Leila Eadie

Optimizing multi-dimensional terahertz imaging analysis for colon cancer diagnosis

Highlights? THz imaging has potential in medical diagnosis but needs consensus about analysis. ? Intelligent analysis methods can help find relevant THz wave parameters. ? The intelligent analysis methods used produce better results than previous analyses. ? A non-patient-specific, generalized analysis method may be possible. ? Results suggest THz imaging analysis can be optimized for accuracy and efficiency. Terahertz reflection imaging (at frequencies ~0.1-10THz/1012Hz) is non-ionizing and has potential as a medical imaging technique; however, there is currently no consensus on the optimum imaging parameters to use and the procedure for data analysis. This may be holding back the progress of the technique. This article describes the use of various intelligent analysis methods to choose relevant imaging parameters and optimize the processing of terahertz data in the diagnosis of ex vivo colon cancer samples. Decision trees were used to find important parameters, and neural networks and support vector machines were used to classify the terahertz data as indicating normal or abnormal samples. This work reanalyzes the data described in Reid et al. (2011) (Physics in Medicine and Biology, 56, 4333-4353), and improves on their reported diagnostic accuracy, finding sensitivities of 90-100% and specificities of 86-90%. This optimization of the analysis of terahertz data allows certain recommendations to be suggested concerning terahertz reflection imaging of colon cancer samples.

Implementing transnational telemedicine solutions: a connected health project in rural and remote areas of six Northern Periphery countries Series on European collaborative projects.

Abstract This is the first article in a Series on collaborative projects between European countries, relevant for general practice/family medicine and primary healthcare. Telemedicine, in particular the use of the Internet, videoconferencing and handheld devices such as smartphones, holds the potential for further strides in the application of technology for the delivery of healthcare, particularly to communities in rural and remote areas within and without the European Union where this study is taking place. The Northern Periphery Programme has funded the ‘Implementing Transnational Telemedicine Solutions’ (ITTS) project from September 2011 to December 2013, led by the Centre for Rural Health in Inverness, Scotland. Ten sustainable projects based on videoconsultation (speech therapy, renal services, emergency psychiatry, diabetes), mobile patient self-management (physical activity, diabetes, inflammatory bowel disease) and home-based health services (medical and social care emergencies, rehabilitation, multi-morbidity) are being implemented by the six partner countries: Scotland, Finland, Ireland, Northern Ireland, Norway and Sweden. In addition, an International Telemedicine Advisory Service, created for the project, provides business expertise and advice. Community panels contribute feedback on the design and implementation of services and ensure ‘user friendliness’. The project goals are to improve accessibility of healthcare in rural and remote communities, reducing unnecessary hospital visits and travel in a sustainable way. Opportunities will be provided for comparative research studies. This article provides an introduction to the ITTS project and how it aims to fulfil these needs. The ITTS team encourage all healthcare providers to at least explore possible technological solutions within their own context.

Telestroke Assessment on the Move Prehospital Streamlining of Patient Pathways

Thrombolysis as a treatment for ischemic stroke is only indicated within the first 3 to 4.5 hours after onset of symptoms, and is more efficacious the earlier it is given.1,2 Patients must thus seek help, receive a clinical diagnosis, and reach a center of care for imaging and treatment without delay. This is a problem in remote and rural areas, leading to a relative disadvantage for rural dwellers: symptom-to-needle time is nevertheless often too long even for people in major urban centers. In the Scottish Highlands, for example, the total amount of time taken from calling for help, transfer to the nearest diagnostic center, undergoing computed tomography scanning to exclude contraindications to thrombolysis treatment, and then receiving thrombolysis often exceeds the 4.5-hour limit.3 The ambulance service reports that the more rural the patient’s location, the longer their response time is likely to be, reflecting the geography and road network as well as the limited number of vehicles.4 Even among patients with stroke in the Highlands who make it to hospital within the 4.5-hour thrombolysis window, mean times from onset to thrombolysis range from 130 to 210 minutes at the various hospitals audited, and <8% of patients with stroke actually receive the treatment at all.5 Scotland has a telestroke program run by the Scottish Center for Telehealth and Telecare, featuring 5 networks around the country.6 They use videoconferencing from the acute hospital site where local physicians can discuss their patients with specialists many miles away. This service has been running successfully since 2008, and thus the idea of using communications technology in stroke assessment is already in place and being successfully used. However, this service is hospital-based, providing support to smaller institutions rather than in prehospital situations. Initial code stroke systems were set up …

