The global radiology gap is far less discussed than infectious-disease outbreaks and natural disasters, but its dangers to public health are every bit as urgent. “It affects the entire global health care system,” explains Dan Mollura, a radiologist and the CEO of RAD-AID International, an organization that works to improve access to radiology for the world’s poorest people. “Without radiology, most health-care systems have serious gaps and can't provide any care.”
Without ultrasounds, doctors can’t monitor pregnancies. Without chest x-rays, they can’t tell if tuberculosis treatment is working. And without a CT scanner, they can’t catch internal bleeding from a motorcycle accident or cancer at its earliest stages. “Every part of medicine in which the patient has a problem and the answer isn't obvious on physical exam or labs benefits from imaging—particularly trauma,” says Jeffrey Mendel, the senior health and policy advisor for radiology at Partners in Health.
Though CT scanners are available in more than 96 percent of U.S. emergency departments, people in rural Nepal often spend a month’s income and travel more than two days find a facility with an x-ray or ultrasound. But the high price doesn’t guarantee that the imaging is reliable. Nearly 50 percent of x-rays and more than 40 percent of ultrasounds in resource-deprived countries aren’t fully functional, often because they are donated at the end of their lives and getting replacement parts isn’t possible.
“We received an ultrasound donated to our organization along with a lot of extremely valuable stuff. When you turned it on, it was an MS DOS prompt and it said Copyright 1992. I hadn't seen an ultrasound like that in 15 years,” says Ryan Schwarz, a physician and the COO of Possible, an organization that brought working x-rays and ultrasounds to a million people in rural Nepal. The machine wasn’t totally useless; a technician, who traveled a day-and-a-half to reach them, told them one of its probes still functioned. “It’s currently sitting in one of the procedure rooms for a very limited scope of tests and, for those tests it can be very effective, but it’s literally two things,” Schwarz says.
Even when the machines work, there may not be an electrical system to keep them working. Modern hospitals run on three-phase electric power, which guarantees an uninterrupted supply of current. “Getting three-phase to rural Nepal is a tremendous task,” Schwarz says. “With unreliable current, you run into shocks. This is a problem every day in developing countries.”
Closing the radiology gap, then, also means overcoming many non-medical challenges: a lack of electricity, roads, or an information system to store the images. To know what problems exist in an area before launching a program, RAD-AID International developed Radiology Readiness Assessments, which are lengthy downloadable surveys that help organizations measure unmet needs.