Trees and Values day 2019

The ability to reverse the environmental problems of planet Earth is within our grasp.  It is time to stop despairing and finger-pointing and start acting in a conscious and more caring way toward our shared planet.

TMC recognises that every year the flights we book for our radioloigsts to report from the other side of the world cause a minimum of 360 metric tons of CO2 to be released into the environment.  In order to offset our carbon footprint, we are proud to partner with where, for the last 3 years, we have come together to help improve the sustainability of “El Dalmau”, a local forest now owned by the Generalitat of Catalonia.

Sunday 24th February 2019 marked the 3rd year celebrating Trees and Values and we had the pleasure of spending a day at the Finca Dalmau – a masia dating back to the 12th Century which is nestled into the foothill of the Sant Llorenç del Munt mountain.   This beautiful old house is named after the family who built and maintained it for hundreds of years and it was passed down from generation to generation.  However, when the last of the Dalmau family had no children, the house was passed into the hands of the Generalitat (the local government) who simply don’t have the money to restore and maintain it.

The great thing about our TMC Trees and Values day is that not only to we give back to nature, but we come away feeling that we have learnt something too.  Joakim and his team explained to us how to take care of forests and in particular how to prevent wild fire.  We learnt that the way wildfire is occuring in nature is changing.  Before, the peaks and troughs of a wildfire breakout could be forecast and the peak of the fire would always occur at the hottest time of day.  However, this is changing and we learnt about the wildfires in Portugal in October 2018, when the hottest part actually occured at midnight. Moreover, wildfire nowadays start so quickly and burn so strongly that when they inevitably recede they create their own currents of air, which in turn propogate the fire.

In order to prevent this happening it is very important to maintain the forest and rid it of any unecessary biomass so that in the event of a fire there would be nothing for the fire to feed off.   Since forest fires spread not only outwards but also upwards,  cutting down shrubs, bushes and smaller trees can help prevent the spread of forest fires, while also giving the healthy trees a chance to grow tall and strong by reducing the competition for light, water and nutrients.

This reduces C02 emissions for 2 reasons:

  1. It prevents forest fires, which generate a huge amount of CO2 when carbon stored within the leaves, roots and trunks is burned.
  2. When biomass is not removed from the forest but instead kept on the forest floor, it prevents the C02 from decomposing plants being released into the environment.

It was very interesting to learn that, just like humans, trees can communicate with each other too.  In fact, trees are far more alert, social, sophisticated—and even intelligent—than we thought.  Joakim explained to us an example of this – the acacia trees in Africa.  When a giraffe starts chewing acacia leaves, the tree notices the injury and emits a distress signal in the form of ethylene gas. Upon detecting this gas, neighbouring acacias start pumping tannins into their leaves, which taste bitter and stop the giraffes from eating them.  Therefore trees work in networks in order to warn and protect each other from harm.  For more information on this topic have a read of The Hidden Life of Trees by Peter Wihlleben.

At the end of this relaxing and educational day we shared a delicious paella together in the sun.  Everyone enjoyed this special day and we allowed our prefrontal cortex (the part of the brain that is calmed by walking in nature) the chance to relax and take some well-deserved rest.

We would like to thank Joakim and everyone at Social Forest for such an interesting and educative day.  Hopefully in the future the Dalmau Masia will be restored to its former glory and, who knows – maybe TMC will one day be able to use it as a retreat.

Could AI hit a stumbling block with data?

Speakers at a recent Radiological Society of North America course in Paris, France, highlighted a potential challenge for artificial intelligence (AI) in radiology.

A common message among experts speaking at the ‘Practical Applications in Artificial Intelligence’ course was that the quality of data could be an issue for systems looking to learn from human examples.

A consistent message was that radiologists may have to scrub up on their annotation skills before AI can do its job.

Luke Oakden-Raider, research associate of the Australian Institute of Machine Learning, noted that AI performance improves when the software is trained on lots of data… from 50,000 to a million examples, for instance.

The annotation of training data by doctors will be an important part of AI development, he pointed out. However, today AI algorithms are being trained on fixed data sets.

To allow AI to keep learning, he said, a limiting factor will be access to data… and how willing and able radiologists will be to build high-quality datasets through careful annotation. Katherine Andriole, associate professor of radiology at Harvard Medical School, echoed this view.

