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| Taken from http://www.huffingtonpost.com/2013/08/29/most-efficient-healthcare_n_3825477.html , Accessed on 10/21/2014 |
Radiology has the potential to contribute an important
component to evidence-based medicine in United States (US). It is intriguing to
know the way medicine is practiced in other parts of the world, especially in
resource-restrained countries. Do they rely more on radiographs and ultrasound,
or do they depend mostly on the disease endemicity, medical history and
physical examination? Empirical literature is available on health care gap
across the world, but the literature is severely limited when it comes to imaging
resources, their availability and utilization. This raises the need to identify
this gap in radiology healthcare and literature to help us build a strong
foundation on which we can judiciously and effectively allocate resources for
global health.
In most areas of the US, the ability of a primary care
physician to utilize any imaging modality instantaneously to diagnose disease
or to generate a differential diagnosis is taken for granted. In resource-restrained
countries, the problem is multifaceted. The
disease burden is heavy and diverse. Additionally, populations in these countries
typically have little income and no health insurance. Due to the absence of medical screening, patients
usually present late in the disease cycle. The absence of resources only contributes
to the challenges a physician may face. Emergency physicians themselves usually
lack proper facilities, supplies and equipment to effectively manage trauma and
treat disease. This is compounded with
the shortage of imaging equipment, trained staff, equipment maintenance, and quality
and safety standards. Radiological
imaging is an essential component in the management of trauma, obstetrical and gynecological
issues, HIV/AIDS, tuberculosis and cancer, just to name a few.
In resource-restrained settings, patients presenting with
right lower quadrant pain maybe denied a basic computed tomography (CT) scan or
even an ultrasound due to absence of imaging resources. This may be further
accentuated by the absence of trained radiologists in settings where the
resources maybe available. Moreover, even if there is a radiologist available, he
or she may not be equipped with sub-specialty knowledge. It becomes an essential
first step in outreach efforts to understand the current health care system
including the distribution of imaging resources, presence of radiologists per
population segment and the availability of sub-specialty radiology services.
While we are struggling with the question of imaging utilization in developed
countries, the gap is enormous compared to other countries where the imaging
resources are not even listed.
Another problem resource restrained countries are currently
facing is inequitable resource distribution within the health care system. This
difference is not just in equipment but is also seen in terms of training. Not
only must the radiological equipment be accessible and maintained, but also
trained staff and skilled physicians must operate and utilize the
equipment. There are usually central or
capital cities that are diversified with multiple resources including sub-specialty
radiology services. Conversely, more remote locations have a significantly different
set of resources and quality of care.
With this overwhelmingly obvious ‘Imaging Gap’ across the
globe, what can be done? Utilization of
ultrasound is promising, as this equipment has no ionizing radiation, is portable,
and provides real-time images that can instantly aid in diagnosis. Who will interpret the studies
generated? Should the primary care
physician be required to gain knowledge in image interpretation during their
training? This model is plausible as emergency
medicine residents learn how to perform the focused assessment sonogram for
trauma. However, what about the
complicated study? Is teleradiology a
possibility? Would US radiologists volunteer
services to assist colleagues in diagnosing disease overseas? These learning opportunities would be
extremely valuable for radiology residents to gain exposure to pathology abroad
and generate a sense of global community that may foster increasing support for
global imaging initiatives. Significantly,
there is also the critical question of sustaining the equipment, training and
payment of radiology services over time.
Gauging the wide gap in availability of imaging services on
one end and dealing with appropriate imaging utilization on the other end helps
us realize the efforts which need to be undertaken. Several efforts have been
made by American College of Radiology and other organizations in radiology as
first steps. However, such efforts need to be supported on a larger scale to
mitigate the current existing gap.
