Abstract
PurposeThyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide.MethodsThe telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard.ResultsNovice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care.ConclusionThyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
Highlights
Thyroid disease is ubiquitous throughout the world affecting millions of people [1]
Images are obtained by individuals without prior ultrasound experience after a few hours of training on ultrasound volume sweep imaging (VSI) protocols which are based on simple external body landmarks
Thyroid ultrasound has an important role in the evaluation of thyroid nodules and goiter which are worldwide health issues
Summary
Thyroid disease is ubiquitous throughout the world affecting millions of people [1]. Thyroid ultrasound is an established pillar in the diagnosis and management of palpable thyroid findings and thyroid cancer, but at least 2/3 of the world lacks access to ultrasound imaging [2,3,4,5]. Journal of Endocrinological Investigation (2021) 44:2699–2708 approaches which are otherwise viable solutions to bring imaging to underserved areas [9 –12]. To address these problems, a new telediagnostic system utilizing ultrasound volume sweep imaging (VSI) has been previously piloted (Fig. 1) [13]. In VSI, the operator sweeps the probe over the target area to acquire cine clips which are sent for remote interpretation In this asynchronous system, clips can be acquired without internet and sent over low internet bandwidths [14]. Real-time telemedicine systems require higher bandwidths for videoconferencing and the concurrent presence of a specialist which are often not available in rural and underserved areas [9, 15, 16]
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