Abstract
BackgroundOver the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied.MethodsUltrasound services were introduced at two rural Rwandan district hospitals affiliated with Partners in Health, a US nongovernmental organization. Data sheets for each ultrasound scan performed during routine clinical care were collected and analyzed to determine patient demographics, which ultrasound applications were most frequently used, and whether the use of the ultrasound changed patient management plans. Ultrasound scans performed by the local physicians during the post-training period were reviewed for accuracy of interpretation and image quality by an ultrasound fellowship trained emergency medicine physician from the United States who was blinded to the original interpretation.ResultsAdult women appeared to benefit most from the presence of ultrasound services. Of the 345 scans performed during the study period, obstetrical scanning was the most frequently used application. Evaluation of gestational age, fetal head position, and placental positioning were the most common findings. However, other applications used included abdominal, cardiac, renal, pleural, procedural guidance, and vascular ultrasounds.Ultrasound changed patient management plans in 43% of total patients scanned. The most common change was to plan a surgical procedure. The ultrasound program appears sustainable; local staff performed 245 ultrasound scans in the 11 weeks after the departure of the ultrasound instructor. Post-training scan review showed the concordance rate of interpretation between the Rwandese physicians and the ultrasound-trained quality review physicians was 96%.ConclusionWe suggest ultrasound is a useful modality that particularly benefits women's health and obstetrical care in the developing world. Ultrasound services significantly impact patient management plans especially with regards to potential surgical interventions. After an initial training period, it appears that an ultrasound program led by local health care providers is sustainable and lead to accurate diagnoses in a rural international setting.
Highlights
Over the last decade, utilization of ultrasound technology by non-radiologist physicians has grown
We investigated the impact of a diagnostic ultrasound program on two rural district hospitals
We evaluated which ultrasound applications were most commonly used in this setting, the accuracy of ultrasound image acquisition and interpretation post-training and how the introduction of a diagnostic imaging modality such as ultrasound impacted patient mangagement plans and diagnoses
Summary
Utilization of ultrasound technology by non-radiologist physicians has grown. Ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied. With non-governmental organizations efforts to strengthen and scale-up existing public sector health care models in rural international settings, attention has focused on appropriate placement of cost-effective, durable technology that will assist local health care providers in the clinical care of their patients. We hypothesize that ultrasound is sustainable in a low resource international setting, that ultrasound impacts patient management positively and can boost the diagnostic capacity of a rural center [2]. Questions regarding which patient populations would benefit most from this technology, which ultrasound applications are most useful, and how ultrasound impacts patient management plans and use of resources persist. We present answers to these questions based on our experience in rural Rwanda in 2008
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