Technology

New technology connects rural patients to radiologists

On a computer monitor in Aga Khan University Hospital, Nairobi, radiologists examine x-ray scans, CT scans and other medical images of patients from miles away. After interpreting the scans, they send the diagnoses to doctors in Kitui, Nakuru, Thika and Kisumu at the touch of a button.

In a country with shortage of radiologists, Aga Khan hospital has paved the way for rural dwellers to receive correct diagnosis fast, thanks to a new technology — teleradiology.

Patients from remote areas visit outreach diagnostic centres, x-ray images of the affected body parts are taken by trained technicians using a sophisticated technology known as computed radiography that produces digital images. This image is different from the conventional screen-film radiography that produces static images on films.

These digital images are then sent—through a sophisticated software known as the Picture Archiving and Communication System (PACS)— to radiologists seated at Aga Khan University Hospital (AKUH) in Nairobi.

“We have invested in high quality display monitors that allow our doctors to have an enhanced view of medical images received, allowing them to rapidly make correct diagnoses,” said Dr Sudhir Vinayak, the head of radiology department at AKUH.

He adds that PACS— used in teleradiology— allows radiologists to conveniently manipulate medical images. “They can increase or reduce image sizes, make them lighter or darker, and even view them at various angles,” he said.

Once doctors have satisfactorily reviewed and interpreted the radiographic images, they voice out a diagnosis by speaking into a microphone connected to their advanced computers. Immediately, a voice recognition programme —embedded in PACS— identifies the words and types the report automatically.

“This saves time and allows our radiologists to send reports to outreach centres fast as delays can endanger patients’ lives,” Dr Vinayak said.

Shortage of radiologists

The Ministry of Health has cited the gap in radiology services as a major drawback to universal healthcare in Kenya. Most hospitals in rural areas lack machines to perform chest x-rays used to diagnose pneumonia, mammograms that indicate the presence of breast lumps or ultrasound scans that ascertain the health status of unborn children.

The ideal scenario would be for the government to construct state-of-the-art health facilities in all remote regions, with medical equipment and radiologists. Attaining these goals would be an uphill task due to the meagre resources allocated to the health sector.

Currently, the proportion of government funding to health is still way below the 15 per cent recommended by the Abuja Declaration signed by African leaders in 2001. But health experts are optimistic that technological innovations will enable Kenya to leap frog these resource hurdles and address gaps in radiology services.

Teleradiology in Aga Khan hospital is one of the technologies that has paved the way for remote medicine.

Dr Vinayak notes that whereas few specialised doctors—if any— are found in most rural health facilities, the use of teleradiology brings radiologists to these far flung communities thus allowing them to enjoy quality healthcare services just as other Kenyans.

“Our clients in remote areas get excellent radiology services just as those that come to us directly. Yet, they also pay less compared to those that come here at AKUH in Nairobi,” he says.

Whereas the hospital previously reviewed radiographic images of about 15 patients daily, Dr Vinayak notes that the number has now risen to about 60 after the roll-out of teleradiology services in various counties since 2012.

“We expect these numbers to grow to about 300 in about three to five years as we expand and increase our capacity,” he says. But, he says teleradiology process isn’t as simple as it may appear. He notes that whereas most pictures can easily be sent via e-mail, medical images are quite bulky and will require high speed Internet connection for effective transmission.

For instance, a computed tomography (CT) scan of the head will be about 100 megabytes. “Yet, you need to ensure that it reaches the radiologist on the other end fast, for prompt diagnosis. And the image quality should not be distorted,” said Dr Vinayak.

For effective adoption and application of teleradiology, AKUH has invested heavily in a sophisticated PACS software which provides an effective medium through which medical images can be stored, transmitted, viewed and interpreted in radiology departments. While dealing with conventional static images, radiology departments can mix up patients’ diagnoses if x-ray films for instance, bear similar names.

“But through PACS in teleradiology, medical images are merged with electronic health records of patients. So there’s no room for confusion,” says Dr Vinayak.

In conventional static film images, the identity of patients cannot be hidden as the names are often inscribed on the x-ray films.

But PACS can allow radiologists to respect the confidentiality of patients by making their medical images anonymous. “So anyone looking at the images on the screen will not know, apart from those authorised,” he says.

The use of computed radiography in teleradiology (as opposed to the conventional screen-film technology) is beneficial to patients as it reduces the amount of radiation that they are exposed to during x-ray sessions.

[email protected]