What: Many patients with respiratory symptoms are sent by their Family Doctor or Primary Care Physician for an initial chest x-ray. However, those patients where the chest x-ray demonstrates evidence of cancer, must then wait for the chest x-ray to be reported before they can be sent for a high resolution chest CT which will act as the primary diagnostic method to confirm the initial find of Ca Chest.

In this circumstance an AI chest x-ray tool can be used by the Rad Tech or Radiographer to identify patients with a positive AI finding of Ca Chest, and then arrange for them to have a same day or next day CT Chest to speed up the diagnostic process.

Why: Workflow Optimisation: A same day CT removes the interim steps that are incurred during the chest x-ray reporting time, and the administration time for the subsequent CT. This substantially reduces the time to primary radiological diagnosis for the patient.

Clinical Benefit: These efficiencies could deliver a marginal improvement in the survival rates via earlier staging, but there is no clear evidence of this.

Operational Benefit: The AI tool can be connected with whatever system is generating the reporting worklists so the Chest x-ray and the CT Chest can be prioritized for earlier reporting. Relieving the bottleneck for urgent cases.

Patient Experience: Although the patient has to be told the worrying information that they need a same day CT. The overall patient experience is enhanced because they can rapidly move on from diagnosis to treatment planning without having to wait a long time for their imaging results.

How: Cost: Generally, the cost of the service will be based on the number of studies per year that will be analyzed, and the pricing structure set by the supplier. 

Information Governance: Routine conditions for your country and organization. The service will tend to be offsite, so the location of the servers will be an issue, and the confidentiality of the patient’s clinical information. 

Systems Integration & Setup: A virtual server will need to be stood up to support a gateway server. The getaway server will connect your PACS with the supplier’s off-prem service through your organizations firewall. Any integration to facilitate worklist prioritisation will also be managed through the gateway server. Lastly, a priority service must be set up by your PACS supplier to send all the relevant chest x-rays to the gateway server as soon as they are archived to ensure an analysis turnaround time under 30s.

Change Management: The overall patient pathway stays the same, but the process of a same day (or next day) CT must be set up and managed. It is also useful to provide explanatory information for the patients which can be read while they are waiting for their CT. 

Primary Workflow Integration: The positive or negative Ca AI finding is provided to the Rad Tech or Radiographer via a stand-alone app on their workstation, after image review and archiving. The result should be available within 30s, the Rad Tech (or assistant) then takes the patient to CT to see if they can accommodate a same day or next day HRCT of the chest.

Secondary Workflow Integration: The results from the AI chest app can be fed into whichever system is providing the reporting worklists, so that the worklists can prioritise the Ca positive chest x-rays and CT Chest examination for immediate reporting.

Clinical Safety & Patient Care: The patient is receiving potentially negative information when they are told they need an urgent CT, so explanatory information about the benefit of the fast-track service is helpful.

Ideally, the aim is to have the chest x-ray and CT chest reported and electronically returned to the referring doctor before the patient leaves the CT scanner.