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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.
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