology solutions. Methods: A search was conducted using broad inclusive terms non-specific to subtypes of medical imaging devices or informatics. Work published in the English language between 2005 and 2022, conducted primarily in India, and with full manuscripts were included. Two authors independently screened the abstracts against the inclusion criteria for full-text review and a senior author settled discrepancies. Data were extracted using DistillerSR software. Findings: 43 original articles and 52 non-academic materials were finally reviewed. The data was from 10 Indian states with n = 9 from rural settings. The broad trends in original articles were: connectivity using teleradiology (n = 7), mobile digital imaging units (n = 9), artificial intelligence (n = 16); mobile devices and smartphone applications (n = 7); data security (n = 7) and web-based technology (n = 2); public-private partnership (n = 9); cost (n = 2); concordance (n = 19); evaluation (n = 4); implementation (n = 2). Interpretation: Available evidence suggests that teleradiology when combined with AI and mobile digital imaging units can address radiologist shortages; strengthen programs aimed at population screening and emergency care. However, there is insufficient data on the scale of teleradiology networks within India; needs assessment; cost; facilitators, and barriers for implementation of technologies solutions in primary healthcare settings. Regulations governing quality standards, data protection, and confidentiality are unclear. Funding: The authors are The Lancet Citizen's Commission fellows. The Lancet Commission has received financial support from the Lakshmi Mittal and Family South Asia Institute, Harvard University; Christian Medical College, Vellore (CMC), Vellore; Azim Premji Foundation, Infosys; Kirloskar Systems Ltd.; Mahindra & Mahindra Ltd.; Rohini Nilekani Philanthropies; and Serum Institute of India. The views expressed are those of the author(s) and not necessarily those of the Lancet Citizens' Commission or its partners.

Bladder varices--rare cause of painless hematuria in idiopathic retroperitoneal fibrosis.

A patient presented to the urology outpatient department with complaints of recurrent episodes of painless hematuria. A contrast-enhanced computed tomography scan of the abdomen revealed vesical varices that had developed secondary to obstruction of the inferior vena cava. Additional investigation revealed idiopathic retroperitoneal fibrosis. Steroid therapy was started and tapered during a 6-week period. No recurrence of the hematuria was noted on follow-up. We have described a unique presentation of hematuria due to vesical varices in a patient with idiopathic retroperitoneal fibrosis.

Determining standard liver volume: assessment of existing formulae in Indian population.

BACKGROUND: With the increasing numbers of living-related donor liver transplantation, accurate means of calculating standard liver volume (SLV) based on patient body indices becomes important. Three formulae reported in literature for this purpose have been derived from studies on Western and Japanese populations. AIM: To assess the existing formulae for calculation of SLV in Indian population. METHOD: Total liver volume (TLV) of 238 patients was measured using axial helical CT images obtained for conditions unrelated to the hepatobiliary system. Body surface area (BSA) was calculated from height and weight. Measurements obtained using CT were compared with the SLV calculated based on the previously reported formulae. RESULTS: Though there was significant difference (p< 0.001) between the TLV obtained by CT and the SLV calculated using the three formulae, they also showed good agreement. On an average the formula derived from the Japanese population underestimated the SLV by 63 (202) cc (p< 0.001). Regression models for SLV (SLV = 243 + [186 x BSA] + [11.4 x Weight], SLV = 375.23 + [14.24 x body weight], SLV = -204.092 + [874.461 x BSA]) were derived from the data obtained from our population. Age and gender had no effect on the SLV. CONCLUSIONS: Formulae derived from Japanese population for calculation of SLV is not suitable for the Indian population. The newly described formulae may prove useful in the Indian population.

Retroperitoneal lymphatics on CT and MR.

We report the CT and MRI appearances of dilated retroperitoneal lymphatic channels in six patients. In two patients, these dilated channels resembled a mass of confluent low-density lymph nodes on CT. On MR urography the lymphatic channels in all six patients were seen as a meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum of the abdomen and pelvis. On axial T1W images, these channels were seen as numerous, interconnected small, nodular and streaky intensities and as a cloak of diffuse homogenous hyperintensity on T2W axial images. The lymphatic nature of these abnormalities was confirmed at surgery in one patient. In another patient, the calibre and number of the dilated retroperitoneal channels reduced following anti-filarial therapy. The remaining four patients presented with chyluria.

Direct intrahepatic cavo-portal shunts in Budd-Chiari syndrome: Role of simultaneous fluoroscopy and trans-abdominal ultrasonography.

BACKGROUND: Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging. METHODS: In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture. RESULTS: Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention. CONCLUSION: Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.

Retroperitoneal leiomyosarcoma infiltrating the inferior vena cava (IVC)--a case report.

Retroperitoneal soft tissue sarcomas are difficult to treat because the retroperitoneal organs and great vessels are often involved by the time the patients come to a surgeon. We present the case of a 48 year old woman with a retroperitoneal leiomyosarcoma that had infiltrated the IVC and the renal veins.

Primary lymph node gastrinoma in jejunal mesentery.

Primary gastrinomas have been reported in lymph nodes within the gastrinoma triangle. We report a 56-year-old woman with possible primary lymph node gastrinoma in the jejunal mesentery. Six months after excision of the tumor, she is asymptomatic and serum gastrin level is normal.

Autoimmune pancreatitis--an uncommon type of chronic pancreatitis.

Autoimmune pancreatitis is a recently recognized clinical entity characterized by narrow strictured main pancreatic duct on ERCP, diffusely enlarged sausage-shaped pancreas on CT scan and MRI, seropositivity for antinuclear antibodies, hypergammaglobulinemia, and excellent response to steroids. We report a 25-year-old man and a 53-year-old man with this condition.