Steering a path towards integrated diagnostics

Imagine trying to describe a flower by looking at a black and white photo. You can probably make a good guess of the structure, but without adding colour into the picture you could miss vital information about the subject you are studying.

In medicine, something akin to this is driving calls for more integrated diagnostics. Radiologists, for example, do work that is closely related to pathology and genomics, but in practice these professions tend to work in silos.

A more cross-disciplinary approach could improve patient outcomes by offering a more complete view of medical conditions, according to a paper in Radiology last October.

“In recent years, however, voices have been raised calling for tighter collaboration creating deeply integrated workflows between radiology, pathology and genomics,” note the authors.

They advocate giving diagnosticians a greater role in deciding on follow-up studies and say the use of integrated diagnostics, increasingly supported by computational methods, could help cut costs as well as improving diagnoses.

“Whenever no mindset or organisation barrier exists between disciplines, the most appropriate examination can be selected, regardless of whether the diagnostic examination is offered by radiology, pathology or a laboratory-based test, including genomics,” says the paper.

“In this way, costs can potentially be reduced by shortening pathways and avoiding unnecessary studies.”

Interestingly, commercial healthcare services providers have started to move towards a more integrated approach, too. In 2017, for example, Unilabs conducted a number of acquisitions of various diagnostic groups throughout Europe.

The goal is to become the leading European supplier in genetics, lab medicine, pathology and radiology, where quality and new solutions such as integrated diagnosis and innovative application of artificial intelligence become key components.

TMC’s carbon offset project “takes root” at Finca Dalmau

Business can no longer stand apart from society and increasingly, the best businesses recognise that we all have a role to play in influencing behaviour and behaving responsibly. For us all to thrive in a connected world, we need to be aware of the consequences of our actions and work to minimise our impact on our planet, our city and our local environment.

At TMC, we are no different.

We’re committed to ensuring that we set an example as a responsible business and that this is reflected in the way we operate, the people we work with, the organisations that we support such as the Conscious Capitalism movement (www.consciouscapitalism.org) and through specific projects where we believe our support can help to make a real difference.

Last year, we were proud to announce a partnership between TMC and the Departament d’Agricultura Ramaderia, Pesca I Alimentació of the Catalan Government. Specifically, we agreed to support them in their work to improve a forest at Finca Dalmau in the Parc Natural de Sant Llorenç del Munt in Catalunya (not far from our European head office in Barcelona).

So, why should a teleradiology company be interested in sustainable forestry?

Our business, like more and more businesses, understands the importance of public/private partnerships to work for the common good. By working together with the Generalitat and Social Forest, we are helping to improve the sustainability of “El Dalmau”, a local forest owned by the Generalitat of Catalonia and located in Sant Llorenç Savall (Vallès Occidental), within the spectacularly beautiful Natural Park of Sant Llorenç del Munt and l’Obac.

Our work will help to reduce the risk of fire, thereby preventing the emission of about 80 tonnes of CO2/ha that would naturally enter the atmosphere if the area was caught up in one of the forest fires that regularly rage across our region and which cause such devastation. That is a good thing for the environment, for the local community and for our colleagues at TMC – something we are proud to support.

And the Generalitat’s Joan Vallhonrat Matalonga agrees: “We think this is a great example of the private sector working closely with government to develop activities which promote the conservation and improvement of our natural environment. This innovative project will see TMC working closely with the Department of Agriculture to deliver an improvement project for a local forest. While these sorts of partnerships are increasingly common across Europe, this is a progressive move in Catalunya where public/private partnerships of this kind are much less common”.

TMC’s Chief Executive Alexander Boehmcker says: “Increasingly, companies and their employees are looking for ways to contribute to their communities by working alongside government and charitable organisations.

“In our company, we have more than 200 radiologists working across a network of more than 120 hospitals in Europe. With our headquarters based in Barcelona and Sydney, many of our workers fly regularly on business trips and we’re very conscious of the impact that air travel has on our planet in terms of CO2 emissions. This carbon offset programme is something we can all get behind and it will help to mitigate our impact and offset almost 100% of the greenhouse gas emissions derived from our business travel this year.

This sustainable forest management project will not only help protect the forest from fire in the future, but will also allow our business, our workers and their families to take part in a hands-on project that will ultimately enable and benefit the conservation of this forest for the whole community to enjoy”.

Claudio Silvestrin, who managed the project for TMC added: “The actual forestry work itself is carried out through Social Forest (www.socialforest.org), a forestry services company which also works with young people at risk of social exclusion including long term unemployed, recovering drug addicts and former prisoners. Their work not only reduces the potential risk of forest fires and minimises the environmental impact, but it also helps young people with social integration by bringing them back into contact with nature.

