Radiology in Uzbekistan and Beyond: Leveraging Telemedicine With MSF
Programs like Médecins Sans Frontières (MSF), also known as Doctors Without Borders, do invaluable work in bringing advanced medical care to developing and unstable nations. Often overlooked, however, is the role that radiology plays. As the diagnostic specialty, radiology can be critical in clinical scenarios where imaging plays an essential role, according to Saskia Spijker, radiographer with MSF International. “Diagnostic imaging is an area within MSF that has seen significant growth in the past few years and is a core element of the diagnostic services provided by MSF in the communities where we work,” Spijker says. “Worldwide, our tuberculosis (TB)/HIV, surgical, trauma, and emergency obstetric programs use both radiography and ultrasound to assist in diagnosis and therapy for our patients.” Remote Expertise In her role, Spijker advises on all aspects of medical imaging for MSF field projects, ensuring that image quality remains high, that local radiographers are adequately trained, and that the equipment selected is appropriate, she explains. From some projects, images are then transmitted digitally to be read remotely by radiologists. Recently, Virtual Radiologic (vRad) saw an opportunity to help. Michael Vollmer, vice president for business development in vRad’s Zurich office, says, “It’s becoming so easy to report from anywhere to anywhere. We decided to contact some of these humanitarian efforts to see if they had a need for our services, and MSF responded right away, saying they were looking at telemedicine and teleradiology as steps toward providing services remotely.” Brad Snyder, MD, vRad’s medical director, adds, “One of the things that struck us early on about teleradiology, and one of its biggest advantages, is that it increases access to care for underserved communities. The same model that works in rural South Dakota works for communities isolated by politics, poverty, or violence. This is a model that you can apply to any number of situations and places.” At the moment, 20 vRad radiologists are volunteering their time to read difficult cases from an MSF project based in Uzbekistan. “Multidrug-resistant TB is becoming endemic there, and as the disease becomes desensitized to certain antibiotics, treatment options diminish, creating the danger of a world health crisis,” Snyder explains. “MSF has installed a DR system at a government hospital there so that patients with TB can be monitored using radiographs of the chest. Those images are transported to a location with Internet access, uploaded to the vRad system, and routed to the radiologists by our support staff.” Unique Challenges The Uzbekistan project highlights some of the unique challenges inherent in bringing imaging services to developing nations. The hospital where the CR system is located lacks Internet access, so images need to be downloaded to a memory stick and transported to the MSF office—often, on foot—before being uploaded. Another complication is equipment. “A reliable and regular power supply is needed, as well as good road access to deliver the equipment,” Spijker notes. “Consideration also needs to be given to the space in which we install the equipment, to ensure it adheres to radiation-safety standards.” For these reasons, financial donations can make a big difference to a community-health project, but donations of time are also critical, Spijker says. “We highly prioritize training provision for radiography technicians to ensure that diagnostic quality remains high and radiation practices remain safe,” she says. “Training for our physicians and midwives in ultrasound is also important; a portable ultrasound system is easy to deliver, but its use is highly dependent on operator skill. Training visits by radiologists—to build the capacity of our physicians and clinicians in x-ray interpretation—are also incredibly valuable.” Looking Ahead Moving forward, vRad hopes to collaborate with MSF on future projects (including new services to the Central African Republic and Uganda), even as the company works to refine its approach to helping with the images from Uzbekistan. “We just sent one of our radiologists over to see how it’s going—how they’re benefiting or not benefiting—and to understand where the bottlenecks are,” Snyder says. “We want to understand how we can do better as we expand this model to other places.” Spijker stresses that the participation of parties such as vRad is invaluable in providing exceptional care. “We strive to improve field access to specialized clinical support through the promotion of teleradiology services,” she says. “The specialized support is very valuable to MSF and to the communities in which we work.” Snyder says that vRad has also looked at independently applying the same donation of time and expertise to underserved communities in the United States. vRad is investigating how to scale up its offerings effectively, enabling the company to broaden its service to underserved populations worldwide. “This is an exciting collaboration, and we love being affiliated with MSF,” he says. “It’s a small world, and we’re all neighbors.” Cat Vasko is editor of Medical Imaging Review and associate editor of Radiology Business Journal.