David Andrew Rosman MD, Presenter: Nothing to Disclose

Louise Kalisa, Abstract Co-Author: Nothing to Disclose

Peter Valere-Carlo Smeets MD, Abstract Co-Author: Nothing to Disclose

Radiology in Rwanda is markedly underserved with 6 radiologists serving 12 million. The health system of Rwanda is decentralized comprised of 430+ health centers,39 district hospitals (inpatient and outpatient) and 4 national referral hospitals. The University Central Hospital in Kigali (CHUK) is the single point of final referral in the country. As a result the pathology seen is that of the entire population of 12,000,000. An American Radiologist living in Rwanda served in CHUK and frequently encountered cases that require subspecialty expertise for ideal interpretation. We sought to create a real time subspecialty consultation service given the low resource availability.  

CHUK is equipped with a 64-slice Siemen’s scanner. Using an IPhone, the local radiologist would photograph key images, include history and then triage. An internet connection with speeds less than 100kb/sec was used. Those which did not need prompt response were emailed to colleagues at the home institution which had a time difference of 6-7 hours. Those that needed prompt attention were emailed to a Belgium (usually the same time zone). A phone call was placed but not answered from Rwanda to Belgium (zero cost). Seeing the call, the Belgian Radiologist would look at the case and triage to the appropriate subspecialty radiologist and email a reply.

Over 20 cases were sent to Belgium predominately over a 3-month period. Diagnoses included: pleiomorphous adenoma, agenesis corpus callosum with fat; CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids); 13 day old with Rhabdomyosarcoma; parapharyngeal Lymphangiohemangioma; Megalencephalic leukoencephalopathy with subcortical cysts, metachromatic leukodystrophy; HIV associated emphysema. Klippel-Trénaunay-Weber; and many others. Urgency was indicated in the text of the email and when so indicated results have been returned as quickly as 17 minutes. Cases on average were answered in under 24 hours.  

Using only the camera and internet capabilities of an iPhone in urban Rwanda, near real time subspecialty consultation is achievable in low resource settings at nearly zero cost allowing for remarkably improved diagnosis

With a worldwide shortage of radiologists, marked in impoverished nations, the need for teleradiology is obvious – we present a way to achieve that with an iPhone and slow internet.

Rosman, D, Kalisa, L, Smeets, P, Real Time Radiology Consultative Service for a Resource Poor African Nation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005497.html