Incorporating emerging technologies as part of radiology training is need of the hour
Today, radiology is one of the most sought-after branches and specialties of medicine. It is continuously evolving and becoming competitive, driven by availability of advanced medical imaging modalities like CT, MRI and increased level of acceptance and utility of new technologies like teleradiology accompanied by artificial intelligence (AI) and machine learning (ML). This is in turn fast tracking the journey of radiology becoming a key specialty not only for diagnosis but also in guiding and monitoring the treatments that the patient receives.
However, it is now important for the future radiology workforce to expand and strengthen their skills in line with the need and upgradation of the technology in this sector.
Sharing her views on this, Dr Meinal Chaudhry, Director, Radiodiagnosis and Intervention Radiology, Aakash Healthcare said, “Given the importance of medical imaging in effective clinical practice, radiology education and training are of paramount clinical importance. Basic radiology has continued to evolve in the medical curriculum, with a focus on teaching image interpretation skills, appropriate radiological investigation ordering, judicious use of ionising radiation, and exposure to interventional radiology. The digital revolution has fuelled advancements in radiology, which has had a positive impact on education and training.”
Sharing her views on this, Dr Meinal Chaudhry, Director, Radiodiagnosis and Intervention Radiology, Aakash Healthcare said, “Given the importance of medical imaging in effective clinical practice, radiology education and training are of paramount clinical importance. Basic radiology has continued to evolve in the medical curriculum, with a focus on teaching image interpretation skills, appropriate radiological investigation ordering, judicious use of ionising radiation, and exposure to interventional radiology. The digital revolution has fuelled advancements in radiology, which has had a positive impact on education and training.”
Dr (Col) M.L.Bera, Consultant & HOD-Radiology, HCMCT Manipal Hospital, “The practice of radiological services is undergoing rapid change in recent years due to technological advancement, workload escalation, workforce shortage, privatisation, corporatisation and globalisation of healthcare facilities. Simultaneously with more and more advanced cutting-edge technologies, the radiological services have transformed into multiple sub-specialities. This sudden proliferation of radiological services into multiple sub-specialities has adversely affected the quality of patient care and patient safety due to shortage of skill manpower.”
Dr Vimal Someshwar, Head, Radiology & Head, Interventional Radiology, Kokilaben Dhirubhai Ambani Hospital believes that, “The scope and importance of radiology has increased exponentially with invention of latest imaging technologies. There is increase in demand for radiologists and the placements are relatively easily available. Subspecialisation has become the norm and the trainee should focus on the subject of his / her interest. Continuous learning, attending clinical meetings and conferences would help remain well versed with the subject. The future depends on how the AI impacts the practice of radiology.”
Incorporating emerging technologies as part of radiology training
An international survey on AI in radiology published in the September 2021 edition of European Radiology, involving 1041 radiologists showed that a large proportion of radiologists consider the lack of emerging tech knowledge as a major hurdle to their work. The survey highlights that 48 per cent of radiologists and residents surveyed, who were from 54 mostly European countries, have an open and proactive attitude towards AI, while 38 per cent of them fear replacement by AI. This survey suggests that intermediate and advanced AI-specific knowledge levels may enhance adoption of AI in clinical practice, while rudimentary knowledge levels appear to be inhibitive, an observation which would probably be true of their peers from India as well.
Although the current curriculum on radiology is upgrading with some changes, it is still not in complete sync with what the actual practice is and that is why strengthening the uniformity of the curriculum accompanied with more incorporation of practical training is the need of the hour
With technology on the rise in the field of radiology, streamlining the young workforce of radiology with focus on sub-specialisations is very important
Highlighting the initiatives to train radiologists on AI based subjects, Vikram Thaploo, CEO, Apollo TeleHealth added, “Even though training on innovative technologies is not part of the radiologist training curriculum, several initiatives have been taken to train radiologists on AI-based subjects. For instance, The European Society of Radiology (ESR) offers an online radiology training curriculum which includes learning the application and function of AI tools to gain better knowledge of various technical options to implement deep learning and AI applications in the radiology workflow. The EuSoMII or the European Society of Medical Imaging Informatics has even supported the adoption and promotion of this curriculum for the integration of both ethical and technical aspects of AI into the radiology curriculum.”
“Another initiative worth mentioning is the NIIC (National Imaging Informatics Course) co-organised by the SIIM (Society for Imaging Informatics in Medicine) and RSNA (Radiological Society of North America). It includes using AI algorithms for medical imaging and the foundations of deep learning. This programme is not only offered to radiology residents but even caters to PACS managers and various professionals in the medical imaging domain. Additionally, the American College of Radiology has also been active in offering training programs based on the foundations of artificial intelligence and itspossibilities in radiology practice,” he added.
Stressing on the importance of technology knowledge, Meenakshi Singh, Co-founder and CEO, Synapsica said, “Advanced technologies like AI can improve radiologist efficiency and thereby patient care. But it is only possible when radiologists become comfortable with these tools, so they can use them to their maximum benefit. And to use a product efficiently, one needs to have basic, if not detailed knowledge about it.”
Dr H.K. Mahajan, Additional Chief of Medical Administration, Indian Spinal Injuries Centre added, “It becomes paramount to adapt radiology training programmes, so that the students are well-versed with the use of AI in imaging. Radiology training programmes should aim to give residents an understanding of the fundamentals of type of AI in radiology and how to access AI applications in radiology. The training should also be aimed at building resources that can enhance or build their knowledge in AI applications in radiology. Today, there are many AI training programmes offered to radiologists, but most of them are short and stand-alone sessions that are not part of a longer-term learning trajectory. The training programmes mainly focus on the basic concepts of AI and are offered in passive mode. While professional institutions and commercial companies are active in offering the programmes, academic institutes are limitedly involved.”
