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  • Radiologists Seek Global Healthcare Solutions

    Imaging is making strides in providing outreach programs to underserved areas across the world, but obstacles remain. By Shelley Taylor


    June 1, 2017

    St Luke
    RSNA IVP team members Teresita L. Angtuaco, MD, (third from left), Robert D. Harris, MD, MPH, (center) and Sheila Sheth, MD, (second from right) traveled to the Philippines in 2016.
    Rad Aid
    Director of RAD-AID Cape Verde Program, Robin N. Sobolewski, MD, at Centro de Saude in Mosteiros, Ilha do Fogo, Cape Verde. (Source: RAD-AID International)
    Global Health
    Sister Angela (right), pictured with a medical student, is the nurse midwife at Nawanaygo Health Centre III in Uganda, and has been trained through Imaging the World’s (ITW) ultrasound training program to perform and interpret ultrasound at the point of care. (Source: ITW)


    The World Health Organization estimates that two-thirds of the world lacks access to basic medical imaging services, and that gap leads to large-scale healthcare deficiencies in those regions.

    Radiology should think more globally, according to Kristen K. DeStigter, MD, professor of radiology at the University of Vermont, Burlington, chair of the RSNA Committee on International Radiology Education (CIRE), and president and co-founder of Imaging the World (ITW). “The goal should be to focus more on opportunities for education, research and implementation of clinical best practices in underserved locations,” she said.

    Several organizations — including RSNA, RAD-AID International (RAD-AID) and ITW — have developed outreach programs that enhance radiology capabilities worldwide.

    “RSNA has been a trailblazer in clinical care internationally,” said Matthew P. Lungren, MD, assistant professor of radiology at the Stanford University Medical Center and Stanford Child Health Research Institute Faculty Scholar. “Seeing how RSNA supports this endeavor illustrates how important global radiology really is.”

    But any organization tackling global radiology outreach faces numerous obstacles, notably a lack of sustainability and infrastructure, experts agree.

    “Certainly there are areas where progress is being made,” said Robert D. Harris, MD, MPH, clinical professor of radiology in the Division of Body Imaging at the University of Iowa Carver College of Medicine in Iowa City. “It’s kind of a slow process, and sometimes you go backward before you can go forward.”

    Tackling those barriers is no small feat. While a number of programs are working to provide outreach, a paradigm shift is needed from donating equipment to assessing specific needs and developing solutions, according to Dr. Lungren. For example, hospitals may have imaging equipment that sits broken and unused because maintenance contracts are non-existent or too expensive.

    Dr. Harris, who was a member of the RSNA International Visiting Professor (IVP) team that traveled to the Philippines in 2016, has been taking similar trips for 10 years. He traveled to Nicaragua in 2006 with an informal group of radiologists and later took several trips to Haiti through the American College of Radiology International Outreach Program and Partners in Health. He also spent 11 months in Kigali, the capital of Rwanda, where he experienced first-hand the problem of sustainability with expensive imaging equipment.

    “We had a nice CT scanner, but it broke one time. They knew what was wrong, but they didn’t have a service contract, so it lay broken,” he said. “They didn’t have a CT scanner for two months in the biggest public hospital in Kigali,” Dr. Harris noted.

    Capacity Building is Key to Sustainability

    As radiology builds infrastructure in areas of need, the goal is sustainability, according to Dr. DeStigter. “We must establish programs and processes that allow radiology teams in resource-insecure countries to function independently,” she said. “Our role is to help with capacity building and capability strengthening — establish best practices for quality and safety, develop teach the teacher and continuing education programs, establish reliable communication networks, guide financial models that will work for the long run — and then to leave.”

    ITW was founded with these principles in mind, and the organization is currently integrating ultrasound services in clinical facilities throughout rural Uganda.

    Recognizing the need for capacity building led Daniel J. Mollura, MD, to create RAD-AID, a nonprofit platform operating in 25 low-resource countries at 44 hospitals abroad to increase and improve radiology. RAD-AID enables U.S. and Canadian academic radiology institutions to establish chapters for conducting outreach projects in underserved parts of the world. The 56 chapters receive project guidance, logistical travel support, educational tools, funding, equipment, and legal assistance.

    “Because radiology is such a structural backbone for all of the other specialties, if you don’t have effective radiology in low-resource countries, you have a systematic gap in all of healthcare and that becomes a global healthcare problem,” said Dr. Mollura, president and CEO of RAD-AID. “That gap propagates out into deficiencies in caring for cancer, delivering babies and undergoing surgery safely.”

    A key factor in capacity building, however, is ensuring that the programs meet the unique needs of each location. When programs are targeted appropriately, they end up looking very different from one region to another.

    “It doesn’t make sense to donate mammography machines in a place that can’t take care of breast cancer patients, or CT scanners where there’s no electrical grid,” Dr. Mollura said.

    The Case for a Global Radiology Subspecialty

    One solution proposed by Dr. Lungren and others is to establish global radiology as a subspecialty, which could create a systematic approach to education and training, providing radiologists with the skills required to address the needs of low-resource countries. Dr. Lungren and colleagues wrote an editorial on the topic that was published in the November 2016 issue of the Journal of Global Radiology.

    Developing competency in global radiology requires much more than “a few electives in infectious disease imaging,” Dr. Lungren said. “A dedicated curriculum would provide people who have the passion and desire to do this work with the tools and knowledge they need to understand some of the stakeholders and responsibilities related to the radiology enterprise.”

    He said there are two ways to approach this — either build the information into a curriculum or develop fellowships — which both face logistical and financial challenges. But as interest in global radiology grows among trainees, he believes more residency programs will adopt the concept.

    “In my opinion, a comprehensive global health imaging curriculum is the only sustainable and responsible way forward to successfully address the worldwide lack of access to medical imaging,” Dr. Lungren said.

    Importance of Cultural Context

    Yet fundamental differences persist in the way radiology is practiced in different parts of the world. That is why Dr. DeStigter emphasizes the importance of understanding factors including socioeconomic conditions, political tenor and cultural beliefs, all of which impact the implementation and success of a radiology program.

    “The cultural context with which we practice radiology in any one place is so important to the success and to the sustainability of a program,” she said. “Those are the pieces that are often forgotten.”

    Dr. Harris agrees. “You have to adjust your thinking. You can’t have western-styled expectations,” he said.

    International Radiology Outreach Programs Aid the World

    RSNA’s international outreach programs include:

    • The International Visiting Professor program sponsors teams of visiting professors to teach at hospitals and radiology society meetings around the world.

    • The RSNA Derek Harwood-Nash International Fellowship provides the opportunity for promising international radiology scholars to study at North American institutions.

    • The Introduction to Research for International Young Academics program invites young radiologists from countries outside the U.S. and Canada to learn about careers in academic radiology. The four-day seminar takes place at the RSNA annual meeting. Learn more about RSNA’s international programs at RSNA.org/International.

    • CIRE will sponsor a course titled, “Equipment in the Global Radiology Environment: Why We Fail, How We Could Succeed” at RSNA 2017.

    Imaging the World is a nonprofit organization that integrates technology, training and community to bring medical expertise and high-quality
    imaging to remote and under-served areas worldwide. Learn more at imagingtheworld.org.

    RAD-AID International’s mission is to increase and improve radiology resources in the developing and impoverished countries of the world.
    The nonprofit organization operates in 25 countries with over 7,000
    volunteers. Learn more at rad-aid.org.




    DeStiger
    DeStigter

    Lungren
    Lungren

    Harris
    Harris

    Mollura
    Mollura




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