Cloud-based referrals set to transform radiology services

Web-enabled imaging services and AI promise to improve patient outcomes

As often as not, necessity is the mother of invention and the healthtech start-up xWave Technologies is a prime example of what happens when those most frustrated by a particular problem decide to solve it.

In this case it was inefficiencies in the provision and delivery of imaging services that drove a group of radiologists to look at how AI and cloud technology could transform the current referral system.

Radiology is a complex and continually changing field with many different types of imaging now available. As a result, it is not always clear which test is best for a patient and there is no easy way a referring consultant or GP can access specialist radiology support to help them make their decision. The existing referral system is also problematic as it’s an ad hoc mix of fax, letter and email, which makes it difficult for referrers and radiologists to keep track of a patient’s progress throughout the investigative process.

XRefer tackles both issues by providing a full audit trail of patients throughout and an integrated guidance portal that can help clinicians to decide the most appropriate scan for their patients’ needs.


Clinicians using xRefer input key patient information and clinical indications and the system uses a numerical score (based on European Society of Radiology guidelines) to rank the suitability of the available tests. The system also indicates the level of radiation associated with each test to avoid patients being exposed unnecessarily.

“XRefer was created to solve a number of problems and add real value to the referral process,” says xWave chief executive Mitchell O’Gorman. “It is a cloud-based solution that’s available on the web and on iOS and Android apps and it connects healthcare systems allowing clinicians to create and send evidence-based digital radiology referrals from anywhere to any hospital or imaging centre whether public or private.

“Our system is easy to use, fast, informed and secure and offers ease of integration coupled with full encryption and world-class data security. One of the key advantages of having the apps as well as the web is that it enables the use of push notifications for urgent situations.

“With our system, people will be sent for the optimum test from the get-go. This ensures earlier diagnosis, earlier treatment and reduced costs. At present, up to 30 per cent of scan requests fall into the less-than-optimum category resulting in significant inefficiencies in health systems, longer waiting lists, increased costs and poorer outcomes for patients, so this is no small problem,” says O’Gorman who adds that the system’s ability to save millions on unnecessary scans should pique the interest of health authorities and private healthcare companies alike.

Research expertise

XWave was established in April last year and is based at UCD’s Nova centre for entrepreneurs and new ventures – the company was keen to have access to the university’s research expertise.

It has four founders: Mitchell O'Gorman, who was previously head of Kantar research in Ireland; Mark Kearns, chief executive of Irish software development company Threadable; Colin Keane, a partner with accountants Gallagher Keane; and Prof Ronan Killeen, consultant radiologist with the St Vincent's healthcare group and head of radiology at the Royal Victoria Eye and Ear Hospital. The company also has a medical advisory team of three.

It has raised about €600,000 in pre-seed funding from private investors and will be looking for further investment later this year.

“Which way we go on funding has yet to be decided because it’s not just about the money,” O’Gorman says. “It’s about what’s strategically important for the business so a VC with a good knowledge of the healthcare sector could be a good fit but ultimately another avenue such as angel or crowd funding might suit us better. It will really depend on what’s at play commercially when the time comes.”

O’Gorman says the company will employ about 22 people by 2023 with the first group of six due to come on board this year. Its revenue model is software as a service, but it will operate a fixed monthly fee in order to “give users predictable costs and help with their budget control”, says O’Gorman, who admits to being a bit of a data geek and was attracted to join this data-driven start-up by the prospect of a steep learning curve.

"I was approached out of the blue to provide the commercial know-how to move the idea along and while I know nothing about medicine, I understand data, I know how to move fast in a commercial environment and I understand innovation, having had this role with Independent News & Media in the past."

Potential customers

Inefficient radiology services are a global problem and the company’s potential customers will be public hospitals, private hospitals and imaging centres around the world. xRefer was soft launched in Ireland in January with the Eye and Ear and St Vincent’s hospitals and the system will have its official launch in conjunction with the company’s strategic partner, the European Society of Radiology, later this year.

“The collaboration with the European society was very important as it allowed us to use their guidelines on our platform,” O’Gorman says. “The society has 120,000 members and they will promote our technology to them and we are also in discussion about releasing other services through our platform. We’ve started with referrals but there are big opportunities to adopt AI right across the radiology workflow because it consists of a series of interlinked stages from the referral through to scheduling and delivering the final report. Furthermore, digitalising the workflow is not limited to radiology. It is equally applicable in other disciplines such as pathology.”

Starting a new business during a pandemic has been challenging O’Gorman admits, not least because everything is being done remotely. “Normally, I’d want to dig into how something works by talking to the people involved face to face about their day-to-day lived experience of it, but because of Covid I haven’t been able to set foot inside a hospital,” he says. “Despite the lockdown, however, we have been able to get through a lot and actually had our initial funding MPV in place very quickly.

In terms of rival solutions, O'Gorman says there are some large businesses providing radiology information systems to hospitals including Siemens, GE Health, Philips and Change Healthcare. "We see ourselves as potential collaborators with these businesses rather than as potential competitors as combined we can bring greater interoperability across hospitals and healthcare systems," he says.