An Imaging Unicorn | Interval Misses | DLIR Works

“Even my wife thinks I’m not a ‘real doctor,’ but let someone in the fam get x-rays or a scan and I’m America’s Top Doctor.”

A Twitter comment from a radiologist and occasional “Top Doctor.”

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The Imaging Wire

DispatchHealth’s Imaging Entry

Home and virtual care company, DispatchHealth, just expanded into the imaging space with its acquisition of mobile imaging company, Professional Portable X-Ray (PPX). Regional mobile imaging providers are acquired all the time with little fanfare, but this one is worth some extra attention.

  • About PPX – PPX is a pretty standard mobile imaging company, listing just 35 employees on LinkedIn, and providing imaging services (X-ray, ultrasound, bone density) to homes and various facilities (e.g. nursing homes, jails, clinics) across seven states (AZ, IA, MN, NE, ND, SD, WI).
  • DispatchHealth Buzz – DispatchHealth has been one of the stars of the virtual health boom, due to its unique ability to provide both virtual and in-home care. That combo was enough to earn DispatchHealth $403M in funding and give it “unicorn” status (it has a $1.7b valuation as of March 2021). And all that was before DispatchHealth could even perform imaging.
  • Dispatch Imaging – This is the first step in DispatchHealth’s strategy to offer nationwide in-home imaging. That would lead to a lot more in-home scans, considering that 20% of DispatchHealth’s Acute Care visits require X-ray or ultrasound and the company logged 140k house calls last year. DispatchHealth’s COO also happens to be former vRAD exec, Shannon Werb, so they should have a solid plan for handling all these images.
  • Dispatch Expansion – PPX also expands DispatchHealth into 6 new states, allowing the company to bring its non-imaging services into PPX’s current markets.
  • The Takeaway – The COVID pandemic propelled virtual care to the top of the healthcare megatrends list, but it’s been hard to predict how imaging will be impacted as more patients receive their care virtually. It’s safe to say that DispatchHealth expects this shift to drive a lot more at-home imaging, and it just took a big first step towards becoming a top home imaging provider.

ClearRead Xray’s Top Grades

A new study in European Radiology highlighted Riverain Technologies’ ClearRead Xray – Detect as one of just two imaging AI products to achieve the FDA’s most stringent premarket approval level. See how they measured up against the other 99 AI tools.
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Interval Misses

A new study out of Norway found that the country’s radiologists missed 24% of interval breast cancers that were “obvious” in prior screening mammograms. Here’s how they came up with that surprisingly high miss rate and what they suggest might fix it:

  • The Study – The researchers reviewed two consecutive annual screening mammograms from 1,010 women who were diagnosed with interval cancer between 2006 and 2016.
  • The Results – The review revealed that 24% of these interval cancers were detectable in the first screening mammogram, but weren’t identified until the second mammogram a year later.
  • The Misses – The true and missed interval cancers had the same histopathological characteristics and density, so this wasn’t a patient/case-specific issue.
  • The Solution – To improve miss rates, the researchers proposed shortening screening intervals (although these were already an avg. of 14 months), adopting sensitivity-focused assessment and training programs, and/or adding supplemental screening techniques (double reading, higher image quality, improved positioning, and AI).

Novarad Simplifies Sharing

CD burning issues? Check out this one minute video showing how Novarad’s CryptoChart image sharing solution allows patients to easily access and share their medical images using personalized, highly secure QR codes (rather than CDs).
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The Wire

