Radiology Mammography International
Macedonia Mammography Teaching Project
Sept. 22 - October 6, 2007

RMI recently completed a very successful two week teaching project to Strumica, Macedonia in the south east corner of this beautiful country, close to the borders of Bulgaria and Greece. This mission partnered with the Boris Trajkovski International Foundation headquartered in Skopje. A factory refurbished Hologic/Lorad M IV Platinum mammography machine was donated and shipped prior to the mission. The recipient hospital was the
General Hospital of Strumica. Two radiologists and four female X-ray technologists were trained in the use of this equipment and in mammographic interpretation. Also included in the equipment donations were Maxant mammography viewers and X-rite quality assurance test instruments, as well as Cook needle localization hook wires. Kodak Europe donated a start up supply of mammography film and twelve new cassettes. And the local Kodak dealer donated a new film processor dedicated to mammography. The city of Strumica donated a new ultrasound machine dedicated to breast imaging.

Our volunteer medical team included mammography technologists Jennie Little, Tracey Erb, and Jacquie Barber. Our engineer was Gary Harris. Our radiologists were Dr. Richard Hirsh and Dr. Nancy Wadden from Newfoundland, Canada. Our interpreters were Sonja May and Ana Karovska
(a recent medical school graduate from Skopje).

In addition to mammography, ultrasound was also emphasized as an integral part of breast imaging. Diagnosis of breast lesions and biopsy and
aspiration techniques were taught. Ultrasound core biopsies were performed by Dr. Wadden on one patient with bilateral breast masses. This was the first know use of ultrasound for biopsies in Macedonia. We also performed the first wire needle localization for suspicious non palpable microcalcifications.

Our mission included an extensive Community Outreach Program for public awareness about breast cancer and other women's health topics. This program was organized by the Boris Trajkovski International Foundation. More than 850 women were addressed and lectured to during our two week mission. Kathleen Mueller and Kathy Pardew presented these in depth talks which always included questions and answers.

Follow up will include e-mail communications which will address total numbers of mammograms performed and subsequent suspicious non palpable
lesions detected and then biopsied. We hope to return to Macedonia within two years to observe and to offer additional more advanced levels of training. 

Thank you,
Richard N. Hirsh, M.D., FACR
President
Radiology Mammography International
Akron, Ohio
11, October 2007

Radiology Mammography International
Serbia Mammography Teaching Project
May 26 - June 9, 2007

RMI completed a successful teaching project to Belgrade, Serbia with the guidance and assistance of The Princess Katherine Foundation. A factory refurbished Hologic/ Lorad M IV mammography machine was donated and shipped to Belgrade prior to the mission. The recipient hospital was the University Medical Center Bezanijska Kosa. Two radiologists and three female X-ray technologists were trained in the use of this equipment and in mammography interpretation. Also included in the equipment donation were Maxant mammography viewers and X-rite quality assurance test instruments as well as needle localization hook wires and core biopsy devices from Cook and a start up supply of mammography film and 12 new mammography cassettes from Kodak. Our volunteer American mammography technologists included Linda Corrion and Janice Guntner and Rita Cox.
Our engineer was Robert Warner.

The Princess Katherine Foundation was instrumental in the organization of the entire mission including the Community Outreach Program to many community organizations in and away from Belgrade. We found this to be an integral part of our mission. And this was extremely popular with the Serbian groups who were addressed on a variety of women's health topics, not just breast cancer. Kathy Mueller and Kathy Pardew organized and presented these talks.

Ultrasound breast imaging including guided biopsies was taught by team radiologist Dr. Heather MacNaughton from Vancouver, British Columbia, Canada. Two patients received ultrasound guided core biopsies with hands on participation by the Serbian radiologist, Dr. Magdalena Stefanovic.
These were the first procedures of this type performed in Serbia. We also performed the first wire needle localization procedure for a cluster of suspicious non palpable micro calcifications seen on a screening mammogram done during our first week in country.

Our best friends and strongest supporters during the entire mission were His Royal Highness Prince Alexander and Princess Katherine. We met with them several times during the project at the hospital and at their residence.

Follow up will be in the form of e-mail communications and will address total numbers of mammograms performed and subsequent suspicious non palpable lesions detected and then biopsied. It is our hope to return to Belgrade within two years to observe the level of skills that our trainees will have attained.

Thank you,
Richard N. Hirsh, M.D., FACR
Radiology Mammography International
29 June 2007

Radiology Mammography International
Mammography Teaching Project to Nicaragua, February 24 - March 4, 2007

Follow up mission to Bluefields.

In October 2005, Radiology Mammography International organized a successful teaching project to the town of Bluefields, Nicaragua on the Caribbean coast. A donated Hologic/Lorad mammography machine and an Hologic/Aloka ultrasound machine were donated and installed. Also donated were Maxant mammography view boxes and X-rite quality assurance test equipment. AGFA mammography cassettes and a start up supply of X-ray film was donated as well. The radiology staff of the Regional Ministry of Health Hospital was trained in the skilled use of this equipment.

