Overwhelmed Medical Imaging Systems Clogged Due to High Demand High-Resolution CT (also known as HRCT) Chest for COVID-19 screening

Overwhelmed Medical Imaging Systems Clogged Due to High Demand for CT Chest Screening

-Dr. Amit Kharat

10 June, 2024

High-Resolution CT (also known as HRCT) Chest for COVID-19 screening surged in the latter part of the first wave and is spiking back again with the second wave of the covid 19 pandemic. In the intensely fast-spreading second wave, HRCT of the chest has become commonplace much like the RT-PCR. Post capping of prices for CT chest in India, the studies are being done at an increasingly high rate.

Yet there is a word of caution! CT is not the gold standard. It can detect and quantify pneumonia but that's it. The CT severity score does not predict the severity of the disease to any significant clinical extent. Basics like SPO2 monitoring and clinical symptomatology hold center stage. RT-PCR still is the key confirmatory test. But the clandestine nature of the virus makes it difficult to always detect with RT-PCR, and that’s where clinical parameters and HRCT come in. Simpler studies like X-Ray chest can be a good alternative for assessment typically for those patients admitted as these can be key bedside tools to understand the lung status in the critically ill. Performing CT has challenges as disinfecting CT scan machines is a complex process and needs meticulous attention to avoid cross-contamination and infections. Infection to health care staff also needs to be minimized in the process of patient screening.

Nonetheless, CT taking center stage is yet inevitable. Even if a few patients of the many detected get screened by CT, the number is substantial, and it can overwhelm the imaging process. Currently the graph of imaging at all major hospitals barring a few looks somewhat like this:

Skewed dynamics of the radiology workflow with the onset of the Covid pandemic

Typically, hospitals and imaging clinics perform higher numbers of MRIs as compared to CT on a daily basis. However, in the uncertain times of the current pandemic, everything strange is possible. That's why we see higher CT numbers as compared to an MRI. The routine MRI studies have almost withdrawn. Except for the head injury and stroke studies, all elective work has been relegated to the sidelines.

Reporting HRCT takes time, and even if centers have reduced other imaging to accommodate the patients for COVID-19 CT examination. Unlike an X-ray image where is a single or at the most 2 images to be reviewed, CT COVID-19 imaging takes time as the scanner generates a huge volume of data. Depending on the scanner specification, the data can be as low as 200 images or as high as 1000 images. In addition, there are multiple findings that need to be mentioned in reports like lymph nodes, calcifications in liver or spleen, incidentally detected renal stones, thyroid nodules, etc.

There is also an intense demand for quick turn-around for the diagnostic reports, and it's quite stressful for radiologists and patients likewise. Radiologists work behind the scenes and burn the midnight oil trying to make reports faster to cope with the demand.

Enhancing the capability of radiologists to do the critical cognitive work of report generation minus the stress of reporting and matching report turnaround time has resulted in the creation of innovative few click smart reporting tools which ensure less burn-out amongst experts.

Automation of score (quantification) and using smart structured reporting, is now a reality that significantly reduces the time required for radiologists to type an exhaustive report.

Snapshot of the CT COVID-19 AI model with Segmentation masks superimposed

Typical Covid 19 lung involvement in the lower lobes on a cross-sectional axial CT scan.

The structured reporting tool for COVID-19 screening alone brings in significant productivity gain, the rest of the value comes in by the AI which works in the quantification of lung involvement and triage. The ability to process many scans in a short span using the power of an advanced cloud platform, cognitive image interpretation assistance by AI, and structured reporting toolkits allows faster report turnaround and reduces stress.

Snapshot of a structured reporting template for Covid 19 CT report generation

The productivity approach at DeepTek

Let's hope for the wave to subside soon. As and when it happens, it will likely make enough room for the patients who are scheduled for non-communicable disease (NCD) screening and preoperative planning in the backdrop of an overwhelmed healthcare ecosystem

Productivity Frontier Re-imagined

Technology helping to push the productivity frontier. The power of the platform, smart structured reporting, and AI for chest CT screening is helping DeepTek handle an extensively high number of studies in a short span, thereby allowing experts to balance COVID-19 imaging with other imaging studies.

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