Enterprise Medical Imaging for Streamlined Radiological Diagnosis in Zambian Public Health Facilities

Enterprise Medical Imaging for
Streamlined Radiological Diagnosis
in Zambian Public Health Facilities
1
DataLab Research Group, University of Zambia, ZAMBIA
2
Adult Hospital, University Teaching Hospitals, ZAMBIA
Lighton Phiri <lighton.phiri@unza.zm>1
Ernest Obbie Zulu <obbiernest@gmail.com>2
2023 DRGS Researcch Seed Grant Symposium
December 11– 12, 2023 | Lusaka, Zambia

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December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Outline
● About the DataLab Research Group
● About the Enterprise Medical Imaging Project
● Acknowledgements
● Radiological Workﬂows and Challenges
● Enterprise Medical Imaging Technologies
● Methodological Approach
● Results and Discussion
● Ongoing Work
● Conclusions and Future Work

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About the DataLab Research Group at The
University of Zambia
● The DataLab research group
at The University of Zambia is
composed of faculty staﬀ and
students—undergraduate
and postgraduate—working
in three main areas
○ Data Mining
○ Digital Libraries
○ Technology-Enhanced
Learning
https://datalab.unza.zm

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About the Enterprise Medical Imaging in
Zambia Project (1/4)
https://emi.org.zm

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https://emi.org.zm
https://emi.org.zm/people/current-members

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https://emi.org.zm
https://emi.org.zm/publications

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https://github.com/Enterprise-Medical-Imaging-in-Zambia

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Acknowledgements
● This project is part of a much larger Enterprise Medical
Imaging in Zambia project. The project is funded through
generous grants from Google Research, Data Science Africa
and The University of Zambia. We are very appreciative of
this funding.

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Radiological Workﬂows: Acquisition,
Examination and Interpretation

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Problem Statement
● The Republic of Zambia is faced with a critical shortage of
trained radiologists, with a reported nine (9) Radiologists
servicing a population of 18 million, as of 2021.
○ Radiological workflows are performed using manual
processes
○ With a broad spectrum of stakeholders—Physicians,
Radiographers and Radiologists—involved in radiological
workflows, the efficiency of health service provision is
drastically reduced, subsequently compromising clinical care

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Motivation and Problem Space
● Two fundamental challenges affecting effectiveness and
efficiency of radiological services in the global south:
○ Critical shortage of Radiologists
○ Limited use of modern medical imaging practices
● Potential solution to address the second challenge:
○ Implementation of Enterprise Imaging (EI)—techniques and
workflows for:
○ Acquiring
○ Indexing
○ Managing
○ Storing
○ Analysing [...] clinical images

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Efficient and Effective Workflows Using
Enterprise Medical Imaging Strategies
https://wiki.ihe.net

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Study Goals and Objectives (1/2)
This project was a pilot aimed at investigating the challenges
resulting from the shortage of radiologists and, additionally,
to investigate the feasibility of implementation of efficient
and effective medical imaging workflows using Enterprise
Medical Imaging techniques and strategies, in order to
demonstrate the potential of enterprise imaging in addressing
the grand challenges associated with medical imaging in
Zambia

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Study Goals and Objectives (2/2)
The project was segmented into three (3) specific objectives
1. Understanding Radiological Workflows in health facilities
in Zambia—Highlight challenges that adversely affect
effective interpretation of medical images
2. Empirical Analysis of Archived Imaging Modalities
3. Explore the opportunities associated with the
implementation and adoption of EMI strategies in order to
enhance medical imaging interpretation in Zambia through
the use of Artificial Intelligence techniques

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Methodological Approach: Ethical
Consideration
● Ethical clearance approval
granted by University of
Zambia Biomedical Research
Ethics Committee, National
Health Research Authority,
Ministry of Health and
Public Health facilities
where studies were
conducted from

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Consideration
where studies were
conducted from

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Consideration
where studies were
conducted from

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Consideration
where studies were
conducted from

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Consideration
where studies were
conducted from

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Methodological Approach: Research
Approach
● A mixed-method approach was used as the basis for
conducting this research, combining the use of guided
Content analysis, interview sessions and online
questionnaires
● Study settings
○ Health facilities in Zambia
○ University Teaching Hospitals
○ Maina Soko Medical Centre
○ Medland Hospital

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Methodological Approach: Understanding
Radiological Workﬂows (1/2)
● Study setting
○ Three (3) Level 1 hospitals in Zambia: University Teaching
Hospitals, Maina Soko Medical Centre and Medland Hospital
● Target population and sampling technique
○ Two (2) cadres involved in the study: Radiologists and
Radiographers
○ Convenience sampling was used to identify potential study
participants
● Procedure
○ Guided interviews were conducted to understand the radiological
workﬂows and their associated challenges

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Methodological Approach: Understanding
Radiological Workﬂows (2/2)
● Study setting
○ Health facilities in Zambia
● Target population and sampling technique
○ Three (3) cadres involved in the study: General Practitioners,
Radiologists and Radiographers
○ Random sampling was used to identify potential study
participants
● Procedure
○ Online Google Forms questionnaire used to understand the
radiological workﬂows and their associated challenges

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Methodological Approach: Empirical Analysis
of Archived Imaging Modalities
● Study setting
○ University Teaching Hospitals and Levy Mwanawasa University
Teaching Hospital
● Inclusion criteria
○ Retrospective records reviews conducted on the annual returns
for the number of examinations performed between 2016 to 2020
● Procedure
○ Research Assistants recruited to digitalise medical images and,
additionally, transcribe annual returns

