DICOM Hack | Shimadzu 2020 | CEbCT’s Conspicuous Advantage

“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.

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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.

The Wire

  • 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.

  • 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.

  • 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.”

  • 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.”

The Resource Wire

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