Pediatr Radiol (2014) 44:677–678 DOI 10.1007/s00247-014-2937-9

MINISYMPOSIUM

Volume sweep imaging: open-source technology for pediatric global health collaboration Kara-Lee Pool & Brian S. Garra & Dorothy I. Bulas

Received: 12 November 2013 / Accepted: 13 February 2014 # Springer-Verlag Berlin Heidelberg 2014

The role of imaging technology in the developing world is a topic of debate. Many have questioned how radiologists, with our large and expensive machines, can integrate into underdeveloped health systems. Advances in imaging and communications technology (teleradiology) have finally given radiologists the ability to contribute significantly in the field of global health by answering targeted questions for clinics in developing nations in accordance with the World Health Organization’s “ASSURED” criteria for ideal diagnostic testing. In particular, innovation in US teleradiology has given us the hope that widespread adoption of cheap and clinically useful imaging testing is possible, even in areas with little health care infrastructure. US imaging in the pediatric population is a proven dynamic diagnostic tool that has the potential to be a primary point-of-care examination in resource-poor countries [1]. The World Health Organization’s ASSURED criteria for ideal diagnostic testing for the developing world require the following: that it is Affordable, Sensitive, Specific, Userfriendly, Rapid and Robust, Equipment-free (without the need for special storage) and Deliverable to those who need it [2].

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The majority of diagnostic imaging modalities have, up to this point, come with significant barriers to adoption in developing nations. How can US imaging, which requires well-trained technologists and radiologists as well as significant energy and data storage requirements, meet these WHO criteria as a feasible option for a resource-poor country? A portable batteryoperated device (to avoid electricity constraints) is available, and with the use of teleradiology capabilities allowing for remote interpretation by trained radiologists, US becomes a great point-of-care option for resource-poor health clinics. The World Federation of Pediatric Imaging, whose primary goals are to promote collaboration between pediatric imaging practitioners and facilitate outreach and training to low-resource nations, has begun to reach out to innovators in US technology to develop point-of-care testing for pediatric patients in developing countries. One of the people behind this effort is Brian Garra, MD, of Imaging the World, who has devised a method of data compression for transmission of large volumes of imaging data [3]. Imaging the World and Garra have also developed and tested a model of point-of-care imaging of adult patients, using portable US machines to acquire the scanning protocols produced by local operators who were not been previously trained in US imaging (US naïve). These local operators underwent on-site training to learn how to acquire a video or cine sweep through a target organ or body region using only external anatomical landmarks, with no specific internal imaging anatomy or pathology training. Acquiring a series of images as a short video segment while sweeping across an organ or body region is also known as volume sweep imaging (VSI). The World Federation of Pediatric Imaging (WFPI) is collaborating with Garra to develop, test and implement new pediatric protocols using the VSI technique. Initial protocol development and testing has begun and includes

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evaluation of the mediastinum (for tuberculosis lymphadenopathy), head (for hydrocephalus detection) and kidneys (for hydronephrosis). The first step in this collaborative effort is to prove the diagnostic and triaging capabilities of the pediatric VSI protocols prior to implementation at remote clinics. The mediastinal scan protocol is being tested (through an institutionalreview-board-approved research project) on pediatric patients suspected of having tuberculosis at the Red Cross Children’s Hospital in Cape Town, South Africa. The renal and head VSI protocol scans will be tested in multiple sites in the United States, including UCLA and the Children’s National Medical Center in Washington, DC. Although coordinating training and research at multiple institutions on different continents has its obstacles, the team will be using video-telephone technology to allow remote communication and training. WFPI experts will soon begin training US-naïve volunteers to perform the volume sweep imaging protocols remotely. After initial hands-on training of the operators, two orthogonal cameras will be used to periodically monitor the operators so that our VSI trainer is able to assess the new operators’ skills and assure consistency of practice.

Pediatr Radiol (2014) 44:677–678

While the technology exists for radiologists to begin to validate a World Health Organization ASSURED diagnostic test, it is piecemeal. It is our job to come together as a global community to connect the dots in order for our innovations in imaging to permeate and make a positive impact on the developing world. We need to commit ourselves as physicians to the open-source model pioneered in the technology world, and thereby encourage free-flow of ideas that will have a global impact. The authors of this paper encourage feedback and collaboration to fulfill the goals of the WFPI. Conflicts of interest None.

References 1. Jani IV, Peter TF (2013) How point-of-care testing could drive innovation in global health. N Engl J Med 368:2319–2324 2. Urdea M, Penny LA, Olmsted SS et al (2006) Requirements for high impact diagnostics in the developing world. Nature 444:73–79 3. Garra BS, DeStigter K, Maguire S et al (2008) Data compression for transmission of volume imaging from developing countries. In: Abstracts of the 2008 Convention of the Radiological Society of North America, 30 Nov 2008, Chicago, IL