Her team used its own annotation tool to evaluate three lung nodule AI systems. One algorithm was in line with claimed accuracy, one almost got there and the third fell short.

Andriole’s conclusion was that radiology teams may need to consider creating their own validation datasets so they can measure accuracy of AI tools. This could involve at least two radiologists annotating anywhere between 300 to 3,000 cases per application, she said.

Claudio Silvestrin, head of the AI Centre of Excellence at Unilabs, acknowledged that data could be a stumbling block to the rapid uptake of AI in radiology.

“It is one of the current challenges to obtain enough well-annotated data for training and validation of AI algorithms,” he said.




How your radiology job will change with AI

Is a robot about to get your job? Probably not, according to Thomas Davenport and Keith Dreyer, writing in the Harvard Business Review.

Davenport, a professor of management and IT, and Dreyer, vice chairman of radiology at Massachusetts General Hospital, don’t deny that AI could change the profession.

“Radiological practice would certainly benefit from systems that can read and interpret multiple images quickly, because the number of images has increased much faster over the last decade than the number of radiologists,” they say.

That does not mean AI can take on all the roles of a radiologist, however.

AI would have a hard time consulting with other physicians on diagnosis and treatment, treating diseases, performing image-guided medical interventions or defining the technical parameters of imaging examinations to be performed, for example.

Furthermore, ubiquitous AI remains some way off, and in radiology it faces a challenge because there is no aggregated source of labelled data to train the machines with. Finally, medical regulation has yet to catch up with many of the finer points concerning AI’s use in radiology.

For all this, say Davenport and Dreyer, it makes sense for radiologists to play a leading role in helping the profession take on this new technology. “The only radiologists whose jobs may be threatened are the ones who refuse to work with AI,” they say.

If predicted improvements in deep learning image analysis take place, they say, then “providers, patients and payers will gravitate toward the radiologists who have figured out how to work effectively alongside AI.”

  • Are you thinking of using AI in your department? If so, let us know.

The hidden benefit of remote on-call services

Delivering on-call services via remote teams has clear benefits in terms of helping resource-stretched healthcare providers to deal with workloads. However, recent research shows there may be a further, largely hidden benefit.

In April, the American Journal of Roentgenology published a review of studies on the impact of fatigue on radiologists. Its conclusion was simple: fatigue is present in radiology and affects diagnostic accuracy.

The study echoes research from last year in the Journal of the American College of Radiology that found a worsening in all Swedish Occupational Fatigue Inventory results (lack of energy, physical exertion, physical discomfort, lack of motivation and sleepiness) after overnight shifts.

Fatigue had a significant impact on diagnostic performance, said the authors. This is not surprising. Reading scans is a painstaking process and having to do it against the wishes of your body clock is hardly a recipe for improvement.

Until recently, however, there was little alternative when it came to on-call work. The picture has changed, though, with the advent of on-call services delivered from locations such as Australia. The radiologists there are no longer working the night shift when they check scans.

In fact, given the potential for improved work-life balance in locations such as Sydney, these on-call experts would likely be more alert and motivated even than some of their day-working colleagues in Europe.

Furthermore, this quality factor comes on top of teleradiologists’ ability to enjoy deeper subspecialisation as a result of higher overall caseloads that can be divided up between experts.

When it comes to on-call work, at least, it certainly seems that nearer is not always better.

What would it take to get med students interested in radiology?

It’s no secret that healthcare services across Europe face a significant capacity gap that in the long term can only be solved by encouraging more people into the profession.

The quest for extra practitioners is throwing up ploys as diverse as looking for candidates in India or trying new ways of learning in Sweden. Now a team from Ann Arbor in Michigan has added new insights into another potential source of recruits.

Writing in Academic Radiology, the researchers say that exposing first-year medical students to radiology can greatly improve perceptions of the profession.

“Students showed significantly increased academic interest in radiology and a heightened perception of the effect of radiology on patient care,” they say.

The catch is that while early exposure gave students a greater appreciation of the profession, it did not seem to make them more interested in pursuing a career in radiology.

The findings highlight the difficulties in plugging radiology’s growing skills gap and underscore the need to provide training opportunities at every possible stage of medical training.


