Where there's a will, there's a PACS solution

Ghana is an example of a country with so few radiologists it raises the question of how PACS could assist in establishing teleradiology. Medical care of any kind is often rare in many parts of Africa. A 1999 World Health Organization report found that sub-Saharan Africa has, on average, fewer than 10 doctors per 100,000 people.

Fourteen countries in that region do not have a single radiologist. Ghana is more fortunate.

"We have about three," said Theophilus Ntiri, a radiology technician at 37 Military Hospital in Accra.

The simple answer to the question of whether PACS can help in a full or partial radiologic vacuum is yes, said Henri "Rik" Primo, manager of Image Management (PACS) for Siemens Medical Solutions. But telecom issues need to be addressed first.

Expensive proprietary hardware is no longer needed for teleradiology, and the Web can be used as a communication vehicle, he said.

"Radiologists could do remote diagnosis if they receive images digitally with good quality on a PC," Primo said. "Since few radiologists are available, they could have 'virtual presence' in many hospitals and clinics by teleradiology and cover large geographies without travel."

Although broadband communication technologies are not widely available in Ghana, living with the limitations of dial-up and wavelet compression with progressive viewing will nevertheless beat the delay and expense of transporting patients, which is the only option during emergencies.

For nonemergencies, the postal service of Ghana could be used to ship images on film (analog) or CD (digital) to remote radiology services, Primo said.

In the meantime, broadband is becoming available, bypassing the issues of land line infrastructure deficiencies.

Web distribution of images is possible with cost-effective Web servers. Viewing software can be thin-client technology, making it easy to install automatically and maintain and update remotely on the PC of the radiologist, Primo said.

Currently, images at 37 Military Hospital are obtained on film.

"We attend to about 80 people a day, and the images are read by the only radiologist we have," Ntiri said.