  • DLIR Works: Research presented at last week’s ARRS 2021 meeting detailed deep learning-based image reconstruction’s (DLIR) advantage over standard reconstruction for measuring pulmonary nodules on low-dose CT scans. The study reconstructed LD-CTs using two DLIR solutions (GE’s TrueFidelity & ClariPi’s ClariCT.AI) and one adaptive statistical iterative reconstruction protocol (GE’s ASIR) at three different dosage levels. Images from the DLIR solutions had lower image noise and far lower measurement error rates at all dosage levels (ASIR: 7.27% to 16.79%; TrueFidelity: 4.7% to 6.89%; ClariCT.AI: 3.09% to 7.72%).
  • An AI Collaboration: The ACR Data Science Institute (ACR DSI) and the Cancer Imaging Archive (TCIA) launched an alliance intended to help speed up AI development. The groups linked TCIA’s imaging datasets with the ACR DSI’s use cases (based on: body area, modality, comorbidities), allowing developers to train, validate, and test algorithms with clearly defined imaging data.
  • DBT+DM ROI: A new study out of British Columbia suggests that adding DBT to DM screening programs is cost effective, in addition to clinically effective. The researchers simulated outcomes from 112k screening participants (assumptions: DBT adds $44 per exam, increases cancer detection by 1.6 per 1k exams, reduces recalls by 2.2%), finding that as long as DBT reduced recalls by more than 2.1%, DBT+DM screenings would carry an additional cost of just $17k per quality-adjusted life-years (well below the standard $100k/QALY benchmark).
  • Urologists’ Renal Access Advantage: Urologists’ share of de novo renal access procedures for percutaneous nephrolithotomy (kidney stone removals) increased from 12.8% in 2007 to 32.3% in 2017, with most of that shift coming at the expense of interventional radiologists (down to 40% by 2017). This shift seems to be justified, as the urologist-performed procedures were associated with fewer >2-day hospital stays (18.6% vs. 30.8%), lower 90-day hospital readmission rates (12.8% vs. 16.7%), and lower 90-day blood transfusion rates (0.3% vs. 0.8%).
  • SHINE Fusion: Radioactive isotope company SHINE Medical Technologies acquired fusion neutron generator company and longtime collaborator, Phoenix LLC, bringing SHINE closer to its goal to produce clean energy from fusion technology. That goal goes well beyond medical imaging, but the acquisition will also support SHINE’s shorter-term plan to use nuclear fusion to produce medical isotopes like Mo-99 without a nuclear reactor.
  • Scaphoid Fracture AI: A Dutch team developed a CNN that can automatically detect scaphoid fractures in X-rays with “radiologist-level performance,” suggesting that a tool like this could be used for triage or as a first or second reader. The researchers created a segmentation CNN that identifies the scaphoid region (trained w/ 1,039 X-rays) and then sends scaphoid-localized scans to a fracture detection CNN (trained w/ 3,000 X-rays). They then tested the CNNs with 190 X-rays that were also read by 11 radiologists, finding that the CNNs detected scaphoid fractures with an 0.87 AUC (statistically similar to the rads’ 0.84 avg AUC).
  • CloudVue Cleared: The FDA approved International Medical Solutions’ (IMS’) CloudVue mobile 3D cinematic rendering software, making it the U.S.’ first cloud-based cinematic solution. CloudVue allows physicians to view/share both 3D and 3D cinematic medical images from any device (requires just 1 CPU for 30 users).
  • p-dFDG-PET’s Seizure Surgery Advantage: University of Virginia researchers developed a new PET brain imaging technique, called parametric dynamic FDG-PET imaging (p-dFDG-PET), that shows glucose uptake rates (vs. absolute glucose uptake) to help surgeons target/remove the brain regions causing patients’ seizures. In a small pilot study, p-dFDG-PET scans successfully identified seizure source regions on 7 patients who previously had unsuccessful traditional PET imaging exams.
  • Ultrasound Contrast Warning & Reassurance: The FDA recently notified healthcare providers that the cardiac ultrasound agents, Definity and Lumason, shouldn’t be used with patients that might have polyethylene glycol (PEG) allergies following 11 anaphylaxis reactions and two deaths. The International Contrast Ultrasound Society was quick to encourage providers to continue to use the ultrasound contrasts with other patients, reassuring them that these reactions are rare (estimated 1 per 10k cases).
  • Humana’s PET/CT Expansion: Humana will now cover PET/CT exams for gastric and esophageal oncologic indications, partially reversing a November decision to exclude PET/CT exams for a wide range of indications (cardiac, gastric or esophageal oncologic, neurologic, total body screening) and exclude most other fusion modalities for any indications (MRI/CT, PET/MRI, SPECT/CT, SPECT/MRI). That still leaves quite a few conditions and modalities off of Humana’s coverage list, although the insurer is preparing to review its cardiac/neurologic PET/CT coverage as well as its overall SPECT/CT policy next month.

Siemens Healthineers’ CDS

Are you ready for PAMA? Maximize your local standard of care while minimizing clinician disruption with Siemens Healthineers’ CMS-qualified Medicalis CDS.
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The Resource Wire

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  • Not sure how to navigate the upcoming surprise billing laws? This Healthcare Administrative Partners post details how the No Surprises Act might affect your practice and what processes will be required to handle these changes.
  • The Saint Joseph Mercy Health System doubled its follow-up recommendation identification/tracking when it adopted Nuance PowerScribe Follow-up Manager, achieving ROI within the first year. Find out how in this Nuance case study.
  • Did you know 80% to 90% of sonographers experience pain while performing scans at some stage in their career? Check out this Canon Medical Systems video detailing its latest innovations that improve sonographer comfort and help reduce risk of injury.
  • Learn how the University of Oxford increased its vertebral compression fracture detection rate from 50% to 90% using Zebra Medical Vision’s bone health solution.
  • This Bayer case study details how radiation benchmarking programs can help push CT dose exposure reduction initiatives from achieving compliance to driving quality.

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