Month: October 2024

MRI Predicts Cognitive Decline

Posted on by Brian Casey

Early detection of cognitive decline is becoming increasingly important as new therapies become available for conditions like Alzheimer’s disease. A new 20-year study in JAMA Network Open shows that MRI can detect structural brain changes indicating future cognitive decline – years before symptoms occur. 

Longitudinal research has shown that subtle changes in body structure – be they in the heart, brain, or other organs – can predict future disease risk, in some cases decades in advance.

  • That enables the possibility of targeted treatments or behavioral interventions to reduce risk before sick patients experience a cascade of expensive and invasive therapies. 

Mild cognitive impairment is an excellent example. MCI can be a transition to more serious diseases like Alzheimer’s, and previous research has connected it to vascular risk factors that are signs of brain atrophy. 

  • In the current paper, researchers analyzed MRI scans acquired as part of the BIOCARD cohort, a longitudinal study started in 1995 in which cognitively normal participants got baseline brain MRI scans and follow-up exams. 

In a group of 185 BIOCARD participants, researchers tracked how many transitioned to MCI over a mean follow-up period of 20 years, then compared structural brain changes on MRI, finding …

  • 60 participants (32%) progressed to MCI, eight of whom later developed dementia (4.3%).
  • Those with white-matter atrophy on MRI had an 86% higher chance of progression to MCI, the highest rate of any variable studied.
  • Participants with enlargement of the ventricles on MRI had 71% higher risk.
  • Other variables like diabetes and amyloid pathology also had higher risk, but not at the rate of the MRI-detected variables. 

The findings indicate that white-matter volume is closely associated with cognitive function in aging, and that people with higher rates of change are more likely to develop MCI. 

  • The association of diabetes with MCI was not a shock, but researchers said they were surprised there was no association from risk factors like hypertension, dyslipidemia, and smoking.

The Takeaway

The new findings demonstrate the power of MRI to predict pathology years in advance – the question is how and whether to put this knowledge into clinical practice. One could almost see structural brain scans incorporated into whole-body MRI screening exams (if anyone’s listening).

ABUS Flies Solo for Breast Screening

Posted on by Brian Casey

Is breast ultrasound ready for use as a primary breast screening modality – without mammography? Maybe not in developed countries, but researchers in China gave automated breast ultrasound a try, with results that are worth checking out in a new study in AJR. 

Mammography is unquestionably the primary imaging modality for first-line breast screening, with other technologies like ultrasound and MRI taking a supplemental role, such as for working up questionable cases or for women with dense breast tissue.

  • But the standard mammography-dominated paradigm might not be suitable for some resource-challenged countries that have yet to build an installed base of X-ray-based mammography systems. 

One of these countries is China, which not only has fewer mammography systems in rural areas but also has a population of women who have denser breast tissue, which can cause problems with conventional mammography. 

  • As a result, the Chinese National Breast Cancer Screening Program has adopted ultrasound as its primary screening modality, with women ages 35-69 eligible for screening breast ultrasound every 2-3 years. Mammography is reserved for additional workup. 

But handheld ultrasound has challenges of its own. It’s operator-dependent, and image interpretation requires experienced radiologists – also in short supply in some Chinese regions.

  • So the AJR researchers performed a study of 6k women who were screened with GE HealthCare’s Invenia ABUS 2.0 scanner, which uses ultrasound to scan women lying in the supine position. Images were sent via teleradiology to expert radiologists at a remote institution.

How did ABUS perform as a primary screening modality? The researchers found that after a single round of screening …

  • ABUS had a cancer detection rate of 4.0 cancers per 1k women (4.4 for women 40-69).
  • Sensitivity was 92% and specificity was 88%.
  • Abnormal interpretation rate was 12%.
  • 96% of detected cancers were invasive, and 74% were node-negative.
  • Two interval cancers were detected (rate of 0.33 per 1k).

How do the numbers compare to mammography? 

