Imaging in Lithuania

Imaging in Lithuania

Jurate Dementaviciene

Assoc.prof. Vilnius university

Content

• Geography • Short history

• Praesent situation in imaging • Future perspectives

Historical scetches

• 1896 first presentation at Vilnius society of medical doctors A.Gershun

• 1896 first x-ray examination laboratory F.Dembovski

• 1947 Radiology society V.Krotovas

• 1948-55 scientific theses at Moscow university D.Kuncevic, K.Ambrozaitis

• 1957 Radiology chair at Kaunas university of Medicine

• 1960 first scientific theses at Vilnius university D.Kuncevic

• 1967 established radiology chair at Vilnius university

Human resources

• 467 licensed radiologists • 353 working as radiologists 107/1 000 000 • 109 working as sonoscopists • 8 as interventional radiologists • LRA members 2008 – 313 (280+33 Honorary members), 2007 – 347

Human resources

• Age groups: – <40y.o.- 140 (30%) – 41-60y.o.- 189 (40,5%) – >61y.o.- 138 (29,5%) 0 20 40 60 80 100 120 140 160 180 200 <40 y.o. 41-60 >60 y.o. No.radiologists 30% 30% <40y.o. 41-60 >61y.o.

The problem

• Advanced age

• Emigration

• No radiology physicists at the hospitals

• Too little radiologists are involved in IR. Vascular IR performed by IC, and nonvascular - by

surgeons

Radiological equipment

• 427 conventional x-ray machines, including 129 fluosroscopy units 13/100 000

• 24 Mammografy units

• 20 Angiography units 0,6/100 000

• 49 CT (6 – 16 slices, 1 – 64 and 1 - 128 slices) 1,5/100 000

• 14 MR (6 - 1,5T) 0,42/100 000

State/private sectors

• Rapid increase in advanced technologies • ½ MR machines and 1/3 CT instalations

The problem

• Increasing availability of the imaging • Not enough of trained specialists

Statistics

• No. of radiology examinations: 3664094

1,1/ resident

• Including:

– 2 783 726 for out patients – 264 744 in private centers 76% 24% Inpatients Outpatients 10%

Statistics

• 186 225 CT examinations (85870 for outpts)

5,58/100

• 48 737 MRI examinations (20359 for outpts)

1,46/100 • 31 807 IR procedures • ~15 000 NM procedures 1% 1% 5% IR MRI CT Other

Limitation

• Statistical information is unrelieble, data are missing

• Statistical questions are widely interpreted, so data are not comparable

• Data is incomplete, interpretation is misleading

Financing

• The source of budgeting for radiology

equipment – government, municipalities, private sector

• Health care Ministery provide financing by two ways :

– Directly for radiology equipment

– For special clinical specialities development programms, that cover also diagnostic

Financing

• Healthcare system got 4,6 % out of total budget in 2008 and 4,3% in 2009

• The programm of radiology service optimisation:

Year Amount in LTL Amount in EUR

2005 2 500 000 724 637

2006 3 000 000 869 565

The problem

• Funds are spread not according to the health care requirements

• Radiologists are not involved in decision making process

• In fear of health care reorganization, hospitals compete to purchase more equipment, usually unnecessary

The problem

• Social insurance doesn’t cover the real cost

• According to present income – not

adequate estimation of the radiologist qualification

E-Health

• Ministry of Health implemented project “eHealth services” in 2005

• Establishment and development of an electronic health record (EHR) is one of

the most important development directions • This project includes the implementation of

base Hospital information systems in three regional healthcare institutions

The problem

• It is neccesary to make imaging an integral part of e-health system

• The solution shoud come from a good RIS, that will support web based PACS systems, that will become an integral part of electronic patients record.

The problem

• RIS – does not exist

• PACS – local instalations, the viewing and workstations inefficient, slow transfer of

images , bad providing with computers and radiological work stations

E Health European projects

Baltic eHealth (2004-2007) R-Bay project (ended at 31st

May 2009) Cross – border_{Pilotproject of}

Teleradiology Network Development among hospitals in Latvia and Lithuania

Education

• Vilnius university Medical Faculty • Kaunas university of Medicine

• Scientific personell: 2 Professor, 6 Assist. Prof. • Fellows 11

• Residency (for 4 years) • 14 residents each year

Continuous education

• Refresher courses at VU and KMU • Educational lectures, conferences,

cources by LRA

• International cources (MRI school, RSNA visiting professors programm)

• Training courses are partialy covered at local universities by physicians society for

Research

• Finansing provided by clinical research projects including imaging purposes

• Sites for research: Vilnius university,

Kaunas university of Medicine and Vilnius oncology institute

Research

• Main research topics – imaging in

cardiology, oncology, neuroradiology • Scientific results per year :

– Scientific theses, presentations at Lithuanian, Baltic, international conferences

Lithuanian radiologists

association

• Lithuanian radiologists society founded in 1947 • 313 members in 2008 (347 in 2007), including

33 Honorary memebrs • Main tasks:

– Continuous education – International cooperation – Training in new techniques

– Sharing experience, introducing novelties – Cooperation with universities

Ist Baltic

Congress of

Future perspective

• Establishing team for imaging service: radiologist, medical physicist, radiology technician

• Training teachers for future

• Unification statistical information in imaging

• Taking more iniciative of association in education, research, quality control, financing of speciality, management

Future perspective

• Involvement and cooperation with

government should enhance, based on the experience of other european countries

• Trying to mobilise public opinion and the media towards radiology services

• Increase role in creating the imaging

solutions for e-health project in Lithuania • Extending international cooperation

Future perspective

Common efforts would help to easier achieve progress in Lithuanian radiology