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Sustainable Diagnostic Imaging

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Per Åkeson is the patron of the "Sustainable Diagnostic Imaging Chapter" of TRTF.

Trauma, chest disease, abdominal disease, and pregnancy are the most common indications for diagnostic imaging. In small rural or suburban hospitals, plain radiography accounts for over 90% of all necessary examinations, and ultrasound satisfies a large part of the remaining 10%. Plain radiography or ultrasound are all that is necessary for 70-80% of all diagnostic imaging, even at university hospitals. In trauma – in accidents, for instance – x-rays are pivotal.

In many countries, there is only one radiologist per 5 to 10 million people. To get a simple x-ray patients might have to travel an entire day – or, worse, they won’t be able to get an x-ray at all. Many people in the world can only afford between two and ten dollars per month for health-related expenses. High-technology equipment at prices of a million dollars or more is far beyond their reach – and their necessities. Even basic x-ray imaging systems are expensive in relation to the money available.

In Africa, but not only there, the situation is bleak. What happens to the victims of traffic accidents? First aid, transportation to a hospital, medical assistance … and x-rays? If there are no proper diagnostics, you will have increased suffering and pain, you might have displacement or angulation. Although the fractures may heal, mutilation and permanent disability remain.

Chest diseases are another indication for diagnostic imaging, infections such as pneumonia and tuberculosis, or heart problems. Chest x-rays and aboratory tests are used to confirm the presence of pneumonia, including the extent and location of the infection … But in resource-poor settings without access to these technologies, suspected cases are diagnosed by their clinical symptoms only.

Proper diagnostics require x-rays. The World Health Organization has developed a blue print of a sustainable x-ray system more than 30 years ago.

WHIS-RAD stands for the World Health Imaging System – Radiology, developed according to specifications of WHO’s once existing Diagnostic Imaging Team. The development began in 1975 and the objective was to develop a low-cost, safe, reliable, and easy-to-use x-ray system that would produce high quality images. Approximately 80,000 units are needed
worldwide. Since 1975, about 1,500 units have been installed with several hundred in operation today.

80% or even more of all resources for medical imaging are spent for 20% or less of the world’s population, mostly in the European Union, the United States of America, and Japan.

Meanwhile the Diagnostic Imaging Team at the World Health Organization has ceased to exist. TRTF has decided to help fill this vacuum. It has expanded its mission to include bringing access to highly-trained medical professionals and the use of health informatics to help improve health care delivery in the developing world.

Commentary: "Sustainable Diagnostic Imaging - Where and Why"