Radiology Rounds - May 2011 - Mass General Imaging Global Health Programs
Volume 9 Issue 5 - May 2011
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Mass General Imaging Global Health Programs
Mass General Imaging Global Health Programs (IGHP) aim to address unmet medical imaging needs and healthcare disparities for vulnerable and crisis-affected populations
The Mass General IGHP offer:
Education and training resources
Teleradiology and on-site radiology services by volunteer MGH radiologists
Assistance in procurement and transfer of needed medical imaging equipment and information technology
Research and needs assessment pertaining to imaging in global health


Massachusetts General Hospital has a long history of outreach to those in need, both locally and overseas, to improve healthcare in times of tranquility and to provide disaster relief. Mass General healthcare professionals participate in numerous programs around the world, and a disaster relief team is always ready to depart at a moments notice to help those affected by an earthquake, flood, or other natural disaster. The MGH Center for Global Health promotes the collaborative efforts of MGH multidisciplinary medical professionals, including that of the Mass General Imaging Global Health Programs (IGHP). The IGHP are designed to complement the MGH Center for Global Health outreach programs by providing education and training, clinical service, research and needs assessment, institutional and organizational development, and assistance in imaging technology transfer.

Figure 1. (A) This image, of an x-ray of the lower extremity of a patient with osteomyleitis from tuberculosis, was photographed directly off a lightbox with a mobile phone (specifically iPhone) and sent for remote consultation from Africa directly via email from the mobile phone. (B) Another image, also photographed with a mobile phone, shows close-up of x-ray film of same patient with more detail allowing for optimal quality for remote interpretation.
Figure 1. (A) This image, of an x-ray of the lower extremity of a patient with osteomyleitis from tuberculosis, was photographed directly off a lightbox with a mobile phone (specifically iPhone) and sent for remote consultation from Africa directly via email from the mobile phone. (B) Another image, also photographed with a mobile phone, shows close-up of x-ray film of same patient with more detail allowing for optimal quality for remote interpretation.


Clincial Services
Figure 2. Chest radiograph image of a pediatric patient with pneumonia that was directly exported from digital x-ray machine and sent via email from Africa. Note higher image quality of this method of transmission.
Figure 2. Chest radiograph image of a pediatric patient with pneumonia that was directly exported from digital x-ray machine and sent via email from Africa. Note higher image quality of this method of transmission.

While volunteer radiologists at MGH who provide onsite radiology services abroad in resource-poor settings is one aspect of the IGHP, there are many other important aspects of clinical service. The IGHP offers remote radiology consultation services to non-radiologists who are working abroad. Volunteer radiologists from Mass General and other institutions offer pro bono teleradiology services for physicians who are working abroad via MGH or other non-profit organizations. Images can be transmitted for teleradiology consultation via very rudimentary or more conventional methods of electronic image transmission. For example, photographic images of an x-ray film on a light box or even held up against the sky can be sent as an email attachment or from a mobile phone, such as an iPhone (Figure 1). Photography of films is challenging because of problems of poor light, reflections, and image resolution. But although these images may not be as high quality as those sent by more conventional means, they are usually adequate for interpretation.

Through a strategic partnership with the International Radiology Exchange (iRadX), a non-profit organization operated by volunteer radiologists based at MGH and other institutions, IGHP serves many Partners Healthcare physicians who spend part of their time abroad providing clinical care. For example, iRadX currently provides teleradiology services to Partners in Health hospitals in Africa and Haiti. The VIDAR Corporation has donated a film digitizer for use in a Partners in Health clinic in Rwanda, and the IGHP hopes to acquire more digitizers for other clinics in need in order to facilitate remote interpretation and consultation. The IGHP is also now collaborating on providing radiology services to the new Partners in Health Hospital in Mirabalais, Haiti, which will open later this year.


Education and Training
Figure 3. Sjirk Westra, MD, Pediatric Radiologist at MGH, a faculty member of the IGHP, volunteers on-site in Malaysia to teach pediatric ultrasound.
Figure 3. Sjirk Westra, MD, Pediatric Radiologist at MGH, a faculty member of the IGHP, volunteers on-site in Malaysia to teach pediatric ultrasound.

The IGHP is currently involved in a number of initiatives to improve medical imaging knowledge globally. This is being accomplished through training programs in radiation safety, quality imaging management, medical imaging utilization, and essential diagnostic radiology and interventional skills. Now that portable ultrasound equipment is available, IGHP physicians offer training in basic ultrasound practice and have contributed to the Partners in Health Manual on Ultrasound in Resource Poor Settings, which is available as a free download.

In addition, the IGHP are establishing clinical exchange programs with many clinics and hospitals around the world and is actively encouraging trainees and professional staff to participate in outreach activities locally and abroad. The IGHP provides support and advice on, for example, protocol selection and development, appropriateness criteria, and radiation safety issues. For example, in a close collaboration with the MGH Center for Global Health, radiologists from the IGHP are planning a visit to Uganda later this year to serve onsite by providing basic radiology education and training.

Technology Transfer
Many health facilities around the world lack imaging equipment and communication tools. The IGHP is currently working with Partners Healthcare to facilitate the transfer of equipment as basic as light boxes. IGHP are also actively working on the procurement of other more advanced equipment, such as a portable CT scanner for disaster relief teams (such as IMSURT, The International Medical Surgical response Team led by Dr. Susan Briggs) and portable ultrasound equipment for places in need worldwide. Members of the Information Technology team at Mass General have also provided technology support and are working to better connect remote underserved sites globally with volunteer MGH radiologists of the IGHP.


Research and Needs Assessment
Figure 4. Sanjay Saini, MD, Vice Chairman of Radiology at MGH, and a member of the MGH IGHP, visited Haiti in 2010 to meet with physician leadership of the Haitian Medical Society to discuss sustainable long-term efforts in building infrastructure for radiology training and education.
Figure 4. Sanjay Saini, MD, Vice Chairman of Radiology at MGH, and a member of the MGH IGHP, visited Haiti in 2010 to meet with physician leadership of the Haitian Medical Society to discuss sustainable long-term efforts in building infrastructure for radiology training and education.

The GHP performs public health and needs assessment research in order to identify where medical imaging expertise and resources are needed, with the goal of forming collaborative partnerships to better guide appropriate technology development, develop training programs, and deliver clinical services. For example, in a recent formed partnership with the Tiyatien Health Clinic in Liberia, a clinic started and staffed by MGH physicians, the IGHP is working on radiology needs assessment, imaging facility planning, and technology procurement.

In addition, the IGHP can provide assistance with direct clinical research. For example, IGHP radiologists are collaborating with physicians abroad who are working on learning more about the radiographic manifestations of multi-drug resistant tuberculosis at multiple time points before, during and after treatment.

The GHP is also actively collaborating with other professional societies globally to create guidelines, training standards, imaging protocols, and patient safety programs to improve medical imaging access and care throughout the world.


Further Information
To learn more about the MGH Imaging Global Health Programs and for further questions, collaboration opportunities, or to request any radiology assistance to address global health needs, please contact Garry Choy, MD MS, Emergency Radiology and Teleradiology, Mass General Imaging, at 617-383-9729, or via email at ImagingGlobalHealth@partners.org.

We would like to thank Dr. Choy and Susan M. Briggs, MD, Department of Surgery, Massachusetts General Hospital, for their advice and assistance in the preparation of this article.




References

International Radiology Exchange
Mass General Imaging Global Health Programs
Mass General Center for Global Health
Partners in Health
Partners in Health Manual of Ultrasound in Resource Poor Setting