Practice of teleradiology in crisis zones: the unique case of Syria
Authors: Mohammad Arabi, Ihsan Mamoun, Abdulrahman Masrani, Muhammad Alsayid, Nada Haroun
Journal: The Lancet Global Health (2017)

The use of teleradiology in war zones dates back to the wars of Afghanistan and Iraq.1Graham RN Battlefield radiology.Br J Radiol. 2012; 85: 1556-1565Crossref PubMed Scopus (29) Google Scholar However, the practice of teleradiology during the Syrian crisis presents a new challenge to the international medical community given the repeated attacks on medical personnel and health-care facilities.2Physicians for Human RightsAnatomy of a crisis: a map of attacks on health care in Syria.http://owl.li/wO3GxGoogle Scholar, 3Physicians for Human RightsSyria's medical community under assault.https://s3.amazonaws.com/PHR_other/Syria%27s-Medical-Community-Under-Assault-October-2014.pdfDate: 2014Google Scholar, 4Physicians for Human RightsSyria's medical community under assault.https://s3.amazonaws.com/PHR_other/Syria%27s-Medical-Community-Under-Assault-February-2015.pdfDate: 2015Google Scholar, 5Amnesty InternationalSyrian and Russian forces targeting hospitals as a strategy of war.https://www.amnesty.org/en/press-releases/2016/03/syrian-and-russian-forces-targeting-hospitals-as-a-strategy-of-war/Date: 2016Google Scholar The Teleradiology Relief Group consists of several radiologists located across the globe, who communicate with health-care providers in Syria via the internet and social media to deliver the best care possible to Syrian patients. Use of a traditional teleradiology programme is not possible in Syria because of the absence of picture archiving and communication systems (PACS), even before the crisis. Instead, social media is used to share digital imaging and communications in medicine (DICOM) images and other image formats. Image uploading is often not possible because of the unreliable and interrupted internet service that mainly depends on satellite providers. Emails and social-media applications such as WhatsApp (WhatsApp, Mountain View, CA, USA) and Facebook (Facebook, Menlo Park, CA, USA) facilitate instant sharing of important images, including screen shots, analogue films captured on mobile phones (appendix), and video recordings of ultrasonography. There are several limitations to this practice. Sometimes, the quality of images is not sufficient for interpretation because of poor techniques and the lack of contrast. However, radiologists have to extract every possible piece of information from the provided images to generate reports that guide physicians on the ground. We find ultrasound images the most difficult to interpret, particularly when done by non-trained operators. Since the beginning of 2015, the Teleradiology Relief Group has delivered radiology reports of nearly 100 plain films and 100 CT scans to a specific intensive care unit located in the eastern Ghouta area. Most images were of trauma cases, particularly brain CT scans (appendix), followed by chest and abdomen CT scans (appendix). The group uses Facebook as a platform for communication between radiologists and Syrian health-care providers (figure). Each post on Facebook contains individual patient information and records. Syrian providers also post progress notes and the results of laboratory and imaging studies (appendix). Physicians and radiologists provide their consultations and radiology reports directly through the internet to facilitate the care of patients. We find this method of communication to be effective in improving clinical decisions and patient care in many instances. We declare no competing interests. Download .pdf (.56 MB) Help with pdf files Supplementary appendix