Academic Shift | COVID Quantified | CV19 Cabins

“The value that human interpretation with independent medical judgement brings to patient care cannot currently be replaced.”

The ACR and RSNA encouraging the FDA to restrict AI solutions that might undermine the role of radiologists.

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The Imaging Wire

Cancer Imaging’s Academic Shift

A new study in JACR revealed that advanced oncologic imaging volumes made a big shift towards academic practices between 2004 and 2016, warning that this trend is reducing oncologic imaging exposure opportunities (and therefore expertise) at community and smaller radiology practices.

  • The Study – The NYU and Harvey L. Neiman Health Policy Institute-led team reviewed Medicare imaging data from 2004 (5.03m exams, 1.2m advanced) and 2016 (5.017m exams, 1.5m advanced).
  • The Results – The study revealed that academic practices’ share of advanced oncologic imaging doubled from 18.8% to 34.1% by 2016, reducing the volume performed outside of academia to 65.9%. Meanwhile, state-level advanced oncologic imaging utilization correlated with each state’s supply of radiologists, rather than cancer prevalence.
  • The Takeaway – The researchers called for new efforts to ensure that non-academic radiologists build and maintain cancer expertise and create new support networks to compensate for their reduced exposure (e.g. 2nd opinion networks, telemonitoring, peer learning).

COVID Quantified

A new study in JACR added new insights into COVID-19’s massive impact on community radiology practices, finding that weekly wRVUs fell by 52% between February 2020 and April 2020 (120,450 to 55,188).

  • Declines – Although declines hit nearly all settings and applications, they were highlighted by outpatient imaging (down 66%) and driven by mammography (down 92%, 17% share of total decline). From a modality perspective, CT and radiography/fluoroscopy absorbed the bulk of weekly wRVU declines (31% & 31% share of total decline).
  • Takeaway – Although there’s been plenty of coverage of COVID’s imaging impact (this is another good one), this is among the most scientific accounts on how the pandemic affected community radiology practices. These findings could also help practices as the plan for a potential second wave from a workflow, financial, and patient perspective.

