E-BOOK:

Radiology post-pandemic game plan

A study on the biggest barriers to radiology productivity and
a technology adoption analysis to help form a post-COVID game plan.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN 1

Introduction
The radiology community has taken one of its biggest hits in history with the COVID-19
pandemic. Rapid changes in imaging volumes have caused severe financial damage
for most practices1 and many radiologists have been under serious emotional stress
resulting in escalating burnout rates2. As we approach the end of 2021—with many of us
attending yet another RSNA, this year back at the McCormick Place in Chicago—imaging
volumes are getting back to normal, but challenges continue to mount on the horizon.
Radiology professionals are not only under pressure to manage the massive post-
pandemic backlog. Looking ahead, radiology also needs to adapt to advancements in
cancer care that will bring even higher imaging volumes and increased complexity.

To be successful in the post-COVID era, radiology professionals need to be equipped

with the right and most efficient IT tools to be able to accomplish more in less time—
to handle both the imaging backlog from the pandemic and the growing volumes and
increased complexity from cancer care.

“Using the right diagnostic tools is crucial to deliver improved patient

outcomes and to stay competitive, while at the same time finding a
sustainable and healthy work–life balance.”
Dr. Johan Henriksson, Radiologist, Director of Medical Imaging Services
at Södersjukhuset Hospital, Region Stockholm, Sweden

With this background in mind, we have performed a “health check” to identify the biggest
barriers currently slowing down radiologists during their reading and reporting. We have
also examined the current status of implementing new technologies that can help over-
come these barriers. With knowledge about productivity barriers, and the technologies to
overcome them, you will be able to create a game plan to suit your situation and become
even more successful post-COVID. In our study, we asked some 70 radiologists* from
across North America and Europe to share their views. Join Sectra at RSNA 2021
—in Chicago or virtually!
For more information and
demo requests:
medical.sectra.com/rsna.

*The responses summarized in this report have been collected from an online survey carried out in May 2021. Most responses
come from radiologists in the U.S., but Belgium, Canada, France, the Netherlands, and the U.K. are also represented in the survey.
2
Content

CHAPTER 1 4
The pandemic’s effect on radiology—an overview and a U.S. case study

CHAPTER 2 8
Radiologists’ productivity barriers and the technologies and diagnostic tools
that can help to overcome them

CHAPTER 3 16
The current adoption status of these technologies and diagnostic tools
—and which to add to your game plan

CHAPTER 4 20
Best practices from fellow radiologists when adopting new, productivity-
boosting technologies

CHAPTER 5 25
Summary—time to put your game plan together

Related resources for further insights and experiences 26

Bibliography 27

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN 3

CHAPTER 1

The pandemic’s effect on radiology

—an overview and a U.S. case study
Radiology’s first shock from the pandemic came in early spring 2020, with a sudden drop found that during this period, 19% fewer CTs were performed. At the nadir, the daily
in volumes as elective surgery and screening were largely postponed or cancelled. As reduction in volumes was 53%.
the first wave of the pandemic petered out, radiology faced a rapid post-coronavirus
surge to catch up on the built-up healthcare debt. But new pandemic waves hit and from By September 30, 2020, CT volumes had returned to 84% of predicted “normal” volumes.
September 2020 and six months forward, radiology had to live with, and adapt to, an un- The volume of CT exams recovered as deaths declined and positive COVID-19 tests rose3,
predictable roller coaster ride of workload fluctuations. Finally, in summer 2021, volumes as indicated by Figure 1.
returned to normal levels as vaccination programs progressed and the overall burden on
the healthcare apparatus was reduced. But radiology had been shaken to its core and
left with a large post-pandemic backlog to handle. To better prepare for the future, we 68,521
64,229
need to understand the consequences of the pandemic. As a case study, we have taken 0.6 60K

a deeper look into how radiology, specifically in the U.S. has been affected.
0.4 40K

Changes in volumes during the pandemic

0.2 20K

0.0 0K
As the coronavirus started to spread across the country and put a heavy strain on the Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct.
2020
entire healthcare apparatus in early 2020, most U.S. health providers responded by
restricting access to elective and nonurgent medical care in order to save resources3.
By April 2020, 33 states had state-mandated “stay-at-home orders”. The Centers for 20
68,521
64,229
Disease Control and Prevention (CDC) issued recommendations to reschedule nonurgent 60K
15
patient care and delay screenings in an effort to minimize risks for patients and health-
40K
care professionals1. 10

5 20K

A survey1 conducted by the American College of Radiology (ACR) and the Radiology 0 0K
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct.
Business Management Association reported that 97.4% of 228 radiology practices— 2020

including urban, academic, and rural practices—experienced a decline in imaging vol-

umes in March and April 2020. This was the result of a drop of more than 90% in elective CT volume (7-day avg.) Deaths per 100k (7-day avg.) Positive cases per 100k (7-day avg.)

procedures and 60% in urgent procedures. As an example, they mention the largest
Figure 1. CT volumes in the U.S. vs. number of positive COVID-19 tests and deaths3.
healthcare system in New York, which reported an 88% decline in the number of exams
across all modality types, with mammography use plummeting 94%, MR imaging 74%,
and ultrasound 64%.1 As care gradually reopened between May and July 2020, most U.S. centers were faced
with a significant backlog of past studies that had piled up1.
This was also confirmed by another study3 involving 2,398 U.S. radiology providers parti-
cipating in the ACR Dose Index Registry from January 1 to September 30, 2020. They

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 1 4

A snapshot of volumes among Sectra’s U.S. customers numbers (445 million). The forecast volume for 2021 is 428 million, slightly less than in
To get an overview of the entire pandemic and its recovery phase, we have taken a closer 2019, but a 24% increase compared to 2020, as indicated by the graph below.4
look at how Sectra’s U.S. customers’ aggregated volumes have been affected, analyzed
in our proactive support system, Sectra Monitoring. As reflected in the aforementioned
studies3, 1, the development of CT exam volumes among our U.S. customers reached a
445 24% 428
nadir in April 2020, with a 33% drop from pre-pandemic numbers in January 2020. This
is illustrated by Figure 2. –22% 345

56%
July 2021

24%
Jan. 2021 91 –20% 73
19% 87

2019 2020 2021 (f) 2019 2020 2021 (f)

Baseline
Jan. 2020 U.S. total diagnostic imaging volumes (M) Annual growth % U.S. CT diagnostic imaging volumes (M)

Figure 3. Exam volumes reported on in the U.S. in 2019, 2020, and 20214.
–33%
Apr. 2020

