Khan Mohammad Siddiqui MD, Presenter: Nothing to Disclose

Nabile M. Safdar MD, Abstract Co-Author: Nothing to Disclose

Faaiza Mahmoud MD, Abstract Co-Author: Nothing to Disclose

Bruce Ian Reiner MD, Abstract Co-Author: Nothing to Disclose

Eliot Lawrence Siegel MD, Abstract Co-Author: Nothing to Disclose

This project was initiated to identify barriers to adoption of filmless imaging in developing countries, where all-digital techniques hold promise for implementation of remote interpretation, large-scale screening, and streamlined delivery in areas of growing need.

Using the imaging infrastructure of Pakistan as an example, the author surveyed practitioners for cumulative experiential observations on adoption of filmless imaging. These radiologists identified 3 core problem areas that were elaborated for review and comment.

(1) The first area was lack of investment, compounded by a pay-for-service delivery system. With no national health or viable private insurance mechanisms, 95% of patients pay for their own imaging services. Low per capita incomes (<$470 U.S./y) force continuing cuts in health spending. Patients pay $1–$2 for a chest x-ray, ~$25 for a CT head study, and ~ $50 for MR spine imaging. Even when paid in full, such fees leave no margins for investment in innovation. (2) Cultural factors sustain the second barrier. Medical images in Pakistan have long been considered “products” exchanged for payment, often with no in-house reference copies maintained. A “shop-for-health-care” mentality prevails, as patients take their studies for second opinions and cost comparisons. A lack of understanding of the radiologist’s role contributes to this “cash-and-carry” mentality, with most patients believing that radiologists simply acquire images and are not competent to interpret results. (3) Lack of a robust information technology (IT) infrastructure stands in the way of productive change. Without broadband solutions, electronic image access to referring physicians is difficult. Even tertiary centers must rely on municipal and state electrical and communication systems that are fragile and unpredictable.

Efforts to welcome developing countries into the digital imaging world cannot succeed unless complex barriers to change are addressed. In Pakistan, these efforts should include top-down changes in investments in health care, coordinated education efforts on radiologic expertise, and robust IT infrastructure solutions.

Siddiqui, K, Safdar, N, Mahmoud, F, Reiner, B, Siegel, E, Cultural and Economic Barriers to Filmless Radiology in Developing Countries.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411389.html