Field hospitals’ diagnostic radiology standards in low-resource settings




radiography, diagnostic imaging, mobile health units


Objective: To review the current standards being followed for diagnostic radiology at low-resource settings.

Design: A systematic review was conducted.

Setting: Low-resource field hospitals were reviewed.

Patients and participants: All patients who were diagnosed using imaging in field hospitals were included in this review.

Interventions: Only standard care diagnostic imaging was reviewed.

Results: Scanty evidence on the standard quality control for mobile health unit (MHU) in low-resource settings is observed. The lack of evidence makes it inconclusive to decide if suboptimal quality of care is being provided to patients at the MHUs or if the quality is optimal. Multiple international societies such as the Radiological Society of North America and European Society of Radiology do provide extensive guidelines and algorithms for radiologists under normal conditions in the hospital. However, no such guidelines were found for MHUs. The most significant contributions that have been done in the guidance and quality control of the MHUs have been done by the World Health Organization with their emergency medical team guidelines and publications.

Conclusions: MHUs are critical interventions introduced to mitigate crises and manage health campaigns. Diagnostic imaging also plays a pivotal role in ensuring successful patient management in the MHUs. No international or local diagnostic imaging standard for quality control was found in the evidence. Investigations to access the feasibility of different quality control standards in the MHUs are warranted.

Author Biographies

Hisham Ali Dinar, MBBS, MSc, EMDM

General Directorate of Emergencies, Disasters & Medical Transportation, Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia

Amel Faisal Hassan Alzain, BSc, MSc, PhD

Department of Diagnostic Radiology Technology, Taibah University, Madinah, Saudi Arabia


Andronikou S, McHugh K, Abdurahman N, et al.: Paediatric radiology seen from Africa. Part I: Providing diagnostic imaging to a young population. Pediatr Radiol. 2011; 41(7): 811-825. DOI: 10.1007/s00247-011-2081-8.

Andronikou S, Mngomezulu V: Paediatric radiology seen from Africa. Part II: Recognising research advantages in a developing country. Pediatr Radiol. 2011; 41(7): 826-831. DOI: 10.1007/s00247-011-2080-9.

Daiski I: The health bus: Healthcare for marginalized populations. Policy Polit Nurs Pract. 2005; 6(1): 30-38. DOI: 10.1177/1527154404272610.

Simsek Z, Koruk I, Doni NY: An operational study on implementation of mobile primary healthcare services for seasonal migratory farmworkers, Turkey. Matern Child Health J. 2012; 16(9): 1906-1912. DOI: 10.1007/s10995-011-0941-3.

Luque JS, Castañeda H: Delivery of mobile clinic services to migrant and seasonal farmworkers: A review of practice models for community-academic partnerships. J Community Health. 2013; 38(2): 397-407. DOI: 10.1007/s10900-012-9622-4.

Wray NP, Weiss TW, Christian CE, et al.: The health status of veterans using mobile clinics in rural areas. J Health Care Poor Underserved. 1999; 10(3): 338-348. DOI: 10.1353/hpu.2010.0527.

Higgins SJ, Walls EA, Fisher AG, et al.: The establishment and validation of the mobile immunization team concept at a clinic level. Military Med. 1991; 156(2): 53-55.

Suhayda L, Riley MA, Roth L, et al.: Cancer screening in the community. Taking the show on the road. Cancer Pract. 1997; 5(2): 105-110.

Swaddiwudhipong W, Chaovakiratipong C, Nguntra P, et al.: A mobile unit: An effective service for cervical cancer screening among rural Thai women. Int J Epidemiol. 1999; 28(1): 35-39. DOI: 10.1093/ije/28.1.35.

Rodriguez KL, Appelt CJ, Young AJ, et al.: African American veterans’ experiences with mobile geriatric care. J Health Care Poor Underserved. 2007; 18(1): 44-53. DOI: 10.1353/hpu.2007.0016.

Oboler SK, Blieden MA, Carter SA, et al.: A mobile internal medicine clinic. Arch Intern Med. 1983; 143(1): 97-99.

Krol DM, Redlener M, Shapiro A, et al.: A mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi. J Health Care Poor Underserved. 2007; 18(2): 331-340. DOI: 10.1353/hpu.2007.0038.

Cross ICotR: Mobile health units: Methodological approach. Available at Accessed February 24, 2022.

Chan EY, Kim JJ: Remote mobile health service utilization post 2005 Kashmir-Pakistan earthquake. Eur J Emerg Med. 2010; 17(3): 158-163. DOI: 10.1097/MEJ.0b013e328331ddd3.

Taylor MM, Stokes WS, Bajuscak R, et al.: Mobilizing mobile medical units for hurricane relief: The United States public health service and Broward County Health Department response to hurricane Wilma, Broward County, Florida. J Public Health Manag Practice. 2007; 13(5): 447-452. DOI: 10.1097/01.PHH.0000285195.39179.7d.

Brito A: Continuing mobile care for Katrina’s children. Pediatrics. 2011; 128 (Suppl. 1): S34-S36. DOI: 10.1542/peds.2010-3724N.

Chen Z, He S, Li F, et al.: Mobile field hospitals, an effective way of dealing with COVID-19 in China: Sharing our experience. Biosci Trends. 2020; 14(3): 212-214. DOI: 10.5582/bst.2020.01110.

