“Rather than succumb to fear and skepticism, future radiologists must be equipped with a working knowledge of ML to leverage the tools as they are deployed.”

Mass General Hospital radiologist, Monica J. Wood (and team), in an editorial on the growing gap between the role of AI/ML in radiology and the level of AI education/understanding.

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.
• OpenMarkets – A marketplace for healthcare equipment, used by hundreds of hospitals and suppliers to buy and sell imaging equipment in the most efficient way possible.
• Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation technology to disrupt the industry.

The Imaging Wire

A Call for AI Education
Despite the growing adoption of AI in radiology and the widespread expectation that radiologists will increasingly use AI/ML-based solutions in their daily work, there’s still a lack of formalized AI-related education available to radiologists, and therefore a general lack of AI understanding. That’s from a JACR editorial highlighting the need for (much) more AI training to ensure that radiologists understand how AI works and how to safely and effectively use the solutions available to them. The researchers urged radiology and medical imaging organizations to create curriculum covering all stages of AI (model development, translation, and clinical use), while suggesting that radiologists build their own understanding by getting involved in AI-related projects.

Mammography’s Big(ger) Three
IHS Market reported that the global mammography equipment market’s huge growth in 2017 allowed the segment’s leaders to capture an even greater share of the market. Hologic maintained its dominant position with an over 50% share, GE Healthcare (~20%) achieved the most growth to strengthen its second place position, and Siemens Healthineers (~10%) grew enough to keep its third spot (followed by Fujifilm and Philips). IHS Market attributed the big three mammography players’ growth to their innovative products (mainly 3D and comfort-related), which drove their sales in developed markets, while smaller players targeted emerging markets and struggled due to low demand compounded by low unit pricing. Strong performance in developed mammography markets was the name of the game in 2017, as these country’s well-established/funded screening programs drove replacement sales (W. Europe, N. America, S. Korea, and Japan). Although posting slower growth in 2017 than other developed regions, the US remained dominant, representing over half of all global mammography equipment revenue and 3D unit shipments.

Evidence for 3CB-Radiomics
A new study found that breast tissue composition data from three-compartment breast (3CB) imaging, analyzed using a radiomics CAD algorithm, could improve physicians’ ability to predict cancer and significantly reduce unnecessary biopsies. This latest study in support of 3CB imaging used 109 dual-energy mammograms that were identified as “suspicious or highly suggestive” of a malignancy (would typically be immediately biopsied), applying 3CB imaging and mammography radiomics to achieve an almost 50% positive predictive value (vs. 32% for visual interpretation), a 97% sensitivity rate (correctly ID’d 34/35 cancerous tumors), and a 36% reduction in unnecessary biopsies. The researchers were most excited about 3CB-radiomics’ ability to reduce biopsies, which combined with the fact that it can be implemented without major changes to existing mammography equipment, could earn the technique a role in breast cancer screening and diagnosis practices.

Healthcare’s Fax Dependency Goes Viral
The role of the fax machine in healthcare was a major topic in the news this week, following the UK NHS’ announcement that it will stop using the devices by 2020, aligning with the US CMS’ previously-announced (but possibly less-firm) 2020 goal. Dozens of publications (CNBC, the BBC, Vox, Forbes – plus all the healthcare and tech sites) covered the story, with angles ranging from how and why fax machines are still being used in healthcare, the experiences of young doctors learning to use fax machines for the first time (in addition to learning medicine), and how healthcare may be able to break its fax addiction. This was about as viral as a non-clinical healthcare tech story gets, but it’s really a story about interoperability and change management, and an important notice that more heavy-handed, NHS-style approaches to pull the plug on fax machines in healthcare may be on the way. This is probably a good trend to get in front of.

The Healthcare IT Bubble
A KPMG and Leavitt Partners survey of healthcare investors (n=175) found that, much like FANG stocks in 2018, healthcare IT will go into 2019 as a hot investment target that is also widely viewed by investors as overvalued. Healthcare IT led all segments in terms of investor interest (34% “most interested” in HIT), and despite the fact that 64% of all investors viewed healthcare IT companies as overvalued (12.5x acquisition multiplier vs. EBITDA), the vast majority of investors expect healthcare IT valuations to increase (40%) or stay the same (51%) in 2019. This doesn’t seem like a sustainable trend, but it’s an interesting one to watch, and could be a sign that it’s a good time to sell your HIT business while multipliers are in double digits. Notable from a radiology perspective, investors are also interested in Specialty Physician Groups (19% “most interested”, 8.9x acquisition multiplier) and Medical Devices (10% “most interested”).

The Wire

• Fujifilm announced the Japan launch of the SonoSite FC1-X V3.0 laptop-style ultrasound system, highlighted by a new automatic blood flow measurement feature to support daily shunt management during dialysis treatment. The third-generation system replaces the SonoSite FC1-X (apparently V2.0) that launched in 2016/2017 and may end up expanding to all regions the previous FC1/FC1-X ultrasounds were available.

