“This initiative will radically elevate the importance of primary care in American medicine.”
Health and Human Services Secretary, Alex Azar, on the new CMS Primary Cares initiative that compensates primary care physicians for managing patients’ illnesses and avoiding hospital visits.
Imaging Wire Sponsors
- Carestream – Focused on delivering innovation that is life changing – for patients, customers, employees, communities and other stakeholders.
- Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
- Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time.
- Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation technology to disrupt the industry.
- Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging.
The Imaging Wire
Handheld Ultrasound Climbs the Adoption Curve
Despite the handheld ultrasound market “largely fail(ing) to live up to expectations” during its first 10 years, Signify Research sees more opportunities for the segment as product improvements and market adoption both advance. The handheld/POCUS ultrasound category currently maintains a less than 2% share (< $138m) of the $6.9 billion global ultrasound market, but is projected to grow by 50% this year and nearly triple in size by 2023 to over $400 million. Here’s Signify’s take on how the handheld ultrasound market got to this point and how the firm expects the handheld ultrasound adoption curve to progress over the next few years:
- First Wave– Handheld ultrasound’s early adopters were largely cardiologists and traditional POCUS users (emergency, critical care, MSK, etc.). Emergency medicine remains the largest handheld market ($15m), although handheld systems only have a 10% share of the emergency ultrasound market, which is still dominated by compact and cart-based systems, and the “same is true for the other POCUS specialties.”
- Current Wave – As handheld ultrasound transitions from early adopters to the early majority, there’s been increased demand from office-based specialist physicians (e.g. urology, GI, vascular), who are using the systems for quick exams and initial screenings and have been attracted by the systems’ improved affordability. However, challenges with reimbursements, credentialing, data security, quality assurance, and IT infrastructure remain adoption barriers.
- Next Wave – The peak of the adoption curve will bring greater handheld adoption from the massive primary care physician segment (over 250k PCPs in the U.S.), which is already embracing handheld ultrasound in rural and developing markets, with urban adoption PCP coming in the future. Signify expects that falling costs, improved ease-of-use, and AI integration will drive growth during this wave, potentially leading to adoption by a wider range of medical roles (e.g. home care, community midwife), and even consumers, by 2030.
VR Consultation
We’ve heard a lot about the benefits of virtual reality for clinicians and medical students, but a recent study reveals a compelling VR use case for patient consultations. Research from Virginia Commonwealth University suggests that virtual reality is superior to CT scans or other informational materials for helping patients understand their condition. The researchers developed a 3D VR model of an abdominal aortic aneurysm (AAA) based on CT scan data. The researchers then used the VR model with 19 AAA patients, finding that:
- 17 (89%) patients agreed or strongly agreed that the VR model made them better informed about their health status and would like to use VR more in their healthcare.
- 16 (84%) patients agreed or strongly agreed that the VR model made them feel more engaged with the healthcare.
- 17 (89%) felt comfortable using VR and 16 (84%) actually enjoyed using it
- A compelling 18 (95%) found VR to be the most useful educational method, followed by verbal explanations (63%), viewing their CT scans (53%), illustrations (42%), and handouts (25%)
Although additional studies with more than 19 patients would be helpful, this is a strong indication that VR supports patient understanding. Considering that other studies have found that patients want to understand their scans and are more likely to make lifestyle changes when they do (like quitting smoking to curb AAA), VR may be a very useful way to support patient-centric healthcare.
Primary Care Overhaul
CMS revealed an experimental initiative that might lead to an overhaul of the primary care system by compensating doctors for managing patients’ chronic illnesses and avoiding expensive hospital visits. The CMS Primary Cares initiative pays primary care doctors for providing services that keep patients healthy and out of the hospital, allowing them to take financial responsibility for improving care and lowering costs.
The initiative is expected to come with increased reliance on technology, telehealth services, and remote patient monitoring, while it’s believed that they will also result in more doctor-patient interactions (emails, text messages, online and in-home visits).
This is seen as the most aggressive attempt to implement value-based care among PCPs, which is directly connected to just 3% of healthcare costs, but influences significant downstream costs. There’s no mention of imaging, but the CMS Primary Cares initiative’s general focus on limiting high-cost referrals and treating patients from their home will undoubtedly have an influence on imaging if it’s successful.
The Wire
- A new survey (n=215, over 30% are radiologists) in JACR found that despite the growing trend of radiology sub-specialization, a majority of radiologists and referring physicians “prefer to have a single radiologist read in a single report for a multipart CT scan” compared to reports from multiple sub-specialist radiologists. The respondents also viewed reports from a single radiologist with “mildly greater confidence” and believed they would lead to “more rapid patient care decisions.”
- Samsung announced that its S-Vue 3.02 image post-processing engine is now cleared by the FDA for use with pediatric patients, after gaining FDA clearance for adults in late 2017. The S-Vue 3.02, which is included with Samsung’s GC85A and GM85 DR X-ray systems, uses an advanced noise-reduction algorithm to produce high quality images with lower radiation dosage (up to 45% lower for pediatric abdomen exams, 15.5% lower for chest, and 27% lower for skull).