Herrmann TL, Fauber TL, Gill J, et al.: Best practices in digital radiography. Radiol Technol. 2012; 84(1): 83-89.

Carmichael J: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. Luxembourg: Office for Official Publications of the European Communities, 1996.

Radiology ACo: ACR–SPR–STR practice parameter for the performance of chest radiography. Available at Accessed September 21, 2022.

Ouzzani M, Hammady H, Fedorowicz Z, et al.: Rayyan—A web and mobile app for systematic reviews. Syst Rev. 2016; 5(1): 210. DOI: 10.1186/s13643-016-0384-4.

Health NIo: Study quality assessment tools. Available at Accessed June 27, 2022.

Bai Z, Wang B, Tian J, et al.: Diagnostic utility of CT for abdominal injury in the military setting: A systematic review and meta-analysis. Medicine. 2021; 100(50): e28150. DOI: 10.1097/md.0000000000028150.

Mango VL, Ha R, Nguyen B, et al.: RAD-AID Asha Jyoti mammogram quality assessment in India: Optimizing mobile radiology. J Am Coll Radiol. 2016; 13(7): 831-834. DOI: 10.1016/j.jacr.2016.03.018.

Bateman TM, Stowers SA, Herndon WM: Statement on mobile and remote-site provision of nuclear cardiology imaging services. American Society of Nuclear Cardiology. J Nucl Cardiol. 1997; 4(2 Pt 1): 174-177. DOI: 10.1016/s1071-3581(97)90069-6.

Browder C, Eberth JM, Schooley B, et al.: Mobile mammography: An evaluation of organizational, process, and information systems challenges. Healthcare. 2015; 3(1): 49-55. DOI: 10.1016/j.hjdsi.2014.12.001.

Radiology ACo: ACR-AAPM-SIIM practice parameter for determinates of image quality in digital mammography. Available at Accessed June 27, 2022.

Siegel E, Krupinski E, Samei E, et al.: Digital mammography image quality: Image display. J Am Coll Radiol. 2006; 3(8): 615-627. DOI: 10.1016/j.jacr.2006.03.007.

Drake BF, Abadin SS, Lyons S, et al.: Mammograms on-the-go-predictors of repeat visits to mobile mammography vans in St Louis, Missouri, USA: A case–control study. BMJ Open. 2015. 5(3): e006960.

Carkaci S, Geiser WR, Adrada BE, et al.: How to establish a cost-effective mobile mammography program. Am J Roentgenol. 2013; 201(5): W691-W697. DOI: 10.2214/ajr.12.9825.

World Health Organization: Management of Limb Injuries During Disasters and Conflicts. Clayton, MO: Courtland & Associates Inc, 2016.

World Health Organization: Classification and Minimum Standards for Emergency Medical Teams. Geneva: WHO, 2013.

World Health Organization: Self-Assessment Checklist for Emergency Medical Teams. Geneva: WHO, 2017.

World Health Organization: Global Emergency Medical Team Classification. Geneva: WHO, 2016.

World Health Organization: A Guidance Document for Medical Teams Responding to Health Emergencies in Armed Conflicts and Other Insecure Environments. Geneva: WHO, 2021.

Radiology ACo: ACR information on field radiology care during the COVID-19 pandemic. Available at Accessed June 23, 2022.

Lien C, Raimo J, Abramowitz J, et al.: Community healthcare delivery post-Hurricane sandy: Lessons from a mobile health unit. J Community Health. 2014; 39(3): 599-605. DOI: 10.1007/s10900-013-9805-7.

Iyama A, Utsunomiya D, Uetani H, et al.: Emergency radiology after a massive earthquake: Clinical perspective. Jpn J Radiol. 2018; 36(11): 641-648. DOI: 10.1007/s11604-018-0771-y.

Gregan J, Balasingam A, Butler A: Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities. J Med Imaging Radiat Oncol. 2016; 60(2): 172-181. DOI: 10.1111/1754-9485.12315.

International Atomic Energy Agency, WHO, Pan American Health Organization, et al.: Specific safety guide, no. SSG-46; radiation protection and safety in medical uses of ionizing radiation. Available at Accessed June 27, 2022.

Alpert EA, Weiser G, Kobliner D, et al.: Challenges in implementing international standards for the field Hospital Emergency Department in a disaster zone: The Israeli experience. J Emerg Med. 2018; 55(5): 682-687. DOI: 10.1016/j.jemermed.2018.07.019.

Mollura DJ, Culp MP, Pollack E, et al.: Artificial intelligence in low- and middle-income countries: Innovating global health radiology. Radiology. 2020; 297(3): 513-520. DOI: 10.1148/radiol.20202014344.

Sen D, Chakrabarti R, Chatterjee S, et al.: Artificial intelligence and the radiologist: The future in the armed forces medical services. BMJ Military Health. 2020; 166(4): 254-256. DOI: 10.1136/jramc-2018-001055.



How to Cite

Dinar, MBBS, MSc, EMDM, H. A., and A. F. H. Alzain, BSc, MSc, PhD. “Field hospitals’ Diagnostic Radiology Standards in Low-Resource Settings”. American Journal of Disaster Medicine, vol. 17, no. 3, Sept. 2022, pp. 197-05, doi:10.5055/ajdm.2022.0434.



Review Articles