AI Promises and Pitfalls | COVID Impact

“Accountants have known this for years. They use calculators, which you could think of is as a simplistic form of AI, to help them remedy their limitations. But they don’t let a machine do your entire taxes . . .”

Gary Marcus, PhD sharing a ‘simplistic’ analogy to explain why AI isn’t about to replace radiologists.

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The Imaging Wire

AI Promises and Pitfalls

In a recent JAMA interview, Gary Marcus, PhD shared his perspective on healthcare AI’s status and potential, displaying a solid mix of caution and optimism. Here are some of his main points:

  • AI Limitations – Healthcare AI currently has “a lot of limits,” particularly because we don’t have much complete or structured data and “have to go out on a limb” to reach conclusions.
  • How Healthcare AI is Succeeding – Currently the combination of “clinicians and AI is the way to go,” allowing doctors to use AI the way accountants use calculators.
  • Perception vs. Reality – Many people talk about AI replacing radiologists, but AI has only replaced small pieces of radiologists’ workflows so far.
  • Should Clinicians be Worried? – In the short term, clinicians should only be concerned if they don’t learn to use the AI tools that are becoming available to them. However, eventually “these tools will become good enough for most ordinary situations.”
  • Only Two Trials – Even though there have only been two published randomized clinical trials (RCTs) comparing imaging AI and expert clinicians, this might not be as big of a deal as many suggest. RCTs are unlikely to address AI’s generalizability challenges, so successful RCTs don’t guarantee real world success.
  • AI for COVID – We’re already seeing a lot of work on CV19 AI, and although it might help with imaging triage, AI is “certainly not anything like a miracle cure.”
  • AI’s Future Role – In the short term, AI should be used for triage. In the long-term, “medicine will be completely different” because of AI, as artificial intelligence solutions will produce expert-level diagnoses based on a range of inputs and potentially catch issues that experts might miss.

Signify’s COVID Projection

A new Signify Research white paper detailed how the medical imaging segments could bounce back from the COVID-19 pandemic, forecasting a “swoosh” shaped recovery for imaging equipment, while imaging software experiences a less-dramatic but longer decline. Here are some of the big takeaways.

  • Budgets and Spending – 2020 healthcare spending will be propped up as much as possible by stimulus efforts and helped by the return of elective procedures. However, Signify views 2021 and the first half of 2022 with more uncertainty due to reduced stimulus, the completion of the pre-COVID order backlogs, and related budget cuts.
  • Ultrasound – Signify expects the overall ultrasound market to decline by between 4% and 12% in 2020, returning to pre-pandemic levels in 2023, as CV19-related demand for handheld systems won’t be enough to overcome declines in the main US segments (radiology, cardiovascular, women’s’ health).
  • Radiography & Fluoroscopy – Although COVID-19 has been great for mobile X-ray (+15 – 20% in 2020), fixed radiography and fluoroscopy systems will suffer this year (down 10% – 20%), before returning to normal in 2021.
  • Mammography – COVID-19’s well-publicized impact on breast cancer screening will drive a 15% to 20% decline in mammography system revenue in 2020, but the segment should bounce back to pre-pandemic levels by next year due to the surge from postponed screening appointments.
  • Imaging IT – The imaging software markets were less impacted than hardware, due in part to their recurring revenue business models, with 2020 imaging IT revenue projected between an 8% decline and a 2% increase. However, imaging IT’s post-COVID rebound might also be less significant due to a lag between implementations signed pre-pandemic and new deals signed during or following the CV19 pandemic.
  • Imaging AI – Although not necessarily helped by the COVID-19 emergency (reduced budgets, less attention, increased risk-aversion), imaging AI will continue to grow in 2020 and beyond. In the short term, AI will be helped by radiology departments’ needs to efficiently handle the post-COVID surge as well as hospitals’ demand for new CV19 triage solutions.
  • Teleradiology – The COVID-19 emergency is driving an overall telehealth boom, and although teleradiology isn’t directly benefiting from this growth (down in H1 2020), it will still grow throughout 2020 and continue to grow along with imaging volumes in future years.