Figure 2. CT exam volumes from Sectra’s U.S. customers, January 2020 to July 2021.
The percentages in the graph show the volume relative to the baseline in January 2020.
The same data set tells us that volumes returned to the baseline in June 2020. After that,
volumes were higher than normal and grew steadily until July 2021, when the increase
seemed to level out. In August 2021, volumes were 56% above normal level.
Annual change in CT exams and total diagnostic
imaging volumes
Looking at a year-over-year perspective across all U.S. healthcare providers, Signify
Research shows that a total of 73 million CT exams were reported in 2020, which
was a 20% decline from 2019’s 91 million. The forecast number for 2021 is a total of
87 million—an annual increase of 19% compared to 2020, but slightly less than 2019.
We see similar numbers looking at all modality types, with total diagnostic imaging vol-
umes amounting to 345 million in 2020, which was a 22% decline compared to 2019’s
The impact on cancer screening
In a report5 published in JAMA Oncology, researchers estimated that widespread lock-
downs and fears of visiting the hospital have resulted in the U.S. having aggregated a
cancer screening deficit of roughly 9.4 million. They also found that the sharpest drop
was in April 2020, with breast cancer screening experiencing the biggest fall at 90.8%,
followed by colorectal (79.3%) and prostate (63.4%). Both breast and prostate had seen
a “near complete recovery” of monthly screening rates by July 2020. The researchers also
anticipated a devastating effect of the canceled screenings: “The U.S. could potentially
see 10,000 excess breast and colon cancer deaths over the next decade because of
COVID-related screening delays.”5
Shifts in demand lead to a dramatic financial impact
for radiology providers
When assessing the economic effect, looking at volumes alone could be misleading since
this underestimates the financial impact given that the loss in high-RVU (relative value
unit) exams was even greater. For example, one study6 found that during the pandemic

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 1 5

surge, case volumes fell 57%, while RVUs fell 20% more (69%) relative to the pre- shifted rapidly to “home PACS”, going from having 100% of the radiologists onsite to 80%
COVID-19 baseline. reading from home within just a few weeks.1

In total, over the 228 practices from all over the U.S. that were surveyed in one study1,
there were mean reductions of about 50% in both receipts and gross charges, and more
than 70% of the respondents reported applying for some sort of governmental financial
relief. Among U.S. academic radiology practices, a quarter had furloughed or laid off staff
during 2020, and significant reductions in radiologist and staff salaries were made in
about 50% of the practices.1
Imaging volumes looking ahead
In summary, the devastating financial strain, mental stress, and organizational and
workflow-related changes that radiology has been experiencing have completely
reshaped the business. As death numbers started to decline in early 2021 and elective
surgery resumed, there was a quick return to normal—or even higher-than-normal
—imaging volumes.

About half of the healthcare practices in California furloughed or laid off employees,
reducing staff hours by almost two-thirds. On the organizational side, 100% of academic
radiology departments reported that they reorganized their waiting rooms and dressing
areas to comply with social distancing mandates. Significant changes in scheduling were
made, with increased evening or weekend hours along with changes in protocols for
shorter MR imaging scan times, for example.1
In a survey7 published by Medscape in May 2021, more than 700 radiologists were asked
how they had been impacted by COVID-19 financially. 46% said they saw their income
decline in 2020, with about 92% citing COVID-19 as the cause, including job loss, a reduc-
tion in hours and lower patient volumes. In more detail, the average radiologist annual
salary in the U.S. was $413,000 in 2020, down 3% from the previous survey, and roughly
50% of imaging physicians expect their income to return to pre-pandemic levels in 2021,
while 35% said it will take longer. About 11% believe their pay will never return to the
same levels as before the pandemic.7
What conclusions can we draw from this? Given that the U.S. had a peak in deaths
during the first two months of 20218, as illustrated in Figure 4, and that the forecast
full-year number of imaging exams, as previously presented, is expected to return to
pre-pandemic levels4, we can assume that radiology should be prepared for higher imag-
ing volumes than normal during the remainder of 2021 and early 2022, partly fueled by
the backlog from the pandemic. Added to this is another emerging trend that has been
somewhat neglected during the pandemic—the significant growth in the number of
reports that must be created due to advancements in cancer care.
4,000 deaths
COVID-19 peak deaths
2,000 deaths

Mental health effects

Looking beyond the financial impact, the effects on radiologists’ mental health through- 7-day
out this crisis have been substantial. This was shown in a survey2 of 2,150 radiologists average

published in the journal Insights into Imaging in February 2021, where more than 50%
responded that they had experienced increased emotional stress during the pandemic.
More than 60% of 600 radiologists in 44 states rated their anxiety as a 7 out of 10 during
the pandemic. Moreover, their physical work environment had also been changed signifi-
Feb. 2020 May Aug. Nov. Feb. 2021 May Aug.
cantly to reduce the risk of disease. Radiology practices restructured reading rooms and
Figure 4. Daily reported COVID-19 deaths in the U.S.8.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 1 6

Increasing demands as the revolution in cancer care continues
The aftermath of the pandemic is, of course, not the only challenge facing radiology.

Over the last few years, we have seen growing imaging volumes and exam complexity
driven by the rapid establishment of more advanced cancer care, including new person-
alized treatments that have introduced different ways of performing diagnostics. This was
the main topic at a Sectra roundtable discussion in conjunction with ECR 2021, where
radiology experts and opinion leaders from four countries gathered to discuss the most
urgent challenges and emerging trends in diagnostic radiology. Despite representing dif-
ferent countries, they all agreed that managing the growth in oncology will be their num-
ber one challenge in the years to come. Some of their key conclusions were:

» They see a massive growth in the number of reports that must be produced due to
the steady increase in exam volumes, in particular in cancer care.

» The growth is particularly strong in terms of the number of CT exams, mainly driven by
new targeted therapies in cancer care where progression needs to be followed up.

» Many new biomarkers, reporting guidelines, and new clinical routines for the follow-up
of all new drugs are being introduced, which is creating added complexity. This is
triggering a strong need for increased automation and faster adoption of AI.

» The higher workload from oncology and more multidisciplinary tumor boards (MDTs)
are fueling an increased need for cross-specialty collaboration, in particular between
radiology, pathology, and nuclear medicine.

