CV19 Differentiating AI | Practice Navigation

“It was a nail-biter all the way along. We were building the airplane while it was in flight.”

Thomas Jefferson University Hospital neuroradiologist and professor Adam E. Flanders, MD on the creation of the largest public brain hemorrhage image database.

The Imaging Wire is thrilled to announce that Hitachi Healthcare Americas is now an Imaging Wire sponsor. Hitachi delivers amazing medical imaging technologies to healthcare providers across the country and we’re so excited to share their message with you.

Every issue of The Imaging Wire is made possible by Hitachi Healthcare Americas and the rest of our sponsors, so make sure to keep up with the great things they’re doing.

Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • 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

CV19 Differentiating AI

A new paper in the Radiology Journal found that AI can help radiologists differentiate COVID-19 pneumonia from non-CV19 pneumonia using chest CT scans.

  • The Model – The Chinese research team used chest CTs from 521 CV19-positive patients and 665 patients with non-COVID-19 pneumonia to develop a deep learning system (132,583 total CT slices), then divided the images into training, validation, and test sets (7:2:1 and equal ratio).
  • The Study & Results – Six radiologists reviewed the test studies with and without AI assistance, with the final model achieving a 0.95 AUC and scoring higher accuracy (96% vs. 85%), sensitivity (95% vs. 79%), and specificity (96% vs 88%) than the radiologists. Meanwhile, AI assistance helped improve the radiologists’ accuracy (90% vs. 85%), sensitivity (88% vs. 79%), and specificity (91% vs 88%), which is probably the more important result.

Practices Navigate CV19

A new JACR paper detailed how leaders from six private and academic radiology practices navigated the COVID-19 emergency and how they plan to move forward as the crisis subsides. Here are the big takeaways:

  • Electives Postponed – No big surprise that the practices postponed elective and non-urgent imaging, while continuing to perform diagnostic workups. This policy shift created a greater need to collaborate with referring physicians to understand each patient’s level of urgency and forced practices that support multiple health systems to align their definition of “urgent” with each system.
  • Workforce Strategies – Most practices did what they could to allow working from home (5 out of 6 practices mainly worked remotely), although all of the practices also maintained some on-site presence. The practices also found that relying on multispecialty radiologists and scheduling shifts by case types (e.g. interventional in the morning) helped reduce the number of on-site radiologists and helped maintain social distancing. The drop in imaging volumes also led to more creative staffing solutions such as reassigning imaging center technologists to hospitals or making interventional radiologists responsible for central access device placement or even bedside service.
  • Revenue Concerns – It’s also no surprise that the practice leaders are concerned about how and when volumes and revenue will recover. The practices applied different strategies to address these concerns, including moving more reading in-house (away from telerad, outsourcing, moonlighting) and taking advantage of federal programs, although reducing bonuses and cutting pay were also common. The practices also plan to explore new ways to generate revenue going forward, including expanding their own telerad businesses, doing more contract research work, and adding outpatient centers.
  • The Volume Comeback – The practice leaders had different expectations for the anticipated imaging volume comeback, with some expecting a surge in May and June, others expecting much slower recovery, and some suggesting that we won’t ever return to pre-CV19 volumes. Still, the practices are actively preparing for the post-CV19 surge, with plans to expand hours/days and shorten scan times in order to meet this demand.

