Teleradiology Solutions – 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.

Panademic Crisis Boon Teleradiology

A medical system by which patient’s radiological images from a variety of health care facilities are transmitted electronically for review and reporting by experienced, offsite radiologists and that’s teleradiology. The resulting reports are then transmitted back to the original facility, providing key insights about the images and helping to determine the course of further patient care. The true fact is that this system is grown within the medical field over the last number of decades, only a few are familiar with the particulars of teleradiology.

Now in the present scenario use of teleradiology is highly recommended as the covid 19 crisis threatens the entire world. Moreover, it ensures the safety of professionals and patients simultaneously. However, optimization of IT solutions and implementation of the right change process is a significant milestone for a successful transition.

Radiology plays an important role during the pandemic as it is essential to maintain the continuity of the health service to the patients. Using such technology based on the transmission of radiological patient images from one location to another and allows radiologists to provide services without having to be in contact with the patient is peculiarly important to minimize the expansion of the covid 19 virus.

In some countries, radiology departments in public and private experienced this solution of remote working, showing a positive impact during the outbreak.

The physical distance between the technologist radiologist, the referring physicians, and the patient is of great advantage now as concerns the present situation. If the concerned patient is in self-quarantine due to exposure to a covid patient, in such situation teleradiology helps much with doctors as being able to read, albeit from far x-rays or CT scan of coronavirus patients.

In China at an early stage of a pandemic outbreak, before swab testing was really available, CT scan was used by doctors to assess the probability of covid 19 infections, same time used to track and monitor the progression of the disease as described by some researchers from China.

Teleradiology allows radiologists to work and be productive when isolated from the rest of their community, while the necessity for social distancing is inevitable in the current pandemic, definitely help to restrict the virus transmission. This practice of receiving images to interpret from a facility and that too is out of radiologists’ geographical vicinity is a truly valuable contribution at this time of unprecedented crisis. By supporting areas of the physician shortage and backing up they are in hospital counterparts, teleradiology serves in a significant way to relieve some of the stresses that global health care systems are currently experiencing.

Medical Science has proven time and again that when the resources are provided, great progress in the treatment, cure, and prevention of diseases can occur.

When there is a crisis we can use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger and the other for opportunity. In a crisis, be aware of the danger but on the other hand recognize the opportunity. It’s really an unpredictable situation for the medical field globally, the danger is on the way we move on. But on the other side of the coin, we are forced to find innovative solutions to problems we may never face before.
When we approach the crisis from a hopeful perspective rather than with a stance of resistance, we can navigate this difficult situation by making it beneficial for the modern medical system knows to be teleradiology.

How Teleradiology Can Help Early Management of Acute Stroke

Dr. Shriram Varadharajan, Consultant Neuroradiologist (Neuroimaging & Stroke)

Awareness of stroke and immediate arrival to the hospital plays a major role in its treatment and recovery. Unlike acute coronary syndrome (ACS – heart attack) where pain plays a prominent role in patients presenting early, stroke patients ignore the negative signs such as sudden onset weakness or numbness. Often minor stroke or TIA (transient ischemic attack) serves as a warning for subsequent major stroke (CVA – cerebrovascular accident). Stroke patients need to complete timely evaluation with various imaging tools. Treatment decisions in acute stroke require ultrafast imaging. It should be performed immediately after clinical triage and emergency stabilization of the patient.

Imaging starts with the very basic question of differentiating Ischemic (clot in the vessels supplying the brain) from Hemorrhagic stroke (bleed) using a simple plain CT scan. Ischemic stroke patients may be given an injection called intravenous thrombolysis (IVT or clot lysis). Plain CT aims to exclude hemorrhage and established large infarcts which are contraindications to intravenous thrombolysis. Additional findings such as hyperdense vessel sign and ASPECTS are helpful to decide on endovascular thrombectomy. Further vascular imaging (imaging of the blood vessels – CT Angiography) is used in Ischemic stroke to detect patients with large vessel occlusion (LVO) i.e. clot inside larger blood vessels. They may need additional emergency endovascular thrombectomy (EVT or clot removal) using advanced catheter-based techniques in DSA (cath.) lab.

These treatments are currently offered to patients presenting within narrow time windows of stroke onset (3-4.5 hours for injection – IVT and 6 hours for cath. lab – EVT). CTA involves evaluating routine angiography and additional venous/delayed phases, regarding the site and presence of LVO as well as to estimate collateral status.

However, few patients who arrive late (beyond 4.5 to 6 hours and till 16-24 hours) can also be treated based on their imaging if we can identify salvageable penumbra (affected brain parenchyma but without permanent damage) using advanced imaging techniques that analyze brain parenchymal perfusion.

All of these decisions can also be taken collectively and more accurately using MRI. Ultrafast Stroke MRI takes less than 20 minutes using limited protocols and involves basic sequences as well as Angiography. MRI in acute stroke can be done without having to administer intravenous contrast and is especially very useful in differentiating from other mimics. Parenchymal and vascular information both can be obtained. MRI involves DWI for infarct core and MRA for LVO while FLAIR mismatch can be used for IVT in stroke patients with unknown time of onset or wake-up strokes. SWI can help detect thrombus/clot burden in RBC rich clots and serve as a penumbral marker by demonstrating vessels with raised oxygen extraction.

