Teleradiology – Cloudex Radiology

Teleradiology Services Are Forerunners Among the Healthcare Providers to Adapt to Hybrid Work in Contemporary Times

The healthcare management faced a tough situation during a pandemic time and emerged victorious in extending the best care to COVID & Non-COVD patients as well as safeguarding its medical care providers (clinical & non-clinical); and with the understanding that technology-driven practices and contact-less patient care are the new norms and necessity.

Today, medical technology integrated with deep learning and artificial intelligence is one of the major contributing factors. On-line consultation through telemedicine, teleradiology, drone services, e-pharmacy, remote working, and at home services are some of the examples contributing to reduced or no exposure. Radiology was among the forerunners that made a swift adaption to new norms and supported the system with remote working. The technology companies too supported the medical system’s functionality either in maintaining or increasing the efficiency of the operational team during the patient flow surge.

Teleradiology system driven by technological advancement has emerged as one of the most reliable modes of the patient care system in any given situation to deal with, be it a reporting for emergency or isolated COVID patients or IP/OPD patients, and could cope with the surge in image reporting through the option of remote reporting. This hybrid work norm supported many institutions in delivering patient care without any delay. Today’s teleradiology is integrated with the latest PACS, AI enabled workflow, internet connectivity with wide bandwidth and an experienced back-end support team that has made the reporting possible with short TAT. Technology companies have developed systems to transfer and archive the large dataset with integrity fulfilling the radiologist’s need for high-quality images for reporting.

Machine Manufacturers are also contributing by developing systems that capture high-quality images with low dose radiation and high sensitivity. And to catch up with the trend of imaging services at point-of-care, compact mobile machines are getting developed to fulfill the need. The ultrasound machine and mobile X-ray machines are proving it with their wire-less and cloud-computing features.

Remote Learning is being embraced by educators and many clinicians. The online recorded or live sessions have become the mode of learning for aspiring future physicians and medical professionals. Webinars/conferences and interactive sessions are being conducted virtually benefiting the healthcare providers and patients.

With progressing time, the positive and productive approaches of radiologists, healthcare providers and technology companies the recovery from the pandemic is becoming a reality.

Cloudex Teleradiology Solutions during Pandemic

Cloudex with its advanced teleradiology service in India supported many health centers worldwide managing the patient surge with its prompt reporting services. The reporting was dominated by X-rays, CT and MRI scan mainly for emergency cases as other patients were curtailed from outpatient services. Our experienced and expert teleradiologists team extended their much needed services relentlessly round the clock. Safety measure guidelines were strictly followed by the back-end team while reporting was done remotely. The non-stop and timely service deliverance which includes subspeciality reporting in this crucial time helped many centers in facilitating patient recovery and saving lives and it turned out as their winning edge.

At Cloudex, we support you to have that winning edge.

Cloudex Celebrates its 10 years of Teleradiology with 6 million patient’s smile curves

A humble start of Cloudex’s teleradiology services in 2012 has grown in leaps and bounds and has reached this celebration point. The journey so far covered has been full of coordination, compassion and patience filled. Each day has passed by with learning, growth and sometimes stumbling’s too. Today, we can share and write on our success stories; and redefine it with growing service demand, advancing technology and addition of sharper minds.

Our success is because of our dedicated team who nurtured Cloudex’s initiation into international presence, helped in soaring the service avenues and winning many hearts and clients.

The intention of contributing to community has been formulated with care in order to bridge the gap in radiology services – learning & skill upgradation programs apart from setting up radiology service centres and teleradiology service support to healthcare centres. Cloudex has initiated online and offline developmental programs for aspiring radiology clinicians, expanding its service network through partnership beyond boundary. We are intensifying our venture in improving accessible radiology by establishing scan centres under PP partnership where increasing patient scan numbers talks about our investment on people, technology, equipment and customer service.

Our Milestone achievements in past 10 years can listed as –

Over 6 million patients benefitted with our services
Over 100 Radiologists contributing to the smile curve
International presence of 16+ countries
Team of 40+ roped together with one mission of service

Currently, Cloudex is extending its clinical service to healthcare centres across India including those located in difficult to reach terrains and rural parts. And internationally, some of the centre in African countries like Botswana, Ghana, Ethiopia, Sudan, Nigeria, Uganda, Kenya, Tanzania and Southeast Asian countries like Malaysia, Philippines, Indonesia, Thailand, Vietnam are benefitting from our services.

In this demanding pandemic time, empowering the health centres with the winning edge seems to be success mantra. And Cloudex accepts it and strives to remain at par with industry trend, match the expectations of the associated healthcare service providers, raise the service delivery standards. And create a conducive work environment for the team which propels to give their best efficiently. At Cloudex, we strive to provide that winning edge or satisfaction and saving life.

