Author: Brian Casey

More Support for Cardiac CT’s Value

Posted on by Brian Casey

A new study in Radiology offers more support for the value of CT-based coronary artery calcium scoring, finding that people with higher CAC scores had worse outcomes, and suggesting that those with scores of 0 could potentially avoid invasive coronary angiography. 

Evidence has been building that by measuring calcium buildup in the heart, CAC scores can predict clinical outcomes, in particular major adverse cardiac events, particularly in patients with stable chest. 

  • Studies ranging from MESA to SCOT-HEART to PROMISE have found that patients with CAC scores of 0 have MACE risk that’s lower than 2% – meaning they could be discharged without further invasive workup. 

The new study is an update to the DISCHARGE trial, which in 2022 published results comparing a CT-first evaluation strategy to one with invasive coronary angiography. The new study investigates the value of CAC scoring by analyzing its prognostic power in patients with stable chest pain who were referred for invasive coronary angiography. 

  • The DISCHARGE study is notable for its diversity – 26 clinical centers in 16 European countries – as well as its use of 13 different models of CT scanners from all four major CT OEMs from 2015 to 2019. 

In all, 1.7k patients were studied, and CAC scores were generated based on CT scans and used to stratify patients into one of three groups; they were then followed for 3.5 years and rates of MACE were correlated to CAC levels, finding … 

  • Patients with CAC scores of 0 had the lowest rates of MACE compared to those with scores of 1-399 and ≥400 (0.5% vs. 1.9% & 6.8%)
  • Rising CAC scores corresponded to higher prevalence of obstructive coronary artery disease (0=4.1% vs. 1-399=29.7% & ≥400=76%)
  • Revascularization rates rose with CAC scores (0=1.7% vs. ≥400=46.2%)

While the authors steered away from commenting on the study’s impact on clinical management, the findings – if confirmed with additional studies – suggest that stable chest pain patients may not need invasive coronary angiography.

  • And in another interesting wrinkle to the study, the researchers pointed out that 57% of the DISCHARGE study’s patient population were women, a fact that addresses sex bias in previous research. 

The Takeaway

The DISCHARGE study’s findings are yet another feather in the cap for cardiac CT, with higher CAC scores indicating the long-term presence of atherosclerosis. Should they be confirmed, individuals with stable chest pain in the future will benefit from less invasive – and less expensive – management.

ECR 2024 Video Highlights

Posted on by Brian Casey

The theme of ECR 2024 was Next Generation Radiology, and those who were in attendance at Austria Center Vienna truly got a glimpse of what the future of medical imaging will look like. 

From the latest in cutting-edge AI research to new developments for classic technologies like radiography, ECR 2024 spotlighted why radiology has a bright future ahead. 

In this special edition of The Imaging Wire newsletter, we offer a recap of our ECR video interviews with thought leaders and imaging vendors from the exhibit floor. 

We hope you enjoy watching our coverage as much as we enjoyed producing it! Check out the links below or visit the Shows page on our website, and keep an eye out for our next Imaging Wire newsletter on Thursday.

MASAI Gets Even Better at ECR 2024

Posted on by Brian Casey

One of the biggest radiology stories of 2023 was the release of impressive interim results from the MASAI study, a large-scale trial of AI for breast screening in Sweden. At ECR 2024, MASAI researchers put an emphatic cap on the conference by presenting final data indicating that AI could have an even bigger impact on mammography screening than we thought. 

If you remember, MASAI’s interim results were published in August in Lancet Oncology and showed that ScreenPoint Medical’s Transpara AI algorithm was able to reduce radiologist workload by 44% when used as part of the kind of double-reading screening program that’s common in Europe.

  • Another MASAI finding was that AI-aided screening had a 20% higher cancer detection rate than conventional double-reading with human radiologists, but the difference was not statistically significant. 

That’s all changed with the final MASAI results, presented at ECR on March 2 by senior author Kristina Lång, MD, of Lund University.

  • Lång presented data from 106k participants who were randomized to either screening with Transpara V. 1.7 or conventional double reading without AI.

