The Future of Radiology: AI, Cardiac Imaging | With Chief of Cardiothoracic Imaging, Narayana Health

Summary

Highlights

• Dr. Vim Raj shifted from neuro to cardiac radiology with the influence of inspiring mentors in the UK 🔄.
• An impactful career decision driven by a calling to contribute to Indian healthcare, leading him to leave a successful UK career 🌍.
• The podcast highlights the striking difference between Indian and UK healthcare systems and Dr. Raj’s insights on both 🏥.
• AI in radiology is making strides, but the transition requires careful adoption and understanding, particularly in developing regions 💡.
• Leadership in healthcare is about inspiring a unified focus on patient care, which could transform hospital efficiency and morale 🚑.

Key Takeaways

• Radiology is evolving rapidly with the integration of AI, streamlining processes, and improving diagnostic accuracy 🚀.
• Cardiac imaging is at a critical juncture, offering non-invasive solutions and aiding in early disease detection in India 💓.
• Adopting cardiac CT and MRI in India faces challenges like limited technology access and awareness among healthcare providers 🤔.
• AI could enhance radiologist workflow and reduce workload, but its full replacement of human expertise is unlikely anytime soon 🤖.
• Leadership in healthcare requires clear communication, teamwork, and a unified mission focus to truly improve patient outcomes 🏥.

Overview

Chapters

• 00:00 - 00:30: Introduction This chapter, titled "Introduction," discusses a scenario involving British soldiers and the Taliban, emphasizing the risks and consequences of conflict. The narrative then transitions to advancements in medical technology, highlighting the development of an AI program that significantly reduces the time required to report cardiac MRIs from 45 minutes to just 30 seconds.
• 00:30 - 01:00: Podcast Introduction and Discussion Overview In this introductory chapter, Dr. Vim Raj is welcomed to the podcast. The host outlines the primary focus areas of the podcast, which include discussions on healthcare and leadership within the healthcare sector.
• 01:00 - 01:30: Conversation Format and Focus Areas The chapter is a discussion format focusing on radiology as a career. It emphasizes a conversational style rather than an interview, aiming to share insights and personal journeys in the field of radiology. Key points include providing listeners with an understanding of radiology as a career, its prospects, and personal views related to the profession.
• 01:30 - 02:00: Guest's Background and Family Influence The chapter explores the guest's journey into medicine and radiology, with a particular focus on the role of family influence and personal background. It indicates that AI in radiology is a critical topic for discussion, suggesting its significance in the field's future. The narrative offers insights into whether the guest's path to medicine was intentional or accidental, starting from their childhood fascination or experiences that led them to pursue this career.
• 02:00 - 02:30: Educational Journey and Initial Inspiration The chapter titled 'Educational Journey and Initial Inspiration' begins with the author's expression of gratitude for being part of the show. The author describes the journey to becoming a doctor as interesting, hinting at a complex background involving various factors. They also mention coming from a family with parents in the armed forces, indicating a culturally diverse upbringing as a South Indian born and raised in the North.
• 02:30 - 03:00: Influence of Family and Society on Career Choices The chapter explores how family backgrounds and societal influences shape career decisions. It begins with a personal anecdote, describing frequent relocations across India, including Pune, Chandigarh, Jaipur, and Bangalore, due to a parent's career in the Air Force. Although the father was a trainer in the Indian Air Force and not a doctor, these moves impacted the family dynamics and potentially shaped career aspirations. The narrative underscores the broader theme of how familial and societal contexts contribute to career choices.
• 03:00 - 03:30: Decision to Pursue Medicine Over Engineering In this chapter, Vimel shares his childhood aspiration to join the National Defense Academy (NDA) with the intention to serve in the armed forces. However, his father suggested a different path within the same domain, encouraging him to pursue a career as a doctor in the armed forces. Vimel reflects on this new direction proposed by his father, emphasizing the need for more doctors within the military. This chapter explores the pivotal moment when Vimel decided to pursue medicine over engineering, influenced by his father's advice and the needs of the armed forces.
• 03:30 - 04:00: Medical School Experience and Technical Inclination The chapter titled 'Medical School Experience and Technical Inclination' explores the author's early ambition to enter the medical field and their inherent technical skills. Despite being selected for the National Defence Academy (NDA), the author chose not to attend due to a strong desire to pursue a career in medicine. The narrative delves into the pressure from societal norms, particularly within the Indian family context, that often dictates one's career path between becoming a doctor or engineer. The author reflects on their proficiency in mathematics, physics, and practical skills, indicating an inclination towards technical fields alongside their medical aspirations.
• 04:00 - 04:30: Transition from Medical School to Armed Forces Aspirations The chapter discusses the speaker's transition from initially aiming to be an engineer to eventually pursuing medicine due to family expectations. The speaker's elder sister was supposed to become a doctor, but due to her obtaining lower marks, she became an engineer. This resulted in the responsibility being passed to the speaker to fulfill the role of a doctor in the family. The speaker mentions successfully achieving good results in their 12th grade, which paved the way for a medical career.
• 04:30 - 05:00: Pivotal Events and Career Decisions The chapter titled 'Pivotal Events and Career Decisions' recounts the narrator's journey into the medical field, influenced by family decisions, such as a sister entering engineering. Despite a natural inclination towards technical fields, the narrator pursued medical education in Bellari, acknowledging this divergence in career path as a defining moment.
• 05:00 - 05:30: SSB Interview and 9/11 Impact This chapter discusses the author's journey towards engineering, highlighting their passion for practical skills and technology. It contrasts this with their experience in medicine, which, while not difficult, was not as enjoyable due to the extensive amount of learning involved.
• 05:30 - 06:00: Balancing Career Opportunities Between UK and Indian Armed Forces The chapter discusses balancing career opportunities between the UK and Indian Armed Forces. It reflects on personal experiences related to practical learning in medical school, highlighting the common perception among peers and seniors that the narrator would not pass. However, the narrator excelled, becoming one of the top performers in college. The chapter also briefly mentions traveling to Delhi.
• 06:00 - 06:30: Life-changing Decision and Joining the UK Medical System The chapter begins with the protagonist recalling a significant personal event coinciding with a major world event: the 9/11 terrorist attacks. The protagonist was in Delhi at the time for an SSB interview, which marks a pivotal moment in their life. The incident is mentioned as part of a broader narrative about life-changing decisions that eventually lead to joining the UK medical system. The chapter sets the stage for exploring how global events intertwine with personal fate, using the protagonist's experience during this critical moment as a focal point.
• 06:30 - 07:00: Early Career in Surgery and Joining the British Army In the chapter titled 'Early Career in Surgery and Joining the British Army,' the speaker discusses the selection process for joining the armed forces, expressing a preference for the Air Force. However, despite qualifying, the speaker was informed that a call letter would not be sent immediately due to increased security checks following the twin towers incident, indicating the global impact of the event on military recruitment, including in India.
• 07:00 - 07:30: Experience and Training in the British Territorial Army The chapter discusses the process and time frame for joining the British Territorial Army, emphasizing the detailed personal background checks required. The narrator expresses a fascination with the education and training systems in the Western world as compared to the Indian system.
• 07:30 - 08:00: Career Focus Realization in Neuro-radiology The chapter titled 'Career Focus Realization in Neuro-radiology' discusses the author's journey through medical education, highlighting the challenges faced during competitive exams. It delves into the difficulty of MBBS compared to pre-medical exams and touches on postgraduate courses and exams, which the author finds distinct and more challenging. The chapter also mentions the author's application to armed forces after completing the MBBS degree.
• 08:00 - 08:30: Get Exposure to Cardiac Imaging in the UK System The chapter discusses the author's decision to apply for exams to qualify and work in the UK, mentioning a 3-month period from the interview date to the booked flight to the UK. It also touches on the prevalent trend at the time of many people moving to the UK.
• 08:30 - 09:00: Experience in Research and Development of Cardiac Imaging The chapter titled 'Experience in Research and Development of Cardiac Imaging' appears to discuss career choices and challenges faced by medical professionals in India, particularly in the field of cardiac imaging. It touches on the migration of MBBS graduates from India to the UK and US, driven by better career opportunities and dissatisfaction with Indian entrance exams. The narrative suggests the author felt more aligned with overseas opportunities and possibly faced hurdles with the Indian examination system. There is also a mention of foundational examinations, indicating initial steps taken in pursuing an international medical career.
• 09:00 - 09:30: Professional Growth in the UK Healthcare System The chapter discusses the author's journey in the UK healthcare system, focusing on their professional development. It highlights the necessity of clearing specific exams in the UK, despite having passed basic exams in India. The author experienced a significant waiting period of three months for a call letter for a position. The narrative suggests that if 9/11 hadn't occurred, events might have unfolded differently for the author, possibly implying that the tragedy indirectly affected the opportunities or timing of their professional path.
• 09:30 - 10:00: Motivation and Decision to Return to India The chapter discusses a pivotal moment in the narrator's life where they reflect on their career path. The narrator had a chance to join the armed forces in India, but due to timing, they missed the opportunity by just 12 to 24 hours. This led to a different career trajectory, one that eventually took them to the UK. The narrator recalls contacting their parents upon arrival in the UK and learning about the missed opportunity, highlighting how close they came to a drastically different life.
• 10:00 - 10:30: Impact of Influential Mentors and Career Shift The chapter explores the significant impact of mentors and a notable career shift in the protagonist's life. Initially, the protagonist aspired to pursue a particular path, but eventually transitioned into the British Army. The narrative highlights the protagonist's long-standing aspiration to join the armed forces, driven by their appreciation for the discipline and hierarchical structure prevalent in military life. This career move, influenced by the protagonist's mentors, reveals the pivotal role they played in shaping this decision and the fulfillment of a lifelong dream.
• 10:30 - 11:00: Technology and Cardiac Imaging Advancements The chapter discusses advancements in technology and cardiac imaging, with a focus on the narrator's career path. The narrator reflects on their education and the initial interest in neuroraiology during medical school. The timeline is set around the late 1999 to 2000 period.
• 11:00 - 11:30: Professional Achievements and Perspectives on Education The speaker discusses their journey in neuroradiology and interventional neuroradiology, largely influenced by their experience in a medical school in India that lacked necessary facilities. They recount witnessing numerous patient deaths due to brain issues that could have been treated by an interventional neuroradiologist, highlighting the impact and importance of this field in saving lives.
• 11:30 - 12:00: Contribution and Growth in Indian Healthcare The chapter discusses the early stages of neurology in India, highlighting that during the speaker's medical education in Bellari, the field was in its infancy. Notable institutions like Neimans were distinguished for their volume of work in neurology, although many units in the country had not yet matured.
• 12:00 - 12:30: The Future of Radiology and Technology Integration The chapter titled 'The Future of Radiology and Technology Integration' discusses the restricted pathway to joining the field of radiology in the UK, highlighting the maturity of their system. It contrasts this with the Indian system, where medical graduates could immediately pursue radiology after completing their MBBS. This context sets up a broader discussion on how different educational frameworks influence the integration of technology in radiology, emphasizing the UK's structured approach to nurturing expertise before specialization. This foundation presumably aids in more effective technology integration within radiology, suggesting a link between training pathways and the adoption of technological advancements in medical fields.
