ArticlePDF Available
2011 year of the bold step?
Øystein E. Olsen &Catherine M. Owens
Received: 9 February 2011 / Accepted: 14 March 2011 / Published online: 3 June 2011
#Springer-Verlag 2011
According to one of the commissioned articles by
Andronikou et al. [1], only 2% of the original research
articles published in Pediatric Radiology in recent years
originated in Africa. At the 2011 International Paediatric
Radiology Congress in London, of a total of 620 accepted
abstracts, only 32 (5.2%) are from developing countries in
Asia, and 11 (1.8%) from Africa. Pediatric Radiology
attempts to move at least some attention from the western
world and to stimulate and accommodate invited contribu-
tions from colleagues in developing countries. This
began with the HIV mini-symposium in 2009, and
continues in this edition with two commissioned papers
by Andronikou and coworkers [1,2].
When there are such obvious needs for a more suitable
infrastructure, expertise and specific knowledge in the
major part of our world, why do we so seldom discuss it?
Perhaps we have become accustomed to shaming and
blaming politicians, national organizations, a hopelessly
skewed resource distribution, instead of asking: what is our
own contribution, and what can I do. This is where we must
begin, but there are many more questions to be asked, and
some will shake our very foundations.
When resources are scarce, the mechanisms of the
market take the driving seat. Good people want to enhance
their skills, improve their chances of succeeding both
professionally and academically, and maximize their
earnings, encouraging individuals to be mobile. However,
the flip side is that the developing world continues to be
drained of its most precious resource, skilled people:
radiologists and allied professionals. We do not think that
this professional labour market can be regulated; neither
do we find any imposed restrictions or regulations
desirable. However, a counter-balance to the brain drain
is needed, and our professional societies can help with
less-dramatic interventions.
An obvious step is to help design and support training
schemes within paediatric imaging that are suitable for
the disease spectrum, preexisting skills and manpower,
resource limitations, and the particular climatic and
geographic conditions within developing countries. We
may think that our field is too high-tech to be of much
practical value in rural Africa, but avoiding fatalities in
thousands of children from tuberculosis by early diagnosis
and appropriate therapy cannot be done without a reliably
functioning X-ray unit, people who know how to get the
exposure right (at a reasonable radiation dose) and produce a
diagnostic image, and people who can translate an image into
appropriate effective therapeutic action. However at least two
uncomfortable questions arise from this.
First, are we willing to support skill-mix and professional
role-extension, and let non-medics act as diagnostic radiol-
ogists? This may be a prerequisite, because there simply are
not enough doctors out there. But this concept also shatters
our guild mentality and threatens our perhaps complacent
professional monopoly. Next, will we train people gratis
when we demand a financial commitment from participants
in our lucrative educational market at home?
Assuming willingness, there is a definite need to identify
potential partners, who already exist, possibly a mix of
local academic institutions, local professional groups, and
governmental and non-governmental (aid) organizations.
Furthermore, tapping into existing infrastructure is crucial.
Similar strong links must be established with equipment
manufacturers, who historically have focused almost
Ø. E. Olsen (*):C. M. Owens
Great Ormond Street Hospital for Children NHS Trust,
Great Ormond Street,
London WC1N 3JH, UK
Pediatr Radiol (2011) 41:799800
DOI 10.1007/s00247-011-2138-8
exclusively on the high-tech end of the spectrum of product
development. Are they as willing to develop digital (tele)
radiology systems suitable for dusty south Asian country
roads as they are to develop MR/PET systems?
Teleradiology is a cue for discussing how we can ensure
that subspecialized and expert opinion will actually have an
impact on individualized clinical management. Although
setting up volunteer rosters to provide opinions from
experts in the rich world to practitioners in the field is
commendably altruistic and a wonderful start for our
project, it is probably not sustainable. It will not help
people to help themselves. We think that the role of
teleradiology and telemedicine primarily is within the
country or region, and that it ought to depend on a few
strong, self-sustaining national academic tertiary referral
centres, rather than on interested volunteers further afield.
As pointed out by Boland [3], effective clinical decision-
making is based not only on expert opinion, but also on
trust and camaraderiebetween clinician and radiologist.
Intimate knowledge about local conditions is one important
foundation for trust. The weakness of teleradiology is the
remoteness itself, and the absence of a clinical presence. We
should step forward with caution.
How do we diagnose parasitic infections? How can we
optimize ultrasonography and radiography for multisystem
assessment of tuberculous infection in children? The
radiological map has a large number of glaring white spots
relating to diseases that are truly global in scale. Research
and development with a global viewpoint is paramount if
we are to fill these gaps. Development of more durable
suitable equipment, and shifting the focus to a more
relevant end of the disease spectrum, are obvious priorities.
However, critical appraisal of the efficacy of diagnostic
imaging tests is another gaping deficiency in academic
paediatric radiology. Proven cost-effective algorithms for
diagnostic imaging in childrenwithspecificclinical
presentations should be a core academic goal, but currently
we are lucky if we know which modality offers the best
sensitivity and specificity compared to a clinical or
histopathological reference. We are hard pushed if asked
exactly what our impact is on clinical decision-making, not
to mention long-term morbidity and mortality, or overall
cost-effectiveness of health care. This is common ground
for radiologists in developing and developed countries. In
the developing world, these questions are enforced by
necessity due to dire resource limitations. But, increasingly,
the galloping costs of health-care in western societies are
under scrutiny; and when seeking the lowest reasonably
achievable radiation dose, the same questions bubble to the
surface. So in these important areas of research there seems
to be common ground, and perhaps one of the most
important tasks for our professional societies is to coordi-
nate the exploration for answers.
It is our responsibility and duty to unite and provide
some of the necessary support and aid to facilitate
development of a more robust global network for paediatric
radiology. The level of basic requirements has been well
researched and documented by Médecins Sans Frontières,
its off-shoot Téléradiologie Sans Frontières, the World
Health Organization, and the International Atomic Energy
Agency (radiation exposure issues). We believe that a
support network is already in existence within all of our
societies, and hence it is time to pool the resources of the
Asian-Oceanic, European, Latin American, and American
societies of paediatric radiology, and create a world
federation of paediatric imaging. A group of world leaders
must engage and commit to practical means of addressing
the global problems, and proactively provide appropriate
help and support as defined locally.
Our proposed strategy is to
1. Establish a world federation devoted to improving
child health via diagnostic imaging globally, by
promoting development and dissemination of appro-
priate equipment and skills, and protecting children
from unnecessary procedures and ionizing radiation.
2. Become the acknowledged liaison body for all
matters relating to imaging and radiation protection
in children, for the World Health Organization and
other international governmental and nongovernmen-
tal stakeholders.
This mission is not going to succeed without the support
of our membership. Some questions may be uncomfortable,
but are nevertheless pertinent. If we want change, are we
willing to give up the European and North American
hegemony and let our joint conferences be hosted in, and
for the additional benefit of, developing countries? Are we
willing to stand up for skill-mix, which challenges our
professional monopoly? Will we lobby manufacturers to
develop more suitable equipment for rural users? Will we
disseminate skills free? But most importantly, are we ready
to take the very necessary bold step forward?
1. P-RAD-10-00592.R2
2. P-RAD-10-00712.R1
3. Boland GW (2008) Teleradiology coming of age: winners and
losers. AJR Am J Roentgenol 190:11611162
800 Pediatr Radiol (2011) 41:799800
ResearchGate has not been able to resolve any citations for this publication.