“A normal chest x-ray is no guarantee.”

The title of a recent study in the Journal of Urgent Care Medicine on the high rate of normal CXRs from CV19-positive patients.

---

Imaging Wire Sponsors

• Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
• GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
• Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
• Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
• Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging .
• Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

---

The Imaging Wire

A Profound Impact

A new paper in RSNA Radiology forecast that the COVID-19 pandemic will have “a profound impact on radiology practices across the country,” as preventative policies (delaying screening/elective procedures), reduced hospital resources/attention, and an economic downturn all hurt the specialty. This might not be a shocker to many of you living through this right now, but the article does a good job summarizing what’s happened so far and how the future may shake out:

• Volumes Down – Outpatient-focused practices will suffer the most, with volumes potentially falling 50%-70% during the next 3-4 months (maybe >70%). Imaging volumes won’t be much better in emergency and inpatient settings, which have declined by as much as 50% at some hospitals.

• Economic Impact – Although the passage of ACA and expansion of Medicaid could help avoid some of the healthcare declines experienced in previous downturns, it’s still unclear how long this recovery will take or how long/often imaging-related procedures will be suppressed.

• States Have to Pay – Depending on how quickly we emerge from the CV19 era, the financial burden on states could lead to future Medicaid reimbursement rate cuts.

• Practice Prep – Practices should expect significantly lower revenue over the coming months, so they should start figuring out how to reduce their overhead, but still make sure they can ramp-up operations once the pandemic subsides.

• Permanent Changes – The authors suggest that COVID-19 could bring long term changes to the way radiology works, including redefining what imaging we consider necessary, changes in the referral/order process, increased remote reading, and a greater shift towards corporatization (to name a few).

Back to ‘Normality’

White House COVID-19 response director, Deborah Birx, M.D., outlined the government’s plan to reopen the country, which would also mean reopening many medical procedures and the imaging that comes along with it.

• The Criteria – We’ll be ready to start phasing in our CV19 reopening after 14 straight days of CV19 declines, once hospitals can efficiently support all their patients, and when we have the antibody test infrastructure to protect healthcare workers.

• Phase 1 – Once this criteria is achieved, state governors can launch their reopening efforts by allowing the first phase of businesses to resume operations (e.g. restaurants, movie theatres, sporting venues, gyms) and allowing elective outpatient procedures to resume.

• Phase 2 – States that still have no evidence of a CV19 rebound and accomplish another 14 days of CV19 declines can reopen childcare/education organizations (e.g. schools, day cares, summer camps), resume non-essential business travel, and hospitals can begin performing elective inpatient procedures.

• Phase 3 – States that achieve 14 days of declines for a third time and show no evidence of a CV19 rebound can allow businesses and venues to resume relatively standard operations, although with greater hygiene and distancing efforts than the Pre-CV19 days.
  

---

The Wire

• 3D Fusion for CAD: New research published in Radiology: Cardiothoracic Imaging found that multimodal 3D image fusion (CTA, CT FFR, whole-heart dynamic 3D cardiac MRI perfusion, 3D cardiac MRI late gadolinium enhancement) could allow more comprehensive coronary artery disease diagnosis and help overcome issues with divergent CT and MRI findings.

• CuraCloud Clears FDA: CuraCloud announced the FDA approval of its CuraRad-ICH software, a computer aided triage and notification system for the early recognition of intracranial hemorrhage (ICH) in non-contrast head CT scans. CuraRad-ICH analyzes cases using deep learning algorithms to identify suspected ICH findings (in ~ 20 seconds) and makes case-level output available to a PACS/workstation for worklist prioritization or triage.

• Blood Flow MRI in 5 Minutes: A Zurich-based team developed an MRI method that could shorten blood flow MRI scans to less than 5 minutes (vs. 30 minutes), potentially expanding the role of 4-D flow MRI in medicine. The researchers’ new FlowVN solution uses a set of continuously learning algorithms to reconstruct 4-D flow MRI images far faster and with more accurate results than conventional reconstruction methods.