• 12:30 - 13:00: AI in Healthcare and Radiology The chapter titled "AI in Healthcare and Radiology" explores the significance of clinical exposure for radiologists. It discusses the importance of understanding how diagnostic reports can influence patient management. The complexity of incorporating AI into radiology underscores the need for radiologists to be well-versed in the clinical implications of their work, ensuring that they are not just confined to imaging but also engage in broader patient care contexts.
• 13:00 - 13:30: Role of AI in Improving Efficiency and Workflow The chapter discusses the role of AI in improving efficiency and workflow, particularly in the medical field. It highlights an individual's journey through surgery and radiology, showcasing how AI can streamline processes in these demanding fields. The narrative also touches upon the importance of acquiring surgical skills, particularly hand-to-eye coordination, which were meticulously planned. Additionally, the individual balanced their medical career with volunteering for the British army, illustrating a commitment to both personal and professional development.
• 13:30 - 14:00: Opportunities and Challenges for AI Adoption in Radiology The speaker shares their experience of volunteering and joining the British army, specifically the territorial army. The concept of the territorial army is explained, where the army enlists fewer numbers than needed, potentially for flexible deployment. This anecdote, however, takes place before the speaker becomes a radiologist and during their surgery career, highlighting a diverse professional journey before venturing into radiology and engaging with AI in the sector.
• 14:00 - 14:30: AI’s Role in Redefining Radiologists’ Work The chapter discusses the structure of the personnel in the army, where only 20% are full-time members classified as infantry. The remaining 80% consists of professionals from various fields such as lawyers, doctors, and policemen, who are part of the territorial army. These members continue their regular public sector jobs while serving part-time. The relationship between full-time and part-time roles reflects a broader theme of AI's role in potentially redefining traditional job structures, much like the division of labor within the army.
• 14:30 - 15:00: Radiology Training and Educational Initiatives The narrator shares their experience of a unique training period within the army, where instead of practicing their medical specialty as a surgeon or radiologist, they participate in standard army training. This includes activities such as shooting drills and developing navigation skills, emphasizing versatility and readiness beyond their medical expertise. The narrator mentions becoming a decent marksman and excelling in navigation, highlighting personal growth and skill development during this phase.
• 15:00 - 15:30: Comparative Experience in UK vs. Indian Healthcare Systems The chapter provides insights into the speaker's training experience at Sandhurst, a prestigious military academy in the UK. Sandhurst is noted for training various royals and prominent military officers. The speaker shares that although they attended the academy, they did not meet any royals during their time there as notable figures like Prince Harry had completed their training just before their own attendance.
• 15:30 - 16:00: Ethics and Efficiency in Healthcare Settings This chapter explores the complex interplay between ethics and efficiency within healthcare settings, especially in challenging environments such as war zones.
• 16:00 - 16:30: Cultural and Systemic Observations in Global Healthcare The chapter discusses cultural and systemic observations within the global healthcare, focusing on the experiences of the narrator who was training to become a radiologist during a notable time of conflict. It touches upon the practice of teleradiology, which involves remote reporting by radiologists. The chapter briefly mentions the Gulf War, with senior personnel engaged in remote diagnostics while doctors and allied healthcare workers on-site handled treatment.
• 16:30 - 17:00: Leadership in Healthcare and Patient Care Best Practices The chapter discusses leadership in healthcare and emphasizes patient care best practices, particularly in challenging environments such as war zones.
• 17:00 - 17:30: Final Thoughts and Podcast Conclusion The chapter discusses the role of a radiologist deployed as an army major, highlighting the rules of engagement and medical ethics in conflict situations. It uses a hypothetical example of treating both Taliban and British soldiers impartially in a hospital setting, emphasizing equal treatment based on medical urgency rather than allegiance.

The Future of Radiology: AI, Cardiac Imaging | With Chief of Cardiothoracic Imaging, Narayana Health Transcription

• 00:00 - 00:30 you went into army of British yes taliban and I am the British soldier i shoot you you shoot me we are bound to bring both of us to the hospital in cardiac MRI it used to take me 45 minutes to an hour to report a cardiac MR today we have developed an AI program which does it in 30 seconds [Music]
• 00:30 - 01:00 so uh thank you thanks uh Dr vim Raj to be here and um so today so what we do at this podcast uh really is have a conversation um around uh topics of healthcare topics of leadership in healthcare uh so that's one of the things that we cover uh it's very
• 01:00 - 01:30 conversational so basically it's not an interview so we will have a overall in general discussion about uh about your journey about your views on radiology my views on radiology and it will be like more a conversation around that um and uh in general there are some areas of course for sure that I want the listeners uh takeaway for the listeners in general uh those would be a is radiology as a career or you know in terms of so that people know what it
• 01:30 - 02:00 takes to be uh what's in general the future of radiology uh definitely the hot topic of radiology and AI uh so these are definite ones that I would want to cover in general but otherwise it's going to be just a conversation uh between your journey and I'm sure There's so much to learn from your journey uh so let's start there let's start begin in terms of um what what from your childhood right what drew you to uh to medicine or how did it happen was it an was it an accident or was it
• 02:00 - 02:30 deliberate or where did it start so first Amit thank you very much for having me in this uh show i'm really privileged to be here [Music] uh me becoming a doctor is a interesting story I'd rather say and lots of things attached to it and uh I come from a background where my parents were in armed forces so we uh I am a south Indian but born and brought up in North
• 02:30 - 03:00 India and every 5 years we would move to different parts of the country where where all you would have said I was born in Pune Really oh that's not what I knew yeah I was born in command hospital Pune no and uh then I we moved to Chandiga so your father was also a doctor no he was not a doctor he was in the Indian Air Force he was a trainer in Indian Air Force then Japur Bangalore is where we spent all our life and uh in 10th
• 03:00 - 03:30 standard I wanted to join the NDA national defense academy and wanted to get selected so I was always aimed to go into the armed forces that was my destiny i always wanted to do that somewhere down 10th standard dad told me that Vimel you should join armed forces but you should join as a doctor the armed forces needs more doctors they
• 03:30 - 04:00 need more medical professional and that was one of the directions that I wanted to go so NDA I got selected but I did not go because then it was the aim to become a doctor and even then I was very very technically oriented i was very good at at my maths and physics more practical skills and then when came 12th standard you know the Indian family story in our generation was doctor one patient one person in whom becomes a
• 04:00 - 04:30 doctor one person becomes an engineer it was my sister who was meant to be the doctor elder sister and I was the engineer oh okay oh so it was like decided it was decided so intelligently I keep teasing my sister my sister got less marks so she did not become a doctor she became an engineer which basically led to the fact that it was on me now to become a doctor of the family and fortunately I did well in my 12th
• 04:30 - 05:00 standard and I became a doctor that was so armed forces sister going into engineering and me having to go into medicine is where we went into medicine and uh did my medical education in Bellari all along even in that time I clearly knew that I am a technical person but it changes later on and uh that actually defined
• 05:00 - 05:30 what I do where I am today is defined by this whole uh attraction towards engineering attraction towards uh practical skills uh getting your hands dirty in terms of technology learning newer things and medicine was I wouldn't say hard but was not that enjoyable to me because uh in medicine you have to learn a lot of
• 05:30 - 06:00 facts which you have to memorize and it was not practical learning a lot of it was not practical learning but uh with God's grace I did well in medical school I did reasonably well where most Most of my colleagues my friends my seniors were surprising we never thought you will pass but I actually was quite one of the toppers in the college so did well so I take a train to Delhi and that's where
• 06:00 - 06:30 my SSB is i land in Delhi and it's the day when 9/11 happened the twin towers got uh destroyed you mean uh when you went for the EF when I went for the SSB interview interview 911 happened and now it's all the reason I'm saying this is all connected wow so I go in and uh I have a very good interview i have a whole
• 06:30 - 07:00 selection process they say what do you want army air force navy i wanted to be in air force so that was my first preference they said you have qualified but we will not send a uh call letter for you because of the twin towers there is going to be enhanced security check on every recruitment that the armed forces even in India even in India because the entire world got shook by the security
• 07:00 - 07:30 lapse which had happened so usually they have a 30-day period so they said it can take anywhere from 60 to 80 days for us to send you a call then okay so they will do your personal background check exactly more detailed more detail before they will take anybody wow okay so at the same time I have always been fascinated with education and training that happens in western world and the Indian system of
• 07:30 - 08:00 giving entrance exams which is highly competitive where you have to mug up a lot of things and warm it out was something I was never good at though you master though you kind of I did but MBBS was a different level the post-graduation uh courses and exams are very very different before the postgraduation you went to uh armed forces or after so after MBBS armed forces armed forces I applied for it and
• 08:00 - 08:30 at the same time I had applied for an exams to qualify and work in UK oh okay so the date of interview to my flight which was booked to go to UK was 3 months okay and it was whichever country so how did UK like what what what made you look at UK was it so natural at that time to not really right there was there was a big outflow of people going to UK
• 08:30 - 09:00 and US at that time okay uk and US both were in medicine time in medicine a lot of people after MBBS were moving out especially those who felt that what they wanted to do as a career was not very well established in India or the ones who felt like me that they are not suited to give Indian entrance exam entrance exams okay and I had done basic exams there were some
• 09:00 - 09:30 basic exams which you could take in India which I had cleared so I had to go for one specific exam in UK so from the date of my armed forces interview there was a 3 month period for the UK flight so I said whichever comes call letter comes first this comes first whichever I'll do the call letter didn't come for 3 months for 3 months it just did not come so if 911 hadn't happened we wouldn't be
• 09:30 - 10:00 sitting here and chatting with each other because my career would have had a totally different trajectory so the time came I took the flight I land in UK and I called my parents and say I have reached dad says your call letter has come it was just by 24 hours maybe 12 hours 24 hours seriously yeah wow so you missed the armed forces to do the armed forces in India by 12 24 hours
• 10:00 - 10:30 because you've already gone there you thought you will continue that absolutely yeah and you did that but ultimately you went into army of British yes so you went to British army so you have to tell of course how that happened so yeah so as they say in Hindi the kea I always had that kea of wanting to be in the armed forces i love the discipline nature i love the hierarchial system in armed forces that
• 10:30 - 11:00 was there so this was all in late 1999 2000 we and I'm guessing that that's primarily because you saw that growing up growing up absolutely absolutely in that so I went to UK did my exams did well and all along in my career I wanted to do neuroraiology even earlier when I'm doing medical school I knew I wanted to do
• 11:00 - 11:30 neuroraiology how did that and interventional neuroraiology for that matter and main driving force was the medical school that we were in India it was a medical school which lacked a lot of facilities where I saw a lot of patients die because of brain issues which an interventional neuroraiologist would have sorted out and saved a lot of lives and that kind
• 11:30 - 12:00 of was something I wanted that kind of made an impression to you when you were learning medicine medicine this is like in MBBL in Bellari in Bellari and that is when I also realized the international neurology in India at that time was at its inter uh at its infancy and uh people were doing it but they were not very mature units only Neimans was one of the units which was doing a volume and as was doing but it was not a
• 12:00 - 12:30 very mature system and that was the intention to go to UK and do that and one of the good things about the UK system was they did not allow people to join radiology straight after MBBS at that point in time really they were just not allowed to oh because in Indian system what happens is now you do medical school and then you join
• 12:30 - 13:00 radiology you have no exposure to treating patients the clinical exposure is just not there and they want you to give that ah they want you to have that clinical exposure because then you know whatever I report what impact it has on patients management that's very interesting oh so that solves my puzzle of because when I was going through your profile I the first time I actually came across a radiologist profile who has
