{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:51:20Z","timestamp":1784263880736,"version":"3.55.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010750","name":"Inn\u00f3vate Per\u00fa","doi-asserted-by":"publisher","award":["409-FIDECOM INNOVATEPERU-PVE-2017"],"award-info":[{"award-number":["409-FIDECOM INNOVATEPERU-PVE-2017"]}],"id":[{"id":"10.13039\/501100010750","id-type":"DOI","asserted-by":"publisher"}]},{"name":"medical innovation and technology"},{"DOI":"10.13039\/501100011871","name":"Pontificia Universidad Cat\u00f3lica del Per\u00fa","doi-asserted-by":"publisher","award":["Per\u00edodos de Investigaci\u00f3n 2020"],"award-info":[{"award-number":["Per\u00edodos de Investigaci\u00f3n 2020"]}],"id":[{"id":"10.13039\/501100011871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated \u201cpoor\u201d on 36.8% of exams, \u201cacceptable\u201d on 38.9% of exams, and \u201cexcellent\u201d on 24.3% of exams. Among telemedicine exams of \u201cacceptable\u201d or \u201cexcellent\u201d image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen\u2019s kappa of 0.84 (95% CI 0.7\u20130.98, p &lt;0.0001). Finally, among these teleultrasound exams of \u201cacceptable\u201d or \u201cexcellent\u201d image quality, the sensitivity for cholelithiasis was 93% (95% CI 68.1%-99.8%), and the specificity was 97% (95% CI 89.5%-99.6%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0255919","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T17:32:36Z","timestamp":1628703156000},"page":"e0255919","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":31,"title":["Testing telediagnostic right upper quadrant abdominal ultrasound in Peru: A new horizon in expanding access to imaging in rural and underserved areas"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1529-5097","authenticated-orcid":true,"given":"Thomas J.","family":"Marini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Oppenheimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy 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