Transpara triaged mammograms by giving them a risk score of 1-10, and only those classified as high risk received double reading; lower-risk mammograms got a single human reader. In the final analysis, AI-aided screening … 

  • Had a 28% higher cancer detection rate per 1k women (6.4 vs. 5.0), a difference that was statistically significant (p=0.002)
  • Detected more cancers 10-20 mm (122 vs. 79)
  • Detected more cancers of non-specific histologic type (204 vs. 155)
  • Detected 20 more non-luminal A invasive cancers and 12 more DCIS grade 3 lesions

The Takeaway

When combined with the Lancet Oncology data, the new MASAI results indicate that AI could enable breast radiologists to have their cake and eat it too: a lower workload with higher cancer detection rates. 

Report from ECR 2024

Posted on by Brian Casey

ECR 2024 kicked off yesterday in Vienna, Austria, with European radiology professionals gathering to celebrate the field and demonstrate the latest in medical imaging research and technology. 

As we noted in last year’s coverage, ECR has bounced back strongly from the disruptions of the COVID-19 pandemic. 

  • While this year’s attendance numbers aren’t in yet, the rooms and halls of Austria Center Vienna appear to be just as crowded as in the pre-pandemic days.

In particular, the show’s opening ceremony on Wednesday evening was standing room only, with attendees delighting in friendly banter on the future of AI and radiology between congress president Carlo Catalano, MD, and Ameca, an AI-powered animatronic robot. 

From a content perspective, this year’s meeting continues a strong focus on AI.

Some highpoints from the first few days are as follows:

The Takeaway
Based on the first two days, ECR 2024 is off to a great start. We’ll be featuring additional coverage in upcoming issues, so be sure to come back, and check out our YouTube channel and LinkedIn page for video highlights from the conference.

The 35 Best Radiology Sources

Posted on by Brian Casey

Our list of the top radiology news sources last year generated a lot of excitement, so we’re updating the list for 2024 with the people and publications we rely on to find the most interesting medical imaging stories. 

Top Radiology Sites

From a radiology newsletter with a laser focus on AI to an educational site with thousands of radiology cases, you’re sure to find something that meets your needs from the list below.

  • AI for Radiology – A great source for news on AI, including the Project AIR testing clearinghouse.
  • DI Europe – Two European journalists reviving one of radiology’s most venerable brands.
  • Medality Radiology Report Podcast – Medality CEO Daniel Arnold interviews the biggest names in medical imaging. Think Howard Stern for radiology.
  • radHQ.net Forums – In a short time this has become the go-to public bulletin board for radiologists. Bring popcorn. 
  • Radiopaedia – The best site for educational radiology content, bar none.
  • Signify Research – Home of the best radiology market analysis, backed by actual market data.

Top Radiology Key Opinion Leaders

Radiology is fortunate to have a wealth of really smart people sharing their thoughts on medical imaging technology. Here are a few of the best.

  • Jan Beger – OEM executive with insightful high-level thoughts on AI.
  • Mike Cannavo – The one and only PACSman, with invaluable insights on AI and enterprise imaging.
  • Francis Deng, MD – Great analysis of radiology education and residency trends.
  • Rich Duszak, MD – Always a superb source for radiology leadership and responsible imaging.
  • Tobias Gilk – Radiology’s conscience on MRI safety. 
  • Tom Greeson – The authority for perspectives on legal issues in radiology.
  • Laura Heacock, MD – A leading voice on AI research and advancements.
  • Saurabh Jha, MBBS – Delivers keen radiology insights with a biting wit.
  • John Kalafut, PhD – Former vendor executive now offering AI wisdom.
  • Woojin Kim, MD – One of radiology’s best sources for keeping up with the latest AI research. 
  • Amine Korchi, MD – A radiologist with an eye for business news.
  • Nina Kottler, MD – Eloquent and informed insights from the frontlines of imaging. 
  • Curt Langlotz, MD, PhD – The first place we look for imaging AI context.
  • Rizwan Malik, MD – Incredibly insightful and uniquely autobiographical. 
  • Geraldine McGinty, MD – New platform, but still the moral compass of radiology.
  • Herman Oosterwijk – The unquestioned authority on DICOM and enterprise imaging.
  • Sebastian Schmidt – OEM executive with insightful analysis on CT lung cancer screening.
  • Vikas Shah, MD – Radiopaedia managing editor. Come for the educational content, stay for the dart takes. 
  • Ben White, MD – Excellent insights into the vagaries of being a working radiologist.
  • Reza Zahiri – Detailed LinkedIn posts that deconstruct the financial positions of medical imaging vendors.

