Hospital Reports - Next Generation Mobile X-ray Solutions - Solutions for tomorrow by Global Business Media

SPECIAL REPORT

Mobile X-Ray Solutions

Powering the Future: New Developments in Battery Technology The Road to True X-ray MobilityÂŽ !M1 The Importance of Image Quality Going Mobile: What to Look for From a Mobile X-ray Machine

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Published by Global Business Media

The Limitations of Battery Power Published by Global Business Media

Solving the Problem

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Introducing X-tech cell®

Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Tom Cropper Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.

True X-ray Mobility® !M1

The Road to True X-ray Mobility® !M1

Solutions for tomorrow AB

Decentralized Care True X-ray Mobility® !M1 Benefits of Mobile X-Rays

The Importance of Image Quality

Tom Cropper, Editor

A Major Cause of Surgical Error Mobility and Flexibility Into the Future

Going Mobile: What to Look for 11 From a Mobile X-ray Machine Jo Roth, Staff Writer

Issues with Existing Mobile Systems Design and Aesthetics Easy Cleaning Choosing the Right Equipment

References 13

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MOBILE X-RAY SOLUTIONS

Foreword T

he X-ray unit is changing. It is becoming

for radiologists trying to make a diagnosis. This

more mobile with the ability to get out into the

increases the risk of error and also leads to more

community. Doing so has enormous benefits for

rescans. Inevitably, patient outcomes suffer, and

patients and staff, but it requires a fresh approach

expenses grow.

to design.

The good news is that technology is on the move.

Our opening two articles come from Solutions for

Images are becoming clearer and in the future

tomorrow who provide the cutting edge !M1 mobile

radiologists will have more tools at their disposal

X-ray Unit. As we’ll discover, this is ground-breaking

to support the decision-making process such as

in a number of ways. First it transitions from a

artificial intelligence (AI).

traditional lead acid battery to a lithium-based battery

Finally, Jo Roth will examine some of the issues

similar to those used in the automotive industry. This

hospitals need to consider when choosing mobile

gives it a much longer battery life with much faster

X-ray units. Aside from just mobility there are

charging than their competitors. It reduces the time

issues such as design, hygiene and even aesthetics,

needed to prepare the device. Just 30 minutes of

all of which have important roles to play in delivering

charging gives it several hours of operation and

better care.

allows it to deliver 24/7 availability.

Greater mobility in X-rays is one of those features

As they go on to demonstrate, longer battery life

which plays into the future direction of healthcare. It

also paves the way for what they call ‘True X-ray

creates a bridge between primary and secondary

Mobility®’, as they take the unit outside of the hospital.

care and brings technology which would have

One high profile project recently saw them using that

required a visit to the radiology department direct to

mobility for the World Rally Cross Championships.

the patient. It can save money, improve outcomes and

But on a more mundane day to day level, it will

make patients more comfortable and satisfied with

see the device taken to care homes and primary

their treatment. As such, it’s one of those technologies

care centres to create the more integrated care that

which will shape the future of healthcare.

health services are looking for. Elsewhere in this Report, we’ll look at the importance of image quality. Poor images make it more difficult

Tom Cropper Editor

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ANZ Bank, ING and KPMG.

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MOBILE X-RAY SOLUTIONS

Powering the Future: New Developments in Battery Technology Solutions for tomorrow AB The goal of 24/7 X-ray availability and true mobility have always been held back by one thing: limited battery life. Now, though, that could be about to change.

Our revolutionary battery technology was developed in-house specifically for usage within mobile X-ray.

X-tech cell® keeps the unit working, not waiting! - Start up time 10 sec - 10 min charging gives 1 hour operation time - 8 years battery warranty

ECHNOLOGY WITHIN hospitals has transformed over the past few decades and patients are feeling the benefits. Devices are becoming more powerful, more mobile and more efficient. Even so, one area is often overlooked: batteries. Mobile X-ray machines are battery operated which can create a number of challenges. They take hours to charge, have only a limited lifespan, can be expensive to run and have a considerable carbon footprint. So, when we set out to create solutions which solve key practical problems within healthcare, our focus quickly turned to batteries.