  • The cancer detection rate in the Breast Cancer Surveillance Consortium study was 5.1 cancers per 1k women, so not far off. 

The Takeaway

The results offer an interesting look at an alternative to the mammography-first breast screening paradigm used in developed countries, where ABUS is mostly used as a supplemental technology. For resource-challenged areas around the world, ABUS with teleradiology could solve multiple problems at once.

PSMA-PET Reduces Prostate Deaths

Posted on by Brian Casey

Using PSMA-PET instead of conventional imaging to stage patients with recurrent prostate cancer could reduce deaths by 13% and lead to improved quality of life. The new paper in JAMA Network Open confirms the value of PSMA imaging compared to traditional imaging approaches. 

Recurrent prostate cancer is one of the trickiest cancers to manage, especially as biochemical recurrence can occur in up to half of patients getting local treatment. 

  • PSA tests work well for detecting rising prostate antigen levels that could signify recurrence, but it can be difficult to locate recurrent cancer with existing imaging tools like CT and bone scans.

PET using a new generation of PSMA tracers offers a better solution thanks to tracers that target the PSMA protein that builds up on the surface of prostate cancer cells.

  • Previous studies have shown that PSMA-PET is more sensitive and specific for detecting recurrent prostate cancer, especially at lower PSA levels – but the modality’s long-term effects haven’t been explored. 

In the new study, researchers wanted to investigate the impact of switching to PSMA-PET on mortality and quality of life using statistical modeling to predict outcomes from three imaging approaches …

  • Conventional imaging with CT and bone scan.
  • CT and bone scan followed by PSMA-PET for negative or equivocal cases.
  • PSMA-PET alone.

They then projected outcomes for a hypothetical population of 1k patients with biochemically recurrent prostate cancer, defined as a persistent or rising PSA of 0.20 ng/mL after prostatectomy or PSA 2.0 ng/mL or higher following radiation therapy. They found …

  • PSMA-PET had the lowest number of prostate cancer deaths at 512, compared to conventional imaging plus PSMA-PET (520) or just conventional imaging (587).
  • PSMA-PET diagnosed 611 patients with metastasis compared to 630 with conventional imaging plus PSMA-PET and 297 with only conventional imaging.
  • PSMA-PET yielded 824 more quality-adjusted life years per 1k patients than conventional imaging.

The Takeaway

The findings are not only good news for patients with recurrent prostate cancer, they are also a boon for developers of commercially available PSMA-PET radiotracers like Lantheus Medical Imaging’s Pylarify (approved in 2021), Telix Pharmaceuticals’ Illuccix (approved in 2021), and Blue Earth Diagnostics’ Posluma (approved in 2023). 

Using AI-Powered Automation to Help Solve Today’s Radiology Crisis

Posted on by Partner Content

Reimbursement cuts. Radiologist and staff shortages. Rising costs. Surging imaging volumes. Overwhelming staff workloads. Shrinking margins. 

Sound familiar?

Radiology departments, imaging centers, and radiology practices are facing a perfect storm of challenges to deliver high-quality patient care while remaining profitable and competitive. 

  • This familiar narrative emphasizes the need for change and to embrace automation, AI, and technology solutions that automate routine tasks. 

RADIN Health has developed an innovative, cloud-based (SaaS), all-in-one technology stack based on the firsthand experience of radiologist Alejandro Bugnone, MD, CEO and medical director of Total Medical Imaging (TMI), a teleradiology group that reads for imaging centers and hospital systems nationally.  

  • Dr. Bugnone and his team of radiologists were similarly suffering from supply and demand imbalance, reimbursement cuts, increasing study volumes, and customer pressures to maintain their margin. 

As a software developer and seasoned radiologist, Dr. Bugnone was equally frustrated by the lack of a comprehensive, end-to-end technology solution in the market to address these same issues for his teleradiology practice.  

