In our interview series this week, we speak with Stephen Townrow, Imaging Systems Manager, at The Princess Alexandra Hospital NHS Trust.
Stephen takes us through the intricacies of how enhancements in their digital imaging technology has allowed for cost saving, time saving, and accuracy of diagnoses, all of which importantly culminate into improved patient outcomes.
Could you quickly take us through your position and your background?
I’m the Imaging Systems Manager at The Princess Alexandra and a radiographer by profession. I’ve got an IT background and that’s how I got involved with PACS (picture archiving and communication system), and all things imaging.
I’ve been in the role for a few years now and I’ve seen a lot of change, certainly in terms of technology. We’ve had to make several changes to our systems over the years and Agfa HealthCare have been at the heart of that change.
Could you talk us through the implementation of Agfa’s imaging solutions to where it is now?
Back in late 2016 to early 2017, we started looking at a new PACS system. We used Agfa for PACS before, but as part of our due diligence and market testing, we started a new procurement process to determine what we needed as a trust. We wanted something that was not just going to be a PACS for radiology, but a PACS for the whole trust, looking at the needs of other specialisms, and creating a unified medical imaging strategy pathway.
We made the decision in late 2017 to go with Agfa. We were particularly impressed by Agfa’s data migration; for previous projects we had managed to migrate our data overnight – and it was a piece of cake!
We went live with Agfa’s XERO solution in April 2018. The system, which meant that everyone outside of radiology and cardiology could access the solution and view the images, was well received. One of the key aspects that everyone was waiting for was multi-planning reconstructions (MPRs), which meant that all users could use iPads to show patients their imaging at the bedside and to talk them through what it means in terms of their care.
It was also very well received by consultants. We went from a workflow that was driven by the radiological information system (RIS) for reporting to one that was PACS driven, which took some getting used to. However, a few weeks later you could really see the benefits. For example, prior to this, we had several medical secretaries typing imaging reports out, meaning as a patient you would wait several weeks for a result, but with the new system, results would be available the very same day – a massive change! Another key aspect has been with voice recognition, which makes everything faster and improves the turnaround time dramatically.
We have also worked on a MS Teams integration within XERO to help manage and treat COVID patients, so that clinicians can quickly press a button straight from their desktop when looking at images. Using the collaboration tools on Teams the images can be shared with the entire group of clinicians (400 doctors) or just directly sent to another clinician.
We have since developed it further and integrated a separate list for ITU and critical care, which again enabled a web link to be sent to the clinician to look at the image; this cut out the previous necessity of having to call through and provide patient information.
We have also been able to arrange for clinicians to view images on their phones – to provide support to the registrar, rather than making a diagnoses. And to use the system for our vascular on-call team, which is centralised in a separate hospital, Lister Hospital.
And finally, we are in the very early stages of adopting AI to report on imaging. We’ve started with breast imaging and so far, it’s proving really effective. Once we’ve implemented the full system, it will allow us to stop double reporting everything – AI will report on the image first, followed by a human checking using a verification process, essentially halving the workload overnight.
As a country we are very short on radiologists which puts the system under stress, so freeing up existing radiologists to complete other tasks is extremely good news.
Can you tell us more about how AI deep learning image analysis is playing a role?
Aside from the breast imaging, we are looking at ways in which it can help with chest analysis, for example by prioritising chest X-rays for consultants that require urgent attention due to the visibility of illnesses such as TB or pneumonia. We’re also hoping it will help with nodule scans to help identify the nodules and assist the radiologist in making a diagnosis, saving them from having to look for them manually. We expect this to be introduced within the year.
Could you take us through any challenges that you have had in the implementation of the project?
We didn’t actually have any major challenges with the project, but one of the areas we prioritised from the start was the trust’s infrastructure. Other trusts, like ourselves, have a lack of funding for technology such as infrastructure networks, and at that time of choosing Agfa we realised we were going to get this brilliant fast system, but without the right infrastructure to make sure it ran as fast as it could.
We collaborated with Agfa on how we were going to get the best out of the system, and went on to implement a very high-end fibre-optic network that the PACS system sits on. This ensures we get the sub-second load times for main imaging. Some trusts have to wait up to 20 seconds to see an image, and of course that’s time that clinicians could be using to treat patients. Making sure we’ve got that right back-end infrastructure is really important.
Would you like to share any learnings from this particular project?
It is about making sure the infrastructure is there; you don’t want to put in place a very fast system on a very slow infrastructure. We decided to also invest in workstations and speech microphones, to be able to take advantage of every second and remove as many of the frustrations for the clinicians as possible.
What’s coming up in the near future for digital imaging at your trust?
We have recently purchased a cardiology module from Agfa, which will allow for the reporting of epicardiograms directly into the PACS – contributing to our strategy of having all our imaging in one place.
We are moving forward with different technologies all the time and one of the key ones we are looking at right now is XERO Capture – this allows for the staff on the wards to take photographs of wounds and integrate it into the imaging database. We are also looking at using XERO Exchange Network (XEN), which will be implemented over the next few months, so that we can share our imaging with other trusts.
All in all, we have achieved a huge amount in achieving our imaging strategy, but we are very excited about all the developments still to come!