The Limitations of Battery Power Jan Bååt, CTO and one of the founders of Solutions for tomorrow, explains more. “When Solutions for tomorrow started, we went out into hospitals and looked into the problem of existing machines,” he explains. “One of the

biggest problems was battery performance. Battery life is very short - it also takes a very long time for charging. One hour gives you ten or fifteen minutes.” The problem lies in the battery technology currently being used within hospitals. Traditional lead-acid batteries are slow charging, inefficient and short-lived. This has a cost for the hospital and a high environmental impact. The average battery life of a traditional lead/acid battery is up to two years. Given that each machine uses between 20 and 30 batteries over the course of an average tenyear lifecycle, a mobile X-ray machine will consume the equivalent of up to 200 car or motorcycle batteries during that time. This corresponds to 1,000kgs of lead batteries. Disposing all those waste batteries is a delicate business. Batteries use toxic chemicals such as sulfuric acid which can cause water pollution and be a hazard to human health. Hospitals WWW.HOSPITALREPORTS.EU | 3

MOBILE X-RAY SOLUTIONS

“One of the biggest problems was battery performance. Battery life is very short - it also takes a very long time for charging. One hour gives you ten or fifteen minutes.”

routinely implement battery disposal and recycling schemes, but this comes at a cost. In addition, lead-acid batteries have a selfdischarge when unused, which increases energy consumption. Charging takes a long time and is ineffective. Most models take 10 hours to charge which only gives an operation time of five hours.

Solving the Problem This is the problem that we at Solutions for tomorrow set out to address. We started marketing our first product in 2016 with the aim of developing technology which addresses practical problems facing hospitals. Our success in doing so has been the catalyst for rapid growth. We are market leader in Scandinavia, active in Europe and the US and we have begun operations in Asia. From the beginning, our focus has been on delivering True X-ray Mobility® !M1 by bringing the device to the customers. One of the biggest steps in addressing this has been to create a new and improved battery.

Introducing X-tech cell® The result was our revolutionary X-tech cell® battery technology which has been developed 4 | WWW.HOSPITALREPORTS.EU

specifically to be used with X-ray machines and is based on lithium technology. The batteries are perfectly designed for their end use and provide a revolutionary advance over existing lead acid batteries. They have a charging efficiency of 97% compared to just 60% for lead- based competitors. They can charge more quickly, are more efficient, last longer and have less of an impact on the environment. Charging takes place up to eight times faster than competitors. Just ten minutes of charging will allow continuous operation without limitations for up to one hour. “X-tech cell®, for the user is a total game changer,” adds Jan Bååt. “You can charge it in your 30-minute lunch time, which gives you several hours of battery life so you can use it 24/7.” The batteries can be fully charged in just 90 minutes which provides a full nine hours of operating time. The device also has LED lights on the column providing clear communication. Everything including the power cable, charger and precision control joystick has been designed to optimise use and improve overall performance. Where lead acid batteries have a short life span

MOBILE X-RAY SOLUTIONS

Our revolutionary battery technology was developed in-house specifically for usage within mobile X-ray.

True X-ray Mobility® !M1

of just up to two years, lithium-based X-tech cells® come with a warranty of eight years, which means they will last for the lifespan of a mobile X-ray machine. They should not need to be changed at all during the machine’s life. The !M1 Mobile X-ray unit which houses the batteries also uses this power extremely efficiently. Compared to alternative devices, it consumes less energy giving it a lower carbon footprint, helping hospitals meet more stringent carbon emissions guidelines and saving on operational costs.

Superior battery technology has another benefit. It allows us to take the technology to where the customers are. Within the hospital environment it’s much easier to manoeuvre, especially in tight situations and take it wherever it needs to go within the building. It leads to faster scanning times and reduces the stress experienced by patients. More than that, a long battery life allows us to go outside of the hospital into the community. By using specially modified vans, we can go to primary care units or care homes to take X-ray scanning directly to the patient. In an environment in which more people require long term care, this helps hospitals to treat patients within the comfort of their own home. Technologies such as this play an important role in helping people to avoid hospital care, driving down the overall cost of treatment and maintaining independence. The benefits, therefore, are significant. Thanks to the X-tech cell®, we’ve achieved True X-ray Mobility® reaching out beyond the confines of the hospital environment and into the community. We take healthcare directly to the places it is needed most while improving usability, driving down costs and reducing the impact on the environment. All these gains come from one simple component that most healthcare managers may not have thought about - the batteries. It just goes to show, even a small overlooked change, can make a huge difference.

