A Billion Images Exposed | The Data-Driven Physician

“every day, millions of new medical images containing the personal health information of patients are spilling out onto the internet.”

TechCrunch on the billion patient images accessible online through vulnerable PACS servers.

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The Imaging Wire

A Billion Images Exposed

TechCrunch continued its investigation into medical image server vulnerability (here’s the last one), this time revealing that millions of medical images with personal health information “are spilling out onto the internet” every day. Here are some details:

Exposed Images – TechCrunch found that hundreds of hospitals, medical offices, and imaging centers are running insecure PACS servers that give “anyone with an internet connection” and the right software access to over 1 billion medical images. Half of these images belong to patients in the U.S.

The Issue – TechCrunch blamed the issue on healthcare providers who connect their PACS servers directly to the internet without password protection, exposing patient images and personal health information often found on scan cover sheets (name, DOB, diagnosis info, even SNNs).

The Investigation – In addition to citing previous breaches, TechCrunch set out to identify currently vulnerable PACS servers, discovering that one of the largest hospitals in Los Angeles is exposing tens of thousands of patients’ scans and identifying a number of U.S. imaging centers with decades of accessible patient scans. TechCrunch actually notified the vulnerable providers, finding that most of them didn’t secure their servers even after being notified.

Governance – Although providers are required to protect patient info, the article suggests that PACS vulnerability is rarely enforced if a breach doesn’t happen, in part because smaller providers don’t have the resources to comply with security regulations.

The Data-Driven Physician

Stanford Medicine recently detailed how medical students, residents, and physicians (n = 77, 133, 523) expect technology to change the practice of medicine and what they are doing to prepare for these changes.

Healthcare Transformation – To set the stage, Stanford detailed how the digital health maturation, increased data availability, and AI moving from theory to practice is transforming healthcare and may force physicians to change with it.

The Data-Driven Physician – In light of these changes, 73% of medical students are seeking out additional classes/training, far more than the 47% of current physicians attending such training. There were also notable differences in study topics, as med students were most likely to attend training on advanced statistics & data science (44%) and population health (36%), while physicians were most likely to attend classes focused on genetic counseling (38%) and AI (34%).

The Transformation Gap – These students and doctors are wise to seek data-driven training on their own, as only 18% of medical students and residents said that their education was “very helpful” in preparing them for these changes and 44% physicians said that their education was either “not very helpful” or “not helpful at all.”

The Future Physician’s Toolkit – Not surprisingly, EHRs led the list of healthcare tech that students and physicians will/do use (84% / 87%), followed by telemedicine (41% / 39%), while high-buzz technologies like VR (9% / 3%) and AI (14% / 7%) were at the bottom of the survey’s adoption list.

