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Vital Signs

Student from Serbia brings ultrasound to his homeland

Getting an ultrasound, MRI, or CT scan—technologies taken for granted in industrialized nations—is unheard of in remote and impoverished parts of the world. Even when such procedures could save a life, they're simply unavailable. Veljko Popov, a fifth-year M.D.-Ph.D. student at DMS, has been chipping away at this disparity for a few years now, with the assistance of Robert Harris, M.D., director of ultrasound at DHMC.

In 2002, Popov and Harris began investigating the feasibility of transmitting ultrasound images from Popov's hometown—Zrenjanin, Serbia—to DHMC for interpretation. With a grant from the Dartmouth International Health Group, the pair traveled to Zrenjanin to set up a basic computer infrastructure in a local hospital and to conduct preliminary tests.

The people of Zrenjanin are "a population to which I felt in debt, to whom I felt sorry for after all those years of suffering and political and social crises," says Popov, who emigrated from Serbia in 1995, during its war with Bosnia. This project is a way to give back to the community he left behind.

Unit: In January 2004, Popov and Harris returned to Zrenjanin with a compact, portable sonography unit, donated by DHMC's Department of Radiology, and began collecting ultrasound images of patients. They used 50 of the images in a study to compare the quality of transmitted scans—compressed so they could be emailed—with the original, uncompressed images. They found the quality to be comparable and the overall process feasible—not to mention inexpensive.

Ultrasound is an ideal form of imaging to use in remote and resource- poor countries, say Popov and Harris. After x-rays, ultrasound is the most widely used diagnostic tool worldwide. It does not use ionizing radiation, so safety concerns are minimal; it produces low-resolution images that are e-mailable; and the equipment is portable and relatively cheap—from $5,000 to $20,000 per unit. By comparison, a simple x-ray machine costs about $75,000; a CT scanner, at least $500,000; and an MRI machine, about $1 million.

"It's hard to put an MRI machine in a little village in Africa," says Harris. But "it's easy to take a compact ultrasound [unit], because you can move that around [from] village to village, house to house." Harris and Popov are now seeking discounted or gratis satellite transmission links because, as Popov explains, "there are only so many remote locations that have terrestrial internet links."

There is also a domestic aspect to Harris and Popov's international initiative. They look on the project as a pilot for

Popov, left, and Harris, right, have been working on an international imaging project together since 2002.

figuring out how physicians can consult from afar during mass emergencies or natural disasters in the U.S.—"to examine large numbers of people in settings that are not necessarily hospital-based," says Popov. To develop this concept, the pair is collaborating with Dartmouth engineering professor Susan McGrath, Ph.D., who specializes in mobile computing systems.

Ultimately, Popov and Harris would like to export what they learn in Serbia to DMS initiatives in other parts of the world and to other medical schools.

Remote: Popov recently told the international news outlet Voice of America (VOA) that he believes many radiologists will donate their time to such efforts. "One goal of this project was to enable physicians who want to do humanitarian and philanthropic work but who cannot necessarily travel to remote areas and third world locations to still be able to do this work remotely," Popov told VOA. "This was started as a humanitarian project, and it depends on the good will of . . . the physicians of this country."

Jennifer Durgin

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