“The most important part of a stethoscope is between the ears. Same for handheld US.”
A commenter on the Auntminnie.com message boards, suggesting that just like the stethoscopes that POCUS is increasingly compared to, the value of handheld ultrasound depends on the knowledge and skill of the user.
We’re thrilled to announce that Nuance is now an Imaging Wire premium sponsor. Nuance does amazing work at the frontlines of radiology, benefiting both radiologists and the patients they serve, and we’re excited to share their message with you. Every issue of The Imaging Wire is made possible by Nuance and the rest of our sponsors, so make sure to keep up with the great work they’re doing.
Imaging Wire Sponsors
- Carestream – Focused on delivering innovation that is life changing – for patients, customers, employees, communities and other stakeholders.
- Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
- Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time.
- Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
- Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation technology to disrupt the industry.
- Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging.
The Imaging Wire
Over the last few months we’ve learned that just about everything in the medical imaging ecosystem “could” be hacked (PACS, ultrasound, AI, CT scanners) and DICOM is now getting its turn. Medical cybersecurity firm, Cylera Labs, identified a design flaw in the DICOM image format that could allow malware to “infect patient data by directly inserting itself into medical imaging files,” creating executable hybrid files that “preserve the original patient data and can be used by clinicians without arousing suspicion.” Imaging files would serve as more than just a convenient host for this malware, as Cylera Labs suggests that the malware’s potential impact is multiplied by patient files’ HIPAA-protected nature (attempts to fight it could damage/delete images or release protected info).
Cylera’s suggested long-term solution is an official modification to the DICOM file format, although given the complexity of that option, the firm also suggests that healthcare organizations fortify their existing security systems to avoid and mitigate attacks.
Shimadzu’s 2020 Growth Strategy
Shimadzu published an update on its 2020 Medical Systems Growth Strategy, recapping the plan’s first two years and outlining its goals for the plan’s final year. The updated 2020 plan brought few surprises, maintaining unchanged 2017-2020 revenue (+10% to ¥71B / $637M) and profit (+135% to ¥4B / $35M) growth goals and a similar emphasis on the angiography segment (+57%), the North American market (+26%), and its aftermarket business (+9%) to drive this growth. Those are pretty big numbers, but Shimadzu has a plan:
- Shimadzu’s North America strategy will leverage a combination of expanding its business development and service capabilities (e.g. Core Medical acquisition, establish parts and training centers), promoting key business areas (e.g. angio and mobile X-ray segments, healthcare clinic market), and launching new products with a specific focus on the R/F segment.
- After expanding its angiography lineup in 2018, Shimadzu is now focused on growing its angio business, particularly targeting international markets and urgent care applications.
- Shimadzu’s aftermarket strategy will rely on its 24-hour customer support centers (including a new branch in China), its global parts center, and it’s expanded direct service network (particularly in the US).
CEbCT’s Conspicuous Advantage
Researchers from UC Davis and UCSB found that contrast-enhanced dedicated breast CT (CEbCT) performs equal to or better than DBT and digital mammography for visualizing suspected breast lesions, making it a “promising diagnostic imaging modality.”
The researchers studied 100 women with BI-RADS 4/5 lesions who underwent CEbCT and/or DBT and DM prior to a biopsy, 50% of which were confirmed to be malignant. CEbCT achieved higher lesion conspicuity scores than DBT or DM for malignant masses (9.7 vs. 6.8 vs. 6.7 – out of 10), while malignant calcification (8.7 vs. 8.5 vs. 8.8) and benign masses (6.6 vs. 6.4 vs. 5.9) were similarly conspicuous across the three. However, CEbCT performed worse than DBT and DM for benign calcifications (4.0 vs. 8.5 vs. 8.8).
Most of the researchers on this UC Davis and UCSB team have been studying breast CT for well over a decade and they appear to be making progress. Still, we don’t see a lot of CEbCT research amid each week’s flow of breast imaging studies, suggesting that breast CT has more work to do in order to get beyond the “promising modality” phase.
- Neusoft Medical recently announced its new Mobile CT, targeting usage by smaller providers, pre-hospital stroke care, and battlefields and disaster areas. The announcement highlighted the Mobile CT system’s 5G and cloud connectivity, while also noting its air suspension platform, radiation protection cargo area, power supply, and air conditioning (all relevant mobile features). The Neusoft Mobile CT launched at a trade show in China and there’s little evidence to suggest that it will sell stateside, although it should reach Neusoft’s other geographies.
- The FDA released a new draft guidance for medical devices with quantitative imaging functions (e.g. MRI relaxometry), recommending that manufacturers provide additional information in their premarket submissions (describe functions, add safety and effectiveness info, improve product labeling) due to these device’s impact on clinical decision making and susceptibility to error and variation.
- CoapTech announced the FDA clearance of its PUMA-G ultrasound gastrostomy system, which allows physicians to place percutaneous gastrostomy feeding tubes at the bedside using POCUS imaging. The company states that PUMA-G could eliminate the need for a surgical suite when placing enteral feeding tubes, while reducing waiting times and cost.