• Izotropic’s CT Density Patent: Breast CT imaging company Izotropic landed a 20-year U.S. patent for its CT-based breast density measurement algorithm. The company suggested that the new technology will “revolutionize” how breast density measurements are captured, elevate the role of breast CT imaging, and help reduce false-negatives.

• No Guarantee with CV19 CXR: A new study examined 636 CV19-positive patients’ chest X-rays taken at a NYC urgent care clinic, finding that the vast majority of the patients had normal (58.3%) or mildly abnormal CXRs (30.6%). The study provided useful details on how the remaining 41.7% of patients with abnormal CXRs presented, but the main takeaway was that “a normal chest X-ray is no guarantee” that someone is CV19-free.

• RefleXion’s $100M: Fresh off its first FDA approval and first clinical client, RefleXion wrapped up an $100m equity round (now $223.6m total), that it will use to expand its operations and commercialize its new RefleXion X1 system.

• Rads As Treating Physicians: The ACR called on CMS to revise its Medicare Benefit Policy that restricts the situations where radiologists can act as “treating physicians” and order Medicare-covered tests. The ACR argued that this revision would correct a disparity versus other physicians and help overcome physician shortages during the CV19 crisis.

• InteleConnect EV for Mobile Review: Intelerad’s InteleConnect EV solution gained FDA approval for diagnostic image reviews on mobile devices, expanding upon the clinical portal’s existing support for clinical usage on mobile devices. The FDA approval comes as a result of the recertification of Intelerad’s IntelePACS product.

• More Bad Science: A review published in AJR added to the growing criticism against early studies supporting the use of CT for CV19 diagnosis (here’s some previous criticism), suggesting that the studies were low quality (biased, confounding variables, faulty design) and led to inappropriate and potentially overreaching conclusions. Until more high quality data becomes available, the authors suggested that CT should only be used to evaluate CV19 complications or if alternative diagnoses are suspected.

• SR Adds MD Practice: Strategic Radiology added Maryland-based Chesapeake Medical Imaging (12 radiologists, 13 imaging centers) to its consortium of independent radiology practices, which now includes 28 private practices and over 1,100 radiologists. Chesapeake Medical Imaging is the first Strategic Radiology-affiliated practice in Maryland.

• Perspectum’s $36M: Perspectum Diagnostics closed a $36M round (increasing total to $46.7M) that it will use to commercialize its LiverMultiScan software for clinical use, expand its contract research business, and develop new products.

• behold.ai CE Marked: UK-based AI developer behold.ai announced the CE Mark approval of its chest X-ray diagnosis tool that can diagnose CXRs as ‘normal,’ suggesting that the solution could cut £100m in NHS costs per year, help clear radiology case backlogs (e.g. suspected lung cancer), and speed up the detection of CV19 cases.

• Sectra Signs St. Elizabeth: Sectra announced a 5-year enterprise imaging contract with Cincinnati’s St. Elizabeth Healthcare (5 facilities, “numerous” outpatient centers), that will include Sectra’s radiology and breast imaging modules and will be integrated with Epic Radiant.

---

The Resource Wire

– This is sponsored content.

• This blog article from Healthcare Administrative Partners outlines the legislation passed that can help support radiology practices during the COVID-19 pandemic.

• ClearRead CT from Riverain Technologies is the first FDA-cleared system for the automatic detection of all lung nodule types, allowing radiologists to reduce search and reporting time and improve nodule detection rates.

• As the world navigates the unprecedented challenge presented by the COVID-19 pandemic, GE Healthcare supports healthcare providers, partners, communities and patients around the world in addressing it. Find information on GE Healthcare’s COVID-19 Resources here.

• Nuance’s latest blog reveals how the COVID-19 pandemic could be the catalyst behind the UK NHS’ digital healthcare transformation.

• This Qure.ai blog post details how it repurposed its qXR chest X-ray AI tool to detect signs of COVID-19, creating a CV19 detection tool that is already in use at 28 global sites.

• The Focused Ultrasound Foundation is accepting abstract submissions related to the use of image-guided focused ultrasound for its 7th International Symposium in November.

---