X-tech cell® keeps the unit working, not waiting! - Start up time 10 sec - 10 min charging gives 1 hour operation time - 8 years battery warranty

The !M1 Mobile X-ray unit which houses the batteries also uses this power extremely efficiently

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MOBILE X-RAY SOLUTIONS

The Road to True X-ray Mobility® !M1 Solutions for tomorrow AB Globally, five billion people are without any access to hospital imaging. We are here to change it. Welcome to the beginning of True X-ray Mobility®.

Travelling to hospital to receive those services can be time consuming and stressful. From the hospital’s perspective, it will also add to the total cost of care. This is why we developed the !M1, to improve the range of uses of X-ray machines

N AGING population requires a new approach to healthcare, one which is person centred, integrated and connected. The aim is to transfer some of the functions of secondary care into the primary sector, not only to save money but also to improve the wellbeing of patients. To help with this goal, Solutions for tomorrow are taking the X-ray unit out of the hospital and into the community. Both patients and hospitals are feeling the benefits.

Decentralized Care In a world in which the population is aging and more people are living with long term and complicated conditions, that has significant consequences. More and more people will need X-ray technology. Travelling to hospital to receive those services can be time consuming and stressful. From the hospital’s perspective, it will also add to the total cost of care. This is why we developed the !M1, to improve the range of uses of X-ray machines. The !M1 combines the latest imaging technology, smaller size, lighter weight and longer battery life to create a truly mobile X-ray machine. We use only high DQE Cesium Iodine (Csl) wireless detectors with state-of-the-art image 6 | WWW.HOSPITALREPORTS.EU

processing to produce the best quality images possible. This enables shorter examination times improved outcomes and better patient comfort. A sleek design not only looks good, but it also facilitates cleaning. A lack of sharp corners or edges reduces the opportunities for dirt to accumulate. An easy cleaning process makes it ideal for hospitals, minimising maintenance time and the risk of infection. We’ve even created a paediatric version designed to appeal to children. The appearance and sound of equipment can be intimidating so we created a kids’ device which has been designed using artwork created by children to present a friendlier and less frightening image. Initially the focus was on producing a device which was more mobile and manoeuvrable within a hospital setting. Most machines are relatively large and can be inconvenient to move around. The !M1 is smaller and lighter and much easier to move around the hospital. One piece of feedback from a user tells the whole story: “For the first time it was like I was driving the machine and not the other way around.” The final ingredient is improved battery technology. By transitioning away from lead-acid batteries to lithium batteries similar to those used

MOBILE X-RAY SOLUTIONS

Our revolutionary battery technology was developed in-house specifically for usage within mobile X-ray.

in the automotive industry, we’ve created batteries with a much longer life span. Just 30 minutes of charging provides enough power for hours of operation. It has a maximum charge of nine hours giving it all the power it needs to get out of the hospital to wherever it needs to go. This is what we mean when we talk about True ‘X-ray Mobility®’. Now we’re running projects in which the device can be taken to care homes and primary care services and where patients can be assessed on the spot.

True X-ray Mobility® !M1 It does this with a modified van which carries the !M1 unit to primary care centres and care homes. Staff just have to open the back of the van, release the ramp, unplug the charging, unclip the straps and it is ready to be used. There is no need to transport the patients to the hospital with all the cost and upheaval that can cause. “For many years, X-rays were limited to hospitals,” says Mattias Guldstrand, CEO of

Solutions for tomorrow, “but with digital detectors and wireless technology, old limitations are gone. Our product is the smallest and the lightest and can therefore be transported in a standard sized van. Now we offer hospital grade images outside of the hospital.” The devices can offer value in a range of settings. In 2019, for example, we were selected by Aleris as their partner to provide mobile X-ray services during the Rally Cross Championships and Rally Cross World Cup in Sweden. New regulations stipulated that the event needed the capacity to provide X-ray services on site to improve safety for the competitors1. Over the course of the event, the unit treated a number of injuries on the spot and images were sent to Aleris for review. It meant that injuries could be assessed more quickly onsite without the need to travel long distances to the nearest hospital. Diagnosis waiting time was reduced and long, uncomfortable and expensive hospital journeys were avoided.

