DBT Goes Mainstream | AI Unreadiness | Quantum Imaging

“If I think it’s not pneumonia, it’s not.”

UCSD radiologist and Arterys co-founder, Albert Hsiao, with a reminder on who makes the decisions when it comes to AI-supported diagnosis.

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The Imaging Wire

DBT Goes Mainstream

Sometimes gaining mainstream status means not waiting for an official endorsement, and that appears to be true for digital breast tomosynthesis (DBT). A team of Yale researchers detailed DBT’s rapid U.S. expansion, which has occurred despite the fact that it still isn’t endorsed by the USPSTF or the American Cancer Society (it is endorsed by the ACR and the ASBrS) and despite its lack of support from long-term studies. Here’s what the researchers found using Blue Cross Blue Shield data (n = 9.67m women, 40-74yrs) and why they believe DBT is on the rise.

  • DBT screenings grew from 12.9% of exams in 2015 to an impressive 43.2% in 2017
  • Hospital referral regions (HRRs) using DBT as their main screening method grew by even more, from 4.6% of all HRRs in 2015 to 41.8% in 2017
  • DBT’s growth was strongest in areas with higher household incomes, education levels, and more white residents
  • The researchers positioned DBT’s growth without the support of key endorsements or long-term studies as a testament to the technology’s clinical value
  • However, the racial and economic divide in DBT access could lead to even worse disparities in breast cancer mortality

AI Unreadiness

We’ve heard nearly all the opinions on imaging AI’s challenges by now, but sciencemag.org may be the first to run through them in a single article, reviewing the various reasons that AI has a long way to go before it is revolutionizing medicine. Here’s what they pointed out:

  • “Most AI software is designed and tested in one hospital, and it risks faltering when transferred to another.”
  • “The signals (AI) recognizes can have less to do with disease than with other patient characteristics, the brand of MRI machine, or even how a scanner is angled.”
  • Despite these challenges, few multisite studies have been published, and although more multisite studies are now taking place it’s happening “less than you would think.”
  • The FDA is increasing its focus on AI, but there “are major questions everyone is struggling with” around the regulation process, particularly regulating algorithms that improve over time.

These are criticisms that many AI evangelists would even agree with, which makes sense given that these statements actually came from folks with a stake in artificial intelligence. Of course, AI sceptics would agree with these too, although they may be less bullish about whether these challenges can be overcome and what the results will be.

NY Stays Strict with MSOs

New York’s highest court dealt a blow to corporate medical practices that are owned by non-physicians and/or are largely controlled by management services organizations (MSOs). The NY court stated that these practices are ineligible to be reimbursed by no-fault automobile insurers because they are “fraudulently incorporated,” so “fraudulent intent” doesn’t need to be proven to justify non-payment.

The New York court found that a radiologist served as an auto claim radiology practice’s sham owner, performing little to no medical or management work at the practice. This structure eventually caused insurers to stop reimbursing the practice, leading to this lawsuit, and the state’s judgement in favor of insurers.

New York was already among the strictest states regarding corporate medical practices, but this is seen as a decision with cross-border ramifications, with some suggesting the judgement may influence other states to take a similar position.

Quantum Imaging

phys.org detailed the EU’s Quantum Flagship Program’s ongoing quantum technology development efforts, which the group believes could bring major changes to a range of modalities and “revolutionize” medical imaging.

  • Quantum Sensors – Quantum technology’s main imaging approach involves small quantum sensors that can be added to imaging helmets or other factors. This new technology may eliminate many of the disadvantages of Magnetoencephalography (MEG) scanners for brain imaging (large, high cooling needs, can’t go near patients, potentially less accurate), while sensors could also have applications for cardiac imaging and drug discovery.
  • MRI Amplifiers – The researchers are also exploring quantum hyperpolarization in an effort to make MRI imaging “a factor of 10,000 more sensitive.” This process hyperpolarizes select biomarker molecules that are injected into patients before an MRI, overcoming the time and cost challenges of current techniques, helping MRIs target specific tissues and potentially allowing imaging on a “nano scale.”

The Quantum Flagship Program suggests that these new quantum sensor and quantum hyperpolarization technologies may be reaching the market within the next five years, suggesting that the quantum “revolution” may come sooner than many would think.

The Wire

  • Arrhythmia imaging and treatment company, Acutus Medical, raised another $170 million ($100m Series D, $70m credit) that it will use to fund global business development and the commercialization of its vascular access products. After starting off with an imaging focus, Acutus is now apparently using its ultrasound-based AcQMap cardiac mapping system as the foundation of a far more comprehensive arrhythmia treatment platform. As part of this strategy, Acutus recently acquired catheter hardware developer, Rhythm Xience, and entered a number of arrhythmia-related partnerships that it will look to commercialize with its new funding.
  • Reports from White House officials revealed a forthcoming executive order that will create new rules requiring hospitals to communicate healthcare costs (both to insurers and out-of-pocket) in an “easy-to-read, patient-friendly format” before patients receive care. The order also touches on consolidating quality measures, facilitating access to anonymized healthcare data to support research, expanding the way HSAs can be used, addressing surprise billing, and improving healthcare “shoppability.”
  • UK scientists unveiled the Sonopill, a tiny indigestible imaging device that captures micro-ultrasound images of the colon to identify early signs of cancer, and could eventually serve as an alternative to endoscopy. Using “intelligent magnetic manipulation,” the magnetized Sonopill is guided through the digestive tract by a magnetized robotic arm until attaching to the gut wall and capturing micro-ultrasound images of the colon.
  • Barco launched a new remote radiology reading solution, using a new graphics box to achieve the level of quality, security, and performance expected from medical workstations. The new solution combines an eGFX graphics box with a Barco MXRT display controller and Thunderbolt 3 connector that “resides between the laptop and the medical displays” and gives radiologists access to Barco’s clinical workflow tools.
  • A new report from The Conference Board of Canada estimates that excessive wait times (sometimes months) for CT and MRI scans cost the Canadian economy $3.54 billion in lost productivity each year and drag down Canada’s GDP by $430 million annually. The report called for $469 million in imaging funding to address Canada’s current needs (151 new CTs and 91 new MRIs), while asking for $4.4 billion to fund the ongoing modernization of Canada’s fleet through 2040.
  • The ACR achieved an early milestone in its goal of democratizing AI through its ACR AI-LAB platform, expanding its pilot program to five additional major healthcare institutions (Lahey, Emory, U of Washington, UCSF, and BWH — in addition to existing pilots at MGH and Ohio State) that will use the NVIDIA and Nuance-based platform to create and evaluate AI models without the use of a programming language. Once this pilot is complete, the ACR AI-LAB initiative is slated to expand to all institutions interested in participating.

The Resource Wire

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