5 Influencing Factors in Teleradiology Reporting

Radiology reporting with shorter TAT aided with tele reporting has brought about significant improvement in patient care outcomes in many departments of medical centers. TeleRadiology report plays a crucial role in terms of diagnosis and treatment planning. And sometimes, a few minutes of waiting period feels like long years and one wonders how to overcome those anxious moments of dilemma. Silence prevails on the patient’s side whereas an array of actions happens on the other side for radiology reporting. So, behind the complexity of radiological image interpretation lies an array of actions involving technology, protocols, coordination, communication, expertise which keep happening seamlessly. Many of these are visible in action status at the reporting stations or work stations of radiologists (on-site/off-site).

The radiologist/teleradiologist’s work-station is made up of hardware, software, and appropriate furniture & interiors. Factors like illumination in working space, ergonomics of chair & table to smallest of an object like a mouse which can possibly trigger the discomfort level to radiologists matters in the process. Briefing out these dynamic factors for understanding behind the scene actions in teleradiology –

1. Hardware:

The dual QHD monitors of size 21 / 30” diagonally equivalent to a 3 or 5 megapixel are used to view the images and write reports simultaneously. This monitor size reduces the need for repeated zooming in or panning out.
CPU with 8th generation, 16 GB RAM, 1GB GPU memory to match the speed of the image interpretation process of the radiologist.
V shaped keyboard and optic mouse with a scroll which contours the fit into adult hand providing the ergonomic posture for convenient working.
Bluetooth enabled headsets helps in audio and dictation.

2. Software:

PACS provides seamless transmission of images in correct order along with other required supporting health documents.
DICOM calibration to meet the DICOM standards which ensures the image displayed is perceptually linearized. This software also provides alerts for out-of-compliance issues through emails/notification.
Notification system alerting the radiologists on an upcoming critical case that needs urgent attention, TAT alarm, call out from other physicians for case discussion/clarification.

Communication platforms contribute in an immeasurable manner. The interaction between the reporting teleradiologist and referring physician is crucial and is a deciding factor and lifesaving in many cases. The alerts/notification / textual or audio messages etc have added speed to the reporting system.

TAT enhancing voice recognition services add lot of value to teleradiology services. It enables teleradiologist in engaging more time in image interpretation and sparing them from initial drafting of reports with features like Real-time self-editing, formatting, auto-punctuation, and electronic signature. It works as workflow accelerator helping in completing the greater number of image reporting in given time frame.

3. Furniture & Interiors:

The versatility of working space supports the radiologist’s long working hours. The ergonomics of the furniture like height of a table, lumbar supporting chair with adjustable seat height are important for comfortable viewing and reporting. This subtlety adds in promoting alertness and efficiency.
Luminance is given special care so as to safeguard radiologists from ocular distress and physical strain. The minimum standards of 350 ccd/m2 is maintained.

4. Connectivity & Server: Speed is the vital part because a lot of activity depends upon it – transmission, downloading, and storage-related rendering or archival of images, interpretation, and reporting of images.

A dedicated reliable high-speed internet connectivity is maintained. The minimum required internet speed is 512 KBPS-1MBPS whereas the speed of 4-8 MBPS is considered ideal enabling a smooth process for interpretation & reporting, and desirable speed is above 25 MBPS for interpretation of large image data set.
The whole process is supported through cloud computing or a quality-controlled web server

5. Cybersecurity: The infrastructure of PACS & DICOM are build keeping in mind the various guidelines provided by HIPPA/FDAs which are further integrated or upgraded with mitigation measures decided by the Teleradiology companies as company policy or SOP decided upon with their clients. Some of the well-known measures are selective encryption of the DICOM header/files, transport security, image de-identification, water-marking or digital signatures, and access to the system thru assigned user ID/password, etc.

Cloudex’s user-friendly work stations delivering customer satisfying results

At Cloudex, reporting stations are configured involving lots of detailing to ensure that teleradiologists are able to concentrate on interpretation and reporting without any distractions/interruptions and operational issues. The reporting platforms are integrated with various software like voice-recognition dictation, multimedia communication, notification apart from the latest PACS & case managing RIS. Importance is also given to illuminance, work-space comfort, sitting ergonomics, monitor configuration for maintaining teleradiologit’s optimal concentration and efficiency. We invest beyond infrastructure too for creating a conducive environment that is free from administrative burdens or logistical hurdles for teleradiologists. The organization’s emphasis on accuracy of reporting without a miss at required TAT facilitates in winning the confidence of referring Physician and scoring high on service satisfaction score.