X-tech cell® keeps the unit working, not waiting! - Start up time 10 sec - 10 min charging gives 1 hour operation time - 8 years battery warranty

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MOBILE X-RAY SOLUTIONS

With digital detectors and wireless technology, old limitations are gone. Our product is the smallest and the lightest and can therefore be transported in a standard sized van. Now we offer hospital grade

Benefits of Mobile X-Rays The benefits of this solution to hospitals and patients can be profound. In a PhD Thesis on mobile X-rays, Elin Kjelle concluded: “Mobile radiography services contribute to increased access to imaging services. This could provide more accurate diagnosis and thus better treatment and care for most nursing home residents, tailored to their need for a familiar environment and coordinated services. Mobile radiography services contribute to the strengthening of primary care2.”

Transferring tasks from secondary to primary care phase, she said, is in line with the modern drive for integrated person-centred care services and would save money. Her paper found a 30% reduction in the mean cost per patient through better use of hospital resources. True X-ray Mobility® should be the next step in radiology. It facilitates modern integrated care pathways designed to reduce the burden on hospital resources while also improving the wellbeing of patients. With more people requiring long term care, the ability to take services to them and work around their needs has profound implications for quality of life.

images outside of the hospital True X-ray Mobility® should be the next step in radiology. It facilitates modern integrated care pathways designed to reduce the burden on hospital resources while also improving the wellbeing of patients

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MOBILE X-RAY SOLUTIONS

The Importance of Image Quality Tom Cropper, Editor Technology is delivering increasingly sophisticated, X-ray devices with improved image quality. As a result, the gap is widening between the best solutions and the rest.

EDICAL IMAGING has changed the face of healthcare and given doctors much more knowledge about patients than ever before. It has made it easier to confirm a diagnosis and to take preventative action by spotting potentially serious problems at an early stage. However, the technology is not perfect. Limitations in image quality lead to errors and can impact outcomes.

A Major Cause of Surgical Error A study from Diagnostic and Interventional Radiology found that approximately 90% of errors in lung cancer diagnosis occur during the chest X-ray. Radiologists may struggle to differentiate a lung lesion from bone, pulmonary vessels, mediastinal structures and other complex anatomical structures3. Observer error was found to be the biggest cause with the performance and expertise of the radiologist being a critical factor. However, difficulty in distinguishing between different tissue also contributes to errors. Another study found an alarmingly high estimated day to day rate of 3% to 5% of reports having errors or discrepancies4. Excess workload, the experience of the radiologist and the technology used, all contributed to errors. Krupinsky et al also found that fatigue

had a significant impact on a doctor’s ability to recognise issues such as fractures. The study compared the performance of radiologists at the beginning of the day and at the end. At the end of the day, radiologists would have reduced ability to focus, increased symptoms of ocular strain and reduced ability to detect fractures5. It is a common misconception that a radiologist’s report will be definitive. While this may be possible in some cases, more often than not the report is an expert opinion influenced by what can be seen in the scans and knowledge of the patient’s past medical history. It will always be open to error or interpretation. Nevertheless, better imaging technology increases the likelihood of making a definitive determination and reduces the risk of error. The latest high-performance devices with cutting edge detector and image processing technology, therefore, are vital in reducing the risk of such errors and minimising the need for further rescanning or investigations. The advent of cutting-edge digital image processing technology offers an appealing alternative to digital film and development. It is faster and the latest systems can now offer superior image quality to film. All information in an image can be captured and presented in a

Our revolutionary battery technology was developed in-house specifically for usage within mobile X-ray.

X-tech cell® keeps the unit working, not waiting! - Start up time 10 sec - 10 min charging gives 1 hour operation time - 8 years battery warranty

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MOBILE X-RAY SOLUTIONS

balanced way. Nonetheless, as a raw image this can be blurred and indistinct making it impossible to make determination with the naked human eye. Image processing software refines the image into something clearer. However, image processing software can vary in quality and performance. Advanced integrated systems which offer the highest performance while being integrated into a device make it possible to improve the speed and accuracy of diagnosis.

