Besides ventilators and oxygen kits, the Covid-19 pandemic has turned the focus on manufacture and supply of X-ray machines and CT scanners as indispensable tools for the prognosis and management of patients with moderate and severe symptoms. In its list of 33 “critical devices” in Covid management, the Centre included imaging devices, but, significantly, flagged mobile X-ray units and portable ultrasound machines. An indication that the need is for equipment needed at point of care, either during screening or at the ICU bed itself. Indian manufacturers are pointing towards a slow but sure surge in orders from state governments and hospitals. They also highlight the use of Artificial Intelligence (AI) software to make sense of images and scans of Covid patients for better diagnostics. Read| Govts to homes, Covid case spike lifts demand for oxygen Harsh Mahajan, Chief Radiologist and Founder of Mahajan Imaging, said he has a dedicated facility in West Delhi for Covid patients. He cites an international analysis of CT scan features of Covid patients — he participated in April — in which 93% of the 3,615 patients who tested positive exhibited a specific pattern and location of lung lesions. “Imaging, chest and lung scans are playing a larger role than we had presumed at the beginning of the pandemic,” said Mahajan. “It helps in triaging and determining the aggression of the treatment. Often, CT scans have to follow X-rays since small lung lesions can be missed out in an X-ray.” G C Khilnani, Chairman of the PSRI Institute of Pulmonary and Critical Care, cautions that radiology tools should not be mixed up with diagnostic tools for Covid. “X-rays and CT scans add to the acumen for providing a line of treatment and are indicative of the disease even when the RT-PCR test may throw up a false negative. The problem is they are expensive equipment and, therefore, not being used much in small towns and in rural India.’’ Read| As Covid curve rises, surge in ventilators causes glut Leading Indian manufacturers say that while there was a spurt in demand for imaging equipment, the focus remains on procurement of testing kits and other life-saving equipment. There are no directions yet on use of X-ray and CT scanners — specially portable ones — for prognosis or to supplement testing. Officials in Philips India, for instance, are marketing their recently launched ultra-portable ultrasound machine called “Lumify”. Said a senior company executive: “The machine itself is the size of a cigarette pack and thus very useful in the Covid-19 situation. We have given demonstrations to NITI Aayog and got some orders from Maharashtra.” The Philips mini machine costs Rs 10 lakh and the company is targeting sales in hospitals where Covid patients need repeated lung scans to track the response to treatment. Dr G S K Velu, Chairman of Mumbai-based Trivitron Healthcare, said they now had the capacity to manufacture 500 X-ray machines every month. “It is very clear that radiology and pathology go hand in hand and that is true of Covid-19 treatment also, “ he emphasised. “In Europe and USA, all modalities were used for Covid-19 treatment and in China, imaging technology was used the most. In India, portable imaging equipment should be rapidly moved into Tier 2 and Tier 3 cities to manage patients and, ideally, teleradiology solutions should be used.” As has been done in several countries, both manufacturers and radiologists have mapped the pattern of deterioration in patients using AI. One such company is Allengers Medical Systems Ltd, located in Chandigarh, which has recorded a 40% spike in sale of its imaging machines the past four months. Its Director (technical), Sanjeev K Marjara, told The Sunday Express that their algorithm was developed with the help of Motilal Nehru National Institute of Technology (MNNIT), Allahabad, using 1,500 X-ray images of Covid-19 patients. He said, “We are now giving this software as a value-addition to hospitals and clients and the accuracy is almost 95%. So, AI is being used to pick up the pneumonia-like lung infection faster. The results are encouraging." There are several other AI experiments in progress. One project is by a Mangalore-based interventional cardiologist with KMC Hospital, Padmanabh Kamath. He recalled that his project for commencing X-ray screening in clusters in Mangalore began with a patient from Thokkottu who was breathless but reluctant to get an X-ray done. He finally sent his X-ray results which showed a clear Covid-19 deterioration in the lungs and was admitted to hospital but, unfortunately, passed away. Said Dr Kamath, “There are several infected clusters in the outskirts of Mangalore where we want to use X-ray technology since it can be used as a red flag for detecting Covid-19.” Working with him is Dr Geetha Manjunath who said they have developed their AI software using thousands of X-ray images of patients of viral pneumonia and had begun a Whatsapp service wherein images are posted for doctors to give their confirmatory or negative findings. “We want to take mobile X-ray units door-to-door in contaminated clusters and maybe later spread out to other parts of the country,” she said.
