In situations without imaging capacity, clinicians need to rely more on the history, physical exam, observation with repeat exams, and, in some cases, exploratory surgery.
The World Health Organization (WHO) lists what they consider the essential diagnostic imaging equipment worldwide (Table 18-1).1 This varies with the four levels of hospital capabilities (see Table 5-1 in Chapter 5, Basic Equipment).
Table Graphic Jump Location Table 18-1 WHO Imaging Essentials ||Download (.pdf)
Table 18-1 WHO Imaging Essentials
|Portable plain radiography||I||D||D||E|
|Ultrasound for trauma (pleural cavity/abdomen for hemoperitoneum; fluid/heart for pericardial effusion)||I||D||D||D|
|Computerized axial tomography (CT scan)||I||D||D||D|
|Contrast radiography (barium, Gastrografin)||I||I||D||D|
|Magnetic resonance imaging (MRI)||I||I||D||D|
|Nuclear medicine imaging||I||I||D||D|
Limited Imaging Situations—the Hot Light
Even if radiology is available, it may be intermittent and the images may be of poor quality. Film, rather than digital images, may be the norm.
To help illuminate dark areas of the film, make a "hot light." Using a lamp with a 25-watt regular lightbulb, take off the shade and slip a tin can with both ends cut out over the shade's support wires. The can should fit tightly so the wires support the can. If this is not the case, cut the can lengthwise and wind tape around it so that it sits securely on the shade supports. Then take a piece of heavy cardboard, aluminum foil, or thin metal and cut a 2- to 3-inch-diameter hole in the center. Lay this on top of the can and tape it in place. If using cardboard, be careful that it doesn't get too hot and burn. When you need to see a dark area on the film, turn on the light and hold the film over it—but not too close or it will begin to burn. Don't bother trying to use flashlights (too diffuse a beam) or pen lights (too narrow).
Light boxes (view boxes) to view radiological images may be scarce. View boxes can be made (Figs. 18-1 and 18-2) or the film can be read without one. Methods to view films without a view box include the following:
- Hold the radiograph up to a light source such as a lamp or ceiling light. If you just want to get a general look at an x-ray (perhaps to make sure it's the right one), then all you need is some basic background lighting to reveal the contrast. If ...