Radiologists in crisis-affected, vulnerable countries grappling with substantially unmet imaging needs are desperate for global outreach programs to help meet those deficiencies.
That was the finding of a survey of radiologists in developing countries across Asia, Europe and South America, assessing imaging needs and seeking input on the most effective ways to improve the situation. The survey was conducted by Bhavya Rehani, M.D., a clinical assistant in neuroradiology at Massachusetts General Hospital in Boston, as part of research presented at RSNA 2013, “Making Imaging around the World Better: Global Survey of Radiologists in 10 Countries.”
“Our survey shows the immense need for radiologists and formal training programs in developing countries,” Dr. Rehani said. “Although humanitarian teleradiology has been recently given emphasis and offers hope, high demand may limit use due to lack of sustainability. Our results show that the focus should be on creating innovative interactive online teaching modules and building training programs.”
Seeking input on their imaging needs, Dr. Rehani sent a standardized online questionnaire to 26 radiologists from 18 nations across the world. To choose which countries to survey, Dr. Rehani based her selection on the International Monetary Fund’s World Economic Outlook Report, April 2012, and World Bank data. Radiologists from Belarus, Sri Lanka, Thailand, Burma, Macedonia, Costa Rica, Czech Republic, Lithuania, Tanzania, Slovenia and Serbia responded.
“The need for more radiology residency training programs in their respective countries was expressed by 88 percent of the radiologists in our survey,” Dr. Rehani said. “A total of 96 percent of the radiologists expressed need for more subspecialty training in their country.”
A sample question on radiation safety knowledge revealed the critical need for better training. Respondents were asked: “If a patient underwent a chest CT and plain abdomen X-ray in the last two weeks and has been found to be pregnant now, will you ask for termination of pregnancy?”
“The correct answer is ‘No’ as this is very a small dose to ask for termination of pregnancy,” Dr. Rehani said. “However, multiple anonymous responses answered: ‘Yes.’ Thirty percent of radiologists responded that they don’t have availability of colleagues who can provide advice on radiation dose and radiation risk issues. This throws further light on the need for more radiation safety training globally.”
“Given the immense unmet imaging needs, our survey helped us prioritize and triage the areas of most weakness, so that we can specifically focus our efforts on those areas for maximum impact,” Dr. Rehani said.
Along with data assessment, surveys such as Dr. Rehani’s are vital for properly designing global health outreach efforts, said Daniel Mollura, M.D., founder of the Washington D.C. -based RAD-AID International, a nonprofit organization dedicated to increasing international radiology services in developing countries and optimizing radiology for public health initiatives.
RAD-AID developed a comprehensive multifaceted assessment tool, “Radiology-Readiness,” to assess needs and strategies for implementing radiology in resource-limited regions.
“Because imaging capabilities and needs are as diverse as the countries in which we have partners, a ‘one size fits all’ approach to medical imaging outreach—such as that used with large capital equipment donation—is not clinically practical or cost-effective,” Dr. Mollura said. “Instead, the Radiology-Readiness assessment is invaluable in ensuring that the right collaborative medical imaging program is put into place and that sustainable implementation is possible, and eventually, scalable.”
Currently, the Radiology-Readiness tool is the standard for the World Health Organization’s Pan American Health Organization (WHO/PAHO) and has been translated into Spanish to serve member countries in the technical partnership between the institutions.
Countries across the world are already benefitting from the outreach. One of the first RAD-AID programs built from the ground up by the Radiology-Readiness Tool is the Asha Jyoti Women’s Health Program in Northern India. The program received a Champions of Action Plenary Session Award of the Clinton Global Initiative for its innovative women’s health outreach program in Chandigarh.
“Since 2012, our team of radiologists, technologists and local partners have screened more than 4,000 women in our mobile health van for osteoporosis, breast and cervical cancer—three of the biggest public health needs facing impoverished women in Northern India,” Dr. Mollura said.
Another example of the organization’s work was filling the need for digital imaging solutions in Africa, which led to RAD-AID’s implementation of PACS in Korle Bu Hospital of Ghana, Dr. Mollura said.
When an assessment revealed a need for radiologic technologist education and educational loan finance in Kenya, the organization partnered with the Deutsche Bank Foundation and Kenya Medical Training College to begin structuring educational tracks for technologists. WHO-endorsed training in Kenya via RAD-AID’s team was set to begin in June 2014, Dr. Mollura said.
Additionally, Radiology-Readiness assessments have guided RAD-AID’s program in Haiti, mainly in terms of education and clinical aid for hospitals rebuilding after the 2010 earthquake. As a result, the American Medical Association awarded the organization the Community Service Award in 2013 with the following quote: “Our governing council was thoroughly impressed with the impact of RAD-AID on the global practice of radiology and medical imaging outreach.”
“The key is to empower radiologists locally for long-term sustainability rather than short-term solutions,” Dr. Rehani said. “The more radiologists who can join hands in helping colleagues in developing countries the better.”
RSNA helps meet training and resource needs throughout the world with its International Visiting Professor program. IVP teams comprising North American professors have traveled to 43 developing nations to lecture at radiology meetings and work one-on-one with radiology residents in local hospitals. Professors and radiologists in the countries visited all call the experiences “eye opening,” “useful” and “exciting.”
Among those who have served in the IVP program is Teresita L. Angtuaco, M.D., a professor of radiology and director of the Division of Imaging at the University of Arkansas for Medical Sciences and now chair of RSNA’s Committee on International Radiology Education (CIRE). During Dr. Angtuaco’s visit to Thailand in 2010, the IVP group was asked to help improve the country’s seven radiology residency programs. She noted that all seven of the country’s residency program directors were in attendance at meetings and were eager to learn from their North American counterparts. “Interactive relationships are the most important things we can offer in our education programs,” she said.
Felicia Dechter is a Chicago-based freelance writer.
As part of RSNA’s partnership with the Radiological and Diagnostic Imaging Society of São Paulo (SPR) the RSNA booth traveled to Brazil for the 44th Jornada Paulista de Radiologia (JPR) in May. In August, RSNA News will feature photos and a report on the meeting which drew more than 5,000 attendees.
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