Lung CT scan aids quick detection of COVID-19: Surajkumar Chandrasekharan

With the promise of vaccines still on the horizon, doctors are dealing with recurring waves of COVID-19 cases, which are expected to continue through winter. Surajkumar Chandrasekharan, Head of Diagnostic Imaging, Siemens Healthineers, India, explains how Computed Tomography, with innovative plug-ins like the “syngo virtual cockpit lite”, aid quicker, more accurate diagnosis of COVID-19 while also safeguarding technicians conducting the scan, in an interaction with Viveka Roychowdhury

What makes diagnosis of COVID-19 particularly difficult and where does imaging fit into the diagnosis protocols?

The main difficulty in diagnosis of COVID-19 is the sheer volume of samples to be tested. Effective containment depends of the speed with which COVID-19 is diagnosed. There are various methods of testing available and one of the foremost methods is the use of a CT scanner to detect COVID-19 induced changes in the lungs of the patients, using high resolution CT imaging of lung area. There are innumerable instances where this method has helped quick detection of COVID-19 ensuring early treatment of the patients and contain the spread.

What are the major clinical challenges faced by hospitals and COVID-19 Care centers in accessing imaging solutions?

During the peak of the COVID-19 times, imaging was high in demand. Hospitals and diagnostic centers with imaging facilities saw tremendous surge in demand for imaging. They also had the challenge of ensuring stringent sanitation, isolation and social distancing protocols which are paramount in ensuring the safety of the patients as well as the paramedical staff attending to the patients.

How much of a role does financial resources play in access to such imaging solutions, given that the second wave of COVID-19 in India seems to be in smaller cities, rural areas, possibly where migrant labour returned during the initial lockdowns? These areas might not have healthcare facilities and if they do, they might have intermittent electricity, lack clinical staff to perform the diagnosis using imaging equipment. Are there any solutions made with such constraints in mind? Does Siemens Healthineers’ has a strategy to tap Tier 3 and 4 towns, with entry level products which are more affordable? What are the market expansion strategies for this segment of the market? 

Healthcare in in India is still majorly based on out–of-pocket payments and affordability to high end imaging is still a challenge in many parts of our country. However, demand for imaging solutions are increasing in Tier 3 and 4 towns. Siemens Healthineers believes in bringing in the best and latest technology to our country making healthcare facilities affordable and accessible to the larger population. Keeping this in mind, we have started a manufacturing facility for CT scanners this year in Bengaluru. Systems manufactured here are designed in consultation with customers to suit our specific requirements. Our state-of the-art medical imaging manufacturing facility in Bengaluru has already rolled out over 100 units of CT machines since start of the facility in January 2020.

To advance the digitalisation of healthcare and better serve the needs of emerging markets, we have recently announced our plans to invest INR 1,300 crore (EUR 160 million) over the next five years in an innovation hub in Bengaluru, India. The investment is part of Siemens Healthineers’ strategy 2025, in which India plays an important role as a growth market for the company.

What are the advantages of CT scanner and how are it helping healthcare professionals diagnose faster and more efficiently so that suspected COVID-19 patients can be quarantined and contact tracing can start to contain the spread?

CT scanner is a non-invasive diagnostic method which can detect COVID-19 induced changes in the lungs of infected patients. It plays a major role in the detection, prognosis and treatment efficacy monitoring of COVID-19 patients. A typical CT scan takes only a few seconds to complete and images are available immediately, ensuring quick diagnostic decisions for further treatment. It is easier for the patients as well. The faster output and high sensitivity make CT a preferred choice for the practitioners.

Of course, this is not a substitute to the various diagnostic tests being done for COVID-19, but aids in faster detection and initiation of treatment.

How much does CT imaging cost per COVID-19 patient?

The cost of a CT imaging may vary depending on various parameters like geographical location, the specific studies being taken up and other facilities being offered.

Given these advantages, has there been an increase in demand for CTs during the pandemic?

Yes, the surge in the demand for CT is primarily due to the following two reasons:

• Population and higher number of infected patients requiring CT scan has placed a stress on the existing facilities, eventually leading to the increase in demand
• Time required to complete the sanitisation process of the CT machine after each patient scan is approximately 45 minutes. Thereby creating a demand of additional resources to scan more patients in a single day.
  

What are the market trends in diagnostic imaging, comparing India vis-a vis globally? How much has the diagnostic imaging portfolio of Siemens Healthineers expanded this FY/CY?

