Mammograms for women at risk for breast cancer, ultrasounds for expectant mothers and X-rays for injured and sick children. These diagnostic procedures are standard in U.S. hospitals and the basis for much of the medical care people receive, yet half the world's population has no access to such tests.
That unsettling statistic from the World Health Organization spurred the launch of a Maryland-based aid group that works to bring equipment and training to areas in developing countries where hospitals, medical schools and even electricity are scarce.
"I thought about how critical imaging was, and there was this major break in medical care," said Dr. Daniel J. Mollura, a Bethesda radiologist who launched RAD-AID International eight years ago while a radiology fellow at Johns Hopkins Hospital. "You can't get to other areas of health care without radiology."
The nonprofit group that began with a few dozen people now has 47 chapters at medical schools such as Hopkins and the University of Maryland, and 4,500 volunteers around the world. Programs are underway in Africa, Asia, the Caribbean, and Central and South America. RAD-AID is officially affiliated with the World Health Organization and is about to expand into Eastern Europe and, for the first time, is looking domestically in a rural area of Alaska.
Radiologists believe RAD-AID is now the largest organization of its kind, though it operates almost exclusively on donations of time, expertise and equipment. Government filings required of nonprofits show a budget of under $200,000 and no full-time employees. Mollura, who is president and CEO, estimates that thousands of hours were donated just in the first couple of months of this year.
The group relies on volunteers who come to annual conventions and suggest places to go and services to offer. A RAD-AID board then assesses specific needs and determines what can be offered, given practical limitations. This process stems from Mollura's premedical background as a Wall Street analyst.
RAD-AID partners with government agencies, nonprofit groups, hospitals and corporations when funding is needed for equipment or expenses. But those who work with RAD-AID say donations of time, services and equipment aren't usually the problem.
Cape Verde, a group of islands off the northwestern coast of Africa, had no medical school to train workers to use equipment, so RAD-AID arranged for technicians and radiologists to travel there and show people how to take images and read them. Rural villages in India had no hospitals, so RAD-AID built a mobile clinic to screen women for breast and cervical cancer and osteoporosis. China had high-tech equipment but needed advanced training, so RAD-AID sent experts.
In Laos, volunteers set up X-ray and ultrasound equipment that had been donated but was still in boxes because no one knew how to use it, Mollura said.
Many places also lacked the necessary technology infrastructure to allow images to be transmitted and stored so doctors could access them. Merge Healthcare, a Chicago-based imaging technology company, is donating the necessary systems under a partnership announced last fall. (Justin C. Dearborn, the CEO of Tribune Publishing, parent company of The Baltimore Sun, was CEO of Merge at the time.)
RAD-AID also makes use of so-called cloud-based storage, where images can be accessed securely online instead of through a local server.
Another necessity is proper installation and use of equipment so images aren't blurry. Safety also is a concern since some imaging involves radiation.
At Western hospitals like Johns Hopkins, the walls of a radiology facility may be lined with lead to shield patients and staff from radiation, said Mahadevappa Mahesh, the chief physicist for Johns Hopkins Hospital, who also works to solve problems for RAD-AID.
At a new center in the works in Haiti, Mahesh said lead lining was too expensive, so he suggested 6-inch-thick concrete walls instead. In other places where electricity isn't reliable, he said portable X-ray machines that run on rechargeable batteries are a good solution, as long as the batteries are available.
"You want to make sure you're doing things in the right way, that you connect all the dots, and this is where RAD-AID comes in," said Mahesh, also a professor of radiology and radiological science in the Johns Hopkins School of Medicine. "You don't want to scan people incorrectly. That can be a negative."
There were many efforts before RAD-AID by radiology professionals and charitable companies and organizations that wanted to ensure that imaging made it to the masses, said Dr. Jonathan S. Lewin, executive vice president for health affairs at Emory University. Lewin was the head of the radiology department at Hopkins when Mollura approached him about forming RAD-AID.
Lewin believed the effort could unite all those efforts, and he used department resources to host the annual convention until last year, when it moved to WHO offices in Washington. He also helped Mollura connect with department chairs at other medical schools to accelerate formation of new chapters to ensure a steady stream of ideas, expertise and volunteers.
"It's wonderful to see what had been a very fragmented collection of well-intended people trying to bring different aspects of imaging to different locations," he said. Mollura "brought everyone together and aligned their efforts and created a more cohesive framework."
With a model and volunteers in place, it's easier for projects to get off the ground, Mollura said.
At any given time, about three teams are abroad, typically made up of radiology professionals as well as faculty and residents from medical schools and professional organizations such as the American College of Radiology and the American Society of Radiologic Technologists, as well as similar groups in the United Kingdom and Canada. It also works with other nonprofits such as Project HOPE, an international health care organization based in Bethesda.
Volunteers can spend up to eight weeks setting up equipment and training professionals to use and maintain it. The group can also respond quickly when catastrophe strikes. After an earthquake last year in Nepal, a team was assembled in days and sent to assess damage to equipment and new needs.
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"We did an assessment to see how we would rebuild," Mollura said. "Some hospitals were condemned and some were untouched."
Brad Short, who helps coordinate the volunteers for the American College of Radiology, said groups like RAD-AID make it easier for radiologists and related professionals to find outlets to offer their services.
"The biggest challenge is the huge gap in imaging access," he said. "A number of organizations are helping to close that gap, but it's important that we coordinate and communicate so we're being as efficient as we can be."
Those who work in developing countries need radiology machines for a lot of their work, said Dr. Tigistu A Ashengo, associate medical director for Jhpiego, a Hopkins-affiliated nonprofit group that focuses on global health care for women and families.
Problems with imaging compound already daunting delays for those needing surgery, said Ashengo, who leads Jhpiego's safe surgery initiative. For example, in some rural Ethiopian communities, there is a seven-year waiting list for orthopedic surgery, often needed after an injury such as a broken bone, he said.
"Sometimes we're dealing with a broken leg and sometimes it's an obstruction that needs to be diagnosed with an X-ray," he said. "There's electricity and radiology machines, but the equipment is broken. ... It's so sad. The problem is so huge."