The Wire

  • GE and Lunit’s AI Partnership: GE Healthcare announced the launch of its Thoracic Care Suite, a collection of AI algorithms from Lunit’s Insight CXR solution suite intended to flag eight abnormalities in chest x-rays (97-99% accuracy), including COVID-19 pneumonia and tuberculosis. This could prove to be a solid move for both GE Healthcare and Lunit, as it significantly expands Lunit’s distribution and quickly expands GE’s portfolio, while potentially representing a model for future modality/developer partnerships (especially if they can demonstrate commercial value for hospitals).
  • CT AI for Appendicitis: A South Korean team developed a CNN algorithm that uses abdominal CTs to detect acute appendicitis, suggesting that a similar algorithm could fill-in for radiologists (e.g. overnight shifts). The researchers trained the model using CT data from patients who visited the ER with abdominal pain (n = 667 patients, 215 w/ appendicitis). They externally validated the model with CT data from two other ERs (1st ER: 60 patients, 26 w/ appendicitis; 2nd ER: 40 patients, 20 w/ appendicitis) achieving promising levels of sensitivity (88.5%, 95%), specificity (91.2%, 100%), accuracy (90%, 97.5%), and AUCs (0.96, 0.95).
  • Split Ring Resonators: New research from Imperial College London reveals that split ring resonators (SRRs, a split copper loop surrounded by oil) could help overcome acoustic ultrasound’s limitations related to wavelength (too long) and transducers (bulky, require power sources). The researchers demonstrated that the wireless SRR transducers could be placed anywhere on the body and generate acoustic waves when exposed to microwaves.
  • CV19 CT Test Corrections: New research out of China found that chest CT can identify patients with negative RT-PCR test results who might actually be CV19-positive. The study reviewed chest CTs and RT-PCR results from 21 symptomatic patients (initial RT-PCR results: 7 negative & 14 positive), finding that the patients with negative test results were also less likely to show pulmonary consolidation (p < 0.05), while otherwise showing the typical CV19 CT features.
  • Blue Earth PET Agents via PETNET: Bracco’s Blue Earth Diagnostics subsidiary and Siemens Healthineer’s PETNET Solutions subsidiary announced a commercial supply agreement covering Blue Earth’s PET imaging agents. Under the multi-year agreement, PETNET will manufacture and distribute Blue Earth’s FDA-cleared Axumin (Fluciclovine F 18) prostate PET agent, potentially adding Blue Earth’s rhPSMA-7.3 (18F) investigational imaging agent upon its FDA approval.
  • More Walmart Clinics: Walmart is continuing its standalone clinic expansion, opening a new Walmart Health location in Loganville, Georgia and a smaller footprint prototype location in Springdale, Arkansas, while revealing plans to launch additional Georgia locations later this year. The June openings give Walmart at least four standalone clinics that provide a range of services (including X-ray imaging) and are part of the retail giant’s strategic push deeper into healthcare. Walmart also just bought a pharmacy software company last week.
  • Ultrasound Down: Research firm Omdia (formerly IHS Markit) forecast that the COVID-19 crisis will reduce global ultrasound revenue by 8.4% in 2020, while pent-up demand will drive 9.2% revenue growth in 2021, and the market will continue to grow through 2024. Omdia sees CV19 amplifying the recent POCUS/handheld growth trend due to their value for CV19 care (particularly in the U.S. and W. Europe), while demand for costlier cart-based systems will decline in many regions due to reduced budgets and lower provider attention.
  • RamSoft Adds Telehealth: RamSoft and QliqSOFT expanded their partnership, integrating QliqSOFT’s Virtual Visit telehealth platform into RamSoft’s RIS and PACS solutions. QliqSOFT’s Virtual Visit platform allows providers to connect with patients (via text, chatbots, video conferencing) and the integration expands upon the companies’ 2018 partnership that made QliqSOFT’s secure texting solution available to RamSoft users.
  • MRI for CTE: Researchers from Israel’s Ben-Gurion University developed a modified dynamic contrast-enhanced MRI (DCE-MRI) protocol and related analytical methods to diagnose chronic traumatic encephalopathy (CTE) by measuring leakage of the blood-brain barrier (BBB). The study of 42 Israeli Football League players (plus control groups), found that 27.4% of the football players had leaky BBBs, three-times higher than the controls groups. Before now, the neurodegenerative disease related to repeated collisions could only be diagnosed postmortem.
  • Practice Community and Marketing Reentry: Healthcare Administrative Partners published its latest set of guidelines on radiology’s reentry, this time focusing on supporting volume rebounds through community collaboration and marketing. HAP encouraged practices to collaborate with their referring hospitals and physicians based around the shared goal of quickly treating patients, while maintaining consistent communication with them throughout the rebound. Community marketing is just as crucial, communicating tailored messages focused on safety, logistics, supportive technology, and promoting any positive patient feedback.
  • FDG PET/CT for BC Recurrence: Italian researchers found that FDG PET/CT markers can be used to predict breast cancer recurrence. The study reviewed FDG PET/CT data from 561 patients who completed surgery for invasive primary breast cancer and had increased tumor markers, finding that patients with no detected distant metastases had much lower median CA 15-3 and CEA tumor markers (35.0 U/mL & 6.6 U/mL) compared to patients with detected metastases (58.9 U/mL & 12.4 U/mL).
  • Staffing Firms’ Slower Rebound: S&P Global forecast that healthcare staffing companies will face a more difficult path to recovery as hospitals prioritize keeping their own staff and aggressively renegotiate rates with staffing companies. However, S&P Global was more optimistic for specialist staffing (specifically naming radiology and anesthesiology), suggesting that specialist practices should rebound at the same pace as patient volumes.

The Resource Wire

– This is sponsored content.

  • When preparing your radiology practice to reenter the market after the dip in imaging volume caused by COVID-19, be sure to evaluate your human resource policies, physician staffing considerations, and scheduling parameters as discussed in this blog article from Healthcare Administrative Partners.
  • 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.
  • 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.

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