» Advanced modalities are being used in practice to a greater extent and producing
huge amounts of data that need to be stored and made usable in diagnostics to
benefit the patients. “It’s a heck of a lot of cancer work. All radiologists in our department
have a subspeciality interest, but 90% of us will report general
» The increased use of advanced imaging and personalized treatments are significantly oncology scans simply because it’s so much work.”
improving patient outcomes, but also driving costs to alarming levels. A key challenge
Dr. Tom Newton, Consultant Radiologist, Clinical Director for Radiology
is to connect investments to improved patient outcomes measured from a population at East Lancashire Hospitals NHS Trust
health and reimbursement perspective.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 1 7

CHAPTER 2

Radiologists’ productivity barriers and the technologies

and diagnostic tools that can help to overcome them
Managing the imaging backlog from the pandemic and the growing volumes from the together with an analysis aiming to guide your decision on which of the technologies to
rapid development in cancer care will affect all radiology professionals. Luckily, technolo- adopt, trial, or assess.
gy and IT tools are also advancing and here to help you tackle these higher volumes and
increased complexity, and to become more productive while also reducing the risk of
Barriers hindering radiologists from being productive
burnout. To adopt the right technologies that truly unlock the full potential of your diag-
So, what are the biggest barriers hindering radiologists today from feeling productive
nostic system, you need to identify what your current barriers are—what is hindering you
and realizing efficient workflows in their daily reading and reporting? This is important to
from feeling productive in your reading and reporting today?
understand in order to be able to efficiently tackle the post-COVID backlog and increas-
In a nationwide survey9 performed by California-based Canopy Partners, radiology execu- ing demands from oncology. We conducted an online survey of some 70 radiologists
tives representing 67 organizations in 24 states were asked about the barriers hindering from across North America and Europe and asked them to share their views.
radiologists from being productive. They found that the biggest challenges were related
The survey participants comprised a representative spread between different subspecial-
to workflow, including image sharing, remote reading, interface upgrades, the radiolo-
ists (see Figure 5), and the average respondent has worked for 16.4 years since residency.
gists’ communication, and access to prior exams. They especially highlighted the need
74% of the respondents spend 40 hours or more per week working with clinical cases.
for efficient workflows and the importance of having one standardized user interface in
order to reach a state of flow9:
Subspeciality within radiology
Breast Imaging 24%
“You don’t want your radiologists logging in and out of disparate systems,
having to remember each program’s interfaces. You want to have everything Neuroradiology 17%

streamlined in the workflow so the radiologist never has to get out of their flow.” General Radiology 16%
Reed Humphrey, VP of Technology Consulting, Canopy Partners
Vascular & Interventional Radiology 11%

Gastrointestinal Radiology 8%
Over a third of the respondents claimed that the pandemic has caused them to think
differently about their IT strategy or capabilities. Some groups reported that they plan to Musculoskeletal Radiology 5%

spend as much as 10% of their gross revenue on radiology IT.9 Radiation Oncology 5%

Chest Radiology 4%
To provide more hands-on advice on how to achieve efficient workflows and feel produc-
tive in your daily work by overcoming barriers like these through the use of new technol- Nuclear Medicine Radiology 4%
ogy and diagnostic IT tools, we decided to conduct our own survey. The following chap-
Pediatric Radiology 3%
ters will give you an overview of the barriers identified by some 70 radiologists. We will
then match these barriers with technologies that can be used to overcome them. You will Other 3%

also get an overview of how far radiologists have come in adopting these technologies,
Figure 5. Survey respondents’ primary radiology subspecialty.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2 8

Barriers hindering productivity influenced by your
diagnostic imaging system
In the very first question of the survey, we wanted to find out to what extent the radiolo-
gists feel that their daily performance is influenced by their diagnostic imaging system. As
many as seven out of ten responded that their performance is extremely or very influ-
enced by their diagnostic imaging system, and almost a quarter that their performance is
somewhat influenced by it. None of the respondents answered that their imaging system
does not influence their performance at all.
0% Not at all influenced
7% Slightly influenced
What we can conclude is that the highest ranked area, workflow management and case
distribution, aligns well with the results of the aforementioned U.S. study9 performed by
Canopy Partners.
To help you identify technologies to adopt in your game plan, we will now look more
closely at each of these areas. We will look into which factors* decrease the radiologists’
productivity the most when working in their current diagnostic application.
When looking at each factor, we will also recap the different emerging technologies and
diagnostic tools that were covered in the last two editions of Sectra’s “The Radiologists’
Handbook”, published in 2019 and 2020, and describe how these can be used to over-
come the barriers to establishing efficient workflows in your reading and reporting.
The two handbooks cover the following areas (please refer to Chapter 3 for a short
description of each):

41% 23%
Somewhat » Workflow orchestration » Streamlined and smart reporting
Very influenced
influenced
» Multiparametric MRI » End-to-end AI assistance
» Integrated diagnostics » Collaboration enablers for remote reading
29% To what extent is your
and distributed workflows
Extremely influenced daily performance influenced » Smart display protocols
by your diagnostic imaging system?
» Subscription-based pricing models (as an
» Optimized diagnostic context enabler for adopting new technologies)

Let’s dig deeper into the areas in which radiologists experience the most challenges that
negatively impact their performance—ranking these areas from highest to lowest based Sectra’s comments in the following sections are provided by:
on the number of votes* among the respondents:

1. Workflow management and case distribution

2. Oncology image review/reading

3. General image review/reading

4. Multidisciplinary tumor boards, remote work, and collaboration

Fredrik Häll Lisa Lindfors Hans Lugnegård
5. Access to advanced diagnostic tools Vice President Global Product Manager Global Product Manager
Product Management Radiology Imaging Radiology Workflow
6. Reporting and results distribution

*The respondents could select up to three alternatives for each question.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2 9

Workflow management and case distribution
Without a doubt, the biggest challenge in this area is that radiologists often get inter-
rupted and need to spend a lot of time finding the case and rearranging the images
again in order to continue reporting (46 votes). This was followed by the fact that it is
hard to pick the right case to report due to insufficient information about when the
report must be completed (19 votes), and the lack of automatic case allocation based
on specialty (16 votes).
Within workflow management and case distribution, remote work and
collaboration, which factor(s) decrease your productivity and flow the most
when working in your current diagnostic application?
1 Often get interrupted when working on a case and must spend a lot of time
finding the previous case I was working on and rearranging the images before
I can continue reporting.
2 Hard to pick the right case to report due to insufficient information about when
the report must be completed (time due, clinical priority, patient’s next visit, etc.).
3 Lacking automatic case allocation based on speciality.
4 Lacking tools for efficient vetting and second opinion workflows.
5 Other
6 Often start reporting on the same case as my colleague due to not being able to
see who is reading which case in the worklists.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2
Sectra’s comments: How to tackle this challenge
Being interrupted and the hassle of finding the case again, rearranging images, and
getting back to an efficient state of reading are considered significant barriers to feeling
productive, according to the survey. Your diagnostic application should support seamless
and dedicated workflow capabilities for handling interrupted workflows, such as easily
being able to go back/forward and resume image presentations.
The struggle of picking the right case to report on due to insufficient information about
when the report must be completed and the lack of automatic, specialty-based case allo-
cation can be solved with well-integrated workflow orchestration software. Rules-based
workload allocation will enable the right exam to be distributed to the right radiologist
more easily, based on a set of criteria and tailored for each department’s needs. More-
over, an analytics dashboard can provide an overview of the exam distribution, the status
of SLAs, and the current performance.
“When developing products for radiologists, we must focus on everyday
tasks and remove all unnecessary clicks. A good example of this is
new visualization of relevant priors based on anatomy and laterality.”
Hans Lugnegård, Global Product Manager Radiology Workflow, Sectra
Oncology image review/reading
When it comes to reviewing oncology cases, the biggest challenge reported is getting
a good patient overview and disease progression due to the lack of support for
efficiently handling multiple priors and follow-ups (50 votes). Secondly, radiologists feel
that it is too time consuming to adhere to and follow tumor evaluation guidelines
and assessment rules, such as RECIST, PI-RADS, iRECIST, and PERCIST (38 votes). The
third biggest barrier is the lack of relevant clinical measurement tools for lesions
(13 votes).
10
 Within oncology image review/reading, which factor(s) decrease
“When it comes to oncology image reading, we focus on making it easy to
your productivity and flow the most when working in your current
create a good overview of all cases, including both the current exam and a
diagnostic application?
comparison with findings from previous exams. Oncology is also using more
and more types of modalities, so we must ensure the radiologists have
1 Hard to get a good patient overview and disease progression due to multiple easy access to the right advanced tools, such as fusion of images.“
priors and follow-ups. Finding relevant priors requires manual search and sorting. Lisa Lindfors, Global Product Manager Radiology Imaging, Sectra

