Changing Imaging Across Borders

The ACR joins international partner organizations to boost radiology in Trinidad and Tobago

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Alexander R. Sinanan, MBBS, a specialist in clinical radiology and chair of the South West Regional Health Authority in Trinidad, observed that patients in his country were experiencing a problem with imaging services. Backlogs in radiology departments were causing extremely long patient wait times for both procedures and results.


“During the Zika virus outbreak, there were no formal protocols in existence for guiding the indications for requesting examinations,” says Sinanan. “Because there were no guidelines or protocols to guide the clinicians, the number of requests for obstetric ultrasounds increased, and the frequency with which these scans were being requested per pregnancy also increased. This led to inappropriate requests for imaging, which simply served to increase the already lengthy wait times for examinations.”

Ryan Ramcharan, IT director for Trinidad and Tobago’s Ministry of Health, reached out to the Pan American Health Organization (PAHO) regional office of the World Health Organization (WHO) — of which Trinidad and Tobago is a member state — to help evaluate the country’s radiology services. His request engaged the PAHO/WHO Radiological Health Program in Washington, D.C., a unit established in 1960 with activities revolving around research, training, radiation protection, public health, and clinical medicine. Kayiba P. Medlen, MPH, RT(R)(M), who works for the PAHO/WHO Radiological Health Program, contacted the ACR in July 2017 for additional assistance. ACR BOC Secretary-Treasurer Howard B. Fleishon, MD, FACR, stepped in to help guide the effort in Trinidad and Tobago.

“PAHO and the ACR have worked together previously in identifying volunteers to donate time and efforts to improve medical imaging services beyond the United States,” says Fleishon. “The ACR is recognized as a leader in radiology not only at home but abroad.”

Improving the Status Quo

The trip to Trinidad and Tobago, which took place in October 2017, required a significant amount of planning. A survey was sent to the Trinidad and Tobago Ministry of Health to disseminate to the five hospitals where the assessment would take place. The team also had virtual meetings to discuss expectations, logistics, and more, planning out the day-to-day of each assessment.

TCPARDKPMHBSThomas C. Perry Jr., CIIP, Alexander R. Sinanan, MBBS, Kayiba P. Medlen, MPH, RT(R)(M), and Howard B. Fleishon, MD, FACR, (left to right) collaborated to improve radiology in Trinidad and Tobago.

Once in Trinidad and Tobago, the team assessed one facility per day for five days. Each site appointment included a walkthrough of the radiology department, with team members focused on evaluating a specific area or workflow. As a visiting radiologist on the team, Fleishon went to the reading room to see how the radiologists work and pinpoint areas for assistance. Medlen evaluated the work of the staff and gathered information on radiation protection, procedures, and training. Thomas C. Perry Jr., CIIP, a PACS administrator with Outpatient Imaging Affiliates in Franklin, Tenn., and temporary advisory to PAHO, accompanied local IT staff to assess challenges with PACS. 

“This assessment was an interesting study in population health management because there are different realities to consider in other healthcare systems.”- Howard B. Fleishon, MD, FACR

After each site visit, the entire team, both visiting and local, convened over lunch to debrief. Later, the PAHO/ACR group met with Ramcharan to share the results and present recommendations for improving radiology in Trinidad and Tobago.

“In Trinidad and Tobago, there are a lot of factors to consider when it comes to healthcare — cultural, social, political, and financial,” says Medlen. “We had to keep in mind that what works here in the United States won’t necessarily work in another country. However, patient safety should not be compromised. Radiology must be used appropriately to produce desired results.” 

The PAHO/ACR team agreed on a few areas for improvement, including incorporating a national PACS and radiological information system that removes existing geographical barriers to accessing patient information and images. According to Fleishon, “Unified policies of quality assurance and performance metrics will also help define success as we move forward.” 

Formulating Next Steps

This past November, a quality assurance workshop was offered in Trinidad and Tobago to an audience of radiologists, technologists, and medical physicists. The next steps include a formal presentation of the PAHO/ACR team’s recommendations to the Trinidad and Tobago Ministry of Health. A working group is also planned to help implement the recommendations from the team. 

According to Fleishon, “From an American point of view, this assessment was an interesting study in population health management because there are different realities to consider in other healthcare systems. I see tremendous potential for radiologists to get involved in an environment like Trinidad and Tobago. Radiology could have a huge impact there.” Medlen agrees, noting that the ACR’s continued involvement is crucial because radiology in Trinidad and Tobago has room for growth: “After all, radiology is all about helping each other.”

By Nicole B. Racadag, MSJ, managing editor, ACR Bulletin, and Alyssa Martino, freelance writer, ACR Press

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