Category: Teleradiology

14 Dec 2018
Dr Arjun Kalyanpur

Artificial Intelligence in Teleradiology

A Report, based on the Keynote Speech delivered
– By –

Dr. Arjun Kalyanpur, Chief Radiologist and CEO, Teleradiology Solutions
at Artificial Intelligence in Radiology 2018 Symposium, November 10, 2018
Organized by Telerad Tech and Image Core Lab

Dr Arjun Kalyanpur began his speech recalling how Teleradiology Solutions for the past few years has been engaged in the field of artificial intelligence (AI) with the health-IT company Telerad Tech and drug trial company Image Core Lab. He also¬ congratulated Telerad Tech for launching MammoAssist – its AI software for breast cancer detection and also for establishing a new dedicated AI lab facility at the same time.

Dr. Kalyanpur noted that his company Teleradiology Solutions had reached an inflection point in its journey in the direction of artificial intelligence and it was an opportune moment for their company to be part of an event like this and be amongst the distinguished speakers in the field of AI.

AI and Teleradiology – synergistic and disruptive technologies

As per Dr. Kalyanpur, both AI and Teleradiology are very closely linked to each other and are extremely synergistic. They both address the same fundamental clinical issues about shortages of radiologists and both provide technology-enabled solutions for the same clinical issues.

Revisiting their journey of how teleradiology brought them to the current point where AI is seen as the direction forward, Dr. Kalyanpur said that the drivers that set them on this path 15 /16 years ago was the shortages of radiologists with most of them being focused in metros, and emergency radiology being the most severely affected area and still continues being one today.

He noted, that the numbers of radiologists haven’t changed much in the past 20 years and that there was still a dramatic shortage of radiologists the world over. Drawing up a scenario, Dr. Kalyanpur highlighted that even a developed country like the US with the best radiologist to population ratio, considered itself of being in the deficit with India being in the middle of the curve somewhere, whereas Tanzania on the other end had 1 radiologist for over 1 million population.

AI is important for addressing the increasing burden of diseases

He cautioned that, there is an increase in chronic diseases, due to progressively unhealthy lifestyles and living conditions, all of which required repeated imaging at multiple times in a patient’s life, leading to an increase in the number of images and their complexity in studying them. He added that in the 123 years, between the first X-Ray being produced in Roentgen’s Lab, till today, advancements have led to a dizzying array of imaging modalities of extremely high resolution, in all shades and hues being available to the radiologists, increasing work for them analyzing the data.

Understanding the gaps, Dr. Kalyanpur noted that, 15 years ago teleradiology evolved as a solution to these factors delivering the value proposition of not needing to have a radiologist at every hospital. It was technology driven solution with work flow and efficiency being at the core. It also had a quality benefit because the images were being brought to the most qualified radiologist, spawning the term “nighthawk”. The company was serendipitously at the forefront in the sector, providing night shift emergency services to hospitals at different parts of the world resulting in better performance and better quality services.

Emphasizing again, Dr. Kalyanpur said that, both teleradiology and AI were essentially disruptive technologies. Having been through and seen the evolution of teleradiology, he felt that, AI was seeing the same disruption as they had witnessed in teleradiology. Citing similarities between the two, he noted, that the resistance pattern was similar, and AI also faced the same concerns and fears that teleradiology had previously faced. Depending on how one would see them, both could either be seen as a threat or as a benefit. The same drivers were present for both innovations. Since both are IT enabled solutions and follow Moore’s law principles, one could only expect them to be faster, more effective and cheaper in the coming years. He also noted that both had the potential to transform healthcare by simultaneously increasing radiologist quality and productivity – a double whammy in terms of their benefit and impact on healthcare.

Key trends in radiology

Describing radiology as a quantitative science, Dr. Kalyanpur said that radiology today was beyond a simple image description. Studying a few trends in radiology prevailing today, Dr. Kalyanpur chose to highlight 3 of them, sub-specialization being one. Further, he noted that there was an increase in focus on report turn-around time as all of medicine was becoming metrics- driven. Turnaround time was becoming the basis of judging the performance of a radiologist or a radiology group. He also pointed out that the evolution of cloud-based workflows also had made a tremendous impact in the field.

