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Belarussian Radiology

ECR Today Newsletter published at the European Congress of Radiology in Vienna started its Bridge to the East series on March 1st, 2002 with the article below

Article citation: Khoruzhik SA. Belarussian radiologists face growing challenges. ECR today: news, views, and analysis from Europe's leading imaging congress 2002 March 1:6.

Belarussian radiologists face growing challenges.
By Serguey Khoruzhik

When planning to attend international meetings I first have to ask: "Who will pay?" My registration fee and accommodation cost for ECR 2000 were paid by the congress Eastern Europe Scheme, while the European Society of Gastrointestinal and Abdominal radiology (ESGAR) funded my travel.

From 1996 onwards, when my career in radiology began, I went to between one and four international meetings each year, including the annual meeting of the Radiological Society of North America in 2000. Every trip was made possible by sponsorship from different sources; I cannot afford to travel so far for my vacations.

Few of my Belarussian colleagues have attended ECR. Even in this era of Internet communication and information technology, some radiologists in East Europe have never heard of ECR or the European Seminars on Diagnostic and Interventional Radiology (ESDIR). Perhaps inviting lecturers from East Europe would make ECR more attractive to radiologists from this region. Other reasons for not attending include inadequate proficiency in English and financial problems. Lack of interest is also a factor.

My top priorities at ECR 2000 were to attend some state-of-the-art symposia and to view modern imaging technologies. I never missed an opportunity to converse with the lecturers, many of whom were world-renowned specialists. More time should possibly be allocated for interaction between the lecturer and the audience. Knowledge I acquired about MRI from the ECR and RSNA technical exhibitions proved extremely helpful when I had to help produce a tender for our hospital's first MRI unit.

I am glad ECR is staying in Vienna, not only because I really like the city, but also because it is not too far or too expensive to get there. Many options exist for travel to ECR from Grodno. A return train ticket from Minsk costs 150 euros (more than one month's salary for many Belarussian radiologists) and takes roughly 12 hours. The same trip by air should cost 345 euros, which few radiologists will be able to afford. I travelled to ECR 2000 by bus from the neighbouring Polish city of Bialystok, 60 km from Grodno. This was the cheapest option at the time, though I may not be able to use this route in future if Poland introduces a visa requirement for Belarussians.

Doctors in Belarus who deal with x-rays work one hour less than their colleagues from "non-dangerous" fields. This means that most radiologists work six hours a day and have no additional duties. Radiologists at our hospital have two days off each week, except for those in the CT unit who also work Saturdays and may have to perform emergency CT examinations at any time. A radiologist who can perform ultrasound and an x-ray technologist (radiographer) are available on-site 24 hours a day, seven days a week, all year round.

Teleradiology and picture archiving and communication systems are no more than theoretical concepts for us. Yet while the technical capacities of our radiology sections may not match the "gold standard" of most Western hospitals, they are still better then analogous conditions in smaller Belarussian hospitals. We do not tend to experience shortages of never x-ray films or contrast agents, for example.

The diagnostic capabilities of ultrasound are not always recognized in our hospital. Patients are often sent for additional examinations that are either less effective or more expansive when an ultrasound scan should be sufficient. It is not surprising that the outpatient waiting list for CT is two months (inpatients can receive scans within a day if necessary). This situation may resolve itself once diagnostic imaging specialists use a range of modalities. Few of my colleagues practise both radiography and ultrasound at present.

Low salaries are one of the greatest concerns, though rapid improvement does not seem likely. As mentioned earlier, a mid-ranking radiologist with around five years of experience who works standard hours will often earn no more than 100 euros. This is a big problem, especially given that the cost of living is rising steadily.

Our system of medical training is completely different to that in most Western European countries. After leaving secondary school, students can enter medical school to train as doctors, graduating with an M.D. after six years. Some students may first choose to go a "medical uchilitse", undergoing a three-year training course as a specialty "medical nurse." Qualified doctors need just one more year of dedicated training to specialise as a radiologist. This "internatura" year is mandatory.

Doctors can start a two-year practical postgraduate course ("ordinatura") and/or a three-years research postgraduate course ("aspirantura") at any stage during their career. Only a minority of radiologists have ever taken advantage of these schemes. All radiologists must also undergo a prolonged CME course every three years, lasting from two weeks to two months.

I have been working as radiologist in Grodno Regional Clinical Hospital since 1997. Grodno is one of six major cities in the Republic of Belarus (total population 10 million) and the regional hospital is the biggest and best equipped in the area. Patients from the Grodno region, which is home to one million people, are referred to us by smaller hospitals when more advanced level of diagnostics and therapy are needed.

Belarussian radiologists are normally called "lucevoj diagnost." The first term might be translated as "by the means of rays" and the second one as "diagnostician." Radiographers, known as "roentgenlaborant," meaning "roentgenology laboratory assistant," are not authorized to perform examinations. We have nine full time radiologists in our Roentgenology Department, plus two in the CT unit, two in the DSA unit, and two in the MRI unit. We also have 21 radiographers, bringing the total number of staff involved in diagnostic imaging to more than 50. The completely independent Department of Ultrasonography employs 11 additional doctors, seven nurses, and two assisting nurses, while the Medical Genetics and Prenatal Diagnostics Department has two radiologists who specialize in ultrasound as well.

A total of 24,000 patients passed through the Roentgenology Department in 2000, including 6,500 outpatients. The department has five stationary x-ray machines (including a 21 year-old machine that is due to be thrown out). Three mobile scanners are also used, in addition to a dental and a mammography device. A new stationary conventional radiography system is scheduled for installation this year.

The Department of Ultrasonography has three portable and seven stationary ultrasound machines, while the hospital's most advanced ultrasound system (installed last year) can be found in the Department of Medical Genetics and Prenatal Diagnostics. Our solitary CT scanner is used to examine 5000 patients each year, though the non-spiral system may be replaced with newer technology in a few years. Our DSA system has been in operation since 1998 and our newest MRI 1T scanner is being installed at the moment.

Dr. Khoruzhik was a radiologist at Grodno Regional Clinical Hospital, Republic of Belarus from 1997 until the end of 2001. He is now based at the Belarussian Scientific Research Institute of Oncology and Medical Radiology, Minsk, where the country's first multislice CT scanner is being installed.

Further reading
Khoruzhik S. A. European congress of radiology 2000: from century of progress in diagnostic imaging to challenges of new millennium. Novosti Lucevoj Diagnostiki 2000 1: 32-35. Full text in Russian available at http://nld.by/100/stat14.htm.


Lern more about Belarussian Radiology!
Read article Technology provides Belarus with a bridge to high-level radiology. Former Soviet state moves forward with its first MDCT scanner by Michaela Lev-Ram from The Global Face of Radiology project

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