Imaging in the Lion City: Singapore Radiology Country Report

Singapore is a small tropical island city-state with limited natural resources that has achieved remarkable healthcare outcomes through effective long-term planning and judicious investment in human resources and technology. A full-range of medical imaging services is available in the country, with integrated care delivered to patients through a network of both government and private hospitals. Training in diagnostic radiology, interventional radiology, nuclear medicine and diagnostic radiography continue to evolve in Singapore, with an aim to further increase the range of subspecialty medical imaging services available and address projected challenges for the healthcare system in the future, such as an aging population. Continued government investment in technology and biomedical imaging is expected to further expand the scope and depth of medical imaging services in the future

The State of Interventional Radiology in Myanmar: A National Report

Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges. Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix. Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties. Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future

RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020

The COVID-19 pandemic has challenged and changed our healthcare systems around the world. There has been a heterogeneity of disease burden, healthcare resources, and non-imaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding of how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. Here we detail experiences from radiology experts in representative countries from around the world, to share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides

Burnout, anxiety and depression in healthcare workers during the early COVID-19 period in Singapore

acceptedVersionPeer reviewe

High Suspicion Sub-Centimeter Thyroid Nodules: Cost-Effectiveness of Active Surveillance versus Fine Needle Aspiration.

PurposeTo compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious sub-centimeter thyroid nodules.MethodsA Markov model was constructed to compare the cost-benefit of three strategies from point of discovery till death: 1) Surveillance of All Nodules; 2) Surveillance of Nodules with Positive Cytology; and 3) Surgery of Nodules with Positive Cytology. The reference case was a 40 year-old female with a sonographically suspicious sub-centimeter thyroid nodule. Transition probabilities, costs, and health utilities were derived from the literature. Sensitivity analyses were performed to evaluate model uncertainty. Willingness-to-pay threshold was set at $100,000/quality-adjusted life year (QALY).ResultsSurveillance of Nodules with Positive Cytology dominated in the reference scenario, and was cost-beneficial over Surveillance of All Nodules independent of the utility of AS. Surveillance of All Nodules was cost-beneficial only at life expectancy ConclusionWhile current guidelines recommend AS of sonographically suspicious sub-centimeter nodules, this study's results suggest immediate FNA (Surveillance of Nodules with Positive Cytology) is more cost-beneficial compared to AS (Surveillance of All Nodules). Patients with positive cytology on FNA may subsequently opt for AS (Surveillance of Nodules with Positive Cytology) or surgery (Surgery of Nodules with Positive Cytology) according to their level of comfort (i.e. utility) with AS

Optimizing integrated imaging service delivery by tier in low-resource health systems

Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved

The State of Interventional Radiology in Myanmar: A National Report

Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges. Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix. Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties. Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future