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Addressing Global Radiology Disparities: Increasing Access to Interventional Radiology Education

2021; Radiological Society of North America; Volume: 41; Issue: 5 Linguagem: Inglês

10.1148/rg.2021210176

1527-1323

Anna Sophia McKenney, Tushar Garg, Esther Kim, Andrew Kesselman,

Healthcare cost, quality, practices

HomeRadioGraphicsVol. 41, No. 5 PreviousNext Education CornerFree AccessRG TEAMAddressing Global Radiology Disparities: Increasing Access to Interventional Radiology EducationAnna Sophia McKenney , Tushar Garg, Esther Kim, Andrew KesselmanAnna Sophia McKenney , Tushar Garg, Esther Kim, Andrew KesselmanAuthor AffiliationsFrom the Division of Interventional Radiology, Department of Radiology, New York–Presbyterian Hospital/Weill Cornell Medical Center, 425 E 70th St, New York, NY 10021 (A.S.M., A.K.); Division of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India (T.G.); and Department of Diagnostic Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.).Address correspondence to A.S.M. (e-mail: [email protected]).Anna Sophia McKenney Tushar GargEsther KimAndrew KesselmanPublished Online:Sep 1 2021https://doi.org/10.1148/rg.2021210176MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In More than half of the world’s population lacks access to essential radiology resources. While access to diagnostic imaging and interventional radiology (IR) skills is a given in many developed health care systems, improving access to imaging is vital to meeting various Sustainable Development Goals laid out by the United Nations (1). Research shows that there are more radiologists in a single academic center on the Eastern Seaboard of the United States than there are in the entire population of many low- to middle-income countries (2). Despite recent increased access to previously cost-prohibitive radiologic equipment, the lack of formal education and trained radiology professionals is a key contributor to global radiology disparities (1).Interventional radiologist availability worldwide is even more scarce. At the time of this writing, to our knowledge there are no formally trained interventional radiologists in Tanzania, which has a population of 60 million, and Kenya has only 10 interventional radiologists to service its population of 54 million (3,4). In Latin America, there are an average of 29 (range, 0–120) interventional radiologists in each country (5). In contrast, a recent analysis of Association of American Medical Colleges workforce data has estimated the number of interventional radiologists in the United States to be close to 3500 (6).The main limitations around the world for starting and maintaining IR practices include a lack of training pathways and the costs of acquiring and maintaining procedural equipment (3,4,7). A comparison between the number of training programs in some representative countries around the world and in the United States is shown in the Table.Estimated Number of IR Professionals and Training Programs by Country Compared with Population SizeSeveral ongoing efforts to close this gap have shown great promise and have overcome unique challenges. In 2015, a group based at the All India Institute of Medical Sciences, New Delhi envisioned a structured approach to mobilize funds and logistical support for skilled interventional radiologists and their teams to provide intensive training in person (7). In their work of over 3 years, this group enabled 15 formal educational events as part of three training institutes working with 12 participating countries. These events had intensive web integration, creating a force-multiplier effect to allow virtual lectures and continuing medical education programs to be transmitted even more widely. The structured approach resulted in the ability to train 51 interventional radiologists, with the promise for future sustainable growth and continuing education (7). This program highlights the synergistic effect of a robust network of professionals from different countries working to improve training in multiple locations simultaneously.In 2018, an effort by the radiology program of Yale University in New Haven, Connecticut, to partner with Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania’s main medical academic teaching center, resulted in creation of a master of science degree in IR (4). This 2-year program necessitated the creation of a formal IR service at MUHAS. Part of their assessments revealed that pathologists, who performed all fine-needle aspirations, were overwhelmed