The UK is facing a sustained shortage of radiologists across the country, which is having a devastating impact on patients and the healthcare system. Currently, the NHS is short of nearly 2,000 radiologists and 200 clinical oncologists, numbers which the UK’s Royal College of Radiologists (RCR) says could hit 6,000 and 700 respectively within just nine years.
The NHS is currently facing the biggest backlog in its history, expanding to all areas of medicine from surgery to general practice appointments. Around a third of patients are currently waiting over six weeks or more from referral for diagnostic imaging procedures like MRI and CT scans, with some waiting as long as three months.
While the NHS has been criticised for years for its long waiting times, the Covid-19 pandemic and suspension of elective procedures during 2020 is largely to blame for the dire straits the healthcare service now finds itself in.
Dr Struan Wilkie, a radiologist based with NHS Grampian , says: “Before Covid, demand was increasing year on year. Overnight, it was like someone suddenly switched off the tap – the response was to shut everything off and only concentrate on emergencies.
“But that doesn’t stop cancer and it doesn’t stop any other potentially life-threatening conditions patients may have. We’re only now starting to see the ramifications. Patients are presenting with cancers that six months ago may have been curable but now are inoperable or untreatable.”
Medical school in the UK usually takes five to six years, followed by a two-year foundation training programme and then five years of specialist radiology training – meaning sourcing the next generation of radiologists isn’t something that can happen overnight. But a number of tech companies say their novel technologies, while not a silver bullet to fix the problem of the UK radiologist shortage, could go a fair way toward plugging the gaps in the system.
Teleradiology can facilitate smarter working
Teleradiology is one area where tech companies are stepping in to shoulder some of the burden NHS radiology services are facing. While the term conjures up images of patients undergoing screening and scans from the comfort of their own home, teleradiology simply refers to transmitting and displaying radiological images to a second location. Many teleradiology services are now partnering with NHS Trusts to step in when their radiologists are at capacity and need support to complete their caseload.
Hexarad, a teleradiology firm that recently received £1.7m to expand it services, works with NHS Trusts as well as private healthcare providers in the UK to provide support when demand outstrips supply.
The company has a network of radiologists around the country. When any healthcare provider it partners with reaches capacity, a member of the Hexarad network can step in and provide a report on any scans that the core team doesn’t have time to process.
Hexarad co-founder and CEO Farzanah Rahman says: “We’re helping hospitals and healthcare providers better manage their own resources so they’re making the most of them. Everyone’s got the same problem – too many scans and not enough radiologists – so when they need to, they can send them to us to get those scans reported.
“It’s an answer to a problem, and it’s a relatively comprehensive answer which helps with managing resources more effectively in a department while giving you the comfort to know you can outsource when you need to.”
UK radiology lacks necessary infrastructure
Hexarad is also in the process of developing a workload management software called Optirad, which Rahman says will help radiology departments better understand their own reporting capacity so they can use their resources more efficiently and only outsource when they need to.
“Clinical staff are spending a lot of time on administrative tasks within a department, working out how they’re going to allocate scans and managing rotas, and that clinical time is precious,” says Rahman. “What our tool does is make it easy for administrative staff to do administrative tasks and free up clinical staff to do clinical tasks.”
While Hexarad can help radiology services better manage their caseload, co-founder and chief financial officer Sam Dumonteil says the real problem the industry is facing is a lack of infrastructure.
“People often say it’s just because there’s not enough money, but that’s oversimplifying the problem,” he says. “There’s physically no more room in hospitals, there’s no workstations for people to sit down at. Radiology is actually quite a popular speciality – every year about 1,000 people apply and there are only 300 places to do it – but there are not enough consultants to train new registrars.”
The lack of trainee spaces is, Dumonteil acknowledges, is something of a catch-22. Even if the number of spaces to specialise in radiology doubled, the number of hours trained consultants would then need to donate to teaching would lead to its own workforce crisis, with fewer people available to take and interpret scans.
AI is making radiology more accurate
Alongside smarter working, many radiologists are turning to artificial intelligence (AI) to speed up their day-to-day work.
Annalise CXR, an AI-powered decision support tool for chest X-ray, is used by one in three radiologists in Australia, according to CEO Dimitry Tran. A recent study funded by Annalise AI and published in The Lancet Digital Health, found that radiologists assisted by AI demonstrated statistically significantly improved classification accuracy 80% of the time. In the study, 20 radiologists reviewed 2,568 chest X-ray images over a three-month period, both with and without the assistance of AI.
“I think in the early days there was a fear that AI would take over and replace humans in some jobs,” Tran says. “But I think as people are using AI, especially in healthcare, there’s a clear sense that this is a co-pilot, this is a safety net to help me.”
Annalise’s technology is able to tackle a whole chest X-ray across 124 findings. The algorithm processes the scans and will highlight any areas of abnormality it detects, allowing radiologists to feel more confident in the decisions they make and flagging any areas they may otherwise miss.
“Chest X-rays usually only take 122 seconds to read,” says Tran. “With AI, they’re much more accurate but also faster as well, by about 15%. I think that 15% is like adding an extra radiologist to the department.”
Annalise’s technology is now being used by Wilkie and his colleagues at NHS Grampian, in the company’s first UK partnership.
“We wanted to use it in an NHS environment,” says Wilkie. “We’re going to be evaluating its use within our board, primarily looking at how does it enhance or improve our workflow, how we can reduce wait times for getting reports and we’re looking at it to pick up findings which may have been missed before.
“Rolling in tandem with that will be AI prioritisation, which will hopefully streamline and show us which cases really are important and need to be done quickly.”
Outsourcing and obsolete equipment
Research from the RCR and WPI Economics has found that the NHS could waste £420m by 2030 if it doesn’t invest in training more radiology consultants and continues to plug the gap with outsourcing and overseas recruitment.
The RCR estimates that, even with the helping hand of AI programmes and smarter working, the current situation will cost just over £1bn by the end of the decade, while sustained investment in radiology and oncology would cost £652m and provide nearly all the clinical oncologists the NHS will need and around half the forecast shortfall of radiologists
Furthermore, about a third of NHS Trusts in England are using technically obsolete imaging equipment. Channel 4’s Dispatches programme found that 21.4% of Trusts in England have at least once CT scanner that is ten years old or more, while 34.5% have an MRI scanner in the same category. NHS England recommends that all imaging equipment aged ten years or older be replaced – software upgrades may not be possible on older equipment, plus older CT scanners can require higher doses of radiation to deliver images.
Novel technologies can certainly offer the sector a helping hand, but they’re no replacement for concrete government investment in radiology.