Modernisation of radiology

Dr Minal Chaudhry, HOD, Radiology, Aakash Healthcare, talks about the evolving role of digital technology in diagnostic imaging

The importance of radiology in modern day healthcare cannot be overstated. On November 8 every year,  scientists and medical professionals throughout the world celebrate International Day of Radiology. It has been more than 100 years since radiology came into existence, and it has come a long way since its birth. It has evolved from purely diagnostic devices to interventional technologies taking active part in the treatment of the patient.

Digitisation and technology play a crucial part in almost every industry and in our personal lives; simplifying things. Likewise, digitisation has revolutionised almost every facet of medicine. Medical service providers in India are heavily investing in information technology and breakthroughs in biotechnology and medical equipment have made notable involvement in improving health of people in India and around the world.

Radiology has seen increased productivity and efficiency by the adoption of Radiology Information System (RIS), which is a networked software system for managing medical imagery and related data. RIS is useful for tracing radiology imaging orders, billing details, and is often used in combination with Picture Archiving and Communication System (PACS) to manage image archives, record-keeping and billing. PACS provides electronic storage, retrieval, distribution, and presentation of images.

Hitherto images were not accessible unless a physician had access to the hospital or imaging centre’s PACS. To view it outside the premises, CDs were burned and sent by courier, which did not always open and used to take very long time to view the data sets. Repeat imaging exams were often performed if the CD’s were corrupt or due to some other technical problems, increasing the cost and exposing the patient to additional radiation.

Present day systems allow access to images and reports via e-mail through a module for PACS, third-party standalone systems or systems that are linked to the facility’s archive/ storage. Most are cloud or web-based systems, and easily accessible from anywhere.

The systems and the transmission of data is highly safe with encryption and password protection to meet HIPAA requirements, (Health Insurance Portability and Accountability Act of 1996) which is the US legislation that provides data privacy and security provisions for safeguarding medical information. PACS assists the handling of digital radiology images so that they can be easily accessed and viewed by various clinicians in different locations and settings, improving operational efficiency. The digital images provide improved dynamic range and contrast, with exclusive screens and software for each process, which enables accurate diagnosis. Digitisation and PACS improves productivity, saves time as juxtaposed with analog readings, reduces errors and cuts costs.

A few vendors have made it easier and less taxing for – tech savvy – patients to view their images by providing an access code, instead of a CD, which can be shared with physician(s) to view the data via an app on a tablet or a cell phone and hence the medical folder can be carried wherever one is mov ing.

The flow of data is seamless and wireless in contemporary times, with digitisation in imaging. Ultrasound scans and other diagnostic imaging can be done without wires, for instance, new age probes let the radiologist do the ultrasound or a procedure, without the discomfort caused by the cord attached to it.  Various digital detectors can now transmit less images wirelessly to the console without physically connecting the system to the console hence allowing increased efficiency.

Radiology, along with the rest of the healthcare sector, is moving to cloud-based systems, and it is at an extremely fast pace. According to an article published in Applied Radiology, the initial upfront costs can vary between the intensity of building an organisation’s own private cloud, or the ease and flexibility of using public cloud architecture. The process efficiency, financial predictability of paying for only what the organisation needs, and long-term cost savings are making the cloud a worthwhile investment.

Collaboration and communication is a must for healthcare facilities. No department can work in isolation, and the ‘patient experience’ has to be given importance. Vendor neutral archives (VNAs) have progressed from just being a repository for radiology. This has enabled storage and exchange of clinical content in DICOM and/or non-DICOM formats. It is extremely different from conventional competence of a VNA system. Currently, VNA’s embed intelligent lifecycle management and meta-data management to optimise the efficiency of multiple archives. This means that all the clinical data is easily accessible and usable, which leads to better patient care.

Advancements in diagnostic imaging – digital detectors and softwares – has completely replaced investigative surgery and reducing radiation dose for various procedures by up to 75 per cent. Earlier clinicians used to do surgery, just to have a look at the insides of the body, and to find out what’s wrong. In preceding years, such practice has been replaced with new age MRIs, ultrasounds and CT scans. In contemporary times, with the help of digitisation and new age post processing techniques the images taken from the scans look exactly the same as the insides of the body during operation. And for this reason, text-only reports are fading away. Multimedia Enhanced Reporting in Radiology (MERR) has improved understanding of radiology findings by correlating images to text reports. The study also found that the multimedia reports provided easier access to images while monitoring progression of a condition, and saved time understanding findings without supporting images.

The unification of telehealth, teleradiology and medical equipment technology has also led to robotic surgeries where on occasions the doctors can operate remotely, and the patient can get operated in a hospital close to them, eradicating the stress and hassles of travelling.

And, all this digitisation can sometimes come with a decreased price as well. For instance, several key imaging vendors showed how lower-volume hospitals can use one wireless digital radiography (DR) detector for multiple machines, eliminating the need for several at a cost of about $100,000 each.

So, with upcoming advances in digitisation the future will bring new capabilities that have even greater medical value. We will see radiation dose continue to drop and utilisation of imaging services become more efficient, with fewer healthcare resources wasted, including the increasingly scarce commodity of time—to the benefit of patients, physicians and workers in the healthcare system.