The IKON tele-radiology network in Mali

The new information and communication technologies (ICTs), in turn, made it possible to transmit virtually unlimited quantities of digital data via satellite from one point on the earth to any other point, or even between planets. Thus the concept of tele-diagnosis became possible and took on the importance it has today.

Inception of the IKON tele-radiology project
Tele-radiology is only one aspect of tele-diagnosis, namely its application to medical radiology. Whereas in the developed countries remote diagnosis by experts can be a cause of unemployment, in the developing countries it can help to offset the shortage of qualified human resources.

Mali – a huge, landlocked, under-developed, under-populated and poor country – has only about a dozen radiologists, nearly all of whom, in both the private and public health sectors, are located in Bamako. Only one works outside of the capital (currently in Ségou). The country is thus in dire need of qualified radiologists.

Mali’s current health policy was implemented after a programme of heavy public investment in the health system, which established community health centres in remote locations, referral health centres in towns, and regional hospitals in regional capitals, in some cases with the assistance of foreign volunteer physicians. Where these provincial medical facilities have a simple X-ray apparatus, doctors have only a technician and their personal experience of X-ray diagnosis to cope with the enormous need for radiological examinations. Yet this is a field in which, apart from a few very basic images, the “eye” of a qualified radiologist is very often indispensable.

A project to establish a computer network between regional and central hospitals was therefore envisaged at a forum for health sector stakeholders organised in Bamako in 2002 by the International Institute for Communication and Development (IICD), an organisation based in the Netherlands. This tele-radiology network was dubbed IKON. Initially, it is to be applied only to radiology, but may be extended to other medical specialities.

The main purpose of the project was to enable remote consultation of all radiological files requiring a specialist’s opinion. The project was declared to be in the public interest and was accepted by the IICD, which then decided to finance implementation.

The IKON tele-radiology network today
The project was implemented in two phases: a one-year trial or pilot phase in which three regional hospitals were linked to the Point G hospital in Bamako, and a four-year scaling-up phase during which other hospitals will gradually be connected to the network.

After many difficulties and obstacles, the project finally got under way in 2004, with the training of staff in the Mopti and Sikasso hospitals. Initially, the Ségou hospital was to be the third regional hospital, but it was replaced by that of Tombouctou owing to a shift in priorities (the Ségou hospital had just obtained its own radiologist).

Actual transmission of X-ray images began in July 2005, between Mopti and Bamako. At the time of writing, the physicians in Mopti have sent some 20 X-rays to Bamako for interpretation. In all cases, the images were examined and replies sent back the same day.

The Sikasso hospital is waiting until some problems with its Internet connection are resolved before starting to send radiological imagery.

Prospects
- Each case transmitted provides an opportunity to detect flaws in the system and possibly to find solutions to be used in future cases.
- The Tombouctou hospital will soon be connected to the network, replacing that of Ségou.
- The country’s other hospitals will gradually be hooked up as well, in order of priority as determined by need, staffing and certain technical criteria.
- Efforts are under way, with Bamako’s Francophone Digital Campus, to find a secure site in Mali that could serve as a host for these remote transmission activities.

Some technical characteristics
The hospitals exchange data over the Internet via a switched telephone network, which enables them to send high-quality images.

Initially, these data exchanges transited through the relay server of Keneya Blown, a project of the Malian medical information network REIMICOM. After some technical problems with this server, they were transferred temporarily to a more secure server abroad.

The project opted to use open source software: Mandrake, Gimp, etc. A software package suitable for tele-radiology, called “Open Yalim”, was developed specifically for the network by the technical team of RéoNet, a network of young computer specialists and physicians.

Practical illustration of the value of tele-radiology
This picture from the Mopti hospital is the first radiological image transmitted by the IKON network. A routine hand X-ray taken on a patient in Mopti shows a “constructed” image of bony trabeculae in one of the metacarpals. The doctors in Mopti interpreted this image as showing an osteal lesion and were considering vigorous or aggressive therapeutic measures until the diagnosis from the radiologist in Bamako came in. The latter’s more expert analysis showed that this was simply a variant of the normal structure, and thus spared the patient a costly and unnecessary operation.

Click here to read this article in French.

For more information:
-  Description of the IKON project
- article Le projet de Teleradiologie IKON a été lancé au Mali
- article Linux et téléradiologie IKON à l'hôpital de Ségou et de Sikasso au Mali

For further details contact:
Dr Mahamadou Touré, coordinateur du projet IKON
Service de Radiologie
Hôpital du Point G Bamako
BP 333, Mali
E-mail : maduture@yahoo.fr ou maduture@gmail.fr