Strategies to Decentralize Breast Ultrasound in Rwanda

Summary

Diagnosing breast cancer early is critical to reduce preventable breast cancer deaths in sub-Saharan Africa. This can be done in part through increasing patients' access to breast ultrasound, which is essential for evaluating breast masses. However, ultrasound is typically provided only by radiologists at urban referral hospitals. Training clinicians at rural district hospitals who are not radiologists could increase patients' access to breast ultrasound, but strategies to support and supervise these clinicians and ensure they are providing high-quality ultrasound services has not been studied.

This project will examine the effectiveness and cost of two strategies for training non-radiologist clinicians to perform breast ultrasound in Rwandan district hospitals.

Conditions

• Breast Cancer
• Early Detection of Cancer
• Ultrasonography

Interventions

BEHAVIORAL

Teleultrasound with Philips Lumify ultrasound probes and Reacts software

Clinicians at hospitals randomized to Arm 1 will be provided with Reacts licenses and trained to use Reacts with Philips Lumify devices immediately following the baseline training. Each hospital will be assigned to 2-3 radiologist supervisors (typically 1 Rwandan, 1 U.S.-based), with at least one available on each designated U/S clinic day to provide real-time teleultrasound mentorship. Clinician trainees scan the breast, document their independent findings and management plan in the study REDCap database, and then "call" the supervisor using Reacts. Reacts permits supervisor and trainee to see each other virtually; the supervisor can also view live U/S images and the trainee's probe and hand position to provide real-time feedback.

BEHAVIORAL

Asynchronous virtual feedback

Clinicians at Arm 2 hospitals will save static images, with or without video at clinicians' discretion, onto the Philips Lumify tablets. These will be uploaded to a secure internet-based folder with case descriptions, and assigned U.S.- and Rwanda-based experts will be notified that images are available. Experts will review images within 24 hours and email feedback to trainees on imaging quality/ technique and management; trainees can also email questions.

Sponsors & Collaborators

• Partners in Health

  collaborator OTHER

• Memorial Sloan Kettering Cancer Center

  collaborator OTHER

• University of Pennsylvania

  collaborator OTHER

• Harvard Medical School (HMS and HSDM)

  collaborator OTHER

• Obafemi Awolowo University

  collaborator OTHER

• Kaiser Permanente

  collaborator OTHER

• National Cancer Institute (NCI)

  collaborator NIH

• Brigham and Women's Hospital

  lead OTHER

Principal Investigators

• Lydia E Pace, MD, MPH · Brigham and Women's Hospital

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-04-01

Primary Completion

2028-07-01

Completion

2029-11-30

Countries

• Rwanda

Study Locations