Improving Radiology Readiness in Low-Resource Countries and Regions

Reading Time: 10 minutes read

RAD-AID deploys Radiology-Readiness and volunteers worldwide.

Radiology shortages come in many forms – lack of radiologists, lack of training, or perhaps lack of equipment. RAD-AID understands that a single model can’t address all aspects of radiology shortages. That’s why its critical first step is to deploy Radiology-Readiness, RAD-AID’s trademarked data collection and analysis tool.

RAD-AID founded in 2008, is an international, volunteer-driven, non-profit organization dedicated to increasing radiological availability, expertise and infrastructure around the globe.

Everything Rad recently interviewed Melissa Culp, RAD-AID Vice President and Chief Operating Officer. During our conversation, we asked Melissa to explain RAD-AID’s origins, objectives, and programs, and to share examples of improved radiology readiness.

Addressing injustice and inequity in radiology services

ER:

Hi, Melissa. Thanks so much for taking the time out to speak with us today. Let’s start with a big-picture question: Why does the world today need an organization like RAD-AID?

Melissa:

According to the World Health Organization, over half the people in the world are without access to diagnostic and interventional radiology services. At the patient level, this gap means that cancer patients who need CT or MRI for diagnosis and treatment planning have no access to it. The same is true of mothers and babies who need ultrasound for safe delivery, as well as of trauma and infection patients who require X-ray or CT to assess injuries and outbreaks. The list continues and it demonstrates the urgent need for radiology services in global health. These gaps occur in low- and middle-income nations, but they also exist in low-resource parts of high-income nations.

ER:

Before we get into RAD-AID’s Radiology Readiness approach to addressing these issues, I’m curious about how you became so deeply involved with the organization.

Melissa:

My rationale for global health involvement has evolved and deepened over the years. In my clinical training and background, I am an MRI technologist so I am very well acquainted with the potential of radiology to help improve patient care outcomes.

I have two young sons, and I am extremely fortunate to have access to multiple top medical centers here in North Carolina. Both of my sons have received medical imaging at some point. I know that the technologists who obtained images were educated in dose optimization and that the images were interpreted by radiologists with subspecialty training in pediatric radiology.

As grateful as I am to have that level of expertise and care for my children, is it fair that my sons have superb care when millions of children around the world do not have access? Simply by virtue of where they were born? That is an injustice and inequity that needs to be addressed in global health – and that’s the very reason for RAD-AID’s existence.

As my knowledge of global health has deepened, I see the importance of working together with colleagues from high, middle, and low-income nations to address change. Relationships are the most important part of creating sustainable progress in global health.

ER:

And what has your career journey with RAD-AID looked like thus far?

Melissa:

In 2012, I joined the faculty at the University of North Carolina at Chapel Hill’s School of Medicine teaching in an undergraduate program for radiologic technologists. While there, I founded the school’s associated RAD-AID chapter. As a RAD-AID volunteer, I traveled to Malawi, a nation in southeastern Africa, conducted Radiology Readiness, and established the RAD-AID Malawi Program.

Before long, a position opened on the management team at RAD-AID for the Director of the Technologist Program. It was terrific because technologists go on RAD-AID work trips to all locations so I was quickly able to learn more about the entire organization. I became more and more involved in operations and became Vice President of Operations in 2014. By 2015, those roles ended, and I became the Chief Operating Officer of RAD-AID.

RAD-AID programs begin with Radiology Readiness assessment

ER:

Let’s talk about RAD-AID’s process. When you identify a country or region where the standard of radiologic care is lacking, how do you decide where to start and how to help?

Melissa:

RAD-AID programs begin with a tool that we call Radiology Readiness – a trade-marked RAD-AID data collection and analysis tool. It lets us analyze the specific needs, infrastructure constraints, and healthcare system attributes of a country, region, or facility. Then we talk with in-country partners about their goals and needs. RAD-AID management team volunteers and in-country colleagues create a plan for each location based on its unique starting points and goals. This could involve setting up training, configuring workstations, or even innovating a new technology. Because of this model, each RAD-AID regional program varies in objectives and program measurement.

As RAD-AID has grown over time, supplemental Radiology Readiness Assessments have been created to address specific goals that might arise within a RAD-AID Program. These include RAD-AID Interventional Radiology Readiness, RAD-AID PACS Readiness, RAD-AID Breast Imaging Readiness, Radiation Oncology, and others.

ER:

And what sort of initiatives would such a plan not include?