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Methodological Approach: Exploration of EMI
and AI Potential
● Enterprise Medical Imaging meta-analysis
○ Literature review conducted to consolidate prior work on
Enterprise Medical Imaging.
○ Literature surveyed was restricted to work highlighting challenges
and strategies associated with implementation of Enterprise
Medical Imaging
● SWOT Analysis
○ SWOT analysis conducted in order to identify challenges and
opportunities with implementation of Enterprise Medical Imaging
strategies in public health facilities in Zambia

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Results: Understanding Radiological
Workﬂows (1/7)
● 2815 health facilities in
Zambia
○ Government of the
republic of Zambia (GRZ)
○ Military
○ Non-Governmental
Organisations (NGO)
○ Private
● Our work focused on public
health facilities (GRZ)

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Workﬂows (2/7)
● No Radiology Information System (RIS) or Hospital
Information Service (HIS)
○ Inadequate request forms
○ Repetitive entries of patient details
○ Uncollected ﬁnal reports
○ Tedious annual returns report generation
● No Picture Archiving and Communication System (PACS)
○ No systematic storage of images and reports
○ Manual reporting
○ Multiple registration of same patient
○ Use of non-DICOM image acquisition

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Workﬂows (3/7)
● Long report turnaround time
○ Few Radiologists
○ Heavy workload

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Workﬂows (4/7)
● How are the radiological images (where applicable) stored?

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Workﬂows (5/7)
● In your opinion, how would you grade the ease with which
archived images are retrievable?

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Workﬂows (6/7)
● How are the reports (where applicable) stored?

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Workﬂows (7/7)
● In your opinion, how would you grade the ease with which
archived reports are retrievable?

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Results: Empirical Analysis of Archived
Imaging Modalities
● Total examinations: 92, 599
● Majority of modalities are X-rays and Ultrasound

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Results: Exploration of Enterprise Medical
Imaging and AI Potential (1/3)
● SWOT Analysis: Strengths
○ Well-trained radiologists
○ Organised existing imaging stakeholder departments
○ Well-established administrators
○ Standard Operating Procedures (SOP)
○ Manual workﬂows in place, could be incorporated in EI-centric
ecosystem
○ Fairly equipped imaging ecosystem at all levels (level 1, 2 and 3),
DICOM-compatible machines
○ Ongoing mobilisation of Teleradiology equipment

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● SWOT Analysis: Weaknesses
○ Subsidiary departmental imaging services not integrated into
mainstream clinical imaging
○ Continued use of analog imaging in some modalities
○ Use of visible light based image capturing equipment in some
subsidiary services
○ Poorly-serviced equipment with frequent and long downtimes
○ Lack of good ICT infrastructure

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● SWOT Analysis: Opportunities
○ Developing EHR system (SmartCare)
○ Pre-existing e-Government services for internet connectivity
● SWOT Analysis: Threats
○ Unreliable internet connectivity
○ Uncertainty over acceptability of EMI

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Ongoing Work: Picture Archiving and
Communication Systems (1/2)
http://netd.ac.zm:8042/app/explorer.html

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Ongoing Work: Picture Archiving and
Communication Systems (2/2)
http://netd.ac.zm:8042/app/explorer.html

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Ongoing Work: Radiology Information
Systems

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Ongoing Work: Semi-Automated
Interpretation of Medical Images (1/3)

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Ongoing Work: Large Scale DICOM
Compliance Metadata Analysis

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Conclusion and Future Work
● Work conducted to investigate challenges resulting from the
shortage of radiologists and, additionally, to investigate the
feasibility of implementation of efficient and effective
medical imaging workflows using Enterprise Medical Imaging
techniques and strategies
● Ongoing work focused on implementing production-quality
PACS and RIS platforms
○ Base infrastructure required to explore the use of Artificial
Intelligence in addressing challenges with radiological workflows

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Q & A Session
● Comments, concerns and complaints?

[1] Chileshe, E., and Phiri, L. (2023). Large-Scale Analysis of Medical
Image Metadata. In Proceedings of International Conference for
ICT (ICICT)-Zambia (Vol. 5, No. 1, pp. 44-48).
[2] Shawa, A., Zulu, E. O., and Phiri, L. (2023, December). Software
Tools for Supporting Automatic Interpretation of Medical Images.
In Proceedings of International Conference for ICT (ICICT)-Zambia
(Vol. 5, No. 1, pp. 49-52).
[3] Zulu, E.O., and Phiri, L. (2022). Enterprise Medical Imaging in the
Global South: Challenges and Opportunities. In Proceedings of
2022 IST-Africa Conference (IST-Africa 2022).
Bibliography

[4] Zulu, E.O. and Phiri, L. (2021). Enterprise Medical Imaging for
Streamlined Radiological Diagnosis in Zambian Public Health
Facilities. The University of Zambia.
Bibliography

Enterprise Medical Imaging for
Streamlined Radiological Diagnosis
in Zambian Public Health Facilities
1
DataLab Research Group, University of Zambia, ZAMBIA
2
Adult Hospital, University Teaching Hospitals, ZAMBIA
Lighton Phiri <lighton.phiri@unza.zm>1
Ernest Obbie Zulu <obbiernest@gmail.com>2
2023 DRGS Seed Money Grant Symposium
December 11– 12, 2023 | Lusaka, Zambia

Enterprise Medical Imaging for Streamlined Radiological Diagnosis in Zambian Public Health Facilities

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