teleradiology in haiti

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  • 1. A prototype for remotely assisting distressed areas

2. A 7.0 magnitude earthquake hit Haiti with an epicenter 10 miles west of Port-au-Prince and its 2 million inhabitants. The major quake sent 33 aftershocks ranging in magnitude from 4.2 to 5.9. Haiti has no real construction standards, which magnified the resulting damage and casualties. 3 million people were in need of emergency aid after the earthquake. 3. Devastation after the January 12, 2010 earthquake. Father Rick and Bishop Pierre Dumas performblessings over mass graves in Titanyen. The state left the bodies piled up and the priest brought inbulldozers to give them a proper burial. Photo by Alison Wright. Used by permission. 4. Over a million displaced people have been made homeless and forced to live outside under tarps andtents.Photo by Alison Wright. Used by permission. 5. Nearly 10% of children die before their 5th birthday, largely of treatable illnesses. Half of all the deaths in Haiti every day, are children under the age of 5. 1 out of 4 children are moderately to severely malnourished 138,000 children die of preventable diseases each year.Photo by Alison Wright. Used by permission. 6. Near the epicenter of the quake. Treats more than 37,000 children per year. Performs about 4800 x-rays annually. 90% of all x-rays were chest x-rays wereperformed to exclude respiratory tractinfection. After the quake, most x-raysperformed were trauma-related. 7. The suite was designed on a limited budget.Paradoxically, this is the reason it survived thequake. The expensive lead sheets commonlyutilized in the USA to shield the walls of x-raysuites were bypassed by the suites designer infavor of a much more inexpensive alternative:The wallswere being constructed with rebar andcinder blocks. I suggested filling the cinder blockswith concrete, making them solid concrete blocks. Itested my idea with x-rays and sure enough, noradiation penetrated the one foot wall of concrete-Barbara Tomasini, RTR, CV, RCIS 8. CRRS: a teleradiology practice specializing inradiology interpretations for private imagingcenters. After the Haiti earthquake, CRRS sought a wayto help, volunteering our interpretations. Doctors Without Borders and the US StateDepartment were not receptive to our offer. We found an article in Aunt Minnie(AM)regarding the St. Damien Hospital forChildren. 9. AM article: St. Damiens Hospital x-ray suitehad survived the quake and was operational. We contacted the AM reporter who forwardedour email to Ms. Barbara Tomasini, who haddesigned St. Damiens digital x-ray suite. Through Ms. Tomasini we made contact withthe hospital, and explained our offer to their ITspecialist. 10. CRRS was immediately able to access the St.Damien PACS system. We were relieved to findtheir system was one familiar to us: VizteksOpalRAD system.In conjunction with Viztek engineers, weconfigured the hospital system to automaticallysend a copy of all x-rays performed to our serversin New York for interpretation by our radiologists.CRRS received the first St. Damiens examination4 hours following our initial contact with Ms.Tomasini. 11. One small PC was being utilized for: Hospital employee email and surfing Local viewing of x-ray examinations Housing their PACS Satellite internet issues Relatively slow and unreliable internet connection Reports not accessible easily Problems with DICOM transmission No fax machine Unreliable email No way to communicate urgent findings 12. One small PC at St. Damien utilized formultiple tasks: Hospital employee email and surfing Local viewing of x-ray examinations Housing their PACS CRRS with Vizteks help, donated a large, powerful, high capacity OPALRAD server to St. Damiens in order to provide them with a dedicated PACS server. The server arrived pre-configured at the hospital several weeks following the earthquake, It was installed by Patrick with remote assistance from Viztek engineers. 13. Satellite internet provider at St. Damien- arelatively slow and unreliable internetconnection. This remains an issue. Their internet line speedranges between 4-10 kBps. Under a load itdrops to 1-2 kBps. For reference: an old styledial-up modem runs at 24-56 kBps. 14. The CRRS PACS distributes our reports via our webserver. Because of the intermittent and slow internetconnection at St. Damiens this was not an option, nor wasemail. The hospital did not have a fax machine either. CRRS designed a system to convert all St. Damienreports to PDF files which are automatically uploaded toour FTP server and then automatically downloaded to afolder on the desktop of the St. Damien viewing computerwhenever a connection is available. 15. Their satellite provider sends a packet receivedresponse to the St. Damien PACS server before the datahas been received by the CRRS server. If data packetsare dropped after this spurious response, the sendingserver will not resend the dropped packets, producingmissing studies and images on the CRRS server. Viztek engineers designed a workaround to addadditional packet checking and to force synchronoustransfer through the satellite connection. 16. The limitations of the internet connection and theresulting lack of dependable email and the lack of a faxmachine was problematic. CRRS developed an email to SMS gateway that allowsour radiologist volunteers to instantly communicateurgent findings to the St. Damien doctors cell phonesdirectly by sending an email to the SMS gateway. 17. 6 fxs pelvis/crush 18. Saint Damien Hospital, Haiti.Photos by Alison Wright. Used by permission. 19. Photos by Alison Wright. Used by permission. 20. Saint Damien Hospital, Haiti.Photo by Alison Wright. Used by permission. 21. Saint Damien Hospital, Haiti.Photo by ALISON WRIGHT. Used by permission. 22. RDS/PTX 23. Free Air/NEC 24. CHD 25. Rickets vs OI vs short-limbed dwarfism 26. Photos by Alison Wright. Used by permission.