“We’re delighted that our colleagues in Barcelona are right behind this project, so we recently organised our second Corporate Social Responsibility day in “El Dalmau” so that they (and their families) could see the great work that has been done so far and to share our exciting plans for the second phase of the project, which gets under way in June 2018.

“We encouraged them all to “get their hands dirty” by taking part in the work themselves. And it looks like it’s already catching people’s imagination, since everybody enjoyed the day and said how pleased they were that TMC was making this effort on behalf of them and their local environment”.

 

Could teleradiology give structured reporting a boost?

The case for structured reporting, where radiologists submit findings according to a standardised template, continues to grow stronger.

In January’s American Journal of Roentgenology, for example, a study on MRI reporting concluded that “all neurologists could understand lesion load significantly more often when reading structured versus non-structured reports.”

The finding adds to a growing body of evidence in favour of structured reporting. Despite this, there is still resistance to adopting structured reporting. As Health Imaging reported last October: “Radiologists may be resistant to change.”

Previous research has suggested technology may be able to help, but implementing a new system purely to force the use of structured reporting is unlikely to be a popular move. One way to increase the use of structured reporting, however, might be through teleradiology services.

These already rely on a high level of standardisation to maximise workflow efficiency. They also have a big incentive to move towards structured reporting because the efficacy of teleradiology readings is closely scrutinised by clients.

A growing use of structured reporting for teleradiology could also help to improve acceptance of standardised reports across the profession at large. Teleradiology won’t be the only factor that helps radiology embrace structured reporting, but at least it could play a significant role.

  • What do you think? Is structured reporting helpful, and can teleradiology help extend its use? Let us know.

 

Radiology speech recognition gets brainier

Speech recognition, which has long been seen as a valuable aid to radiology, is getting smarter. Recent months have seen increasing moves to couple speech recognition with artificial intelligence (AI) so machines don’t just hear what you are saying, but understand you, too.

Nuance, the speech recognition market leader whose Speechmagic software is bundled with platforms such as CDxN, has launched an AI-based system that it says can help automate many day-to-day radiology tasks.

And the clinical documentation services provider Saince has a product called Verbatim that is said to offer 99% speech recognition accuracy thanks to AI. The use of AI promises to further enhance a technology that has already been shown to offer major benefits to radiology.

In one study, voice recognition software was found to cut radiology report turnaround times from 28 to 12.7 hours, increasing the volume of verified reports by 5%.

Opinion: heeding the RCR’s capacity calls

By Dr. George McInnes, Consultant Radiologist at Poole Hospital

As we all know, capacity challenges seem to be an ongoing feature of the European radiology scene. Far from nearing a resolution, though, in some markets the situation appears to be getting worse.

Perhaps nowhere is this more the case than in the National Health Service (NHS) bodies of the UK.

The main UK organisation tasked with sounding the alarm over radiologist shortages is the Royal College of Radiologists (RCR), and it is hard not to miss the sense of growing panic accompanying many of its recent announcements.

In December, for example, the RCR blasted a cancer workforce plan published by Health Education England, an executive non-departmental public body of the Department of Health. The trainee doctor numbers envisaged in the plan were “a drop in the ocean,” said the RCR.

The College’s president, Dr Nicola Strickland, said the RCR was grateful of a commitment to fund 35 new clinical radiologist training posts per year, but pointed out that imaging departments across England already had more than 300 vacant radiology jobs.

The extra trainee posts “will only scratch the surface,” she said.

Against this backdrop, the RCR was understandably supportive last month of a plan by NHS Scotland to go on an international recruitment campaign with the aim of boosting Scottish radiologist numbers by 10%.

NHS Scotland was looking to fill 32 vacancies with candidates from as far afield as Western Europe, India, Australia, the USA and Canada.

For people coming from Europe, though, the matter is complicated by seemingly interminable doubts over what will happen to foreigners working in the UK after Brexit.

In another alarming development last December, it emerged that UK lawmakers might junk Europe’s Working Time Regulations, which protect radiologists and others from working excessive hours and thus potentially increasing work-related risks.

The RCR joined the British Medical Association and other medical organisations in decrying the move.

“With health and care services under more pressure than ever before, and staff being called upon to work ever-longer hours, what is needed is proper resourcing and investment to increase our workforce, not the removal of safeguards,” said the bodies in a strongly-worded letter.

Are these messages getting through, though? While the Scottish recruitment campaign is a welcome sign, I fear policymakers in the UK are far too worried about navigating the stormy waters of Brexit to spend much time on radiology’s capacity problem.

This is leaving the NHS to muddle through as best it can. Private-sector services are helping to bridge the gap, but unless they can help train more radiologists their impact can only be short-lived. Luckily, some have taken up the training imperative.

