Global IR: Interventional Radiology in Developing Countries

Abstract

standardized approach to collecting pertinent data must be one of the first steps in building IR practice in LMIC. This database would illuminate regional differences in clinical demand and capacity. It would guide investments in health systems to create maximum development for IR-related care. Several efforts to meet this goal have emerged over the past decade for diagnostic radiology (DR). RAD-AID (rad-aid. org) is a nonprofit public service organization that began in 2008 to improve radiology resources for developing nations. In 2010 it began implementing a formalized assessment called Radiology-Readiness to determine the baseline capacity for radiology services among LMIC.9 Radiology-Readiness examines the availability of physical infrastructure, power supply, workforce, antibiotics, biopsies, and laboratory testing. More specific assessments, such as the IR Readiness Assessment Tool, have also been proposed.10 This tool collects information on imaging devices, procedural equipment, personal protective equipment, medications for periprocedural care, and affiliated medical services. Though it is yet unclear whether the scope of this tool will be sufficient, it constitutes a great starting point to assess the clinical and infrastructural capacity of a health care system interested in building a new IR service. As a parallel, the lack of baseline capacity data has also been a barrier for the development of essential surgical services in LMIC. To overcome this obstacle, the Lancet Commission on Global Surgery has partnered with multiple countries around the world to implement National Surgical, Obstetric, and Anesthesia Planning (NSOAP) to better characterize current resources and needs.11 A key step in this effort was the commission’s ability to bring together a diverse group of experts in the field to advise its creation. Its first meeting in 2014 included professors of surgery, anesthesiology, and obstetrics; directors of public health programs and human rights groups; and managers in the World Health Organization (WHO) and World Bank. One opportunity for IR would be to partner with the Lancet Commission and RAD-AID to coordinate efforts for broader procedural development in LMIC. Interventional radiology (IR) has grown remarkably in the United States over the past few decades. The expansion of minimally invasive image-guided procedures has brought with it a demonstrable improvement in patient outcomes. For example, percutaneous abscess drainage has shown reduced morbidity compared with operative management and become standard of care in many instances.1 It can also serve as a temporizing measure in critically ill patients with complex abscesses who are not surgical candidates.2 Several cost-effectiveness analyses provide evidence that image-guided techniques can also be more economical than the invasive alternatives, as demonstrated in studies of chest tubes,3 abscess drainage,4 biopsies,5 portosystemic shunting,6 central venous access,7 and uterine fibroid treatment.8 Despite these proven advantages of many IR procedures in high-income nations, the same sort of revolution in image-guided procedures has not occurred in lowand middle-income countries (LMIC). Global health is not a single disease issue—quite the opposite. It encompasses a variety of pathologies that cross national borders and require international response. With a fundamental set of techniques and tools, such as the Seldinger technique and a pigtail drainage catheter, IR may be able to treat an incredible variety of disease conditions found all over the globe. This article discusses the expansion of IR in LMIC, focusing on current barriers and opportunities for growth.