Cloudex with its wide range of teleradiology services – Emergency, Subspecialty, Nighthawk, Round-the-clock, Weekend / Holiday, Second Opinion; enables the referring physician or medical center in having an edge of being quick, effective, and efficient in delivering patient care. At Cloudex, we support you to have that winning edge.

Role of CT Chest and Teleradiology for 30 Minute Report in Current COVID-19 Pandemic

India is going through a grave crisis with a rising number of Covid cases. People are deprived of timely medical care due to an overwhelmed health care system. People are dying in ambulances and waiting areas for want of beds and essential life support. Health care facilities are facing difficulty in triaging the patients and deciding on whom to treat first. RT-PCR and antigen tests are recording high false-negative rates and there is an inordinate delay in getting the test reports too, which is adding to the delay and confusion in care delivery.

It turns out that the majority of casualties are due to viral pneumonia which is resulting in low blood oxygen saturation levels. Timely diagnosis of the lung pathology and grading of its severity can help save the lives of many. Unfortunately, the endless wait for a diagnosis of Covid by RT-PCR / antigen to decide on hospital admission has taken many a life. There are instances where a breathless patient diagnosed with Covid like pneumonia with CT chest given a score of almost 30 percent of lung affected had to wait for her RT PCR result which came negative twice after waiting nearly 48 hours each time around to get admitted in a hospital. Her wait ended when a hospital agreed to admit her to their SARI (Severe Acute Respiratory Illness) ward despite her RT PCR negative status, but unfortunately, it was too late and she succumbed to the savage virus.

There are innumerable similar deaths happening in all the badly hit cities of India. Hospitals are not able to decide whether to admit or not and if admitted, to the Covid care ward or the non-Covid one. A few hospitals thus decided upon setting up a ward for the breathless and named it SARI (Severe Acute Respiratory Illness) ward like in the case mentioned above. Still, there was a confusion on admission criteria when the Union Health Ministry in its revised national policy for admission of COVID-19 patients on 8^th May said “A suspect case shall be admitted to the suspect ward of COVID Care Centre (CCC), Dedicated COVID Health Centre (DCHC) of Dedicated COVID Hospital (DHC) as the case may be,” in the directive to all the states and Union Territories and that no private or government hospital shall deny admission/care to any patient and that positive coronavirus disease (Covid-19) report is no more mandatory for admissions.

The relevance of a CT chest cannot be emphasized more in the current situation. A CT Chest in the symptomatic patient can quickly assess the lungs and with the help of CORADS score can determine whether the lung is affected or not and classify the disease into non-Covid / low/high possibility of Covid pneumonia. A CT Severity Score of 0-25 out of 25 in the meanwhile can grade the lung involvement into mild (<30%), moderate (30 – 60%), and severe (>60%) disease. The radiologist can quickly assess the CT chest according to these criteria and issue a report, and the quantitative report greatly aids the treating physician to triage the patients and prioritize admission and treatment delivery.

In the current pandemic scenario, the Turn-around-time (TAT) of any diagnostic test (imaging, laboratory, or pathological) plays a crucial role in diagnosis and saving a life. The highly virulent strain of COVID is playing its trick with widely conducted RT-PCR but gets caught in CT Chest. While RT-PCR results are taking up to 48-72 hours at many places due to the unmanageable load, CT chest reports are delivered in less than an hour and are helping physicians in faster diagnosis, prioritization of admissions, and treatment plan for the sick and high-risk patients with comorbidities.

The Healthcare system is facing multifaceted challenges, the biggest one being the shortage of staff and expertise. Hospitals and diagnostic centers are looking for support in a quick, accurate diagnostic process with an unmanageable number of cases every hour. Teleradiology is capable of providing the required support in reporting the large numbers in less time irrespective of the system’s location (urban/rural). Simultaneously serving multiple centers, each teleradiology system has its own team of radiologists and TAT management protocols wherein reports are delivered in promised time despite the large volume.

The teleradiology service providing consistency, shorter TAT, and quality reports benefit the referring physician- aids in diagnosis and guides treatment plan; develops a strong relationship with its client resulting in delivery of quality patient care with high patient satisfaction score.

We at Cloudex have absorbed the gravity of the situation and are working 24*7*365 doing our best to help and serve the country’s healthcare system in this crisis. Our promise to the needy is a report within 30-45 mins for every suspected Covid CT Chest.

Cloudex Radiology Solutions delivers shorter TAT than agreed upon … benefiting referring Physician’s quick action.