• 13:00 - 13:30 done surgery and you did surgery and then went to radiology and I was like how did that happened in the first place right so so yeah it was one it was a requirement and second because I wanted to do intervention I wanted those skills the surgical skills of hand to eye coordination of it was planned surgeries in a way it was planned in wow nice so surgery and while I was doing surgery I volunteered myself into British army and
• 13:30 - 14:00 your army uh can that didn't go no it never went away it never went away so I volunteered and joined British army british army has a they have an interesting concept called as territorial arm whereby if they need 100 people in their armed forces they only have this was during after doing surgery or this was during surgery this was you're not a radiologist yet i'm not yet a radiologist so if uh British army needs 100 armed
• 14:00 - 14:30 personnel in the army they'll only have 20 people who are full-time yeah remainder 80 are all what they call as territorial army which is basically lawyers doctors policemen uh plumbers and all that the infantry will be the 20% that they will recruit everybody else HR and everyone they will take from the public sector they'll say you keep working what you are doing
• 14:30 - 15:00 dedicate some time to us so in a year two months I would spend with the army where I don't train as a surgeon or radiologist I train as a soldier so we would be doing shooting drills we'll be really and all that so all even the standard army stuff you have to do every standard army stuff because you know how to shoot and all oh yeah i am a decent marksman uh in there and I'm very good with my navigation skills uh I had the
• 15:00 - 15:30 privilege of getting trained in a military academy called as Sandhurst this is the academy where all the royal family go uh the British royal the Middle East royal all the uh big army uh officers go and train so I was trained there you got to meet some of them not in my time no there were no I think uh Prince Harry and all they had just left before me uh they were ahead of me in their training in this so that's when
• 15:30 - 16:00 I volunteered and they loved the fact that I was a surgeon they wanted as a surgeon and then when I took up radiology at that point in time uh around Gulf War we had a when I say we the British army had a CT scannon in a ship park on the Gulf Bay so all the patients and soldiers were being flown into the ship
• 16:00 - 16:30 and scans were happening there tell us more about this so how how does this work and and you were a radiologist already not at this time but yeah in another four years time I became a radiologist but you were still flown i was never flown so I was not part of the Gulf War because at that point in time I was still getting trained okay so my seniors at that point in time were all doing remote report we were doing teley radiology work there was AN personnel doctors etc on the ship were treating
• 16:30 - 17:00 patients ct scan was there patients get flown in we scan so the injured Yeah injured soldiers injured soul of of British army okay so that is the common conception but it's not true anybody and everybody even the enemies even the enemies wow so there's some honor there there is a big honor there and I'll tell you about this which uh so later on when we fast forward and I was in Afghanistan uh
• 17:00 - 17:30 where I deployed as a uh army major and deployed as a radiologist in there we will have so for example you are let's say the Taliban and I am the British soldier I shoot you shoot me we are bound to bring both of us to the hospital as a doctor wow we will treat both equally okay and if you are more unwell you will
• 17:30 - 18:00 be treated more than me it doesn't matter and that's the mandate that's British uh it's it's a mandate and we are all doctors at the end of the day and the worst which which is funny also is when you're in the intensive care unit you may be in the bed opposite me and you might have actually shot each other yeah we may have shot each other and you are sitting next to me oh seriously that happened that happens and of course we cuff each other we cuff you
• 18:00 - 18:30 to the bed so we cuff this person also so what what's the experience as a doctor and a radiologist for you there in terms of what would be some of the learnings uh as an as an individual that you got from such an experience because it's a very rare kind of an experience right what made you all India in the sense is it is it that same army thing that you wanted to be part of it definitely is the army thing but more than that I feel
• 18:30 - 19:00 this sense of uh commitment sense of giving back to the community giving back to the world of what I have learned and uh doing things which is righteous in that manner and the fact that in the war zone we are going to help a lot of people uh it was a big calling for me and and at the end of you got any friends with you who came as well uh we
• 19:00 - 19:30 my unit army unit came with me so we had a lot but then I made a lot of other friends there uh in there and uh interestingly uh the radiologist there so the trauma care is the best in the world you will get anywhere in the world understand more so how how would that person we the armed forces which manages is a combination of different country doctors so we had Americans we had Dutch people
• 19:30 - 20:00 we had British people all put together and everybody there is purely for patient care there's no politics yeah okay there's no finances involved and there is a very very clear system of hierarchy okay there is a very clear system of hierarchy don't care who you are you're here to manage the patient which doesn't happen in normal hospitals there's always a politics there there's always a
• 20:00 - 20:30 hierarchy there and you know cardiac surgeons so in a way you're saying that was easier to manage it was very easy everybody knew their role okay and for example if uh all other patients we were the base was in the middle of desert okay it was a huge base about 10 mi in either direction was plain land because people can come and attack us so that was strategically put in there in our base we had around 40,000 soldiers uh so
• 20:30 - 21:00 it was a city on its own and the patients show so soldiers civilians who get injured during this gunfights all would come in helicopter they won't come on road it's all our patients would come in helicopters and we would bring them in some of them were in very very very bad shape and uh we became the hospital
• 21:00 - 21:30 became a target for Taliban over a period of time because Taliban would get into a gunfight and they would say we've killed 20 soldiers 3 days later the forces will release a news that there was a gunfight two soldiers died taliban says 20 and we say two because Taliban has lost so many people we've actually saved 18 so they were like whatever we are
• 21:30 - 22:00 doing these guys are saving them we might as well blow these guys out so we've had rocket attacks and stuff in our hospitals we had to go in bunkers and stuff uh it's it's an experience quite an experience so so if you have to borrow any learning from those times and just imagine that you have all the power to execute in in this world in the civilian world or whatever in the org which is which today has what would
• 22:00 - 22:30 those be like what would the couple of things that you think uh you would love to just execute if you had all the power to make it better because in a way you are saying that discipline actually and clarity of roles if I I in what I get from you and also the context of the situation of a singular focus of care helped uh all of you to deliver much better and felt more fulfilling as well is that right absolutely i mean if I summarize
• 22:30 - 23:00 what you're saying right so if that is what you feel what is it that if we had to create a similar thing here what would those be and what can couple of things be done see I think what worked very well for us was that we worked as a team with a single focus and a single focus at the end of the day was to save that patient's life okay and uh we were so so so
• 23:00 - 23:30 um what shall I say we lived together in such close proximity and we knew that for the next 6 months this is what we're going to be doing day in day out this is what we're going to be doing and we knew each other so very well okay if I say look at it I will my the radiographer will know what I'm asking for they will do that even without me having to say so the biggest learning for us was the
• 23:30 - 24:00 teamwork this to really be it makes a difference it makes a big difference give an example like uh so we were part of a trauma team okay now a soldier gets blown up from an IED improvised explosive device comes in okay his legs are dangling okay he has one leg left the other leg is dangling and we have a
• 24:00 - 24:30 protocol okay that six people will attend to him and on the table there are six people attending to him we know who those six people are no seventh person is allowed and there are about 15 people standing there where the team leader calls them i want you i want you nobody is allowed to come okay now in here in normal practice the person comes and the
• 24:30 - 25:00 leg is dangling the orthopedician will come running to tackle his leg the cardiac surgeon is here the anesthetist is there the person who is a team leader may be the most junior person in the whole gang and the person behind there's a yellow line actually we say don't cross that line nobody can cross that line till that team leader has actually called and the team leader doesn't necessarily to be the most senior person it's usually not it's an emergency physician it's an emergency physician and his boss may be beyond that yellow
• 25:00 - 25:30 line and his boss will not come until this guy works so and I am there as part of the trauma team the first six people the radiologist is that first six people which you don't see anywhere else in the world cuz we are actually doing an echo we are doing an ultrasound and saying diagnosis this is fine safe and then I step out no there is blood take to OT directly so the orthopedician in that
• 25:30 - 26:00 case is itching and saying that leg is falling that leg is falling and this junior is saying stay there he's not going to die because of his leg he's going to die because of other things first let them get everything and you have to but why is it so hard to uh in say implement it in in hospital setting in uh in normal in normal hospitals like uh ego there's a lot of ego in healthcare which doesn't work and we don't work as a team in a closed
• 26:00 - 26:30 environment if you see what happened in Afghanistan we were working in a closed environment as a team which basically meant we know we are only dealing with seriously ill patients they are only dealing with gunshot injuries IEDs and everybody knew their role in normal healthcare you have such a uh Pandora's box you have no idea what's coming in
• 26:30 - 27:00 next and for everything you can't do so true but can we just for for the sake of con because this is very exciting can we for example hypothetically okay can we create a zone within an hospital saying this is for emergency alone which anybody is there right there is a emergency physician in an hospital as well he is that team leader he or she is that team leader and we create a task force uh along with them which only does
• 27:00 - 27:30 that for 6 months in an year and follows exactly these protocols and that care at least will get elevated a lot not everything but that care would get elevated a lot which itself is is immensely useful because that's the care when people need it like the most it's the emergency kind of care would would that see this is what actually happens in a restricted environment so if you go
• 27:30 - 28:00 into for example if you come into our hospital you will see that there is a operating theater OP team one team 2 team three if that team one is made up of a standard group of people for a standard period of time the efficiency of that team is super high cuz they know each other they know what this person wants they know how this person operates what's the next thing they're going to do and the same thing in a closed
• 28:00 - 28:30 environment in an emergency team you have a trauma team trauma team one trauma team two or three and if that team constantly work they very well know I know this is what he's going to do i know this is what she's going to do and the efficiency improves significantly the communication becomes so much more faster and easier to do and I think the biggest thing which worked for all of us was that we were there for one singular
• 28:30 - 29:00 purpose that was one important thing then we were there for one singular purpose there was no finances involved there was no promotion involved uh the hierarchy did not matter to us uh we were all given ranks we had colonels we had majors we all sitting together and eating lunch we all are going in the same vehicle there is nothing to uh aspire apart from saving that patient's life which makes a big difference in a
• 29:00 - 29:30 in a way this is so much relates back to what we were earlier discussing about the need for leadership in in healthcare and one of the roles of any big leader is to kind of galvanize the team towards a singular purpose right uh and and so I mean somewhere probably more of that has to happen absolutely and I understand in in a condition like a war that becomes
• 29:30 - 30:00 easier and natural to happen because the purpose is so uh kind of compelling that it happens but how can we create similar conditions in in hospitals uh so for example today someone is listening this and is running in hospital or intends to run in hospital what is it that he or she can take from this and put it into their system so that the chances of they delivering that kind of care or and team building that
• 30:00 - 30:30 kind of a team they're a leader for that entity they can take away from see I think if you believe in setting up such a hospital which works in an efficiency that we see in these units is the first thing is ethos of that leader has to be very very clear and that ethos has to be pushed down to
• 30:30 - 31:00 the entire team and the leader has to lead by examples and there has to be very very very clear communications and saying this is what is expected this is how we are going to do we've had teams within our departments and in every hospital that we've gone and worked we see some teams work some teams are very dysfunctional in there and there are many reasons for that to make things work I think everybody has to understand
• 31:00 - 31:30 their purpose everybody has to realize what is it that they are contributing into it and it has to be led by an example strong ethos of how to do it and the third thing which happens is communication if your communication channels are very vague we used to have this so we will have a trauma case and that trauma case will be 3 hours four hours everybody's time and then we go sit together and say what went well what