- The TAILORx clinical trial revealed that widespread adoption of genetic testing would allow most women with HR-positive, HER2-negative, axillary node-negative breast cancer to skip chemotherapy because it wouldn’t be more effective than hormone therapy. The widespread adoption of genetic breast cancer testing would lead to 50% more genetic tests and an estimated 8% reduction in chemo costs, cutting U.S. breast cancer testing and treatment costs by $50 million to $2.766 billion in the first year.
- Ireland’s radiographer shortage may get even worse due to the expected retirement of 7% of the country’s radiographer workforce within the next five years. In an effort to mitigate a potentially serious radiographer shortage, Irish imaging provider Alliance Medical Diagnostic Imaging will sponsor a new MSc Diagnostic Radiography Program at University College Cork (UCC).
- Researchers from the Mount Carmel Health System found that bedside ultrasound may be able to identify pulmonary edema more accurately than chest radiography, the traditional imaging method to assess pulmonary congestion. The study (n=99) highlighted bedside ultrasound’s sensitivity advantage versus X-ray (96% vs. 65%) and comparable specificity (90% vs. 96%), combined with its ability to eliminate radiation exposure, reduce imaging costs, and allow patients to remain in their bad, which does make a strong argument in favor of increased usage.
- Signify Research recently highlighted the five trends shaping the future of the global radiology IT market. The firm suggests that 1. Enterprise imaging will continue to grow (~$400M in 2017 to ~$750M in 2022; 2. Emerging markets will drive Radiology IT’s “new revenue” growth (~$950M in 2018 to ~$1.12B in 2022); 3. More VNA revenues will be bundled into enterprise imaging deals (~42% in 2017 to ~68% in 2022); 4. Opex business models such as “flat-fee” and subscription models will grow (~3% in 2017 to ~8% in 2022); 5. Demand for universal viewers bundled with PACS/EI systems will increase, while demand for standalone viewers will diminish. There are some helpful charts in the article, too.
- Research from IMV Medical Information Division and published on Auntminnie.com found that 80% of the US X-ray installed based is now based on digital radiography (vs. 50% in 2015, 25% in 2010). This trend is expected to continue, as about three quarters of the remaining CR systems installed in the U.S. are scheduled to be replaced by DR systems or retrofitted with DR kits over the next three years. General X-ray remains the most-used radiology modality in hospitals (152.8M X-ray procedures vs. 114.9M CT/MR/PET/Nuclear) and X-ray has an even greater share when combined with the estimated 61.4 million mobile/portable general x-ray procedures performed last year.
- A survey from the American Society for Radiation Oncology (ASTRO) found nearly complete agreement among radiation oncologists (93%, n=633) that prior authorizations result in delayed treatment, with the majority suggesting that authorizations lead to delays of either 4-5 day (32%) or more than 5 days (31%).
- Hologic launched its new Trident HD breast specimen radiography system, making a range of generational improvements over the current Trident system. The Trident HD launches with improvements to imaging quality and workflow, a 37% smaller size, support for larger surgical specimens and biopsy samples, the ability to perform instant sample verification during surgeries and stereotactic breast biopsies, and the ability to display prior mammography or biopsy images.
- A team from Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine developed a new DNN-based PET image reconstruction technique, called DeepPET, that can reconstruct images directly from PET sinograms with better image quality and 108 times faster reconstruct speeds than conventional techniques.
- Philips announced the launch of IntelliSpace Radiation Oncology, a new patient management solution intended to improve efficiency in radiotherapy departments by connecting all the steps in the process from the patient’s referral to the start of their treatment. IntelliSpace Radiation Oncology is the latest addition to Philips’ radiation oncology suite, which also includes Pinnacle Evolution treatment planning software, Big Bore RT, a dedicated oncology CT simulator, and the Ingenia Elition 3.0T MR-RT and Ambition 1.5T MR-RT systems.
- Philips also announced plans to expand its MR-only radiotherapy simulation portfolio with MRCAT brain, which automatically generates CT-like density information on the MR console – enabling clinicians to rely on a single modality for radiotherapy imaging. Philips’ MR-only simulation portfolio, which also includes MRCAT pelvis and prostate, combines MR’s soft-tissue contrast for delineation and density information for dose calculations.
The Resource Wire
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- Qure.ai is no stranger to peer-reviewed publications and the latest addition to its list of studies is this joint research that it performed with the Yale School of Medicine, exploring whether machine learning can predict heart transplant survival rates.
- A team from Oxford University and France’s National Institutes of Health and Medical Research (INSERM) successfully used focused ultrasound neuromodulation to affect the memory behavior of macaque monkeys, revealing that focused ultrasound could be used to determine which region of the brain influences decision making.
- The latest Carestream blog shares how radiographers and technologists view technology and provides some steps to help them adopt new tech.
- POCUS Systems’ forthcoming ultrasounds will combine ease of use, durability, and reliability, allowing clinicians to focus on their patients.
- This Medmo video details how its healthcare marketplace platform and network of participating radiologists help underinsured patients pay as little as possible for their imaging procedures.
