Our newest entity Image Core Lab, or ICL, is focused on image analysis and management for clinical research. This is an interesting new space, requiring its own dedicated focus, team, infrastructure and technology while still being closely allied to the core practice of teleradiology. Our experiences in this space over the past few years inspired us to conduct a one-day workshop on Clinical Trials Imaging in partnership with the DIA. The DIA is the Drug Information Association (http://www.diahome.org/) whose mission is to “provide knowledge resources across the full spectrum of medical product development”. As a member of the DIA India Advisory Board, it is also my commitment to honor this mission, which is clearly aligned with our own organization’s goal of sharing information and training. The one day workshop which was held at the end of July was a resounding success, despite some early trepidation that there would not be sufficient registrants. Eventually a strong showing by representatives from medical imaging, pharma, biotech and healthcare companies resulted in a highly interactive and stimulating workshop. The chief guest was Prof Vijay Chandru, Chairman of Strand Life Sciences, who in his thought provoking speech also revealed interestingly that his respect for medical imaging in part arose from the fact that he was the scientist at the Indian Institute of Science who was shot and seriously injured in the terrorist attack there, requiring multiple subsequent up close and personal encounters with radiology and radiologists. The panel discussion with distinguished representatives from Biocon, Siemens and Quintiles addressed several of the issues that arise in Clinical Trials Imaging, as well as the role that Core Labs and Technology can play in addressing these issues. The grand finale of the workshop was the e-lecture by Prof Dushyant Sahani, Director of CT Imaging at Massachusetts General Hospital on the role of Imaging Biomarkers in Oncology, a real tour-de-force in terms of its futuristic imaging content and scientific clarity. A scintillating event!
One of the main issues we face as a teleradiology organization is Quality Assurance. Our reports are peer reviewed and we receive constant feedback on our misses. Of course we greatly appreciate being notified of our discrepancies and find it a valuable learning. Good QA is the cornerstone of good clinical practice. From the radiologist perspective, our only issue is when the alleged discrepancies are subjective (ie not confirmed or definite, but merely suspected or questioned, and may not be discrepancies at all). Essentially these represent interobserver variability. A significant amount of our time and effort goes in reviewing and responding to such QAs, without added learning value or positive impact on patient care. Our only expectation therefore is that QAs that are sent to us be valid discrepancies, ideally based on surgical follow up, or at least something that is a definite miss and not simply a suspected finding. One of our other clients has a practice that their own internal peer review team evaluates each QA before deciding whether it merits being sent to us at all. Although I admit that this is a Utopian ideal, some sort of such process is optimal in order to ensure that the QA process achieves its goals which I understand to be threefold, namely 1) valid performance feedback, 2) physician education and 3) improved patient care