Bringing portable X-ray imaging to Canada’s remote communities
March 3, 2023
When it comes to accessing healthcare services, Indigenous peoples are considered the most marginalized in Canada, with the poorest health outcomes and the most barriers. One example, a joint study released last year by the First Nations Health and Social Secretariat of Manitoba and the Manitoba Centre for Health Policy, demonstrated that decades of poor health outcomes have resulted in a life expectancy gap of 11 years between status First Nations people and all other Manitobans. Shockingly, the 11-year gap is growing.
This is primarily due to lack of access to healthcare that has been allowed to develop over decades. First Nations reserves are often remote and far from major cities, in which there is better access to healthcare.
However, in my role as a Medical Radiation Technologist specializing in Mammography, I have had a unique perspective. I provided cancer screening in a hospital setting near the Mississauga of the Credit First Nation and Six Nations of the Grand River First Nations Reserves, and I also worked on the Screen for Life Coach, a cancer screening mobile coach bus that provides breast, cervical and colorectal screening services directly on Reserve.
This program uniquely partners with Indigenous community health promotion professionals who encourage and support women to use our services. I recognized that the first few on-site visits were unsuccessful in number of cancer screenings, but many women would stop in for a tour.
In time, our numbers started to rise and over the years our presence on these two Reservations has been extremely positive, with many new clients. In contrast, as a mammography technologist at a nearby hospital, I noticed the ratio of Indigenous patients is very low, considering the geographical proximity of the Reservation. In contrast, most Indigenous women appear frightened and vulnerable.
In reflecting of the contrasting presentations of patients, a few thought-provoking questions were made. The Indigenous women who access cancer screening services on the mobile coach were relaxed and are eager to use the provided services and actually commented to me that they feel supported and safe, whereas the women in the hospital setting appeared extremely hesitant to use the services.
From my personal experience, bringing technology into these communities does in fact work and I have witnessed the profound effects of providing this type of care into an environment where patients feel safe, valued and respected.
In December 2020, I joined FUJIFILM, where I was introduced to the FDR Xair, an ultra-portable, X-ray unit that weighs only 3.5 kg and is totally battery operated. Its design means it can be easily transported into remote communities that may otherwise not have imaging available, especially those with limited access to electricity. Using its battery, the portable unit can create 100 images on a full charge.
The FDR Xair is used in combination with FUJIFILM’s DEVO III Detectors that incorporates the patented image processing technologies Dynamic Visualization and Virtual Grid. They allow users to create optimum images with very low dose, especially with the low 450-watt output of the FDR Xair.
In addition, by incorporating AI technology, healthcare providers in remote areas can make decisions based on imaging results that are comparative to urban, full-service hospitals.
In reflecting on the Indigenous patients who are unwilling to leave their own communities to access healthcare, the FDR Xair with AI technology becomes a game-changer. It dramatically changes how healthcare is accessed in rural Canada in a variety of clinical settings.
In August 2022, I had the opportunity to participate in an initiative to deploy the FDR Xair into three primary healthcare centres that are part of the Peter Ballantyne Cree Nation Health Services Inc., based in Prince Albert, Saskatchewan.
The team consisted of myself as a FUJIFILM product manager, Medical Imaging, as well as Dr. Deepak Kaura, a radiologist and chief medical officer of start-up company Synthesis Health, and Genevieve St. Denis, preventative health manager – PBCN. It was a true collaboration of the right people at the right time and place.
TB is an infectious disease caused by bacteria that mainly affects the lungs and is preventable and curable. Active TB is a serious infection that can be spread to others by coughing or sneezing. Unfortunately, the rate of TB among First Nations living on reserve is over 40 times higher than Canadian-born non-Indigenous population.
This is mainly due to the overcrowded and poorly ventilated homes on the reserve, as well as the number of Indigenous people living with untreated Latent TB Infection. There may not be symptoms, but the latent disease can eventually develop into Active TB.
Thus, monitoring TB by chest imaging is vital in the control of TB on reserve and the FDR Xair turned out to be an excellent solution. Not only is it ultraportable, but it is also very simple to use.
There is a human health resource crisis in Canada, with limited numbers of Medical Radiation Technologists who are licenced and qualified to apply radiation to patients and create images. Part of this initiative was to train Advanced Practice Nurses how to acquire chest images.