by the demand and often obtained inadequate samples due to an inability to perform core biopsies, one of many responsibilities eventually absorbed by the new IR service. The formal educational experience is primarily experiential, and radiology trainees participate as the primary operators in many procedures under the supervision of rotating faculty. Six Tanzanian radiology residents were enrolled in the first two classes for this degree, and there are plans to graduate the first class in 2021 (4). This program shows how an academic model can help expand the global IR community.As part of its conscientious approach to global health intervention, RAD-AID International, in coordination with the World Health Organization, has used their Radiology-Readiness assessment and subsequent tools to help identify actionable interventions that can improve gaps in radiology care. At the University of Nairobi in Kenya, RAD-AID International determined that there was sufficient procedural capacity to help foster efforts to create a dedicated IR fellowship for interested radiology residents. In 2019, a formal 2-year IR fellowship curriculum based on the RAD-AID global IR curriculum was approved by Kenyan university leadership (3). The RAD-AID global IR curriculum, created in collaboration with the Society of Interventional Radiology Resident, Fellow, and Student section (SIR-RFS), describes nonprocedural skills, core procedures (eg, incision and drainage, line placement, and trauma embolization), and more complex procedures (eg, thrombolysis and thrombectomy, treatment of vascular malformations) (3). Interventional training is delivered through a series of scheduled site visits two to four times per year by RAD-AID International volunteers who include IR attending physicians, nurses, and technologists.The program at the University of Nairobi benefits from the unique presence of three in-country interventional radiologists and an established IR service, decreasing the need for continual volunteer deployments. At the time of this writing, two fellows are enrolled in this novel fellowship experience. Traditional IR teaching is supplemented through use of a dedicated IR learning management system and other web-based strategies.Partnership and collaboration have been the backbone of these educational experiences. Partnerships with industry and collaboration with IR societies have allowed access to medical devices, educational resources, and tool kits for expanding IR services (1). RAD-AID International has developed a robust volunteer network to pair interested interventional radiologists with appropriately selected deployment teams, a model used by the organization since its creation in 2008. On-site deployments are often supplemented with procedural simulations ranging from low-fidelity biopsy phantoms to complex endovascular simulators (Figure). However, in the era of COVID, these on-site deployments have been limited. Necessity has fostered an expansion of virtual web-based interactions during this unprecedented time, offering an enormous opportunity for growth, especially in online educational resources. Given these successes, remote didactics, simulation sessions, and global conferences will continue to play a large role in ongoing educational efforts as on-site deployments begin to resume.Figure. Photograph shows a high-fidelity simulation session with the University of Nairobi IR fellowship program accessed on a web-based platform.Figure.Download as PowerPointOpen in Image Viewer Medicine as a field is moving increasingly toward minimally invasive image-guided techniques, as part of efforts to reduce procedural morbidity and mortality, shorten recovery time, and allow symptomatic and palliative treatment for patients who otherwise would not be candidates. For example, thrombolysis or treatment of peripheral vascular disease, embolization for hemorrhage, and targeted cancer treatments such as thermal ablation are vital procedures in IR. These potentially life-saving therapies can be assets to the global community. However, these therapies require the coordination and education of teams of IR nurses, technologists, and physicians.Trainee involvement is a key element in creating lasting change. According to Mollura and Lungren (1), “Among current undergraduate and graduate medical trainees in high-income countries, there is well-documented keen interest in global health, to include global radiology,” and this enthusiasm is irreplaceable. However, perhaps more importantly, global health work as a trainee allows exposure to