A remote spot in an eastern Arctic region of Canada that is closer to Greenland than Toronto has received its first CT scanner, as well as a PACS and satellite link to go with it. The new technologies are revolutionizing healthcare in the region, as images no longer need to be transported by cargo plane to the southern part of the country.
Iqaluit is a town of about 7,000 people on Baffin Island in the Arctic territory of Nunavut. Previously, residents had their ultrasound or x-ray scans -- as well as those from 12 surrounding communities -- collected and sent twice weekly via a cargo plane to Ottawa, Ontario, which is 1,296 miles to the south.
That's all changed with the installation of the $2.1 million CT scanner and PACS, according to Jennifer Sharpe, manager of diagnostic imaging at Qikiqtani General Hospital.
"The reporting times were about four to seven days [for Iqaluit] and longer in the remote communities, sometimes upward of a week or two weeks," Sharpe said.
A harsh environment
The harsh weather of the Canadian Arctic sometimes further slowed reporting times between Iqaluit and Ottawa by delaying the cargo planes, said Sharpe, who spoke on the topic in June at the 2015 Joint Congress on Medical Imaging and Radiation Sciences. The Montreal meeting brought together the Canadian Association of Radiologists (CAR) and the Canadian Association of Medical Radiation Technologists (CAMRT), as well as French-language associations based in Quebec representing radiologists and radiation technologists.
"One of the challenges with the North is that there may be inclement weather, and the cargo planes may not be flying in or out of the area," Sharpe explained.
With the new technology, images are acquired with the CT scanner and transmitted via PACS, and the radiologist's report is available in about 90 minutes. Radiologists from southern Canada visited the Arctic to train radiologic technologists on how to use the CT scanner and PACS, she said.
Previously, if physicians in Iqaluit decided they could not rule out diagnoses based on findings from x-rays and ultrasound scans, they could order a CT scan, but that meant patients had to travel by plane to Ottawa to undergo CT imaging.
"We were sending out about 400 to 500 patients per year for CT examination, both elective cases and trauma [emergency] cases," Sharpe said, noting that the cost per patient for being transported to Ottawa for a CT exam is about $4,000, including airfare and lodging.
Family members sometimes needed to travel with patients, such as when the severity of symptoms necessitated an escort or when patients were unable to communicate because of a language barrier. The Inuit make up the majority of the population in Iqaluit and the surrounding areas, and elderly patients might primarily speak Inuktitut, Sharpe noted.
Patients in Iqaluit and the surrounding communities continue to visit southern Canada to see specialist physicians, as no such doctors are based in the Arctic. Only a handful of general practitioners are available in Iqaluit and other remote Arctic communities in Nunavut.
The CT scanner can provide additional detail about trauma cases, helping to determine if emergency care is necessary, for example. This could decrease the need for emergency medical evacuation to southern Canada, with each emergency case representing a $25,000 expense, Sharpe said. The scanner will also likely address imaging needs for patients with various cancers, she added.
The scanner in Iqaluit marks the first instance of a CT scanner operating over a satellite network in Canada. Telecommunications companies in Canada have maintained that there is not a business case for creating the infrastructure to provide Internet access via broadband in the Arctic because the geographic areas are sparsely populated. Consequently, communities in the Arctic rely on satellites for Internet access and transmission of data.
"We have to learn to use the network that we have [over satellite] to increase transmission times and allow other communities to also be part of the network," Sharpe said. "We won't be going to fiber optics anytime soon."
Current Internet speed is about 1.5 megabits per second in parts of the Arctic, far short of the target set by the Canadian Radio-television and Telecommunications Commission, the public authority tasked with regulating and supervising Canadian broadcasting and telecommunications. The commission has aimed to have download speeds of 5 megabits per second for the entire country.