Mobility and Flexibility

The latest highperformance devices with cutting edge detector and image processing technology, therefore, are vital in reducing the risk of such errors and minimising the need for further rescanning or investigations

One of the key issues will be flexibility and mobility. As part of a drive to optimise workflows and productivity, there is a growing demand for mobile X-ray machines which can be moved around the hospital. This places particular pressures on design and performance. Hospitals are looking for lighter devices with a smaller footprint which are easier to move around hospital corridors, but they don’t want to compromise on image quality or the range of features available. In essence, the goals are the same as in consumer electronics where manufacturers are constantly trying to produce systems which are smaller, lighter and more mobile, but maintain high performance. For example, the gold standard is the removal of the X-ray column which blocks the line of sight during driving. Clinicians want to be able to take high performance X-ray imaging wherever they want to in the hospital without compromising on image quality or performance. Advanced wireless detectors make it possible to take this technology out of the radiology department and around the hospital. Indeed, as this technology becomes more refined, it is making it possible to break away from the confines of the hospital and into the community.

Into the Future Technology, then, is transforming the scope of what is and what isn’t possible within radiology. X-ray machines are becoming more portable, while also dramatically improving the quality of images and reliability of diagnosis. This reduces the risk of errors and the costs incurred by prolonged hospital stays, poor patient outcomes or repeated scans. Furthermore, digital technology is accelerating the pace of change. As we move into the future, image quality is steadily improving in definition

and quality. Advanced technologies, such as deep learning, artificial intelligence and 3D printing are also aiding diagnostics. A study in the Journal of Radiology found that a new type of AI deep learning could interpret scans as reliably as experienced radiologists. “We’ve found that there is a lot of subjectivity in chest X-ray interpretation,” said study co-author Shravya Shetty, an engineering lead at Google Health in Palo Alto, California. “Significant interreader variability and suboptimal sensitivity for the detection of important clinical findings can limit its effectiveness.” AI systems can be trained to scan images and recognise subtle patterns and has the potential to improve the interpretation of chest scans. However, results from one group of patients cannot always be generalised in the wider population. Researchers use deep learning models to overcome these limitations and large datasets to develop, train and test these models6. AI is still developing, but as healthcare services become more adept at collecting and storing information, it is evolving rapidly. The ability to analyse large amounts of stored digital scans makes it possible for systems to learn from large data sets to improve the reliability of diagnosis. They can be used as a useful verification tool, picking up some signs which a human operator might miss. Image quality in X-rays, therefore, is everything. While much focus has been on portability and cost of systems, limitations in image quality increase the risk of error and the cost of treatment. New technology plays a pivotal role in giving clinicians the advanced solutions they are looking for – total mobility alongside highly advanced image quality.

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MOBILE X-RAY SOLUTIONS

Going Mobile: What to Look for From a Mobile X-ray Jo Roth, Staff Writer Small, light, mobile, convenient to use and high performance: the demands being placed on modern X-rays machines are considerable.

E SEE it every day. Technology is in a process of perpetual evolution and renewal. Whether at home or at work the goal is to achieve high performance technology on the go. Workers are becoming more mobile and services are coming to people. Convenience, speed and efficiency are everything. These demands also extend into the world of X-rays where manoeuvrability, flexibility and affordability are top of the list of priorities. However, putting that all into a single package can be a challenge. Modern solutions must balance the need to cater to the demands of cost, mobility and convenience with the vital issue of retaining all the high-performance features which are critical to patient outcomes.

Issues with Existing Mobile Systems Mobile X-ray machines are widely available. However, they are limited. The biggest problem

mentioned by staff is a lack of manoeuvrability. X-ray units need a huge amount of technology which requires a substantial footprint and means equipment is often heavy and difficult to move. Designing units which can be driven anywhere around the hospital is the most basic requirement. This means a focus on smaller, sleeker designs which still incorporate all the features and technological performance of existing machines. Safety is also an issue. Mobile X-ray machines will expose patients to scatter radiation. A report from Antonio Abrantes, published in Health Management found that patients and staff would be at risk of exposure to radiation from mobile X-ray units. The exposure was lower than international limits required for radiation protection as long as patients maintained precautions by staying more than a metre away from the centre of the exposure fields. His conclusion was that precautions should be taken when using X-ray machines around the hospital.

Our revolutionary battery technology was developed in-house specifically for usage within mobile X-ray.