Healthcare Newsletters and Sites

Looking to get out of the radiology niche and broaden your horizons? Check out some of these healthcare newsletters and websites.

The Takeaway

This list should cover all your bases for staying informed about the latest developments in radiology news, especially in the red-hot AI segment. Or, just sign up for The Imaging Wire and we’ll do it for you.

PS – As always, if there’s any radiology publications or healthcare news sources that should be on this list, let us know!

Earnings Season Momentum

Posted on by Brian Casey

As medical imaging vendors wrap up another quarterly earnings season, most radiology companies for the November to January period continued with the momentum they showed in the fall of 2023. 

Large multimodality OEMs in particular saw continued success, with most saying that hospital capital equipment purchasing is crawling back to a normal level. Smaller vendors and niche players were more likely to struggle, on the other hand. 

Accuray – This radiation therapy vendor saw sales at constant exchange rates drop (-8% to $106M) while its net loss grew (-$9.6M vs. -$1.9M). 

Canon – Canon’s medical business unit enjoyed strength in Europe and Japan and in MRI, X-ray, and ultrasound, propelling the division to record quarterly revenues (8.9% to $1.12B) while operating profit boomed (38% to $93.3M). 

Fujifilm – Fujifilm saw revenues grow in its healthcare division (+10% to $1.65B) thanks to steady sales of endoscopes and CT/MRI scanners. The company has also seen strong sales of mobile X-ray systems in the US and PACS and 3D software in the US and Europe.  

GE HealthCare – GE HealthCare turned in a strong final quarter in its first full year as an independent public company thanks to good revenue growth (5% to $5.21B), with segment revenue increasing in imaging (4%), pharmaceutical diagnostics (25%), and patient care solutions (5%), making up for a decline in ultrasound (-1%). Net income slipped on lower margins (-27% to $416M). 

Hologic – Hologic continued to put supply chain problems in the rearview mirror, seeing quarterly revenue jump in its breast health business (12% to $378M). The company’s overall net income spiked (32% to $247M). 

Konica Minolta – Revenue after currency adjustment edged up in Konica Minolta’s medical business (2% to $236M) but the division posted an operating loss (-$11M) on “restrained investments” that slowed the US hospital market.  

Philips – Philips saw revenues after currency adjustment grow 5% in its diagnosis and treatment division for its final quarter of the fiscal year ($2.7B), while operating income slipped ($142M vs. $200M). Sales grew in the high single digits in image-guided therapy. 

Siemens Healthineers – Strong revenue growth in its Varian radiation oncology business (22%) helped offset a decline in COVID-19 antigen testing to propel an overall increase in Siemens’ first fiscal quarter sales. The company’s imaging segment grew 5.3% to $3B and advanced therapies was up 5% to $511M, while Varian reported sales of $981M.

Varex – Due to a 13% drop in medical segment sales, Varex saw quarterly revenues decline (-8% to $190M). The digital X-ray vendor fell into the red for the period against the year-ago quarter (-$400k vs. $3.2M).

The Takeaway

This earning season’s results show that radiology continues to emerge from COVID’s long shadow with building momentum. Future earnings periods will hopefully demonstrate continued prosperity.

When Access to Screening Isn’t Enough

Posted on by Brian Casey

A new study published this week in JAMA Network Open indicates that – even when women have access to breast screening – other factors can limit mammography’s life-saving impact. Researchers found that women with more unmet social needs had lower breast screening rates and higher rates of advanced disease – even if they had access to a mammography center. 

