CR in Haiti: Durability and Sustainability
In the wake of the January 2010 earthquake in Haiti, the US Navy deployed an emergency medical fleet, equipping it with an array of state-of-the-art onboard digital-imaging solutions. iCRco, a manufacturer of imaging solutions, provided these first responders with the ability to obtain DR images and diagnose patients’ problems on the spot using the company’s VertX CR system. In late 2011, iCRco reached out again, this time to Health4Haiti, a nonprofit organization that had established a presence in the country several years earlier and had been building a clinic in the city of Gonaives when the earthquake struck. Stephen Neushul, CEO of iCRco, says, “When the disaster in Haiti first happened, I knew I wanted to do as much as possible to help, but it was surprising that nobody seemed to want medical equipment—just money.” Health4Haiti contacted iCRco following the donation of an older radiography system manufactured by the company; the nonprofit group was trying to decide whether it could be used in place of its conventional film-based system. Neushul recommend that Health4Haiti choose an iCRco CR system over conventional analog radiography, enabling the organization to create high-quality digital images without the additional costs associated with film. John Smith, MD, president of Health4Haiti, says, “We were trying to get things lined up for a darkroom; iCRco recommended that we go digital, so we wouldn’t have to have a darkroom, film, and chemicals.” iCRco went a step further, donating two of its iCR3600 CR systems to the organization. “I believe that our machine is perfect for this setting,” Neushul says. “If you’re in Haiti, without consistent power and without a lot of access to service personnel, this is the machine for you.” Engineering Designed to Last Matt Changala, director of engineering for iCRco, notes that many CR systems are designed so that the plate is handled with every scan, leading to wear and tear that eventually requires the plate to be replaced. “The plate is like anything else. If you bend it enough times, it will begin to break down,” he says. The iCR3600 was designed with a single moving part; the phosphor plate never leaves the cassette, and the company says that users can anticipate getting at least 500,000 images out of a single plate, with no degradation of the digital plate. “We designed our system so that the plate is never handled,” Changala says, noting that many CR systems require plates to be run through rollers in the CR reader. “In addition to ensuring that the plate lasts longer, the design minimizes the chances that the plate will be dropped and damaged,” he adds. Neushul notes that one iCRco site in Argentina recently produced its 600,000th image using the company’s CR equipment, without a single plate replacement. “People have yet to make the distinction between everyday and industrial-grade technology in our industry, but it’s really important,” he says. He offers an analogy: “There’s industrial-grade printing and then there’s desktop printing. A desktop printer couldn’t produce 10,000 documents a day. It would break. Our CR system is an industrial-grade machine that can run all day, day in and day out, literally for years on end," he says. Evolving Needs More than two years after the magnitude 7.0 earthquake devastated much of Haiti, leaving 1 million to 1.8 million of its residents homeless, the focus for aid groups has shifted from immediate triage of the injured to long-term sustainability in the community. “This clinic serves about 20,000 people in the city, and our goal is to make it self-sustaining,” Smith notes. “The staff is actually seeing patients there year-round, as opposed to just a couple of weeks a year.” Neushul notes that a market without easy access to the kind of service personnel or biomedical-services teams available in the United States requires durable technology, which is why the company chose to send the iCR3600 units (which use True Flat Scan Path™ technology to ensure detector durability). “For Haiti, or anywhere that’s remote, our machines are going to do very well,” he says. “They can handle 300 patients a day, and the plates will hold up; the True Flat Scan Path technology doesn’t have the series of gears, belts, and motors that can cause maintenance issues.” Smith observes that in order for Health4Haiti’s Gonaives clinic to be self-sustaining in the future, it will have to begin making money at some point—and that imaging equipment, in Haiti as in the United States, has a role to play in ensuring its sustainability. “We can find equipment and supplies to be donated, and we have enough money to buy medicines, so we are able to keep the clinic in medical supplies,” he says, “but there are salaries to pay—we opened with a physician and a couple of nurses. With a CR machine running, the clinic can make revenue because physicians from other parts of the city will send patients to the clinic for imaging. Our hope is that the systems donated by iCRco will go a long way toward making this clinic self-sufficient.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.