  • In evaluating numerous RIS, PACS, AI voice recognition, and workflow management solutions, his team found that each required expensive interfaces, separate company fees, and ongoing support, yet as an ecosystem still did not deliver a seamless experience that would provide a return on investment. 

An alternative is a system based on straight-through processing, a concept first pioneered in the financial services industry in which automation electronically processes transactions without manual intervention. 

“I knew there had to be a better way forward. I founded RADIN Health for healthcare and teleradiology practices [like TMI], imaging centers, and radiology departments based on straight-through processing, similar to how Wall Street sped up financial transactions without any human intervention,” Dr. Bugnone said. 

RADIN Health is a cloud-based platform that combines RIS, PACS, dictation AI, and workflow management into an all-in-one software solution. 

  • It leverages artificial intelligence, machine learning, OCR/AI, natural language processing (NLP), and other intellectual property.

Dr. Bugnone said TMI has achieved remarkable efficiencies with RADIN. 

“Our results at TMI have been staggering since implementing RADIN over the past 18 months for our complex teleradiology practice,” Dr. Bugnone noted. “With RADIN DICTATION AI, our radiologists have increased their productivity and efficiency, reducing dictation times 30% to 50%.” 

By adding RADIN SELECT, TMI reduced its SLAs more than 50% and FTEs by 70% for managing operational workflow tasks, all while adding 35% in study volumes.  

  • RADIN’s all-in-one technology solution has enabled Total Medical Imaging to meet the challenges of the radiology crisis without hiring new personnel – simply by unlocking the efficiency of their existing staff. 

“We have enjoyed significant growth in 2024 without the need to hire additional staff,” Dr. Bugnone concluded.

Watch the video below to see how RADIN’s all-in-one solution can help your practice.

FFR-CT Reduces Invasive Angiography Rates

Posted on by Brian Casey

Performing automated CT-derived fractional flow reserve with Shukun Technology’s software reduced referrals to invasive coronary angiography by 19% in a new study in Radiology. The findings suggest that software-based FFR-CT can serve a gatekeeper role in managing workup of patients with suspected coronary artery disease. 

Cardiac CT has been a revolutionary tool for assessing people with heart problems, evolving rapidly into a first-line modality that’s eclipsed other more traditional imaging technologies. 

  • But CCTA’s prowess also has a downside – more referrals to invasive coronary angiography, in some cases for patients without obstructive disease.

Rising to this challenge is FFR-CT, which uses automated software to calculate maximum blood flow in the coronary arteries and detect dangerous coronary lesions that could be early signs of a cardiac event. 

  • The segment to date has been dominated by HeartFlow, thanks to its early start in the field: its FFRCT software got FDA clearance in 2014 and the company has used its dominance to build a massive cash position.

In the new China CT-FFR Study 3, researchers in China used another FFR-CT application, Shukun’s skCT-FFR, and compared angio referral rates for 5.3k patients with suspected coronary artery disease who were scanned with either CCTA alone or CCTA and FFR-CT. They found …

  • Referral rates were lower for those who got FFR-CT (10% vs. 12.4%), a 19% relative difference.
  • Fewer cardiac events occurred in the FFR-CT group at one year (0.5% vs. 1.1%).
  • There was no statistically significant difference in major adverse cardiac event rates at 90 days (0.5% vs. 0.8%, p=0.12) and one year (2.9% vs. 2.8%, p=0.9).

Shukun is not as well known in the West as other developers of FFR-CT software like HeartFlow, but the company has raised over $250M to date – enough to land it in the top echelon of AI developers. 

  • One advantage of Shukun that was evident with the new study is that image processing was performed on-site, rather than being shipped off-site as is the case with other applications. 

The Takeaway

The study shows that FFR-CT can make cardiac CT more precise while tamping down on referrals to invasive angiography that have come from growing CT use. The results should also help put Shukun on the radar of many industry observers in a segment that so far has been dominated by HeartFlow.

