Relieving workforce stress through streamlined workflows, enabled by AI

By Anna Colvin, AuntMinnie.com contributing writer

June 2, 2022 -- The challenges faced by radiology departments today increasingly revolve around workforce shortages. The COVID-19 pandemic has exacerbated this situation, highlighting the need for imaging departments to work with more efficient systems that optimize their workflows.

One such system is Philips CT Smart Workflow, available on the Incisive family of scanners. This package of AI-enabled tools supports all members of the radiology team during the entire examination process. From patient setup to image acquisition and postprocessing, Philips CT Smart Workflow enables a seamless experience for staff and patients every day to deliver precision in dose, speed, and image quality.

Chest scanned on incisive CT and reconstructed with Precise Image
Chest scanned on incisive CT and reconstructed with Precise Image using 80 kVp, 35 mAs, CTDIvol 0.8 mGy, DLP 33 mGy*cm. Images courtesy of Philips.
Joel Greffier
Dr. Joel Greffier.

CT Smart Workflow received clearance in most markets in 2021 with U.S. Food and Drug Administration 510(k) clearance following in 2022. Earlier this year, Nîmes University Hospital in southern France deployed the solution on their Incisive scanner.

"We're thrilled," said Dr. Joel Greffier, medical physicist at Nîmes University Hospital "It's quite a big leap forward, we've had very good first results. The radiologists immediately appreciated the quality of the images and it's been very well accepted among the team."

A more fluid experience -- right from the start of the exam

The impact of CT Smart Workflow starts the moment the patient lays on the examination bed with Precise Position, a fully automatic feature that helps radiographers position the patient for a scan. An infrared camera placed above the scanner's couch detects 13 reference points on the body and reconstitutes the shape of the patient with the help of AI. The algorithm then sets up the scanning range and adjusts the table based on patient habitus.

Djamel Dabli
Dr. Djamel Dabli.

"Compared with previous technology, it's much more fluid and intuitive," said Dr. Djamel Dabli, medical physicist at Nîmes University Hospital. "The camera is quite reproducible and suggests the same position with a deviation of 1.5 mm, whereas manually the standard deviation is 9 mm."

The use of Precise Position can improve the accuracy of vertical positioning by up to 50%, improve consistency from user to user by up to 70% and reduce patient positioning time by as much as 23%.1 These benefits not only support staff workflow but also patient satisfaction given the enhanced experience and reduced number of scans due to efficient scan setup.

"The control panel and functionalities have been moved from the scanner to the bedside, so radiographers don't have to run back and forth to the control room," according to Dabli. "They can focus more on the patients, who greatly appreciate having the technologists near them during the scan. The precise positioning and detection of landmarks means one click less for the operator. In the end, we have something much more fluid and easy to operate."

Automatic positioning also helps significantly reduce interoperator variability, the team found in a comparative study performed on phantoms.

Customized image appearance to boost reader confidence

Another AI-enabled advancement of CT Smart Workflow is Precise Image. This feature allows users to simultaneously reduce dose, reduce noise, and improve low-contrast detectability2. With previous approaches, these would all come with tradeoffs -- and often be accentuated further by changes to texture that would make the images look less natural and result in reconstruction times that just couldn't support patient volumes.

Renal stone protocol scanned on Incisive CT reconstructed using Precise Image using 120 kVp, 48 mAs, CTDIvol 6.2 mGy, DLP 349 mGy*cm.
Julien Frandon
Dr. Julien Frandon.

Precise Image has overcome these tradeoffs using trained neural networks to preserve the natural look and feel of images while delivering reconstruction times that allow advanced imaging to become routine.

"The tool allows us to have different image readings that are of sufficient quality for diagnosis depending on personal preferences," said radiologist Dr. Julien Frandon. "Just like personalized medicine for patients, with personalized treatments, we're starting to have personalized medicine for radiologists, and we can choose the image quality we like."

Precise Image offers five levels of image reconstruction that users can choose depending on the situation and their own preferences.

Mark Olszewski
Mark Olszewski.

"Over the years, we've found that when an image reconstruction technique takes images that people are used to working with and alters the way they look, for example making them appear more artificial, adoption is much slower," said Mark Olszewski, product management leader for CT and Precision Diagnosis at Philips. "With Precise Image, radiologists are able to take advantage of the improved image quality and lower dose while tailoring the appearance to their liking. This can improve reading time because it builds confidence."

At Nîmes, the team collectively decided to reconstruct all the images with a single setting.

"Everyone agrees that two of the filters improve image quality, but we had to decide which to use," Frandon said. "It's like wine, some people prefer Burgundy, others Bordeaux. With the one we chose, called Smooth, we have a good table wine that everyone likes."

Surpassing expectations

CT Smart Workflow brings AI-driven advances to deliver intellect at every step, elevating performance to enable facilities to meet their clinical and operational needs.

"We did not expect to have such a perfect result," Greffier said. "We're quite satisfied and the radiologists are bluffed by image quality. Image protocols are already optimized, that took us two to three months instead of the average six months."

David Corcos
David Corcos.

Ultimately, the final goal with CT Smart Workflow is simple: achieving a faster diagnosis that will lead to better patient care.

"Our goals are first-time-right diagnosis and accelerating scan times to free up time for physicians and technologists, that's the number one priority now," said David Corcos, business leader for precise diagnosis in Western Europe. "Every time, we look at what kind of technology we can bring in to help gain some acquisition and interpretation time and better workflows for the patient to get better outcomes."

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.

Footnotes

  1. Based on Philips in-house assessment by five clinical experts, comparing manual versus Precise Positioning in 40 clinical cases using a human body phantom.

  2. In clinical practice, the use of Precise Image may reduce CT patient dose depending on the clinical task, patient size, and anatomical location. A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. Dose reduction assessments were performed using reference body protocols with 1.0-mm slices at the "Smoother" setting and tested on the MITA CT IQ Phantom (CCT189, The Phantom Laboratory) assessing the 10-mm pin and compared to filtered-back projection. A range is seen across the 4 pins, using a channelized hoteling observer tool, that includes lower image noise by 85% and improved low-contrast detectability from 0% to 60% at 50% to 80% dose reduction. NPS curve shift is used to evaluate image appearance, as measured on a 20-cm water phantom in the center 50 x 50-mm region of interest, with an average shift of 6% or less. Data on file.


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