Melissa:

Because of the Radiology Readiness approach, our programs are all different. Typically, we want to help our in-country partners create solutions to be sure their advances and innovations in radiology are wholly sustainable. For example, we don’t have our technologists perform exams. Instead, our technologist volunteers teach new technologies or best practices based on Radiology Readiness goals. Another example is that we don’t have radiologist volunteers dictate studies for a partner institution. Instead, we have our radiologist volunteers educate in-country radiologists on subspecialty areas, or create radiology training paths where none existed previously.

At the same time – and just as importantly – RAD-AID volunteers are being educated by our in-country partners to achieve a better understanding of the region’s unique clinical and cultural factors. This exchange of ideas and learnings is absolutely critical in helping us design even better programs together in the future.

Evaluating the effectiveness of RAD-AID programs

ER:

And is there also an evaluation phase?

Melissa:

Absolutely. The last step of any RAD-AID program is to work with our partners to analyze the program’s results – what worked, what didn’t, and what we could have done better. This helps us recognize new challenges to meet, and if necessary, what new resources we need to develop.

ER:

What are some of the biggest challenges you face in implementing your programs?

Melissa:

Not all health systems are alike. This means that RAD-AID volunteers take into consideration different contexts based on each area’s social culture, form of government, economy, degree of technological sophistication and so on. It’s all very nuanced. You can’t go into a country thinking your American solution would automatically make sense there. Listening, understanding, cultural humility, and adapting are the keys.

Improving Radiology Readiness in low-resource countries and regions

ER:

Using this process, what countries or regions have you implemented programs in, and which diagnostic modalities have you helped support?

Melissa:

In Asia, we have programs in China, India, Jordan, Kazakhstan, Laos, Nepal, and Vietnam.

In Africa, we have active partnerships in Cameroon, Cape Verde, Ethiopia, Kenya, Liberia, Malawi, Morocco, Nigeria, South Africa, and Tanzania.

We have two programs in Eastern Europe—Albania and Ukraine.

Finally, in the Americas, we have relationships in Grenada, Guatemala, Guyana, Haiti, Jamaica, Nicaragua, and in low-resource areas of the United States, like Appalachia, Washington DC, and rural areas of North Carolina.

Global health is defined as health issues that transcend national boundaries that require global, multidisciplinary cooperation to achieve equity – so the needs exist in low-resource regions of high-income nations also.

ER:

And which modalities do you deal with?

Melissa:

All of them, really. Predominantly radiography and ultrasound, as they are more readily accessible in many low-resource regions. But also MRI, CT, mammography, nuclear medicine, interventional radiology, and even radiation oncology services.

ER:

Could you give a couple examples of programs that stand out in your mind? 

Melissa:

All of our programs are special because of the hard work of our volunteers and in-country partners, but I’ll share a few of examples of Radiology Readiness in action.

The RAD-AID Malawi program provides training of technologists in sonography and assists with support for a Malawian physician completing a radiology residency program in South Africa with intent to practice in Malawi upon completion. Additionally, RAD-AID volunteers work with clinicians on radiology integration and appropriateness criteria.

Based on Radiology Readiness in Guyana, RAD-AID worked with the Ministry of Health, Georgetown Public Hospital, and the University of Guyana to create a radiology residency for Guyanese physicians to increase human capacity. Additionally, this program includes CT education, patient care, nursing curriculum, and technologist training.

Examples of secondary Readiness completions to supplement initial Radiology Readiness include: An IR Readiness completion in Kenya, where RAD-AID is working with several institutions to create an IR Fellowship for Kenya radiologists. Or, the PACS Readiness in Ghana, which led to PACS installation to network the department and RIS integration to improve patient workflow.

An example of Radiology Readiness being conducted in a low-resource region of a high-income nation is a partnership with Breast Care for Washington to help address issues that stop women from receiving the breast care they need. The partnership operates a mobile radiology clinic, with mammography, ultrasound, and patient intake suites that serve low-access areas in Washington, DC.

ER:

Melissa, we’d like thank you so much for talking with us today about RAD-AID. Are there any last messages you’d like our readers to hear?

Melissa:

Just that RAD-AID International is made possible by our wonderful volunteers. They’re truly the lifeblood of what we do, and we’re ALWAYS looking for more – radiologists, technologists, nurses, physicists, administrators – whatever your role in radiology, there are major ways you can help make a difference in the world.

To explore a volunteer experience with RAD-AID, please visit www.rad-aid.org.

Watch your Everything Rad feed for an upcoming profile on Jamie Surratt, M.D, and Steve Surratt, M.D., practicing radiologists and dedicated RAD-AID volunteers.