Translation App Streamlines Imaging Exams During COVID-19 Pandemic

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The COVID-19 pandemic, now entering its second year, has thrown into relief a number of challenges in providing equitable care to the many populations served by Massachusetts General Hospital. Mass General researchers and clinicians, including those in the Department of Radiology, have continually risen to meet these challenges.

Sometime in late 2019, Jennifer McGowan, operations manager with the 3D Imaging Lab at Mass General; Joy Williams, RN, of radiology nursing; and Margo Moskos, MD, MPH, a radiologist in the Breast Imaging Division came to a meeting of the Education Taskforce under Mass General's Radiology Diversity, Equity and Inclusion Committee with an interesting idea: Wouldn't it be great, they said, if instead of having to call in a translator to help with common imaging exams, we had an app that could play whatever instructions we needed in a host of different languages?

Daniel Chonde, MD, PhD, a Radiology resident and co-chair of the Education Taskforce at the time, suggested they develop the idea for a proposed Mass General hackathon centered on health equity. But then the COVID-19 pandemic hit and plans for the hackathon were temporarily set aside.

As the pandemic worsened, especially in Chelsea, a community with large populations of patients with limited English proficiency, Mass General Imaging staff started looking for ways to address workflow issues—including the growing strain on translation services. Dr. Chonde remembered the idea for a translation app and approached the MESH Incubator, an in-house prototyping and entrepreneurship center at Mass General, and within a matter of days, a web app was born.

Launched in April of 2020 and now used by a number of radiology departments across the country, RadTranslate has played an important role in providing care to patients who primarily speak a language other than English, especially as such patients have had to shoulder a disproportionate burden of the pandemic. In this Q&A, Marc Succi, MD, attending emergency radiologist at Mass General and founder and executive director of the MESH Incubator elaborates on the web app and how it can help in radiology and in other specialties.

Q. What is RadTranslate?

Succi: RadTranslate was born from a need keenly identified by the Diversity, Equity and Inclusion Committee in the Massachusetts General Hospital Department of Radiology to provide translated directions for basic one-way communication with patients. Essentially, MESH brought the technical expertise and iterative user-centered design process to create an app that can play audio clips of exam instructions in various languages for non-English speaking patients undergoing imaging or other exams. This has several benefits. In addition to helping acquire the best possible images, it gives the patients more agency by facilitating improved communications during the exams. The idea grew out of a particular need with the COVID-19 pandemic, but the app could also help with exams like mammography screening and fall risk assessment.

Q. What led to the development of the app?

Succi: During the early COVID surge, the MGH Chelsea Respiratory Infection Clinic (RIC) was seeing a lot of patients who needed chest X-rays. Chelsea has a large Spanish-speaking population and many of the patients didn't speak English, so Medical Interpreter Services was really strained and still is. The Diversity, Equity and Inclusion Committee identified this as a problem and brought it to me here at the MESH Incubator, an in-house prototyping and entrepreneurship center at Mass General Brigham.

We went to the end-users, the technologists doing the exams, and asked what would help them complete the exams more efficiently for non-English speaking patients. Their answer was: audio instructions in Spanish. So we wrote down the instructions they give at every step of the chest X-ray exam and used certified medical interpreters to convert them to Spanish and other languages, such as Mandarin, Arabic and Cantonese. Then we used an AI-powered text-to-speech generator to convert the text phrases to audio. The audio is included in the app so you can play it directly off your phone when you're with a patient.

Q. What sorts of benefits are you seeing with RadTranslate?

Succi: We recently published a paper in JACR on the operational impact of RadTranslate. We looked at all of the Spanish-speaking patients requiring an interpreter who received chest X-rays after implementation last April and then compared them to controls from before implementation. We found that the average chest X-ray was an average of 12 minutes for both populations. Where we really saw a difference, though, was in the standard deviation.

With RadTranslate, there was a 95 percent certainty that the exam would take between about 9 and 15 minutes. But without RadTranslate, using the previous method of calling an interpreter when translation services were needed, the same exam could take between 4 to 18 minutes: 4 minutes if you have a Spanish-speaking tech, 18 or more minutes if you have a delay with the interpreter. With more certainty about the length of an exam, you can schedule more exams and make sure the room is not left open and unused, while also reducing patient wait times. So you're really aligning incentives for operational and financial managers in the hospital.

Q. Can other specialties develop similar apps?

Succi: We can help any specialty at Mass General that performs basic exams or procedures that require one-way communication: inserting IV lines, intubation, any procedure where you want to explain what you are doing but don't necessarily have time to step out and call a translator. We can work with you, at no cost, to make a script and put it online so you can play it through the app from your phone, iPad or another device.

Learn more about the MESH Incubator

Learn more about MGH Radiology Diversity, Equity and Inclusion