Citing stroke as an example, Dr. Arjun said that, in the 15 years that they had been practicing teleradiology the specialty had evolved to the point where it was no longer just a matter of looking at the CAT scan of the brain and determining whether it was a stroke or not. Today they had a CT angiogram or a perfusion CT to analyze as well, increasing the number of imaging modalities available to assist in clinical decision making. Quantitative imaging today helped in quantifying the size of the stroke, determine the collateralization of the brain and the impact on patient outcome. Therefore, radiology was no longer just a diagnostic science but had evolved into being a prognostic tool while Quantitative imaging was available in every sphere – Whether it was tumor detection, tumor analysis or quantification of vascular disease.

Looking at it from the operational standpoint, Dr. Kalyanpur noted that turnaround time was another factor that entities needed to be conscious of. He mentioned that, every tele-radiologist in the organisation practiced medicine under the scrutiny of the stopwatch. Citing it as a challenge, he said that, finding a fine balance between quality and speed was important as the faster a radiologist reads an image, the greater was the chance of him/her missing a finding. As per him, teleradiology had made the important aspect of work flow possible by allowing decentralized reporting and being a cloud-based solution, a radiologist could read for hospitals in any part of the world, with the understanding that compliance with licensure and certification was adhered too.

Making a radiologist more efficient and productive

Taking a step back and speaking on his role as a radiologist, Dr. Kalyanpur said that, usually a radiologist detected and quantified the lesion, analyzed the finding, communicated and recommended the follow up. Tackling the criteria on making the radiologist more efficient and productive, he suggested making the process of reporting, the work flow smooth by providing all the relevant information to the radiologist and assisting them by creating a templated report. Speaking on the productivity, Dr. Kalyanpur said that, the average productivity of a radiologist in the world was between 6-10 RVUs (relative value unit) an hour. That could probably be increased by about 15-20% by using these techniques. However, AI could potentially double the productivity of a radiologist, thereby helping in solve the radiologist shortage issue of half the world.

Highlighting the larger issue of radiologist errors, Dr. Kalyanpur mentioned that as per some studies, 3-5% of radiologist reports contain errors, such as for example small bleeds in the brain, small clots in the lungs or very subtle fractures in the spine. Considering that a billion scans were performed around the world every year, it meant that around 30 million scans would have reporting errors – a gravely concerning huge number. He opined that radiologist accuracy and patient outcome could be improved by allowing AI to detect these findings.

Predicting on the estimates on the size of the industry, Dr. Kalyanpur said that, the initial figures in teleradiology suggested it being a billion dollar industry, however it had grown beyond 4 billion currently and he was confident that it would further grow. Similarly, he was optimistic about AI growing beyond the current 2 billion in the future and wished best of luck to Telerad Tech for its endeavours.

Developing AI in radiology

Speaking on the importance of developing AI in radiology, Dr. Kalyanpur said that, it was important to have communication between radiologists, scientists and engineers. This would enable data with labelled information help in developing the tools and would require radiologists to validate them once they were developed to confirm that they actually worked. He suggested that this could be integrated into the workflow most effectively by integrating it into the teleradiology workflow which allowed these technologies to be deployed at scale across the globe, where the entire world population of radiologists could be the consumer.

The synergies between teleradiology and AI was that at every stage of the AI cycle teleradiology had a valuable role to play and offer – whether it was data acquisition from around the world (as many as over 200 hospitals in 20 countries) forming a huge repository for analysis, testing an algorithm in a teleradiology environment and the teleradiology workflow to be used as a distribution tool for AI software.

Simplifying it, Dr. Kalyanpur noted that, teleradiology could be seen as being a shopping mall, in which each AI algorithm was an individual store or teleradiology could be an I-phone on which each individual app resided and allowed the consumer to connect with the product. He expressed his satisfaction to note that Telerad Tech, apart from developing its own software algorithm, was also partnering with other entities in the same space. And allowed their workflow to be used as a distribution module for teleradiology algorithms or for AI algorithms to radiologists around the world allowing all possibilities of detection, quantification triage for smaller lesions and detection for the larger lesions.