2 Time consuming to follow tumor evaluation guidelines and evaluation assessment

rules (RECIST, PIRADS, iRECIST, PERCIST, etc.).

3 Missing relevant clinical measurement tools for lesions.

4 Lacking tools for nuclear medicine (PET/CT, PET/MR, SPECT/CT, fusion, etc.).

5 Other

Sectra’s comments: How to tackle this challenge

When reviewing oncology cases, streamlined and smart reporting forms and structured
reporting templates—together with consolidated information in one application—can
efficiently manage multiple priors as needed for patient overview when doing follow-ups.

Built-in structured reporting that can be customized to the disease or subarea facilitates
adherence to reporting guidelines, which was reported as another productivity barrier.
When it comes to structured reporting, integrated tools such as those for assisting in
tracking lesion progression over time play an important role. Sectra’s lesion tracking
tool allows for semi-automatic population of image measurements into the reports
and a structured comparison of lesions over time, which can significantly speed up oncol-
ogy case reviews and help to tackle the third biggest barrier—the lack of relevant clinical
measurement tools for lesions.
General image review/reading
Looking instead at factors related to general image review, the survey responses were
much more evenly spread. The top factors selected were that the radiologists experience
too many context switches to other systems due to not having access to relevant EMR
data in the diagnostic application (25 votes), that the system generally is too slow
(24 votes), and almost a tie between poor display protocols (21 votes) and that the
system is not easy to use (20 votes).

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2 11


Within general image review/reading, which factor(s) decrease
your productivity and flow the most when working in your
current dianostic application?
1 Too many context switches to other systems due to not having access to relevant
EMR data directly in the diagnostic application.
2 The system is too slow in general.
3 Poor display protocols that do not provide a suitable initial image layout
or cannot be personalized.
4 The system is not easy to use (too many clicks, non-intuitive, difficult to learn, etc.).
5 The system crashes too often.
6 Too many context switches to other systems due to not having access to tools I
need (AI-based tools, tumor measurements, fusion, etc.) in on user interface.
7 Other
Sectra’s comments: How to tackle this challenge
To overcome the main barrier of having too many context switches to other systems due
to not having direct access to relevant EMR data, your diagnostic application should offer
an optimized diagnostic context. It needs to provide the right information at the right
time. This is enabled by an efficient exchange of data between the diagnostic system and
the EMR. An essential first step is to ensure context synchronization and single sign-on,
which will result in significant time savings.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2
To avoid context switches when using various AI applications, access to these through
a unified marketplace will be key. A single source that provides a broad set of validated
AI applications will give you freedom to select quality-assured AI tools that meet your
demands. Such a marketplace should also ensure a seamless integration between the
diagnostic system and the AI over various parts of the workflow, including worklist triage,
tumor detection, and image analysis. Adoption of AI will be incremental, with integration
in order to gain access to a marketplace as the first step.
”Over the past two years, we have seen that the single most important aspect
of capitalizing on the efficiency potential of AI is that it is seamlessly integrated
into your everyday workflows. The need to avoid adding yet another extra step
of work or user interface cannot be overstated.”
Fredrik Häll, Vice President Product Management, Sectra
Other high-ranking barriers were systems that are too slow as well as poor display proto-
cols and the fact that the application is not easy to use. Here, a combination of adopting
smart and “forgiving” display protocols and end-to-end AI assistance is something that
will make general image review and reporting significantly easier. In the short term, as AI
matures, smart display protocols will be an important facilitator to create a more person-
alized initial image layout by considering configurations made by a specific user and
automatically adapting to the context of priors. “Forgiving” display protocols are also key
for hangings to be easily adjusted when images are not presented in a suitable way or
quickly need to be presented differently.
In regards to the application not being easy to use; one often neglected aspect is to
ensure that the user can easily configure interaction devices, such as the keypad for
breast radiologists. The ideal solution is that such devices can be configured properly in
a menu or similar function by dragging and dropping different functionality to specific
buttons. Our experience is that users love this.
Another highly appreciated usability feature is the ability to adapt the “right click” on im-
ages to the type of modality, so that you can only see the relevant tools for that specific
exam. This makes it easier to find the right tool for a specific task, saving you a great deal
of time.
12
To solve the issue of a slow system, there are of course several aspects to consider. Slow-
ness and instability should not be neglected, and finding a system that can deliver stabili- Within multidisciplinary team meetings, remote work, and collaboration,
ty is worth its weight in gold—definitely an aspect that should be part of your game plan. which factor(s) decrease your productivity and flow the most when working
Asking for proven system uptimes is a powerful way to assess how well vendors perform. in your current diagnostic application?
Also, it is often easy to forget to make sure the diagnostic application is optimized for
handling high-latency and suboptimal network conditions when working remotely.
1 Lacking access to reports and images from other specialist areas, such as
pathology and cardiology.
Multidisciplinary tumor boards, remote work, and collaboration
As mentioned earlier, the radiology experts and opinion leaders who participated in
Sectra’s roundtable discussion in April 2021 articulated the increasing prevalence of
2 Lacking built-in support for preparing MDTs/tumor boards in conjunction
with my daily case review.
MDTs and collaboration across disciplines as a growing challenge. These meetings are
not only time consuming to conduct, but also to prepare and to follow up on. Within this
area, the two highest-ranking factors hindering radiologists from feeling productive were 3 Lacking integrated functionality for following up on cases after the meeting.

the lack of access to reports and images from other specialist areas such as pathol-
ogy and cardiology (24 votes), closely followed by the lack of built-in support for pre- 4 Poor system performance when working remotely/from home.
paring MDTs in conjunction with the daily case review (22 votes). Thirdly, radiologists
lack integrated functionality for following up on cases after the meeting (18 votes). 5 Unable to make efficient presentations at the meeting.

