Command centers are key to operating remote imaging equipment
What made the remote operation of magnetic resonance and computed tomography equipment emerge as an innovation and become a great differential in Brazil and in the world?
We live in a time of great demand, costs, and access challenges in the healthcare sector, leading to a need for efficient, safe, and effective technological advances. In addition to population-ageing, the urgency of new technologies in the field is largely due to the COVID-19 pandemic, which brought a huge change in requirements, demands, and models of healthcare assistance all over the world. Telehealth gained unprecedented strength, with great innovations in the field of radiology and diagnostic imaging.
We have noticed a constant increase in the demand for computed tomography (CT) and magnetic resonance imaging (MRI), which is not accompanied by the quantity and territorial distribution of available equipment, nor by the number of qualified professionals available to operate them, including radiologists, technologists, technicians, and biomedical doctors.
Data prior to the pandemic already showed, in a study presented at the 2021 RSNA conference, that the growth in demand for imaging tests in the United States had been around 5% greater than the capacity to train new radiology professionals between the years of 2012 and 2019.
In Brazil, the increase in demand is confirmed by the growing number of diagnostic imaging services. Data from the 2021 Brazilian Association of Diagnostic Medicine (Abramed) panel show that at the end of 2020 there were approximately 24,500 establishments linked to the activities of diagnostic and therapeutic healthcare services in the country. Of this total, around 6,000 (24.7%) were from diagnostic imaging service units. The panel points to a growth of more than 10% in the sector in the last ten years.
The technology related to remote operation, both for CT and MRI, comes with the possibility of increasing the number of exams offered, better quality of care, lesser errors, a larger number of exams performed and, last but not least, reducing the idle capacity of CT and MRI equipment installed in clinics, hospitals, and imaging centers. With this technology, it is possible to carry out exams at alternative times and days (such as at nights and on weekends), and concentrating the operations center in a single location, with the best in terms of quality and capacity of highly trained professionals who operate the equipment, following strict and constantly updated protocols.
This remote operation, which we will call command centers, leads to greater quality, due to the possibility of training and standardizing protocols, and patient safety, both in relation to the examinations acquisition and to what is delivered as a result of the process to the patient; this requires a series of changes in the institution's workflow, team training, and technologies.
Many important steps are already being taken to make command centers a support to local operations, such as the update of the safety manual for MRI operation, produced by the American College of Radiology (ACR). The next update will include remote operations as a requirement for greater quality and safety for patients. Likewise, a recent Brazilian resolution of 2022 establishes healthcare requirements for the organization and operation of diagnostic radiology services in the country, with a specific section on teleradiology and remote control of equipment, emphasizing patient safety and the importance of direct communication with the operator.
A real-life example in Brazil
iDr – Inteligência Diagnóstica Remota, is a health tech of Alliança Saúde, one of the biggest diagnostic companies in Brazil, with more than 100 patient service units and MRI equipment. iDr started its operations in 2015, with a few machines remote controlled as a proof of concept. One year later, there were 30 connected equipment, at that time of a single vendor. After the development of dedicated technology with a local partner, the operations have scaled up and reached almost 150 CT and MRI equipment of different vendors, configurations, and models, performing more than 900,000 examinations annually. There is total control of the machines, either using a digitized system or with the support of analogic systems, using little robots which reproduce a local operator’s actions. There is also a chat system with our medical team and the possibility of screen sharing in real time to clear doubts and improve acquisition protocols.
Our system is fully compliant with the Brazilian general data protection law, ensuring that no medical information goes outside the client's site, making the operation light and completely secure. Operating environments are connected by direct VPNs and dedicated networks, and all sites have a redundant electrical network through UPSs and generators, thus avoiding loss of connection due to power outages.
The biggest advantages of our command centers are:
- No absenteeism, as an equipment can be exchanged among specialists in case of personal absence.
- The possibility of performing complex examinations at all sites.
- A centralized supervision, saving travel and accommodation expense.
- The low recall rate (below 0.6%), since our specialists are of senior level, with greater knowledge and experience.
- Reduction of sick leaves and the possibility, for pregnant professionals, to keep working during most of their gravidness.
- Cost-reduction when compared to a fully local operation.
The great challenge for the near future in healthcare is to resolve access, high demand, and limited resources. This brings us the “remote – local” paradigm: the transition from an examination performed entirely on site to a hybrid model of operation: local, with greater focus on the patient, and from a distance, with a highly specialized remote control.
References:
1. Avgousti S, Christoforou EG, Panayides AS, et al. Medical telerobotic systems: current status and future trends. BioMed Eng OnLine 15, 96 (2016). https://doi.org/10.1186/s12938-016-0217-7
2. Scheffer M, Cassenote A, Guilloux A, et al. O perfil do médico especialista em Radiologia e Diagnóstico por Imagem – São Paulo: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2019. 179 p.
3. Henderson M. Radiology Facing a Global Shortage. Specialty affected by COVID-19, aging population, and demand for imaging. RSNA 2021. Available at: https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage
5. Abramed (Associação Brasileira de Medicina Diagnóstica). Painel Abramed 2021 - O DNA do Diagnóstico. Available at: https://abramed.org.br/publicacoes/painel-abramed/painel-abramed-2021-o-dna-do-diagnostico/
6. OECD. (2022). Health Care Resources: Medical technology. Available at: http://stats.oecd.org/
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Article written in partnership with José Leovigildo Coelho and Franco Morais.
Publicado na coluna de abril de 2023 na The Yuan.