Reduce the Mess, Reduce the Stress: Automating and Accelerating Efficiency in Complex Medical Imaging Environments

Posted on by Partner Content

Repetitive, arduous tasks are a major contributor to burnout – an increasingly prevalent issue in healthcare. While digital innovation is transformative, introducing more technology to workflows often creates additional layers of complexity, hindering efficiency, performance monitoring, and ultimately the quality of care.

As a result, once-simple traditional workflows have grown cumbersome over time, filled with many interconnected tasks that are difficult to manage. 

  • As these processes become more complex, it’s clear that healthcare needs to reduce, subtract, and simplify to maintain high standards of care.

Every traditional (or macro) workflow consists of multiple smaller tasks or steps (micro-workflows), many of which are still performed manually. 

  • Consider a wound care scenario where a practitioner takes images, searches for the patient’s record in the EHR, uploads the images, and manually enters encounter details. 

While each individual task may seem small, when multiplied by dozens of similar interactions each day, these repetitive steps …

  • Decrease the time providers have for meaningful patient interactions.
  • Lower overall productivity.
  • Increase the potential for human error.
  • Contribute to burnout and fatigue.

Micro-workflows address this by breaking down processes into discrete, manageable steps. For example, by …

  • Identifying the patient within the EHR.
  • Capturing the image.
  • Automatically inputting relevant metadata.
  • Seamlessly sharing the image with the care team.

This granular approach enables automation, allowing individual components to be optimized or modified without disrupting the entire process. 

  • Micro-workflows offer adaptability, efficiency, and responsiveness, meeting evolving clinical requirements while reducing complexity.

Moreover, micro-workflows make it possible to monitor individual tasks with precision. 

  • This approach allows healthcare organizations to pinpoint workflow gaps, troubleshoot issues, and resolve performance bottlenecks. 
  • In multi-vendor environments, where integrating various systems and applications can be a challenge, the ability to streamline processes and automate tasks becomes especially valuable.

Strings by Paragon is a platform specifically designed to help healthcare organizations harness the power of micro-workflows. 

  • By breaking traditional workflows into smaller, more manageable steps, Strings enables automation, real-time performance tracking, and monitoring across a wide range of applications and infrastructure. 

The platform’s single-pane-of-glass interface provides visibility into complex, multi-vendor environments.

  • Strings offers actionable insights and automated optimizations tailored to specific clinical workflows.

With Strings, organizations can proactively identify workflow bottlenecks, implement targeted optimizations, and measure performance and ROI with precision – leading to improved efficiency, enhanced imaging quality, better patient outcomes, and a value-driven approach to care.

Learn more about Strings by visiting Paragon Health IT’s website, or visit them at RSNA 2024 at booth #1849.

Do Imaging Costs Scare Patients?

Posted on by Brian Casey

A new study in JACR reveals an uncomfortable reality about medical imaging price transparency: Patients who knew how much they would have to pay for their imaging exam were less likely to complete their study. 

Price transparency has been touted as a patient-friendly tool that can get patients engaged with their care while also helping them avoid nasty billing surprises for out-of-pocket costs. 

  • Price transparency is considered to be so important that CMS in 2021 implemented rules requiring hospitals to disclose their standard charges online, as well as post a user-friendly list of their services that includes prices. 

But given that the rules were implemented relatively recently, not much is known about how they might affect patient behavior, such as compliance with recommended follow-up imaging exams.

  • Indeed, a recent study by some of the same authors found that patients are largely unaware of how much their imaging exams will cost them. 

So researchers analyzed data from two previously published studies of patients who either completed or were scheduled for outpatient imaging exams in Southern California. 

  • Patients were asked if they had been told how much their exam would cost them out-of-pocket when they scheduled it. 

