Kristen K. DeStigter

White Paper Report of the RAD-AID Conference on International Radiology for Developing Countries: Identifying Challenges, Opportunities, and Strategies for Imaging Services in the Developing World

The RAD-AID Conference on International Radiology for Developing Countries was an assembly of individuals and organizations interested in improving access to medical imaging services in developing countries where the availability of radiology has been inadequate for both patient care and public health programs. The purpose of the meeting was to discuss data, experiences, and models pertaining to radiology in the developing world and to evaluate potential opportunities for future collaboration. Conference participants included radiologists, technologists, faculty members of academic medical institutions, and leadership of nongovernmental organizations involved in international health care and social entrepreneurship. Four main themes from the conference are presented in this white paper as important factors for the implementation and optimization of radiology in the developing world: (1) ensuring the economic sustainability of radiologic services through financial and administrative training support of health care personnel; (2) designing, testing, and deploying clinical strategies adapted for regions with limited resources; (3) structuring and improving the role of American radiology residents interested in global health service projects; and (4) implementing information technology models to support digital imaging in the developing world.

Challenges and Opportunities in Restructuring Radiology Residencies: The APDR Residency Restructuring Committee Report

Changes to the ABR certification process are imminent, with a core examination after 36 months of training and a certifying examination 15 months after the completion of training replacing the current examination structure for residents entering training in July 2010 and beyond. The Residency Restructuring Committee of the Association of Program Directors in Radiology was developed to analyze the challenges and opportunities of these upcoming changes and provide recommendations to programs. The guidelines included in this article represent a summary of the work of this committee to date.

White Paper Report of the 2010 RAD-AID Conference on International Radiology for Developing Countries: Identifying Sustainable Strategies for Imaging Services in the Developing World

The 2010 RAD-AID Conference on International Radiology for Developing Countries was a multidisciplinary meeting to discuss data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services reduce health care quality. The theme of this years conference was sustainability, with a focus on establishing and maintaining imaging services in resource-limited regions. Conference presenters and participants identified 4 important components of sustainability: (1) sustainable financing models for radiology development, (2) integration of radiology and public health, (3) sustainable clinical models and technology solutions for resource-limited regions, and (4) education and training of both developing and developed world health care personnel.

A Low-Cost Ultrasound Program Leads to Increased Antenatal Clinic Visits and Attended Deliveries at a Health Care Clinic in Rural Uganda

Background In June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics. Methods and Findings Records at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit) were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3–20.6, 95% CI) from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3–111.5, 95% CI) from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits. Conclusions The availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.

Low-Cost Teleradiology for Rural Ultrasound

In under-resourced communities, there are several preventable pregnancy complications that can lead to significant maternal or perinatal morbidity and mortality when left untreated. The lack of access to prenatal imaging is one of many factors that contribute to the greater mortality rates in such populations. Analysis of the most common complications suggest that even limited access to obstetric ultrasound imaging could have a positive impact, particularly in a rural context in which imaging can prompt transport of the patient to a capable facility. The authors describe their work to establish and validate an obstetric care model in Uganda, and the design and for a clinical study to measure this models efficacy in terms of improving outcomes at delivery. The central objective of this care model is to reduce mortality in remote locations by providing expectant mothers and their primary care-givers with advance notice of complications so that women at risk can be referred to appropriate care centers in time. The components of this model are described, including portable ultrasound machine, scanning protocols for clinical data acquisition by local operators, custom clinical data compression and transmission capabilities, and internet-based infrastructure for remote reading and reporting. The objectives, hypotheses, and design of the associated clinical outcomes study and progress to date are also presented.

Mantle Cell Lymphoma Presenting as a Subcutaneous Soft Tissue Mass With an Unusual Appearance

CLINICAL HISTORYThe patient is a 61-year-old man with a medical history of hypertension who originally presented for an ultrasound of a right lower-back mass, which had been growing for 2 weeks. A magnetic resonance imaging (MRI) was initially recommended based on the ultrasound appearance. However,

Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

BREAST cancer is the most common cancer among women worldwide and is the most frequent cause of cancer-related death in women in low-income countries (1). In Ugandan women, breast cancer is the second most common malignancy behind cervical cancer. The incidence of breast cancer in Uganda has been rising during the last half-century from 11 per 100,000 in 1961 to 33 per 100,000 as of 2007 and increased at a rate of 4.5% yearly between 1991 and 2006 (2-4). The increase is at least partially attributed to the progressive integration of westernized lifestyle into Ugandan society, but may also be due to improved data collection (5). A recent study demonstrated that Ugandan women are developing cancer at an earlier age and presenting at a later stage than those in higher-income countries such as the United States, a pattern also recognized among black women in other sub-Saharan countries (6,7). Fewer than 20% of Ugandans with breast cancer are diagnosed at an early stage (I & II) while more than 80% are diagnosed at a late stage (III & IV) (8). Early diagnosis is imperative as those who are diagnosed at an early stage have better options for treatment and potential cure than those who present with late stage disease. In the United States, breast cancer is most often pathologically diagnosed via percutaneous image-guided core-biopsy. Physicians performing breast biopsies are specifically trained in breast procedures Abstract