The Story of Imaging the World
Imaging the World (ITW) was founded in 2007 by two radiologists, Dr. Kristen DeStigter and Dr. Brian Garra. The idea for ITW came out of Dr. DeStigter’s work in rural Kenya where she was participating in World Health Organization-sponsored parasite research. After she had finished her parasite research each day, the team would open up a field “clinic” and people would walk from all over to stand in line by her Land Rover to receive ultrasound diagnoses. With a transducer in her hand, Dr. DeStigter was able to diagnose a wide variety of ailments that could not be detected through routine health exams. She was able to detect conditions ranging from internal parasitic infections, broken bones and liver lesions to potential maternal health complications. When she realized that people were desperate for more evolved health care, and that it was evident that they could and would travel great distances for diagnoses, and even greater distances to receive hospital care for more complex conditions and treatment, Dr. DeStigter became committed to creating a new model of field care that included basic ultrasound technology. Back home she enlisted the expertise and creativity of Dr. Garra and sonographer, Gail Rouillard, to develop a new paradigm for ultrasound. Together they experimented with the idea of a tele- radiology platform where images could be sent via the internet to a network of radiology experts. Aware that there were few trained sonographers in developing countries, they developed a new model of teaching people without medical training to scan patients using only external body markers such as the ribs and hips. Dr. Garra created novel video compression software that enabled ultrasound video clips to be sent over low bandwidth internet connections so they could be viewed by radiology experts anywhere in the world. They conducted a pilot study in rural Vermont to test the training methods, transmission of data, and the diagnostic quality of the images. The results from the study were encouraging and Imaging the World was born.
With this breakthrough also came a need for technology. Through partnerships with GE and Philips, ITW secured ultrasound units to launch several beta sites. McKesson partnered with ITW to supply Picture Archive and Communication Systems (PACS) to store the scans so radiology experts worldwide could login, read the scans and make diagnoses.
As ITW expands, there will be a great need for portable, inexpensive ultrasound machines. Currently GE has committed to developing a prototype model that will be available within the next two years. This new model will cost less than $2000 and will be key to a large scale implementation of the ITW model, allowing for global growth. Many other vendors are also interested in developing extremely low cost US equipment for use in rural areas and our target is the sub $1000 price.
With doctors, software and equipment on board, ITW also needed to develop a reproducible training curriculum and program. To aid in this, ITW partnered with nationally renowned medical education specialist, Pegasus Lectures to take part in a national training work-group made up of radiologists, sonographers, academics, global health training specialists and ultrasound experts. ITW has developed a global training template that is culturally sensitive, concise and easily transferred. ITW has also developed a classroom module teaching basic ultrasound physics and ethics to supplement the basic scanning protocols.
Needing more field work, ITW conducted a second pilot study rural Belize. This study demonstrated that non-english speaking individuals who lack medical training were able to successfully conduct the protocols and produce useful and diagnostic ultrasound imagery. After two successful pilots, ITW decided it was time to implement permanent sites and launch a longer-term conclusive outcomes study.
In June, 2010, in conjunction with local healthcare institutions and the Ugandan government, ITW will implement three sites in rural Uganda. These sites will serve as operating ITW sites and outcomes data will be gathered and compiled quarterly. This project will test the long-term feasibility of ITW, as well as the affect of ultrasound diagnoses on the health of a population. Data collected during these operations will be groundbreaking, as no study such yet been conducted in the U.S. or anywhere else. While ITW will be gathering data on all types of health conditions, this outcomes study will focus on maternal health. Uganda currently has the highest birth rate in the world with each woman having an average of 7 pregnancies. With increased pregnancy rates, women have a higher risk of placenta position issues. Placenta previa as well and other placental position issues often lead to hemorrhaging – in fact hemorrhaging is responsible for 21% of all maternal deaths. The good news is that placental position is easily detectable through ultrasound. If a woman is diagnosed with a placenta position issue she will always be advised to labor in a hospital. This early warning allows the mother and her family to make arrangements to leave their home and make the trek to a local hospital. With the help of trained medical providers, placental placement issues can be dealt with safely, resulting in healthy births.