Navigating the crisis year with élan and high-end technology

In 2020, Diagnostikum Linz, Austria, embarked on a process of modernization – and the team isn’t letting COVID-19 push it off course.

Photos: Werner Harrer

The Diagnostikum Group consists of leading radiology centers at four locations in Austria. Peter Brader, MD, became medical director of Diagnostikum Linz in January of 2020, a year that has turned out to be one of the most unusual in his career so far. It is the year that COVID-19 turned the practice’s workflows upside down; the year that lockdown forced patients to cancel or postpone long-awaited radiological examinations; the year that saw X-ray and ultrasound examinations drop by some 90 percent from one day to the next. And it was the year that Brader had to put his team on furlough.

Yet 2020 has also marked a new beginning for Diagnostikum Linz. The radiologists have invested in fully equipping the practice with state-of-the-art devices. Now they are working with Siemens Healthineers to make sure that the artificial intelligence contained in many of the systems can really bear fruit. Our conversation was frequently interrupted by noise from ongoing construction work at the practice, but Brader remained unruffled, saying: “I can feel a new sense of energy here. And that makes me extremely happy.”

“The first lockdown was especially hard for us,” he recalls. “No one was prepared for it. The whole of Austria shut down in a single weekend.” Patients became anxious, and the number of examinations gradually started to fall.

The practice saw a decline of as much as 90 percent in X-ray and ultrasound examinations, and 40 to 50 percent fewer MRI scans. “Some patients had already waited a long time for their appointment and definitely didn’t want to go without.” Others were put on waiting lists, which the team began working through once the restrictions eased. Although Diagnostikum Linz didn’t close for a single day, many examinations simply didn’t take place during lockdown. Brader worries that the effects of the missed appointments will become apparent in the coming months: “At the moment, the waiting time for a mammogram is just one week. But a lot of women should have had checkups during lockdown. The fallout from the spring cancellations could last for a long time.”

Efficiency is a particularly important topic for mammography, especially as the screening program was almost completely stopped at the beginning of the pandemic. This is one of the reasons why the experts in Linz have upgraded their mammography equipment: As of this summer, they are using a MAMMOMAT Revelation¹ system, which combines efficient 2D screening and tomosynthesis. The latest software has further improved the “synthetic 2D image” generated from tomosynthesis data. “This is a huge step forward!” says Brader. “The algorithm produces a slightly different image impression but is in no way inferior to the quality of a conventional 2D image. We now first look at the synthetic 2D image and can switch to 3D for complex questions. This allows us to observe suspicious-looking overlaps very closely.” The new technology can help speed up the reading time by allowing radiologists to easily compare current images with conventional 2D images from previous exams. What is more, no additional 2D images have to be acquired in addition to the tomosynthesis, which avoids unnecessary radiation exposure.

COVID-19 has changed workflows – the additional hygiene regulations have made examinations more time-consuming. The Diagnostikum team has also invested in this aspect of its work to help keep its patients safe. For instance, patients used to have to return to the practice the day after their examination to collect their results. “For safety reasons, we no longer want to ask our patients to come back to the practice a second time, so we’ve started making the results available electronically. Patients receive a text message containing a transaction authentication number (TAN). After entering it, they can see all the key information online,” says Brader, explaining the new paperless process.

An AI-based algorithm in the YSIO X.pree radiography system supports the technician in aligning the field of view with the patient’s thorax region. Auto Thorax Collimation2,3 detects the thorax, aligns the tube, and provides collimation support.

When preparing long-leg and full-spine exams, Smart Virtual Ortho^2,3 enables touchscreen collimation using the live camera image of the patient.

The optimal collimation can be adjusted quickly and precisely via touchscreen, thanks to the 3D camera and Virtual Collimation^2,3.Patient movements can be corrected immediately before the image is taken, thereby avoiding unnecessary retakes.

Brader and his colleagues want their patients to always have access to state-of-the-art technology – in other words, to high-end radiology outside of hospital settings. “Every day, I see how beneficial it is to also use artificial intelligence as an aid – whether it’s for 2D images in mammography or for the brand-new X-ray system YSIO X.pree² with its automatic collimation^{2, 3}. I think the people who develop these solutions are real rocket scientists. It’s really impressive. However, AI-supported systems can learn best if they get good feedback – which is why we’ve been involved in their development for many years now,” says Brader. “With YSIO X.pree, we want to give early feedback about where we think it needs to be sharpened up. Putting such a groundbreaking new device into practice can only succeed through collaboration. And in this case, we’re investing the experience that we have as a team of 100 experts within Diagnostikum.” Brader firmly believes that effective AI needs to be developed together with radiologists: “Practitioners are the only ones who can evaluate how AI needs to function so that it really makes life easier or improves handling. If a process doesn’t work in daily routine, we flag it 

As a radiology technologist, Judith Feichtinger is on the front line when it comes to working with the new system and looking after patients. She’s been using the YSIO X.pree digital X-ray system for a few weeks now, testing the presets and individually adjusting the image quality. Her opinion so far: “The new remote control function is practical and really does simplify our work. The presets for the autocollimation also work incredibly well. The system moves into the correct position on its own,” says Feichtinger. “But the patients can’t position themselves automatically,” she adds with a wink. This is an important point, however. YSIO X.pree has a 3D camera that helps to avoid mistakes in X-ray exposure by allowing technologists to identify and correct patient movements. Nevertheless, human care and attention remain paramount at the practices – especially these days, when the new hygiene regulations are turning workflows upside down. “We have to talk to our patients a lot and explain what’s happening. An examination is an exceptional situation for many people – it’s only routine for us. Controlling everything from outside the room and shouting instructions to the patient doesn’t work. Patients need human care and attention, and we are glad to provide it.”

Peter Brader joined Diagnostikum Graz in 2013. He specializes in urogenital radiology and in molecular and oncological imaging. He became medical director of Diagnostikum Linz on January 1, 2020.

The Diagnostikum Group consists of leading radiology centers at four sites in Austria. Patients in the Vienna, Graz, Schladming, and Linz regions can be sure that they will benefit from “the highest quality and expertise” at all four centers. To fulfil this shared mission, the Diagnostikum Group deploys high-end technology and also collaborates in its development.