6 Lacking integrated communications tools, such as built-in chat and video.

7 Other

Sectra’s comments: How to tackle this challenge

To truly improve collaboration across disciplines and in conjunction with MDTs, support
for integrated diagnostics needs to be adopted. Utilizing an enterprise imaging system
that includes both pathology and cardiology in the same platform as radiology makes it
easy to access each other’s images and reports—before, during, and after the MDT.

It is important that your diagnostic imaging system offers built-in support to facilitate the
steadily growing MDT preparation, follow-up, and presentation work. Enablers for remote
reading are important for remote participation in MDTs as well as for ensuring efficient
collaboration regardless of physical workplace. In both these scenarios, the system needs
to guarantee high performance and secure connections and ways of sharing patient data.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2 13

One common facilitator is to use a single diagnostic application that offers embedded
tools for efficient communication with colleagues and at the same time a high-
security connection to the diagnostic imaging system, such as a VPN or client-based
certificates.
To simplify the implementation of a comprehensive enterprise imaging system, a sub-
scription-based pricing model normally facilitates an expansion to other departments as
well as managing the growth in the number of exams.
Sectra’s comments: How to tackle this challenge
Using a single diagnostic application for diagnostics, workflow, reporting, and advanced
tools is an important enabler to overcome the two main barriers reported in this area:
the complete lack of advanced functionality for specific tasks and too many context
switches between applications. This also facilitates remote work, since you don’t have to
switch applications or workstations. Instead, you get access to all clinical tools through
one user interface, where all patient data is syncronized, without the need to log in to
several systems.

Access to advanced diagnostic tools The third biggest barrier among our respondents was poor integration with third-party
The main barriers reported by the radiologists when it comes to access to advanced
applications. To improve workflow and reading efficiency, the diagnostic application
diagnostic tools were the complete lack of advanced functionality for specific tasks
should be able to offer a comprehensive portfolio of a combination of native tools and
(28 votes), followed by too many context switches between applications due to a lack
tightly integrated third-party tools, hence minimizing the need to switch to separate app-
of integrations (21 votes), and the fact that the integration with these advanced tools
lications. This is particularly important for radiologists handling high volumes such as
is not seamless (20 votes).
breast radiologists, who need quick access to, for example, ABUS/ABVS and breast mpMRI.

When it comes to the integration of third-party AI applications, a marketplace for access

Within access to advanced diagnostic tools (mpMRI, 3D, vessel analysis, to AI applications becomes important. Not only will you be able to select the applications
fusion, etc.), which factor(s) decrease your productivity and flow the most you want, you can also be sure they are seamlessly integrated with your diagnostic appli-
when working in your current diagnostic application? cation and workflow.

1 Missing advanced functionality for specific tasks.

2 Too many switches between applications due to a lack of integrations with

advanced tools.

3 There is an integration with advanced tools, but the integration is not seamless.

4 There is an integration with advanced tools, but the tool itself is not user-friendly.

5 Not able to select and use the tools I prefer.

6 Other

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2 14

Reporting and results distribution
When it comes to reporting and results distribution, the top three barriers selected by
the radiologists were the lack of structured reporting tools (28 votes), the lack of func-
tionality to compare findings in the current exam with priors (25 votes), and poor
speech recognition software and language detection (23 votes). The fourth biggest
challenge within reporting, namely too many context switches between different
systems, was mentioned by about one-fifth of the respondents. We think this is worth
mentioning—context switches between systems seem to be a commonly mentioned
productivity-decreasing factor across all questions in this survey.
Within reporting and results distribution, which factor(s) decrease your
productivity and flow the most when working in your current diagnostic
application?
1 Lacking integrated structured reporting tools (templates, standard reports,
automated RECIST conclusions, etc.).
2 Lacking functionality to compare findings in the current exam with priors.
3 Poor speech recognition software and language detection.
4 Too many context switched due to separate systems for image review
and reporting.
5 Unable to link findings in the images to the report.
6 Other
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 2
Sectra’s comments: How to tackle this challenge
The lack of structured reporting tools was the top challenge reported by the radiologists
in this survey. Support for structured reporting templates together with supporting tools
such as assistance for tracking lesions over time will be very helpful to increase produc-
tivity and enhance the workflow. For example, image measurements can easily be popu-
lated into the structured report and compared with findings over time. These technolo-
gies, combined with consolidated information in one application, will also help overcome
the second biggest barrier—the lack of functionality to compare findings in the current
exam with priors.
“With our structured reporting capabilities, we are not only able to provide a very
powerful structured reporting environment for the radiologist, and consistent
high-quality reports for the referring physician, but also to automatically store the
structured data in national quality registries and databases. This saves both time
and manual work, and increases data quality and consistency.”
Fredrik Häll, Vice President Product Management, Sectra
To tackle the issue of poor speech recognition software, having a single diagnostic appli-
cation for diagnostics, workflow, reporting, and advanced tools will help. So-called PACS-
based reporting is often perceived as a way of streamlining the reporting workflows and
is something we see being increasingly adopted, in particular in Europe.
Streamlined and smart reporting that offers one application for image review and report-
ing will address the challenge of too many context switches—mentioned by about a fifth
of the respondents.
15
CHAPTER 3

The current adoption status of these technologies and

diagnostic tools—and which to add to your game plan
What we can conclude is that the technologies and diagnostic tools covered in the pre-
vious editions of “The Radiologists’ Handbook” can be used to overcome several of the
main barriers that radiologists currently rank as most influential in hindering productivity.

In the second part of the survey, we asked the radiologists to assess their current imple-
mentation status in each of these technology areas. We did so in an attempt to identify
gaps where radiology as a whole seems to have improvement potential in regard to
performance and efficient workflows by moving forward in the adoption journey.

On the next page is a summary of the aforementioned technologies and diagnostic tools
together with an estimation of the current implementation status of each. Here’s what we
found.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 3 16

 40% or more “already done” 20–40% “already done” <20% “already done”

Current implemention status Already Will be done within Not Current implemention status Already Will be done within Not
done two years or currently considered done two years or currently considered
investigating investigating

Enabler for remote reading: Enabler for remote reading: one application
54% 10% 4% 31% 17% 19%
secure connection A single diagnostic application for
High-security connection to the diagnostic diagnostics, workflow, reporting, and
imaging system, such as a VPN or client- advanced tools—reducing the need to install
based certificates. all applications on all workstations.

