Clinical tech: when radiologists work alongside robots

 Tomorrow’s radiology professionals won’t just work alongside the usual assortment of clinical experts. They may also have to partner with artificial intelligence systems, according to two distinguished US radiologists.

Richard Baron, professor of radiology at the University of Chicago Medical Center, and Keith Dreyer, vice chair of radiology at Massachusetts General Hospital and associate professor of radiology at Harvard Medical School, are set to discuss robot radiologists at a talk next month.

One of the implications of having artificial intelligence working alongside you is that you may have to get better at some of things robots cannot do so well, such as interacting with patients, said the doctors in an article in Health Data Management.

Learning to work with artificial intelligence may not be to everyone’s taste, Dreyer accepts. But “artificial intelligence and the automation it brings to those best able to use it will bring benefits to clinicians and their patients,” he said.

The profession: world celebrates International Day of Radiology

From banners in the streets of Barcelona to celebrations in Kerala, radiologists gained recognition worldwide this month thanks to the International Day of Radiology.

With a focus on breast imaging, November 8 saw more than 140 medical societies around the globe “celebrating the thousands of lives saved by the many contributions of breast imagers and radiation oncologists,” HealthCareBusiness reported

Breast imaging saves many thousands of lives around the world. In the US, for example, breast cancer mortality has been reduced by almost 40% since 1990 through the use of screening mammograms alone.

Not all International Day coverage focused on the positive aspects of the profession, however.

The British Daily Mail, which has the most visited newspaper website in the world, picked up on the UK’s radiology capacity challenge and said it was ‘putting UK cancer diagnostic services at risk.’

The news report cited Royal College of Radiologists president Dr Nicola Strickland as saying: “It’s difficult to celebrate in the UK where we only have seven radiologists per 100,000 people.”

A Department of Health spokesman responded: “In the short term we would encourage the College, employers and others to seek innovative ways to ensure delivery of specialist breast screening services.”

o   What did you do for the International Day of Radiology? Was it a normal working day or did you get involved in any of the events organised around the world? We want to know .


Clinical practice: surgeons don’t speak our language

If you sometimes wonder whether your message is getting through, you may be right to worry. According to this month’s American Journal of Roentgenology, surgeons don’t always see things the same way as you

A team from Emory University School of Medicine in Atlanta, US, and Vancouver General Hospital in Canada looked into 133 cases where radiologists had worked alongside surgeons on facial trauma surgery, and analysed the descriptions used by both sets of professionals.

Worryingly, the study found that the descriptions used by radiologists differed from those used by surgeons in more than 38% of cases.

The research points to the need for greater standardisation of terms between radiologists and surgeons, but also perhaps hints at the value of radiology second readings as a way of moderating some of the language used in reports.

In any event, said the authors: “Speaking a common language can potentially improve communication between the radiology and surgery services and can help expedite management of cases requiring surgery.”

Medical life: where surgeons are judged on paper cuts

If you think it’s tough to qualify as a radiologist, then pity prospective surgeons trying to get a job at Kurashiki Central Hospital in West Japan.

The hospital has adopted a “disruptive recruitment process” to check whether job applicants have the dexterity and hand-eye coordination to excel at surgery: they are asked to fold tiny origami cranes, put together mini insect models and make sushi with a single ran of rice.

The tasks are all carried out against the clock to add to the pressure facing applicants. Whether origami and sushi making skills have ever been correlated with surgical intervention success rates in an independent, peer-reviewed study is not clear.

Furthermore, the fact that Kurashiki Central developed its novel recruitment techniques in association with TBWA/Hakuhodo Japan, an advertising agency, suggests that the initiative may have been more  about attracting media attention than pulling in first class students.

Nevertheless, it is clearly an eye-catching stunt…and so maybe the kind of thing that other medical disciplines that are facing skills shortages, such as radiology, should take note of.


A call to preserve equivalence

In the last edition of The Bigger Image, I commented on the outcome of the European Union (EU) referendum in the UK.  Since then, parliament has been closed and we are no closer to understanding the implications of Brexit than we were two months ago.

The referendum result was 52% leave to 48% remain, with  a turnout of 71.8%, meaning only 37.3% of the electorate actually voted to leave. Nevertheless, the government has indicated that it will honour this result, expressing its commitment to a careful withdrawal from the EU.

Powerful groups such as financial institutions and manufacturers are gearing up to lobby for protection of their industries under the new, yet-to-be-agreed rules.

While many of those who voted out did so to restrict movement of people around the EU, specific industries want freedom of movement of workers in their sectors to be protected along with free trade. So where does this leave medicine?

So far, hospitals, doctors and surgeries around the UK have benefited from the ability to employ skilled European doctors and nurses.

However, equivalence of qualifications around Europe has been a major factor in this, and many are concerned about whether these professionals will be welcome in the UK after Brexit.

Furthermore, the movement of British professionals as a consequence of Brexit has been barely touched upon. I worked in Bermuda for five years and obtaining a work permit there  was a long and complex process.

As long as there was a Bermudian radiologist to fill the post, I had a job. I would never have been head of department as long as my excellent Bermudian colleague wanted the role, and if a Bermudian wanted my job, I’d have to leave.

For me, to work three years in Barcelona, where my rights were the same as those of a Spanish radiologist was a privilege. It was a pleasure to know that I could go anywhere in Europe to live and work or even retire with healthcare provision.

This work was with Telemedicine Clinic (TMC), which uses skilled subspecialists registered with the General Medical Council (GMC) with a license to practice. They undergo appraisals and are revalidated according to GMC rules.

The TMC radiologists who report for the UK are based around Europe. Some are in the UK, but many are in other countries. TMC’s model relies to a small extent upon freedom of movement, but equivalence of qualification around the EU is more important.

It is a model that is increasingly popular in the UK. If bankers, car manufacturers and other exporters are lobbying for special conditions post-Brexit, then it is just as important that decision makers are aware of the facts specific to radiology.

The UK has the worst capacity shortfall of any country in Europe, with just 4.8 radiologists per 100,00 people.

If our ability to use these skills in an imaginative way, using networks of teleradiologists, is inhibited under Brexit, our ability to cope with the ever-increasing demand for imaging will be seriously compromised. That’s the overview. What can you do as an individual though?

There is a group that was formed out of the ashes of the “remain” campaign:

Having accepted defeat, its members will be working hard to achieve the best outcome for all sectors of UK society and business.

I have volunteered to help them build a radiology solution…and I urge you all in the UK to consider whether you too may be able to help to build something that preserves our freedom, as doctors, to share skills across Europe.

– George McInnes

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Clinical policy: should your first choice be a second opinion?

Getting another expert to review your work is not always feasible… or enjoyable. But research last year has added to mounting evidence that second opinions should be used wherever possible because they improve patient outcomes.

A paper by Yulia Lakhman, Melvin D’Anastasi, Maura Miccò and Evis Sala shows second-opinion reviews of gynaecological oncology MRI scans could have prevented unnecessary surgery in up to 7.5% of patients.

Naturally this poses a challenge for our profession. It is intuitively obvious that double-checking results could help improve the quality of work, and Telemedicine Clinic’s teleradiology service, for example, already involves double reading of 10% of scans, for quality purposes.

But how can this be done in environments where resources are already stretched? What do you think?


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