Radiologists From Ukraine Share Their Stories

Antonenko

This is one of a series of stories for RSNA News provided by radiologists working in Ukraine. The story is posted as written and the opinions of the authors are their own. 

My name is Yurii Antonenko. I am 27 years old and I have been practicing radiology since 2018. On 24th of February, when Russia launched the full-scale war in my country, I was practicing radiology in the Mykolaiv City Hospital #3 and Mykolaiv City Hospital #5. Due to the proximity of  Mykolaiv to Kherson region and occupied Crimean peninsula, my city was at very high risk of being occupied, but due to the outstanding bravery of our Ukrainian Armed Forces this advancement was suppressed and Russian forces stopped and created a frontline in approximately 18 miles from my city. This distance was approachable for every Russian MRL, which were faced toward the city.

Before moving to Kyiv in May, I had been staying and working in Mykolaiv since February until April. During this time, due to the very close location of Russian troops to my city, almost every day Mykolaiv was bombed from all different kinds of multiple rocket launchers. All artillery strikes were directed against civilian infrastructure–universities, schools, hospitals, and public places.

The cruelest bombing I remember was in the beginning of April, when a usual bus stop was bombed by cluster munition. This took place on Peremohy Square, during rush hours, when Mykolaiv residents usually return from their work and many people would sell goods at the little marketplace. As the cluster bombs release many small bomblets over a wide area, many people were wounded and killed that day—those who were staying waiting for their bus and usual flowers and food sellers.

My technologist with her grandson, who were returning from the X-ray room in my outpatient clinic, miraculously survived that day because they got off at the stop which preceded the Peremohy Square and were able to hide behind the transformer box during the explosion. On the next few days, she left Mykolaiv with her grandson and moved to Germany. Ironically the square which Russians bombed-Peremoha Square-was named after the victory of Soviet Union against Nazi Germany in 1945, where the citizens of many Soviet Republics, including Ukrainians, were fighting against Nazism.

Almost every hospital in Mykolaiv suffered bombings by Russians, including those I had been working in. Both of my hospitals were located on the side of the city which were facing Kherson region and that were the closest hospitals to the frontline. The number of radiology staff had been gradually decreasing. In Mykolaiv City Hospital #5 by the end of March me and one technologist were the only one who were working in CT room. In cases when there is a sudden artillery fire and victims of the shooting requiring emergent care, the technologist who lived near hospital would come there and make the study, while I report it remotely and consult the referring physician. In the X-ray room of outpatient clinic in Mykolaiv City Hospital #3 there were me and one radiologist, one technologist and one environmental services worker.  

In the end of April, after surviving a severe bombing in my neighborhood in Mykolaiv I decided to move to Kyiv. Since then, I have been working in one of the Kyiv’s hospitals as a radiologist and also as a chief of the department.

This year in Kyiv has been quite a challenge.

In mid-November Russian military decided to begin missile rocket terror on our energy infrastructure, which lasted until the end of winter. This led to an unexpected power outage in the hospital. The uninterrupted power supply (UPS) in our CT room unfortunately was unable to manage drops in voltage, which led to repeated shutdowns of the CT scanner.  These resulted in disruption and delay of the CT exam in progress, patient care and management. Multiple power disruptions negatively affected the future function of our CT scanner and right now, while the energy supply is stable we are experiencing constant glitches of the console which sometimes forces us to stop our CT room from working. It may take place during emergency days, when a lot of patients require head CT imaging in the setting of acute stroke management.

In our department daily we provide imaging for up to 100 patients in our X-ray rooms and up to 25 patients daily in the CT room. Right now we are dealing almost with any pathology: emergency with wounds of war and their major complications; oncology; pulmonology and infectious diseases; general surgery; urology; orthopaedics. Another challenge is interpreting a lot of previously rarely seen trauma cases and its major complications, as well as decision making in the optimal management for these patients. This requires reading lots of publications in combat radiology and consulting with experienced radiologists.

But despite all these challenges, this war showed me the best example of compassion from the medical community around the world. A lot of people from different countries are trying their best to help our healthcare, which has been facing various challenges during this war. Radiology is not an exclusion and I would say the leader in the amount of help we get thanks to the dedicated and extremely talented radiologists, as well as professional organizations.

