How teleradiology can assist clinicians categorise patients during the COVID-19 pandemic

Radiology drives diagnosis for semi-urban and rural population making tele-radiology essential to fix the expertise lag in the era of tele-medicine. In the current COVID-19 pandemic, teleradiology can assist clinicians categorise the patients for testing, quarantining or practice social distancing norms, writes Kalyan Sivasailam, CEO, 5C Network. With the scale of testing that India may now need, RT-PCR tests will have to be selectively administered and use of radiology as a front-line screening tool will help us make better and faster decisions.

Healthcare accessibility has multi-dimensional issues in the complex Indian terrain. Shifting towards empowering people to avail medical services agnostic of geographical challenges, the healthcare leaders, providers and policy makers are now looking at technological innovation supported by a holistic internet ecosystem for the adoption of health-tech. Digitisation of healthcare processes and services help resolve information asymmetry, lack of access to specialists, and poor healthcare outcomes despite expensive treatment.

Even today, basic CT and MRI scans take longer in hinterlands lacking radiologists, resulting in delayed treatment process and progression of the disease. Besides, capital intensive imaging machines also result in plummeting ROI to the organisation. To this multifaceted challenge, teleradiology provides a holistic solution.

Studies by Report Linker and GlobalData predict that teleradiology is set to grow at 16 per cent CAGR over the next five years. As Indian healthcare undergoes transformation, radiology is now seen as a key part of the diagnostic process, in both rural and urban areas. Even the Ayushman Bharat Scheme lists radiology scans as precondition and postcondition for most surgeries.

How AI bridges the gap

Artificial Intelligence (AI) in radiology is a reality and plays a role in helping radiologists diagnose faster and better. Broadly, there are two kinds of inputs: quantitative, where algorithms measure a certain characteristic (eg. amount of ground glassing in chest CT scans), and qualitative, where the algorithm suggests a diagnosis.

Well-built algorithms trained on a wide range of data can have sensitivity and specificity of well over 90 per cent. Using AI in radiology has helped reduce the Turn – Around – Time (TAT) by over 60 per cent for critical cases. Technology bridges the gap and helps teleradiology play a pivotal role in overcoming obstacles. Outputs of radiology, unlike that of PCR, are completely digital, and through tech-innovations like AI, teleradiology support diagnostic centers, combined with reports from remotely located qualified specialists. Even with the given limited resources, healthcare experts  in remote locations across the country can make informed decisions about their patients.

Prominence in COVID-19 testing

In the current COVID-19 pandemic, teleradiology can assist clinicians categorise the patients for testing, quarantining or practice social distancing norms. Since COVID-19 is primarily a respiratory disease, pulmonologists need detailed insights into their patient’s scans. In most places, especially in non-urban areas, thoracic specialised radiologists are not available, therefore making teleradiology the best tool available.

Today, a majority of people infected with COVID-19 are asymptomatic for a while, before showing symptoms, thereby unknowingly infecting others. In order to arrest the rapid spread of this disease, we need large scale efficient screening, diagnosis and monitoring.

The test for COVID-19, RT-PCR (Reverse Transcriptase Polymerase Chain Reaction), is complex. Currently, RT-PCR is the standard test to determine if a person has COVID-19. However, because of the complexity involved and the time taken, access to the test is still limited.

Viral pneumonia is routinely and correctly diagnosed using a chest CT. With assay testing yet to scale up, CT scans will be imperative. Pulmonologists across the country consider CT scans for patients with high fever, bilateral distribution with ground glass and no pleural effusion.

Scaling up tele-diagnosis

In developed nations, teleradiology is used as a top-up to improve radiology throughput. In India, the primary problem that teleradiology solves is access.

In healthcare, time is extremely critical. For example, in Japan the expected turn-around-time (TAT) of a diagnosis is 18-24 hours. In India the phone starts ringing after 60 minutes. Teleradiology is playing a vital role in bringing down the time factor, especially in current times.

Access to quality healthcare and timely medical intervention is gaining relevance now more than ever with the pandemic causing irrevocable impact. Reliance on teleradiology will extensively help people move from prescription to preventive healthcare.

Radiology will also be a significant weapon for health authorities in fighting the pandemic. With the scale of testing that India may now need, RT-PCR tests will have to be selectively administered and use of radiology as a front-line screening tool will help us make better and faster decisions.