Dr Vipin Kumar Pathak, HOD & Senior Consultant, Radiology, Apollo Hospitals highlighted that, “The duration of the training and the protocols should be predefined with necessary changes and amendments as per the need. Each hospital should have the facility of training in these subspecialties with adequate facilities. We should also encourage conferences and workshops involving groups of hospitals to spread the knowledge of recent advancements. Involving the international faculties in these conferences would also help us in keeping pace with new advancements at the international level. Along with the radiologists’ training, the training of radiographers is of immense importance considering their role in handling the equipment.”
Role of industry in training the next generation of radiologists
In order to achieve the right balance of theory and practical, greater involvement of the industry is very critical. While the academic institutes are already focusing on imparting the theoretical knowledge to the students, industry can prepare them on the advancements and use of the technology, considering the fact that they are the ones manufacturing it. An enhanced focus on industry-academia collaboration accompanied by formation of Centre of Excellence can be one important step in this direction.
Explaining the role of industry in training, Nikhel Goel, Country General Manager-India Cluster, Carestream said, “The medtech industry has an important role to play in training radiologists. Given the advanced nature of X Ray, CT & MRI equipment being manufactured, the training has centered around learning the advanced technology involved for getting the best out of these advances for medical imaging output. Mostly this involves work flow management, understanding how various software can help understand detailing of anomalies for critical ailments such as breast imaging, musculo-skeletal imaging and learning how AI features and applications can help them make predictable analysis for clinicians to diagnose faster. Beyond this, I believe there can be peer to peer learning modules, experiential sharing with Centre of Excellence and skills to manage large volumes such as in the recent pandemic that can be facilitated through industry organised programmes.”
“Industry-academia collaboration is paramount for training. Various possibilities include a module on medical imaging with hands on experience that can be introduced in final years of radiology education to having formal MOUs with leading hospitals by industry players to impart advanced training on medical imaging,” he added.
Current challenges
Academic institutes should understand that it is essential for young radiologists to have at least the basics of the fast-advancing technologies for better results and less diagnostic errors.
Talking about the challenges, Dr Bera said, “With technological advancement patients now enjoy the benefit of early diagnosis and less invasive treatment alternatives with less cost and lower morbidity and mortality. However, due to sudden technological outburst with increasing volume and complexity of work, there is acute shortage of skilled workforce to meet the growing demand on a day-today basis. This may lead to workload/ workforce imbalance and may adversely affect the quality of patient care and patient safety in the coming days. To overcome these problems, conventional training programmes of technical manpower need to be replaced with more specific and focussed training programmes to face the challenging tasks in the near future.”
Dr Chaudhry explains that, “Allocating adequate teaching time, educational budgetary constraints, framing educational needs, professional development for facilitating radiology teaching-learning sessions, and difficulties in developing instruments to assess teaching quality are all challenges that radiology educators face today. Non-subject experts frequently lead radiology teaching-learning sessions in most institutions, despite the fact that radiologists teach diagnostic imaging better than any other specialty.”
Talking about the issues with AI training programmes for radiologists, Thaploo said, “Most of the training programmes concentrate on the conceptual aspects of emerging technologies like the basics of AI, machine learning, etc. and its potential for medical practice in general which is not necessarily related to radiology. Only a handful of programmes practically engage radiologists in hands-on training of working with some tech-based tools. Another significant problem with the training programmes is that a majority of them are targeted toward other medical professionals like medical researchers, GPs and other specialisations. In fact, a lot of the programmes are quite generic.
The training instructors of the programmes are observed to be from diverse backgrounds like “founders of tech companies,” “radiology professors” and “researchers” from research and development departments. Half of the programmes are jointly offered by instructors with medical and technical backgrounds. Only a handful of the programmes are offered by radiologists”
Way forward
Government and other stakeholders should work in a collaborative mode to strengthen the current radiology training ecosystem in India for young radiologists via initiatives like increase in investments and developing more Centre of Excellence along with pushing the PPP model which can play a major role as far as incorporating the practical skills is concerned.
Talking about the way forward, Singh said, “The benefits of any technology can be realised only when they are successfully incorporated into the workflow. To successfully incorporate emerging technology in the radiology space, healthcare providers should start by interviewing their radiology staff. Engaging professionals from the medical imaging division helps in better understanding their needs and challenges in technology adoption. Consulting radiologists from the start also encourages them to share their opinions and ideas during the transition process, which will make technology implementation a much easier task.”
“Essentially product vendors provide technical support to help users while facing challenges with their applications. But some technical glitches can be easily solved with the help of tech-savvies in the room. Some healthcare professionals have an innate ability to learn new technologies quickly. Identifying these tech savvies can be advantageous as they can provide timely help to their less-trained coworkers when things go south and also help them improve their tech knowledge, eliminating the need to wait for vendor-provided technical support to resolve the issue”, she added
Dr Bera highlights that, “Due to exponential growth and recent technological advancements in imaging services, now it is becoming necessary to change the training programme on modality-based training schedule for better understanding of technological advancement and effective implementation of various imaging protocols for better diagnostic yield”
Stressing on developing a systemic training programs, Dr Mahajan said, “There is a need to further develop systematic training programs that can help with introducing as well as incorporating emerging technologies in radiology practices. There training programs need to be pedagogically integrated into radiology curriculum. The training need to further focus on learning how to work with AI, ML, AR & VR and be further specialised and customised to the context of radiology work.”
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