- New research from New Jersey healthcare network, RWJ Barnabas Health, found that contrast-enhanced breast MRI is extremely effective at helping women avoid surgery when their imaging and biopsy results conflict. The study looked at 45 patients who underwent contrast-enhanced MRI after receiving discordant ultrasound or stereotactic biopsy results, with MRI revealing suspicious findings in 14 of the patients and thus allowing 31 patients (68.9%) to avoid unnecessary lesion excision surgery.
- The NIH awarded a Washington University Mallinckrodt radiology professor a $5.1 million grant to develop a PET-based imaging method used to reduce the risk of cardiovascular disease. Over the next seven years, the grant will be used to develop a method to differentiate vulnerable plaque from less-dangerous plaque with the goals of enabling early detection and individualized treatment, while avoiding unnecessary surgery.
- A new Reaction Data survey (n=153) reveals that 39% of outpatient providers are considering replacing their EHR system and other IT tools in the next 18 months. EHRs are most likely to be on the chopping block (27%), followed by patient engagement (18%), revenue cycle management (12%), and population health (12%) solutions. There’s no shortage of reasons these providers are considering swapping providers, led by existing systems not meeting their needs (33%), the availability of better alternatives (20%), negative service and support experiences (20%), and the lack of new functionality released (18%).
- A team of researchers led by the A*STAR Singapore Institute of Manufacturing announced a breakthrough imaging method that “could revolutionize medical imaging and security scanning.” The new method generates X-rays by colliding free electrons with surface waves on a material illuminated by a laser, potentially allowing protein-level imaging with synchrotron-level brightness using a tabletop-size system (vs. current “tens of meters” size synchrotron systems). This smaller form factor could have a “revolutionary” impact, potentially making these high-brightness X-ray systems available in “every lab and hospital.”
- The ACR recently highlighted a tech innovation incubator created within MGH’s radiology department that “turns physicians into inventors.” The Medically Engineered Solutions in Healthcare (MESH) Incubator at MGH provides the tools, equipment, and training needed for MGH physicians to validate ideas, prototype new devices, and translate ideas into clinical applications. Although MESH has educational origins and goals, it does intend to “get inventions to bedsides in five to 10 years” and has the potential to be a royalty profit center in the future (although that’s not the focus).
- Research from a German and Austrian team revealed that 1.5T and 3T breast MRI achieve comparable diagnostic accuracy, giving healthcare providers the flexibility to use either MRI type without concern for effectiveness. The study (n = 1.5T 1,746, 3T 215) revealed very similar levels of sensitivity (1.5T 94.1% /3T 97.9%), specificity (91.6 / 89.3%), accuracy (92% / 91.2%), and negative predictive value (98.9% / 99.3%).
- Konica Minolta’s imaging CRO subsidiary, Invicro, and German biomedical imaging company, iThera Medical, announced a deal to place iThera Medical’s MSOT inVision imaging platform (multispectral optoacoustic) in Invicro’s in vivo laboratory. The combined solution will be used to “identify and quantify disease-related biomarkers at both a molecular and anatomical level through pre-clinical full body tomographic scans.”
- Carestream announced a 10-system deal with Calgary, Canada-based imaging center network, Mayfair Diagnostics. The deal, which follows a competitive bidding process and a 1-year trial, will include three DRX-Evolution/DRX-Evolution Plus systems, two DRX-Ascend Systems, and retrofitting five existing X-ray systems with five DRX-1 detectors.
- Researchers from South Korea’s Kangbuk Samsung Hospital found that contrast-enhanced digital mammography (CEDM) is as accurate as contrast-enhanced breast MRI (CEMRI) at measuring breast cancer tumor size before surgery, suggesting that CEDM is an appropriate alternative to CEMRI (the current standard). The study looked at 52 women who underwent CEDM and CEMRI scans before surgery, discovering that the two modalities achieved similar lesion measurements (MLO 21.1mm vs. 20.3mm; CC 21.2mm vs. 20mm).
The Resource Wire
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- The University of Rochester Medical Center’s adoption of Nuance mPower Clinical Analytics and PowerScribe Follow-up Manager solutions brought significant improvements to its Backstop follow-up tracking program. URMC now satisfactorily closes 91% of its 500 tracked monthly recommendations, reducing the risk of delayed diagnosis by 80% and increasing its examination completion rate by 29% (from 55% to 71%).
- Qure.ai is no stranger to peer-reviewed publications and the latest addition to its list of studies is this joint research that it performed with the Yale School of Medicine, exploring whether machine learning can predict heart transplant survival rates.
- A team from Oxford University and France’s National Institutes of Health and Medical Research (INSERM) successfully used focused ultrasound neuromodulation to affect the memory behavior of macaque monkeys, revealing that focused ultrasound could be used to determine which region of the brain influences decision making.
- The latest Carestream blog shares how radiographers and technologists view technology and provides some steps to help them adopt new tech.
- POCUS Systems’ forthcoming ultrasounds will combine ease of use, durability, and reliability, allowing clinicians to focus on their patients.
- This Medmo video details how its healthcare marketplace platform and network of participating radiologists help underinsured patients pay as little as possible for their imaging procedures.