Author: Brian Casey

Radiology Puts ChatGPT to Work

Posted on by Brian Casey

ChatGPT has taken the world by storm since the AI technology was first introduced in November 2022. In medicine, radiology is taking the lead in putting ChatGPT to work to address the specialty’s many efficiency and workflow challenges. 

Both ChatGPT and its newest iteration, GPT-4, are forms of AI known as large language models – essentially neural networks that are trained on massive volumes of unlabeled text and are able to learn on their own how to predict the structure and syntax of human language. 

A flood of papers have appeared in just the last week or so investigating ChatGPT’s potential:

  • ChatGPT could be used to improve patient engagement with radiology providers, such as by creating layperson reports that are more understandable, or by answering patient questions in a chatbot function, says an American Journal of Roentgenology article.
  • ChatGPT offered up accurate information about breast cancer prevention and screening to patients in a study in Radiology. But ChatGPT also gave some inappropriate and inconsistent recommendations – perhaps no surprise given that many experts themselves often disagree on breast screening guidelines.
  • ChatGPT was able to produce a report on a PET/CT scan of a patient – including technical terms like SUVmax and TNM stage – without special training, found researchers writing in Journal of Nuclear Medicine.
  • GPT-4 translated free-text radiology reports into structured reports that better lend themselves to standardization and data extraction for research in another paper published in Radiology. Best of all, the service cost 10 cents a report.

Where is all this headed? A review article on AI in medicine in New England Journal of Medicine gave the opinion – often stated in radiology – that AI has the potential to take over mundane tasks and give health professionals more time for human-to-human interactions. 

They compared the arrival of ChatGPT to the onset of digital imaging in radiology in the 1990s, and offered a tantalizing future in which chatbots like ChatGPT and GPT-4 replace outdated technologies like x-ray file rooms and lost images – remember those?

The Takeaway

Radiology’s embrace of ChatGPT and GPT-4 is heartening given the specialty’s initial skeptical response to AI in years past. As the most technologically advanced medical specialty, it’s only fitting that radiology takes the lead in putting this transformative technology to work – as it did with digital imaging.

Software Closes Radiology Reporting Loop

Posted on by Brian Casey

In the never-ending quest to get referring physicians to follow radiologist recommendations for follow-up imaging, Massachusetts researchers in JAMA Network Open offer an IT-based solution: Structured reporting software that was found to triple the number of radiology reports judged to be complete. 

A recent study found that 65% of radiologist recommendations for follow-up imaging aren’t followed by referring physicians. Authors of that study found that recommendations that were strongly worded and communicated directly to referring doctors had higher uptake. 

But what if radiologists don’t follow this advice? In the new paper, researchers from Brigham and Women’s Hospital and Harvard Medical School offer a more structured solution thanks to software developed as part of their Addressing Radiologist Recommendations Collaboratively project. 

The ARCC software is a closed-loop communication system that’s designed to channel radiologist recommendations into a structured format that’s clearly understood, while also tracking whether they were accepted and fulfilled. The ARCC tool runs separately from the radiologist’s dictation software, so while it asks them to include a standardized recommendation sequence in their report, it leaves the specific free-text language up to them. 

Under the ARCC criteria, the main factors that make up a complete follow-up recommendation are:

  • Reason for imaging study
  • Timeframe when study should be completed
  • Imaging modality to be used

The researchers implemented the ARCC software in October 2019 in thoracic imaging, and rolled it out to other departments through December 2020. Use of the software was “strongly encouraged but voluntary.” 

In testing the ARCC software’s effectiveness, the researchers found that the number of follow-up recommendations considered to be complete – with all three key elements – rose from 14% to 46%. Even so, one-third of reports filed with ARCC “still contained ambiguous language” in the free-text section – indicating that old habits are hard to break.

The Takeaway

Radiologists may hate it when their recommendations for follow-up imaging are ignored, but referring physicians are also frustrated with free-text radiology reports that are wishy-washy and contain vague impressions. The ARCC software could bridge the gap by steering radiologists toward recommendations that are more concrete and specific – and more likely to be followed.

Is CCTA Set for Cardiac Screening?

Posted on by Brian Casey

A new study out of Denmark suggests that coronary CTA could be headed for population-based screening for heart disease. Researchers found that CCTA was remarkably effective in identifying individuals without symptoms who were more likely to experience heart attacks in years to come.

