Artificial Intelligence in Low- and Middle-Income Countries: Innovating Global Health Radiology.

Scarce or absent radiology resources impede adoption of artificial intelligence (AI) for medical imaging by resource-poor health institutions. They face limitations in local equipment, personnel expertise, infrastructure, data-rights frameworks, and public policies. The trustworthiness of AI for medical decision making in global health and low-resource settings is hampered by insufficient data diversity, nontransparent AI algorithms, and resource-poor health institutions' limited participation in AI production and validation. RAD-AID's three-pronged integrated strategy for AI adoption in resource-poor health institutions is presented, which includes clinical radiology education, infrastructure implementation, and phased AI introduction. This strategy derives from RAD-AID's more-than-a-decade experience as a nonprofit organization developing radiology in resource-poor health institutions, both in the United States and in low- and middle-income countries. The three components synergistically provide the foundation to address health care disparities. Local radiology personnel expertise is augmented through comprehensive education. Software, hardware, and radiologic and networking infrastructure enables radiology workflows incorporating AI. These educational and infrastructure developments occur while RAD-AID delivers phased introduction, testing, and scaling of AI via global health collaborations.

2016 RAD-AID Conference on International Radiology for Developing Countries: Gaps, Growth, and United Nations Sustainable Development Goals.

The 2016 RAD-AID Conference analyzed the accelerated global activity in the radiology community that is transforming medical imaging into an effective spearhead of health care capacity building in low- and middle-income countries. Global health efforts historically emphasized disaster response, crisis zones, and infectious disease outbreaks. However, the projected doubling of cancer and cardiovascular deaths in developing countries in the next 15 years and the need for higher technology screening and diagnostic technologies in low-resource regions, as articulated by the United Nations' new Sustainable Development Goals of 2016, is heightening the role of radiology in global health. Academic US-based radiology programs with RAD-AID chapters achieved a threefold increase in global health project offerings for trainees in the past 5 years. RAD-AID's nonprofit radiology volunteer corps continue to grow by more than 40% yearly, with a volunteer base of 5,750 radiology professionals, serving in 23 countries, donating close to 20,000 pro bono hours globally in 2016. As a high-technology specialty interfacing with nearly all medical and surgical disciplines, radiology underpins vital health technology infrastructure, such as digital imaging archives, electronic medical records, and advanced diagnosis and treatment, essential for long-term future health care capacity in underserved areas of the world.

Computed Radiography Photostimulable Phosphor Plate Receptors: Effect on Grid Conversion Factors.

BACKGROUND: Grid conversion factors were established for using grids with varying ratios for film-screen systems. Evidence from the physics community suggests that the relationship between grid conversion factors and exposure to the receptor does not apply with different types of digital imaging receptors. PURPOSE: To evaluate the relationship among analog grid conversion factors when using various grid ratios with a photostimulable phosphor plate (PSP) receptor system. METHODS: Three experiments were conducted using a range of grid ratios (6:1, 8:1, 12:1) to assess the effect of conversion factors on exposure indicators with a computed radiography PSP receptor. RESULTS: When using the analog grid conversion factors established for varying grid ratios with a PSP receptor and constant peak kilovoltage (kVp), the plate was overexposed with an exposure indicator outside the acceptable limits. CONCLUSION: The discussion of antiscatter grids in radiologic technologist literature should remain in the context of receptor type and digital imaging system being used so that technologists can make appropriate decisions about the use of grids while minimizing patient radiation dose. Calibrated grid conversions based on the digital systems in use and the radiologist's image quality preference could be created within radiology departments.

Copper Filtration and kVp: Effect on Entrance Skin Exposure.

BACKGROUND: The selection of technical factors to produce an image is driven primarily by the patient, body part, and factors regarding the status of that patient or part. Analog receptor systems are restricted by the ranges of data they are able to record, as well as the quantity and quality of data required to record an image. Using digital receptors allows for a wider range of exposure factors because of the nature of the receptor systems and the data processing methods employed. Thus, factor selection can be more patient centered when using digital receptors to produce a radiograph. PURPOSE: To explore the relationship between milliampere seconds (mAs), kilovoltage peak (kVp), and additional copper filtration with exposure indicators and entrance skin exposure (ESE) using both analog and digital receptors. RESULTS: Researchers conducted 2-tailed t-tests using Stata/IC version 11.2 software (StataCorp LP) to compare ESE from several trials using hip and knee phantoms. The analysis indicated that increasing kVp, adding 0.1 mm copper filtration, and correspondingly reducing mAs reduced ESE on a hip phantom by 64%, from 151 mR to 54.4 mR and reduced ESE on a knee phantom by 51%, from 27.2 mR to 13.4 mR. CONCLUSION: Radiology departments and radiologic technologists can consider these data when creating dose reduction protocols. The wider latitude range of digital radiography can be used to minimize patient exposure while still producing images of diagnostic quality within the acceptable exposure indicator range stated by the manufacturer.

Melanocortin peptides: potential targets in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease resulting in loss of self-tolerance with multiple organs, such as the kidney, skin, joints, and the central nervous system (CNS), being targeted. Numerous immunosuppressant therapies are currently being used for the treatment of SLE, but their clinical utility is somewhat variable because of the clinical heterogeneity. Melanocortins are a family of peptides derived from the common precursor protein pro-opiomelanocortin. These multifunctional peptides activate five subtypes of melanocortin receptors expressed on immune, skin, muscle, bone, and kidney cells and cells within the CNS. Melanocortin peptides have demonstrated a variety of biologic actions including immunomodulation, melanogenesis, and renoprotection. This review aims to introduce the melanocortin system and explore the mechanisms by which they may be beneficial in diseases such as SLE.

Shield placement: effect on exposure.

PURPOSE: In children, red marrow is present in the majority of bones, including the shafts of long bones. Shielding can reduce exposure to radiosensitive tissues adjacent to the collimated field of view. The goal of this study was to determine the shield placement for adjacent bone marrow (bone marrow that is not in the primary beam) that results in the greatest reduction in exposure during knee imaging. METHOD: Radiation exposure was measured with both an ion chamber and a cassette in 2 locations using a knee phantom. Location 1 was directly superior to the collimated field of view facing the primary beam on the anterior surface of the phantom. Location 2 was directly superior to the collimated field of view on the posterior surface of the phantom. Sources of exposure outside collimation include tube leakage, off-focus radiation, scatter radiation, and remnant primary radiation. RESULTS: Using an independent 2-tailed t test, it was determined that shielding in the first location resulted in a significant reduction in exposure outside of collimation. DISCUSSION: This study reinforced the finding that collimation does not entirely eliminate exposure outside the field of view. Shielding should be used in conjunction with collimation to reduce exposure as much as possible. Shielding on the surface of the patient facing the primary beam results in the greatest reduction in exposure outside of collimation. CONCLUSION: The importance of shielding as much pediatric long bone, and therefore, red marrow, as possible cannot be overstated. Shielding on the surface of the patient facing the primary beam provides the best decrease in exposure outside of collimation.