The Wire

  • A new study from Yale and New York University (n= 1,928 women across the U.S.) added even more evidence that state-mandated breast density notification (DBN) laws are not worded effectively (here’s a previous example). The study found that although DBN laws helped women understand that they had increased breast density (43.6% vs. 32.7% in non-DBN states) and didn’t increase anxiety, women who received DBNs weren’t more likely to know that dense breasts were associated with higher breast cancer risk (23%, statistically similar to non-DBN states) or that density limits the ability of mammograms (68%, statistically similar to non-DBN states). These challenges were even greater among less-educated women.
  • SapienML released SapienSecure v0.9 Beta, a medical imaging anonymization tool intended to help doctors and researchers more thoroughly anonymize patient data for use in AI/ML development. Although in its early stages (they are seeking feedback, not offering it as a commercial solution), SapienSecure certainly addresses a market need.
  • A recent post from IHS Markit highlighted the benefits of AI’s expansion to ultrasound (short term: efficiency & usability; longer-term: diagnostic accuracy), but warned that it may come with unintended consequences (security and patient privacy). Although security and patient privacy are major concerns across all of healthcare and AI, IHS Markit noted that connected ultrasound systems are particularly vulnerable to hackers, especially as POC ultrasounds expand the boundaries of healthcare networks.
  • Independent radiology practice coalition, Strategic Radiology (SR), announced a partnership with Mach7 Technologies to provide infrastructure and IT connectivity that SR members will use to exchange clinical data. The new SR Connect platform will link each of the member groups through a centrally hosted platform from Mach7, allowing aggregation and routing of HL7 and DICOM information between the members and other affiliated organizations.
  • Radiologists reported about “average” levels of happiness compared to other specialties in Medscape’s 2020 Physician Lifestyle & Happiness Report (n= ~15,000, ~450 radiologists), with 51% of radiologists reporting that they are happy outside of work (roughly average) and 51% in happy marriages (third lowest specialty). Rheumatologists and general surgeons were the happiest doctors (60%), while critical care workers and neurologists were the least happy (44%).
  • South Korean AI developer Lunit completed a $26 million Series C round (now raised $50m since 2013) that it will use to fund the global expansion of its chest X-ray and mammography solutions (particularly in to the U.S. and Europe).
  • A new study exploring ways to leverage mammography’s role as a major patient touchpoint, found that breast cancer screening may be an opportunity for “radiology practices to advance population health goals” like tobacco cessation and lung cancer screening. The MGH-led study (n = 1,907) added questions regarding patients’ 1) smoking history and 2) interest in a tobacco cessation program to their screening intake questionnaire, finding that 26.4% of the 201 current smokers requested tobacco cessation referrals and 9.3% of the 756 current/former smokers were eligible for lung cancer screening.
  • Imaging center company, Rezolut, acquired mobile mammography company Assured Imaging,which offers mobile breast screening across Arizona, New Mexico, Washington, Oregon, and Texas. The acquisition expands Rezolut’s mobile mammography presence across much of the western U.S., as Rezolut’s Alinea Medical Imaging subsidiary already deploys 17 mobile mammography vehicles across California. Rezolut also has 16 imaging centers across the northeast and western US.
  • The Pennsylvania Superior Court upheld a previous decision that a Philadelphia-based radiologist’s delayed diagnosis did not cause the sepsis that killed a woman with ovarian cancer. The woman’s husband argued that a delayed ovarian cancer diagnosis (the doctor initially missed lesions in a CT scan in 2012) increased her risks from a surgery she underwent seven months later (her colon was perforated due to the surgery). He lost this argument in 2017 and the court just decided against granting a new trial.
  • Dutch researchers found that breast cancer screening quality assurance sessions between technologists and radiologists have a limited impact on cancer detection (about the same radiologist double reading), but it does help educate technologists and catches more-invasive tumors. The study analyzed 466,647 screening mammograms that were read by certified screening technologists before being double read by two certified screening radiologists, followed by “screening quality assurance sessions” reviewing mammograms that the technologists considered suspicious but weren’t flagged by the radiologists. Out of the 14,142 women who were recalled, 14,057 came as a result of the radiologist double reading (w/ 3,130 detected cancers) and 85 came from the quality assurance sessions (w/ 26 detected cancers, 17 of which were larger than 10mm).
  • Clinical analytics company, Covera Health, completed a $23.5 million Series B round that it will use to expand its data science R&D efforts into measuring and quantifying the impact of diagnostic errors (initially in radiology) and expand its national Radiology Centers of Excellence program (connects payers with certified radiology practices). Covera Health became a household name last year when Walmart began requiring its employees to receive imaging services at Covera Radiology Centers of Excellence-certified providers.

The Resource Wire

  • Nuance’s AI Marketplace was profiled in Radiology Today, detailing how it integrates AI directly into radiologists’ workflow using Nuance’s PowerScribe reporting software and the radiologists’ PACS.
  • In this GE Healthcare video, ultrasound users and educators discuss how the Vscan Extend handheld ultrasound combines portability and intuitive design so you can use it in the moment to potentially change patient outcomes.
  • This NYU Langone Health article details how high-intensity Focused Ultrasound offers minimally invasive, targeted treatment for patients with essential tremor.
  • Did you know that imaging patients are most likely to no-show for their scans on Mondays and Saturdays? By partnering with Medmo, imaging centers can keep their schedules full, despite the inevitable Monday no-shows.

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