• 31:30 - 32:00 did we do well is there something we can do better did we not do this and interestingly as a team lead or as the radiologist as a surgeon you feel it was great it was fantastic because we saved the patient's life and stuff but then there are people in the team who will turn around and say that was disaster guys I didn't know what you were doing you may know what you were doing but I
• 32:00 - 32:30 had no clue what you were doing there was no communication and in this case the patient survived but we don't know what will happen next time so the communication becomes a very very important and what would be say two to three things what one should do to ensure there is a better communication amongst team members see I think what happens is from the top down uh the leadership of a hospital as the hospital
• 32:30 - 33:00 grows the leadership of the hospital distances itself from the people who are actually delivering the services and there is a expectation that middle level managers would do that would do that unfortunately the middle level managers are often not as inspirational as the leaders are and they are not able to pass very much a corporate story as well correct so what is important is
• 33:00 - 33:30 that the embibing the ethos of the institution into the entrylevel person itself is very very important and that happens through regular dialogues regular meetups and saying hey what's happening what have you guys been up to this is what you've been doing because in today's hospitals we always hear this is not well you know we need to change this this is not well this is nobody comes and tells guys you
• 33:30 - 34:00 did very well last month you know we got this compliment from these patients these patients are happy about it we seldom get positive feedback we always get negative feedback and over a period of time it just becomes noise rather than a proper communication and a dialogue So you have to speak with the entry-level staff and the top level management has to take time to be able to do that because they have to inspire
• 34:00 - 34:30 people okay and that's what lacks we we never had the problem of inspiration in there okay and we were very much interested in that m the other thing which I feel which is a very common problem that we face nowadays is people get bogged down by the sheer volume of things that they and if I am doing 101 things then
• 34:30 - 35:00 my passion for a thing will go down go down you don't have the bandwidth the energy to give that correct what it deserves then so knowing each other right so one is of course you know each other well if you work long enough uh but is there are there ways to accelerate this team formation building i mean we always have this corporate trainings around team building and stuff like that right but are are there
• 35:00 - 35:30 specific things in army or in your experience otherwise in especially in the healthcare environment that helps to build this team strongly uh so we we've done this and what we have realized is that the day outings and stuff like that are more than an icebreaker nothing else okay they are just an icebreaker for people to just know that what works in healthcare is often the
• 35:30 - 36:00 night shift if you're with somebody in the night shift and I used to work in emergency departments and they were long shifts and you would know the persons much much better in a shift where you have nothing else to do but just doing your job and you're working with them together and you get to know them and you talk to them and you realize them realize what their strengths are what their weaknesses are but everybody can't do night shifts
• 36:00 - 36:30 um it takes time it takes time and there is no easy answer to it we have found that if a person joins our unit for us to know them it takes anywhere from 3 to 6 months and often there's so much of churn in the system if they move out or they move around then you just get to not know them at all and we have been
• 36:30 - 37:00 very particular about how we recruit people because we traditionally in Indian healthcare radiology sector recruitment is based on uh clinical acumen they that's generally one of the Yeah so you basically give them examples you ask them to write a test etc we don't do that oh wow so what do you do we don't do that because when we are taking a trainee we are taking them to train them
• 37:00 - 37:30 if they're already good at their job then they don't need our training so we So you generally generally take freshers so we take freshers after med school uh after radiology we take intermediate people also because we will train them that is our job what we actually do is we assess them as a personality so we ask them situations we understand what drives what do you look at them right so we look at people who are committed to work okay and we like
• 37:30 - 38:00 people who are happy to admit that they don't know something how do you find their committed to work so what we one of the things which we very openly turn around and say hey guys we work 12 hours a day okay and we expect you to work 12 hours a day are you okay with that often in an interview they'll turn around and say yes we are okay because they want a job that's that's how it becomes and then when we dig deeper and say you're stressed this is the situation what do
• 38:00 - 38:30 you do in that situation people come up with answers people come up with answers where you clearly pick up and say this person is not uh cut out for doing this or has not had that experience we've I have trained aroundund not 100 actually around 80 85 fellows over a period of last 10 years i've gone wrong in about six of them oh you you do track and measure how during our course we realize Oh you realize we
• 38:30 - 39:00 realize that that we've had six amazing rate who've quit and gone and said sir we can't cope with this wow that's a good because recruitment is a big challenge right we we don't it's tough tough to know uh from an interview at least I find it very tough to know from an interview um everything about what is required or what you are looking at to really find that with evidence to understand and say oh yes
• 39:00 - 39:30 sometimes is obvious yes yes and and then you're really happy to like but many times not yeah just there's no foolproof way so as I said we've also gone wrong but six out of 85 is a phenomenal rate I think we should be calling you for recruitment in life but but yeah but so coming to coming to so so then you did your uh army and you you went back to uh NHS yeah
• 39:30 - 40:00 so how how how long you you stayed in UK what happened what happened after that how how do we find you here so I finished my surgical training and got into radiology and uh which was always the plan which was always the plan got into radiology and during radiology and surgery army was going on two months in the army 10 months in the uh radiology career
• 40:00 - 40:30 and there was a pivotal shift from neuroraiology to cardiac radiology how did that happen right how did that happen i think I think it happens to everybody that there are few people in your life who change the way you do things we want to know more on that for sure so I had one influential doctor in my senior who was a professor and
• 40:30 - 41:00 Richard Kulen richard Gulen uh was my guru as they would say and I always hated cardiac in my med school don't tell me man don't tell me this the man who does the maximum cardiac work in the country is saying that that's that's breaking news i got a caption yeah you got a caption i hated cardiac because I always felt it
• 41:00 - 41:30 was very very complex and I never could get my head around K the disease process how you manage them how you diagnose them was something always an enigma for me and I was not good at it richard Culen and there was another chap called James and Twistle they were my trainers in UK in UK james was the thoracic radiologist richard
• 41:30 - 42:00 Golden was the cardiac radiologist and this was when this is the year this is 2005 2004 200 20 years back yeah 20 years back and they made it so simple you know I'm a technical guy i'm always a tech-minded guy you know 1 + 1 is two that's how I learn and they broke the whole cardiac and chest system down to a level where I'm like "Oh this is I can do this i
• 42:00 - 42:30 understand this." And it was fascinating it really was fascinating and that's where every other part of the body and every other specialtity if you look apart from maybe anesthesia healthcare is a lot of it is knowledge based there is not much technology radiology radiology has I was about to ask you that was this attraction for radiology more because of
• 42:30 - 43:00 the tech part of it no the initial attraction was purely neuroraiology because of patient not getting the services but then as I came into radiology I realized I found what I wanted which is my calling as they would say that this is technology and with cardiac but that was more by accident it was more by accident and or something else yeah in destiny or whichever no I mean something else in the sense radiology you you wanted because you
• 43:00 - 43:30 wanted to detect neuro radiology and interventional and that started then you got into a field which has lot of tech absolutely which was not really by design but but then it just got into the right place lucky correct absolutely yeah and cardiac was even low tech help us understand that so if you look at any other part of the body none of them are constantly moving so as a radiologist you are taking
• 43:30 - 44:00 pictures you're basically capturing pictures and you're doing so if it's your brain you just make your head not move you take pictures you get beautiful pictures you want to take a pictures of your knee you ask people to not move and you get beautiful pictures lungs you can still ask people to stop for 5 seconds 6 seconds whatever and you get good pictures heart you can't heart has to constantly keep beating and
• 44:00 - 44:30 if you're trying to take a picture of your kid running around you know how blurry they become and that is where the technology went leaps and bounds to be able to image the heart a moving beating heart and that is another fascination which triggered and I realized well this is what I want to do and I had the greatest guys in the world who were training me and it made sense something clicked in the system where everything just made sense i I used to say when
• 44:30 - 45:00 people used to when I used to need CT and stuff so when someone who's new to this would say can like in the when I'm training say a new sales guy or something uh can a 16 slice or eight slice CT do a heart imaging right I said yeah definitely it can give great pictures if the patient is dead then there's not a problem at all the best scan is when the patient is remind me about this there's another
• 45:00 - 45:30 thing about me which you don't know which is relating to patient being dead i will tell you about that okay we we'll go there so but yeah so then then uh this cardiac fascination happened largely due to the influence of your uh your your guru and then of course you found tech a lot in it and and with CT scanners and and other technologies probably growing a lot to make that possible is that how that exactly and cardiac CT cardiac MR you constantly had
• 45:30 - 46:00 to work with technology you constantly kept on innovating the technology had kept on improving there were versions of the software every 6 months where you I was always thrilled on new versions look at that my colleagues were like "Oh god we have to learn something again." So that was the difference that was a divide we could clearly see that technology really excited me so cardiac
• 46:00 - 46:30 was my choosing and fortunately I got the opportunity to train in three of the best cardiac units in the world i went to Cambridge i then went to Brompton and then I both in both in UK and then in a hospital called Glenfield which is another large cardiac unit in UK i was a consultant there and uh I was practicing i was doing extremely well i was in the career doing much better at my states
• 46:30 - 47:00 than other colleagues of mine and cardiac imaging played a role in cardiac imaging absolutely and we we were all these units are the high volume cardiac centers they do so just just for our understand when you say high volume cardiac what what are the numbers so so so give some broad numbers in Brmpton we had three MRI machines doing only cardiac and how many cases would that we would be doing somewhere in the region
• 47:00 - 47:30 of 25 to 30 cardiac Mas every day and days a week wow and uh that was standard for us right uh in Glenfield we were doing something in the region of uh 15 cardiac MRS a day cts were less how many cardiac CTS would be there in similar places in similar places we would be doing about 8 to 10 cardiac CTS a day a day which is also a lot which is
• 47:30 - 48:00 also a lot yeah we do much bigger numbers now yeah so you do what now you do about 100 cardiac CTS is what I understand so we do about 150 cardiac CTS and MRS a day ct plus MR ct plus MR so CT would be 100 CT 130 CT cities and 20 MRS cardiac MRS a day a day would you be by far the maximum number of cardiac CTS done in the country and probably top five in the world uh yes to both
• 48:00 - 48:30 definitely for the country nobody else does that many uh in the world the only people who may be doing more than us are going to be one or two Chinese hospitals yeah exactly i I just thought that otherwise just not uh yeah the volume is I I do know that in US and UK none of the institutes do these numbers so what so just for radiologists also listening into it and others as well and what is the role of say a cardiac CT if you want to explain to a lay man in terms of
• 48:30 - 49:00 cardiac CT and cardiac MR what is it for so when we look at a cardiac CT there are two broad categories that we can look at one is screening of people who are suspected or at a high risk of having coronary artery disease and then there's another group who are symptomat who have symptoms Yeah of suspected coronary artery disease or blocks in
• 49:00 - 49:30 their blood vessels and what they have to do is to go and have a catheter angography the traditional angography they may have to go instead of that angography you're going in for a CTN because it is noninvasive and also it is fast highly accurate and you're able to get the results from it in the screening space which is very very dear to our heart is
• 49:30 - 50:00 that currently there are no good tests which actually tell you whether you have a coronary artery disease or not right so today if you say I have a family history of coronary artery disease somebody my relative passed away I want to know if I have coronary artery disease or not you will go and you will traditionally be offered a chest X-ray
• 50:00 - 50:30 you'll be asked to undergo an ECG maybe an echo an ultrasound of the heart and finally a treadmill and sometimes a nuclear stress TMT or something so if you go for the nuclear very few people but if you go for the nuclear I'll keep that aside now in all of these four they are useful if you have significant coronary artery disease and there is almost a damage to your heart already so if you have mild