Diagnostic imaging is expanding globally with new inventions and technological developments. High computational power and AI enabled features are making the technologies more efficient with robust results. We are launching our AI enabled Chest CT reading algorithm in the country now. We expect this algorithm to be a big support to our users and looking forward to bringing many more such technological innovations to our country.

Apart from developing innovative solutions for COVID-19, we are doing so much more from India. We are manufacturing CIOS Fit, a multidisciplinary mobile c-arm ready for demanding environments with a powerful state-of-the art imaging technology and an innovative touch-and-play concept. Cios Fit is designed to help improving quality of care and achieve efficient workflows. It is designed, developed, and made in India and sold in South-East Asia, Africa, Eastern Europe, and South America.

SOMATOM go CT scanners from our Bangalore facility are developed in close collaboration with our customers to meet the demand of emerging markets and is one of the best possible routine and beyond CT scanner.

We have recently installed the 500th CT machine on the go.platform alone, since its introduction in India in 2017.

Our teams have also played a huge role in developing Smart Remote Services (SRS), which provides a fast, secure, and powerful data link that connects medical equipment to service experts. With data transfer via SRS, the performance and condition of your equipment can be monitored in real time.

How has COVID-19 pandemic impacted demand for healthcare services, in comparison with the previous year, with many hospitals postponing expansion and optimising use of existing facilities? Are the other segments recovering, with elective surgeries picking up slowly?

COVID-19 had put a stop to many elective procedures, which are now on the recovery path. We believe that the recovery may take some more time, and this might delay some of the expansion plans from healthcare providers and their CAPEX investments at least for a short while.

Was COVID-19 the only reason for the change in demand?

Innovation in technology, precision medicine and digitalisation are the engines of growth in the imaging segment. This will drive the growth irrespective of the pandemic situation.

How is the division coping with this demand?

We are always in the forefront to support our customers, especially in these difficult times, with our motto “we are in it together”.  To meet the current demand, there have been instances that we have delivered a CT between 2-4 weeks or even earlier.

What are the launches in the pipeline?

Innovation is in our DNA. We are leading research and develop path-breaking solutions in artificial intelligence and new computing technologies, the internet of medical things and data connection, technologies in diagnostics and therapies, automatisation of and robotic devices.

At the same time, our digital health solutions, services and consulting can support healthcare providers in protecting healthcare workers and increasing healthcare delivery capacity. For example, our digital services enable medical personnel to operate systems regardless of their location and thus with a potentially lower risk of infection.

Apart from the AI based algorithms, which are strengthening our imaging machines, we are planning to launch a unique, mobile Head CT scanner in India in near future, which can move to the bed side of the patient, instead of the patient having to move to the CT scanner.

What are the expectations from the government in terms of policies, price caps etc? What is Siemens Healthineers’ participation in initiatives like Make in India/Atmanirbhar Bharat etc,

As mentioned earlier, India is a very price sensitive and the reason for this is the lack of medical insurance and high out-of-pocket expenses. The innovative solutions developed at our campus and the center of competences of emerging technologies will help us address challenges like affordability, accessibility and availability, addressing the future needs of the Indian healthcare industry.

India is already an important R&D location for us with about 50 per cent of all software professionals in the company work here. Presently, about 2,400 professionals work at the center, including 2,200 highly skilled software engineers. We would like to expand in two ways: as an innovation hub driving digitalisation in healthcare and as an R&D and manufacturing center for entry-level products for emerging markets worldwide.

How has Siemens Healthineers supported customers during the COVID-19 pandemic, given that healthcare staff are exposed to patients while doing CT scans? 

We have developed the following plug-ins that would help in the diagnosis of COVID-19 at the same time safeguarding the technicians who are conducting the scan.

• We have enabled a feature called “syngo virtual cockpit lite” in many of our scanners. This feature was to help the operators to stay in a safe environment (within the hospital or in the campus) and connect to the scanners remotely. This has ensured that the critical resources of these facilities, the trained professionals, were protected and the process continued without disruptions. Also, it has reduced the demand for personal protection equipment to a certain extent, within these facilities.
• We have also developed pneumonia analysis, a tool developed to score the severity of illness in patients, enabling healthcare professionals to diagnose the patient accordingly.

A lot of healthcare has gone digital during the pandemic, to reduce exposure as well as tackle huge caseloads with minimal staff.  How has Siemens Healthineers helped customers to go more digital, seamlessly?

Digital is the key word in these times, whether it is to improve the workflow in an imaging center or in improving the clinical outcome. Siemens Healthineers is focused on expanding precision medicine, transforming care delivery and improving patient experience through our digital innovations