Radiology has an obligation to address the lack of equitable access to radiology service in the world's low-resource areas and improve access for people across the globe.
That was the message in the Sunday Opening Plenary lecture by Kristen K. DeStigter, MD, the John P. and Kathryn H. Tampas Green and Gold Professor and chair of the Department of Radiology at the Larner College of Medicine at the University of Vermont (UVM) and the Radiology Health Care Service chief for the UVM Health Network.
DeStigter
"We have a problem that is so complex that we in radiology will not be able to solve it alone," Dr. DeStigter said. "It will require multiple partners to even begin to address it. This is a call to action to begin addressing this problem."
Dr. DeStigter is also co-founder and president of Imaging the World, a nonprofit organization that integrates ultrasound (US) diagnosis into rural health care systems and facilities in Uganda and Malawi.
In her lecture, "The Power of Radiology to Drive Collective Action and Transform Global Health," Dr. DeStigter stressed that there is a disproportionately high burden of disease in low-resource countries – particularly in sub-Saharan Africa – that is projected to persist over the next 20 years.
"In combination with a demonstrated lack of access to affordable technology and a skilled workforce, and insufficient infrastructure compounded by social inequities, we have a seemingly insurmountable complex problem," she said.
Radiology 'Invisible' on Global Stage
In the case of low- and middle-income countries, effective health care remains a goal that continues to be elusive. Dr. DeStigter related statistics showing that these low-resource countries are the most impacted by disease burden (as measured by years of life lost) and are projected to remain so through 2040.
"Without access to imaging services, effective health care is not achievable," Dr. DeStigter explained. "And while radiology is vital to disease protection and treatment, it has remained invisible on the global stage."
For example, she pointed out that the global burden of disease is addressed in the United Nations Sustainable Development Goals, which are targets for global development adopted by the world's countries in 2015 to be achieved by 2030.
One of the goals is to ensure healthy lives and promote well-being for all people. While that goal has 13 targets to reduce the burden of disease, none of the 28 performance indicators mention radiology or imaging.
Radiologists, Equipment in Short Supply
The need for radiology is reflected in several areas, including the radiology workforce. In Africa, for example, data shows that the number of radiologists ranges from 1 per 23,000 people in Tunisia to 1 per 8.8 million people in Malawi.
"The ratios are shocking," Dr. DeStigter said. "I think we can all agree that it would be impossible for one radiologist to manage the imaging care of 8.8 million in the country of Malawi."
A similar inadequacy is seen regarding access to radiology equipment. Obstacles include high cost, delays related to procuring new equipment, training staff, installation failures and the inability of customers to purchase service contracts.
One of the more critical radiology modalities in low-resources areas is ultrasound (US), which is central to the mission of Imaging the World, established in 2008. Dr. DeStigter pointed out that two-thirds of maternal deaths reported globally occur in sub-Saharan Africa, while Uganda and Malawi have the highest rates in the world.
The goal of the non-profit organization is strengthening the health infrastructure of Uganda with state-of-the-art US equipment in rural clinics, developing a trained workforce with certified US training programs, and implementing e-health and telemedicine radiology services to provide quality care.
Among the program's successful outcomes is a significant increase in routine antenatal visits and skilled birth deliveries, developing a workforce with advanced radiology training, and the almost one million patients, family and community members who have benefitted over a five-year period.
"But the successful programming of Imaging the World over the last five years and the vision to impact millions is only a drop in the bucket compared to what's needed," she said. "Traditional methods of global radiology service optimization are important and necessary but won't be enough. We need a collaborative effort to solve our wicked problem."
That effort should include improved radiology capacity and capabilities, new technologies fit for the environment, and a commitment to research and innovation.
"But cross-sector collaboration with groups such as industry, non-government organizations, other disciplines of medicine, governments and donors will be essential. And to the extent where we can collaborate in areas we traditionally have worked alone, the greater the likelihood of success," Dr. DeStigter said.
Radiology, particularly local radiologists, should take the lead in developing solutions to increase access to imaging services in low-resource areas, Dr. DeStigter said.
But the solutions will not be limited to radiology, she added. There is a need to harness new innovations and leverage cross-sector collaborations to improve global radiology services.
"We have an obligation to improve equitable access to radiology services for all people," Dr. DeStiger concluded. "There is no template or one solution for closing our gaps. But there are areas of low-hanging fruit. And there is incredible skill, talent and passion in our radiology community. And there is good will, and there is empathy, and there is hope."
For More Information:
View the RSNA 2020 session The Power of Radiology to Drive Collective Action and Transform Global Health — PS11at RSNA2020.RSNA.org.
