Turning a blind eye: the mobilization of radiology services in resource-poor regions

Abstract

While primary care, obstetrical, and surgical services have started to expand in the world's poorest regions, there is only sparse literature on the essential support systems that are required to make these operations function. Diagnostic imaging is critical to effective rural healthcare delivery, yet it has been severely neglected by the academic, public, and private sectors. Currently, a large portion of the world's population lacks access to any form of diagnostic imaging. In this paper we argue that two primary imaging modalities--diagnostic ultrasound and X-Ray--are ideal for rural healthcare services and should be scaled-up in a rapid and standardized manner. Such machines, if designed for resource-poor settings, should a) be robust in harsh environmental conditions, b) function reliably in environments with unstable electricity, c) minimize radiation dangers to staff and patients, d) be operable by non-specialist providers, and e) produce high-quality images required for accurate diagnosis. Few manufacturers are producing ultrasound and X-Ray machines that meet the specifications needed for rural healthcare delivery in resource-poor regions. A coordinated effort is required to create demand sufficient for manufacturers to produce the desired machines and to ensure that the programs operating them are safe, effective, and financially feasible.

Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students

“…[14] Although our training course performed in this study does not meet WHO's guidelines, Shah et al [18] and Maru et al [26] argues that focused applications of ultrasound may not require as much training as implicated by the WHO's guidelines and that "some degree of flexibility should be allowed to ensure that training does not interfere with treatment access". Furthermore, there is strong evidence that short term, intensive training can be both successful and sustainable for foreign physicians in developing countries.…”

Implementing Diagnostic Imaging Services in a Rural Setting of Extreme Poverty: Five Years of X-ray and Ultrasound Service Delivery in Achham, Nepal

“…For radiography, a World Health Imaging System for Radiology (WHIS-RAD) was purchased via the Spanish company Sedecal (Sedecal, Madrid, Spain). The total cost of deployment was US $51,500 with an additional operating cost of US $5,900 per year (4).…”

“…Subsequently, Possible developed protocols for machine maintenance, appropriate use, and image transfer for review by academic physicians in the United States. Possible's physicians and mid-level providers have used the machine for both obstetric and non-obstetric indications (4). In November 2010, after Possible took over health care operations at Bayalpata Hospital, a district-level hospital in Achham, diagnostic radiology services were expanded to include analogue radiography (9).…”

Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

“…Focused POCUS applications do not require as much training, and thus allow a degree of flexibility. If physicians could be trained in short courses, which will reduce their absence from clinical duties, while providing them with the most relevant US skills, 10 this would widen access to this very useful diagnostic modality.…”

“…Whereas patients' benefit from POCUS in affluent settings is mainly a reduced time to diagnosis and further management, POCUS in resource-constrained settings provides the additional benefit that it is frequently the only diagnostic imaging modality available. 9,10 This review first describes the development and application of "focused assessment with sonography for human immunodeficiency virus (HIV)-associated tuberculosis (TB)" (FASH), [11][12][13][14][15][16] which is the most widely studied and implemented application of POCUS in infectious diseases to date. Subsequently, other infectious diseases, endemic in tropical or resource-limited settings and accounting for significant morbidity and mortality in affected populations and for which POCUS has been investigated or for which POCUS may be a potential diagnostic tool, are reviewed and discussed.…”