X-tech cellÂŽ keeps the unit working, not waiting! - Start up time 10 sec - 10 min charging gives 1 hour operation time - 8 years battery warranty

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MOBILE X-RAY SOLUTIONS

Modern solutions must balance the need to cater to the demands of cost, mobility and convenience with the vital issue of retaining all the high-performance features which are critical to patient outcomes

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Accuracy and scan quality must be maintained. A study from 2016 found that, in general, the effectiveness of portable X-ray units which could be used in nursing homes or taken to intensive care units was ‘adequate’. However, in a minority of cases, images were under exposed requiring rescanning in the hospital7. Reducing these shortcomings, therefore, will be important. Next generation devices which can combine mobility with the highest quality imaging technology, truly fit in with the goal of integrated care. Achieving this brings X-ray scanning to the patients, minimising the disruption of their care and the overall cost. Analysts agree that rebalancing primary and secondary care will be crucial to meeting the future challenges of healthcare8. Greater mobility for X-ray machines can create a bridge between the two.

Design and Aesthetics Until recently, aesthetical design was not considered important. However, specifications for modern mobile X-ray machines increasingly mirror those found in the commercial world. They are described as being ‘sleek’, ‘flexible’ and ‘lightweight’; language which would not be out of place in an advertisement for a smartphone. The latest systems blend mobility and performance into one unit. However, this is about more than looks. A sleeker design aids manoeuvrability around the hospital. It also allows it to be packed into the back of a van and taken to care homes, primary care centres or even sporting events. Good aesthetics also have benefits for both patients and staff. Research shows that beautiful spaces improve wellbeing9. Creating a comfortable, homely environment relaxes patients. Designers are looking to create spaces in which patients feel comfortable by creating living room spaces within the hospital10. Unfortunately, hospital equipment often distracts from this goal.

In paediatric wards, for example, a hulking, ugly machine can be disturbing for patients. To counter this, hospitals are coming up with special child friendly designs, such as a toy giraffe holding a drip, or chemo equipment with a Superman design. It’s all about reducing stress and putting the child at ease.

Easy Cleaning Design also comes into play when cleaning. Using mobile X-ray equipment has implications for hygiene and infection control. A study by Aso et al asked a total of 22 radiologists about their practices when using a mobile X-ray machine. Eighteen wore disposable gloves while handling the equipment, and 11 touched consoles and HIS/RIS terminals while still wearing the gloves creating an opportunity for infection11. Using a mobile X-ray machine around the hospital and even out in the community increases the risk of contamination. An extensive cleaning regimen will be required to minimise the spread of infection which will take time and effort. Easy cleaning mechanisms will be useful in reducing the time spent during the cleaning process and also the risk of contamination. Smooth designs without sharp edges not only make it easier to wipe down, but also reduce the accumulation of dirt and bacteria.

Choosing the Right Equipment Mobile X-ray machines are becoming more common and more sophisticated. The ability to take them to the patients aligns with the vision of the integrated person-centred future healthcare services want. Designs are being refined to increase usability, minimise risk and improve performance. The result is a system in which design, function and technology all come together into one unit. When choosing equipment, therefore, it will be important to consider all these factors: mobility, image quality, design and performance. The leading systems of tomorrow will address all these issues and deliver gains at multiple points.

MOBILE X-RAY SOLUTIONS

References: 1

Solutions for tomorrow Supports with Mobile Xray Rallycross World Cup:

https://www.solutionsfortomorrow.se/solutions-for-tomorrow-supports-with-mobile-x-ray-at-rallycross-world-cup-in-sweden/

Mobile Radiography Services in the Nursing Home: https://openarchive.usn.no/usn-xmlui/handle/11250/2593641

Missed Lung Cancer. Where, When and Why? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338577/

Error and Discrepancy in Radiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265198/

Long Radiology Workdays reduce Detection and Accommodation Accuracy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935843/

AI Improves Chest X-ray: https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2144 Portable Versus Fixed X-ray Machines: https://www.ncbi.nlm.nih.gov/pubmed/27030858

The Future of Primary and Secondary Care: https://bjgp.org/content/63/612/379

Art and Psychological Wellbeing: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458291/

Healthcare Interior Design and its Impacts on Patients: https://lahealthcaredesign.com/healthcare-interior-design-and-its-impact-on-patients/

Hand Hygiene with Mobile X-ray: https://www.ncbi.nlm.nih.gov/pubmed/21799281

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