In situations without imaging capacity, clinicians need to rely on the history, physical examination, observation with repeat examinations, and, in some cases, exploratory surgery.
The World Health Organization (WHO) lists what they consider the essential diagnostic imaging equipment worldwide (Table 19-1).1 This varies with the four levels of hospital capabilities (see Table 5-1).
TABLE 19-1WHO Imaging Essentials |Favorite Table|Download (.pdf) TABLE 19-1 WHO Imaging Essentials
| ||Facility Level |
|Resources/Capabilities ||Basic ||GP ||Specialist ||Tertiary |
|Plain radiography ||D ||D ||E ||E |
|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 |
|Angiography ||I ||I ||D ||D |
|Image intensification/fluoroscopy ||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 or deliver poor quality images. 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 hole with a 2- to 3-inch diameter 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. Do not bother trying to use flashlights (too diffuse a beam) or penlights (too narrow a beam).
Light boxes to view radiological images may be scarce. Make light boxes or read the film without one. Methods to view films without a light 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 is the right one, then basic background lighting should be sufficient. A more detailed examination, however, will ...