Combining transcranial ultrasound with intelligent communication methods to enhance the remote assessment and management of stroke patients: Framework for a technology demonstrator:

With over 150,000 strokes in the United Kingdom every year, and more than 1 million living survivors, stroke is the third most common cause of death and the leading cause of severe physical disability among adults. A major challenge in administering timely treatment is determining whether the stroke is due to vascular blockage (ischaemic) or haemorrhage. For patients with ischaemic stroke, thrombolysis (i.e. pharmacological ‘clot-busting’) can improve outcomes when delivered swiftly after onset, and current National Health Service Quality Improvement Scotland guidelines are for thrombolytic therapy to be provided to at least 80 per cent of eligible patients within 60 min of arrival at hospital. Thrombolysis in haemorrhagic stroke could severely compound the brain damage, so administration of thrombolytic therapy currently requires near-immediate care in a hospital, rapid consultation with a physician and access to imaging services (X-ray computed tomography or magnetic resonance imaging) and intensive care services. This is near impossible in remote and rural areas, and stroke mortality rates in Scotland are 50 per cent higher than in London. We here describe our current project developing a technology demonstrator with ultrasound imaging linked to an intelligent, multi-channel communication device − connecting to multiple 2G/3G/4G networks and/or satellites − in order to stream live ultrasound images, video and two-way audio streams to hospital-based specialists who can guide and advise ambulance clinicians regarding diagnosis. With portable ultrasound machines located in ambulances or general practices, use of such technology is not confined to stroke, although this is our current focus. Ultrasound assessment is useful in many other immediate care situations, suggesting potential wider applicability for this remote support system. Although our research programme is driven by rural need, the ideas are potentially applicable to urban areas where access to imaging and definitive treatment can be restricted by a range of operational factors.

Telesonography In Emergency Medicine : A Systematic Review

Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.

Remotely supported prehospital ultrasound: A feasibility study of real-time image transmission and expert guidance to aid diagnosis in remote and rural communities:

Introduction Our aim is to expedite prehospital assessment of remote and rural patients using remotely-supported ultrasound and satellite/cellular communications. In this paradigm, paramedics are remotely-supported ultrasound operators, guided by hospital-based specialists, to record images before receiving diagnostic advice. Technology can support users in areas with little access to medical imaging and suboptimal communications coverage by connecting to multiple cellular networks and/or satellites to stream live ultrasound and audio-video. Methods An ambulance-based demonstrator system captured standard trauma and novel transcranial ultrasound scans from 10 healthy volunteers at 16 locations across the Scottish Highlands. Volunteers underwent brief scanning training before receiving expert guidance via the communications link. Ultrasound images were streamed with an audio/video feed to reviewers for interpretation. Two sessions were transmitted via satellite and 21 used cellular networks. Reviewers rated image and communication quality, and their utility for diagnosis. Transmission latency and bandwidth were recorded, and effects of scanner and reviewer experience were assessed. Results Appropriate views were provided in 94% of the simulated trauma scans. The mean upload rate was 835/150 kbps and mean latency was 114/2072 ms for cellular and satellite networks, respectively. Scanning experience had a significant impact on time to achieve a diagnostic image, and review of offline scans required significantly less time than live-streamed scans. Discussion This prehospital ultrasound system could facilitate early diagnosis and streamlining of treatment pathways for remote emergency patients, being particularly applicable in rural areas worldwide with poor communications infrastructure and extensive transport times.

Supporting Novice Prehospital Transcranial Ultrasound Scanning for Brain Haemorrhage

Traumatic brain injury is a significant problem due to difficulties in early diagnosis in the field. Computed tomography is the gold standard for detecting brain haemorrhage, but scanners are bulky and expensive. A cheap, portable scanner such as transcranial ultrasound (TCUS) could allow early triage and intervention. Transmitting images to remote experts for diagnosis means TCUS could be used by any minimally trained person in the field. We propose a virtual 3-dimensional model of the head which shows which areas of the brain have been imaged already, where the probe currently is, and where still needs to be covered in order to generate a complete scan. Using sensors to measure the position and rotation of the TCUS transducer, we can link this to the 3D model of the head and visually display which areas have been imaged. The images can be analysed and composited to form a personalised 3D scan with maximal coverage of the brain, which can be transmitted for diagnostic review, reducing data loss compared with streaming ongoing images. Initial testing of the software has been performed in healthy volunteers and further testing is planned in patients with brain haemorrhage.