By Kristen K. DeStigter
According to the United Nations Children’s Fund, for every 1,000 live births, at least 63 infants die before their first birthday in Uganda. Many of those deaths come from complications that could have been predicted by ultrasound technology. The situation also contributes to the country’s high infant mortality rate, with 310 out of every 100,000 women dying in childbirth, and is the leading cause of death for girls ages 15 to 18.
Imaging the World (ITW) was founded in 2008. Our mission is to bring medical expertise and high quality, low-cost health care to most remote and under-served areas worldwide by integrating simple ultrasound technology with training, local capacity building and community support. It is much more than modern technology alone — it is a system solution.
After long days performing ultrasound exams on the border of Kenya and Sudan while investigating a parasitic disease as part of a research team in the early 1990s, I would join my colleagues in an impromptu health clinic, conducting physical exams. Each day, we found that by using ultrasound we were able to discover potentially dangerous conditions, such as breech presentation, multiples or placenta previa in late pregnancy.
As a result, we were able to counsel patients to get to a health care facility where they could get appropriate, lifesaving treatment in time. This made me wonder how one could make ultrasound accessible to people in need in the most remote areas of the world; but at that time, the lack of resources and trained personnel in areas like this made it impossible to make diagnostic imaging available for critical diagnoses; and I knew that traditional methods of ultrasound outreach were simply not sustainable to make a difference for the community in the long-term.
DeStigter in Uganda
with ITW team members
Over the years, I considered the problem of bringing a permanent ultrasound solution to the most rural areas of the world, but it wasn’t until 2007, when I began working with Dr. Brian Garra, that a solution came to light.
Dr Garra had been promoting volume scans for ultrasound diagnosis since 2001. He proposed that we use entirely new ultrasound protocols using volume scanning to reduce the extent of operator training needed while still maintaining high diagnostic quality. Volume scans replace each still ultrasound image with a series of images that is gathered by sweeping the transducer across the organ or body area of interest, capturing all of the information needed to make a diagnosis. This eliminates the need for physician scanning, allowing a trained machine operator to gather images without knowledge of internal anatomy.
We were able to show that ultrasound volume imaging is not only safe, effective, reproducible and repeatable, but that the images obtained could be compressed and decompressed for image transmission over a regular cell phone network for remote interpretation without loss of diagnostic quality. Working together, Dr. Garra and I started an organization to distribute this unique technology worldwide and Imaging the World was founded.
With a newly designed training process, using only external anatomical landmarks, local health providers learn to capture high quality ultrasound scans in less than two days. Through a state-of-the-art data compression and transmission system, the images are sent via the internet to a secure server where they can be accessed and “read” on PACS from anywhere in the world. Within hours, rural health center workers receive potentially lifesaving diagnoses by phone or text message, offering options for treatment.
ITW’s solution can only be as successful as it is adaptable. The ITW platform is designed for maximum flexibility, so it can be adapted to widely divergent cultures and health care systems. Through collaboration with local governments and health care providers and community outreach initiatives, imaging care is seamlessly integrated to improve health and save lives. ITW’s low cost, sustainable and scalable imaging model is possible anywhere cell phone signals are available.
We are very excited about our newest initiative — an interdisciplinary team from Uganda and elsewhere in the world just launched a pilot breast cancer detection program in rural Uganda. Through a Grand Challenges Canada Stars in Global Health grant, awarded to Imaging the World Africa (ITWA) and directed by Ugandan surgeon, Dr. Alphonsus Matovu, Imaging the World is able to help experts to bring high quality and cost-effective breast cancer detection to remote, underserved areas. Breast diagnostic ultrasound can be performed using the same methodology that has been successful for ITW in obstetric ultrasound.
ITW collaborates with ultrasound industry partners and imaging informatics industry experts as well as other radiology and medical organizations, ultrasound education specialists, and academic institutions.
We continue to seek support and volunteers for a number of functions. Visit our website to find out how you can become involved: http://www.imagingtheworld.org
About the author: Dr. Kristen Destigter is the co-founder and president of Imaging the World. She serves as president of the Vermont Radiological Society and is councilor of the Vermont Chapter of the American College of Radiology. She serves as Secretary-Treasurer of the Association of Program Directors in Radiology; she is a member of the New England Roentgen Ray Society Executive Committee; she also sits on the American College of Graduate Medical Education Residency Review Committee for Diagnostic Radiology.
About Imaging the World: ITW is an organization dedicated to mitigating medical imaging deficiencies in the most under-resourced areas of the world using sustainable, low cost, technology-based solutions. As a result of this work, she is a recipient of Bill & Melinda Gates Foundation Grand Challenges Explorations and well as Grand Challenges Canada grants.