Imaging Informatics: The Next Step for Dosimetry
By Keith Loria
Radiology Today
Vol. 25 No. 1 P. 26

TeleDaaS is a medical practice of physicians and technologists who provide dosimetry services using a cloud-based dosimetry platform provided and managed by Mirada Medical. The group provides dosimetry as a service (DaaS), also known as teledosimetry, and specializes in dosimetry for nuclear medicine in cancer cases.

“We have a bench-to-bedside strategy where we want to support therapies as they go from the research bench to the hospital bedside,” says Mark Crockett, MD, FACEP, chief medical officer at TeleDaaS. “So far, we have launched TeleDaaS for clinical trials. We are also starting to contract with [imaging contract research organizations] (iCROs) and radiopharmaceutical companies.”

TeleDaaS’s affiliation with Mirada allows it to remain at the forefront of clinical science while Mirada continuously adds new technology and AI algorithms to the platform.

“Our workflow is very similar to teleradiology in that sites upload the relevant imaging data to TeleDaaS,” Crockett says. “Our physicians and technologists process the case, and we send back the analysis to the customer.”

TeleDaaS’s Role
TeleDaaS is broadly focused on clinical trials involving radiopharmaceuticals. In addition to Y90 trials that have used the software, the group will be supporting trials testing diagnostic agents (F18, Tc99, Cu64, GA68, etc) and therapeutic isotopes (Lu177, Ac255, Cu68, Ra233, I131, Pb212, etc).

“Sponsors are targeting a wide range of cancers,” Crockett says. “Currently in the market are Lu177-based therapies for neuroendocrine tumors and prostate cancer. Moving through the clinical trials are therapies targeting breast, lung, brain, colon, and virtually all solid tumors.”

For clinical trials, an iCRO sends the exams to TeleDaaS via a virtual private network and isolates the data from one trial from another. In clinical trials, the customer is typically the iCRO, although it can also contract directly with the pharma company. The iCRO recruits and manages the site and collects and deidentifies the exams before sending them to TeleDaaS for processing timepoint after timepoint.

TeleDaaS also contributes to the imaging protocol with respect to image acquisition, scanner calibration, and defining the dosimetry analysis.

“We have a trial-specific worklist that our staff uses to manage the cases and keep on top of the data flow,” Crockett says. “For each trial, we will carefully adhere to all regulatory requirements and track who generates the dosimetry results along with capturing the clinical staff’s ID, allowing us to compile a robust audit trial.”

TeleDaaS will also set up automatic processes and protocols to send the data back to the iCRO’s data repository. “After the trial is complete, we will archive the data and the tools used to analyze the data so that we can reconstruct exactly what happened, in case we are audited,” Crockett says.

TeleDaaS is approved for reimbursement, meaning hospitals that contract with them can potentially make money by using their service.

“For clinical trials, the sponsor pays our dosimetry fees,” Crockett says. “In the hospital market, there are very compelling dosimetry reimbursements that we will use to help increase our customers’ revenue.”

Combatting Problems
TeleDaaS was launched to generate the clinical evidence required for the broad adoption of dosimetry and solve the problems faced in the clinic by using dosimetry more often.

“Our work with Boston Scientific’s Y90 product Thera- Sphere in the DOSISPHERE-1 trial, along with others, demonstrated beyond a doubt that dosimetry is better for patients,” Crockett says. “DOSISPHERE-1 showed that advanced or multicompartment dosimetry can increase life expectancy of liver cancer patients by 149% and shrink the tumor in nine times as many patients (36% vs 4%) who could then have the cancer removed surgically.”

He adds that there is a growing repository of research showing that there are potentially substantial benefits associated with other therapies targeting various cancers. All of these studies have come out in the past few years, adding to the breadth of education that can be provided.

“Today, personalized dosimetry is being used for 100% of patients treated with external beam radiotherapy and brachytherapy,” Crockett says. “Yet the use of advanced dosimetry is not as prevalent in radiopharmaceuticals. We found there were many headwinds facing dosimetry for radiopharmaceuticals.”

Those include education about current research and the need for additional research, complex software that can require 30 to 90 minutes to process a case, isolated workstations resulting in poor and inefficient data flows, complex cross-department workflows, and virtually nonexistent documentation to support appropriate billing practices.

“We designed TeleDaaS by leveraging existing best practices across software, cloud, teleradiology, billing, and medical practice structure to come up with a novel and elegant solution that addressed all of these issues,” Crockett says. “Since announcing TeleDaaS, we have received a very positive response. Much like the iPhone is incredibly intuitive because so much thought went into the work behind the scenes, we have spent substantial time to make TeleDaaS as intuitive for our customers.”

Looking Ahead
By participating in clinical research, the TeleDaaS team will increase its clinical depth, and its software will be validated in clinical trials. Crockett believes that will push the future of teledosimetry to the bedside.

He says TeleDaaS will be the first to provide a clinical team that has expertise gained in the research market, provide cutting- edge software and AI algorithms proven in clinical trials, offer a streamlined workflow that doesn’t require new dosimetry software to be installed locally, reduce the staffing burden on hospitals, save substantial time for treating physicians, and provide the documentation needed to capture the dosimetry reimbursements that hospitals are overwhelmingly missing today.

“We just launched TeleDaaS at the 2023 annual Radiological Society of North America [meeting]; however, we are in discussions with many imaging CROs and sponsors and will be announcing a number of partnerships soon,” Crockett says.

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a frequent contributor to Radiology Today.