WASHINGTON — A completely automated ultrasound scanning system mixed with synthetic intelligence–based mostly illness exercise scoring carried out in addition to knowledgeable rheumatologists in hand joint evaluation of sufferers with rheumatoid arthritis (RA), new analysis discovered.
The system, made by a Danish firm referred to as ROPCA, contains an ultrasound scanner referred to as ARTHUR (RA Ultrasound Robotic) that interacts straight with the affected person and scans 11 joints per hand and a neural community–based mostly software program system, DIANA (Analysis Assist Community for RA), that evaluates the pictures and displays RA exercise.
The mixed system classifies the diploma of RA based on the joint European Alliance of Associations for Rheumatology (EULAR)-Final result Measures in Rheumatology (OMERACT) requirements for RA prognosis. It obtained a CE Mark in Europe in 2022 and is at the moment in use in six rheumatology clinics in Denmark, Germany, Switzerland, and Austria, with extra to come back, ROPCA Co-founder and Chief Medical Officer Søren A. Simply, MD, informed Medscape Medical Information.
“Automated programs may assist rheumatologists within the early detection and monitoring of arthritis illnesses. Methods may be positioned or transfer in areas with inadequate rheumatological experience,” Simply stated throughout a particular late-breaker session presentation on the American College of Rheumatology (ACR) 2024 Annual Meeting.
He informed Medscape Medical Information, “At present, there are such a lot of folks referred and few and fewer rheumatologists. So we have to suppose in a different way. We want good automated assistants.” As a screening instrument, the system can decide whether or not an individual with hand ache has RA or simply osteoarthritis “and in addition may give the affected person a right away reply, as a substitute of ready generally as much as 6 months to get the data.”
Simply, who can also be a senior doctor within the Division of Inside Medication at Odense College Hospital, Odense, Denmark, stated that his division can also be utilizing the system to evaluate flares in sufferers with established RA. “They will have a blood pattern taken. They’re scanned by the robotic, and you’ll see if there may be any illness exercise. However I feel that screening of sufferers with joint ache is the start.”
Requested to remark, session moderator Gregory C. Gardner, MD, Emeritus Professor within the Division of Rheumatology on the College of Washington, Seattle, and a member of the ACR convention program committee, informed Medscape Medical Information “one of many causes we selected to characteristic this summary is as a result of we’re concerned about science on the convergence. We actually thought this was a possible technique to transfer the sector ahead for rheumatologists.”
Gardner stated it’s a bonus that the affected person may probably have an ARTHUR scan with a DIANA report and get blood checks finished previous to a go to with the rheumatologist. “It’s actually time-consuming for a human to do these research, so in case you automate it, that’s a step ahead when it comes to having the information obtainable for the rheumatologist to view and use sequentially to comply with how sufferers are doing.”
When introducing Simply’s presentation, Gardner referred to as it “the best summary of the assembly.”
Each DIANA and ARTHUR Carried out At Least as Nicely as Human Rheumatologists
Within the examine, 30 sufferers with RA underwent two scans by ARTHUR, adopted by a scan from a rheumatologist specialist in musculoskeletal ultrasound. The scans have been despatched to DIANA, who graded the pictures based on the International OMERACT-EULAR Synovitis Rating, as did the human rheumatologist.
A “floor fact” was established by one other human knowledgeable who evaluated each ARTHUR’s and the opposite rheumatologist’s photos, blinded to the scanning technique. The picture with the very best illness exercise was deemed “floor fact,” and settlement with that was assessed for the 2 particular person strategies.
Simply confirmed a video of a affected person being scanned by ARTHUR. The machine verbally guided her by eradicating her jewellery, making use of the gel, and inserting her hand on the display underneath the scanner. ARTHUR’s arm moved round on the affected person’s hand, finding the perfect angles to take grayscale photos and Doppler photos and Doppler video. The scan takes 15-20 minutes, and the pictures are saved, Simply stated.
The examine sufferers had a imply age of 65 years, and 23 of the 30 have been males. Their common illness length was 11 years, and imply Illness Exercise Rating in 28 joints utilizing C-reactive protein was 3.86, indicating average illness. A majority (73%) of sufferers have been taking disease-modifying antirheumatic medication, and about one third have been taking biologics. ARTHUR scanned a complete of 660 joints, and 564 scans have been profitable.
For repeatability between the 2 ARTHUR scans, % precise settlement was 63% for synovial hypertrophy, 75% for Doppler exercise, and 60% mixed. P.c shut (inside a degree) agreements have been 93%, 94%, and 92%, respectively. Binary agreements as as to if the joint was wholesome vs diseased have been 88%, 91%, and 85%, respectively.
On the joint stage, ARTHUR and DIANA’s % precise settlement with floor fact was 49% for synovial hypertrophy, 63% for Doppler exercise, and 48% mixed. Binary agreements with illness vs wholesome have been 80%, 88%, and 78%, respectively.
The human rheumatologists scored very equally. P.c precise settlement with floor fact was 51% for synovial hypertrophy, 64% for Doppler exercise, and 50% mixed. P.c shut agreements have been 94%, 94%, and 92%, respectively. And binary agreements with diseased vs wholesome have been 83%, 91%, and 80%, respectively.
On the affected person stage (all joints mixed), ARTHUR and DIANA’s binary illness evaluation of wholesome vs illness confirmed settlement with the bottom fact of 87% for synovial hypertrophy, 83% for Doppler exercise, and 87% mixed. Right here, the rheumatologists scored decrease, at 53%, 67%, and 60%, respectively.
“On this examine, we expect the precision of ARTHUR and DIANA was akin to that of an skilled rheumatologist, at each the joint and affected person stage,” Simply stated.
Gardner identified one other benefit of the system. “DIANA doesn’t get fatigued…With human studying, the precision might change based mostly on the time of day or stress stage…However with DIANA, you’re going to get constant data.”
Simply stated that the Arthritis Basis in Germany just lately put ARTHUR and DIANA on a bus and took it to cities that lacked a rheumatologist. Sufferers lined up, answered a questionnaire, had blood drawn, and obtained their scans. A rheumatologist on the bus then interpreted the information and consulted with the people about their RA threat. “Within the final journey, we screened 800 sufferers in 6 days. So there are positively prospects right here.”
Simply is co-owner of ROPCA. Gardner had no disclosures.
Miriam E. Tucker is a contract journalist based mostly within the Washington, DC, space. She is an everyday contributor to Medscape Medical Information, with different work showing within the Washington Put up, NPR’s Photographs weblog, and Diatribe. She is on X: @MiriamETucker.
