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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
2/54
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
3/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
4/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
About the Enterprise Medical Imaging in
Zambia Project (1/4)
https://emi.org.zm
5/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
About the Enterprise Medical Imaging in
Zambia Project (2/4)
https://emi.org.zm
https://emi.org.zm/people/current-members
6/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
About the Enterprise Medical Imaging in
Zambia Project (3/4)
https://emi.org.zm
https://emi.org.zm/publications
7/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
About the Enterprise Medical Imaging in
Zambia Project (4/4)
https://github.com/Enterprise-Medical-Imaging-in-Zambia
8/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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.
9/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Radiological Workflows: Acquisition,
Examination and Interpretation
10/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Radiological Workflows: Acquisition,
Examination and Interpretation
11/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Radiological Workflows: Acquisition,
Examination and Interpretation
12/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Radiological Workflows: Acquisition,
Examination and Interpretation
13/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Radiological Workflows: Acquisition,
Examination and Interpretation
14/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
15/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
16/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Efficient and Effective Workflows Using
Enterprise Medical Imaging Strategies
https://wiki.ihe.net
17/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Efficient and Effective Workflows Using
Enterprise Medical Imaging Strategies
https://wiki.ihe.net
18/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Efficient and Effective Workflows Using
Enterprise Medical Imaging Strategies
https://wiki.ihe.net
19/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Efficient and Effective Workflows Using
Enterprise Medical Imaging Strategies
https://wiki.ihe.net
20/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
21/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
22/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
23/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
24/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
25/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
26/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
27/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
28/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
29/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
30/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
31/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
32/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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)
33/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
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
34/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
Workflows (3/7)
● Long report turnaround time
○ Few Radiologists
○ Heavy workload
35/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
Workflows (4/7)
● How are the radiological images (where applicable) stored?
36/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
Workflows (5/7)
● In your opinion, how would you grade the ease with which
archived images are retrievable?
37/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
Workflows (6/7)
● How are the reports (where applicable) stored?
38/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Understanding Radiological
Workflows (7/7)
● In your opinion, how would you grade the ease with which
archived reports are retrievable?
39/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Empirical Analysis of Archived
Imaging Modalities
● Total examinations: 92, 599
● Majority of modalities are X-rays and Ultrasound
40/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
41/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Exploration of Enterprise Medical
Imaging and AI Potential (2/3)
● 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
42/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Results: Exploration of Enterprise Medical
Imaging and AI Potential (3/3)
● 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
43/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Picture Archiving and
Communication Systems (1/2)
http://netd.ac.zm:8042/app/explorer.html
44/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Picture Archiving and
Communication Systems (2/2)
http://netd.ac.zm:8042/app/explorer.html
45/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Radiology Information
Systems
46/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Semi-Automated
Interpretation of Medical Images (1/3)
47/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Semi-Automated
Interpretation of Medical Images (2/3)
48/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Semi-Automated
Interpretation of Medical Images (3/3)
49/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
Ongoing Work: Large Scale DICOM
Compliance Metadata Analysis
50/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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
51/54
December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023)
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

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

  • 1. 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
  • 2. 2/54 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
  • 3. 3/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 4. 4/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) About the Enterprise Medical Imaging in Zambia Project (1/4) https://emi.org.zm
  • 5. 5/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) About the Enterprise Medical Imaging in Zambia Project (2/4) https://emi.org.zm https://emi.org.zm/people/current-members
  • 6. 6/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) About the Enterprise Medical Imaging in Zambia Project (3/4) https://emi.org.zm https://emi.org.zm/publications
  • 7. 7/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) About the Enterprise Medical Imaging in Zambia Project (4/4) https://github.com/Enterprise-Medical-Imaging-in-Zambia
  • 8. 8/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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.
  • 9. 9/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Radiological Workflows: Acquisition, Examination and Interpretation
  • 10. 10/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Radiological Workflows: Acquisition, Examination and Interpretation
  • 11. 11/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Radiological Workflows: Acquisition, Examination and Interpretation
  • 12. 12/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Radiological Workflows: Acquisition, Examination and Interpretation
  • 13. 13/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Radiological Workflows: Acquisition, Examination and Interpretation
  • 14. 14/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 15. 15/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 16. 16/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Efficient and Effective Workflows Using Enterprise Medical Imaging Strategies https://wiki.ihe.net
  • 17. 17/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Efficient and Effective Workflows Using Enterprise Medical Imaging Strategies https://wiki.ihe.net
  • 18. 18/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Efficient and Effective Workflows Using Enterprise Medical Imaging Strategies https://wiki.ihe.net
  • 19. 19/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Efficient and Effective Workflows Using Enterprise Medical Imaging Strategies https://wiki.ihe.net
  • 20. 20/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 21. 21/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 22. 22/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 23. 23/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 24. 24/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 25. 25/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 26. 26/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 27. 27/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 28. 28/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 29. 29/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 30. 30/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 31. 31/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 32. 32/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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)
  • 33. 33/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological 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
  • 34. 34/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological Workflows (3/7) ● Long report turnaround time ○ Few Radiologists ○ Heavy workload
  • 35. 35/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological Workflows (4/7) ● How are the radiological images (where applicable) stored?
  • 36. 36/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological Workflows (5/7) ● In your opinion, how would you grade the ease with which archived images are retrievable?
  • 37. 37/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological Workflows (6/7) ● How are the reports (where applicable) stored?
  • 38. 38/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Understanding Radiological Workflows (7/7) ● In your opinion, how would you grade the ease with which archived reports are retrievable?
  • 39. 39/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Empirical Analysis of Archived Imaging Modalities ● Total examinations: 92, 599 ● Majority of modalities are X-rays and Ultrasound
  • 40. 40/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 41. 41/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Exploration of Enterprise Medical Imaging and AI Potential (2/3) ● 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
  • 42. 42/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Results: Exploration of Enterprise Medical Imaging and AI Potential (3/3) ● 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
  • 43. 43/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Picture Archiving and Communication Systems (1/2) http://netd.ac.zm:8042/app/explorer.html
  • 44. 44/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Picture Archiving and Communication Systems (2/2) http://netd.ac.zm:8042/app/explorer.html
  • 45. 45/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Radiology Information Systems
  • 46. 46/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Semi-Automated Interpretation of Medical Images (1/3)
  • 47. 47/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Semi-Automated Interpretation of Medical Images (2/3)
  • 48. 48/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Semi-Automated Interpretation of Medical Images (3/3)
  • 49. 49/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Ongoing Work: Large Scale DICOM Compliance Metadata Analysis
  • 50. 50/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) 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
  • 51. 51/54 December 11, 2023 2023 University of Zambia DRGS Research Seed Grant Symposium (DRSMS 2023) Q & A Session ● Comments, concerns and complaints?
  • 52. [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
  • 53. [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
  • 54. 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