I had not thought much about issues of global health during the first six years of my training as a physician-scientist. I was focused on the challenges of an M.D./Ph.D. program, keeping my head above water during the didactics of medical school, sitting for the first step of the boards, navigating the first block clerkships, choosing a lab and starting graduate studies, defending my thesis, reentering medical school, and completing the bulk of the clerkships. I was really caught up in “me.” During a week of lectures dedicated to global health, I was able to pause the obsessive worries of academic progress and give attention to a project that would become an important part of my medical school experience.
I heard a short lecture on a non-profit organization called Imaging the World (ITW), which is based at UVM. Dr. Kristen DeStigter, co-founder of the organization and interim chair of the Department of Radiology, outlined the organization’s mission: to provide access to high-quality ultrasound imaging in remote and underserved areas. In fact, they have been providing obstetrical imaging in parts of Uganda since 2012. But, how? Using low-cost, compact, rugged, portable ultrasound devices and existing cellular/internet connectivity, images are acquired in these remote or underserved areas and the data compressed and sent wirelessly to trained personnel in the U.S., who then interpret the images and communicate findings back to the field. However, ultrasound requires a trained sonographer to move the the probe about the patient’s skin and locate in real time internal anatomical structures of interest in order to acquire diagnostically meaningful images. The minds at ITW devised an elegant and simple solution to this problem. They trained clinic employees in Uganda—nurses, technicians, anyone willing to learn—to use surface anatomical landmarks to guide “sweeps” of the ultrasound probe. In the case of their obstetrical imaging “sweeps” protocol, the probe is moved across a woman’s abdomen in six different locations to acquire a full set of images to ensure a good view of the fetus and maternal structures. I remember clearly the pang of excitement—here was a program that I felt had a sustainable solution to narrow the medical resource gap and help improve patients’ health around the globe. I decided to get involved.
Early in my fourth year of medical school (year seven of my schooling), I began work on an on-going research project designed by Dr. DeStigter and run by Mary Streeter, RA, that sought to scientifically validate the ITW obstetrical sweeps protocol and maximize the utility of the images. Two first-year medical students were trained to do the ITW OB sweep protocol using the same equipment as in Uganda to obtain images on 100 pregnant volunteers in their second trimester. These volunteers also received a gold-standard second trimester obstetrical ultrasound performed by a trained sonographer. Two obstetricians, Dr. David Jones and Dr. Anne Dougherty, and a radiologist, Dr. Betsy Sussman, read these images and reported findings in a standardized fashion. It was my job to do some light data entry and start comparing the data from the study images to the gold-standard. To our delight, we found in 75 percent of the ITW OB sweeps measurements of fetal anatomy, known as collectively as biometry, were obtainable. Biometry can be used to calculated an estimated gestational age (EGA) of a pregnancy in the second trimester. Dates calculated with biometry obtained from the ITW OB sweeps protocol those of the gold standard were within +/- seven days of the gold standard dates in more than 94 percent of the cases. This was a big deal! It meant we could reliably glean an estimated date of delivery from the many ultrasound studies already being performed by ITW in Uganda. That may not sound like much of an advancement, but we, as consumers and providers of healthcare in the United States, take for granted the monitoring that occurs during pregnancy. We expect access to trained sonographers, advanced ultrasound technology and experienced providers to affect standard antenatal care. In resource-poor areas of the world, all of this is a luxury.
With the help of Sarah Ebert, a fellow fourth-year medical student, Mary Streeter and Drs. Sussman and DeStigter, we presented these results at the Radiological Society of North American’s (RSNA) annual meeting in Chicago this past December. The study was covered by the press and featured multiple online publications. We were certainly excited that the study’s implications did not go unnoticed!
During my interviews for residency, I proudly pointed to this experience as one of the reasons I choose radiology as a specialty. As a radiologist, I believe I will be in a position to exploit inexpensive imaging technology and increasing internet connectivity to help bring access to medical imaging to resource poor areas.