different practice models and mentoring that can positively influence future practice and participation. These experiences can lead to a long-lasting global partnership in both education and service. Although some radiology trainees seek out global health opportunities on their own, greater awareness and access will further improve participation. Several resources are listed below, and we encourage all interested trainees to connect and participate in whatever capacity possible.These efforts highlight the fact that building global capacity in radiology is necessary and that increasing access to IR services is crucial in low- and middle-income countries. There are many constraints to building this capacity both globally and domestically, and advancing education can be a cornerstone of this development. Institutional, societal, and individual trainee support for future IR educational efforts in low-resource settings is an essential part of improving health care outcomes worldwide.Please visit the following web links for further information:RadAID International Interventional Radiology. This site directs to deployment volunteering opportunities, the most recent Global IR Curriculum, and IR webinar series: https://rad-aid.org/programs/interventional-radiology/Kesselman A, Gaupp FL, Colgan F, Dixon R. RAD-AID Global Curriculum for Interventional Radiology. https://rad-aid.org/wp-content/uploads/RadAidIR_Curriculum_2020_v2.1.pdfYale School of Medicine Department of Radiology Global Outreach Program. https://medicine.yale.edu/diagnosticradiology/education/globaloutreach/overview/IR readiness tool. https://escholarship.umassmed.edu/jgr/vol3/iss1/2/References1. Mollura DJ, Lungren MP, eds.Radiology in Global Health: Strategies, Implementation, and Applications. New York, NY:Springer,2014.http://link.springer.com/10.1007/978-1-4614-0604-4. Accessed May 16, 2021. Crossref, Google Scholar2. Silverstein J. Most of the World Doesn’t Have Access to X-Rays. The Atlantic. https://www.theatlantic.com/health/archive/2016/09/radiology-gap/501803/. Accessed May 16, 2021. Google Scholar3. Brown B, Culp M, Olabu BO, et al. Meeting the Need for IR Training in Kenya. J Vasc Interv Radiol 2020;31(11):1929–1932.e1. Crossref, Medline, Google Scholar4. Laage Gaupp FM, Solomon N, Rukundo I, et al. Tanzania IR Initiative: Training the First Generation of Interventional Radiologists. J Vasc Interv Radiol 2019;30(12):2036–2040. Crossref, Medline, Google Scholar5. European Society of Radiology (ESR). Summary of the proceedings of the International Forum 2017: “Position of interventional radiology within radiology.”. Insights Imaging 2018;9(2):189–197. Crossref, Medline, Google Scholar6. Garg T, Bajaj S, Dayan MJ, et al. Temporal and geospatial variations among the interventional radiology physician workforce in the United States. Clin Imaging 2021;78(105):109. Google Scholar7. Sharma S, Ganga K. Establishing IR in Emerging Countries: A Skill Development Initiative. J Vasc Interv Radiol 2019;30(6):956–960. Crossref, Medline, Google ScholarArticle HistoryReceived: June 01 2021Accepted: June 04 2021Published online: Sept 01 2021Published in print: Sept 2021 FiguresReferencesRelatedDetailsCited ByA Decade of Global Skull Base Researchers: Authorship Trends from 3,295 Abstracts in the Journal of Neurological Surgery Part B: Skull BaseRosemary T.Behmer Hansen, Samantha D.Palma, William A.Blocher III, Ryan A.Behmer Hansen, Justin L.Gold, Stephen J.Susman, SaiBatchu, Nicole A.Silva, Angela M.Richardson2023 | Journal of Neurological Surgery Part B: Skull BaseThe Dawn of Training Programs in AfricaFrank JMinja, Mechris CMango, Fabian M LaageGaupp2022 | Applied RadiologyRecommended Articles Updates and New Frontiers in Interventional Radiology The 2022 RadioGraphics Monograph IssueRadioGraphics2022Volume: 42Issue: 6pp. 1577-1578Forging Connections in Latin America to Advance AI in RadiologyRadiology: Artificial Intelligence2022Volume: 4Issue: 5RG TEAM Highlights Importance of Trainee Involvement in RadioGraphicsRadioGraphics2021Volume: 41Issue: 2pp. E60Contrast-enhanced US for the Interventional Radiologist: Current and Emerging ApplicationsRadioGraphics2020Volume: 40Issue: 2pp. 562-588Immunotherapy and the Interventional Oncologist: Challenges and Opportunities—A Society of Interventional Oncology White PaperRadiology2019Volume: 292Issue: 1pp. 25-34See More RSNA Education Exhibits Robotic Devices For Endovascular Interventions: Fantasy Or RealityDigital Posters2021Not Just Renal Mass Ablation. 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