Special Report: Imaging With investment being awarded to digitise diagnostics across the NHS in England, Jennifer Trueland explores what impact this will have on imaging. Last November, the Government announced investment of £24million to help digitise diagnostics across the NHS in England using the latest technology. Imaging was at the heart of it, with specific pledges on sharing scans across different settings, technology to improve the way that scans are requested, and moves to better enable them to be reported remotely. The investment was made in response to Professor Michael Richards’ review of NHS diagnostics capacity, which called for increased digitisation to drive efficiency and deliver seamless care. According to Dr Julian Elford, medical director of membership and business at the Royal College of Radiologists, and a consultant radiologist in Winchester, the investment was very welcome. “It could not be better timed,” he says. “This is the time for radiology. Radiology has been a Cinderella specialty for a while, but our era is here, which is great.” Patients across all medical specialities will require radiology at some point, he adds. “This is the time when we can encompass new technology and new methods of doing things, and digital is one of those,” Dr Elford explains. “The royal college welcomes that, and radiology is coming to the forefront, which is brilliant.” New money to tackle the challenges He hopes the new money will help tackle major challenges, not least workforce shortages. “Mike Richards recommended a massive increase in radiologists and radiographers, and we welcome that,” Dr Elford says. “But part of that [change] is going to be digital – we’ve got to change the way we do things and improve the way we do things to be more efficient.” IRefer, a clinical decision support tool to help other clinicians decide the best test or scan to request, is an example of this. “It saves doctor time, it saves the NHS money because we’re not doing the wrong test and wasting money, and more important than anything else, it’s what’s best for the patient,” Dr Elford says. “That’s a big deal.” This is already being rolled out and is working well, he says. He also welcomes funding for home reporting, that means that he as a radiologist does not have to go to the hospital to read scans. “In this country we have a massive backlog of scans that need reporting,” says Dr Elford. “Part of this money is being used to enable home reporting to the rolled out across the country – it’s more efficient for doctors and better for patients because the scans get reported more quickly.” Importance of networks The medical director of membership and business also welcomes funding for radiology networks – groups of trusts working together to share workforce and specialist expertise. This won’t solve problems of demand and a shortage of radiologists, but it helps. “It’s not actually extra capacity because it’s the same people doing it, but it smooths out the peaks and troughs,” Dr Elford says. According to Jane Rendall, UK managing director with Sectra, the new money was a catalyst, and is already making a difference, particularly in the development of radiology networks. “We had customers who had ambitions, but they just didn’t have the funding available,” she adds. “There was an urgency to spend it before the end of the NHS financial year, so the influx of funding really did help a lot of the networks.” It’s been a busy time, according to Rendall: “There’s been a lot of interest in people wanting to understand exactly what they could achieve with the funding that was available to them, so we had a lot of discussions – and I’m sure other suppliers did the same – trying to flex things to make sure they could get the most for the funding they had. “They also knew that if they could demonstrate progression on that network maturity matrix, if they were able to show a roadmap, it meant they would be able to get future funding as well.” Customers were particularly interested in bringing other “ologies” into their networks, Rendall also says, such as pathology, cardiology and ophthalmology, with the aim of achieving integrated diagnostics. “Basically an enriched level of imaging information in order to support diagnostic care,” she says. “For multi-disciplinary meetings, having all of your imaging, all of your pathology imaging, all of your reports, available on one system. The technology facilitates that enriched space.” As well as expanding the number of “ologies” they encompass, networks are also looking to share information more widely in geographical terms. Rendall for one would like to see this happen more, effectively creating a national “image sharing service” through networks, without going through a third party. “That’s super important because people are mobile, and are moving between imaging networks, so it’s good to facilitate that,” she adds. Working together For Ray Cahill, territory vice president at Change Healthcare, UK and Ireland, the pandemic has helped to make the case for working together across regions and nations. “The way they implemented imaging systems in the past, putting them in individual hospitals, did more harm than good,” he argues. “They created siloes of information, not in any way facilitating the journey of the patient who might go to multiple hospitals for one episode of illness. “What our customers are saying, what the government is mandating, and what we’ve seen happen in the last couple of years is that hospitals care coming together as consortiums.” Change is about people rather than technology, Cahill believes, reflecting on Ireland’s experience of bringing 50 hospitals together. “The technology takes a back step – it’s the process, and how we are going to suddenly operate in a way that we’ve never operated before,” he says. “People know – and Covid really shone a microscope on that – they have to join together, and they need clinical transformation supported by technology.” Gap in digital imaging Cahill also believes that the Department of Health and Care has recognised a gap in digital imaging and has allocated funding to modernise medical imaging and to facilitate clinical collaboration. But they also realise that technology has changed? “Imaging is at an inflection point. In the past, when we moved from film to digital, that was a massive change which produced significant productivity gains. But now it’s at the stage when it’s moving into cloud, and when imaging moves into the cloud, it changes the game altogether,” Cahill says. Cloud native – where something is built in the cloud situation – is probably going to be as revolutionary as film to digital, he adds. Again, Covid helped to make that point. “Accessibility is something that cloud native gives you,” Cahill says. “We anticipated that doctors were going to be mobile and that people weren’t going to be locked to their desks, and Covid has proven and accelerated that.” Still challenges ahead Even with well-functioning networks and the move to cloud, there are some challenges that remain, including workforce. That’s why some are looking to technologies such as AI – not to replace radiologists, but to help them work more efficiently. “With the amount of work that’s going to be needed to get through this backlog, and that’s not changing in the near term, radiologists will take all the help they can,” says Roberto Anello, managing director at Agfa. “AI’s got the ability to turbo-charge their workflow and turbo-charge their outputs.” He points to the Princess Alexandra NHS Trust’s experience in embedding Agfa Healthcare’s RUBEE for AI Framework, which allows consolidation of standards-based best-of-breed applications into specialty-based clinical packages. “We went live with Princess Alexandra with a couple of packages but specifically around lung nodule detection,” Anello explains. “They’re reporting a few things already. One is the time-saving for the radiologist – they’re now quoting up to 35% – because when they’re looking at a CT lung they can immediately see that there’s a nodule there that they might or might not have noticed, and it’s been sized for them. That accelerates their time.” Another advantage is that it’s an opportunity to look at something they might have missed, and consider whether it has an impact on their clinical decision-making, and it also helps to reduce clinical error. “That’s why we digitise clinical systems – to reduce that clinical error,” he says. “Combinations of all these things are resulting in tangible outcomes.” Exciting buzz Radiologists are excited about the potential of technologies like this, and are keen to get them into practice, Anello believes. “That was clear at a BIR [British Institute of Radiology] event I attended in London a few months back. That’s the buzz, everyone’s talking about it,” he adds. The challenge for the NHS is knowing what technologies to choose, but also to get over the “pilot” culture that means that lots of things are tested, but no decisions are taken. Anello thinks that AI is about to get to the point where it is being mainstreamed. “I think that will start to [change] a bit in the next 12-18 months because the technology will be more proven. We’re already starting to see that,” he adds. “I think there’s a real appetite within the NHS across all geographies to work in development partnership and collaboration, to really tease that out, test it, and really tailor those things.” Concluding, Anello believes it is “an exciting time for radiology”. “I don’t see any radiologist who doesn’t want to pursue it because they’re all looking for that extra edge, that extra assistance – anything that can accelerate the time they spend working on images and reporting, that can lead to a better outcome,” he says. 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