In his concluding remarks, Dr. Kalyanpur said that, it was all about perspective and focus. Quoting radicals such as Professor Hinton, who opined that since AI would have taken over in the future, training of radiologists should be stopped because we wouldn’t need them anymore on one hand to moderates such as Professor Langlot, Stanford, on the other who believed that radiologists who used AI will replace radiologists who wouldn’t in the future. He suggested that it would be wiser to have a pragmatic approach since it was an evolutionary area. He was of the view that one needs to learn to adapt and understand the space so that one could utilize it better. Citing Darwin he wrapped up his speech by saying that only the most responsive to change would survive over the more stronger or the more intelligent.

16 Jul 2018
Transforming Radiology Technology

The Transformation of Radiology using Technology

Radiology has indeed come a long way since 1895, the year of the spectacular discovery of X-rays by German physicist Wilhelm Roentgen. It now plays an inherently crucial role in improved and better diagnosis and patient care.

The past few decades have seen the limits of imaging informatics being pushed beyond traditional boundaries thanks to several major changes in computer and communication technology. With the advent of new technologies, such as the World Wide Web, wireless connectivity, and, now, the ever-present social networks, momentous advancement has been made in the way radiological services can be delivered. The Internet has become a crucial gateway for electronic transmission and sharing of health-related data, something we today know as “e-Health”. Many types of e-Health are currently becoming available. In many hospitals, the electronic health record (EHR) is being introduced, which allows a complete electronic record of the patient’s health information. This EHR should not only automate and streamline the physician’s workflow but also allow patients to gain control over their health data through online portals.

The move from an analog to a digital working milieu put the radiologists at the front line of producing and distributing digital images. New dedicated software products were developed. One of the most important shifts being adopted by many healthcare institutions across the globe is a paper-free environment and the Picture Archive and Communication System (PACS) and Radiology Information System (RIS). These are truly remarkable steps in this direction. Radiologists employ the PACS to store myriads of image files which can be easily retrieved at any time in the patient management. Making lives extremely convenient, the entire database of images of all patients across all modalities is just a click away. It not just saves time but with the help of software solutions like RIS, it is now possible to keep a track record of every patient from scheduling appointments to diagnosis and treatment.

Transformative new technologies, many powered by cloud-based RIS-PACS, Artificial Intelligence (AI) and machine learning, promise to redefine the practice of radiology in ways that will considerably improve productivity, diagnostic quality, and medical treatment. Today, cloud-based computing in the imaging market has evolved from a service that provided cost-effective disaster recovery for archived data to fully featured PACS. It’s vendor neutral archiving services can address the needs of healthcare providers of all sizes, on the go.

Taking a look at AI, we need to identify AI’s strengths in analyzing visual images. Researchers train the algorithms to better detect potentially dangerous abnormalities, generating faster and more accurate insights to help guide clinicians’ treatment decisions. AI adoption is sure to ease the overwhelming workloads impeding the profession, facilitating radiologists to do what they’re best at and perform them better.

Going further ahead, we can examine Workflow orchestration technology too. This promises to boost efficiency and alleviate bottlenecks. By directing cases to the right recipient in the correct order, this technology optimizes the effectiveness of the read, especially in teleradiology settings. With the profession’s ever-increasing need for solutions that match demand with supply, a lot of organizations provide solutions that facilitate better collaboration across facilities for effective workflow orchestration.

Teleradiology is another field that is assisting well where streamlining workloads is concerned. Remote radiologic coverage and reliable telecom infrastructures means more radiologic analysis is being performed online to take care of workloads between hospitals. And as the field becomes progressively digitized, apprehensions regarding the security of radiology data accentuate the need for robust solutions that will not just prevent breaches but at the same time also safeguard patient information while complying with regulatory requirements.

Diagnostic images captured at the right place and at the right time give physicians, surgeons, and care centers an important tool to help provide better patient care and at a reasonable cost. For this reason, Telerad Tech has been building out solutions since 2009.

