Building Blocks for Integrating Image Analysis Algorithms into a Clinical Workflow

Purpose Starting from a broad-based needs assessment and utilizing an image analysis algorithm (IAA) developed at our institution, the purpose of this study was to define generalizable building blocks necessary for the integration of any IAA into a clinical practice. Methods An IAA was developed in our institution to process lymphoscintigraphy exams. A team of radiologists defined a set of building blocks for integration of this IAA into clinical workflow. The building blocks served the following roles: (1) Timely delivery of images to the IAA, (2) quality control, (3) IAA results processing, (4) results presentation & delivery, (5) IAA error correction, (6) system performance monitoring, and (7) active learning. Utilizing these modules, the lymphoscintigraphy IAA was integrated into the clinical workflow at our institution. System performance was tested over a 1 month period, including assessment of number of exams processed and delivered, and error rates and corrections. Results From June 26-July 27, 2019, the building blocks were used to integrate IAA results from 132 lymphoscintigraphy exams into the clinical workflow, representing 100% of the exams performed during the time period. The system enabled radiologists to correct 21 of the IAA results. All results and corrections were successfully stored in a database. A dashboard allowed the development team to monitor system performance in real-time. Conclusions We describe seven building blocks that optimize the integration of IAAs into clinical workflow. The implementation of these building blocks in this study can be used to inform development of more robust, standards-based solutions.