Three U.S. radiologists who recently visited St. Petersburg, Russia, to assist with radiologic education came away with valuable lessons from Russian physicians adept at reaping the maximum benefits from an often limited pool of resources.
The second largest city in Russia, St. Petersburg is rich in art and culture, but often wanting for the funding, education and technology necessary to advance its healthcare system. Nevertheless, radiologists who visited the city through RSNA’s International Visiting Professor (IVP) Program left with a true appreciation for the high-quality work Russian physicians are performing despite the lack of resources and other challenges.
“I was impressed by how little physicians are compensated and the dearth of resources they have to do their jobs,” said Curtis E. Green, M.D., a professor of radiology and cardiology at the University of Vermont College of Medicine and an attending radiologist at Fletcher Allen Health Care, both in Burlington. “The Russian physicians could probably teach us a thing or two about making maximum use of our medical resources.”
Dr. Green was joined by Nafi Aygün, M.D., and Johnny Monu, M.D., for the two-week April trip to Russia. The RSNA IVP program annually sends highly regarded professors to lecture at national radiology society meetings and visit radiology residency training programs at select host institutions in or serving developing nations.
All on their first IVP expeditions, the radiologists lectured at various medical institutions, taught intensive seminars to radiology residents, attended various conferences and meetings, and participated in the Nevsky Radiology Forum, which is the second largest national radiology meeting in Russia.
While roughly 2 percent of the country’s budget is devoted to healthcare and many of St. Petersburg’s healthcare facilities and institutions are in need of repair, the physicians and the work they are doing are of the highest quality, the professors said. “The scientific work presented in the meetings I participated in was very sophisticated,” said Dr. Aygün, an associate professor of radiology at the Russell H. Morgan Department of Radiology and Radiological Sciences at Johns Hopkins University in Baltimore.
The medical institutions and facilities on the itinerary offered the professors an up-close look at the day-to-day workings of the city’s healthcare system. Dr. Green said the friendly, inquisitive staff and residents at Pavlov State Medical University and the Saint Petersburg Research Institute of Phthisiopulmonology, showed him some interesting—even surprising—cases.
“I was impressed by the number and severity of cases of tuberculosis (TB) they treat,” Dr. Green said. “Many of the patients come from central Asia and have multi-drug resistant TB. There is a 250-bed hospital devoted entirely to children with TB. It’s truly a devastating disease for these individuals.”
At the Mariinskaya Hospital, a well-received presentation on the diagnosis and management of TB of the spine led professors to the realization that the disease is still a major health issue in Russia, said Dr. Monu, a staff radiologist at the University of Rochester Medical Center and a professor at the University of Rochester, N.Y.
AIDS is another major healthcare issue in the country and public awareness is not as high as it should be, said Dr. Aygün, who lectured at the Nevsky forum, the Bechtereva Institute of the Human Brain of the Russian Academy of Sciences and the Center for AIDS and Infectious Diseases.
“Infections secondary to AIDS are much more common than in the U.S. and appear to overwhelm the capacity of healthcare delivery,” Dr. Aygün said. “On the other hand, at the research level, they are tackling the same problems we have, such as HIV-related cognitive impairment. In short, there is a dichotomy: high-quality work is being done in certain places, but overall standards aren’t as high and there seems to be a huge need for postgraduate CME.”
In terms of technology, the professors describe the radiology equipment as advanced but in relatively short supply. “The quality of equipment was good, but there were far fewer machines than we have here,” Dr. Green said. “For example, the thoracic hospital I visited—with more than 600 beds—had only two CT scanners. I think that much less use is made of each scanner and they seem to rely more on clinical evaluation rather than technology. This is not necessarily a bad thing, however.”
For example, one of the hospitals made extensive use of nuclear medicine perfusion scans of the chest to guide surgical resection of TB lung, Dr. Green said. “I have not encountered that here in the U.S., as surgery is rarely necessary due to our different patient population,” he said.
In fact, nuclear medicine is an area where Russia is excelling, according to the professors. Dr. Aygün said nuclear medicine techniques in neuroradiology are more sophisticated in Russian than in the U.S. “We saw very interesting applications of C11-Methionin-PET in central nervous system tumors as well as cryoablation of brain tumors,” Dr. Aygün said.
Salaries and educational opportunities for Russian radiologists vary dramatically from what U.S. radiologists experience, the professors said.
Residency training is just two years and the country doesn’t offer a formal fellowship program. Because education is sorely needed in all areas of radiology, specialty training could benefit greatly from exchanges with U.S. institutions, they concurred. “Two young fellows wanted to know how to continue their residencies in the U.S.,” Dr. Monu said.
Those who do earn medical degrees often find the salaries for available positions lacking. Although most doctors are employed at government institutions, many also work at private practices or even in other professions, Dr. Monu said. “Many medical doctors appear disenchanted with the system and some claim they may make a better living at other professions than being a doctor,” Dr. Monu said.
“One of our interpreters trained in OB but could quadruple his salary as an interpreter and so never practiced medicine after his residency,” Dr. Green said. “I have no idea what residents’ salaries are, but I am sure they must be quite low.”
Better access to educational materials is critical, according to the professors who say Russian physicians could greatly benefit from the resources available in the U.S, including those offered by RSNA. “Internet is very available in Russia, so access to learning materials from the RSNA would be helpful,” Dr. Monu said.
To meet the needs of radiologists from around the world including a growing number of members from Russia, RSNA is expanding its education resources to include over 600 online courses. For those unable to travel to RSNA 2013, the virtual meeting offers select sessions on-demand throughout the week of the meeting and the following week.
“I would love to see the U.S. sponsor some radiology residents or young faculty to spend a few weeks here,” Dr. Green said.
When not touring medical facilities, the professors found time to explore the beauty of St. Petersburg, which Dr. Green describes as a “very interesting city with stunning architecture, museums, statues and churches. It is amazingly European in ambiance.”
In terms of the Russian citizens, the professors left with a very favorable impression. “All the people were very warm and friendly and generally wanted to help,” Dr. Monu said. “My impression is that the average Russian is very proud of his or her country.”
The Russian IVP trip was hosted by the Nevsky Radiological Society and Philips Medical Systems. In 2014, IVP teams are scheduled to travel to Argentina, Brazil, Mexico, South Africa and Tunisia. q
For more information on the RSNA International Visiting Professor Program, go to RSNA.org/International_Visiting_Professor_Program.aspx. Applications for the 2015 IVP program will be posted in late summer 2013.
The IVP program is made possible by the support of Agfa HealthCare and Fujifilm Medical Systems.
RSNA will offer a new series of informal discussions at its 2013 Annual Meeting, “Navigating RSNA 2013.” Suggested for first-and second-time meeting attendees, these discussions will be presented in various languages, including Russian. The Russian discussion is scheduled for 7:30-8 a.m., Monday, December 2, at the Global Connection booth, part of the RSNA Services Area and located in the Lakeside Center Ballroom (Level 3) at the McCormick Place Convention Center.
First-time attendees may find their experience at the RSNA Annual Meeting to be overwhelming given the large number of education and networking opportunities, and exciting activities Chicago has to offer. The leaders of “Navigating RSNA 2013” are experienced RSNA meeting attendees and will provide advice about cultural insights, the RSNA Annual Meeting and the city of Chicago in an effort to make attendee’s experience the best possible.
For more information about “Navigating RSNA 2013” and the Global Connection Booth, visit RSNA.org/Global_Connection.
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