Structured reporting Integrated diagnostics 29% 43% 13%

47% 40% 9%
Built-in support for structured reporting Pathology and cardiology as part of the enter-
templates that can be customized and where prise imaging system to access each other’s
image measurements can be easily populated. images and reports.
This can, for example, be beneficial in com-
bination with lesion tracking tools that keep
track of and present lesion measurements Workflow orchestration, 28% 32% 10%
managing worklists
over time in a structured manner—a powerful
Distributing the right exam to the right
time-saver.
radiologist based on a set of criteria and
tailored for each department’s needs.
Enabler for remote reading: communication 46% 12% 10%
Embedded tools for efficient communication
with colleagues, such as a built-in chat Workflow orchestration, analytics 24% 34% 7%
functionality in the diagnostic application. A customizable analytics dashboard that
provides an overview of exam distribution
and performance.
Enabler for remote reading: 44% 11% 7%
network conditions
A diagnostic application that is optimized Smart display protocols 22% 58% 12%
for handling high-latency and suboptimal More personalized initial image layout by
network conditions. considering configurations made by a specific
user and remembering earlier set-ups.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 3 17


Current implemention status Already
done
Streamlined and smart reporting 18%
One application for image review and
reporting to minimize context switches
(PACS-based reporting).
Optimized diagnostic context 13%
Efficient exchange of data between the
diagnostic imaging system and the EMR,
making all relevant clinical information visible
directly in the diagnostic application.
“Forgiving” display protocols 12%
Image layouts can easily be changed when
the initial suggestion is not appropriate.
End-to-end AI assistance 9%
Having a marketplace that provides a broad
set of quality-assured AI applications. These
are seamlessly integrated and provide AI
assistance in various parts of the workflow
(worklist triage, tumor detection, image
analysis, etc.).
Subscription-based pricing models 6%
The pricing of the diagnostic imaging
software is subscription-based and linked
to current volumes. Subscription-based
pricing models also facilitate an expansion
to other departments without the need to
buy additional licenses.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 3
To summarize, the technologies and diagnostic tools with the highest rates of “already
Will be done within Not
implemented” among our survey respondents are high-security connection to the diag-
two years or currently considered
investigating
nostic imaging system (54%), structured reporting (47%), and embedded tools for effi-
cient communication (46%). Those with the highest rates of “will be implemented within
57% 15%
two years or currently investigating” are smart display protocols (58%), streamlined and
smart reporting (57%), and end-to-end AI assistance (55%). This is in line with our previ-
ous predictions (refer to “The Radiologists’ Handbook” published in 2019 and 2020), and
can give you some hints as to which technologies to take a closer look at when creating
your post-COVID game plan to tackle future workload challenges.
33% 15%
Something worth highlighting is the growing interest in subscription-based pricing mod-
els, where the current adoption rate is very low (6%), but almost 40% of the respondents
expect to make that transition within the next two years or are currently investigating it.
This development will significantly accelerate the adoption of other new technologies,
as it facilitates the extension of existing contracts to include more modules and new
functionality.
17% 21%
In the following section, we dig deeper and categorize all these technologies and IT tools
based on when to implement them. In your game plan, they should preferably be sorted
into three categories: adopt now, trial, and assess.
55% 25%
38% 25%
18
Analysis of technologies with the highest potential Currently investigating or will be done <2 years
The technologies that are largely “already implemented” or “will be implemented within
two years or are currently being investigated” are categorized as high-potential. Scoring
the technologies based on how the survey respondents assessed their implementation
status provides an indication of which to adopt now, which to trial, and which to assess. 60%
Smart display protocols
Our overall analysis can be seen in Figure 6. Streamlined and smart reporting
End-to-end
AI assistance
To summarize, the high-potential candidates from the analysis
to add to your game plan are: 50%

1. End-to-end AI assistance Integrated diagnostics

2. Streamlined and smart reporting 40% Structured reporting

Subscription-based pricing models
3. Smart display protocols
Workflow orchestration, analytics
Optimized
4. Integrated diagnostics diagnostic context Workflow orchestration,
30% managing worklists
5. Structured reporting

6. Enabler for remote reading: secure connection

20%
“Forgiving” Enabler for remote reading:
display protocols one application
Enabler for remote reading:
communication
Enabler for remote reading:
10% network conditions Enabler for remote reading:
secure connection

Assess Trial Adopt

10% 20% 30% 40% 50% 60% Already done

Technologies to adopt now

Figure 6. Implementation status among the survey respondents.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 3 19

CHAPTER 4

Best practices from fellow radiologists when

adopting new, productivity-boosting technologies
As a final add-on to your game plan, we will share some of the best advice and best
practices received when asking a handful of radiologists about implementing new tech-
nologies to overcome productivity killers. We asked them four questions and you can
see their top advice below.

Responses in this chapter are provided by:

» Radiologist from a university hospital in the southeastern U.S.

» Radiology Chair from a university teaching hospital in the midwestern U.S.
» Prof. Dr. med. Andreas F. Kopp, Chief Physcian and Head of Department,
Clinic for Diagnostic and Interventional Radiology, Krankenhaus Düren, Germany

