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Tele-Radiology Scope in Digital Healthcare

MedPiper Technologies and JournoMed conducted a Webinar Series on “Digital Transformation in Healthcare” in association with IRIA Kerala, Hospex, Indian Junior Doctors Network, ISA Thrissur City Branch, IMA Thrissur and Instaclinik. The sixth-day webinar discussed Teleradiology scope in Digital Healthcare. The event was held on 27th August 2022.

Dr Sreenivasa Raju Kalidindi, CEO & Medical Director of Apollo Radiology International spoke about the Tele-radiology significance in India and globally, the primary focus is to implement teleradiology in today’s healthcare, also the focus is on how to increase the number of radiologists that are available at hospitals and healthcare units, shortage of radiologists in the healthcare sector, advanced techniques concentrating the development of radiologists, how to access radiology and when to use it, how radiology benefits the department services and hospitals across the country. Dr Raju’s main focus is to implement workflow, practice efficiencies, and educational research in machine learning. 

Advances in Tele-radiology

  • Access to radiology is considered a global disparity. Approximately two-thirds of the world’s population lacks adequate access to medical imaging (as per WHO)
  • A steep increase in mortality related to non-communicable diseases (NCDs) is projected in developing countries
  • Lack of access to radiology can grossly undermine the public health initiatives to tackle this treat
  • This fight against other diseases like tuberculosis is also being impaired by a lack of adequate radiology service

India- Urban and Rural Divide

  • Inequities in urban and rural health services including radiology is a major problem in developing countries
  • Almost 67% of the Indian population resides in rural areas
  • Nearly 60% of hospitals and 80% of doctors are present in urban areas
  • 90% of medical imaging facilities are available only in cities and larger towns
  • There is an acute shortage of radiologists in semi-urban and rural areas
  • There is a severe delay in diagnosis of acute/life-threatening conditions and also other serious pathologies like cancer
  • Resulting in a large amount of preventable morbidity and mortality

Radiology workforce in India: Numbers

  • One radiologist per1 lakh population 
  • Only 747 post-graduate training vacancies are available nationally
  • Duration of radiologist training is 3 years
  • Extremely small number of sub-speciality training programs are available across India

Limited scope to change the scenario quickly

  • Training numbers cannot be increased due to a limited supply of further suitable departments
  • Training duration is already short so cannot be further abbreviated

There is a lack of radiologists mainly in the suburban and rural areas and urban cities and it needs a solution as the discussion is on training a greater radiologist. Nothing is going to transform overnight.

Leapfrogging

Through disruptive technologies and innovations, leapfrogging is a combination of both teleradiology and artificial intelligence (AI)

Teleradiology

  • Teleradiology is based on the electronic capture, transmission, storage and retrieval of images for remote viewing and interpretation
  • Historically, the main drove for teleradiology was the need for after-hours coverage for urgent radiologic studies
  • However, in current times teleradiology is used for elective work, sub-specialist opinions, second opinions and other uses 

History of Teleradiology

  • The first documentation feasibility of teleradiology appeared in the literature review in 1948 and it described a telephonic transmission of radiographs, using the earliest version of the fax machine
  • The modern teleradiology practice has been evolving largely over the last two decades
  • The last decade has seen most of the technological advances (mainly cloud-based technology) making teleradiology accessible and affordable globally including in remote locations

Acceptance and Integration 

  • It is estimated that 40% of radiology practices in the United States used teleradiology in 2007
  • This accounted for 11% of their total workloads and 4% of the total workload of all radiologists
  • This has increased further significantly since then 
  • In the UK majority of the out-of-hours work across the National Health Service (NHS) is reported by teleradiology companies
  • There is a significant acceptance for radiologists across Europe.

Scope of Teleradiology

  • Emergencies and out of hours
  • Overflow elective cases
  • Second opinions and sub-specialist opinions
  • Work from home
  • Networked radiology reporting 
  • Government tenders
  • 3D post-processing 
  • Education 
  • Artificial Intelligence (AI)

Standards for a Teleradiology Service

Data Transfer: There should be clear and transparent systems in place for rapid, secure transfer and review of images and where necessary storage of patient data 

Reporting: Reporting must be of desired standard independent of where and whom the data is reported

Communication of the results: The same person should interpret the examination and issue the report to the referring clinician and should be identified, with the results communicated and integrated into the base hospital’s radiology information system (RIS), picture archiving and communications system (PACS) and electronic patient record (EPR) promptly. 

Quality assurance: Teleradiology should be a part of an integrated radiology service, and be subject to the same governance framework as the rest of the service, with all participating radiologists working within a documented quality assurance framework

Concerns and Barriers for Teleradiology in India

  • Price expectations
  • TAT expectations
  • Inadequate provision of history
  • Lack of access to previous imaging 
  • Lack of easy communication with the referring clinician 
  • Lack of structured approach to quality
  • Lack of mandatory standards regarding equipment etc.

Teleradiology is not just reporting 

  • It possesses virtual cockpits
  • Provides remote scanning assistance
  • Helps when skilled technicians are not available
  • Teleradiology is implemented in rare or complex procedures because of the lack of teleradiology professionals

Artificial Intelligence- The game changer?

  • Artificial Intelligence (AI) can significantly augment teleradiology
  • It can help improve access, efficiency and turnaround
  • Artificial Intelligence powered teleradiology can be a game changer in the fight against staff shortages and associated adverse situations

Applications of Artificial Intelligence in Teleradiology

  • Normal vs Abnormal applications

Widely applicable in Health check chest X rays 

CT Brain scans etc.

  • Widely used in Work list Prioritization and Triaging 
  • Assistance in reporting
  • Screening Population Health

    Initial Opportunities 
  • Detection and triage of life-threatening conditions, Road traffic accidents in remote areas- a serious issue 
  • Screening and early detection of cancer. Eg: Breast cancer
  • Early detection of tuberculosis
  • Several other applications. Eg: Coronary calcium from non-gated scans 

How Artificial Intelligence fits in?

Goal: To achieve early tuberculosis diagnosis and treatment

How Artificial Intelligence works: Consider a mobile facility that offers clinical screening and CXR screening. The main limitation here would be the shortage of radiologists

Solution: Use a deep learning system (DLS) with a performance i.e., non-inferior to radiologists to enable large-scale implementation of this strategy

Teleradiology: Widely used to analyze the final reports

Conclusion 

Teleradiology, an advancement in radiology has facilitated healthcare and saved many lives. Technology enhancement has brought a paradigm shift in the field of radiology and healthcare.  It is said that the implementation of technology improves lives, and teleradiology- a technological miracle focuses on improving patient care and experience. When crucial reports like MRI, CT scan, X-rays, etc. need to be interpreted urgently, radiology expertise might not be available immediately, which delays treatment, and costs the patient’s life. Tele-radiology thus plays a significant role in the health care sector. Currently, the burden on radiologists is tremendous and burnout is high among them. With the implementation of artificial intelligence (AI) the mounting pressure on them still increased. Apart from doctors, radiologists are highly professional, and they serve the patients 24*7, all 365 days a year depending upon the requirement. 

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