As a former professor in the Medical Radiation Sciences program at Mohawk College and McMaster in Hamilton, Ontario, I was able to transfer my years of teaching radiography skills to develop accessible learning modules and train nurses how to correctly acquire chest images.
Focus was placed on personnel and patient radiation safety, and on the critique of images to ensure optimum quality imaging procedures were attained. These quality images would then be transferred to the Synthesis Health platform to have AI applied and to a radiologist for a formal report.
Our first deployment was the Arthur Morin Memorial Health Centre in the community of Southend, approximately 500 kilometers north of Prince Albert. It’s mostly accessible by secondary gravel roads and designated as a type II semi-isolated area with a population of 1,734. After an 8-hour day of driving from Prince Albert, the team settled into the nurse’s dormitory for the evening.
An early morning start was made to unpack the three boxes of equipment and assemble the FDR Xair unit, the detector with a stand and to connect the Console Advance, a user interface, to the internet. Within an hour we acquired the first test image and sent it to the Synthesis Health platform.
With a three-hour, hands-on X-ray positioning session, the advanced practice nurses were able to acquire their images on an Indigenous patient. To support their new skillset, Quick User Guides to aid the equipment workflow were used, as well as Positioning Guides and Charts to ensure correct and optimum patient X-ray positioning.
After acquiring and assessing their images, the nurses sent their images to Synthesis Health. Within 90 seconds, Artificial Intelligence software can be applied and the detection of common radiological findings can be found with a very high level of accuracy – including the identification of TB.
Finding active TB at an early stage is vital in controlling community spread, as close contact with someone with untreated TB is the number one factor in increasing your chance of developing TB.
Our patients were asked, “What does this mean to you?” And often, the response was, “I get to stay home. I don’t have to travel 2.5 hours especially in the winter. I am safe.”
The second deployment was in the community of Deschambault Lake, located 328 kilometers northeast of Prince Albert and a seven-hour drive from Southend on primary and secondary gravel highways. The Jonah Sewap Memorial Nursing Station supports the healthcare needs of 1,632 people.
A third deployment of this initiative was in the community of Pelican Narrows. With a population of 3,759, it is located approximately 355 kilometers northeast of Prince Albert. The Angelique Canada Health Centre is a primary Healthcare center servicing a fairly large community with 24-hour ambulance services.
However, until now, it had no X-ray service. In reflecting on this gap in accessing basic X-ray imaging at a primary healthcare centre with ambulance service, one can assume patient outcomes have been directly affected. This initiative is a definite game changer for this community.
The ultimate goal of this initiative is to broaden the skillset of the designated Advance Care Nurses so they are fully trained to image many areas of the body, including extremities, so they are able to rule out common injuries. In turn, this will help to alleviate patient transfers and thus conserve nursing resources when accompanying patients to primary hospitals that could be over 200 kilometers away.
The development of this initiative has been ongoing to ensure it is successful. We have been implementing training and conducting competency-based assessments of all users. The trainees receive ongoing support and make use of two comprehensive learning modules: Radiation Safety and Workflow, Patient Positioning and Image Critique. They are available in a Learning Portal that all new users must complete.
As the Product Manager of the FDR Xair, my vision of the future is bright. The FDR Xair unit is changing how healthcare is accessed in Canada and it is only the beginning.
In time, I would like to see the FDR Xair used to help alleviate backlogs in emergency rooms by creating health professional teams to bring this technology into people’s homes where a diagnosis can be made and care plans implemented virtually. I would like it to be used routinely in long-term healthcare centers where images can be taken by micro-credentialed healthcare professionals to reduce the need to transport patients to the emergency departments. The possibilities are endless.
At FUJIFILM Canada, we are proud to contribute to closing the gap in healthcare outcomes for our Indigenous communities by bringing our most advanced imaging technologies into their communities. No Canadian should die a decade sooner because of their cultural identity. Together we can help First Nations Health Authorities build a new future founded in true partnership.
Anne Hixon B.Ed. (Adult), MRT(R) is Product Manager, Women’s Health and Medical Imaging at Fujifilm Canada. Anne has enjoyed a 30-year career as a Medical Radiation Technologist specializing in Mammography.