Just at the very beginning of war I got a letter from director in RSNA International Affairs, Meredith McNeil. This was a very touching and reassuring message that RSNA stands with radiologists in Ukraine and ready to provide any assistance they can. Without any doubt my first thought was education. This is really what we needed and still need here in order to provide the best patient care we can. This was a life changing event for me, as very soon I was contacted back and found out that Emergency Radiologist and Associate Professor Krystal Archer-Arroyo, MD, from Emory University and Grady Hospital in Atlanta would like to assist. Since then, Dr. Archer-Arroyo has helped me in so many ways during the most stressful period of my life. We created a group in one of the messengers to assist our colleagues from Ukraine in interpreting images from different modalities and allow discussions on major management for certain types of pathology. Through her brilliant expertise in radiology and perfect teaching skills, by educating us here Krystal has helped so many Ukrainian patients, refugees and wounded military.

When I moved to Kyiv and became chief of radiology, I decided that my position is a big opportunity to start changes in the department and improve patient care in the hospital. In order to accomplish these goals Krystal suggested contacting international organization RAD-AID, which helps countries in need as ours with educational support and medical imaging improvement. After meeting with CEO Dr. Daniel Mollura it was decided that the number one priority for our hospital is creating a fully functioning PACS system. The PACS system in Ukraine is not common in state hospitals and mine is not an exclusion. Right now we can store only X-ray images which were made during the last four to five months and all of our CT images are stored on the radiologists' workstation only for no more than eight months. In case we need previous studies, made in different medical facility, we usually ask patient to bring their CD discs. The initiative suggested by RAD AID is extremely exciting, as it’s not only about creating medical image storage in my department, but making it cloud based, which would allow us have constant web-based online access to the image data in our department, promptly provide other hospitals in Kyiv with images made in our department, allow volunteers to join and help from any part of the world. This is very ambitious and allows organizing lots of educational projects. If everything works, we are going to be the first state hospital in Ukraine who would use cloud PACS. Right now we are experiencing some challenges in that implementation due to the gap in Ukrainian legislation, but I hope we can overcome all of that and successfully implement this brilliant initiative.     

In addition to that, right now we are finalizing the grant agreement between us, vendor and RAD-AID as grantor for our console and broken display replacement in CT room. This is a priceless assistance to our hospital and health care, as it would stabilize the workflow in the department and remove previous delays in imaging acquisition for patients with acute stroke, who are admitted from many districts in Kyiv. CT scanner plays a crucial role in our health care, as every patient admitted to the hospital with stroke clinic undergoes brain imaging and then is sorted to the appropriate medical facility in Kyiv, or is being hospitalized to our Stroke Center. Moreover, we provide imaging opportunities for outpatients, whose costs for the studies are fully covered by the government (electronic referrals generated by physicians in national medical system eHealth) and for inpatients in surgical, urology, therapy, orthopaedics and other departments in our hospital.

Regarding the equipment, I would say that my department is clearly lacking an MRI scanner. A lot of patients in the hospital, after X-ray and CT studies require additional imaging, especially in neurology, orthopaedics and gynecology departments. If they need this study, we would refer them to other hospitals or private MRI rooms, which is not the best patient care. Right now, our hospital is sending requests wherever we can to get it, but at the moment no feedback has been given. Also, out of three X-ray units, the one in Admission Unit is quite outdated (produced in 2010) and breaks very often. If we are talking about CT scanner, 16-slice machine is not enough for our clinical demands in the hospital and this scanner requires a replacement with at least 128-slice machine, as the amount of head and neck angiographies, traumas have increased significantly and require better spatial resolution and image quality. Anyway, due to RAD-AID’s assistance in providing us with operating console, we have stable workflow, which gives us enough room and time for months and years for improving equipment in our department. 

My mother and sister left Ukraine at the very beginning of war and right now they live in Germany. My father all this time has been staying in my hometown Mykolaiv, working as radiologist in several hospitals, taking care of our relatives who also stayed in the city and our dog and cat. In the end of May they are all coming to Kyiv, which is the most anticipated event of this year for me. I missed them so much and can’t wait to see all of them.

I would say the major factor which keeps me going is faith in Ukrainian Armed Forces and our very soon victory. Also, I clearly understand what I do and for whom. I am considering my job as my own front, where despite all the challenges my main task is to provide our patients with the best possible care. And this wouldn’t be possible without professional organizations like RSNA, RAD-AID and amazing colleagues like Dr. Archer-Arroyo. Only united we can overcome any challenges we are facing and I am infinitely grateful to everyone for their support and efforts to make radiology better and accessible in Ukraine.