Abstract
Purpose: The purpose of this study was to compare the disease processes encountered on abdominal and pelvic CT examinations at academic teaching hospitals in Rwanda and the United States and to highlight how these differences may impact a global radiology collaboration. Materials and Methods: In this retrospective study, we included 130 patients (mean 59 +/-17 years, range 20-91, F:M 74:56) who underwent abdominal/pelvic CT examinations between April 1st-12th, 2019. CT examinations were prospectively encountered in clinical work at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda, where the radiology report impression, patient age, gender, study indication, CT protocol, and clinical diagnosis were recorded when available. Abdominal/pelvic CT examinations at the Massachusetts General Hospital (MGH) in Boston, Massachusetts, United States were then retrospectively reviewed for the same information. Patient age and gender were compared using Student’s t-test and Chi-square statistic. Frequency of formal recommendations in radiology reports, available comparison of CT examinations, presence of known diagnoses, and intravenous and oral contrast media use were compared using Fisher’s exact test. Diagnostic categories were qualitatively compared. Results: A wide variety of pathology was encountered by abdominal/pelvic CT at both sites of imaging, with qualitative differences observed in cancer types, infectious agents, and how imaging guides care. Patients in Rwanda were older (p=0.0017), more likely to receive intravenous (p < 0.05) and positive oral contrast (p < 0.05) media and less likely to receive a formal recommendation in their radiology report (p < 0.05). Patients in the United States were more likely to have an available prior abdominal/pelvic CT (p < 0.05), to present for follow-up of a known diagnosis (p < 0.05), and to receive a formal recommendation in their radiology report (p < 0.05). Conclusion: Participation in global radiology collaborations is beneficial for radiologists by broadening exposure to pathologies and practice different from their own institution and region.
Highlights
The first radiology residency program in Rwanda, a lowand middle-income country (LMIC), was founded in 2016, based at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK), an academic hospital and the largest referral center in the country
CT examinations were prospectively encountered in clinical work at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda, where the radiology report impression, patient age, gender, study indication, CT protocol, and clinical diagnosis were recorded when available
Patients in Rwanda were older (p=0.0017), more likely to receive intravenous (p < 0.05) and positive oral contrast (p < 0.05) media and less likely to receive a formal recommendation in their radiology report (p < 0.05)
Summary
The first radiology residency program in Rwanda, a lowand middle-income country (LMIC), was founded in 2016, based at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK), an academic hospital and the largest referral center in the country. The radiology department at the Massachusetts General Hospital, a quaternary-care, academic hospital in Boston, Massachusetts, United States, a high-income country (HIC), has partnered with the radiology department and residency program at CHUK in developing a bidirectional, longitudinal, clinical and educational global radiology relationship between our practicing and in-training radiologists. The diversity of disease processes between the two sites is an asset for education of in-training and practicing radiologists based at both centers The purpose of this retrospective, dual-center study was to compare the pathology encountered in adults undergoing abdominal and pelvic CT examinations between academic teaching hospitals in Rwanda and the United States, to highlight differences in the roles of imaging in guiding patient care between LMIC and HIC healthcare settings, and to reflect on how these differences enhance the ongoing collaboration between our radiologists. We share strategies used to build a longitudinal, bidirectional global radiology collaboration
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