Improvements in medical imaging technology have made computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans and other tools of radiology a routine part of any trip to the emergency room in the Western world. This is not the case, however, in many developing countries, which often lack the equipment, expertise and/or infrastructure to diagnose and treat health care problems with the help of radiology.

A team of radiologists and humanitarians who returned last week from a 14-day fact-finding mission in western China and northern India are hoping to change this through the Radiology-Readiness program, an effort launched in October 2008 by a global nonprofit network of radiologists known as RAD-AID to evaluate the need for imaging technology in developing countries and determine how to deliver imaging equipment as well as training and maintenance expertise where it is needed.

Imaging and health care
"Imaging is a major part of almost every clinical decision we make in our health care system, yet this technology is not available to a substantial portion of the world," says RAD-AID founder and chief executive Daniel Mollura. The idea was to first determine what sorts of diseases and other health problems are prevalent in a given area and the extent to which radiology might be useful to physicians there. If a need is identified, the next step is to develop a plan to deliver the imaging equipment, train locals to use it and ensure that the local infrastructure is able to reliably support it.

To determine which locations are most in need of and the best candidates for Radiology-Readiness, Mollura approached the nongovernmental organization (NGO) Project HOPE about a year and a half ago. "We proposed to study the role of radiology and how radiology could be optimized for clinics operating throughout [Project HOPE's] system," Mollura says.

This was a good fit, says Cary Kimble, Project HOPE's director of development, because the NGO's focus is on sustainable health care improvements. "Without a strong base in radiology, the system can't function properly," he adds.

Analyzing Asia
Project HOPE served as a facilitator for RAD-AID in northern India and western China, where the NGO has many contacts. Mollura left for China on July 10 and during his weeklong stay visited five institutions in Project Hope's network located in three cities—Shanghai, Yinchuan and Zhengzhou. In Shanghai these sites included Shanghai Children's Medical Center, Renji Hospital and Tang Qiao CHCC (Community Health Care Clinic). The sites in Yinchuan and Zhengzhou included Affiliated Hospital of Ninxia Medical University and First Affiliated Hospital of Zhengzhou University, respectively.

"We're still analyzing what we saw and discussed in China, so it's a little early to say too much," Mollura says, adding that the RAD-AID and Project HOPE teams will be working closely with the participating institutions over the next several months to design follow-up plans. "China's expanding radiologic capability offers significant new opportunities for physicians in China and the U.S. to work together for improving global health."

In India RAD-AID visited Artemis Health Institute in New Delhi, Okay Diagnostic Research Center in Jaipur, Dr. Shamer Singh Memorial Radio-Diagnostic Center (SSRD) in Chandigarh and the Postgraduate Institute of Medical Education and Research (PGI) of Chandigarh. With the help of the Grameen Foundation, RAD-AID and Project HOPE were also able to meet with ESAF Microfinance and Investments to discuss financial service options for the region.

China and India, in particular, are going through profound changes as their economies develop. Conditions including cardiovascular disease, cancer and obesity (previously a problem mostly in Western countries) are emerging as health risks as their populations' vocations, diets and lifestyles change, says Ronald de Jong, CEO of Emerging Markets for Philips Healthcare, a maker of imaging equipment that is sponsoring Radiology-Readiness and providing RAD-AID and Project HOPE with technical expertise. These health concerns require early diagnosis in order to be treated successfully, he adds. In addition to the collaboration with Project Hope, Philips recently entered a two-year partnership with China's Ministry of Health to train 1,000 rural doctors in 400 hospitals to improve technical breast cancer–screening skills.

The ability to sustain radiology services over time is a major challenge. RAD-AID says it has built relationships with financial institutions including Goldman Sachs and the Grameen Foundation as well as advisors from Columbia University's Business School to study how radiology can be implemented cost-effectively to serve the urban and rural poor. Efforts are underway to analyze how collaborations in India could include privately run health institutions with government and nonprofit NGOs to address health care needs.

Helping Haiti
In addition to the possibilities in China and India, RAD-AID is studying how radiology can be brought to bear in Uganda despite that country's limited health care resources. RAD-AID and Project HOPE also plan to send a volunteer to Haiti this fall to study the radiology needs of post-earthquake reconstruction in several of HOPE's affiliated institutions there.

"We had a team of biomedical engineers in Haiti to look at some of the equipment donated since the earthquake and even before that," Kimble says, adding that most of it was not operable. "The technology couldn't function for lack of a part or people who knew how to operate and maintain it."

The American College of Radiology's (A.C.R.) Foundation Haiti Radiology Relief Fund, set up shortly after January's earthquake in that country, sent out a survey to multiple facilities near Port-Au-Prince to measure the impact of damage to radiology infrastructure and determine some priorities for support, including equipment, infrastructure planning, teaching materials and the coordination of volunteers to assist throughout the process, according to Brad Short, A.C.R.'s senior director of member services. Mollura serves on the college's Foundation International Outreach Committee, though which RAD-AID works with the A.C.R. to improve radiology programs in several countries, including Haiti.