Telerad Tech was established with the goal of optimizing radiology productivity and improving patient outcome delivery through transformational medical imaging software solutions. Today, it is amongst the market leaders in providing integrated RIS-PACS software solutions for teleradiology, medical imaging centres, and hospitals of all sizes globally. Telerad Tech’s solutions cater to workflows needs across departments, including Radiology, Cardiology, Podiatry, Orthopedic, Chiropractic, Oncology and Veterinary.

We are today amongst the market leaders in providing RIS with integrated PACS with significant installations in both cloud and enterprise environment across 1500 facilities in 24 countries.

Our software solutions suite has been incubated, tested and perfected in a radiology ecosystem and are designed to address the unique needs of multiple care pathways across departments, including radiology, cardiology, dentistry, oncology, and veterinary. Our software has customizable workflow features, intelligent productivity tools & analytics and Vendor-Neutral Archive technology. It has strong patient security framework and integrates seamlessly with other systems for exchange and retrieval of electronic health information.

To enable physicians to consistently deliver optimal patient management and to augment the precious time of radiologists, Telerad Tech has also leveraged Artificial Intelligence (AI), for various radiology diagnostics.

We truly believe that the future is here

Technological development has undoubtedly prompted some anxiety among radiologists. But while tech adoption will inevitably alter the way radiologists work, technology’s clinical value will be in supplementing and adding to and not replacing or even displacing the professionals. Radiologists empowered by AI will only encounter a new, more efficient stage of radiology, helping to focus their time and attention on the most crucial elements of their job.

Also, we need to remember that image analysis is just one of the aspects of a radiologist’s job, other tasks, including discrepancy reviews, diagnostic reasoning, and patient-facing work such as invasive radiology, will still be performed by humans. Those tasks will simply be supported and enhanced by advancing technology.

The future of radiology is here, and the prediction clearly states that it will not only better health care but also the lives of all the stakeholders.

Author: Prashant Akhawat, COO, Telerad Tech

Co-Author: Ashwani Sinha, Global Head – Business Development

21 Nov 2016
Patient Portal

Patient portal – why a hospital or clinic must provide this access

Over the last few years, the end user is getting more and more informed and intelligent. The ever pervasive internet and the explosion of the knowledge base have helped spur this transition to a savvier user.

Two more factors are driving this revolution.
1) The compliance needs of certain governments to ensure every citizen is on an electronic patient portal
2) The pressure on the bottom line for hospitals and clinics forces them to find ways to educate the patient and reduce his visits to the hospital which have become a huge burden to the Governments.

While most of the patient portal solutions in the last few years mainly dealt with patient reports and information relating to the visits of the patient, of late solutions are emerging whereby the patient has access to even radiology images.

The spin off benefit for the patient is that he has access to his clinical reports, lab test results, and sometimes images which he can share with another doctor for a second opinion.

In the good old days when a patient walked into an imaging center or an outpatient facility in a hospital and had an XRAY procedure done, he would be receiving an XRAY film immediately or in a few days. This later was replaced by CD’s which had a nice picture of the facility on top and images and reports inside. There was also a low end viewer which opened the images automatically.

While this saved the enterprise hundreds and thousands of dollars (you could now add multiple images from CT or MRI) and was a great marketing tool, it still meant the patient had to have the CD on him all the time if he wanted to share the information. The enterprise also had to invest in automated CD solutions which were mechanical devices and prone to failures.

All the pressures mentioned at the beginning of this article forced vendors to find a more practical and useful solution for the patient.

Today a patient can walk away with nothing but still have access to everything!
He can log into his secure private patient portal and

  • View images with a powerful viewer
  • View reports of the doctor
  • Upload his own documents
  • Share information with his family
  • Share reports and images with another specialist for a second opinion

All this can be done from anywhere and at any time using any browser on his computer or mobile device.
He could get relocated to say Indiana from Arizona and still meet his doctor and have all the information at his fingertips. He does not have to carry any documents or CD’s or films.
From an enterprise point of view this provides a better quality of patient care. The RIS/PACS they invested in would be archiving the images and reports anyway and all they need to do now is to find a cost effective way of sharing this with the patient.