CCTA has proven so effective for cardiac imaging that it’s become a first-line test for stable chest pain, usually for those with symptoms. But researchers have debated whether CCTA’s value could be extended to asymptomatic individuals – which could set the stage for broad-based heart disease screening programs.

To investigate CCTA’s potential in the asymptomatic, researchers in Denmark scanned 9,533 individuals 40 years and older as part of the Copenhagen General Population Study, reporting their results in Annals of Internal Medicine. CCTA scans were conducted with Canon Medical’s 320-detector-row Aquilion One Vision scanner. 

Atherosclerosis was characterized as either obstructive (a luminal stenosis ≥ 50%), extensive (stenoses widely prevalent but not obstructive), or both. Researchers then tracked myocardial events over a median follow-up of 3.5 years. 

They found that 46% of study subjects had evidence of subclinical coronary atherosclerosis, with the type of atherosclerosis impacting risk of myocardial infarction: 

  • Extensive atherosclerosis had eight times higher risk 
  • Obstructive atherosclerosis had nine times higher risk
  • Both extensive and obstructive disease had 12 times higher risk

What’s more, researchers found that 10% of their study population had obstructive disease – which is just 10 percentage points under the 60% atherosclerosis threshold at which therapeutic intervention should be considered for asymptomatic people. 

Participants in the CGPS study did not receive treatment as part of the study, but the researchers have a follow-up study underway – DANE-HEART – in which asymptomatic people will get CCTA scans and some will be directed to preventive treatment if they meet clinical guidelines.

The Takeaway

This study demonstrates not only the widespread incidence of subclinical coronary atherosclerosis, but also CCTA’s ability to detect CAD before symptoms appear. Preventive treatment initiated and directed by CT findings could have a major impact on heart disease morbidity and mortality.

Given CCTA’s prognostic ability and the heavy burden of heart disease on society (more women die of heart disease than breast cancer, for example), how long before calls emerge to add CT-based heart screening to the arsenal of population-based screening programs? DANE-HEART may offer a clue.

Radiology Bucks Doctor Salary Decline

Posted on by Brian Casey

The latest news on physician salaries is out, and it’s not pretty. A new Doximity survey found that average physician pay declined 2.4% last year, compared to an increase of 3.8% in 2021. The drop was exacerbated by high inflation rates that took a bite out of physician salaries. 

The Doximity report paints a picture of physicians beset by rising burnout, shortages, and a persistent gender pay gap. Doctors across multiple specialties report feeling more stressed even as wage growth has stalled.

To compile the 2022 data, Doximity got responses from 31,000 US physicians. There was a wide range of average annual compensation across medical specialties, with radiology landing at number 10 on the top 20 list, while nuclear medicine occupied the 20th spot:

  • Radiation oncology: $547k vs. $544k in 2021
  • Radiology: $504k vs. $495k 
  • Nuclear medicine: $392k vs. $399k

In other findings of the report:

  • Male physicians made $110,000 more than women doctors. At a gap of 26%, this is actually an improvement compared to 28% in 2021.
  • Men physicians over their career make over $2 million more than women.
  • Nuclear medicine had the smallest pay gap ($394k vs. $382k)
  • The pay gap could contribute to higher burnout rates, with 92% of women reporting overwork compared to 83% of men. 
  • Two-thirds of physicians are considering an employment change due to overwork. 

Ironically, Doximity cited results of a recent survey in which 71% of physicians said they would accept lower compensation for better work-life balance. 

The Takeaway

The news about salaries could be a gut punch to many physicians, who are already dealing with epidemic levels of burnout. Radiology salaries bucked the trend by rising 1.6%, which could explain its popularity among medical students over the last three years. 

The question remains, is the money worth it? Rising imaging volumes have been tied to burnout in radiology, and the Doximity report indicates that some physicians are willing to forgo money for better quality of life.

Moral Distress in Radiology

Posted on by Brian Casey

The rising volume of medical imaging studies isn’t just a data point. It’s causing moral distress among radiologists and is a major systemic cause of the specialty’s burnout epidemic. 

Radiology’s problem with burnout is no secret, with a recent analysis disclosing that 54% of all radiologists identify as burned out. Studies have found that a cause of burnout can be moral distress, defined within healthcare as when a clinician knows the right course of action for a patient, but is prevented from taking it due to systemic factors.

