ACR Bulletin

Covering topics relevant to the practice of radiology

The Road Well Traveled

Three radiologists look back on their experience with the ACR Foundation’s Goldberg-Reeder Travel Grant.
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My time in Zambia has been the highlight of my radiology training career, and I hope it will be the beginning of many opportunities that allow me to collaborate with radiologists from a diverse set of backgrounds.

—Andrew Olsen, DO
October 30, 2018

PHOTO CAPTION: Andrew Olsen, DO, discusses an ultrasound result with Dr. Ruth Phiri. 

The ACR Foundation’s Goldberg-Reeder Travel Grant Program is designed to facilitate radiology knowledgesharing, while assisting health facilities with radiological care in low- and middle-income countries. The latest group of recipients brought their skills, expertise, and energy to Zambia, Tanzania, and Namibia, where they worked with local colleagues and patients to advance radiological care. Fresh from their travels, the recipients shared their insights and experiences with the Bulletin.

Andrew Olsen, DO

Now a fellow in Portland, Ore., Olsen spent four weeks of his final year of radiology residency living in Lusaka, Zambia, and working at the University Teaching Hospital — a 1,800-bed hospital that serves as the city’s premier center of medical education.

What was the most memorable part of your experience?

Our primary goal in traveling to Lusaka was to initiate a newly organized class of radiology trainees into a multi-year radiology training program, analogous to a residency program. We would start most days giving one or two hours of formal lectures, after which the Zambian trainees returned to the hospital’s radiology department to work until lunch. While they spent the remainder of the morning working with the hospital’s local in-house radiologists, we would interpret a large backlog of MRI and CT cases. This backlog was the unfortunate result of a shortage of Zambian radiologists, which this new training program is intended to alleviate.

What lessons did you learn during your travels?

I gained invaluable experience interpreting studies for diseases and conditions that were rarely seen among our patient base during my residency at the University of Rochester’s Strong Memorial Hospital in New York. The combination of infectious agents that I think of as exotic (such as schistosomiasis, malaria, tuberculosis, and listeria), a very high prevalence of immunocompromised patients due to HIV infections, and the often-too-late initial presentation of many patients, resulted in a very different practice experience than I am used to. I had access to doctors with experience interpreting these studies, who were willing to help me make sense of them.

My time in Zambia has been the highlight of my radiology training career, and I hope it will be the beginning of many opportunities that allow me to collaborate with radiologists from a diverse set of backgrounds.

Many radiology residents and medical students don’t recognize the need for global health work in radiology. Through grants like this, that awareness and support can be achieved.

—Krishna Patel, MD

Krishna Patel, MD

Patel was in the diagnostic radiology residency program at Dartmouth-Hitchcock Medical Center in Lebanon,N.H., and intended on doing a fourth-year elective in global health, when she applied for the Goldberg-Reeder Travel Grant to support that endeavor. Now a breast and body imaging fellow at Memorial Sloan Kettering Cancer Center, Patel focused primarily on helping train radiology residents at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, and at Muhimbili National Hospital (MNH) in Dar es Salaam — two of the biggest radiology residency programs in Tanzania.

6b(Left to right) Timothy B. Rooney, MD, Krishna Patel, MD, and Matthew R. Caley, MD, perform an ultrasound-guided biopsy on a patient. The patient was referred by one of the breast surgeons (pictured back left) at the hospital.

How did you choose your location?

Timothy B. Rooney, MD, aassociate program director of the radiology residency at Dartmouth-Hitchcock, had a contact at KCMC who expressed interest in havingmradiologists come and train some of their residents, specifically in breast imaging. Dr. Rooney, who heads the global health elective, was also in contact with Frank J. Minja, MD, assistant professor of radiology and biomedical imaging at Yale University, who had an established contact with the residency program at MNH.

The project at KCMC involved putting together a breast imaging workshop for the residents and assistant providers, including a lecture series and a hands-on ultrasound-guided biopsy workshop on gelatin molds. The goals of the project at MNH were to aid curriculum development for the residents through a lecture series and to improve the efficiency and technology in the reading room by introducing a dictation software system.

Do you have any new goals for yourself based on your experiences in Tanzania?

Global health has always been an interest of mine. Through these projects I recognize how important continuous education is to make a lasting change in developing countries. Visiting a country and giving lectures to residents once is not enough. We need continuous effort to slowly bring about change. I hope to find a hospital or residency program in a developing country that may need help with training more radiologists — one that I will be able to return to on an annual or biannual basis to help bring about progress.

Why is the Goldberg-Reeder Travel Grant such an important initiative?

Many radiology residents and medical students don’t recognize the need for global health work in radiology. Through grants like this, that awareness and support can be achieved.

Naiim Ali, MD
Malawi, Namibia, and Uganda

Ali was chief radiology resident at the University of Vermont Medical Center in Burlington when he received the Goldberg-Reeder Travel Grant. Currently a fellow in abdominal imaging and intervention at Brigham and Women’s Hospital/Harvard Medical School in Boston, Ali traveled to Malawi, Namibia, and Uganda with his grant. He focused on provider relations in Malawi and Namibia and patient relations in Uganda. Ali is a member of the board of trustees and a clinical affairs officer at Imaging the World™ (ITW), an organization that integrates low-cost ultrasound programs into remote healthcare facilities that often lack radiologists, other skilled personnel, and imaging equipment.

Did you meet with community resistance to new practices like radiology?

The first ITW ultrasound site was established in Uganda in 2010. For many patients and community members, ITW’s introduction of ultrasound to rural clinics was the first time they had seen an ultrasound machine. Myths about the potential harms of ultrasound were rampant, often spread by traditional healers. Meeting with community members to discuss the benefits and risks of ultrasound and its potential impact in improving patient care was key in obtaining community buy-in.

What were the limitations you experienced?

We faced many challenges in implementing a new ultrasound system at Mercy James Centre (MJC) in Blantyre (one of the few providers of pediatric intensive care in Malawi) and introducing ultrasound in rural clinics in Mangochi, Malawi. MJC is in dire need of a modern ultrasound system that performs the wide-range of functions needed in a tertiary pediatric healthcare facility. The clinic also currently lacks an imaging/ultrasound expert in pediatric imaging.

In Mangochi, ITW will need to develop and maintain a rigorous training curriculum to assure initial competency and promote clinical excellence among its new team of nurses and midwives. Due to the paucity of sonographers and radiologists, initial trainers will have to be brought in.

For both projects in Malawi, the servicing of donated ultrasound equipment will remain a challenge. In my conversations with the radiographers and sonographers at Queen Elizabeth Hospital in Blantyre (one of the largest tertiary care centers in Malawi), it became clear that routine maintenance and servicing of existing X-ray and ultrasound units is almost impossible.

What are the imaging goals in Namibia?

A well-functioning PACS at the state hospitals in Namibia would be game-changing, while challenging to implement. It would prevent inefficiencies that result in the under-utilization of an expensive, well-functioning CT scanner, a fluoroscopy unit, and diagnostic radiology X-ray units. State hospitals could use an overhaul of their protocols for even the most common exams, including head and abdomen/pelvis CTs. As the University of Namibia School of Medicine continues to expand, it will need help developing a functional radiology department that is capable of providing high-quality education to its trainees. The leadership is excited about the prospect of developing a radiology residency program.

Author Lori A. Burkhart, JD  Freelance Writer, ACR Press