Fans of the NHS may claim it is not right to use public money to pay for private services. Increasingly, though, there is little option: scans have to be read in a timely way or lives could be at risk.

At this rate, we may have to stop worrying about public-private distinctions and start thinking in new ways about how we deal with the capacity crisis. After all, bodies such as the RCR can only cry for help for so long before it’s too late.

George McInnes has been a consultant radiologist at Poole Hospital since February 2009 and has worked as a consultant in Glasgow, Edinburgh, Bermuda and Barcelona. His interests include interventional radiology,  and musculoskeletal MRI and his radiology experience includes plain-film reporting, CT and ultrasound. He is a clinical advisor to Telemedicine Clinic in the UK

For more insights into radiology career and life success with Dr. George McInnes, click on the box to the right to subscribe to The Bigger Image, his bi-monthly newsletter, packed with his regular insights into radiology career and life success.

                    

Industry news: teleradiology by the numbers

If accuracy and efficiency are two of the most important requirements for a modern radiology service, new figures from Telemedicine Clinic shows teleradiology can offer them both in spades.

In 2017, the company was dealing with up to around 500 on-call scans a night, with up to 95% of readings being performed within an hour. The discrepancy rate was 4.4%, below Telemedicine Clinic’s 5% target and well under the 20% or so level seen in some studies.

Although the bulk of Telemedicine Clinic’s work was through on-call services provided via specialists in Sydney, Australia, 90% of elective cases were also completed within an hour.

Since Telemedicine Clinic pays its radiologists a fixed wage rather than on a per-scan basis, the high efficiency of the readings is thought to be down to highly efficient workflows and appropriately trained sub-specialists rather than radiologists chasing a premium for extra work.

Despite this, Telemedicine Clinic is still on the lookout for talented radiologists to fill vacancies arising from 17% growth in 2017.

If you would like to find out more about opportunities at Telemedicine Clinic, please check out our website on www.telemedicineclinic.com or click directly on the links below:

Career opportunities

 

Radiology lives: the ultimate spineless patient

A computer tomography (CT) team at the Technical University of Munich (TUM) faced an unusual challenge as part of a nano-CT project discussed in Proceedings of the National Academy of Sciences last year: they had problems seeing the patient, let alone the scan.

That’s because the CT in question was of a velvet worm or onychophoran, an invertebrate that can be as small as half a centimetre long.

Zoologists from the University of Kassel enlisted TUM’s help in trying to analyse the worms, but first the TUM team had to come up with a new way of achieving high-resolution CT scans of objects so small.

The team invented a new x-ray source which, in combination with an extremely low-noise detector, “produces images that approach the resolution possible with a scanning electron microscope,” says TUM.

The investigators say the technology could help spot malignant tumours from tissue samples, for example. It is also pretty good for looking at very small worms.

 

It’s official: fatigue affects results in teleradiology

We all know the challenges of our profession.

We hold people’s lives in our hands every day, and clinical accuracy and excellence are vital in everything we do – there is too much at stake for it to be any other way.

That’s why TMC has always attached such great importance to its procedures, its training, its technology and its committed approach to double readings. It’s what our clients and our patients expect from us.

However, we also know that fatigue can be a great contributor to poor diagnostic results, something which is unacceptable in our line of work. So, we were interested to read a recent article published by Diagnostic Imaging Europe, which confirms this, based on a recent study published in the Journal of the American College of Radiology.

In the DI Europe article, they reported that radiologists are more fatigued and provide worse diagnostic performances following overnight shifts (ONS). This is something that we are well aware of and it is one of the reasons that TMC offers European radiologists the chance to relocate to Australia, where they can report on overnight cases in Europe during local daytime hours.

This leads to demonstrable improvements in accuracy and efficiency of readings using TMC’s leading edge technology and remote reporting systems. It also leaves plenty of opportunities to enjoy the lifestyle benefits of life down under, including weekends at the beach, sunny barbecues and a fabulous relocation service that takes all the pain out of the process. What’s not to like?

So, if you fancy a change of life, helping European health services get the clinical results they deserve, while making the most of the life you deserve, simply check out the careers page on our website or contact us at careers@telemedicineclinic.com for information about available roles.

And if you’d like to read the full article, just click on the link below:

http://www.diagnosticimaging.com/performance/overnight-shifts-negatively-affect-radiologists-performance?rememberme=1&elq_mid=392&elq_cid=1984328&GUID=9B417B4B-6F01-411D-9132-38305306D59E

27% improvement in radiology reporting efficiency: sound good?