Cloudex’s team including administration, operation, and teleradiologists are encouraged to develop a close relationship with the client’s team for familiarity and communication comfort; resulting in delivery of reports within TAT bundled with quality and accuracy. Here, strategically knitted workflow incorporated with advanced technology and expertise ensures the shortest TAT without compromising on the quality that serves & impresses the clients.

The team also emphasizes performance measures, report quality, communication with the referring physician apart from TAT which contributes to the partnered client’s undivided focus on patient care delivery. These efforts of both teams help in remaining competitive and having a winning edge in demonstrating value-based service delivery.

At Cloudex, we support you to have that winning edge.

The Whistle That Never Blew: Real-Time Communication Between Teleradiologists & Referring Physician Aids Diagnosis and Quick Clinical Decision

40-year-old Rani (name changed) in Kerala (Southern state of India) had a Barking cough along with episodes of breathing problems. Many times, had consulted many physicians to get relief from her racking cough which used to get aggravated during the winter season. This year Rani consulted a pulmonologist who listened to her medical history patiently and advised her for a chest CT. The Radiologist who was seeing the CT image had doubts of history and finding mismatch and discussed it with a pulmonologist then reported the presence of a metallic foreign body, and she got referred to a tertiary center with a Bronchoscope facility. The lodged metal (whistle) got removed, and it shocked Rani. She remembered her childhood whistle incident and got relieved to breathe with ease. Whistle… a fun toy brings in many tangy fun-filled childhood memories. And seeing the metal whistle, remembered that she had swallowed one in her childhood while playing with her friends. Scared of getting a scolding from her parents, she drank loads of water to dislodge it and remained silent about the whole incident with her parents. And with progressing time, this incident faded away from her memory. But the lodged whistle did not remain silent. It kept causing.

Many hidden subtle factors have played a crucial role in restoring the easeful breathing of Rani.

The multiple one-to-one communication between pulmonologist and teleradiologist benefited both caregivers.

Teleradiologists‘ experience and the back-and-forth interaction with pulmonologists helped in the identification of the abnormality as a foreign body and encouraged the pulmonologist to refer the patient to a tertiary center for removal of the foreign body.

The communication between the pulmonologist and endoscopy surgeon at the tertiary center resulted in the successful removal of the impacted whistle and smooth recovery of the patient.

The information related to medical history, current illness, physical examination findings, and other diagnostic investigational reports helps the teleradiologists in providing the referring physician with accurate diagnosis and thus helps decide on an appropriate treatment plan with their interpretation. They make deliberate attempts at avoiding any underrating or overlooking of certain possibilities.

Today, programmers, system designers, and developers have incorporated multiple modes of communication (voice/video conferencing like face to face, text or voice messages/chatbox, emails, etc.) into PACS. The different verbal and written communications have enabled the possibility of instant and face-to-face interaction breaking the anonymous barrier aiding the collaboration and understanding between the referring physician and teleradiologists; eliminating the assumption of nameless/faceless association between the distanced healthcare providers.

Good, effective communication is an integral part of good patient care. The contemporary gadgets, programs & systems have enabled a faster, reliable communication platform adding value to the caregiver and patient relationship resulting in higher scores of patient satisfaction. Effective communication of referring physicians with his patients ensures a better understanding of the clinical situation facilitating better decision-making by patient / supporting family members and their involvement in treatment management.

Cloudex Radiology Solutions communicates with Referring Clients aiding diagnosis and clinical decision …

“I want to express my gratitude to Cloudex and Drs. because of whom all this was possible …”

Whatsapp messages received to express thanks by Rani’s Pulmonologist says it all.

Our team of experienced, qualified & expert Teleradiologists and PACS administrators understand the significance of communication and work closely with referring client’s team.

Various initiatives incorporated for communication are as follows:

The protocols are customized based on the type of imaging modality, involved body parts, and the patient’s critical condition.

Ensuring receipt of various information along with image transfer for a better understanding of situation/interpretation and saving on TAT.

The administrators managing the advanced PACS are quick in attending to the queries raised by reporting radiologists and coordinate with the referring client’s team, especially in cases of emergency.

The Teleradiologists raise the red flag to get either the additional information from the referring caterer for a better understanding of the situation from the referring Physician.

If needed, textual/verbal communication is facilitated between the reporting radiologists and referring physicians for the achievement of the desired goal – delivery of appropriate patient care.

The whistle removal story whistles loudly that communication is the key to the success of a team. Here everyone- patient, tertiary center, pulmonologist, and teleradiologist succeeded. The communication between the pulmonologist and teleradiologist improved the working relationship between these care providers and helped the referring physician inaccurate diagnosis and planning of further care, thus gaining the confidence and satisfaction score of patients as winning edge among his peers.