In a March 22 study in American Journal of Roentgenology, researchers describe findings from a survey of 93 radiologists on their feelings of moral distress in different clinical scenarios and the impact it had on their careers. In short:

  • 98% reported some degree of moral distress
  • 48% thought the COVID-19 pandemic influenced their moral distress
  • 28% considered leaving their jobs
  • 18% actually did leave a job

Several factors contribute to moral distress in radiology: 

  • Case volumes that are higher than can be read safely
  • Higher case volumes that prevent resident teaching
  • A lack of action and support among administration

These latter issues lead to burnout in specific ways, the authors wrote. Institutional constraints to providing high-quality care can prompt physicians to spend more time at work. Error rates can also grow during shifts with high study volumes or that last longer than 10 hours. And orders for unnecessary imaging exams can be seen as disregard for professional expertise. 

The Takeaway

This study rips the Band-Aid off the burnout problem in radiology, pointing out that inexorably rising imaging volumes rather than bad bosses or lazy colleagues are a root cause, one that’s been exacerbated by the COVID-19 pandemic.  

A further implication is that no amount of “self-care” – often prescribed as a solution for burnout – will cure the problem in the long run as long as radiologists will have ever-growing worklists to return to after their sabbaticals and motivational staff meetings. The researchers recommended “urgent action” to address the issue.

Medical Students Return to Radiology

Posted on by Brian Casey

Medical students are flocking to apply to U.S. radiology residency programs, with diagnostic radiology seeing the most growth among nearly two-dozen medical specialties. The trend underscores the strong job market for radiologists.

The number of applications to diagnostic radiology residency programs has grown more than 10% a year over the past three years, according to an analysis by Dr. Francis Deng of Johns Hopkins Medicine. Deng has been tracking applicants for 23 medical specialties, and posted a now-viral table containing his analysis on March 13. 

The annual growth rates for diagnostic radiology and the related fields of radiation oncology and interventional radiology exceeded every other medical specialty for the past three years:

  • Diagnostic radiology: 10.5%
  • Radiation oncology: 8.9%
  • Interventional radiology: 6.8%

Diagnostic radiology’s growth is all the more intriguing given the decline it saw in residency applications from 2018 to 2020. Applications fell by 9.5% from 2,033 in 2018 to 1,839 in 2020, before rebounding to 2,409 applicants in 2023. 

What’s behind radiology’s rebound? RadTwitter offered multiple reasons:

  • Generational shifts in preference among medical students.
  • Medical students favoring “money or lifestyle over human interactions.”
  • Reduced worries about the impact of AI on radiologist jobs.
  • The trickle-down effect of a good job market.

RadTwitter pundit Dr. Saurabh Jha expanded on this latter point. A rising volume of imaging studies in the 2010s led to calls to expand the number of residency lots; these calls were ignored, leading to today’s scarcity of radiologists. 

Indeed, other data confirm his analysis. The ACR’s job board last year had the highest number of open radiologist positions ever, while recruiters have been flooding radiologists with job proposals for at least the last two years.

The Takeaway

The medical students entering radiology who celebrated Match Day on March 17 are likely to encounter a robust job market 5-6 years from now, as imaging volume grows while radiology residency slots remain static. Fear of AI’s impact on radiologist jobs appears to be receding, as evidenced by strong growth in radiology applications since 2020.  

Breast Screening’s New Gold Standard?

Posted on by Brian Casey

A new study in Radiology on the use of digital breast tomosynthesis for breast screening makes the case that DBT has so many advantages over conventional 2D digital mammography that it should be considered the gold standard for breast screening. 

Unlike 2D mammography, DBT systems scan around the breast in an arc, acquiring multiple breast images that are combined into 3D volumes. The technique is believed to be more effective in revealing pathology that might be obscured on 2D projections.

Previous research already demonstrated the effectiveness of DBT for certain uses, but the new study is notable for its large patient population, as well as its focus on general screening rather than subgroups like women with cancer risk factors such as dense breast tissue.

Researchers led by Dr. Emily Conant of the University of Pennsylvania reviewed DBT’s performance in five large U.S. healthcare systems, with a total study population of over 1 million women. 

The advantages of DBT were notable:

  • Higher cancer detection rate: 5.5 vs. 4.5 per 1k women screened
  • Lower recall rate:  8.9% vs. 10.3%
  • Higher recall PPV: 5.9% vs. 4.3%.