Building on a great first year: the future is bright at Unilabs TMC

It’s now been almost a year since Unilabs TMC got together to build the first truly integrated diagnostic company, combining radiology, pathology and (in future) genomic solutions – and what a year it’s been.

As we come together as a business, we know we face new challenges and great opportunities. Our core business (and the health care market in general) are in a continuous state of evolution. We’ve been working hard this year to integrate our businesses and develop new ways of working that combine the best of both cultures and we’re already starting to see  the practical benefits of this in our everyday work.

But evolution is not unique to us. The health care market in general is also evolving as it deals with constant pressure on costs and a shift towards value based health care solutions. At the same time, highly qualified medical specialists are a scarce resource and we know that AI solutions are bound to have a strong impact on the future landscape of medical service provision.

At Unilabs TMC, our core purpose remains clear: to provide quality healthcare to all people. But we also want to make sure that we continue to be an attractive employer for highly qualified and scarce medical specialists, so that we can continue to deliver our mission while setting the standards for the highest quality medical service.

But now, it’s time to look to the future. The year ahead is full of exciting opportunities and great potential and we’ll be focusing our efforts on some interesting new areas. One of these is the new SLL radiology and pathology tender in Sweden, which will enable us to shape the way diagnostic services will be delivered to some 250,000 new radiology outpatients and 40,000 pathology patients in the Stockholm region.

We also want to contribute by moving the service from a generalist to a sub-specialist radiology and pathology reporting setting and we’re looking forward to recruiting a top team of radiologists to deliver these services and support them in their journey to become subspecialists.

We will continue to focus our efforts on profitable growth through our on call and elective teleradiology and pathology reporting services both in Scandinavia and the UK.

We will also be rolling out our Optemis platform across the Unilabs Group to ensure a systematic approach to reporting for both radiology and pathology. Our systems contribution will enable seamless communication between radiologists and pathologists in Optemis as a first step and other diagnostic specialities like Genetics will follow.

We continue to believe in education and we see huge potential through the Unilabs TMC Academy to add real value to our proposition, to support our belief in the importance of knowledge sharing and teaching to pursue our purpose and to enable the journey from general to sub-specialist diagnosticians. By offering online training solutions, we want to broaden the scope of our training offerings and reach more people. We’ll develop training offerings for more diagnostic areas like pathology and genetics. We want to play a key role in medical professional education and development in (and outside) of Unilabs Group.

Technology is advancing at a rapid pace, so we’re keeping a close eye on emerging areas of specialist expertise including Artificial Intelligence (AI). We’ll be early adopters of AI solutions and we’ll thoroughly screen the market for and test late stage solutions for their usability before implementing them in our diagnostic reporting environment. Unilabs TMC will continue to be the AI centre of excellence in radiology and pathology reporting within Unilabs Group.

And finally, we’ll continue to carefully explore international options for our core business with particular focus on our On Call service, both in countries where Unilabs is currently active (as internal service provider of reporting or technology solutions) and in other markets as a potential direct reporting solution provider.

So, as you can see, it’s been a busy year as we integrate our businesses and start to seek the synergies and benefits that this will deliver. It’s been a great start already, but the best is yet to come and, as we continue to build the Unilabs TMC proposition, we’ll be focusing on standing out from the crowd by building on our reputation for higher quality and better service. All evidence shows that higher quality diagnostic solutions can decrease the total cost of healthcare as part of a value based healthcare system. We hope that our experience, efficiency and single-minded approach to quality will make us the provider of choice in our field and establish ourselves as the employer of choice in a market with scarce human resources.

Alexander Boehmcker, Chief Executive, TMC



Improving patient care: the TMC Way

Since becoming a part of the Unilabs family last year, we know we have a unique opportunity to improve the lives of millions of patients across Europe through our combined expertise and skill-sets. As with any business, it is vital that we continue to attract the best talent available to deliver the highest quality of patient care, clinical accuracy and customer service. But, we also operate in a competitive market, so we need a compelling proposition to stand out from the crowd.

That’s why earlier this year, TMC’s Director of People and Values, Sebastian Ross, began working on a new video which will help us to build our brand, explain our business and communicate our core values to a wider audience of potential stakeholders. The video is a great way for us to share our vision, which we believe will prove to be an attractive and compelling proposition for potential clients, partners and doctors to join our team.