At the end of last year, we reported on a trial of TMC’s Collaborative Diagnostic Network (CDxN) in Sweden. It resulted in five hospitals in the Västra Götaland Region (VGR) improving radiology reporting efficiency by 27% after setting up an IT network to share magnetic resonance (MR) body cases across all the subspecialists. Discrepancy levels also fell by 42%, according to a recently published a case study of the initiative. The network helped VGR subspecialists who had not previously worked together to communicate and collaborate

Five subspecialists from across the hospital group were selected to carry out all first readings and then the cases were handed over to TMC for a second reading.

“VGR radiologists also received interactive, online case-based training to build up further crucial skills within MR body reporting,” said TMC’s Claudio Silvestrin, who wrote the report.

“Collaboration brought about by the network helped individual practitioners to improve their subspecialist skills in an area that until then had not yielded enough cases per hospital to allow experts to gain much experience. The VGR radiology community was comprised mostly of generalists who found themselves covering all subspecialty areas and radiologists with 300 or more reported cases achieved the highest reporting efficiencies,” Claudio continued.

What is important about this experience is that it could be replicated anywhere. The hospitals were networked via CDxN, which is available to any hospital group that wants it.

CDxN was bundled with a standard Sectra IDS7 picture archiving and communication system and Nuance Speechmagic voice recognition software. In other words, all the elements needed to achieve a double-digit reporting efficiency improvement are there for the taking.

Meet the kite-surfing TMC radiologist who’s “living the dream” on the Sunshine Coast

TMC’s flexible approach down under, now means radiologists have the option of swapping the big city for something more peaceful and quiet in some of Australia’s more remote, but stunningly beautiful areas. Technology is breaking down barriers and giving TMC radiologists better opportunities and more flexibility than ever before.

 Meet Dr. Rickard Bohnmark, TMC radiologist, family man, skydiver and part-time kite-surfer, who has recently made the move with his family from the bright lights of Sydney to the beautiful beach resort of Noosa on Queensland’s Sunshine Coast, where he reports from home and relaxes by cooling off in the family pool.

 Can you tell us a little about yourself?

 I’m 42 years old, married to Carolina, who’s a social worker and yoga teacher. We have two kids – Umbria, who will soon be turning 6 and Enzo, who will be 3 in a few months.

 What was it about TMC that attracted you in the first place?

 I’m from Sweden, so the possibility of working in a warm and comfy climate was very attractive. I actually chose to specialise in radiology rather than surgery with the specific idea of working from an offsite location. Back then, I had a Greek girlfriend and I imagined myself reporting for Sweden from a beautiful Greek Island.

What are you looking forward to most in your new role?

I’ll be doing exactly the same thing in Noosa as I was doing in the Sydney office, but with a different view. I still talk to my Sydney colleagues on a regular basis, either asking for (or giving) second opinions. Now, I simply use chat or phone instead of walking into the next room in the office

What did you do before TMC?

I worked as a consultant interventional radiologist at Linkoping University Hospital in Sweden.

What made you move to Australia and what is it that you find so appealing about the Noosa area?

I love warm climates, and have always wanted to learn to surf. Both were on offer working for ATMC. The decision to move from Sydney to Noosa was partly due to a never-ending quest for an even better climate and partly due to cheaper housing. In Sydney, we lived in a 2-bed apartment within walking distance of the ocean. Now we live in a 3-bedroom house with a swimming pool – and we’re still within walking distance of the ocean. And rent is only a little more than half of what we paid before. Also, we’re now living closer to nature and away from the big city

How easy did TMC make it for you to make the move?

 TMC made it very simple for us. We got good advice and assistance with a relocation agent both when we moved to Australia and after we moved to Noosa, so it couldn’t have been easier.

What are the lifestyle benefits of the new location for you and your family?

Coming from Sweden, winter here in Noosa is like the best Swedish summer day, every day for several months on end. Summer in Noosa is like living in Paradise

What do the kids like most about the new location?

I think the kids appreciate the pool the most. Now in the summer, we swim in it several hours almost every day. My daughter also loves animals and fetches garden skinks (lizards) regularly, so being able to live in a house with a garden is a big plus for us.

Would you recommend a similar move for likeminded radiologists?

Absolutely. I feel very lucky to be able to live and work here. A lot of Aussies would love to live here but have a hard time finding work outside of the big cities. If you love nature and a warm climate, this is the place to be.

From a professional perspective, what are the advantages of this new role?

With our new contract (6 hours instead of 8 hours per day with the possibility to do elective cases after work), the balance between work and family is much better than when I was working in Sweden doing hospital based work

Any interesting or unusual things you’d like to share with us about yourself?

 I’ve been skydiving regularly for around 10 years now but have now picked up kitesurfing and even surfing (to a degree). When I’m not playing with the kids, working or doing anything board-related, you’ll probably find me exploring the countryside on my motorcycle.