Research into social determinants of health – the racial, demographic, and environmental factors that can affect the quality of a person’s health – have gained steam in the last several years.

In the new study, researchers noted that unmet social needs can include housing instability, social isolation, food insecurity, and transportation challenges, and these needs can occur even in high-income areas with access to screening mammography. 

  • They studied the issue in Miami-Dade County, Florida, where all women 200% below the poverty line have access to no-cost screening mammography at safety net hospitals – in theory removing cost as a barrier to breast screening.

Researchers studied 336 women who filled out a survey on social needs; of these, 62% self-identified as Hispanic, 19% as Black, and 19% as White, and 76% had screening mammograms. Researchers found a lower odds ratio for getting a mammogram due to …

  • An increasing number of unmet social needs (OR=0.74)
  • Increasing age at diagnosis (OR=0.92)

Patients were also more likely to present with late-stage disease if they …

  • Had two or more unmet social needs (33% vs. 18%)
  • Had problems with their home utilities (17% vs. 5%) or childcare access (12% vs. 3%)
  • Were presenting to a safety net hospital (31% vs. 18%)

The authors noted that although no single unmet social need was found to have a statistically significant impact on screening mammography rates, multiple needs piling up could “overwhelm” patients so they can’t find the time to schedule preventive health check-ups. 

The Takeaway

The new findings offer a more complex view of breast screening disparities beyond just access to mammograms. Public health authorities and hospitals providing women’s health services may need to offer screening of at-risk patients and a broader range of services in order to make sure that the life-saving benefits of mammography are enjoyed on a wider – and more equitable – scale.

A New Breast Imaging Option?

Posted on by Brian Casey

When it comes to mammography screening for women with dense breast tissue, radiologists have long looked for alternatives to established modalities like MRI and ultrasound. In a paper in Radiology: Imaging Cancer, researchers put a new twist on an older technology, positron emission mammography (PEM). 

Molecular imaging technologies like PEM have been investigated for years as potential adjuncts to conventional mammography due to the challenges X-ray imaging has with dense breast tissue. 

  • These technologies have carried different names – PEM, breast-specific gamma imaging, molecular breast imaging – but in the end all have fallen short due to the higher radiation dose they deliver compared to mammography. 

But Canadian startup Radialis has developed a new version of PEM with its Radialis PET Imager that drastically cuts radiation dose by targeting specific organs, enabling clinicians to use far lower doses of radiopharmaceuticals. The company received clearance for the system in 2022. 

  • Radialis touts its system as having high spatial resolution and a small field of view thanks to digital detectors with thousands of silicon sensors that can be placed next to the target organ; this makes it well-suited for imaging specific organs like the breast.

In the new paper, Canadian researchers tested the Radialis system as an adjunct to X-ray mammography in a pilot study of 25 women recently diagnosed with breast cancer. 

  • They wanted to see if PEM performed as well as breast MRI, but with fewer false positives and a radiation dose closer to screening mammography.  

Women underwent PEM at three FDG dose levels – 37, 74, or 185 MBq (for comparison, standard whole-body PET uses 370 MBq, a level that translates to a radiation exposure of 6.2-7.1 mSv). Researchers found …

  • PEM had sensitivity of 87% across all FDG dose levels (MRI was 100%)
    • The sample size was too small to detect statistically significant differences in sensitivity between dose levels
  • PEM had specificity of 95%
  • PEM detected 96% of known index malignant lesions (24 of 25), with the one miss occurring in a patient at the 37MBq level
  • PEM’s radiation dose ranged from 0.62-1.42 mSv, versus 0.44 mSv for a two-view screening digital mammogram

The Takeaway

The findings show that PEM with the Radialis system is a feasible adjunctive breast imaging modality at a radiation dose that’s mostly acceptable relative to X-ray-based mammography. But (as always) additional studies with larger patient populations are needed.