According to Sebastian: “While we’ve aimed the video primarily at doctors, we also wanted it to work hard for us through more general messages that would be accessible to a wider audience as we build and share our story more widely, so we will also send it proactively to candidates as part of the recruitment process to help potential candidates and partners get a real sense of who we are and what we stand for.

“Implementing the “TMC Way” within the Unilabs Group gives us a great opportunity to improve the lives of millions of patients in Europe. That’s the big chance we saw last year when Unilabs wanted to acquire us and it is now becoming a practical reality. Evidence supports our passionate belief that working as part of a sub-specialised collaborative network increases quality and accuracy. The Unilabs team have already begun this process of transformation, with our Swedish radiology team now working in Optemis under TMC standards. I’d like to thank our Swedish colleagues and our strategy council for all their input and contributions along the way”.

If you’d like to see a short video that looks at how radiology will need to face gaps in capacity and expertise.

The conclusion is that collaborative network technology could play a growing role in helping radiology to adapt to these challenges. Why not take a look and let us know what you think?


Stanford Centre points to the future of integrated diagnostics

How far should the integration of medical disciplines go? While there is a growing view that radiology would benefit from closer ties to pathology and even genomics, a new unit at the Stanford School of Medicine, in the US, is taking things much further.

The Precision Health and Integrated Diagnostics Center at Stanford, which opened last year, is looking to combine smart diagnostics systems with biosensor data to alert patients of possible problems before they happen.

The work could lead to medical data being collected from sources as diverse as nano-sensor-equipped toilets, bras that image breast tissue and a menstrual pad that can detect biomarkers of disease, Stanford Medicine says.

The idea is for this precision health data to be combined with integrated diagnostics to provide much earlier and more effective identification and treatment of medical conditions.

More widely, Stanford Medicine is also aiming to create closer ties between medical research, education and healthcare.

Stanford’s School of Medicine, Stanford Children’s Health and Stanford Health Care have created a unified plan for “tapping into opportunities to improve health care locally and around the globe,” Stanford Medicine states.

For now, it is too early to say what impact the Stanford initiatives might have on patient outcomes. But as interest in the benefits of integration continues to increase, Stanford’s pioneering approach will be watched with interest.


Census highlights UK dependency on European experts

With less than six months to go before the UK is set to leave the European Union, the latest Royal College of Radiologists (RCR) census, published in September, illustrates the extent to which British hospitals are reliant on European radiology talent.

The report shows that in 2017 about one in 10 UK radiologists came from other parts of European Economic Area (EEA). A further 22% came from outside Europe.

The UK’s reliance on European radiology experts was highest in Northern Ireland, where 13% of radiologists were from the EEA.

The census notes that the UK National Health Service was already feeling the effects of brexit. “The proportion of European doctors gaining a licence in the UK has fallen from 25% of the total in 2014 to just 16% in 201,” it says.

The RCR also says the UK is working to improve international recruitment, but efforts so far have been inconclusive.

“There seems to be little evidence that the number of consultant clinical radiologists recruited from outside the UK will change over the next few years, despite current workforce shortages in radiology,” it warns.


Radiology lives: cheesy fMRI study bags an Ig Nobel

Functional magnetic resonance imaging (fMRI) is rightly celebrated as being an important tool in medical diagnostics.

In September, though, the technology also gained the dubious honour of gaining an Ig Nobel prize, a parody of the Nobel Prize which is awarded every autumn to celebrate unusual or trivial achievements in scientific research.

Specifically, the scientific humour magazine Annals of Improbable Research, which hands out the awards, this year decided the medicine Ig Nobel should go to a paper titled ‘The Neural Bases of Disgust for Cheese: An fMRI Study’.

FMRI “reveals that the internal and external globus pallidus and the substantia nigra belonging to the basal ganglia are more activated in participants who dislike or dis-want to eat cheese than in other participants who like to eat cheese,” said the authors.

The research seems likely to attract debate over the possible uses now being found for MRI machines that can cost up to several million dollars apiece.

The fMRI study is far from the most trivial piece of research to appear in this year’s Ig Nobels, though; the peace prize, for instance, went to a team that showed how the regular playing of a didgeridoo is an effective treatment for obstructive sleep apnoea and snoring.