• 50:30 - 51:00 disease moderate disease all of these tests will be negative and you will think I'm fine what a CT would give CT is the only test on today's date even nuclear medicine would not give nuclear medicine is another but so people who argue right uh in this and and I'm sure you have heard this a lot of times but for for everyone's benefit is that people argue that the cardiac CT might not be uh a gold standard in the sense
• 51:00 - 51:30 might not confirm it and you anyway will need to do a kath lab then why don't I do a kath lab directly like there's an argument some people have absolutely and and especially if you have a if you are of higher age you would have a certain level of calcification and you'll not be able to differentiate between I don't know how much of that is real right true but if if you can throw a little light on on this and and the case for it that would be great so if you imagine again
• 51:30 - 52:00 100 people okay the issue where CT is not accurate enough and you need a catheter angography is less than 10 oh Clearly so in 90 cases in 90 cases you can say because a lot of them don't have disease huh of course a lot of them don't have disease we are very very accurate in them so they don't have to go for a
• 52:00 - 52:30 invasive angography second there is a group which has mild disease moderate disease ct is so accurate that this disease will not be even seen in cats m so you have mild disease moderate disease cat will not even see them so but a medicine treatment and a lifestyle change might actually prevent exactly which is required for these people so that's why the invasive angography really is not so would you say would you say as a cardiac CT or cardiac imaging
• 52:30 - 53:00 person in and would you say that the adoption of cardiac CT is much lesser than what it should be in in the country so considering and then People of course argue about radiation whether it should be as a part of the preventive test and screening those arguments so a little more light on those factors so the medicine is traditionally driven by evidence we like to have publications we like to have evidence of doing something
• 53:00 - 53:30 to show that it works right there is evidence relating to coronary artery disease which comes from the western world the disease in the western world is different than disease in Indians okay help us more on this we have different risk factors right when I was in Crabridge or Brmpton then we are doing a CT reporting list if you see a
• 53:30 - 54:00 55 year old having coronary artery disease we would look at left right and say how unfortunate is this guy that he's developed disease at such a young age 55 in India I see 25 years old having disease really 25 years old that is when it surprises us but but even at 25 they're getting scanned for cardiac CT they come with symptoms what are you
• 54:00 - 54:30 saying they come with symptoms they have chest pain they are unwell they are coming with symptoms so we are actually finding this this is this is because of lifestyle changes mostly or a lot of it to do is this a lot is this a lot like so you do a card 100 cardiac cities a day so you have actually a great database so we how many would be how many would be in the age group of say not 25 but 25 to 45 and have a a
• 54:30 - 55:00 reasonably serious cardiac risk i would say we are collecting our data we are in the process of publishing our data and what we find is the group of people who come to us for getting scans are not a general population of course it's a it's a stratified sample so there will be a higher number than the than the sample population no doubt but still right
• 55:00 - 55:30 surprisingly under the age of 40 we still find 15 to 20% of our patients having disease and this this disease level uh if detected in this in this scenario when it is how many would need intervention or a lot of them is at such a level that they can be actually treated through medicine and disease okay so a lot of these are preventive cares they don't need
• 55:30 - 56:00 intervention as in a stent but they need to be put on statins they need to be out on lifestyle modifications what we have traditionally seen I've seen my friends who come and they say "Hey Viml can you scan me?" And I say "Why do you want to scan what's happening?" General uh questions and we look at their blood test and I say "You need to be your cholesterol levels are high you need to be on statins you need to start medication." They said "No Viml i'm going to go change my diet i'm going to
• 56:00 - 56:30 exercise is I'm going to become much fitter than what you're seeing me give me 6 months and I will do that 99% of them never achieve that okay 6 months later is the same same point I do a scan for them and I show that there is already calcium deposit in your blood vessels the aderance is much better aderance is so you're seeing actually this is very interesting point right this is very interesting point so you are saying okay even if you had not
• 56:30 - 57:00 taken a cardiac C by your blood test if they were having higher lipid profiles and correct me I'm I'm not doctor but still uh higher lipid profiles and had the discipline to take the medicine probably cardiacity was not required as much yes if they are asymptomatic if they are asymmetric of course if there is a symptom you anyway you we we will come to that topic as well because that's also very important in terms of understanding the cardiac city role but uh if they are
• 57:00 - 57:30 asymptomatic they have no such big problem but higher lipid levels and had the discipline to take the medicine that most don't everyone knows like I I'm probably one of them right most don't we take it for my dad is a doctor so I probably take it for a while and then again stop really uh but at the same time if they had done a CT just because of that evidence in front of you
• 57:30 - 58:00 and because you measured it the aderance to that by the same person is much higher absolutely right and also there is a subset where the lipid profile is normal and they still have disease still have disease which is which can be detected in the CT which will be only CT will tell you no other test will tell you wow and we will We want to talk more i definitely want to talk a little more on this but I want to cover the symptomatic part as well in the symptomatic part what is the role of CT
• 58:00 - 58:30 because should they have gone directly to CAP versus doing a CT so in the symptomatic part you again have two separate groups one is very acute symptoms where they have ECG changes right they go for a catheterage there are specific ECG changes they go for catheter and then there's a large group of people who say I'm okay now but whenever I climb stairs I'm getting symptoms i'm okay now but by fifth
• 58:30 - 59:00 kilometers of walking I'm getting those symptoms so these stable patients CT makes a huge difference for them because a lot of these patients don't have coronary artery disease okay a lot of these patients have symptoms but they are not typical chest pain they are atypical chest pain they are related to reflux okay they are related to them not being fit they related to other things recently uh there is a big trial which
• 59:00 - 59:30 came out of Scotland so you are saying if I get this right sorry if you you are saying that actually is the other way around you're saying the role of CT is to actually filter out those people who don't need to go to a cath who otherwise have might have gone because of symptoms uh or because of fear of symptoms of C that that they might be having a chest but this will give you a more conclusive yes or no saying that is it because of a
• 59:30 - 60:00 heart disease or something else if you look at the history of catheter angio okay why did CTNO come in people were doing catheter angio and they were finding that there are lots of normal studies that they patient has typical symptoms they take them do an angio it's all norm but it's an interventional procedure you're putting away heart there are complications so they said we need a gatekeeper and city was essentially a
• 60:00 - 60:30 gate gate that's how it started actually a great gatekeeper it's a great gatekeeper and saying 100 people come 80 of you don't need anything in terms of catheter angior out of those 20 10 will need another 10 we will give some medication and bring you back so the role of CT has to be seen as a filter who is you know segregating
• 60:30 - 61:00 people into the right set of groups and preventing people from having unnecessary invasive procedures there is a lot of criticism okay there is a lot of criticism people say no symptoms no scans i often say this and this is something which very true for you me and everybody how old is your car my car is 10 years old how often do I take my car for a checkup
• 61:00 - 61:30 every year how old am I i'm nearing my late 40s 50s how often do I go for a checkup almost never but would you suggest so would you suggest for example and and that that really makes this a very concrete uh discussion in terms of do you suggest that if someone is say 40 or whatever that age is 40 45 age and above cardiac city angio should be a
• 61:30 - 62:00 part of the preventive and checkup so when we say cardiac CT there are two components of it one is a calcium score where we don't give any dye we don't put any needles we just walk in walk out 10 seconds is what it takes and then there's an angio where we put a dye and we do that asymptomatic people in their 40s men even if you have family risk of diabetes hypertension men above 30 women
• 62:00 - 62:30 above 40 otherwise 40 is a good cutff calcium score is sufficient it will give you an idea of it will give you a very good idea if your calcium score and those are accurate they are very accurate if your calcium there is no calcium your calcium score is zero they don't need to do anything more okay so it's conclusive asytomatic it's conclusive enough if you're asymptomatic and that's but it should that should be a part of their
• 62:30 - 63:00 preventive should be a part and it's not an annual thing also if your calcium score is zero no need to worry for the next 3 years but in once in 3 years after 40 you should do a calcium score and should be a part of your preventive check testing in India in India and for India this is not applicable to the western world because they have a different the incidence is different there so that is where and the radiation dose is very yes nowadays with calcium score it's almost I don't say negligible but
• 63:00 - 63:30 it is very easily which is very different than what it was and I think many I feel sometimes right with being in this industry many of times the physicians who are at the front end of this uh still have the perception that CT radiation is of the levels that they probably had learned at what whatever time that would be uh and and the progress and the advance of CT in terms of the radiation dose that has come down is not that they are aware of so they
• 63:30 - 64:00 for smaller things uh so for things which which could have been very useful there is a hesitancy to do a CT uh even the benefit is significant yes and I generally give the example of kidney stone uh where you know uh probably the gold standard and you can correct me if I'm wrong the gold standard is like CT doing uh but most physicians would give an ultrasound and and there can be two good reasons of course one good reason is the money spent M but there's also a
• 64:00 - 64:30 reason that they give when I asked few of them is the radiation dose and I was like gosh now that radiation dose is like an X-ray would you really not give your time X-ray to find this out correct versus now because that CT has become and and most of them don't know this that this has gone down but anyway so that is one hindrance but what would be the what so this whole thing right this calcium scoring and then probably doing even uh angio If it is symptomatic or if
• 64:30 - 65:00 there is some if there is a higher score correctly exactly doing this is done much less than what probably should be currently absolutely much much lesser right what do you think is what are the barriers what is stopping it is it is it the knowhow of the physician on this topic is it the risk of radiation or is it different ideologies about doing this what is stopping it really
• 65:00 - 65:30 so we are perhaps doing 3% or 5% of the volume of cardiac calcium scores in the country that we should be doing wow okay we are probably doing that which is very worrying because we all know that we have coronary art this prevalence is very high and there are things you can do to
• 65:30 - 66:00 alleviate the risk but people are just not doing it why are we not doing it first and foremost I think the there is a gap in technology availability for doing a decent calcium score scams you need a 64 slice CTS for a decent you can do it in lower ends also but you need that 64 slice 64 detector and 64 sorry 64 rows of rows yes
• 66:00 - 66:30 uh in that second is the knowledge and the what shall I say the cardiologist acceptance for this is limited because they have not got exposed to this during their training they still think it's a competing modality than see collaborating CT angography is can be
• 66:30 - 67:00 construed as a competing modality absolutely is it really because the general argument to that is uh is the counterargument to that uh thesis is that if you do more CTS angios you'll actually have more cases of people because the capture rate would be more after saturation probably then you're right but till it saturates which is far away from uh you'll actually get more number of cases to be operated upon by
• 67:00 - 67:30 an an uh catlab angography and plastic because you have detected many more which is is that a right way of looking at it or no not necessarily if you look at our experience at yours is a great experience we do both if you I go back to this example you have 100 people who come to a cardiologist and to all the 100 people you say you need a catheter angography invasive
• 67:30 - 68:00 angography the conversion rate is around 18 to 20% and the only 18 to 20% are those who really have bad symptoms yeah and you just can't do anything can't do anything that's 18 the same 100 people you ask them to have a CT and you the conversion rate is 90 to 95% right because for them it's another scan scan it's an outpatient scan straight and when you're scanning 90 to 95% you are actually bound to found 25 to 30% and
• 68:00 - 68:30 disease because that's the prevalence of prevalence so eventually your numbers increase and you are doing the interventional work which needs to be done not the normal diagnostic you're actually using the invasive procedure for intervention therapy rather than just for diagnostics which is far better way of of doing it exactly and and you're using that asset in the much more way also from a very business angle as well like from the number angle