The recent patient portals provide this facility and with the falling prices of hardware and software these features are becoming lot more affordable now than before.

The hospital and clinics win because they have reduced their costs and provided more benefits to the patient. The patient wins because he or she now feels they received their money’s worth and the access to their information at any time makes them more secure.
Everyone is happy!

21 Nov 2016
RIS

What do you look for in a RIS/PACS for a Tele-radiology application

Let’s face it. Today a PACS is a commodity …has been for quite a while.
Most PACS and for that matter RIS on the market can do most everything………..at least that is what the brochures claim!

For a Tele-radiology application, these are some of the important requirements

  • What are the workflow features it supports?
  •  How easy is it for a Radiologist to set up a practice for himself or herself?
  •  How many reports can the Radiologist dictate in a day?
  •  What is the cost of ownership?

Let’s take the last one first!

Today, reducing reimbursements from insurance companies, increasing competition across the globe, and the need to provide quality care in spite of all the above – are forcing owners of imaging centers to question the cost of ownership.

This is where the cloud-based solution brings value to the table. With a cloud-based solution, the vendor is responsible for the high end redundant servers housed in class III or similar data center, disaster management solutions, archiving studies and reports for 7 years or more. This solution provides a very low or practically nil cost of ownership.

The Radiologist or the owner can focus on building the business, signing up new hospitals, and bringing the bacon home! The cloud based solution gives him a lot more flexibility and freedom to go after new prospects even if they are not in the same state or even the same country.

The number of reports a Radiologist can generate in a day translates to profits. The system must be simple to use and the reporting engine and viewer must allow him to dictate as quickly as possible. Interface with a Voice recognition system, easy content (text and audio) exchange between the Radiologist and transcriptionist, peer review with ABR codes, QA, real time collaboration between different stakeholders are some of the features to look for in a system. The Radiologist must be the last link in the chain and studies/images must reach him only when they are complete in all respects, thereby saving his valuable time. Some systems have the reconciliation feature that handles this part of the assignment. The system must support all DICOM modalities which can be added any time later with ease and also support non DICOM for use with legacy modalities.

The system must be simple to use and more importantly easy to install. The Radiologist must be able to start his business or add a new hospital within hours thereby generating confidence in his business. If the hospital or clinic that is sending studies provides a VPN -then the issue of encrypting, security, and safe transmission are taken care of and there is no need for any hardware purchase by the Radiologist. If not, a simple PC that can house the DICOM router software and route the studies fast and efficiently to the central server, is sufficient. The system must also be universal such that it should not need any proprietary hardware for viewing and should be able to log in from any browser. Viewing and distributing images on a mobile device is becoming ubiquitous today and helps the Radiologist to take instant decisions from an airport or a coffee shop!

Last but not least the workflow features are very important. It is indeed an irony that when you mention workflow, most people have the “deer caught in the headlights look”. The workflow is the most important factor which contributes to the productivity and thereby to the bottom line of the enterprise. Some systems provide a “soup to nuts” solution for the workflow from capture to archive while some provide certain modules. Here it is important to get a standard off-the-shelf software that can be customized -rather than develop one from scratch and make it proprietary, finding it difficult to change in the future. The workflow defines many conditions that improve overall efficiency.

For example:

  • Assignment of studies to a Radiologist depending upon various conditions
  • Workflow parameters like TAT, number of reads, work load, QA score for Radiologist
  • Auto assignment or through manual intervention by an Administrator
  • Monitoring TAT (Turn Around Time) and reassigning studies if TAT is not met
  • Collaboration between various stakeholders through work-list
  • Customizable work-list which enables the user to see what they want to see and hide the extraneous information.
  • Monitoring QA, reconciliation, Peer review to help improve the quality of care to the patient
  • Integration with existing front end or back end solutions using HL7 or web links
  • Accessing PRIORS and showing patient demographics to the Radiologist while reporting to enable faster and more accurate reporting
  • Enabling the patient to get hold of the report and studies through a secure patient portal.
  • Use of mobile devices and maybe a QR code to make it easy for the patient to receive the information.

