X-rays, from dark rooms to AI

Medical x-ray technology has evolved from the bygone days of the darkroom, which was the central hub of the x-ray department, to the current day, when within seconds a high-quality digital image is produced, and report made quickly using artificial intelligence (AI)-based software algorithms. X-rays are still the most frequently ordered examinations in radiology globally despite advances in MRI, CT, PET-CT, and ultrasound. X-ray of the chest was the most-used imaging tool to detect pneumonia during the Covid pandemic, with billions of scans done globally. Not only have x-ray machines evolved from the traditional analog machines to the current-date digital devices but have also become smaller with the advent of portable x-ray machines deployed in ICU settings.

In fact, there are now a number of device manu­facturers selling handheld x-ray machines for clinical use!

Advances in x-ray technology has resulted in significantly improved image quality, lower radiation dose, easy storage and archiving of studies, faster transmission and image-enhancement capabilities, which aid in diagnosis of disease.

However, there is a shortage of trained radiologists to report the scans accurately and quickly. Spurred on by this need before and especially during the pandemic, Qure.ai, Lunit, Gleamer, Vuno, Radiobotics, Annalise.ai, Vin Group, and Oxipit are some companies with regulatory cleared software helping hospitals overcome this shortage to manage x-ray interpretation. These applications provide traging solutions, based on the abnormality probability, detection of diseases, filtering normal studies from those with pathology, bone-age detection, all designed with the intent to enhance workflow efficiency of the hospitals.

However, deployment of AI applications in the clinical routine is a challenge with wide variation between claims and reality of accuracy of AI algorithms. Platform-based companies, such as CARPL.ai, in New Delhi, offer multiple AI applications on a single platform, and enable validation, testing, and fine tuning of AI algorithms pre-deployment, and ensure seamless integration with the radiology department workflows, further allowing hospitals to select the software with the most accurate results on their own hospital data.

Even though new age digital x-ray equipment is more expensive, compared with the traditional analog technology, the future for India is bright, there being many indigenous manufacturers of digital x-ray equipment along with Indian entrepreneurs being at the forefront of development and deployment of AI solutions.

Allengers Medical Systems, India’s leading x-ray manufacturer based in Chandigarh, along with companies, such as BPL (Kerala), Skanray (Mysore), Trivitron (Chennai) develop high-quality digital x-ray machines at substantially lower cost than their Western competitors, enhancing affordability and access to x-ray technology for India and the world.

The companies have entered into other applications of x-ray, such as digital mammography, an essential tool for breast cancer screening and detection, digital fluoroscopy for interventional procedures, and C-arms for orthopedic procedures, pain management, and emergency medicine.

India has also taken giant strides in taking AI from research to the clinical routine, using its translational research capabilities.

Mahajan Imaging and CARPL.ai were instrumental in developing the world’s first on-device x-ray AI tool for pneumothorax detection.

This truly can be a time when we make the statement Made in India for the World come true!