• Primary care providers hold-back on MRI orders when they know they’ll be graded against their peers on guideline adherence. This is from a recent study (n=54 PCPs, 9,349 visits) that used clinical decision support programs (CDS) to send primary care providers (PCP) report cards following lumbar spine MRI orders for lower back pain and/or notify PCPs immediately upon ordering a nonadherent scan. The PCPs who received report cards on their rate of adherent and nonadherent LS MRI orders reduced their orders by 37% the following month, while PCPs who received both report cards and alerts reduced their orders by 27%. Interestingly, PCPs who only received alerts (no report cards) did not reduce their orders, suggesting that the context provided by the report cards is the most effective way to promote cost-conscious healthcare (and maybe that EHR alert fatigue is real).

• Insightec’s Exablate Neuro focused ultrasound system gained European CE Mark approval for sale in configurations with Siemens Healthineers’ MRI systems (Magnetom Skyra, Prisma, and Prismafit) for the MRI-guided treatment of essential tremors, Tremor Dominant Parkinson’s Disease, and neuropathic pain. Coming just a few months after the configurations’ FDA clearance, the Exablate Neuro’s CE Mark approval for use with Siemens MRIs should open-up its addressable market, as the system was previously only available with GE MRIs.

• Breast cancer screening guidelines from the Canadian Task Force on Preventive Health Care included a recommendation against screening for women between 40 and 49 years-old, emphasizing the importance of “shared decision making,” but clearly suggesting that this group’s higher risk of false positives, overdiagnosis, and overtreatment outweigh the potential benefit (they suggest 50-74 yr old women are screened every 2-3 years). Although this is quite different than a recent study suggesting that high-risk women start screening as young as 30, the recommendation is consistent with the Canadian Task Force’s previous position in 2011 as well as the position of the U.S. Preventive Services Task Force.

• Alpha Imaging expanded its northeast US presence with its acquisition of Massachusetts imaging sales and service company, Modern Imaging, expanding Alpha Imaging’s territory and giving Modern Imaging access to new imaging technologies and brands. The move comes about 15 months after Alpha Imaging first entered the northeast with its acquisition of Medical Imaging Systems (Connecticut) and continues the company’s acquisition-driven expansion during the last decade (now in 10 Midwest and Eastern states, plus DC).

• Philips Healthcare signed a 10-year deal with NewYork-Presbyterian Hospital, providing the major NYC academic hospital with its full suite of Health IT and informatics solutions (radiology, cardiology and analytics). Philips already supported some NewYork-Presbyterian locations with its Philips Patient Monitoring and Philips Cardiology Informatics solutions, which will be replaced system-wide by Philips’ IntelliSpace Enterprise Edition.

• New research from the UK found that shifting from film to digital mammography increases cancer detection rates by 14% without increasing recall rates, citing digital mammography’s advantages around image quality, calcification and dense tissue visualization, and reader image adjustment. The study looked at over 11 million screenings in 45 to 70-year-old women, revealing that women between 45 and 52 had a 19% better cancer detection rate with digital, and that digital was particularly effective at detecting grade 1 and 2 invasive cancers (no advantage for invasive grade 3 cancers).

• MaxQ AI announced a US and European distribution agreement with TeraRecon subsidiary, EnvoyAI. The deal will add MaxQ’s Accipio intracranial hemorrhage (ICH) platform to the EnvoyAI Exchange marketplace and make the company’s Accipio Ix solution available through EnvoyAI/TeraRecon’s PACS distribution channels, including TeraRecon’s current customers. EnvoyAI joins a growing list of MaxQ AI distribution partners, as the last few weeks have brought deals with GE Healthcare and Samsung NeuroLogica, in addition to an expected deal with IBM.

• The FDA approved a range of new feature enhancements to Planmed’s Verity Cone Beam CT scanner. The now-approved enhancements include improved image quality, new head and neck imaging options (dental and ENT), its new Planmeca Ultra Low Dose imaging protocol, and its new Planmeca CALM algorithm for motion artifact correction.

• SuperSonic Imagine will use PTC’s ThingWorx Industrial IoT Platform to support the remote monitoring and service of its ultrasound fleet, starting with the recently-launched Aixplorer MACH 30.

The Resource Wire

– This is sponsored content.

• Carestream’s DRX-Revolution Nano Mobile X-ray system may be part of the biggest-growth DR segment, but many of its strengths are the little things (small, light, and low price).

• The 6th Annual Focused Ultrasound Foundation Symposium was packed with valuable insights on the latest developments and future opportunities for focused ultrasound. Here’s a standout speech on how a wearable device could revolutionize Focused Ultrasound.

• POCUS Systems’ forthcoming ultrasounds will combine ease of use, durability, and reliability, allowing clinicians to focus on their patients.

• How much does an MRI scan cost? According to Medmo, that depends.  Scans made with the exact same device on the exact same body part could cost $225 at one facility and $2,500 at another. Medmo also provides some advice to make sure patients don’t pay too much for their scans, including using the Medmo Marketplace where the average MRI costs between $225 and $700.

• In this recorded webinar, OpenMarkets customer, Luke Martin of Shannon Medical Center discusses how he works with OpenMarkets, with a particular focus on using the OpenMarkets platform to sell their used equipment.