The frozen frontier: Bringing digitally-enabled imaging technology to residents on a remote Alaskan island

X-ray technology with digital capabilities is helping evaluate injuries for roughly 1,350 residents who are 150 miles across water from the nearest hospital, connecting them to doctors on the mainland

Imagine a place so remote there are no hotels, no hospitals and only one small grocery store.

Off the far western edge of mainland Alaska in the Bering Sea is St. Lawrence Island. Though part of the United States, it’s closer to Russia – just 36 miles off the coast – than it is to North America. Here, whale is hunted and stored underground in cold cellars. Winter can last up to eight months.

St. Lawrence Island is a remnant of the land bridge that spanned the Bering Strait thousands of years ago. With a current population of roughly 1,350, the island has two villages: Gambell and Savoonga. A ticket off the island on a bush plane is very expensive. That’s how a resident would need to get to the nearest hospital, which is 150 miles away across water in Nome, the closest town on the mainland.

Norton Sound Health Corporation (NSHC), a tribally owned and operated, independent, not-for profit health care organization, was founded to meet the health care needs of the residents of the Bering Strait region. It has clinics in both villages on the island. If NSHC could bring X-ray imaging technology with digital capabilities to village residents, it could offer more visibility to injuries and ailments and help minimize disruption to patients’ lives. But getting the sophisticated medical equipment to such a remote site is not easy.

After days of prep work both on and off the island, three service team members from GE Healthcare spent two hours installing an Optima XR220amx portable X-ray system in the clinics in Gambell and Savoonga to provide first response for residents living in the villages.

“Previously, we’ve had to transport patients on a nine-seater commercial flight to the mainland to further evaluate their injuries,” said Cathy DeAngelis, manager of radiology at NSHC.

Since the X-ray systems provide digital connectivity, local “health aides” – village residents trained to operate the X-ray equipment – can now send the images directly to radiologists on the mainland to read and diagnose. Interpretation of the images can be received in less than 30 minutes.

“We’re now able to evaluate whether a patient can be treated within the village or if they need to be flown to the mainland for further evaluation,” DeAngelis said. “For critical patients, this technology reduces the time between injury and treatment which can save a life.”

But the weather is harsh between Siberia and Alaska, and St. Lawrence Island can have phone, internet and other connection issues.

“The quality of the images with our new X-ray system is so much better that our patients benefit from the lower amount of radiation needed to take the images,” DeAngelis said. “When we have connectivity issues and the images cannot be sent to the radiologist for interpretation, the image quality is detailed enough for the practitioner to evaluate for injury or major trauma. This will also help determine the course of treatment for the patient as soon as possible.”

These digital capabilities will hopefully help eliminate unnecessary trips to Anchorage or Nome for scanning going forward. The cost of air transportation is significantly reduced if the patient can fly a commercial airline. If an emergency transport by EMS is needed, it can cost up to $35,000 per trip. This new X-ray technology helps the EMS personnel know the extent of the patient’s injury or diseases, DeAngelis said.

“Alaska poses huge logistical challenges,” said Cody Pittman, GE Healthcare director of service. “You never really know what you’re walking into.”

Special arrangements for the installation of this equipment were made to deal with inclement flying weather and to ensure the team could land on a rough air strip that requires a short take-off and landing. The team’s flight to the island was rescheduled three times due to bad weather. They brought their own backpacks and sleeping bags, and slept on the floor of the health clinic as they prepared the sites for the new X-ray systems. They also brought enough food and supplies in case of an extended stay since the weather is unpredictable.

Removing the old systems and delivering the new equipment proved challenging. The team got creative and built a ramp out of the facility to load and offload the systems. The front-end loader they used started to sink in the snow and almost stopped the whole process – but they got it to work.

“Meeting the people who were benefitting from these systems was the best part of the experience,” said Adam Reynolds, a GE Healthcare field engineer and member of the St. Lawrence Island install team. “Their willingness to do whatever was needed to make it happen was refreshing. They have a great sense of community and it was evident in how they stepped up and helped when needed.”