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Pediatric Imaging

E1131. CastAway Radiology: Cases from Remote Islands and the Impact of Limited Healthcare Resources

Choi J1,  Wood J1,2,  Gould C1,2,  Rooks V.1,2 1. Tripler Army Medical Center, Honolulu, HI; 2. Uniformed Services University of Health Services, Bethesda, MD

Address correspondence to J. Choi (jaychoi828@gmail.com)

Background Information: In 1988 Senator Daniel Inouye (D-Hawaii) introduced a bill to provide humanitarian care to the underserved Pacific Islanders and benefit graduate medical education at the regional tertiary care facility, Tripler Army Medical Center (TAMC, Honolulu, HI). In the following years, Congress allocated several million dollars annually to defray the costs of the project. Known as the Pacific Island Health Care Project (PIHCP), it would serve U.S. territories and free associations spanning an area in the Pacific Ocean larger than the borders of the continental United States. Its beneficiaries include the people of Guam, American Samoa, the Commonwealth of Northern Marianas, the Republic of Marshall islands, the Federated States of Micronesia, and the Republic of Palau. Medical facilities in these regions are often short of supplies, medicines, power, and water. Subspecialists are rarely represented among the medical staff. Beginning in 1997 a telemedicine consultation service was established and continues today. Medical reports, to include rudimentary representative imaging, are uploaded and patients are regularly screened for treatable conditions that require advanced or specialist care. In the era of redefining reimbursement rates and the drive for value-based imaging, projects like the PIHCP demonstrate an alternative pathway for radiologists to provide value in directing limited medical resources. Patients often present with advanced or atypical manifestations of common conditions, as well as atypical disease processes, that benefit the training of Army physicians assigned to TAMC. A small selection of representative pediatric cases are submitted to demonstrate the breadth and scope of referrals.

Educational Goals/Teaching Points: This exhibit provides representative pediatric cases from a remote island tertiary care center and illustrates atypical or advanced manifestations of common pediatric conditions as each case relates to limited or delayed access to medical care. We demonstrate the value of radiology in the setting of limited medical resources and the opportunity to improve patient health care.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Cases presented include unrepaired congenital heart disease with septic emboli and ascaris infection; osteomyelitis complicated by 15 months delay in care; crushed pelvis from a falling mango tree, healing out of alignment; longstanding leg length discrepancy, due to Ollier disease; congenital diaphragmatic hernia with associated microphthalmia and orbital cyst; chronic lung infection requiring pneumonectomy; achalasia, originally thought to be esophageal atresia; juvenile nasal angiofibroma; longstanding Hirschsprung disease; esophageal atresia; newborn with a cystic abdominal mass; retroperitoneal teratoma; endodermal sinus tumor; juvenile pilocytic astrocytoma; and tracheoesophageal fistula.

Conclusion: Although limited in scope and resources, the PIHCP is able to provide successful treatments and subspecialty care to Pacific Islanders while providing both experience and exposure that benefit the training of Army physicians assigned to TAMC. Such training immediately benefits physicians taking part in medical humanitarian missions as well as providers at tertiary referral centers. In the era of redefining reimbursement rates and the drive for value-based imaging, projects like PIHCP highlight an alternative pathway for radiologists to provide value in directing limited medical resources.