• 68:30 - 69:00 which is also important i mean having the economics behind it working as well is very important but but that that's what would happen but anyway going back to the challenges or why this adoption so one is you saying technology we have knowledge of scanners that is available second is the understanding of the disease process and what does the calcium score give amongst the clinical community is limited third which I find is these things will be driven by
• 69:00 - 69:30 patients these things are driven by patients so we've started having patients come and say I want to so patient awareness patient awareness is not there but if the doctor who is the physician uh says that it's not required because they really don't think it's required then it becomes very difficult right it people do direct choices as well people do direct choices as well see in the one of the biggest problem which I say is we
• 69:30 - 70:00 follow western guidelines in western countries for example UK healthcare is funded by the come okay and for a government to make a test available as a screening test for them health economies have to make sense right they have to have a pickup rate of 10% before they make it as a screening test and in their population it doesn't work so they say
• 70:00 - 70:30 we should not be doing this core test at all for screening we cannot interpolate that data to us this is very interesting okay and if you say okay 8% is the prevalence of disease so you're you should not have this test because the disease only 8% but to you have a 5050% chance of having the disease not 8% versus 92% do you understand for me who is a
• 70:30 - 71:00 health minister I may turn around and say 8% I don't want to roll this package out for people but for an individual so in India when individuals can pay and then they do that it is much more worthwhile for them we anyway seeing Indians needed more absolutely than actually the UK and US and the western developed world which is which is a little different thing because generally they do much more testing correct uh but
• 71:00 - 71:30 you are saying we need more testing because of our uh genetics genetics predisposition to this coronary artery disease see the one thing when we started doing this if you look at it we started doing this uh 6 years ago our calcium score cost was less than a Starbucks coffee wow okay it was this cost is not exactly the prohibit it's not a problem even on today's date it is cheaper than a
• 71:30 - 72:00 meal you can come into our hospital get a calcium score and it is cheaper than you going out on a meal and it gives you so much of information so so I want to summarize this barriers cardiac city adoption barriers and then quickly for for that for people as well and just for me as well to understand and then move to really the MR cardiac imaging as well there's so much more actually to talk radiology and stuff like that which
• 72:00 - 72:30 which is there but but the cardiacity right the cardiac city one you're saying is the availability of the machines uh for cardiac city in India is not there because of probably price or techn technology second you mentioned is that uh there is still that awareness amongst physician as well as even cardiologist uh giving this as an adoption in terms of CT for their is we still struggling
• 72:30 - 73:00 with it we are not there yet correct u what else what else are the barriers i think the these two are such a major barrier for example people uh I go and train a lot of people and I say calcium score is the easiest thing for you to do but you train whom so I'm training radiologists i go and speak to conferences where I speak to the cardiologists superb so you you train
• 73:00 - 73:30 radiologists physicians are still outside the circuit they still don't know but they have a role in yes absolutely right they have a role still I think lot of people and correct me if I'm wrong like lot of people go through the physician route from a healthare delivery system they still don't come directly to a cardiologist uh for a chest pain some of lot of them might be but still I think significant would be going through a their general doctor or a physician or uh through that so they are yet not done but even
• 73:30 - 74:00 radiologists what is interest me and I know of suppose your work around training and and that's another big chapter we need to discuss but you you're quite committed to train uh and you do cardiac CT courses and cardiac MR courses so entire imaging courses for radiologists and that's where we we once had interacted a lot as well now why is that why doesn't the radiologist still that means has the
• 74:00 - 74:30 radiologist has not yet adopted cardiac asma or is they need to learn something more about it uh is it a skill thing that they get what is what happens in this training wheel so if you're talking about cardiac CT angography and cardiac MR there is a learning curve for people to start reporting and is that a barrier as well for adoption because because the radiologists themselves are not pushing it to their physicians that let's do a
• 74:30 - 75:00 calcium scoring or stuff like that even if technology is available uh because they don't have the confidence to do the cardiac CT yet because they've not done it the skill set is that also an issue so calcium score no okay in the tense uh in the terms that the skills required to report a calcium score are not not high it's very straightforward CT angio and cardiac MR the skills required are high
• 75:00 - 75:30 and there is shortage of uh well-trained people and that is one of the m barriers for adoption and that's why we train I I'm so passionate about it that I want people to take it up and the the Reason there is shortage is because the traditional training programs that we have majority of the institutes don't do cardiac so it's a catch 22 we don't so while they're learning
• 75:30 - 76:00 they're not learning this while they have to upskill them at some other point of correct they have to go somewhere else learn and when they start doing then they will start training next person the next and that's what you're trying to do in your own way while doing this cardiac and you do it on online as well right we do both online and onsite training and we've had great adoptability of both the tell us a little more on what the bat sizes how do you deliver that so if someone wants to like really look at this what what they should be expecting so if people are
• 76:00 - 76:30 interested in joining any courses of ours they need to go on LinkedIn and follow me on LinkedIn i I'm reasonably active on LinkedIn and I post my courses there when we are doing an online training program I do not believe in dactic lectures i really don't believe so my training programs are always hands-on workshops we give them cases people have to work on them produce reports that I can then critique and
• 76:30 - 77:00 tell them how they need to do usually have a course size of about 25 people how often you do this and we do the online uh twice a year okay and one will be cardiac CT one will be cardiac MRI it lasts for about 6 weeks is one course onsite it's over weekends we are now starting a mini cardiac MR fellowship whereby we are do going to do it run over 6 months where we're going to train people or handhold people from basics to
• 77:00 - 77:30 a level where they can go and report so this is something which we do in collaboration with NH Narayana and another group of trainers uh we do that and we are seeing good traction so in a year you are about training about 50 people on cardiac imaging or no more I end up training so the on-site programs have a more uh number oh this is only online you're saying this is only online
• 77:30 - 78:00 so total how many people you train in a year if we train the full complete uh as a full course uh we are looking at at least 150 150 if we are looking at just a one day program and stuff then it reaches around 400 uh odd already yeah yeah but then then there is much more scope right ab number to like cover but then as this goes there are many we have like 15,000
• 78:00 - 78:30 radiologists correct and and a big chunk of them might benefit in general from upsklling to cardiac work absolutely right in in general i mean not all of them of course but uh but as technology also penetrates more uh so just just from a tech side right so postco Mhm right when uh CT business from a city business perspectives uh penetration of 1632 slice really
• 78:30 - 79:00 happened extremely well over the last 5 10 years uh since since more affordable technology has been made in India but uh but in covid of course it penetrated a lot more post that we see a trend of actually 64 row detectors uh going in in places where earlier they didn't yeah so some of it is happening now that technology availability is happening there and I think it's like both this
• 79:00 - 79:30 working together might actually make it happen much more I think absolutely i mean that's absolutely and that is one of the adoption like drive barriers for for adoption of cardiac might go apart from the awareness of patient and stuff so so great so let's move from CT then to MR was the role of cardiac MR so even less penetrated in you yes absolutely it is there is a huge scope for cardiac MR also and what is interesting with
• 79:30 - 80:00 cardiac MR is it is not a competing at all it's on its own what it does nobody else can do it is not a replacement for anything it just provides information on top of everything else so what what does it give so say for example in a scenario where people go and say they have got a heart problem the heart problems are broadly classified because of blockages coronary artery disease and everything
• 80:00 - 80:30 else coronary artery disease is si and you catheter angography etc everything else is where the heart is not working because of a problem in the muscle of the heart and what is the cause for that problem is being answered by MRI okay and no one else gives no one else can give so what happens if they have not done a cardiac to those patients what do they do there we treat them empirically
• 80:30 - 81:00 we echo gives a little bit of an idea and echo says that it is likely to be X Y or Zed but cardiac MR gives that confirmation that no this is A B or C and these are factors which mean that the patient will do poorly in the next 6 months you need to intervene in that so Echo is a gatekeeper in this scenario it's the other way around echo does a fantastic job needs to be done in all
• 81:00 - 81:30 the patients that we are talking about mr is restricted for people where Echo says yes there is a problem and MR is going to come and tell what is the problem and how we match and then the adoption of cardiac MR is must be even lesser in terms of and and of course probably the need is also much lesser than a cardiac city am I right because the number of such cases would be less from a absolute number perspective absolute volume you would imagine yes yes but the penetration to what is
• 81:30 - 82:00 needed is even also lesser absolutely absolutely and what is the major reason again used to be technology in terms of MRI machines whereby you had MRI machines but they were not capable of doing cardiac scans that is now being tackled most of the MRI machines do MRI scans so this is something that technology enabled yes right this is this is a more recent relatively recent technology developments that has enabled
• 82:00 - 82:30 correct uh to get that information from an MR which probably earlier was not [Music] poss 25 years in technology the big barrier in cardiac MR is not hardware right now is the software
• 82:30 - 83:00 to process a cardiac MR so it's still a technology problem it's still a technology problem and it's a problem in India because the software will cost you on today's date anywhere from 40 lakhs to 80 lakhs so you're saying it's not the availability of technology but the cost of the technology cost of the technology so which is something we are solving we have some solutions which we have built which is where my tech and AI also come into the third thing which is
• 83:00 - 83:30 the lack of trained radiologists which is a big so even if you have institutes which have the MRI scanner they can get a decent software for reporting you don't have enough radiologists so so for someone who is entrepreneurial watching this and as is in healthcare and then enterpreneur is it safe to say that there's going to be a great business opportunity in building a training
• 83:30 - 84:00 business uh in terms of in terms of training radiologist or upskilling radiologist is that big enough a business uh for some full-time it is a good business is it a big enough business or not is a different question difficult question to answer because this need a lot of people are trying to solve so for example we are trying to solve narina Health is trying to solve indian Association of Cardiac
• 84:00 - 84:30 Imaging is trying to solve there are multiple players who are trying to solve you think it's fragmented it is fragmented it's heavily fragmented there's no mode for one to kind of get together correct in that to do that so there is scope for a business but it's I don't think the market size is big enough for a business to really solely do this do but current best ways is again enhancing the training
• 84:30 - 85:00 capabilities and and doing absolutely something like that yeah yeah super so going back to back to the to to your lifeline in terms of so so you know in UK then you came to when did you come to so to India in 2011 2012 and accidental and uh I had just been to Afghanistan I came back I had an extended holiday and I was in India for
• 85:00 - 85:30 my co sister's wedding and I had not properly worked in India i had done my med school had left and I was always fascinated of how does Indian institutes work we should be knowing about it and seeing is there a career opportunity for me and to cut the long story short I met Dr dishetti and he was he inspired other get in yes absolutely which he has done for many I think absolutely and he was the other
• 85:30 - 86:00 influential person in my life who has made a great contribution in shaping to why did he say it he basically turn he also comes with a similar background he also trained for a long time in UK oh really he did spend his surgical training in UK and then he came back and he said vimel we need people like you in India we need people to set up India because he believes in disrupting the
• 86:00 - 86:30 market and he believes that in cardiac imaging there is nobody there because in India at that time even now radiologists want to do head to toe they want to do everything and I was so niche area of expertise i said "I'm going to do cardiac." And he said "We need people like this come set up our unit and help us in growing help us in treating our patients better." And I said "Great."
