Advanced radiography equipment is still rare in Myanmar.

ULTRASOUND and X-ray equipment are now relatively common in Myanmar. But for more serious and complicated ailments, sophisticated – and expensive – radiography technology is often required.

The medical equipment needed to perform radiography procedures including angiograms, computed tomography (CT) scans and magnetic resonance imaging (MRI) is still only available at high-profile clinics in Yangon. This is primarily because of the expense of purchasing them – one MRI machine can cost up to US$2.5 million – but also because of a lack of trained operators and the space required to house the machines.

“A CT scan machine takes more than double the space of an ordinary X-ray machine, when you include all the associated apparatus, radiation prevention equipment and the waiting areas for patients,” said a spokesperson from a private clinic in Yangon. He added that CT scan equipment is much more common than MRI machines in Myanmar.

“Both the CT scan and MRI are used to X-ray the whole body but MRI has the advantage of being free from radiation and we can also use it to see details of bones, vessels, muscles and tendons,” he said.

CT scans use X-rays to acquire images and so the technology is more suited to examining bones and vessels. MRI uses magnetic fields and can better differentiate and contrast between soft tissue.

Angiogram equipment can cost upwards of $300,000 and is also rare in Myanmar, said Dr Ye Moe Myint, the assistant medical director at Pun Hlaing International Hospital in Hlaing Thar Yar township.

Angiograms are used to visualise the inside of vessels and organs and are commonly used on the heart and brain to detect tumours and coronary heart disease.

“We also do peripheral angiograms, which focus on the narrow vessels in the lower part of the body, particularly the legs,” and can be used to detect forms of peripheral vascular disease, Dr Ye Moe Myint said. The disease, which is the result of a lack of blood flow, can have several causes, including high blood pressure, smoking and diabetes.

Pun Hlaing, which uses a Siemens “Angiostar” machine imported from Germany, is one of two hospitals in Yangon to offer the procedure, along with Pin Lon Hospital in North Dagon township.

U Sithu Aung, the business development manager at Siemens Healthcare, said another reason MRI machines were not widely found in Yangon is because they require reliable electricity supply and liquid helium, which is not produced locally and must be imported.

“The reason MRI is rare at the moment is because that type of machine needs air-conditioning to keep it cool as it is creating a high strength magnetic field. Another difficulty is the liquid helium, which is also essential for cooling the machine,” he said. Most advanced imaging in Myanmar is performed by CT scan, he said, adding that he expected a new generation of CT machines, which use much less radiation, to become more popular in the market.

“The CT that is currently used in the market is known as ‘64 slice’, which has a high amount of radiation. It is limited because if we were to increase the number of slices, there would be too much radiation,” U Sithu Aung said.

“Scans performed with the new, ‘healthier’ CT scanner give off much less radiation than with an ordinary scanner,” he said, adding that one of the scanners was installed in Nay Pyi Taw in March.

The price of the new CT scanners ranges from $70,000 to $2 million, he said. Well known radiography equipment brands are Siemens and Toshiba and the leading importers of radiography equipment in Myanmar are Meditech and Gold Lite.

Sixty-four slice CT scanners are now the leading tool for identifying clogged arteries and cardiovascular risk, according to medical website WebMD, but there are still concerns about the risk of cancer from radiation exposure. A study published earlier this year in The Journal of the American Medical Association showed the use of different techniques to reduce radiation exposure during CT scans varies dramatically between hospitals.

“This new study highlights the fact that radiation doses from cardiac CT can still be quite high,” Columbia University cardiologist Andrew Einstein told WebMD. “That is of concern. But what we don’t want is people avoiding these tests out of fear.”