Project Name: Virtual Magnetic Resonance Imaging (MRI) Reading Project
Start Date & Duration: September 2021, 24 months
Project Summary:
The Trust’s Multiple Sclerosis (MS) Magnetic Resonance Imaging (MRI) reporting service is under significant demand, notwithstanding forecasted increased pressures.
Such pressures include progressive patients requiring frequent MRI scans and also all patients requiring disease modifying therapies (DMTs) moving to having an obligatory 12-month MRI scan.
In November 2019, there were nearly 600 unreported scans in Neurology. These are believed to include a cohort of active MS patients that are sub-optimally reviewed. This has been identified as high risk for both the service and the Trust.
Patient numbers/demand on service remains high at the Trust: 2,903 MS patients, of which 1,166 are taking a disease modifying therapy (DMT).
A capacity and demand analysis was undertaken around MRI and produced the following results:
- If all patients were receiving an annual MRI: the trust would need to do 64 MRIs per week (26 DMT and 38 non DMT patients).
- If all DMT patients were receiving an annual MRI and non DMT patients were receiving an MRI every two years, the trust would need to do 45 MRIs per week (26 DMT and 19 non DMT patients).
The Project will contract the use of third party Icometrix to write the MRI reports for the Trust’s surveillance scans of patients that have already received a diagnosis of MS by the Trust’s Multi-Disciplinary Team (MDT).
By reducing delays in diagnosis it is anticipated that the saved time will facilitate the Trust MS Team to achieve an increase in standards of the following service evaluation, benchmarking and improvements;
- Alignment to NICE Quality Standards QS108 for MS Brain Health by supporting the pillars that underpin patient care;
- Symptom onset
- Referral & diagnosis
- Treatment decision
- Lifestyle
- Disease monitoring, and,
- Managing new symptoms
- MRI provision would help to reduce treatment delays, enable HCPs to monitor disease activity closely and proactively and underpin decision making with up to date scans. It will enable the service to achieve the core standards that they are aspiring to which are to have an MRI completed within 4 weeks of a patient referral (2 weeks for the achievable standards)
- Improved MRI reporting means that this no longer presents a risk to patients and potential clinical governance risks to the trust
- Reduced delays and improved patient management and treatment initiation (including Novartis treatments)
- Opportunity to implement a scalable MRI project across other NHS sites. To collaborate with the NHS Trust to improve their service and patient management, to become a preferred partner of the NHS.
The Project will assess whether the third party makes a positive difference to the MS Service at the Trust.
Planned Milestones:
Milestone 1: Kick-off meeting
Milestone 2: Baseline Report, Trust protocol written and agreed, Trust full review of Icometrix
Milestone 3: Trust contract with Icometrix signed
Milestone 4: Installation and testing of Icometrix “icobridge”* at the Trust, commencement of MRI scans being sent to Icometrix for write up
Milestone 5: Trust sending scans to Icometrix
Milestone 6: Report at end of year one verses baseline at start of project Assessment of Icometrix impact on MS Service at Trust. Decision whether to proceed to second year, Trust contract with Icometrix signed/extended second year
Milestone 7: Project write-up/poster
Expected Benefits:
Expected benefit to the NHS
By reducing delays in diagnosis it is anticipated that the saved time will facilitate the Trust MS Team to achieve increase in standards of the following service evaluation, benchmarking and improvements:
- Adults with MS to have a face to face appointment with a Healthcare Professional (HCP) with experience in MS to take place 6 weeks after diagnosis
- Adults with MS are offered a comprehensive review at least once a year by healthcare professionals with experience in MS
- Alignment to NICE Quality Standards QS108 for MS Brain Health by supporting the pillars that underpin patient care:
- Symptom onset
- Referral & diagnosis
- Treatment decision
- Lifestyle
- Disease monitoring, and,
- Managing new symptoms
- Adherence to NHS England commissioning guidance. These are MS Brain Health Standards (defined in three categories; Core, Achievable and Aspirational) https://www.msbrainhealth.org/article/ms-brain-health-consensus-standards
- MRI provision would help to reduce treatment delays, enable HCPs to monitor disease activity closely and proactively and underpin decision making with up to date scans. It will enable the service to achieve the core standards that they are aspiring to which are to have an MRI completed within 4 weeks of a patient referral (2 weeks for the achievable standards)
- Improved MRI reporting means that this no longer presents a risk to patients and potential clinical governance risks to the trust
- A reduction in referral to treatment time
- A reduction in clinic cancellations and rescheduling which improves waiting times
- Pressure taken off nurse team to chase up results and ensure the pathway is functioning efficiently
- Better management of active/progressive patients
Expected benefit to the Patient
- Reduced waiting times from referral to treatment initiation
- Mitigating issues threatening patient safety, such as delay in referral to treatment, by early intervention
- Improved access to treatments as eligibility is confirmed via MRI
- Increased proactive management of their MS
- Improved patient identification for the correct treatments
- Improved patient experience by reducing risk of clinical cancellations and rescheduling
UK2102125690
Project Name: Virtual Magnetic Resonance Imaging (MRI) Reading Project
Completion Date: November 2023
Outcome Summary:
To set up and use the transfer, analysis and return of reports, alongside annotated images, from icometrix (AI) for decision making in the teams multi-disciplinary team meetings.
Key Project Outcomes Data:
As a result of this project the Partner organisation have successfully applied for an NHSX grant to support a project called Artificial intelligence-assisted magnetic resonance imaging for quality, efficiency and equity in the NHS care of multiple sclerosis (AssistMS), which is a three year project.
Outcomes:
The original goal to set up and use the transfer, analysis and return of reports, alongside annotated images, from icometrix for decision making in multi-disciplinary team meetings, was partially achieved. This is obviously disappointing for the whole team involved at Barts Health & QMUL. The delays incurred were not due to a lack of enthusiasm by the team, but reflect a systemic shortage of resource in the aftermath of the pandemic with high staff turnover, and generally under-staffing, which only more recently has been settling. In addition, the team were unable to start transferring datasets and explore the potential of the technology because of an inability to get the required software (icobridge) installed at Barts Health. However, due to the persistence of the team they are confident that Icobridge will be installed and image transfer started before the end of 2023 through the successful application of a grant to support a project called Artificial intelligence-assisted magnetic resonance imaging for quality, efficiency and equity in the NHS care of multiple sclerosis (AssistMS). AssistMS, which is a three year project, has been awarded jointly to icometrix and QMUL, this has gained the buy-in from the Trust, and respective momentum, to get the software installed as a precondition for starting imaging dataset transfers.
Conclusion:
Without the support for this project, the Partner Organisations would not have been able to achieve the milestone of winning the AssistMS award. Specific references to the support of Novarits, and more generally the interest from the pharmaceutical industry in projects that involve AI-supported MRI were important underpinnings of our argument to succeed.
UK2402213408