Transformation Directorate

How Yorkshire Trusts are delivering better and more efficient care through integrated clinical imaging

The Yorkshire Imaging Collaborative (YIC) is a combined technology and business transformation project aimed at unifying radiology imaging and report-sharing between 9 NHS trusts across Yorkshire, as well as the recently-established NHS Nightingale Hospital Yorkshire and the Humber.


The Royal College of Radiologists (RCR) have identified that there is a significant shortfall in the size of the radiology workforce relative to patient need.

For the YIC, the problems caused by the disparity between service demand and capacity was made worse by the challenges with system integration across the region. The lack of interoperability meant that Trusts were forced to rely on an image exchange portal (IEP) to transfer images, which is renowned among clinicians for being unstable and inefficient.

For a consultant to view imaging from another Trust, they would need to ask their administration team to contact the Trust where the image might exist and send through the IEP. From start to finish it would take between 24 and 48 hours.

For emergencies, the IEP system was unsuitable and often led to patients being re-scanned instead, leading to increased costs, patient inconvenience and radiation exposure.


The collaborative’s overarching ambition was to ensure that every patient in Yorkshire could attend an appointment and have full availability of their medical images and associated reports at the point of care.

Solution and impact

With the contracts for several picture archiving and communications systems (PACS) across the region set to expire, and with the YIC committed to a joint procurement programme, focus turned to how image sharing could be improved across the region.

The goal was to achieve total interoperability between PACS. Therefore, from the outset the YIC established a business case and a list of minimum requirements for the suppliers that were competing for the new PACS contracts. The minimum requirement was to allow viewing of images across the region.

In October 2017, the final contracts were signed for Agfa HealthCare to implement its enterprise imaging (EI) solution and XERO Universal Viewer at the 8 Trusts across Yorkshire, collectively known as XERO Exchange Network. Early in 2020, the YIC began to connect the XERO Image Viewer at each site to form the XERO Exchange Network across 8 Trusts, as well as the recently-established NHS Nightingale Hospital Yorkshire and the Humber. The network was live within 4 weeks.

The impact has been immediate, with the new image sharing capability helping staff and patients to navigate the complexities arising from the COVID-19 pandemic.

Avoiding patients coming into hospitals unnecessarily is particularly important during a pandemic. The Xero Exchange Network, however, enables clinicians to see if a patient has been imaged somewhere else to prevent repeat appointments and the need for duplicate scans.

The immediate availability of imaging ensures that delay in patient care is reduced, while access to past images supports the case history.

The network has also provided significant time-saving benefits on administrative tasks, with less time spent transferring images using the IEP.


EI is an imaging platform that provides Trusts with a unified PACS, complete with clinical tools, reporting functionality and a powerful workflow engine to maximise productivity.

XERO, a web-based platform, is a viewing software that offers clinicians the ability to share images with other XERO users across Yorkshire, as part of a new XERO exchange network (XEN).


  • Xero allows instant access to an image, without having to ask the patient if they have had previous imaging or the acquiring Trust for permission to access the scan
  • Images from a partner Trust can be viewed through read-only access
  • The system provides full interoperability of images and reports


Trusts across Yorkshire can collectively access radiology reports following the launch of an image sharing system.

Key figures/quotes

“XEN cuts out administrative work. Across all of our Trusts, we had half a dozen people just moving images around, but now we can begin to scale back that resource and invest elsewhere.”
Cindy Fedell, chief digital information officer (CDIO), Bradford Teaching Hospitals NHS Foundation Trust and Airedale Hospital Foundation Trust

“During a pandemic, you don’t want patients coming into hospital unnecessarily, so one of the main benefits of the XERO Exchange Network has been quickly seeing if a patient has been imaged somewhere else and preventing repeat appointments.

I have also had instances where a patient has been scanned, and we’ve noticed an abnormality. XERO has allowed me to look into other PACS across the region to get a more complete view of the patient’s imaging history. This means that we don’t need to concern the patient by unnecessarily re-investigating something that’s already in their records.”
Stuart Viner, consultant head and neck radiologist, Bradford Teaching Hospitals NHS Foundation Trust

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More about the Yorkshire Imaging Collaborative (YIC)

Key contact

Yorkshire Imaging Collaborative (YIC)