X-ray Group

Mike Hoaglin, Matt Glucksberg, David Channin, and Michael Diamond



X-ray Group

WHIA team members examine imaging equipment

X-ray specs

McCormick students and faculty tackle health care challenge in the developing world

Imagine breaking your arm in an accident and running to the nearest health clinic. Dizzy with pain, you know your arm is broken, but getting it put back in place may be harder than it seems. Without an X-ray to visualize the break, your doctor promises to give it her “best shot” at setting it properly.

As unsettling as this may sound, it’s the situation that many patients in developing countries face when dealing with an injury. It’s estimated by the World Health Organization (WHO) that two-thirds of the world’s population lacks access to conventional X-ray equipment. And for those who do have access, getting those X-rays developed and interpreted can be a long and difficult process. It’s a problem that students and faculty in the McCormick School and the Feinberg School of Medicine and across the University, along with a host of other collaborators, are teaming up to solve.

Mike Hoaglin (biomedical engineering and electrical engineering ’06) saw the problem firsthand as a student on Northwestern’s Global Health Technologies study abroad program in 2006.

“We saw a guy who had tried to open a bottle with his teeth and had a bottle cap lodged in his throat,” Hoaglin says. “Once he had been x-rayed, he had to take his films and travel several miles on a bumpy road in order to find a radiologist who could interpret the films and determine how the bottle cap should be extracted.”

Hoaglin describes another clinic with limited storage, causing staff to throw out X-rays after less than a year, despite laws that require clinics keep them for three to five years. Other clinics had defunct X-ray machines covered in cobwebs and locked in closets, and those that were functional were running at minimal capacity due to the cost of film and developing chemicals.

“There’s a great need in the developing world for X-rays that’s simply not being met,” says Matt Glucksberg, professor and chair of biomedical engineering and adviser for Hoaglin’s project. “Many rural clinics don’t have anything. X-rays are basic technology needed for trauma and tuberculosis, but they’re just not available.”

From final report to first steps
As part of a senior design project, Hoaglin and fellow student Aaron Eifler (biomedical engineering ‘06) studied the problem and determined that a low-cost digital system would be the best solution for expanding the availability of X-rays. They focused on modifying an existing low-cost system, the World Health Imaging System– Radiology (WHIS-RAD), developed by WHO. Their client for the project was John Vanden Brink, an assistant district governor for Rotary International who has been leading a group of Rotarians in an effort to deploy WHIS-RAD systems. Nongovernmental organizations, including Rotary clubs, have deployed about 1,500 of these machines throughout the world, but there are issues with the sustainable use of the system — particularly with the recurring costs associated with film and chemicals.

Hoaglin and Eifler developed an in-depth report, which served as the beginning of a new partnership. After circulating the report among his peers, Dave Kelso, professor of biomedical engineering and chair of the Center for Innovation in Global Health Technologies, called a meeting to determine how to take Hoaglin and Eifler’s work to the next level. He joined forces with contacts at the University of Cape Town, Northwestern’s Feinberg School of Medicine, Rotary clubs, the Kellogg School of Management, and others to create the World Health Imaging Alliance (WHIA). The group is now a certified nonprofit organization in the state of Illinois, dedicated to bringing X-ray technology to the areas of the world that need it most.

Michael Diamond, an adjunct professor in the global health program at the Judd A. and Marjorie Weinberg College of Arts and Sciences, serves as WHIA’s executive director. He hopes that by creating lower-cost equipment, the group can better serve areas of the world that are of less interest to high-end corporate manufacturers. “Our view is that by partnering with manufacturers, we’re expanding their options and creating a higher level of demand,” Diamond says. “We believe there is a very large market because the economics are so different for a low-cost machine, and these machines will increase economic productivity by restoring people to health more rapidly and with less burden of recurring health problems.”

WHIA is trying to ensure that all of the components work in accordance with the standards established by the WHO and that they are easy to use with interoperable parts. With so many systems on the market, the group will determine how these combined low-cost systems will meet these standards, which is a tricky task. “How do you choose between cost and performance and justify the ethics?” Glucksberg asks. “If you can provide an X-ray machine that will work well enough for tuberculosis and broken bones but won’t pick up tumors, is that a problem?”

In addition to designing a system whose initial cost is low, WHIA is keenly aware of the issues of maintenance and recurring costs. “The big question is how to implement these systems into an existing infrastructure and ensure that it’s a sustainable model,” Diamond says. “We’ve seen far too many examples of donated equipment that’s broken and been tossed aside.”

Combining expertise
In order to adequately handle the variety of expertise needed to address needs assessment, research and development, funding, and deployment, WHIA is drawing on a wide array of experts. Students and faculty at Kellogg will research the market, economics students in Weinberg College will study the economic impact of better X-ray technology on improving health and productivity, and students and faculty from the Feinberg School of Medicine will work on training and medical informatics issues.

Leading the effort at Feinberg is David Channin, associate professor of radiology. A specialist in imaging informatics, Channin was the principal technical architect behind the filmless imaging environment at Northwestern Memorial Hospital. Working under an entirely different set of user needs, Channin and his team hope to create a robust system with lower built-in costs. “The software used in digital systems is a large component of the overall cost,” he says. “In addition to providing lower-cost software, we can also simplify the device and provide functionality that commercial systems wouldn’t have.”

A prototype is being built and tested at Northwestern using donated imaging equipment from SEDECAL and a computed radiography system from Carestream-Kodak, and the group hopes to deploy up to five of the systems for field testing within two years. Graduate students in the Department of Biomedical Engineering’s new master’s degree program with a focus in global health technology will work on the prototype before spending two quarters in South Africa to conduct field research. (The program recently received a grant from the National Collegiate Inventors and Innovators Alliance Sustainable Vision Grant Program funded by the Lemelson Foundation.)

Building the X-ray system and software is only the first step; the group must also determine how patient files should be handled, how they can be viewed without purchasing extensive digital equipment, and how health care workers can be trained to use the system. Despite the many challenges that lie ahead, the group is confident they will meet the challenge.

“It’s not inventing new technology,” says Glucksberg. “It’s designing a system. There’s a difference between invention and design: The components are there, but we need to put them together in a smart way, deploy them in a smart way, with a sustainable business model. We can come up with a product made from existing components that will provide digital X-rays at a reasonable cost. In essence, what we think we’re doing is bringing engineering and design sensibility to the problem.”

—Kyle Delaney