Teleradiology can thus be very effective in acute Stroke if reporting can be accelerated to avoid time delays. Simplified reporting formats can be developed based on local logistics. Although CT and CTA are widely practiced in acute stroke, MRI provides a non-contrast one-stop solution in the emergency especially if reported immediately by dedicated, trained tele-stroke Radiologists. Structured reports for such time-based emergency situations like acute stroke help avoid medico-legal consequences especially in the era of evidence-based medicine and helps guide the referring physicians in making treatment decisions.

References

1. Varadharajan S, et al. Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging). Am J Emerg Med. 2016 Feb;34(2):282-7

2. Varadharajan S. ASAP In Stroke Imaging – Need to Simplify and Standardize in Emergency. Accepted for publication in Neurology India

Quality in Teleradiology Reporting

“Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.” Hillman et al

Teleradiology is playing a crucial role in delivering patient care with its prompt and quality service.

The quality of radiological reporting depends on multiple parameters apart from the internal review and external feedback system like

Communication between the reporting radiologists and referring physician for better understanding of the case

PACS and workflow management

Operational team (CTC)

Access to reporting tele-radiologist for clarification / discussion

The Internal Parameters can be listed as –

1. Internal Quality Assurance Team sets up an auditing system involving methodology on random review of the reports and peer reviews at regular intervals. The key performance indicators (KPIs) are prepared by the team in alignment with the organization’s objective and external auditor’s standards (if involved). The experts evaluate the reporting by carrying out random double reporting, peer review, and discuss the discrepancies with reporting radiologists.

Evaluation of the discrepancies, formulation, and implementation of corrective measures followed by evaluation of implementation is a cyclic process in order to improve the quality of report and service delivery. The option of contacting the reported tele-radiologist for further clarification and discussion on prognosis is available.

The new recruits are initially engaged in preliminary reporting for familiarization with the tele-reporting system and are supported with constant review and feedback. This also involves eLearning, teleconferencing, telemedicine, and other technological processes.

2. Procedure Protocol indicates the Right Procedure & Right Way which impacts many other parameters. The protocol includes a checklist drafted by the team on imaging procedures, image uploading/transfer, availability of support documents, defined TAT for emergency & regular cases, filled request form, to & fro communication between the referring physician and reporting radiologists, assigning of images to radiologists, etc.

3. Credentials of the tele-radiologists including the sub-specialization and experience per se augment the value of the report. In critical cases like emergency / STAT reporting, the unique skill of picking up the hidden markers in a short time plays a critical or decisive role. Their clinical focus in reporting improves referring physician’s proficiency to advise or decide on suitable investigations/management of patients.

4. TAT is variable and crucial for referring physicians in taking control of the situation, be it for emergency or regular cases. Today, because of the technological benefits, the TAT for an emergency case is approximately less than 30 minutes whereas for any inpatient or outpatient 4 to 8 hours is maintained. Especially in teleradiology, the other factor which determines the TAT is mutual agreement between the service provider & referring center and considering cost factor as well.

5. Miss Rate is determined by continuous reviewing of reports at regular intervals by the review panel and a lot of measures are undertaken to keep it low. The positive culture of the review panel establishes an environment that is instructive, supporting cognitive debiasing and retrospective analyses. Clients are also encouraged to report “misses” by categorizing them based on their implicating severity. Feedback and discussions with referring physicians help in the process.

The External Parameters which can be considered are

1. Client’s feedback system serves two purposes – understanding the quality of report and reporting services although both (service provider and referring center) would have laid down the SOPs to be followed at either end. The upload of images of other recently conducted investigations, along with other laboratory, pathology reports and previous documents like discharge summary / clinical and operational notes helps in the accurate and detailed interpretation of the images.

2. Accreditations by the authoritative body confirms compliance with protocols set by the authority matching the industry requirement and benefitting every stakeholder. Inspections are conducted to check the protocol implementation and service delivery at regular intervals and the certification is renewed accordingly. If any discrepancy is noticed, a Plan of Correction (POC) is provided with the timeline for implementation.

Cloudex Solutions ensuring the right procedure, the right way, right time, and correct interpretation

A team comprising of qualified experts like radiologists, clinicians, and technologists who are well supported with state-of-the-art RIS PACS technology, round the clock (24 x 7 x 365) reporting services complement to the client’s advantage. The objective of doing the right thing at right time in the right way is achieved by integrating programs to adhere to protocol, utilize the quality improvement tools, and conduct of skill up-gradation workshops.

Cloudex brimming with experts and a wide range of tele-reporting services ensures delivery of the correct interpretation at right time in the right way; enabling the healthcare service provider to deliver quality patient care without delay and assuring proper treatment saving on time and money.

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

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