A PRACTICAL

APPROACH TO
IMPLEMENTING AI
CONFIDENTLY LAUNCHING YOUR AI STRATEGY 
APPROACHING AI

It seems that everyone in radiology is talking

about Artificial Intelligence (AI) these days.
The RSNA17 Machine Learning (ML) Showcase
propelled this topic to the forefront after a
somewhat lackluster performance by several
big players the previous year. Heading into this
spring’s industry meetings, it’s likely that your
inbox has been jammed with mentions of AI and
ML. Whether attending these educational
sessions in person or reading articles, most
people are still posing more questions than they
are providing answers or advice.

We are certainly at the precipice of broadly

implementing AI and ML in radiology and other
specialties. It is important to leverage the
lessons learned from deploying other clinical
applications while, at the same time, taking
novel approaches. Failure to approach the
opportunity from multiple perspectives will
slow the adoption and raise the cost. With some
of the recent FDA clearances of AI products,
the ‘horse is out of the barn’ and there is no
going back. The path to a successful
implementation begins by realizing that the
solution is often non-linear, an adjunct to
clinical workflow, and that typical approaches
and integrations will not suffice. It’s important
to gather all the stakeholders and take a holistic
approach.
WHERE TO BEGIN

For these solutions to become mainstream it’s important to recognize and prepare
for some of the core differences in technology and workflow vs. PACS or VNA
projects, and avoid thinking of AI as a singular application. This will require a new
approach that puts outcomes and workflow gains first and technology second.

-Start with the right internal team. Engage your

CMO, CTO, CIO, department heads and your IT
staff. It may be time to hire a Chief Innovation
Officer who can lead the initiative. The clinical
and workflow gains can often be lost if not fully
vetted and the project plan is incomplete.

- Start with the right partners. Don’t try to bring

AI to every department at once or through
individualized solutions. At the current pace, you
would need to implement and integrate 100s of
products, many of which do not support standard
DICOM or HL7 communications. Approaching AI
as a platform will allow you to scale as needed and
can reduce your integration and implementation
challenges and dependencies. AI is rapidly
evolving, and being tied to a single vendor for a
single use case is likely to result in repeating the
mistakes made implementing CAD for
Mammography.

- Start with a mission statement and scope of

work that outlines your short-term and long-
term goals of using AI. These goals can differ
greatly depending on the application and the
amount of investment you are willing to make. If
it’s not part of your plan, it won’t get done. And as
with any large-scale IT project, the plan will
change. Implementing AI into your healthcare
delivery system is as much change management as
it is technical work.
 IN WITH THE NEW
Technology has evolved and its finally time for health systems to fully embrace “the
cloud” to get the most out of an AI program. The requirements to process studies and
data in a timely and clinically relevant manner are unlikely to be met with your local
compute resources. A secondary consideration is that the utilization of these large
amounts of resources are not constant and a large on-site investment will go unused.
A hybrid cloud can provide performance and scalability in an affordable manner.

- Plan to send some of your studies to the cloud for processing. The availability of on-demand CPU and
GPU processing and use of a micro-service architecture will give you the best performance for your
money. You will likely need to review your ‘anonymization’ schema as some of the AI engines need
patient date of birth, sex, weight or height that may be currently stripped, but are not unique PHI.

- Plan to leverage what resources you already have, and learn about alternate configurations to get
the best performance. Scheduling non-critical AI runs in the off hours will maximize your system.
Alternate Configurations using nVidia Grid may allow a GPU deployed for a high-intensity clinical
application to be utilized in the off hours.

- Plan to invest in new technologies and learn about them. Most everyone has moved toward
virtualization and there is a rapidly growing use of “containerization” using Docker, Kubernetes or
Azure Container Services.
 DIVING IN

When new technologies and approaches leave the world of research and become
obtainable by mainstream providers with budget constraints, the challenge will
be to adopt these solutions pragmatically. The first few decisions you make and
understanding your own mission is critical.

- Implement ‘quick wins’ first to demonstrate the value of

AI and gain traction. There are AI engines that can save
hours of processing time on CT and MR specialty studies for
technologist and clinicians. For example, several best-of-
breed algorithms provide advanced and detailed
quantitative assessments of Brain MRI that would take most
users hours to process.