» Dr. Christopher Chan, IT Portfolio Executive, Partner, and Neuroradiologist,

Mayfair Diagnostics, Canada

» Dr. J.M. Bisselink, Radiologist, Alrijne Ziekenhuis, the Netherlands

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 4 20

 What new technology/diagnostic IT tools have you implemented in your PACS or enterprise imaging system
in the last couple of years that have increased your productivity? What gains have you experienced?
Radiologist from a university hospital
in the southeastern U.S.
» Enhanced integration between our
VNA and our EMR. This allows our
providers that acquire DICOM and
non-DICOM imaging but do not
follow an order-based workflow
(encounter-based) to use worklists
generated based on their clinic
schedules, obtain imaging, and
upload it directly to the VNA in
patient context.
» AI algorithms for image-based
diagnosis assistance, especially in the
emergency setting for triage cases
that might have findings but are not
the oldest studies on our worklists.
» A workflow analytics dashboard that
tracks all HL7 and DICOM data in our
system to better track KPIs.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 4
Radiology Chair from a university
teaching hospital in the midwestern U.S.
» Our radiology IT team supports over
70 applications, and we have multiple
AI tools either in use or in the
implementation stage. One AI app-
lication we use is to create chest
images without the bones. Another
module is for lung nodule detection
on CT studies. These help to increase
the confidence of the radiologists
when reading chest radiographs,
which contributes to a faster turn-
around time.
» We are exploring ways to transfer
quantitative data from our ancillary
applications into the radiology report
automatically. Automatic transfer of
numerical data into the report saves
time and reduces the likelihood
of error.
Prof. Dr. med. Kopp, Krankenhaus Düren
» Equipping all radiologists with full-
fledged teleradiology workstations
(several diagnostic monitors, monitors
for RIS, HIS, digital dictation, etc.). This
has enabled individual employees to
have a fully equipped home office,
even in quarantine under pandemic
conditions, for example. The Sectra
PACS has proven ideal for this, as it
provides exactly the same working
environment remotely as in the hospital.
» The built-in chat function. This has
facilitated communication within the
radiology clinic without the need for
additional phone calls, even with
employees in home offices.
» Powerful, flexible, and integrated speech
recognition that enables voice input
in all applications at all levels, which
increases productivity.
Dr. Chan, Mayfair Diagnostics
» A complete new enterprise imaging system
from Sectra. Compared with our prior PACS, it
is far faster (especially loading imaging studies)
and has better display protocol features to help
radiologists interpret studies more efficiently.
Sectra’s free fields have allowed several of our
workflows to become paperless. The native
post-processing features enable radiologists to
seamlessly use these tools during study inter-
pretation without switching applications, manu-
ally pushing studies to these other applications,
or waiting for technologists to send post-
processed images.
» Structured reporting for ultrasound. This has
digitized our tech sheets and allowed many of
our standardized report templates to pre-
populate, saving the radiologist a significant
amount of time that was previously spent
transcribing measurements and other details
from the tech sheets into our reports. It has also
allowed us to create standardized digital tech
worksheets that generate standardized scores
and recommendations in our reports to ensure
we follow the latest reporting and data system
guidelines (such as BI-RADS, TI-RADS). Most
importantly, it allows the radiologist to focus on
the images and interpretation. This has easily
resulted in at least 30–40% less reporting time
per study.
Dr. Bisselink, Alrijne Ziekenhuis
» We have a number of packages in use
for which we previously relied on tools
from other vendors, such as vessel
analysis, bone reconstruction, and
other rendering tools. The fact that
we no longer need to launch separate
software and bring studies in there
saves us a lot of time.
» Being able to create standard reports
and the use of limited structured
reporting also saves us time.
» We find that workflow integration with
Sectra is essential, not least now as
the market is bombarded with AI
tools providers.
» Tools to add links to measurements
within reports are used daily for
discussions.
» We have also started to use integrated
speech in the PACS. This allows us to
achieve a slightly better desktop layout
and thereby minimizing mouse milage.
21
 Based on your experience, is there any advice or best practices you could share with other radiology
professionals who are in the process of evaluating or implementing such new technology/diagnostic IT tools?
Radiologist from a university hospital in the
southeastern U.S.
» Do your homework and take your time! Do due
diligence! An ounce of work up front will save you a
lot of hassle later on. Create an RFI asking your most
important questions before bringing in vendors.
Then, only demo the vendors that meet your RFI.
» Then, create an RFP that really answers your ques-
tions. Do not hesitate to use the first part of the RFP
to tell vendors your situation, problems, and use
cases. If you like what you see in the RFP, bring no
more than three top vendors to do a big demo.
Give them de-identified images to show, so you
can see how your imaging looks. Make sure lots of
your people attend. Do not hesitate to ask questions
and request a follow-up. A good vendor partner
will answer.
» Before choosing your vendor of choice, re-review
everything.
» And one last thing, have your budget process started
when you begin this process; you do not want to find
your solution and have no money.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 4
Radiology Chair from a university teaching hospital
in the midwestern U.S.
» Every institution is unique and an analysis of the
who–what–when–where–why of a new application
is a good starting point.
» Who will be using the software; what are the applica-
tions—FDA and not FDA approved
» When will we use it—24/7 or at specific times because
of the need for human interaction.
» Where will we use it—ED? Outpatient? Inpatient?
Everywhere?
» Why are we implementing it?
» In larger institutions, there is a temptation for radiol-
ogists to gravitate towards new systems like shiny
bits of metal attract birds. A clear understanding of
available modules that accomplish the same task
from an existing application may obviate the need
for a new system. Ultimately, this can be cheaper
because the total cost of ownership is reduced when
new functions are added to existing systems versus
adding completely new systems with a similar func-
tion into your portfolio. This is a challenge we are
grappling with now and falls into the task of “applica-
tion stewardship” which we are formalizing.
» Radiologists and others also need to understand
the funding model.
Dr. Chan, Mayfair Diagnostics Dr. Bisselink, Alrijne Ziekenhuis
» Ensure you have comprehensive flow charts and » Always let workflow integration be one of the main
other artifacts to document your practice’s current pillars of any new application—otherwise it will not
workflows to help you identify pain points. be used (enough), regardless of how good the tool
itself is.
» Consider everyone in your organization (such as
patient experience coordinators, operations staff,
your information technology team, techs and radiol-
ogists) in your analysis because a trivial issue may
result in many significant downstream inefficiencies.
» Do a full market search for potential solutions to
solve barriers to productivity.
» The RFP process is an excellent educational expe-
rience to gain a comprehensive understanding of
potential solutions. Ensure you allocate enough
time to complete the project. Also, ensure you have
the right in-house/contracted expertise to assess
and implement the solution and include all relevant
stakeholders in the implementation process.
» Do not underestimate the value of appropriate
organizational change management.
22
 In your opinion, where will we find the most promising developments within radiology IT to improve
productivity and workflow efficiency within three to five years? Can you give a concrete example?
Radiologist from a university hospital in the
southeastern U.S.
» AI on all different levels. For example, AI that reduces
clicks to get the imaging done and quality checked on
the modality level, before it comes into the PACS, AI
that helps sort worklists, and AI that digs through the
EMR to provide the information radiologists need to
make the correct interpretation. If these things occur,
time spent by highly paid radiologists and technolo-
gists will be spent on what they are paid to do best.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 4
Radiology Chair from a university teaching hospital Prof. Dr. med. Kopp, Krankenhaus Düren Dr. Bisselink, Alrijne Ziekenhuis
in the midwestern U.S.
» Any activities we can promote to transfer information » Make the patient and referring physician portal » Using integrated AI to provide normal standard
from applications into the radiology report should be mandatory for exchanging information before and examinations with a standard report and enabling
a top priority for radiology departments. after the examination. rapid review of these to cope with the increasing
volumes could be one of the more important devel-
» We must be conscious of “fatigue alert” and the dan- » Uniform digital transmission of findings and images opments. For now, I don’t see AI reporting complex
ger of providing too many distractions to the radiol- from the PACS to national registries.
MRIs or CTs by itself within the next three to five
ogist. So AI alerts need to be tuned to the urgency
years.
of the information. We must also understand how
we can keep radiologists’ eyeballs on images and not
on alerts or voice recognition systems. The constant
back and forth is fatiguing, reduces focus, and
decreases productivity.
» Ultimately, there is a limit to how many studies a
radiologist can safely read in a day. How do we max-
imize productivity without making the radiologist feel
like a line worker in a Detroit auto plant?
23
 What particular technology/diagnostic IT tools do you think radiology professionals need to adopt in
order to tackle the massive imaging volume growth and to be successful in the post-COVID era?
Radiologist from a university hospital
in the southeastern U.S.
» Update to a new PACS that has a VNA
back end so all imaging is available in
one place—a PACS that has all the tools
available instead of piecemeal third-
party applications, that integrates with
AI seamlessly, and that can view all new
DICOM standards that are out there.
This will be the foundation upon which
to place the AI algorithms, cloud-based
dictation software, and other applica-
tions.
» It should not require additional mini-
PACS for subspecialties. Instead it
should offer the workflow help—like
communication and tumor board
tools—to get all of the radiologists’
work done.
E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 4
Radiology Chair from a university teaching
hospital in the midwestern U.S.
» Embrace AI fully but cautiously. AI
will not replace radiologists, but it will
change the way in which we acquire
images, interpret studies, and manage
our workflow. We need to learn more
about it by implementing systems and
learning how they work in our own
unique microclimates. Get started today.
» You cannot manage what you cannot
measure. Invest in reporting tools that
enable you to monitor your business.
Do not rely exclusively on the numbers
because they do not portray the human
aspects of your business and, although
it sounds like a cliché, people are your
greatest asset.
» Invest in training. Work with your PACS
vendor to improve your workflow. It may
be worthwhile engaging their help as a
set of fresh eyes even if you have had a
system in place for years. You may be
amazed at the tools you have at your
disposal but never use.
Prof. Dr. med. Kopp, Krankenhaus Düren
» AI tools must be uniformly available
under one interface in the PACS
and should facilitate and accelerate
reporting. Proof of the return on invest-
ment will be necessary for large-scale
adoption.
» Workflow orchestration to assist with
prioritization of studies for reporting in
case of a high workload.
» Full integration of tools for oncology
reporting (lung round detection, tumor
volumetry during progression, etc.) in
the PACS to facilitate and accelerate
reporting.
» Tools for quality assurance and support
for a second reader workflow.
Dr. Bisselink, Alrijne Ziekenhuis
» In addition to the AI support covered
in the previous question, I would say
automating comparative studies (on-
cology control, MS control). Ideally this
should be easy to do via right click or
even already automatically built into the
existing workflow.
Dr. Chan, Mayfair Diagnostics
» Workflow orchestration: for automatic distribution of the right studies to the right
radiologists at the right time
» The tool should be able to learn appropriate workload balancing based on each radiology
group’s practice characteristics. For example, a dynamic RVU table that adjusts depending
on the radiology group’s median reporting time in the past three months.
» Smart triage tool that assesses imaging studies for the most urgent pathologies.
» The solution should permit user feedback and automatically learns from this.
» It should also include gamification of this process to motivate.
» Smart display protocols
» Learns how each radiologist arranges their images for each study type.
» Learns what tools a radiologist uses for each study and in what order.
» Ability to discern the series type from the image itself and not only from the DICOM metadata.
» Natural language processing (NLP) applications in radiology reporting
» Auto-populate report impression based on text in the findings. This would include the most
relevant best practice recommendations and automatically send stat results notifications
to the appropriate clinicians.
» Automatically summarize clinical information on the provided clinical history and prior
radiology, pathology/lab reports, and consult notes.
» Smart imaging protocols that reduce imaging time and radiation and IV contrast dose.
» Smart scheduling software that is integrated with our RIS and with referring clinicians’
medical information systems to schedule the right study at the right clinic with the right
techs and the right radiologists at the right time for the clinic and the patient.
» Teleradiology optimization to permit efficient study interpretation from
remote locations.
» Have robust, secure built-in/linked communication tools to quickly contact clinicians
and patients and discuss and show imaging findings in real time.
24
CHAPTER 5

