Welcome to Mayo Clinic RAD-AID
The Mayo Clinic – Rochester campus chapter was founded by three residents in early 2013 for the purpose of developing projects in radiologic service and education in underserved international populations.
Southern Turkey – In April/May of 2013, the three founding members of the Mayo Clinic chapter of RAD-AID traveled to the Syrian border of Turkey. Activities of the mission included a mix of service and education.
We partnered with a clinic run by the Syrian Expatriate Medical Association (SEMA) in Kilis, Turkey to provide care to Syrian refugees. The clinic population, which was comprised of mostly women and children, was served by Syrian internists, pediatricians, and an obstetrician/gynecologist with weekly visits from an ophthalmologist and otolaryngologist. Our role was to provide diagnostic ultrasound services to the physicians at the clinic. Cases varied, but generally fell under the catgories of routine, obstetrical, and subacute postraumatic. The cases that could not be managed by the resources of the clinic were triaged to the Turkish national hospital system.
We then traveled north to Gaziantep, Turkey to an ATLS-like course sponsored by the Syrian American Medical Society (SAMS). Our role was to teach the didactic and hands-on sessions on the topic of the FAST exam to Syrian nurses, residents, and doctors providing acute care within Syria. These healthcare providers were primarily working near the fighting, and were interested in appropriate triage of trauma victims.
Mirebalais, Haiti – Through our involvement in the RAD-AID conference in 2013 and through one of our attending physicians at Mayo Clinic, we made contacts with individuals involved in a teleradiology project serving Haitians. We discovered that a data infrastructure system and web-based PACS were already available to provide teleradiology interpretations of CT scans at the HÈpital Universitaire de Mirebalais in Mirebalais, Haiti.
The Hospital was built in 2012 by Partners In Health and opened its doors in March of 2013. It is located in Mirebalais in the rural, central plateau region of Haiti, just northeast of Port-au-Prince. It currently serves 400-600 patients per day, with a primary and tertiary catchment of 185,000 and 3 million, respectively. Services include internal medicine, pediatrics, OB/GYN, surgery, and outpatient clinic. The hostpital boasts one of five CT scanners in the nation, and is, at the time of this entry, the only CT scanner at a public hospital. Unfortunately, there are no current onsite radiologists to interpret the CT scans that are performed, leaving the clinicians to interpret many of the exams themselves, without former radiology training. With the necessary infrastructure already in place, several academic hospitals, including Mayo Clinic, are now involved with providing interpretations to these studies.
Our experience with this project began in late 2013, when we began to get approval from our resident program director and heads of divisions to implement volunteerism designed to include staff and residents. We also discussed the potential legal implications with our legal department, as well as briefly discussed with our IT department for potential IT issues. After approval, we compiled a list of potential volunteers amongst staff and residents, and credentialed the staff.
We began volunteer shifts in February 2014 and have been interpreting scans during 2-3 sessions per month. Each session enlists an average of 2 body staff, 2 neuroradiology staff, and 6-8 residents for 2-3 hours of interpreting. Reporting is done though the web-based PACS, and is a simple process. Each report contains the unique number of the interpreting staff (although the reports are by-and-large created by our residents prior to staff approval/editing).
This has been an extremely gratifying and educational experience for residents and staff alike. The pathology is unique (TB, ascariasis, neurocystercercosis, AIDS-related pathology to name a few) and advanced (extremely locally advanced breast cancer is extremely commonplace, for example). As the studies do not contain IV contrast and there is no MRI, our problem solving steps are limited, which forces us to optimize our use of noncontrast CT findings. The project has improved resident-staff relationships through comraderie.
Although we believe we have improved quality and quantity of interpretation, the CT list is still quite backlogged, with scanner utilization noticeably increasing. We would love to see other residency programs mimic our model so that the Haitian clinicians, and ultimately, Haitian patient’s can rely on a radiologist’s interpretation.