Of the 532 patients who were surveyed, researchers found …

  • Only 15% said they knew about their out-of-pocket costs before their imaging exam. 
  • Fewer patients who completed their exams knew their costs compared to those who canceled (12% vs. 22%).
  • Patients who knew their costs were 67% less likely to complete their appointment than those who didn’t (OR=0.33).

So what’s the solution? The researchers suggested that healthcare providers may need to take a more proactive approach to disclosing price information to patients.

  • One possibility would be to integrate pricing discussions into patient-provider communications when ordering imaging exams, rather than relying on patients to seek pricing information on their own. 

The Takeaway

The findings show that medical imaging price transparency is more complicated than just posting a list of prices online and expecting patients to do the rest of the work. Imaging providers may need to get more involved in pricing discussions – the question is whether many of them are ready for it.

Optimizing Front Office Operations through Integrated Apps and Cloud-Based RIS/PACS

Posted on by Partner Content

Paradox of High Patient Volumes

At first glance, it may appear having more patients should naturally lead to higher revenue. When you consider extra labor costs and the fact that reimbursements are decreasing, increased volume can turn into diminishing returns.

  • Basically, the cost of adding more staff can end up being higher than the value of additional patient volumes.

Optimal management of growing patient volumes requires a new way of working with automation and cloud-based apps that replace the heavy burden of manual processes.

  • By using technology to eliminate processes, medical facilities manage patient loads better without the need for more labor costs. 

This proactive approach not only improves efficiencies but also lets front office staff focus on patient needs instead of getting bogged down with administrative tasks. 

  • Ultimately, shifting towards automation and consolidation of tasks is key to maintaining clinic profitability and keeping high standards of care, especially with increasing medical demands.

How RamSoft Can Help Simplify Front Office Operations 

Achieving workflow excellence starts with a single sign-on into a unified RIS/PACS and providing access to complementary medical imaging apps via a single worklist in the cloud. 

  • By leveraging cloud applications with scalability across facilities, organizations can “build as they grow,” while maintaining control and flexibility.

RamSoft PowerServer and OmegaAI RIS/PACS platforms reduce administrative burdens and costs associated with manual processes. Here’s how…

  • Blume – Patient Portal: Patient access to diagnostic images and reports, imaging sharing with referring clinicians and family, self-scheduling, intake forms, and appointment notifications. These self-service features decrease the number of phone calls, the time needed for patient registration, and the manual process of intake form completion and filing. 
  • pVerify: Batch verification and real-time eligibility (authorization available soon) eliminates the need to call multiple insurance providers, freeing up staff time while reducing denials. 
  • PracticeSuite: An embedded solution including workflow options to accommodate entries from the RIS/PACS worklist or within the billing module. Quickly accesses top billing functions, Payment Ledger for balances and eligibility, and Payment Entry to add payment and print a receipt. 
  • openDoctor: Automated appointment notifications through SMS and email which replaces lists of confirmation calls and reduces missed appointments. 
  • InterFAX by Upland: Integrated digital workflow for inbound (available soon) and outbound faxes, reducing the need for manual acceptance and processing of referral or report faxes. 

Mobile Applications Are Building a Patient-Centric Experience

Protecting patient data is business-critical for all medical practices, as it is for RamSoft. We’re using Microsoft Azure Cloud to ensure all data and applications are secure.

  • Workflow optimization in medical imaging can significantly impact the patient experience, leading to increased loyalty and satisfaction. 

Is Your Practice Operating Optimally?

Explore how RamSoft’s new automation applications, including patient engagement tools, integrated with cloud-based RIS/PACS can improve operations and profitability of your practice. 

Learn more on the company’s website or book a demo at RSNA 2024 for booth #6513 in the North Hall.  

Did Malpractice Risk Kill V/Q Exams?

Posted on by Brian Casey

CT perfusion angiography exams have largely replaced nuclear medicine-based ventilation/perfusion (V/Q) studies for detecting pulmonary embolism. But a new article in Academic Radiology suggests that CT’s rise wasn’t entirely based on clinical efficacy – fears of malpractice risk may have played a role. 

