Abstract
ObjectiveSub-standard quality in X-ray image acquisition and interpretation is common in low-resource countries, and can ultimately result in higher patient morbidity and mortality. This study aimed at evaluating; 1) feasibility of implementing a digital X-ray device in a second level hospital in Angola; 2) quality of digital X-ray images, when digital radiology was in the hands of local technicians; 3) feasibility of digital teleradiology and its potential impact on case management.MethodsWe developed and tested at the Hospital Divina Providencia (HDP) in Luanda, Angola, a digital X-ray device and a telemedicine network to acquire and print digital X-ray images and send them as DICOM files for remote consultation.Results20,564 digital X-ray images were made at HDP from November 2010 to December 2012, with no major technical problems and no need for on-site supervision. Digital radiology largely improved the number of X-ray images of good and very good quality (100% of images with digital radiology, compared to 15% of screen-film images, p<0.0001). Teleradiology using digital images was used in 7.6% of paediatric cases, and provided, in these cases, an important contribution to case management.ConclusionsThe implementation of a digital X-ray device is feasible in low resource settings with significant improvement in quality of X-ray images compared to standard screen film radiology.
Highlights
Radiology plays a critical role in the management of many acute and chronic diseases – such as pneumonia, tuberculosis and HIV – in low resources settings
Ethics statement The Hospital Divina Providencia (HDP) Project Review Board gave the consent to the implementation of the system for acquisition of digital images, and this was implemented from November 2010 as a new standard of care
Based on the following considerations: a) the implementation of the digital system does not modify the quantity of X-rays received by the patients, nor does it present any additional health risk for the patient compared to standard radiology; b) radiology examination was performed as part of routine care
Summary
Radiology plays a critical role in the management of many acute and chronic diseases – such as pneumonia, tuberculosis and HIV – in low resources settings. In these settings, there is limited access to radiological services of acceptable quality, with massive inequalities in service delivery between the public and private sector [1,2]. Screen-film Xray can’t be directly saved, reproduced and circulated for the purposes of patient follow up, nor for external consultation and training This is relevant in settings characterized by high workload and shortage of human resources [1,2,3]. All these factors may contribute to sub-standard quality in X-ray interpretation, and result in inadequate case-management, higher patient morbidity and mortality [1,2,3]
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