RADIOLOGY
Imaging outside the walls of the traditional hospital environment In response to the web of imaging challenges, the first to be addressed with agility at the peak of the pandemic, and prior to 2020/21 winter pressures, was increasing the access to diagnostic imaging systems. This was done by taking imaging outside the traditional confines of the hospital building. Where once relocatable or mobile imaging units were deployed for community screening programmes or planned scanner maintenance work, the emergency pandemic response led to the development of a fleet of relocatable scanning units for NHS England’s COVID-19 recovery plan. It worked around the shortage of internal hospital space for additional scanners by providing extra scanning support in disused car parking bays or gardens. In total, fifteen COVID-19 response CT Scan Units were delivered to NHS England; a result of extremely quick design and manufacturing here in the UK. It took just eight weeks – from order to build completion – for the first unit to be deployed. Each unit is designed to be deployed quickly on a lorry and moved to different locations in need of extra imaging capacity. Each one features a high-end CT scanner, user control room and a small changing area for patients. It is designed in line with hospital guidelines with correct clinical flooring, hospital grade heating, ventilation and air conditioning (HVAC) requirements. It is fully IT compliant with datalink connectivity and includes a remote service solution that helps respond to maintenance alerts or system errors quickly and without the need for an engineer to visit a COVID-19 restricted area. Kettering General Hospital NHS
Foundation Trust was one site to receive a unit. It was positioned in a car park outside A&E and kept entirely separate from the main hospital building, giving reassurance to outpatients that they would be seen safely despite concerns about the Coronavirus. At the time, Graham Clark, deputy head of radiology at Kettering General Hospital stated: “Keeping a completely clean, ‘green’ CT room free for outpatients that is separate from the main hospital imaging department means that our cancer or other immunosuppressed patients feel more comfortable attending CT appointments. It gives reassurance that they don’t need to come into the main hospital and can be seen safely outside in a separate location. This reduces their understandable anxieties at this time during the ongoing pandemic.”
Similar feedback was received from South
Warwickshire NHS Foundation Trust (Fig.2). Here, the impact of COVID-19 on diagnostic imaging had increased demand for chest CT scans, created a backlog of routine patient scans, and increased time for cleaning CT scan rooms between patients. Before winter
Fig 2. A Canon Medical relocatable CT Scan Unit was deployed to Stratford Hospital at South Warwickshire NHS Foundation Trust as part of NHS England’s COVID-19 recovery plan.
2020/21, it was estimated that an extra 62 hours of CT scanning time was required per week. To meet imaging demand, Stratford Hospital, was allocated one of our relocatable CT Scan Units by NHS England. The concept of taking imaging outside the hospital building is one that I am sure will grow in momentum, not only by using relocatable scanning units but also positioning diagnostic imaging closer to patient communities, perhaps in retail centres, at GP Practices or other central and accessible locations. The conversation on community diagnostic hubs has only just begun.
Innovating to achieve operational efficiency Another step towards addressing the efficiency agenda in radiology is the ongoing innovation of imaging systems. I believe that the importance and longevity of CT and MRI is testimony to the ongoing investment and research into developing the systems to meet the greatest healthcare challenges in an ever-changing world. This is also the case for ultrasound, X-ray, and interventional imaging. At a basic level, the automation of simple procedures to be carried out by radiographers, such as table and patient positioning or dose selection, has helped to improve step processes inside the imaging department. This has generated small, but much needed, efficiencies with every patient seen. We’re talking seconds, but every minute adds up in the working day. In addition to this are the pioneering developments in Artificial Intelligence and Deep Learning. At one end of the spectrum is the development of clinical applications that will support quicker diagnosis of cancers or stroke by giving a first read and report of cases and flagging areas of concern to
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radiologists to ease their workload. Further along that spectrum are the operational advancements of imaging systems using AI innovation.
The introduction of AI-assisted imaging has been a game changer for healthcare. Only a year ago, the UK’s first CT with Advanced intelligent Clear-IQ Engine (AiCE) (Fig. 3), a Deep Learning Reconstruction AI algorithm, was installed at Mid Cheshire Hospitals NHS Foundation Trust. Many more have followed since.
Richard Hawkins, consultant radiologist at Mid Cheshire Hospitals NHS Foundation Trust, championed viewpoints that the new CT innovation had delivered “phenomenal” patient dose reductions of up to 92% below UK National Diagnostic Reference Levels – at the same time as delivering high-quality images never seen before and all in a rapid timeframe suitable for everyday clinical use. The low doses are achieved even when examining people that have traditionally been difficult to image, such as severely ill patients with their arms by their sides, those unable to hold their breath, and bariatric patients. It is developed using a deep learning algorithm to differentiate ‘noise’ from true signal, reducing distortions, preserving edges and maintaining details in image outputs at the same time as achieving lower doses than ever before in routine CT imaging. This gives super clear images for radiologists to report on and lowers the number of CT repeat scans needed to improve image quality – another tick in the time-saving box. The low dose is also much healthier for patients, many of whom will have multiple scans over the course of their lives adding to their cumulative dose, given that CT is now a ‘routine’ diagnostic pathway. MRI is also headed in this direction
SEPTEMBER 2021
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