New Ultrasound Telediagnostic System for Low-Resource Areas: Pilot Results From Peru.

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.

Lung Ultrasound Volume Sweep Imaging for Pneumonia Detection in Rural Areas: Piloting Training in Rural Peru.

OBJECTIVE: Pneumonia is the leading cause of pediatric mortality worldwide among children 0-5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks. METHODS: Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts. RESULTS: It took participants a median number of three attempts (range 1-6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40). CONCLUSION: Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection. KEY MESSAGE: A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.

New tele-diagnostic model using volume sweep imaging for rural areas.

Advances in information and communications technologies provide a new opportunity to improve the access to healthcare in remote rural areas (RA) where there is a lack of infrastructure and medical experts. This paper implements a new model for tele-ultrasound (US) based on volumetric sweep imaging protocols specially designed for the acquisition of US. Non-physician health personnel from the RA are trained on the use of these protocols in a few days. The operator utilizes the medical box (MB), a specially designed telecommunication system, to guide, compress, encrypt and transmit the US sweeps through the cloud to the radiologist who performs the diagnosis remotely. The report is automatically sent back to the MB. The system was able to send US volumetric images with poor connectivity conditions in 6 minutes on average. These results of implementing this tele-ultrasound model in RAs are encouraging and support future validations.

Modelo innovador de tele-ecografía para zonas rurales en el Perú / Innovative tele-ultrasound model for rural areas in Peru

Uno de los principales retos de nuestro sistema sanitario es satisfacer las necesidades actuales y futuras del sector garantizando el acceso equitativo y de calidad a los servicios de salud, por lo que frente a esta necesidad surge el uso de las capacidades que brindan las tecnologías. Por ello, en este artículo se describe un modelo innovador de tele-ecografía (tele-ultrasonografía) implementado en diversas zonas rurales del Perú el cual consiste en un nuevo método de adquisición de imágenes a través de protocolos volumétricos asociados al correcto entrenamiento del operador, el uso de equipos de fácil manejo, así como la nube que permite el diagnóstico en cualquier parte del mundo. Asimismo, se presentan los resultados de las intervenciones realizadas con este nuevo modelo en diferentes regiones con medio rural del país destacando sus ventajas y limitaciones. Este tipo de experiencia sirve como ejemplo de la utilidad de la tecnología la cual puede ser replicada en otros aspectos del sector salud; por lo que resulta necesario seguir generando evidencia científica que sirva como sustento para la implementación de nuevas políticas públicas orientadas a la promoción y fomento de este tipo de innovaciones.

One of the main challenges of our health system is to meet the current and future needs of the sector by guaranteeing equitable access and quality to health services, so that in response to this need, the use of the capabilities provided by technologies arises. Therefore, this article describes an innovative model of tele-ultrasound implemented in various rural areas of Peru which consists of a new method of acquisition of images through volumetric protocols associated with correct operator training, the utilization of user-friendly equipment , as well as the cloud that allows diagnosis anywhere in the world. Likewise, the results of the interventions carried out with this new model are presented in different regions with rural areas of the country highlighting its advantages and limitations. This type of experience serves as an example of the usefulness of technology which can be replicated in other aspects of the health sector. Therefore, it is necessary to continue generating scientific evidence that provides the basis for the implementation of new public policies aimed at the promotion of this type of innovation.