Summary—time to put your game plan together

It is now time for you to create your game plan to make sure you will be able to manage
the growing volumes in the post-COVID era and the increasing demands from cancer
care. In this report, you have been given insights into the biggest productivity barriers
assessed by some 70 radiologists. By studying these barriers, we hope to help you in the
process of identifying your own bottlenecks and the areas where new technologies are
likely to have the biggest impact.

Next, you can look at the technologies mentioned in Chapter 2 as possible solutions to
overcome each barrier. Based on these, you can create a list of IT tools to add to your
diagnostic imaging environment as part of your technology adoption game plan.

The third step will be to look at the analysis in Chapter 3, which gives you an idea of how
far the surveyed radiologists have come in their implementation as well as an estimate
of how mature and widely available the different IT tools are. This will provide you with
insight into the ideal timeline for implementation based on three categories (adopt now,
trial, or assess) in order to mitigate those identified barriers.

In the last chapter, we provided hands-on advice from a handful of radiologists. In their
own words, they shared how they successfully implemented some of the technologies
discussed in this report and hopefully provided you with ideas on other areas of action
to add to your game plan. These ideas can be used as guidance or simply as inspiration
when creating your game plan.

Finally, with a game plan in place, you will be well prepared for the future. The next step
will be to initiate a dialogue with your colleages and your current or future imaging ven-
dor to put your game plan into action. Ultimately, we hope that this report will help you
achieve a better and more enjoyable work–life balance, experience less stress about
future demands, and increase your capacity to help more patients.
Join Sectra at RSNA 2021
—in Chicago or virtually!
For more information and
demo requests:
medical.sectra.com/rsna.

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN — CHAPTER 5 25

Related resources for further insights and experiences
Suggested additional reading

» Case story: An imaging system providing Related on-demand

“flow” in radiology diagnostics [April 2021]
seminars
» Be ahead of the curve with modern
integrations and structured data
exchange [March 2021]

» Integrated diagnostics is here to stay

—how HSS’s single platform implemen-
tation succeeded [March 2021]

» How to justify an investment in AI

—let’s address the elephant in
the room [March 2021]

» AI in clinical use today [Dec. 2020]

» Case story: A radiologist’s report » Implementing AI in clinical radiology
» Article: European trends in on working from home during the [July 2020]
diagnostic radiology [May 2021] COVID-19 crisis [April 2020]

» Case story: Coping with rising demand » Case story: The value of
—how radiologists are fighting back customizable structured
with tech [Aug. 2020] reports in radiology
reading [Dec. 2020]

» Case story: Adopting workflow

orchestration software helps to
improve efficiency and quality across » Case story: Artificial intelligence—
large healthcare system [Aug. 2020] experience from the breast imaging field
[Aug. 2021]

E-BOOK: RADIOLOGY POST-PANDEMIC GAME PLAN 26

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