Big Get Bigger | PoC MRI Works | Rogue LCS

“This is a milestone day.”

Radiology Partners CEO, Rich Whitney, on the significance of RP’s acquisition of Mednax Radiology Solutions.

Happy 250th Imaging Wire issue, everyone. I’m super grateful for all of the readers, sponsors, friends, and family who’ve made Insight Links & The Imaging Wire possible. Thanks, and enjoy today’s issue.

Imaging Wire Sponsors

  • Bayer Radiology – Providing a portfolio of radiology products, solutions, and services that enable radiologists to get the clear answers they need.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire

The Big Get Bigger

America’s biggest radiology group just got a lot bigger yesterday with Radiology Partners’ acquisition of MEDNAX Radiology Solutions for $885 million.

  • The Deal – The acquisition includes Mednax’s entire Radiology Solutions business (including vRAD and the Mednax radiology groups), which was on track to make $550m in revenue this year before COVID hit. It will also allow Mednax to pivot to a pediatrics & obstetrics-focused organization and shore-up its balance sheet.
  • Growth, and Diversification – The acquisition grows RP in many of its typical size/scale-focused ways, adding Mednax’s 825 radiologists (joining RP’s 1,600 rads) and numerous practices and hospital contracts (now in all 50 states). However, the addition of Mednax’s vRad unit might represent the most intriguing part of this acquisition, given its contributions to RP’s teleradiology and AI capabilities.
  • Consolidation Milestone – The massive RP+Mednax organization is a context-changer for many in the radiology industry, who were well aware of the ongoing consolidation trend, but mainly witnessed it at a gradual pace and on a local level before now. Instead, this consolidation event was immediate and national – and it creates a practice with an unprecedented level of scale and influence. Whether this leads to more consolidation (and similar major consolidation events) isn’t guaranteed, but this acquisition certainly isn’t expected to slow this trend.

