When we think about medical imaging, we often imagine it as the exclusive domain of radiologists and radiographers. However, around 10% of all doctors incorporate medical imaging into their practice. This includes specialists in oncology, orthopaedics, surgery, and more, totalling approximately ten thousand imaging-intensive specialists in Australia. These groups waste up to 60% of clinic time dealing with imaging-related problems, which can arise from the moment a study is reported to long after the patient is no longer under treatment.
But why is it so challenging? The crux of the issue lies in the limited number of ways medical imaging can be exchanged between organisations, stemming from the DICOM protocol. The original creators of DICOM did get some things right: they standardised how imaging and its metadata are stored and ensured the metadata was always part of the imaging file. This allows studies to be loaded anywhere, identifying who it was for, who performed it, and other useful details.
However, they also made a few missteps that, in hindsight, have made DICOM cumbersome to locate and exchange. They wrote their own transfer protocol for DICOM files and did not adequately define how to authenticate and authorise access. This is akin to the differences between railways and roads. Railways were great for moving packages around, but trucks are cheaper, more flexible, and don’t require complex infrastructure to operate. Today, exchanging medical imaging packages still necessitates building a railway station—a PACS (Picture Archiving and Communication System)—and maintaining the network infrastructure to connect it to other stations. If you can’t, you either have to visit the station or send it one box at a time, provided you know which station holds the package you want and how to request it.
Essentially, unless you have a PACS system and can negotiate a direct connection with another PACS system, exchanging imaging is nearly impossible. Even with that connection, there’s no way to know which stations have the packages you need unless someone informs you that they left a package there in the first place. If you proposed building such a system today, you’d be dismissed as Railway Controller.
This is why we built Aurabox. Aurabox is not just another station in this network; it’s a complete transportation hub, allowing users to send and receive medical imaging in a patient-centric manner, regardless of their technical capability or location. Aurabox supports the technical capabilities of each end user, whether that be DICOM, DICOMWeb, FHIR, or simply uploading imaging via a webpage, decoupling technology maturity from need, and enabling anyone to exchange imaging. Our platform doesn’t require knowledge of firewalls or PACS setup. Like a modern freight system, even if the package leaves the station on a train, it can arrive at your door in the back of an Uber.
We combine this with identity and consent management, viewing, automatic de-identification for research and teaching, and a host of other features to provide a complete platform for imaging exchange that surpasses any PACS network or simple drop box. This enables us to support individual specialists—like Canberra Brain and Spine—to request medical imaging, run MDT (multidisciplinary team) meetings online and asynchronously for the VCCC (Victorian Comprehensive Cancer Centre) or Western Health, support a regional imaging provider to release imaging to referrers and patients, enable a patient imaged in Australia to be treated in Sweden or retrieve imaging from a London hospital in under an hour, and allow the NRL Dolphins to manage complete medical imaging for their players, no matter where they were imaged.
But we want to go further. There are still unsolved challenges that make imaging exchange much harder than regular health data. Over the next 24 months, we’ll be prototyping and releasing tools for digital discovery of medical imaging across distributed sources. We’ll be launching our Imaging Provider program, ultimately enabling search and retrieval of imaging, no matter where it is held, in real-time and on-demand for authorised use cases.
We’re looking for partners to join us on this journey. If you are a forward-looking healthcare organisation that wants to radically transform your relationship with medical imaging and boost speed and efficiency, or an imaging provider or software platform that can see the competitive advantage of delivering a next-generation experience to referrers and patients, we’d love to talk to you.
This is the text of a short session originally presented at AIDH Health Innovation Community 2024 in Brisbane, Australia.
