Cloud-Based Medical Imaging in Pulmonary Nodule Care: A Mixed-Methods Study of Use, Utility, and User Experience in China (Preprint)

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BACKGROUND The detection of pulmonary nodules (PNs) has increased with the use of low-dose computed tomography (LDCT) screening. Effective management requires the ability to track and compare images over time, yet challenges remain in accessing prior imaging data across institutions. Cloud-based medical imaging (CMI) solutions offer a potential means of improving access and facilitating cross-institutional data exchange. However, the adoption and utility of CMI in PN care, especially in China, remain underexplored. OBJECTIVE This study aims to evaluate the possession, use, and impact of CMI on healthcare utilization, patient knowledge, and financial burden, as well as to identify usability and interoperability barriers through qualitative investigation. METHODS A mixed-methods cross-sectional study was conducted from October 2022 to May 2024. The study involved 701 patients with PNs who completed structured surveys, and 20 participants (10 patients and 10 physicians) were interviewed. Data were analyzed to examine associations between CMI use and healthcare utilization, costs, and patient perceptions, and qualitative interviews were analyzed for usability themes. RESULTS The study found that 87.2% of patients had obtained CMI, with 57.6% actively using it. CMI users accessed more internet hospitals, consulted more physicians, and reported lower healthcare costs compared to non-users. Users also demonstrated higher disease knowledge. Qualitative data identified key barriers including poor system usability, limited retention time for images, and weak interoperability. CMI was perceived as beneficial for patient convenience and clinical efficiency, though concerns over image quality and system fragmentation were prevalent. CONCLUSIONS While CMI is widely available, its usage remains suboptimal. Increased use is associated with enhanced healthcare engagement and reduced costs, suggesting that improving system usability and ensuring consistent access to imaging could enhance the benefits of CMI. Future improvements should focus on ensuring long-term access, better retention protocols, and overcoming interoperability issues. CLINICALTRIAL All participants provided written informed consent under institutional ethics approval [approval number: 2025-KY-122-01].

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