Teleradiology: Doctors Without Borders

Médecins Sans Frontières (MSF), also known as Doctors Without Borders, is an organization that provides health care in areas under-served due to warfare, natural disasters and poverty. One important aspect of their work is providing radiology services. MSF typically uses local resources to acquire images, including local technologists and equipment owned by local public health departments. However, these areas often lack trained radiologists to read the radiographs produced. To this end, MSF has pioneered the use of teleradiology to bridge the gap between local resources and radiologists in the developed world.

Teleradiology is the practice of sending radiographic images from the image acquisition site to a remote site to be read. Teleradiology

The radiologist then logs into the secure website and reads the images and submits a report. The on-site physician then receives an email alerting them that the report is ready. Neither email contains patient information, which can only be accessed via the secure website to ensure confidentiality. The images and report are archived permanently for reference. The exams are usually read promptly. In one study the median response time was 6.1 hours from the time the images were uploaded. The same study reported that 14 radiologists were assigned to take cases as of 2014. The radiologists working for MSF are volunteers who read the images on their own time apart from their other duties. Recruitment of radiologists has been limited by the need to understand local epidemiology (Halton,

Malawi is a country in sub-Saharan Africa. The area has a shortage of health care workers, only about half of what the World Health Organization (WHO) recommends. In fact, as of 2012, there were no staff radiologists in Malawi’s public health system. One of the major concerns in this district is HIV associated tuberculosis (TB) infections. HIV infection of persons 15-49 years of age is 14.5%, among the highest in the world. TB can be difficult to diagnose absent radiographic exams. The chest x-ray is one of the most reliable diagnostic tools. Thus, MSF decided to use teleradiology to send the images to a radiologist at a remote location, in this case at the University of Virginia. An on-site physician with MSF was responsible for selecting cases for this program. Typically, these were cases where the onsite physician was unsure of a diagnosis. An analysis of the program found that the teleradiology system likely improved patient care. Although 71% of cases merely confirmed an existing diagnosis, in 10% of cases the patient was found to be misdiagnosed. In total 23.5% of patients had a finding that changed medical treatment. (Coulborn,