This 2007 follow up two week mission focused on breast cancer screening and an in-depth Breast Clinic. The volunteer team included two radiologists, one surgeon, two mammography technologists, one engineer, and four interpreters. The screening program was initiated by the hospital with full support from the Ministry of Health. Over a period of approximately two months prior to our arrival in country, all of the towns and villages of the region (over 150,000 population with 80% indigenous peoples) were invited to participate in the screening program.

Many hundreds of women traveled great distances and at great inconvenience to Bluefields for their screening mammogram. There are no roads along the Caribbean coast. Therefore, the principal means of travel for these women was by boat, averaging five hours one way. One patient told me that she had to ride horseback for over four hours from her village down to the sea in order to then take a seven hour boat ride to Bluefields. There were many similar stories of personal hardship, each one touching us deeply.

The Breast Clinic was supervised by volunteer surgeon, Dr. Nick Bisconti, from Akron, Ohio. Many of our screening patients seen during the first week were subsequently examined during the second week by the surgical team which also included two of the hospital's surgical staff.
Mammography and ultrasound breast imaging was provided. Volunteer radiologist, Dr. Alda Cossi, from Boston, along with the hospital's radiologist, performed many ultrasound guided breast biopsies and aspirations. In addition, we performed four preoperative wire needle localizations. A total of eight open surgical biopsies were performed.
All biopsy specimens were flown by commercial flights to Managua with results being faxed back to us within two days.

RMI, working in conjunction with the Ministry of Health Hospital, effectively brought quality screening mammography to the underserved population of the Caribbean coast of Nicaragua. The numbers of patients were small for the size of the population. However, this experience allowed us to learn and recommend better and more effective ways of coordinating all of our efforts including community outreach. We are already discussing offering another Breast Clinic for next year. The hospital administration and the surgical and radiology staff have agreed enthusiastically. Our goal will be to reach out to many more women in
2008 and hopefully in the years beyond.


Richard N. Hirsh, M.D., FACR
President
Radiology Mammography International
Akron, Ohio

Radiology Mammography International
Nicaragua Mammography Teaching Mission, Oct. 23 - Nov. 5, 2005

Radiology Mammography International completed a successful mammography teaching project to Bluefields, Nicaragua. Bluefields, which is located on the Caribbean coast of Nicaragua in the Southern Autonomous Zone, is separated from the main population on the Pacific coast by mountains and jungles/forests. This region, with a population of almost 200,000, is served by one Ministry of Health hospital. Close to 90% are indigenous peoples. Until the completion of our mission, there was no mammography at all.

RMI brought new donated equipment including a Hologic Lorad mammography machine and a Hologic ultrasound machine. Other donated equipment included test instruments from X-Rite and Fluke Biomedical. Maxant donated mammography film view boxes and Cook, Inc. donated hook wire localization needles. Kodak provided a start up supply of mammography film along with cassettes. We also brought with us Spanish language patient information pamphlets on breast cancer and mammography and breast self examination (BSE).

Our volunteer teaching/training team included mammography X-ray technologists, radiologists, a surgeon, an engineer (to install and calibrate the equipment), and Spanish speaking interpreters. From the time of our arrival to our last day in Bluefields we provided extensive in depth training in the Department of Radiology in all aspects of mammography including quality assurance, film processor maintenance, breast positioning, needle localization procedure, and film interpretation. Our ultrasound machine donation allowed us to not only enhance their breast imaging capabilities, but also offered to the patients all of the basic ultrasound system evaluations which include abdomen, obstetrics and gynecology, small parts like breast and thyroid, and musculo-skeletal.

None of our many missions has been "ordinary". This one was no exception. We "almost" encountered Hurricane Beta which hovered just off the coast of Nicaragua about one hundred miles east of Bluefields. Had it become necessary, our team had prepared to evacuate our hotel, which was about 300 yards from the bay, to the greater safety of the hospital just a mile inland and on higher ground. But fortunately, this action was not required, as the storm moved north and diminished in intensity.

Our last evening was celebrated by a farewell dinner in Managua hosted by Nicaraguan First Lady Lila Bolanos and also attended by the Minister of Health, Margarita Gurdian. They both expressed their sincere gratitude for the donation of the equipment and to our volunteer teaching team for truly making a difference in the lives of the women of this region. This was RMI's fourth mammography mission to Nicaragua.