• 86:30 - 87:00 You got sold on that and and obviously you've been there since then i've been there since then it's decade yeah 14 years 14 years i I took a pay cut of Oh I was being paid 10% of what I was earning in UK how did you made that decision i think there are many people who are at that kind of decision making sometimes they have to make those kind of decisions in life so what what made you do this really i as I said it very early uh in our talk I told you that
• 87:00 - 87:30 somewhere in my nature I feel I had to give back to the community to the world of what I've done the righteousness of that and I felt this was my calling to give back but still it's a solid uh you know god I mean it's it's a it's a it's a it's a decision which is not that easy it Yes yeah uh I mean see the way I see it is of course if you didn't had that calling
• 87:30 - 88:00 you would never even consider the way I see it correct you that even wouldn't have attracted you if that was not in there correct is like that CT detector and the detect at least you know but you but to take it right that decision where you really make this you you have to have certain benefits that you foresee over a period of time uh which might not be necessarily monetary but there has to some equation that went
• 88:00 - 88:30 in your mind or you were completely like we will do this and let's see what happen even even if you ask my wife why we came back and she said one morning you just woke up and said shall we go to India and she was also shocked and what was her reaction like was she was okay to she I was we were a big group of people who had gone from India to UK we had a very close friend circle and I was doing extremely well in UK and I would
• 88:30 - 89:00 have been the last person to leave UK you like because I was doing so where I was very niche and I am a sports person I is playing the Leicester shy league of volleyball i Wow so you were not only having a professional great time you're also having a overall great time in terms of your life style as some people don't enjoy like say staying in London because of whatever or UK for other reasons right in the sense they they're doing well professionally but they find
• 89:00 - 89:30 personal calling in terms of people or their lifestyles they don't like it or but you were doing all of that well i was doing extremely well so how come I mean it's it's and then I I apart from thanking Dr dishetti what is it that made you no I I think the maybe the other thing which was the driving force was we'd seen a lot of our seniors who were in UK who were near their retirement age they always used to say we should have gone back to India we should have gone back to India and there
• 89:30 - 90:00 was always at the back of my mind that I need to go back to India some and this came in why not now why not now and if it doesn't work we can always come back we came at the same time there were 15 of us in my close circle who had come there only two of us left in India 13 of us went back oh really just the two of us 15 came 15 came there were This is my circle there
• 90:00 - 90:30 were lots of people who came around at that time but 15 people that I knew came 13 of them went back they just could not survive just just let's spend a couple of minutes on this because we have some exciting stuff else to cover AI as well i want to talk for sure but this whole thing right for UK healthcare and Indian healthcare if I have to put you on a spot Mhm uh and say
• 90:30 - 91:00 okay what about the healthare system like professional satisfaction that this people probably didn't had which made them go back uh what is it like what happens between these two what are the pros and cons of this healthare system in general for people as well and as a healthare professional so for a person as a patient if you have money or insurance in India You will not get any better
• 91:00 - 91:30 healthare i always say that if you are amongst the wellto-d do people and access there's nothing like Indian healthare absolutely isn't it if you are nonaffordable or if you do not have insurance then with a caveat that you have serious illness UK health system is great you need to have a serious illness yeah if you have a back pain you are not the time taken to look at you is just six
• 91:30 - 92:00 months for a scone and everything is just not so if you have a cancer or if you've got an heart attack or something like that it's a great system but in India if you can afford or if you have insurance if you can't even afford get an insurance and it's good from a medical personal point of view the Indian system is competitive you really have to work very hard to survive in the system and to
• 92:00 - 92:30 excel in this system there was a time when the gratitude of patience was an extra incentive which and that has come down significantly yeah you see that like it's become more transactional this is what happens in the western world you mean like a consumerish it's a consumerrist people are I'm paying you you're here to treat me why should I thank you for whatever you know that's that's what is the trend
• 92:30 - 93:00 which is happening so when people came to India my why is it more competitive here because it is a most of it is private trip there it is a government and beautiful system I really love that system whether you are a neurosurgeon dermatologist pharmacologist you get paid the same salary really you get paid the same salary but you are saying that's nice but the neurologist might
• 93:00 - 93:30 not feel good about that but that's how the system is run all along even before why so you are seeing all specialities A cardiologist gets paid the same as a as a dermatologist would it only depends on how many hours you work so if I work let's say you have that option to have different hours to so minimum you put 40 hours a week okay some people because a little bit extra and that so it's it's hourly it's not hourly it's called as a session no no but what I mean is it's
• 93:30 - 94:00 the only variable in earning is how many hours you put how many in there so there is no so you know then so if you do a surgery versus a diagnosis you get paid same exactly the same oh this is an insight for me this I didn't knew at all yeah so there's no competitiveness in that do you understand because of oh yeah of course I mean but does that also mean does that mean loss of incentive to do music yes or or that's just a perception like it
• 94:00 - 94:30 does there is some time when you the neurosurgeons or a surgeon who is doing 6 hours of work and then comes and sees somebody else is not doing but what people that system recognizes is it's not just about skill it's the amount of time and effort that you're putting into that so people there people there now I'm I'm tracing back to education because this is very interesting people there who choose neuro or cardiac do
• 94:30 - 95:00 more out of interest not because they have a better career graph because they could done any medicine and could have earned the same correct which is very different from what happens here absolutely absolutely so that but in a way isn't that good like they really come out of their interest not really from I incentive to uh monetary gains or otherwise a status gain or something like that see I love that system and that that is what basically makes me does that also mean does that also mean they have similar status in a sense they
• 95:00 - 95:30 do and like a neurologist or a cardiologist wouldn't be treated like with more uh the way uh in India I mean I always say always say the difference between god and cardiologist is that god uh doesn't think he's a cardiologist um in the hierarchal system in the NHS is human kindness and humanity is more important which basically means the
• 95:30 - 96:00 janitor can tell off a cardiologist cardiac surgeon in NHS you're walking when I've just cleaned walk on this side and he will say I'm really sorry and you'll walk okay which which is in a manner where which is one thing in terms of I think the basic human respecting you But also this whole incentive to do is only based out of interest rather than which is very interesting so in terms of numbers of what they do and of course we
• 96:00 - 96:30 want to go to another topic but in terms of the numbers that they do or the number of specialists they are does that mean they have a much more number of so it's not like super specialtities are much lesser than uh not other doctors or so for example uh let's say because they're doing out of interest not really the rankings system in terms of getting through is very
• 96:30 - 97:00 tough so getting through is tough it is all not purely based on your clinical acument but your overall personality of how well you do the job how well you publish what research work you do and there is a clearcut pathway for super specialization in there so it is a lovely system but because it is government funded it is overwhelmed as of now patients struggle to get appointments
• 97:00 - 97:30 doctors are overburdened junior doctors are really struggling but would they controversial question right would they actually do more without feeling burdened if they had incentive to they already have incentive schemes and they are uh was a private system here here here the radiologist doesn't complain but he has more burden than many other countries but the radiologist does that job so there is a parallel system there which is a private system and they go and do in private where they get paid very well
• 97:30 - 98:00 and then there is a difference in that where the neurosurgeon will get paid more and then anyone else but that private system is very small percentage yeah and yeah in that super super no great so so now move let's move to a topic which is which is of uh immense interest to many people as well as is very exciting and also connects to the future of radiology in a way radiology and AI what do you see how do you see AI
• 98:00 - 98:30 playing a role in radiology it's the most penetrated ology in terms of AI 75% of the uh radio AI applications in healthcare FDA having FDR radiology uh so how do you see this shaping radiology uh and then any examples which can kind of help us and whoever listening understand what's happening in this field so radiology is at the forefront of AI
• 98:30 - 99:00 as you said and that is going to be uh the case for the next two decades is it because people like you who are generally techsavvy who come to radiology or is there no it it is primarily because we are dealing with images data the data is a digital data that we are dealing with with majority of other specialtities don't availability of good quality raw data in
• 99:00 - 99:30 radiology probably because of the historic adoption of correct tech in a way and packs and images and pattern being yeah it's it's that is the reason and it will shape the way we all do practice radiology it has already transformed the way we do a lot of things uh for example I'll tell you if you look at the way UK system has gone uk system
• 99:30 - 100:00 started with radiologists reporting everything then the number of radiologists was less there were more scans to do so we started training nurse practitioners or radiographers to do ultrasound scans m 80% of the ultrasounds in UK are not done by radio i understand the reporting is also allowed in some of X-ray at least exactly isn't it so that was first ultrasound do you think we should follow that so next came X-rays
• 100:00 - 100:30 where because they were short staff there were so many CTS and MRS to be done they got radiographers to do X-ray report now if this happened now AI would do that yeah ai plus a radio a radiographer can do even more or a radiologist rather than training another group of workforce oh you saying it can be completely replaced actually it can be completely replaced for example in so we
• 100:30 - 101:00 don't we don't need to go through the radiography training route we can just directly go to we will jump AI we will jump that because now AI is available and the use case for this is normal abnormal or is there is that more to it even everything see the the one of the biggest problem when people talk about AI adoption is they say how accurate is your AI okay and people say our accuracy is 95% they say oh you make five mistakes in every 100 cases and people
• 101:00 - 101:30 feel yeah and they So that's very bad but nobody knows a radiologist i'm curious exactly nobody has tested a radiologist there's other field we'll come to which you are you're kind of working on that as well very interesting yeah so this becomes a major problem so on a good day I would imagine I will be 95 to 97% accurate i I would like to think so on a bad day I have no clue what my accuracy is so AI is going to
• 101:30 - 102:00 become a big time assistant to me where do you see the applications more like where will it help you the most the rad the AI in general or where will it take over in terms of certain work so is it more in terms of productivity in terms of allowing the radiologist to do many more things because of because of removing certain kind of work like normal abnormal detection or or few
• 102:00 - 102:30 others or is it diagnosing better uh or workflow optimization which are the areas you are seeing AI applications coming in and also are useful so I think all of these to be honest okay when you start off whereby workflow optimization whereby prioritizing my worklist so that I am dealing with the emergencies more or abnormal ones than normal ones that is something AI is doing a fantastic job in
