Clinical Specialist Sonographer Sonia Charles Highlights Gaps in Montserrat’s Radiology Services

Teleradiology, a remote service for reading diagnostic images, is a new addition to the island’s healthcare system, with a Caribbean-based company contracted to deliver the service. Government officials have advocated for teleradiology as the way forward for Montserrat’s healthcare system, given the island’s population size and budget constraints. However, while it now enables residents to get CT scan and mammogram reports without the need to travel abroad, it remains a temporary solution with notable limitations. Clinical Specialist Sonographer Sonia Charles, President of the Pink Ribbon Charity Montserrat, has raised concerns about the urgent need for a dedicated radiologist and comprehensive training for radiographers to ensure the safe and efficient delivery of radiology services on the island.

“A large majority of Caribbean islands have employed resident radiologists,” Charles noted. “Having a resident radiologist can help to reduce patient anxieties, offer reassurance, and provide a quicker turnaround time for reports than that offered by teleradiology.”

Charles believes that transparency around the qualifications, experience, and operational costs of the current teleradiology service provider should be available to the public to ensure patients are receiving the highest standard of care.

Through the FCDO, the government was able to purchase mammogram and CT scan equipment in 2023, and the Ministry began offering on-island mammograms in October 2024. However, Charles emphasised that without the appropriate manpower, the full benefits of these machines cannot be realised.

“Upon hearing of plans to purchase the mammogram and CT scan equipment, I informed the concerned Ministry officials that the recruitment of a resident radiologist and the appropriate academic and clinical training of radiographers in CT and mammography were all essential,” she revealed.

Adding to concerns, the machines were rushed into operation in temporary facilities ahead of the construction of the new Glendon Hospital. While mobile imaging solutions can provide essential diagnostic services, experts caution that temporary setups may not offer the same level of service, safety, and efficiency as permanent installations. Proper environmental controls, shielding, and maintenance infrastructure are critical for the optimal functioning and longevity of such advanced medical equipment.

Despite her recommendations, no significant steps have been taken to address these crucial elements. Charles had suggested hiring experienced senior radiographers with expertise in mammography, CT scanning, and ultrasound to provide coverage while local staff undergo training overseas. Additionally, she highlighted the need for mentorship upon their return. Training in CT scanning and mammography, she noted, takes approximately two to two-and-a-half years to complete, making forward planning essential.

In her renewed appeal to the Ministry of Health, Charles is advocating for the recruitment of a senior multi-skilled radiologist to oversee the delivery of radiology services. She believes Montserrat must compare the cost of employing a full-time or locum radiologist against the continued reliance on teleradiology.

“Montserrat is still in its infancy of using highly specialised radiology equipment, and therefore it is essential that a radiologist be available on island to support and develop the multi-modality service,” Charles stressed.

Additionally, she argues that more trained radiographers are needed to improve efficiency and reduce staff burnout, which has been an ongoing concern. “The current manpower is inadequate for a sustainable and safe delivery of a multi-modality radiology service.”

Another significant issue raised is radiation safety, which is critical for the protection of staff, patients, and the general public. Charles insists that a preventative and corrective maintenance schedule must be implemented to ensure the safe operation of radiation-emitting equipment.

While ultrasound is a non-radiation-based imaging modality that can be operated independently by qualified sonographers or radiographers, certain highly specialised scans require the expertise of a radiologist. “There may be instances when the supervision of a radiologist is required or highly specialised ultrasound scans are needed, and these can be performed by the radiologist,” Charles explained.

With Montserrat investing in advanced medical imaging technology, the island must ensure that its healthcare system has the necessary professionals to maximise the benefits of these tools. Charles’ appeal to policymakers is to recognise the gaps and take immediate action to ensure that the people of Montserrat receive the quality healthcare they deserve.