The Wire

  • Philips’ CV17 Imaging Cabins: Philips announced the deployment of COVID-19 “imaging cabins” in the Philippines, intended to help manage imaging volumes and enhance patient/staff safety during the pandemic. The offsite CT and X-ray suites are built into converted shipping containers, are designed to allow imaging of CV19-positive patients with minimal or no patient contact, and feature built-in UV sterilization systems.
  • Not Ready for Autonomous AI: The ACR and RSNA urged the FDA to adopt strict policies for autonomous imaging AI products (solutions that don’t require physician oversight), while endorsing AI solutions that provide decision support or administrative assistance to radiologists. The groups argue that the FDA can’t assure the safety or effectiveness of autonomous AI solutions, encouraging the regulator to wait until “support” algorithms have wider market adoption before approving autonomous AI tools that “remove the physician from the image interpretation.”
  • Possible Paper Mill: A Wall Street Journal exposé revealed that Chinese researchers reused medical images in at least 121 research papers that were published in international journals, prompting some to allege that this may be evidence of “paper mills” operating out of China and others to question major journals’ peer review process (again). The papers came out over the course of four years (by different authors/universities) and focused on different topics, but they all shared at least one of the same pathology images that were sometimes rotated or cropped to appear unique.
  • MITA Prepares: A letter from The Medical Imaging & Technology Alliance (MITA) to the U.S. Senate outlined five recommendations to make sure the imaging sector is prepared for future pandemic events. Here they are: 1) Include medical imaging in the Strategic National Stockpile; 2) Streamline FDA requirements for applicable imaging devices; 3) Create processes to ensure continuity of non-pandemic medical care; 4) Implement consistent caseload reporting metrics; and 5) Fund research on imaging’s value during health crises.
  • PE and CV19: A NYU-led study found that 37.1% of COVID-19 patients who underwent CT pulmonary angiogram (CTPA) scans before their CV19 diagnosis were also found to have pulmonary embolisms (vs. 14.5% control group). Although coverage of this study has been criticized for incorrectly inferring that 37% of all CV19-positive patients could have PE (these patients were already at risk of PE), it still underscores how COVID-19 increases PE risks. It also revealed that D-dimer can be used to understand patients’ PE risk and potential severity.
  • Hologic’s Premium Ultrasound: Hologic just rolled out its new SuperSonic MACH 40 cart-based ultrasound system, marking the first product to come from its 2019 acquisition of SuperSonic Imagine. The MACH 40 bolsters Hologic’s already solid breast imaging portfolio, giving it a premium ultrasound system to go with its mammography lineup and Clarius-based handheld ultrasound.
  • Referrings’ Needs: A new study out of Stanford University detailed referring providers’ imaging preferences and tendencies. The survey of 349 referring providers found that they prefer faster exams / interpretations and working with specialists. The survey also revealed that urgent care providers order more exams, primary care and urgent care providers order more diverse exams, primary care providers rely more on radiologist interpretations, and all provider types highly value direct interactions with radiologists.
  • ASPECTS Cleared: RapidAI’s ASPECTS AI solution became the first neuroimaging analysis device to achieve CADx clearance from the FDA. Rapid ASPECTS helps physicians interpret Non-Contrast CT (NCCT) scans using a standardized ASPECT score, leveraging a ML algorithm to automatically identify the brain’s ASPECTS regions and generate an ASPECT score to indicate early signs of brain infarction.
  • Telerad Growth: Signify Research just rolled out a nifty infographic detailing the global teleradiology market’s 10% CAGR between 2019 and 2024 (when it will hit $2.2b). Over this period, telerad’s overall procedure share is forecast to grow from 1.6% to 1.9% (to 108m total reads) while a shift to more advanced imaging will increase average revenue per read from $16 to $19. This combination will allow revenue from telerad reading services ($1.2b to $2b) and telerad IT services ($112m to $198m) to each nearly double.
  • Rads on Calls: A new study published in AJR revealed that including radiologist contact info in radiology reports leads to increased patient interaction and greater radiologist satisfaction. This is based on an online survey of 53 radiologists within a single practice that found 78% of the radiologists include their telephone numbers in most of their reports (>75% of their reports) and 56% of these radiologists experienced increased patient interactions when they include their contact numbers. Most radiologists found that the increased patient interaction was satisfying and only 2% reported that it interrupted their workflow.
  • Superior Liver Cancer Agent: A new study out of China found that the new PET/CT radiopharmaceutical, 68Ga-DOTA-JR11, achieved “excellent imaging performance in tumor detection, staging and restaging” for neuroendocrine cancer patients with liver metastases. The study (n = 31) found that 68Ga-DOTA-JR11 performed better than 68Ga-DOTATATE PET/CT for detecting liver metastases in whole-body time-of-flight PET/CT, detecting significantly more lesions and achieving a superior tumor-to-background ratio.
  • PenRad Notifications: PenRad Technologies launched its new PenAlert patient notification system, intended to help radiologists notify patients of their results with a focus on limiting workflow disruptions and practice liability. PenRad has historically supported mammography patient communications and the new PenAlert solution expands across diagnostic modalities.

The Resource Wire

– This is sponsored content.

  • This GE Healthcare white paper details how its suite of point of care ultrasound AI tools simplify complex patient assessments, enable faster clinical decisions, and calculate precise results.
  • In its latest Q&A, Nuance sat down with Imbio founder Mike Hostetler to discuss how Imbio’s lung AI models support lung disease diagnosis and to share about Imbio’s AI Marketplace partnership with Nuance.
  • Rural hospitals have unique needs and most know that bigger doesn’t always mean better when it comes to healthcare. This Hitachi blog details why its combination of the right features, ROI, service levels, and philosophy make it the right partner for rural hospitals.

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