• 102:30 - 103:00 second is where we are able to segregate normal from abnormal ai is doing a good job in there third is complex repetitive tasks that we have to do i'll give you an example which is very pet to me is cardiac MR i remember when I was training uh in cardiac MMA it used to take me 45 minutes to an hour to report a cardiac MR cuz we had to draw contours around each slices of the heart which would take me half an hour to do that
• 103:00 - 103:30 today we have developed an AI program which does it in 30 seconds wow seriously yes wow so we do not have to do that i manually does not have to do that now this MRI scan which would take me 45 minutes to an hour I report it in 10 to 12 minutes because AI has processed the data ai has prepared the data for me for me to go and say "Okay this is correct this is correct." And I put in my expert opinion at the end and
• 103:30 - 104:00 the report is ready yeah but there was this this kind of fear and I think still is there among some people have reduced probably over a over the last two years is AI is evolving so rapidly but that will AI really replace uh um radiologist most of the task or any any for that matter not just radiology with many more today we are talking at a human level whether AI will become make humans redundant but uh but
• 104:00 - 104:30 uh from a radiology perspective Ive where do you see what would be your response to this argument in terms of AI taking disproportionate share of radiologyy's work and still the accountably lying with radiologist uh uh being completely this this tussle and conflict between who is accountable versus what will actually take and and also the counter view to that in terms
• 104:30 - 105:00 of no it can actually enable and one should use it to his benefit where is it going little more like uh if you distill it in terms of how you see this is happening see when people said AI will replace radiologists there was a big uproar about it and then people tried to sugarcoat it by saying AI will replace a radiologist who doesn't use AI but radiologist using AI will replace a radiologist not using
• 105:00 - 105:30 honestly the bottom line of that is AI will replace radiologist in terms of if I am recruit recruiting five radiologists in my hospital to do CT reporting X-ray reporting i will need with a good adoption of AI only need to recruit two radiologist okay so that it will replace the it will replace but but in that sense with with so much gap
• 105:30 - 106:00 between radi between the number of radiologist required so-called for the population would this mean it's not actually replaced but they will uh you will see more radiologist actually in places where today they are not see or or how will that that is the aspirational thinking that is what ideally should happen and this is might not it it does not happen see if you look at so would you say
• 106:00 - 106:30 would you say for example and I'm I'm opening a box I know but would you say someone who is right now has done their MBBS and is choosing an MD program should think carefully before choosing a radiology versus others no no i think it's it's not that i think radiology still is one of the most rewarding specialtities if you are of a mind where you enjoy
• 106:30 - 107:00 diagnostics not being a front face in front of patients treating the patients okay of course interventional radiology the career of radiology will remain you are seeing much more there is no reason why they shouldn't pick radiology if it's their interest just because career prospects wouldn't remain correct but why would it if if if those are getting replaced why would it still have that demand see the thing what happens is on today's date the big question which
• 107:00 - 107:30 again you have also asked is who is responsible for this AI who where does the accountability will build is going to be with radio and AI is not yet there in a lot of things it is there in some things it is very good in some things I had an discussion with one of my senior colleagues and they said no it's of no use I said AI on today's date is much better
• 107:30 - 108:00 in a chest X-ray scenario is much better than my 90% of my residents AI is far far far better than 90% so I'm getting do you see adopting this so are are do you see many and we'll not go to a particular institute per se but do you see many institutes adopting AI in India because general perception I have in notion and I've been in AI for a while is that the adoption in India is very low people
• 108:00 - 108:30 still don't uh is that changing dramatically or depends on the solution overall the adoption is very poor but then there are some specific niche area solutions that people are really adopting ting it for example the solution which I was talking about CVI oh the cardiac MR uh it's being adopted by individuals so rapidly because it is making their reporting very very easy and fun so so
• 108:30 - 109:00 in a way you are saying and probably this is this is more input to the lot of the multiple startups in AI if they have to do something it's encouraging but they have to really find a meaningful solution to it meaningful solution which is cost effect right in India the the price consciousness is too high and the ROI is difficult to prove in an AI solutions as of now and that's where the
• 109:00 - 109:30 adoptability is low is it ROI generally the bigger one or the clinical still not validated or what is bigger uh so even for a validated product the ROI becomes the barrier right of course so if you don't have a clinical validation you just don't even come on the table for discussion so you need that clinical validation and then if it is not getting adopted that is purely because the ROI is but you must be meeting a lot of AI companies right lot of are they if there
• 109:30 - 110:00 are two things before we move to uh to the final session but if if there are two to three things that these AI companies should really learn right in terms of are they first of all are they really solving the problem that you guys have what would be broadly Not one or two but are 80 90% of them that you see are really solving a problem that you have 60% are solving the problem that we have so there are still 40% who are not solving our
• 110:00 - 110:30 problem but they're solving somebody else's problem but are they they are they because one of my notions is many of times they've not understood the problem uh I I strongly think many of times they're technology forward in the sense that they they have a tech they know they can do this clinically they do it without trying to find out whether that problem is as big as a problem that they need to get solved by this technology is the best way or uh you
• 110:30 - 111:00 know uh so in that sense are they really useful enough to get paid all of them that come like a big percentage of them or are still a lot of improvement in that area so it's very tricky to answer that because for example when somebody comes to us and says we've got a solution which can pick up nodules in a chess CT we don't want it but the same thing when we were in NHS we would love to have it because we do so many nodule follow-ups
• 111:00 - 111:30 which is headache in India it's not a problem so yeah so they probably have not understood that market it's a market specific issue which is that which is which is a great point yeah which a great point in that so there are people who are solving it the message to them see I would like to say is Indian market is very very very different to the market that you see invested we've had people who've come and say we're doing this for X in India we'll do for X by $3
• 111:30 - 112:00 or X by $4 one quarter of cost and we say it doesn't make sense yeah it seriously doesn't make sense so uh I'll give one example there's one solution a US-based patented FDA approved solution which looks at uh blockages in the hearts on a CT scan and it gives very good output okay it charges somewhere in the region of $1,700 per patient oh god okay and it's
• 112:00 - 112:30 it's fantastic it's been they get a CPT code and they can claim insurance uk also has adopted it at a slightly better price they came to India and said we want to do it i said that price won't matter then they said we'll do it in $600 we do bypass surgeries yeah that's right it's just not possible it's just not possible so if for them it is one/ird so you are saying in a way in a way what is true
• 112:30 - 113:00 for bigger products like some cutting edge tech med tech products which cannot be adopted in India just because of the cost of those even AI which is a software algorithm has a similar challenge that a make in India AI might actually help to solve it it's just that prohibitive because it's made in dollars it's not been sold correct wow that's interesting okay that's that's that's interesting yeah so so going to probably the last part of the discussion in
• 113:00 - 113:30 future of radiology mhm right uh where do you see the future of radiology like if you have to see three five years 10 years down how is how is the future of radiology you see at a broad level and also at a specific see I think the there is still a lot of growth pending in radiology when it comes to scans patient volumes equipment there is
• 113:30 - 114:00 still a lot of growth there's still a huge gap between the demand and supply in India at least and in the western world also there will be a significant growth in the machines that are sold the number of scans that we do more and more there will be AI adoption we will be adopting AI left right and center and we will become more and more efficient now if you look at
• 114:00 - 114:30 the Indian system we already are super efficient efficient in what we do and but you see AI penetration AI penetration any other technology you feel or any other change in the delivery model will change we'll tell you radiology for example have a whatever right apart from EI which I I I get it anything else you feel that's going to be a very big driver of radiology I think the biggest driver for a I I would like biggest driver is going to be uh
• 114:30 - 115:00 screening programs that are going to start coming in the Indian market a lot of more testing will happen a lot of more testing will happen technology wise I see many of the OEMs starting make in India projects so the cost of that is going to come down and more and more uh radiologists are I I don't think I think telly radiology is going to be there i
• 115:00 - 115:30 don't think it's going to become too big or it's going to become too small i think it's just going to continue the way it is but I believe there will be for another five years at least there will be a lot of external western world country teley radiology coming to India oh okay for the next few years okay and after that the AI will start solving their problem and then it'll Oh you mean tell
• 115:30 - 116:00 radiology done by us for them oh okay i got it now yeah in that great so last speeds uh I'll do some rapid fire with Okay right and and then we probably will see what else remains um as a city Bangalore or London uh as a city London yeah of course favorite food favorite food chicken okay favorite restaurant in Bangalore uh there is a Chinese place in
• 116:00 - 116:30 Lemon Tree Hotel in called Republic of Noodles okay and favorite restaurant say in Punea you come to Puna often pune not that often although I was born there no I was there in Frost the other day and Frost as a pub was so you should come to Puna we should go but u X-ray CT MR ultrasound your favorite modality uh uh MR MR okay uh two things that very few people know about
• 116:30 - 117:00 it um people don't know that I've played uh national level cricket and county level cricket in UK in UK county level cricket and national level cricket in India in my school days wow and you about your football i didn't about cricket i used to play cricket yeah of a district in Yeah wow that's one and uh people don't know that I have a patent in postmortem cardiac cities we
• 117:00 - 117:30 were to talk about that we to tell me more about it what is what is postpart so there is a increasing requirement for a lot of geographies in the world when people have an unexpected death uh the laws of those countries require them to have a postmortem where you open the scan open the chest body do everything instead of that you can do a CT scan wow and you can diagnose what what they died
• 117:30 - 118:00 from so if somebody died from brain does that happen in India uh very very very niche areas it's just started in it just started but at very research level so we were doing this as a big time in UK it happens in Switzerland it started in Dubai Middle East where wow as a Muslim doing a postmortm is against that religion oh so we were doing cardiac MRS cardiac CTS
• 118:00 - 118:30 uh whole body CTS whole bodies MRS for these people very useful thing isn't it i mean absolutely it should be probably adopted yeah wow uh two most important decisions of your life uh definitely coming back to India uh was a good decision i really really uh uh am proud of that and very happy that I made that decision another one was pivoting from neuroraiology to cardiac in the professional sense uh marrying my wife
• 118:30 - 119:00 was a very good decision in the personal front and uh I think those were the two maybe even the army but army that decision was taken away from me was in my hand super thank you so much thank you very much thank you very much to have me thanks