RadTranslate: An Artificial Intelligence-Powered Intervention for Urgent Imaging to Enhance Care Equity for Patients With Limited English Proficiency During the COVID-19 Pandemic

Abstract

Purpose: Disproportionally high rates of coronavirus disease 2019 (COVID-19) have been noted among communities with limited English proficiency, resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, the authors created a freely available web application, RadTranslate, that provides multilingual radiology examination instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology.

Methods: The device-agnostic web application leverages artificial intelligence text-to-speech technology to provide standardized, human-like spoken examination instructions in the patient's preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff members. RadTranslate was piloted in Spanish for chest radiography performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latino community. Implementation included a tablet displaying the application in the chest radiography room. Imaging appointment duration was measured and compared between pre- and postimplementation groups.

Results: In the 63-day test period after launch, there were 1,267 application uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the examination (30% of total), followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in imaging appointment duration (11 ± 7 and 12 ± 3 min for standard of care versus RadTranslate, respectively), but variability was significantly lower when RadTranslate was used (P = .003).

Conclusions: Artificial intelligence-aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput and resulting in more reliable average examination length.

Keywords: English proficiency; Innovation; disparities; operations.

Graphical abstract

Fig 1

MESH implementation and design philosophy. Adapted with permission from Succi et al [10].

Fig 2

Left to right: RadTranslate landing page as accessed on an iPhone, examination selection, chest radiography user interface with Spanish selected as the language, and more chest radiography phrases. Using a device-agnostic infrastructure, the tool will appropriately display on a desktop, tablet, phone, and so on. The distributed database design allows the site and audio clips to load instantaneously.

Fig 3

Distribution of RadTranslate and control patients by performing technologist.

Fig 4

Imaging appointment duration for the intervention (RadTranslate) versus control (in-person or telephone interpreter).

Fig 5

Survey of technologists at pilot site on their experience with RadTranslate.