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1100. Clinical Analysis of a New Telediagnostic Imaging System Piloted in Peru
Authors * Denotes Presenting Author
  1. Thomas Marini *; University of Rochester
  2. Daniel Oppenheimer; University of Rochester
  3. Timothy Baran; University of Rochester
  4. Deborah Rubens; University of Rochester
  5. Marika Toscano; University of Rochester
  6. Kathryn Drennan; University of Rochester
  7. Benjamin Castaneda; Pontifical Catholic University of Peru
Objective:
In this study, we piloted a new telediagnostic ultrasound system which combines a telemedicine system and volume sweep imaging (VSI) protocols requiring no on-site radiologist or expert sonographer. This system can be deployed in low resource areas where billions of people lack access to diagnostic imaging.

Materials and Methods:
VSI is an ultrasound imaging technique in which cine clips are obtained of the target region based solely on external body landmarks through a series of simple sweeps of the probe; no advanced technical skill or ultrasound knowledge is required. The telemedicine platform used compresses and sends VSI imaging data over low bandwidth. Software installed on a tablet connected to the ultrasound machine guides the operator into uploading VSI acquisitions of the target region which are encrypted and saved to a PACS for expert interpretation at a later time. The system was piloted in Lima, Peru and the Peruvian Amazon. VSI protocols for obstetrics, abdominal right upper quadrant (RUQ), and thyroid were tested by ultrasound naive operators after less than 12 hours of training. 67 subjects were scanned; 29 with the RUQ protocol, 22 with the thyroid protocol, and 16 with the obstetrics protocol. Blinded readers interpreted the VSI acquisitions using standardized sheets detailing visualization of major structures, their confidence in estimations, and image quality.

Results:
Overall, 96% of the exams were rated as diagnostic imaging quality. Obstetric exams showed excellent agreement on placental position and amniotic fluid volume (100%), fetal position (93%), and fetal age (93%). RUQ exams adequately visualized the liver, right kidney, and gallbladder in 85% of cases with overall moderate agreement (65-85%). Cholelithiasis and hepatic steatosis were diagnosed. Thyroid exams showed excellent visualization of the right lobe (92% with 96% agreement) and the left lobe (96% with 100% agreement). Nodules, cysts and thyroiditis were identified.

Conclusion:
A new telediagnostic system combining a low bandwidth telemedicine system and VSI allowed adequate examination of pregnancy, RUQ, and thyroid without an on-site radiologist or expert sonographer. Deployment of the system could assist in delivering imaging to underserved regions for high quality examination of the pregnant abdomen, RUQ, and thyroid without significant medical or technical operator training.