- Implement a “platform” like EnvoyAI. EnvoyAI’s platform

is ideal as it allows you to try AI solutions with a single
integration point and is flexible enough to expand with your
identified mission. This approach also enables you to
leverage the single investment across departments planning
to use AI. It’s simple – Join the platform, try various AI
machines before you buy them.

- Implement a solution that is flexible in its ability to take

various inputs and provide outputs that are usable and
geared toward standards so that the solution does not end
up being a closed loop answer machine with limited access
to the results. Imaging is not all DICOM. Visible light
studies in dermatology, pathology, and endoscopy can all
benefit from AI.

SYNOPSIS
The revolution and evolution of AI in medicine will greatly outpace the relatively slow adoption
of the technologies and applications we encountered during the boom of the digitization of
imaging. Even with the large investments and incentives, we are yet to achieve an entirely
seamless and efficient electronic medical record. Act now to get the larger benefits available
with this burgeoning technological shift. The true innovators are prepared to become your
partner, help build your team, draft your mission statement, and identify a strategy that will
allow you to move at a pace commensurate with the artificial intelligence and machine learning
applications that promise to reshape medicine.
 AI IMPLEMENTATION CHECKLIST

Even with this practical advice, it’s assured that you have a few more of your own questions, and that’s to be expected.
Many challenges with PACS came from the challenge that it was not just a radiology solution. Making assumptions in a
project, where you are deploying AI into clinical workflow will almost always lead to the discovery of the “unknown
unknowns” that derail and delay such projects. Be prepared to adapt. Here are a few more questions you may want to try
and answer as you create your mission statement for AI, form your team, and select the vendors who will make it a reality.

Who will manage the AI infrastructure and integration points?

With many departments contributing and consuming results in
WHO

the future, Radiology is poised to lead the charge. Including

your PACS Admin may be the best place to start, as they have
often worked cross-departmentally and are familiar with
multiple integrations.

What systems will be integrated? It’s likely that you will need
to integrate multiple modalities, PACS, VNA, HIS, EMR,
reporting applications and eventually your EHR and patient
portal. These workflows can fall into several different
categories, each with unique needs. Think about these three
categories as you consider AI solutions.
    
        o “Quantitative” AI that can produce complex reports         
WHAT

            containing images that may be distributed directly to     

            PACS or the EMR

        o “Automation” AI that can provide results used for such

            things like driving worklist prioritization or may be used
            to automate simple diagnostic tasks.

        o “Assistive” AI that labels anatomical structures, indicates

            findings or completes complex segmentations that are
            used to assist with diagnosis.

TeraRecon, Inc. |  US 650.372.1100 | EU +49 (0) 69.9510.352.0 | info@terarecon.com | www.terarecon.com

TeraRecon©  2018  |  All  rights  reserved |  030618AQ-B/AI-1

Reproduction,  adaptation  or  translation  of  this  document  is  prohibited  without  prior  written  permission  of  TeraRecon 
 AI IMPLEMENTATION CHECKLIST

When should we start an AI program? Start planning now,

as the innovation and commercialization is happening at
WHEN

light speed. It’s likely that you have applications that use
basic predictive modeling “AI”. Understanding how those
applications are already impacting your workflow and
quality of care can help lead you to find other AI solutions.

Where do the AI results go? and How do clinicians access

them? This is important because the workflows will vary for
each use case. The inputs may be images alone or images
and data such as lab results. Outputs may be simple text,
WHERE

numerical representations, or can be complex segmented

color images with quantitative findings. Knowing who the
end user is, and identifying their specific need will
determine that answer. Sometimes sending the result
directly to the EMR may be the answer. However, at this
time of early adoption, radiologists and other clinicians will
want to validate the AI results before applying them.

TeraRecon, Inc. |  US 650.372.1100 | EU +49 (0) 69.9510.352.0 | info@terarecon.com | www.terarecon.com

TeraRecon©  2018  |  All  rights  reserved |  030618AQ-B/AI-1

Reproduction,  adaptation  or  translation  of  this  document  is  prohibited  without  prior  written  permission  of  TeraRecon 
TeraRecon, Inc. |  US 650.372.1100 | EU +49 (0) 69.9510.352.0 | info@terarecon.com | www.terarecon.com

TeraRecon©  2018  |  All  rights  reserved |  030618AQ-B/AI-1

Reproduction,  adaptation  or  translation  of  this  document  is  prohibited  without  prior  written  permission  of  TeraRecon