On the negative side, DBT had higher biopsy rates, of 17.6 biopsies per 1,000 women versus 14.5 biopsies for 2D digital mammography. But PPV of biopsy for both techniques was largely the same. 

Researchers note that breast cancer mortality rates have fallen 41% since 1989, a development attributed to earlier diagnosis and better treatment. DBT could help accelerate this trend as it finds more cancers relative to 2D digital mammography.

The Takeaway

This study reinforces the idea that DBT is now the gold standard for breast screening. While mammography vendors have already seen high market penetration for DBT systems, the new study is likely to convince any remaining holdouts that 3D mammography is a necessary technology for any breast imaging facility. 

FDA Finally Moves on Breast Density

Posted on by Brian Casey

After a long wait, the FDA issued a final rule that adds details on breast density reporting to the Mammography Quality Standards Act. The rule takes effect in September 2024 and should go a long way toward clarifying the issue of breast density for patients. 

Breast tissue density is a risk factor for cancer, and dense breast tissue can make it more difficult for radiologists to identify tumors on conventional x-ray mammography. This shortcoming is often not communicated to women who receive “normal” mammograms, but later find out that a cancer was missed.

Prodded by a strong patient advocacy movement, individual states have been passing laws requiring women to be notified of their density status, creating a patchwork of regulation across the U.S. 

The FDA in 2018 agreed to set a national standard by rolling breast density reporting into an update of the MQSA. But the long wait has frustrated many in the breast density advocacy movement.

There are several major components to the new rule, which: 

  • Requires breast imaging facilities to provide patients with a summary of the mammography report written in lay terms that identifies whether patients have dense or non-dense breast tissue.
  • Instructs facilities to include a section in the mammography report explaining the significance of breast density. 
  • Establishes four categories for reporting breast tissue density in the mammography report. 
  • Sets the specific language to be used for reporting density. 

The new rules provide much-needed national consistency in breast density reporting, and will replace the patchwork of state regulation that has developed over the years. Developers of breast density software may also benefit from the new federal rules, as they simplify the number of regulations that need to be tracked. 

The Takeaway

Better late than never. While the FDA should have signed off on this years ago, now that the rules are issued the breast imaging community can move ahead with integrating them into clinical practice. The new rules should also help density reporting software developers by setting a national standard rather than a patchwork of state regulation. 

ECR 2023 Bounces Back As AI Tops Clinical Program

Posted on by Brian Casey

The European Congress of Radiology is back. European radiologists returned to Vienna in force last week for ECR 2023, surprising many naysayers with crowded presentation rooms and exhibit booths.

Due to the COVID-19 pandemic, it was the first ECR meeting since 2019 to be held in the conference’s traditional timeframe of early March. And after a lightly attended ECR 2022, held during Europe’s July vacation season, many were watching with bated breath to see if the conference could mount a comeback. 

Fortunately, ECR 2023 didn’t disappoint. While attendance didn’t hit the high water mark set prior to the pandemic, it was strong enough to satisfy most that the show was indeed healthy, with chatter on-site placing attendance at around 17,000.

As with RSNA 2022, interest in AI was strong. AI-based content permeated the scientific sessions as well as the exhibit floor, and the show’s AI Theatre was packed for nearly every presentation. 

In his opening address, ECR 2023 President Dr. Adrian Brady of Ireland addressed concerns about AI’s impact on radiology in the years to come, characterizing it as one of the “winds of change” that should be embraced rather than shunned. 

Other major trends at ECR 2023 included: 

Patient Safety – Many sessions discussed how to reduce risk when scanning patients, ranging from lowering radiation dose to limiting the amount of contrast media to MRI scanning of patients with metallic implants.

Sustainability – Energy challenges have gripped the European continent since the Russian invasion of Ukraine in 2022, and imaging energy conservation was a key focus across several sessions. 

Workhorse Modalities – Unlike RSNA, where new product launches were focused on high-end premium systems, scanner introductions at ECR 2023 concentrated on workhorse offerings like mid-range CT and 1.5-tesla MRI.

The Takeaway

ECR is indeed back. It may not yet be a mandatory show for most U.S. radiologists, but it has regained its importance for anyone interested in a more global look at medical imaging. And given the European emphasis on research, it’s a great place to learn about new technologies before they appear in North America.

Get every issue of The Imaging Wire, delivered right to your inbox.

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Imaging Wire team

You're all set!