These are just some of the important workflow features to look for. It is best to ask the vendor what they provide – to help you improve the productivity of the Tele-radiology center. An important characteristic the software should provide is the flexibility to customize the features to get the best bang for your buck.

Many vendors who are in this business should be getting constant feedback from their valued users and keep improving their product.

Make sure they provide 24x7x365 support otherwise all the above is not as attractive as it sounds!

19 Nov 2015
Benefits of Teleradiology

Benefits of Teleradiology

Telemedicine is the application of information technology and telecommunications networks for the purpose of medical diagnosis and therapy from remote locations. A host of recent technology innovations have made it possible for telemedicine to expand its reach across every medical speciality– its usage in radiology is called “Teleradiology.”

Radiology incorporates the diverse methods used in medical science to capture images of the internal body structure and function (eg. x-rays, MRIs, ultrasounds), to assist in the process of medical diagnosis or treatment.
Teleradiology is the capability to acquire these medical images in one location and facilitate their transmission over a range so that they can be viewed and interpreted for diagnostic or consultative purposes by a radiologist.

This practice is becoming widely adopted by hospitals, urgent care clinics, and diagnostic imaging centers. The factor responsible for its rapidly growing implementation is due to the fact that it addresses the inadequacy of appropriately skilled personnel to provide radiological analysis and the lack of practitioners of this specialty.

The process of teleradiology, in essence, is based on a fundamental triad; an image sending station, a transmission network, and a image retrieval station that should have a high-quality display screen. Additional more recent technology innovations include the incorporation of cloud for redundancy and cost reduction, mobile technologies for greater access and sophisticated teleradiology workflow that enhances radiologist productivity, provide performance metrics and track quality. .

Teleradiology improves client care by enabling radiologists to supply their expertise without necessarily being at the same location as the patient. This is especially essential when radiologist subspecialists (e.g. MRI radiologists, pediatric radiologists, neuro-radiologists) are required, because these specialists are few in number and typically located in metropolitan cities. Teleradiology therefore enhances the quality of radiology reporting by bringing the images of a patient in a small town to the most specialized radiologist who is best qualified to interpret the particular radiologic scan..

On the other hand, smaller sized healthcare facilities in rural areas might use only one radiologist or none at all. In such situations, it is virtually impossible for the radiologist to be available 24 x7 x 365. Having the support of a teleradiology reporting service can both improve the quality of life of the solo radiologist as well as improve the quality of care that might be potentially diminished by radiologist overwork..

Teleradiology can be a means through which physicians can collaborate when they are not in direct contact. For example an emergency doctor at a rural urgent care center can gain obtain a radiology consultation from a specialist urban radiologist and discuss the case telephonically while simultaneously viewing his or her patient’s images. (e.g. they are in remote places). This can be extremely valuable from the perspective of enhancing patient care and improving outcomes.

Using the services of outsourcing companies or radiology groups to supply and maintain the needed radiology coverage, smaller medical facilities are able to make better usage of their own on-site specialists and enable them to maintain their regular working hours.

This can likewise be economical for the medical facility as the outsourcing institution need only spend based on utilization, and is spared the significant fixed cost of having a radiologist on site at a small institution where they may not be fully utilized . The arrangement of these expert services to manage inpatients at small hospitals without experts on site has been revealed to be a reliable way of providing high quality care that would otherwise be unavailable.

In summary, the benefits of teleradiology are related to affording access to specialist radiologist expertise where or when none exists, to the appropriate utilization of radiologist time and energy, and to the overall enhancement of patient care, while at the same time reducing healthcare costs!

The technologies today are mature and evolved, and the outsourced model wherein images are routed to a teleradiology reporting service is an established and tested one which affords significant value, especially to small rural and community hospitals. Startup costs, as well as running costs, are reasonable and affordable and the process is smooth and streamlined.

Sounds like a pretty compelling value proposition? Try it and find out for yourself!!.