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Lung Ultrasound Volume Sweep Imaging for Pneumonia Detection in Rural Areas: Piloting Training in Rural Peru
Thomas J Marini1, Benjamin Castaneda2, Timothy Baran1
1Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States.
Insights
Rural health workers can quickly learn a volume sweep imaging (VSI) ultrasound protocol for diagnosing childhood pneumonia. This training requires minimal prior experience and time, making VSI a promising tool for remote areas.
Area of Science:
- Medical Imaging
- Pediatric Health
- Global Health
Background:
- Pneumonia is a primary cause of death in children under five globally.
- Lung ultrasound offers high accuracy for diagnosing pediatric pneumonia, especially in resource-limited settings.
- A shortage of trained sonographers hinders ultrasound's widespread use in rural healthcare.
Purpose of the Study:
- To evaluate the feasibility of training rural health workers in Peru on a Volume Sweep Imaging (VSI) ultrasound protocol for pneumonia detection.
- To assess the learning curve and time to proficiency for this VSI protocol among healthcare workers with limited prior ultrasound experience.
Main Methods:
- Rural health workers received brief didactic training followed by hands-on practice with the VSI protocol.
- Training involved timed attempts, with errors recorded until participants achieved two consecutive mistake-free performances.
- Performance metrics including time to mastery and number of attempts were analyzed across different professional backgrounds and ages.
Main Results:
- Participants achieved proficiency in the VSI protocol within a median of three attempts (range 1-6).
- The average time to mastery was 51.4 ± 17.7 minutes.
- No significant differences in training time or success rate were observed based on participants' professional roles (doctors, nurses, technicians) or age.
Conclusions:
- A Volume Sweep Imaging (VSI) protocol for pneumonia detection can be rapidly and effectively taught to rural health workers with no prior ultrasound experience.
- The VSI protocol requires minimal anatomical knowledge and technical skill, facilitating its adoption in underserved areas.
- Further research is recommended to determine the clinical effectiveness of this VSI protocol in diagnosing pediatric pneumonia.
Objective:
Pneumonia is the leading cause of pediatric mortality worldwide among children 0-5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks.
Methods:
Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts.
Results:
It took participants a median number of three attempts (range 1-6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40).
Conclusion:
Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection.
Key Message:
A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.
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