Thank you very much, and thank you for the invitation to come and speak today to give the Australian perspective. So unlike the small island of the UK, Australian is a really, really, really big island, and we've superimposed the Australian map over the US just to give it an idea of scale. The distances that we have to travel can be very long, and the roads can be very difficult to traverse, and oftentimes patients are flown to different cities or different states. Now unlike a country the size of Australia, like the US, which has a very large population, our population is much, much smaller. And so most of our population in the outback, and by outback I mean not near the sea, is very sparsely populated. Just for some background, I've previously worked in northern Australia all the way down in Tasmania, and I'm currently a lead radiologist for mobile CT screening across the state here of Queensland. So I've had a lot of experience with how we get patients around. Now when we talk about the population, as I said, it's very sparsely populated in the outback. Most of our population, so 72%, live in major cities. And of course major cities tend to be in the nicer areas near the sea, where the access and the infrastructure is a lot better. So places like Brisbane, I'm biased, best city in the world, Sydney, Melbourne, and Perth, where Annette's from. You might be biased, Annette, as well. But then 18% of the rest of the population live in the inner regional, which as you can imagine is very close to those major cities. We're talking within about 50 kilometers or about 30 miles. And then the percentages of patients that live more remotely goes down. And so we're talking about extremely remote areas, only sort of 1% to 2% of patients that would live there. Now what does this mean for lung cancer? Well we know from our own evidence, and this is Australian data, that not only do we have a higher prevalence of lung cancer the more remote you live, but the later you tend to present and of course the worse your prognosis. So if we look here, we have in the major cities, this is our age standardized mortality, the more remote you get, the higher these bars get compared to the whole of Australia. And so we know that the people who live in regional and remote Australia are a vulnerable risk group. We also have a strong independent association between socioeconomic status and how remote we live, knowing that the more remote we live, typically the socioeconomic status goes down. And this again is SES related mortality. So this is again another predictor for poor lung cancer mortality the more remote we live. So I really like this slide because what it tells us is the more red we have, then the higher risk we are for lung cancer outcome. If you have lung cancer and you live out here, the risk or your risk of mortality and poor outcome is very high. And superimposed upon this, we have the green dots that say where we have CT scanners. Now we have a CT scanner on every corner, it feels, in our major cities because we have a very robust private radiology industry. But it is difficult to financially justify putting a CT scanner in every small town. And so a lot of these areas within Australia just do not have access to CT with the traditional bricks and mortar approach. So there's clearly a mismatch that needs to be addressed when we start our national program in the middle of 2025. So how do we in Australia bring the CT to the people? Well, we go big or we go home because we have issues with roads. We have issues with space on the truck, which we've dealt with. Not in the three trucks next to each other, we just have a really big truck. Issues with weight. Now this is 40 tons, but we have a lot of space on the roads. The biggest issue we have when we come up with these mobile CT scanners is power. So a lot of the towns do not have the infrastructure in existence to be able to provide a steady power source. So we got around that. We have the first CT in the world that's battery powered using solar panels. It is like the infinite power source. We may lack many things in the outback, but sunshine is not one of them. So power is dealt with very efficiently to the point where after you've done a CT, by the time the next patient gets onto the table, the battery is fully powered again. You do not plug in to a power source. You just take the truck wherever you want to take the truck. Data transmission was more of an issue at the start because we needed to be able to transfer the scans to the radiologist. As much as I do enjoy going out on the truck, I'm probably better served sitting in my normal reporting room reporting these cases in my normal workflow. And so it used to take a couple of days to get a full CT transmitted to the main center depending on where we were and how remote we were. But with increased data bandwidth, we now get this down in a couple of minutes. And then there's time pressures because the truck's only there for maybe a week in that site. And if we need to get patients back for further imaging, we need to have that result back so that the patient can come back there and then. So this is what it sort of looks like on the inside. We don't just provide a CT or an X-ray. We provide a full service. So we have GPs, we have primary care physicians, we have nurses. We provide a heart check as well as a lung check. We do respiratory function testing and audiology because a lot of these patients don't have access to those services either. The image at the top there is one of the images of the truck being built and there's a wonderful time lapse. It took about three months to build this as the first in the world. And you can see people in the time lapse walking in, standing there, shaking their heads, thinking, what are we going to do? And then they walk off and they come back with a really big piece of machinery. It's been an amazing engineering feat. So currently we've been running mobile CT for about three years. And whilst we haven't had a lung cancer screening program, we have had a really robust occupational lung screening program for people exposed to dust. So silicosis, pneumoconiosis, Australia, well, our economy is dependent upon us digging up the ground. So we have a lot of mining and quarrying going on, particularly in the areas that I work. We also do a lot of indigenous community heart and lung checks because these communities do not have access to that normally. We've also been offering coronary artery CT services to regional areas because, again, that's not a service that they have available to them. And we do have a full clinical team on site rather than just a radiographer. So this is my state of Queensland where I live and practice and the CT scanner itself has travelled quite a long number of kilometres. We go to 70 different communities, most of which have no CT infrastructure. We've looked at more than 7,000 patients. Not every patient is eligible for a CT, but we've done over 1,500 CTs so far. In fact, I think every week we do an increasing proportion of CTs because patients now realise the value of the truck. We take the truck up to places like Weepa, which is all the way here at the very northern part of Australia, and to get up there, we need to put it onto a barge and to float it around the top of Australia. When we go there, we go there for a month. We don't just go up there for a couple of days. And we screen all of the patients in the far north up there in the Cape. So this is a really important service that otherwise those patients would not have any access not just to X-ray and CT, but actually just to general clinical care. The really important thing for us is we have to take it onto unsealed roads. Now there's a lot of different pressure that we have in this environment compared to a normal radiology clinic. The scanner obviously is there to acquire the imaging. We need to send that to the cloud, and then sending it to IMED, which is where I work as a radiologist. That then goes on to my workflow, and I need to be able to report it. And then I need to be able to make sure that the patient gets that result delivered to them while the truck is still available. We don't get a lot of patients coming back for follow-up there and then, but it does happen. What sort of outcomes have we seen so far? Well, given that we're doing a lot of people exposed to dust, as you'd expect, we see emphysema and pneumoconiosis. And then we have an unexpectedly high number of lung cancer and lung fibrosis findings. Really important is that we then navigate for them how they access the rest of their care. So that's referral to specialist physicians, as well as things like PET-CT or biopsy. Here's an example of a lung cancer that we found in someone who was asymptomatic, subsequently of course then underwent a diagnostic pathway for that. Here's another one, a patient who'd had a CT five years before in a different facility. You can see that they've now developed that lung cancer. And here's something that we see much more commonly in this cohort, which is a call worker's pneumoconiosis case. It looks like lung cancer, but turned out to not be. So we are setting up for the national program to begin for lung cancer screening next year. The mobile CT screening will be rolled out at scale to cover all states. We will have an off-road capability, which is really important for our regional areas. We will have its own internal QA program, and the radiologists unfortunately will have to report remotely, because I can tell you it's really fun to go out on the truck. But doctors and nurses will be present on site in the mobile CT to provide the holistic program of care. So thank you very much.

medical imaging

mobile CT scanners

remote healthcare

lung cancer screening

Australia