V/Q studies can help diagnose PE by enabling clinicians to visualize lung perfusion, showing defects such as blockages in pulmonary vessels. The scans are typically performed in three phases … 

  1. An albumin injection to show pulmonary vasculature.
  2. A radiopharmaceutical that’s inhaled and imaged with a gamma camera.
  3. A chest radiograph to correlate findings. 

The scans dominated PE imaging in the 1980s, but the rise of CT saw radiology facilities begin to shift.

  • CTPA was seen as having higher spatial resolution and was easier to perform than nuclear medicine exams. 

But the new article suggests that there were other forces at work as well – in particular, fear of malpractice risk from PEs that weren’t adequately followed after inconclusive V/Q exams.

  • The problem originated with clinical guidelines for V/Q reporting that classified some 20% of V/Q studies as “low probability” for PE when they probably would have better been classified as “inconclusive” or “non-diagnostic.”

As a result, a number of “low probability” patients weren’t followed up adequately, with tragic results that later figured into medical malpractice cases …

  • A patient who was diagnosed with pneumonia after an inconclusive V/Q exam, sent home, and died one day later of a “massive” PE.
  • A patient with leg and chest pain who was given heparin after a negative V/Q scan and later suffered internal hemorrhage; fortunately she survived.
  • A patient with “vague symptoms” who had an inconclusive V/Q scan and later died of an undiagnosed PE that some claimed would have been detected on CTPA.

Indeed, the theme of PE malpractice cases began to shift over time, from failure to diagnose V/Q scans to failure to order CTPA exams – which were soon seen as the clinical gold standard.

The Takeaway

Given the fast pace of development in radiology, it’s inevitable that some technologies that were once clinical staples fall by the wayside. But the new article offers a fascinating look at how clinical language can lead to medico-legal concerns that influence physician behavior – often in ways that are impossible to detect as they happen.

Low-Dose CT Confounds CAD in Kids

Posted on by Brian Casey

When it comes to pediatric CT scans, clinicians should make every effort to reduce dose as much as possible. But a new study in AJR indicates that lower CT radiation dose can affect the performance of software tools like computer-aided detection. 

Initiatives like the Image Wisely and Image Gently projects have succeeded in raising awareness of radiation dose and have helped radiologists find ways to reduce it.

But every little bit counts in pediatric dose reduction, especially given that one CT exam can raise the risk of developing cancer by 0.35%. 

  • Imaging tools like AI and CAD could help, but there have been few studies examining the performance of pulmonary CAD software developed for adults in analyzing scans of children.

To address that gap, researchers including radiologists from Cincinnati Children’s Hospital Medical Center investigated the performance of two open-source CAD algorithms trained on adults for detecting lung nodules in 73 patients with a mean age of 14.7 years. 

  • The algorithms included FlyerScan, a CAD developed by the authors, and MONAI, an open-source project for deep learning in medical imaging. 

Scans were acquired at standard-dose (mean effective dose=1.77 mSv) and low-dose (mean effective dose=0.32 mSv) levels, with the results showing that both algorithms turned in lower performance at lower radiation dose for nodules 3-30 mm … 

  • FlyerScan saw its sensitivity decline (77% vs. 67%) and detected fewer 3mm lung nodules (33 vs. 24).
  • MONAI also saw lower sensitivity (68% vs. 62%) and detected fewer 3mm lung nodules (16 vs. 13).
  • Reduced sensitivity was more pronounced for nodules less than 5 mm.

The findings should be taken with a grain of salt, as the open-source algorithms were not originally trained on pediatric data.

  • But the results do underscore the challenge in developing image analysis software optimized for pediatric applications.

The Takeaway

With respect to low radiation dose and high AI accuracy in CT scans of kids, radiologists may not be able to have their cake and eat it too – yet. More work will be needed before AI solutions developed for adults can be used in children.

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