How to create Radiology Second Opinion culture in Japan?

Japan is a well-fed country in terms of diagnostic supply. The country has both public and private diagnostic infrastructure including MRI and CT scanning centers. Increased diagnostic supply means more MRI or CT readings required that gives scope for fatal errors in reporting. The culture of MRI second opinion or CT second opinion is just on the rise in Japan, but it has to go a long way to be just like the USA or Europe.

 Japanese Progress and Diagnostic Supply

Japan has progressed after the second world war. The period was crucial to reconstruct the depilated 'war time Japan'. The Japanese society including monks in temples acted as socio-economic Samurais and put their energies together to build factories. Most of the early entrepreneurs like founders of Suzuki or Honda were technicians. The concept of reverse engineering helped Japanese technicians to start manufacturing complicated machines along the households and streets. Needle making machines, Lathe machines, bikes, cars and several others were manufactured on a great scale and exported. This entrepreneurial bait also found its way into the diagnostic and healthcare sector. The new advanced machines like MRI or CT machines were reverse engineered, invented and technicians started to manufacture it from Japan. Japan became a hub for precision engineering that shaped the entire healthcare ecosystem with precision tools and machines. The Japanese would sell these machines across the globe. The availability of machines at the source of origin was always high and it helped to increase the diagnostic awareness and supply in urban centres of Japanese islands. Increased demand from Government and Private Hospitals saw more CT and MRI machines at their diagnostic facilities. Logically, it increased the supply of MRI and CT scans even in the interior areas in late 80s even before some countries seeing their first MRI machine installed.

Japanese Diagnostic Ecosystem and Teleradiology

Once there was a rise in the diagnostic activity, doctors started to specialize in radiology. The radiologist started to report a huge load of cases from the console at the facility. However, the pace of manufacturing machines was far ahead of the infusion of newly trained and skilled radiologists. Over the period, the number of radiologists lagged the race with machine numbers. According to official sources, the number of radiologists in Japan is 8,610 (board-certified radiologists 4,753, radiation oncologists 927 (2012). This is just 3% of the total doctor community in Japan, especially in Tokyo, Kybe, Osaka and other city centers. This is alarmingly low. Every radiology conference one can witness the similar urge is felt by the community. It reflects huge work-load- the present radiologists have to do 3 times the work that radiologists in other developed countries might be doing.

Other countries have invested in Teleradiology. With the advent of teleradiology, radiologists can cater to the reporting workload at their will. The distant and flexible teleporting back up has helped to report the MRI or CT case in given Turnaround TIme in USA and Europe. The blessing of teleradiology is yet to arrive in that proportion in Japan, still a local radiologist's freedom is limited, potentially he or she works from the same place and cannot take extra work.

 Japanese teleradiology and MRI or CT second Opinion

The slow prevalence of teleradiology also pushed the reporting to become untimely. The reporting becomes slow and more work for local radiologists as they have to do 100s of reports in a day. This increased the chances of error into the MRI or CT report especially in south areas of Hokkaido. Multiple reports with fault were rejected by the local physician. Patients were asked to undertake a second opinion. However, to seek a second opinion in Japan is a herculean task. Once you have undertaken your scan from one hospital or diagnostic center, you can hardly find the alternative radiologist to get another opinion despite your wish to confirm primary findings. Japanese patients generally try to find one in their network. This again is a handicap situation where more reliance on the existing radiologist. 

Internet and Second Opinion Culture

With the advent of internet based online radiology, multiple radiologists from different countries' presence were felt for the first time on the internet. There are platforms like TeleradiologyHub working in Japan to provide a second opinion. One of the limiting factors is conservative insurance companies. They still find it difficult to reimburse the second opinion fee. The fall out is Japanese patients are not able to get the best skills from the world to consult on their CT or MRI cases. This can further be dragged due to protective measures by local government and radiology associations in Japan.

The opening up of the field of second opinion for global experts would essentially help the patient and physicians to get the best diagnostic outcomes. It is possible to avoid the fatal consequences of error in reporting. RSNA classifies 5 types of errors in reporting from grave to normal. These errors can be further clubbed into two groups. The first type of error is due to human error- negligence on the radiologist part. The second type is Judgmental error. This error is more known to radiologists as this is to do with their misinterpretation of images. Both the errors are not welcome. In any case to remove the error we need the report to be checked afresh by the right radiologist.

TeleradiologyHub senior radiologist Dr Saini says,'' We go further and suggest let's work out a culture of Panel for Second Opinion by bringing together radiologists from different boards situated in Japan, India, USA, Europe or other countries. Let the complicated cases be given to the panel and invite second MRI or CT readings. This process shall help to filter out obvious errors in reporting including judgmental errors and human error. It will also bring in patients in the process making reporting more transparent."

Rightly said, the movement to bring in transparency would give rise to diagnostic democratization.  The related technology like cloud PACS is gravitating the cause further. This will largely help patient groups across the globe including Japan. It would not only tackle complicated cases but aid local radiologists in further learning and providing refined and actionable reports.