Richard N. Hirsh, M.D, FACR
President
Radiology Mammography International
Akron, Ohio

November 2005

Radiology Mammography International
Teaching Project to Nepal
April 3 –April 16, 2005

Radiology Mammography International completed a successful mammography teaching mission to Nepal. This mission provided a brand new donated Lorad mammography machine for the Tribhuvan University Teaching Hospital in Kathmandu. This equipment was installed and calibrated and training was provided by the team’s mammography technologists and engineer. Approximately four days were spent in Kathmandu. In addition to the training on the mammography equipment, there was also in-depth ultrasound training provided by the second team radiologist, Dr. Alda Cossi, from the Lehay Clinic in Boston, MA. This included ultrasound guided biopsy and aspiration techniques. Towards the end of the first week, members of the teaching team provided lectures at a breast cancer workshop which took place on the campus of the University Teaching Hospital. This workshop was well attended by over 100 physicians and surgeons from all over the country of Nepal.

On the weekend at the mid portion of the mission, the team flew to the Chitwan Region for the purpose of providing instruction on the mammography machine at the BP Memorial Cancer Hospital. This hospital was built approximately 9 years ago and was supplied at that time with a General Electric mammography machine. Our team members were able to obtain donated accessories including compression paddles and needle localization paddles for this machine in order to upgrade the overall level and quality of service for the patients of this region. The preoperative wire needle localization procedure was taught using an apple for demonstration purposes.

Our team spent some time discussing the purpose and effectiveness of screening mammography both at the BP Memorial Cancer Hospital as well as at the Tribhuvan University Teaching Hospital. Up until our mission, the Cancer Hospital had not performed any basic screening mammography. However, after our discussion with the director of the hospital as well as the head of the radiology department it was agreed upon that they would start providing this type of service. Their first patients would be female staff employees of the hospital as well as wives of male employees and medical staff. Since our return, I have been contacted by the head mammography technologist at the BP Memorial Cancer Hospital who informed me that the hospital has now started the screening mammography service. They are performing approximately 10 mammograms per day and at the University Teaching Hospital, they are performing over 20 per day.

This 2005 Nepal mammography project is a follow up to my original project from 1994 at which time we delivered a new donated Lorad mammography machine to the University Teaching Hospital in Kathmandu. This follow up represents an extraordinary experience in that it has allowed us to renew old friendships and has also demonstrated the high level of enthusiasm and expertise and commitment that the Nepali radiologists have shown. Over the past 11 years the Tribhuvan University Teaching Hospital has performed an average of 1,000 mammograms per year.

Generous donations for this mission from American companies included Lorad/Hologic (new mammogram machine), General Electric (mammographic accessories), X-rite (quality assurance test instruments), Nuclear Associates/Cardinal Health (breast phantoms), Cook (localization needles), and Kodak (mammography film and cassettes).

Richard N. Hirsh, M.D, FACR
President
Radiology Mammography International
Akron, Ohio

May 2005

Radiology Mammography International
Follow up Teaching Project to China
August 24 –Sept 3, 2004

During a ten day period RMI conducted a follow up mammography project to Beijing, China three years after the teaching mission from September 2001.

The original two hospitals who received new donated Lorad mammography machines were revisited; First Hospital of Beijing University and Tong Xian Women’s and Children’s Hospital. Much to our delight but not to our surprise, both radiology departments were producing wonderful quality mammograms. The equipment remained in good working order.

In three years First Hospital had performed over 3,000 mammograms with over 120 cancers detected. Tong Xian Hospital has performed over 2,400 mammograms with over 90 cancers detected and 18 needle localizations performed for microcalcifications in occult cancers.

Three members of our team, surgeon Nick Bisconti, technologist Lesley Ewen-Foster, and radiologist Richard Hirsh, did a two day visits to Jinan, population 5.9 million, the Capital of Shandong Province. We consulted and lectured at Jinan Central Hospital which is affiliated with the University medical School. We lectured to over 200 doctors, surgeons, nurses and technologists on specific topics related to breast cancer and mammography.

These lectures included questions and answers. We observed their new Italian manufactured mammography machine and their computed radiography (CR) processing system. Both required significant critiquing. Mammography technologist Lesley Ewen-Foster provided some basic hands on training in breast positioning.

As in all of RMI’s missions, Community Outreach was an integral part of the teaching. Several women’s health topics were presented to a variety of women’s organizations and medical and nursing students and faculties as well as a group of cancer survivors. Some of these topics included breast health, osteoporosis, cardiac health and sexually transmitted diseases. They also offered a special presentation, “Compassionate Care When Giving the Patient Breast Cancer Diagnosis”. Kathy Mueller, RN, a professional women’s health educator, was the outreach team leader. Kathy also served during RMI’s recent May 2004 Mission to Bulgaria.

We were invited to lecture and consult at several other Beijing area hospitals. This and our primary hospital observations kept us quite busy during our visit. I congratulate our volunteer hospital team of four technologists, one surgeon and two radiologists, as well as our three volunteer health educators.

This was a very successful mission. The Chinese with whom we worked demonstrated an excellent grasp of mammography. It is our hope that our former trainees will become the future trainers in China in this important field in women’s health.

Richard N. Hirsh, M.D, FACR
President
Radiology Mammography International
Akron, Ohio

7 Sept. 2004