MRI’s Value for Prostate Screening

Posted on by Brian Casey

Among cancer screening tests, prostate screening could be the most problematic. But a new study published this week in JAMA Network Open offers guidance on the role that MRI can play in making prostate screening more effective – and opening the door to population-based screening.

The problem with prostate screening is that PSA tests often discover disease that’s either indolent or slow-growing. 

  • This can lead to a cascade of interventions that are expensive and have harms of their own. 

But prostate cancer remains a common – and deadly – cancer, with 1.5M cases globally in 2022, and it’s the second most commonly occurring cancer in men after lung cancer.

  • Given these statistics, there has to be a way to perform prostate screening more effectively.

MRI offers one such alternative, and a clinical consensus has emerged that performing a single MRI scan after a positive PSA result can help stratify men before biopsy. 

  • In this scenario, men might not be referred to biopsy if their MRI scan is negative, and adoption of this protocol has helped reduce prostate biopsies in PSA-positive men while still detecting clinically significant cancer.   

But if one MRI scan is good, are repeat MRI scans even better? In the new study, Swedish researchers investigated this question in a secondary analysis of the STHLM3-MRI trial, which involved repeat screening of 1.5k men 2-3 years after an original prostate screening.

Of the group who got repeat PSA and MRI screening, 667 men had PSA levels of 3 ng/mL or higher, the threshold for MRI testing, with the repeat scans finding … 

  • 51 men (7.6%) had equivocal lesions (PI-RADS score of 3)
  • 33 men (4.9%) had suspicious lesions (PI-RADS score of 4)
  • Only 10 men (1.5%) had lesions with PI-RADS scores of 4 or greater

The findings led the authors to conclude that cancer detection was “limited” in the second round of PSA and MRI prostate screening, and detection of low-grade tumors was low.

The Takeaway

At first blush, STHLM3-MRI may seem like a negative study, but it actually helps frame the debate over prostate cancer screening and MRI’s role by omitting the need for multiple repeat scans. The results also give clinicians confidence that it’s safe to omit prostate biopsies in men who have a single negative MRI result – a key finding in reducing the downstream costs of any population-based screening program.

Real-World AI Experiences

Posted on by Brian Casey

Clinical studies showing that AI helps radiologists interpret medical images are great, but how well does AI work in the real world – and what do radiologists think about it? These questions are addressed in a new study in Applied Ergonomics that takes a deep dive into the real-world implementation of a commercially available AI algorithm at a German hospital. 

A slew of clinical studies supporting AI were published in 2023, from the MASAI study on AI for breast screening to smaller studies on applications like opportunistic screening or predicting who should get lung cancer screening. 

  • But even an AI algorithm with the best clinical evidence behind it could fall flat if it’s difficult to use and doesn’t integrate well with existing radiology workflow.

To gain insight into this issue, the new study tracked University Hospital Bonn’s implementation of Quantib’s Prostate software for interpreting and documenting prostate MRI scans (Quantib was acquired by RadNet in January 2022). 

  • Researchers described the solution as providing partial automation of prostate MRI workflow, such as helping segment the prostate, generating heat maps of areas of interest, and automatically producing patient reports based on lesions it identifies. 

Prostate was installed at the hospital in the spring of 2022, with nine radiology residents and three attending physicians interviewed before and after implementation, finding…

  • All but one radiologist had a positive attitude toward AI before implementation and one was undecided 
  • After implementation, seven said their attitudes were unchanged, one was disappointed, and one saw their opinion shift positively
  • Use of the AI was inconsistent, with radiologists adopting different workflows and some using it all the time with others only using it occasionally
  • Major concerns cited included workflow delays due to AI use, additional steps required such as sending images to a server, and unstable performance

The findings prompted the researchers to conclude that AI is likely to be implemented and used in the real world differently than in clinical trials. Radiologists should be included in AI algorithm development to provide insights into workflow where the tools will be used.

The Takeaway

The new study is unique in that – rather than focusing on AI algorithm performance – it concentrated on the experiences of radiologists using the software and how they changed following implementation. Such studies can be illuminating as AI developers seek broader clinical use of their tools. 

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