The Wire

  • Pediatric Headache Over-Imaging: New research out of Emory University found significant room to improve appropriate imaging rates among children with headache or migraine symptoms. The retrospective review of 4,257 imaging studies found that 3,098 (73%) were appropriate, while 1,159 (27%) were presumably imaged outside of guideline recommendations, creating $322k in unnecessary costs and a loss of 845.3 imaging hours.
  • Butterfly iOS Update: Butterfly’s iOS iQ App update v1.18 brought a number of new features, highlighted by the addition of OB Calculations (gestational age & amniotic fluid index calculations) and a new Vascular Pulsed Wave Doppler feature. The update also allows iOS users to capture still images and save & share 3D bladder volume views.
  • CV19 Volume Impact: A survey from IMV Medical Information Division detailed on AuntMinnie.com found that 92% of U.S. imaging centers experienced a major decline in non-CV19 imaging procedures (only 1% had “no decline”). Even when CV19 imaging is included, all modalities experienced volume declines with the greatest declines identified in mammography (70.4%), fluoroscopy (-48.1%), MRI (-47.4%) and nuclear medicine cameras (-47%), while mobile X-ray and CT saw lower declines (-6.8% and -37.5%) due in part to their relevance for COVID-19 scanning.
  • NinesAI: Teleradiology and AI development startup Nines followed through on its early promise, rolling out its first FDA-cleared AI product. The new “NinesAI” tool supports the triage of head CT images for intracranial hemorrhage and mass effect, making it the first FDA-cleared AI product to triage mass effect. NinesAI will be deployed across all Nines teleradiology practice radiologists and will be made available to Nines’ telerad customers for in-house use at no added costs.
  • Canon’s CV19 CT: Canon Medical launched a new CT solution intended to “quickly and safely” image patients with COVID-19 and other infectious viral diseases. The new solution combines a deployable configuration of the Aquilion Prime SP CT (modular or mobile) along with a UV-C decontamination solution.
  • OrthoGrid & nView: OrthoGrid Systems and nView medical launched a partnership to produce integrated musculoskeletal surgery solutions that combine OrthoGrid’s alignment and guidance technology with nView’s real-time 3D imaging platform. The companies will first launch a proof of concept solution for periacetabular osteotomies (hip dysplasia surgery) before expanding to other musculoskeletal procedures.
  • ACR Asks to Suspend PAs: The ACR called on commercial payers to suspend prior authorization requirements during the post-CV19 imaging surge. The industry group sent the request to payer heavyweights (United Healthcare, Aetna, Cigna, Anthem, and Health Care Service Corp.), asking them to suspend PAs during the three-month period after the CV19 emergency subsides. If this sounds familiar, it’s because the ACR also asked CMS to suspend PAs for Medicare patients just a few weeks ago.
  • Mindray’s CV19 US: Mindray Medical launched its ME-branded portable ultrasound series across Europe and “selected countries,” specifically positioning it for COVID-19 exams. Although just about every launch is CV19 targeted these days, the new ME series does justify this CV19 positioning with its disinfection and transducer tracking features. Its other features are common across other Mindray lines (smart fluid management solutions, UI, flexible batteries, 3kg weight).
  • 874k Head CTs: A collaboration between RSNA and the American Society of Neuroradiology (ASNR) led to the creation of the largest public brain hemorrhage image database. Assembled with the goal of speeding up AI development, the database includes 874,035 de-identified & annotated brain CT images (25,312 exams) that are marked as normal or abnormal and detail the abnormal images’ hemorrhage subtype.
  • CV19 Sue & Labor: Kansas City-based practice Alliance Radiology filed a lawsuit against its insurer, claiming that it is owed coverage for coronavirus-related losses under the “sue and labor” clause in its policy. Alliance Radiology’s lawsuit argues that since its policy does not contain a virus exclusion, the virus constitutes physical damage and should be covered under its policy. This is one of dozens of recent CV19-related “sue and labor” lawsuits against insurers (also filed by restaurants, car dealerships, etc.), but the first known action by a radiology practice.
  • CO-RADS: The Dutch Radiological Society developed the COVID-19 Reporting and Data System (CO-RADS) intended to standardize the assessment and reporting of COVID-19 on non-enhanced chest CT scans. CO-RADS was modeled after other standardization efforts (e.g. Lung-RADS, BI-RADS), using chest CTs from 105 patients with suspected CV19 to create a framework to assess the pulmonary involvement of COVID-19 on a 1-5 scale, achieving a 0.91 AUC among patients with positive RT-PCR results.

The Resource Wire

– This is sponsored content.

  • This Hitachi blog post and associated white paper detail how multi-parametric MRI (mpMRI) can reduce unnecessary prostate biopsies by more than one third and increase disease detection by more than 50%.
  • Join Healthcare Administrative Partners’ webinar, “Reentering the Post-COVID-19 Radiology Market,” on Wednesday, May 13 where we will discuss several factors radiology practices should take into consideration to ensure safe and successful reentry into the market.
  • Riverain Technologies is dedicated to providing enterprise software tools to aid clinicians in the efficient, effective, early detection of lung disease. Learn more.
  • In this Nuance blog, Diagnostics SVP and GM Karen Holzberger details how the company’s solutions helped support radiology practices’ hard pivot amid the COVID-19 emergency.
  • As the world navigates the unprecedented challenge presented by the COVID-19 pandemic, GE Healthcare supports healthcare providers, partners, communities and patients around the world in addressing it. Find information on GE Healthcare’s COVID-19 Resources here.

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