The Wire

  • Hyperfine Feasibility: A new study in JAMA Network detailed the feasibility of using portable low-field MRI systems (specifically Hyperfine’s) at the bedside of critically ill patients. The Yale New Haven Hospital-based researchers imaged 50 ICU patients with a range of neurological issues (e.g. stroke, TBI, hemorrhage, tumor, COVID, altered mental status), detecting abnormalities 29 of 30 patients who did not have COVID-19 (97%) and 8 of 20 patients with COVID-19 (40%) – without any adverse events.
  • Enlitic & Google’s DoD Deal: Enlitic and Google announced contracts with the U.S. DoD’s Defense Innovation Unit to support the DoD’s ambitious push into imaging AI for early cancer diagnosis (along with a third still-unnamed AI company). Over the next two years, Enlitic will pilot a diagnostic imaging AI platform in various capacities and Google Cloud will similarly prototype an AI-enabled digital pathology solution (AR microscopes + AI models), potentially leading to the solutions scaling across the DoD’s massive healthcare footprint.
  • Rogue LCS: An MGH study in JACR revealed that referring providers knowingly order lung CT cancer screenings when patients don’t meet screening criteria and wouldn’t be covered by Medicare, suggesting that more education is needed. A review of their CT screening best practices advisory alerts from November 2018 to December 2019 found that 42 patients were referred for guideline-discordant screenings (1.9% of 2,248 patients screened). The discordant screenings were most commonly due to the patients’ higher perceived cancer risks (e.g. family history) even if the patients weren’t old enough or didn’t have the appropriate smoking history to qualify.
  • Nanox in Mexico: Nanox continued its global expansion, signing a distribution agreement with SPI Medical to deploy 630 Nanox.ARC systems across Mexico (pending regulatory approval), that could give Nanox $119 million in service fees over 7 years. Nanox’s Mexico alliance follows similar expansions into Taiwan (500 units), Russia and Belarus (500 units), Italy (500 units) and South Korea and Vietnam (2,500 units), and the USA (3,000 units) since February. Although almost all are awaiting regulatory approval, these alliances at least show that Nanox’s service-based business model is resonating with global partners.
  • Radiation Pad Benefits: A team of German researchers found that reusable radiation-absorbing pads significantly reduces dosage during IR exams by reducing scattered radiation at its source. The researchers found that a radiation-absorbing pad with a lead equivalence of 0.5mm reduced radiation absorption by 51.4% compared to pads with a lead equivalence of 0.25 mm and by up to 80.6% compared to not using a radiation-absorbing pad.
  • MRE for Epilepsy: Magnetic resonance elastography (MRE) can improve the detection and characterization of epilepsy by measuring hippocampal stiffness. That’s from a University of Illinois study (n = 12 w/ epilepsy, 13 health) that used MRE scans to confirm that patients with mesial temporal lobe epilepsy (MTLE) have greater hippocampus stiffness than healthy patients (stiffness ratio: 1.14 vs. 0.99).
  • Imaging AI Growth: Signify Research forecasts the global imaging AI market to reach $1.5 billion by 2024 (vs. ~$400m in 2020), with the majority of the market still concentrated on cardiology, neurology, breast, and pulmonology (86% 2019, 75% by 2024). After a COVID-related slowdown, the firm expects growth to peak in 2022 at 44%, but suggests that the certain barriers will have to be overcome (clinical utility, workflow integration, reimbursements) in order for radiology AI to reach widespread adoption.
  • Google Case Dismissed: A lawsuit against the University of Chicago and Google for illegally using / sharing patients’ identifiable medical images (some images had date stamps & doctors notes) was dismissed this week, after a federal judge found that the plaintiff could not demonstrate any damages and the images had no value to the patient. The dismissal surprised few, but still avoided what technically could have been a major image ownership hurdle for AI developers, as well as a challenge to Google’s hospital partnership model.
  • The Case for IR Dialysis Access Maintenance: Shifting more dialysis access maintenance interventions to IR would bring significant healthcare cost reductions. That’s from a new RSNA Radiology study (n = 1,479 beneficiaries, 8,166 interventions) that found that annual Medicare payments to radiologists ($71k) and nephrologists ($89k) were far below costs for surgeons ($174k) due to surgery’s additional operating room and anesthesia costs.
  • CheXaid: Stanford published the takeaways of its CheXaid project, a global health initiative intended to leverage AI to help non-radiologist clinicians (PCPs, NPs, PAs) diagnose tuberculosis in HIV-positive patients’ chest X-rays, thus helping to overcome regional radiologist shortages. The team developed CheXaid using clinical information and CXR images from 677 HIV-positive patients with suspected TB in South Africa, finding that the algorithm improved non-rad accuracy from an AUC from 0.60 to 0.65. Meanwhile, CheXaid performed even better on its own (0.79 AUC).
  • Withheld CXR Case: A Catskills, NY-area woman is suing Kingston Hospital and its medical records vendor for withholding a radiology report she would need to sue the hospital for her husband’s death before the statute of limitations expires (today). The woman claims that the allegedly withheld 2017 chest X-ray report would reveal her husband’s missed lung tumor that led to a delayed diagnosis and eventually his death.
  • AI for No-Shows: A new AJR paper details how a Singapore hospital used an AI-based predictive analytics platform to reduce outpatient MRI no-shows, by identifying patients most likely to miss their appointment and prompting a telephone reminder. Trained on records from 32,957 outpatient MRI appointments and tested against 1,080 records, the program was able to reduce now-show rates from 19.3% to 15.9%.
  • Questionable Merit: New research from Weill Cornell Medical College found that physicians’ performance in Medicare’s merit-based MIPS program might depend more on their patient populations than the physicians’ actual performance. The study of physicians who participated in the first year of the Medicare MIPS program (n = 284,544 physicians) found that physicians who served more low-income patients had lower MIPS scores than those with higher-income patients (64.7 vs 75.9, range: 1-100). This was true for all specialties except psychiatry.
  • AR-SMS, the Abbreviated Breast MRI Leader: Axially reformatted–simultaneous multislice (AR-SMS) imaging is the highest resolution/image quality DWI abbreviated breast MRI protocol (vs. SE echo-planar and RS echo-planar), according to researchers at the University of Minnesota. In a study of 30 lesions in 28 women undergoing 5-minute 3T breast DWI MRI, only AR-SMS detected the smallest feature (1 mm) and AR-SMS achieved higher image quality scores than the DWI alternatives. The researchers suggest that high-spatial protocols like AR-SMS could help make abbreviated breast MRI a more mainstream imaging option.

The Resource Wire

– This is sponsored content.

  • Severe sepsis strikes more than a million Americans every year at an annual cost of more than $20 billion. Learn how point of care ultrasound can help improve sepsis outcomes in this GE Healthcare paper.
  • Learn how Bayer Radiology is ensuring ongoing support, supplies, and safety during the COVID-19 pandemic.
  • Did you know that one in three Americans is obese and obesity is even more prevelant in rural communities? This Hitachi blog shows how its wide aperture CT and MRI systems are the best fit for rural hospitals, helping them care for patients of all sizes and get more ROI from their imaging systems.
  • They say that in times of crisis, you get to know who your real friends and partners are. This Q&A session details how Healthcare Administrative Partners stepped up to guide their client Triad Radiology Associates through the challenges presented by the COVID-19 pandemic.
  • Vessel suppression from Riverain Technologies’ ClearRead CT software was found to significantly improve nodule detection, interreader agreement, and reading time with oncologic chest CT scans.

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