“If carried out, the mandate would backfire, resulting in unnecessary patient confusion and misinformation while distorting the current competitive free market.”

FAH President and CEO, Chip Kahn, arguing against CMS’ upcoming healthcare cost transparency rules.

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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 genuine AI technology to disrupt the industry
• Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging

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The Imaging Wire

Quantifying Emergency Imaging

An Emory University team developed a new metric to quantify patient-level emergency imaging utilization, called it the h-index, and using it to reveal the significant impact of high-utilization patients on overall ED imaging volumes. Here’s some details:

h-Index – To create the ED imaging h-index, the team calculated total imaging RVUs for each patient per ED visit and then assigned each patient an annual imaging h-index based on ED visits and RVUs.

The Study – Using a database of ED visits and associated imaging services between 2009 and 2015 (n = 86.5m people, 232.9m person years, 38.8m ED visits), the team measured h-index levels and their role in overall volumes.

h-index ≥ 2 – The team found that people with two or more ED visits with two or more imaging RVUs (an h-index ≥ 2) represent just 0.2% of the sample and 1.4% of ED visitors, but accounted for 4% of ED visits and used 18.6% of imaging resources. This trend is apparently escalating, as ED imaging resource allocation for patients with a ≥ 2 h-index increased from 16.5% to 21% over the study period, surely influencing the overall increase in ED patients undergoing imaging from 25.1% to 34.6%.

Radiology Corporatization

A new white paper from the ACR Corporatization Task Force (CTF) published in JACR detailed the influences and impact of the U.S. radiology corporatization trend and what to look out for in the future.

Why Radiology? – The paper surprised few by suggested that radiology may be more prone to corporatization than other specialties due to its high fragmentation, high valuations, and reimbursement uncertainty. However, radiology is far from the only specialty targeted by corporations, which are also acquiring dermatology, ophthalmology, emergency medicine, and orthopedics practices.

Consolidation Trend – The U.S. radiology practice acquisition trend has been escalating since 2001 and peaked in 2015 (30 investors and just under 40 deals), but is expected to continue consolidating through 2023 depending on capital liquidity, legislative/regulatory changes, and market volatility.

The Australia Example – Perhaps as a cautionary example, the paper referenced Australia’s path to corporatization, which began in the early 1990s and resulted in 70% of practices being corporatized by 2015, while resulting in limited opportunities for equity/partnership positions in the country. Australian corporate practices even formed a national advocacy group that rivals Royal Australian and New Zealand College of Radiologists.

Is Corporatization Bad? – The paper didn’t define radiology corporatization as negative or positive, but did warn of potential conflicts of interest created by having obligations to serve both shareholders and patients. They also warned that the “longer-term impacts of radiology corporatization may not be apparent for several years.”

Nuance’s Qure.ai Q&A

Qure.ai’s Chief Commercial Officer, Chiranjiv Singh, sat down with Nuance for a Q&A to discuss the companies’ upcoming partnership and Qure.ai’s solutions and strategy. Here are some of the big takeaways:

About Qure.ai – After three years and over 80 deployments, Qure.ai’s solutions are now available across 14 countries and have analyzed over 200,000 scans. Qure.ai has two commercially released algorithms, qXR (scans chest X-rays to identify and localize 18 clinically relevant findings) and qER (triages head CT scans to identify critical head injury or stroke cases), with more in development.

Qure.ai & Nuance – The interview makes Qure.ai and Nuance’s future partnership public, adding Qure.ai to a range of AI leaders on the Nuance AI Marketplace, while continuing Qure.ai’s platform-based strategy that follows a European partnership with Incepto. Upon FDA approval, Qure.ai’s algorithms will be integrated into Nuance’s PowerScribe One Radiology Reporting Platform, most likely starting with the 510(k)-pending qER head CT triage algorithm. Singh highlighted the Nuance AI Marketplace’s role as a single platform to review, try, and buy AI algorithms and how PowerScribe One allows radiologists to use AI tools on the same platform that they rely on to review images and dictate reports.

Qure.ai Vision – In the next five years, Singh sees Qure.ai providing more comprehensive solutions across various clinical domains and addressing challenges at various points in the diagnostic journey. This evolution will include more measurement and diagnostic tools to support radiologists and even perform tasks like treatment progression monitoring for other clinicians.

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The Wire

• Fujifilm Japan announced the development of the iViz air, a new wireless abdominal ultrasound system intended for in-home, emergency, and hospital use. The iViz air appears to be a smaller and specialized extension of Fujifilm/Sonosite’s iViz family, shipping with a 7-inch wireless convex abdominal probe (vs. four 7” probe options) and a smaller smartphone-style 5.5-inch viewing screen (vs. 7”). The the iViz air also features a new automatic urine volume application, boasts a faster 20 second startup time (vs. 35 sec.), and has just a 0.76 lb. total weight (vs. 1.25 lb.).

• MGH radiologists developed a deep learning algorithm that can automatically detect pneumothorax on chest CT scans in under three minutes, helping with prioritization. The team trained an eight-layer CNN using 80 chest CTs (50 w/ pneumothorax) and tested it on 200 scans, detecting 100% of pneumothorax cases with 82.5% specificity. Although largely focused on chest X-rays until now, pneumothorax detection has been a focus for a number of major AI players (GE, Qure.ai, Lunit, Zebra).

• U.S. Radiology practices will see some benefits from CMS’ new Patients Over Paperwork initiative, which is expected to eliminate 4.4 million administrative hours and $800 million in labor costs annually. Radiology represents nearly $60 million of these cuts, achieved by reducing training requirements for technologists to perform portable x-ray services (eliminates ~$31m in labor) and simplifying the portable X-ray ordering process by allowing telephone and electronic orders (eliminates $27.7m).

• Epica International announced the FDA clearance of its SeeFactorCT3 multimodality imaging system, which combines CT, fluoroscopy, and DR with a patient table/chair and a sterile drape for interventional procedures. The diagnostic/interventional/intraoperative imaging platform differs from conventional CT systems due to its ability to provide non-interpolated image data (slice-less), while achieving isotropic image resolution as fine as 0.1mm and detect lesions as small as 0.2mm.

• As expected, the Federation of American Hospitals (FAH) and other hospital organizations voiced their opposition to the CMS’ healthcare cost transparency plan as they submitted their final comments. The FAH specifically criticized the requirement to disclose payer-specific negotiated rates, suggesting that it doesn’t reveal actual healthcare costs and would be difficult to comply with (plus plenty of other complaints), while urging HHS to cancel the plan and collaborate with hospitals on an alternative method.

• Canon Medical Systems announced the Japan launch of the Aquilion Prime SP / i Edition, adding Canon’s new AiCE-i image reconstruction software to its 80-slice Aquilion Prime SP CT platform. Canon’s AiCE solution was previously available with the higher-end Aquilion Precision and Aquilion ONE GENESIS CTs and the down-portfolio shift should make AiCE (or AiCE-i as it’s called in this Japan announcement) available to a wider range of customers. It’s quite possible that Canon will similarly expand its AiCE / AiCE-i solution to its mid-range CTs outside of Japan in the coming months.

• German researchers developed an open-source AI algorithm that can automatically calculate total lung capacity (TLC) in CT scans in just 5 seconds, achieving an “excellent” >95% correct segmentation rate and improving efficiency by integrating it into their workflow (TLC usually requires a manual upload step). A retroactive study of 288 patients found that the CT algorithm only produced poor segmentation results with 13 (4.5%) of the patients while matching the patients’ pulmonary function testing results with a 0.87 correlation rate.

• A new study in AJR reveals that there’s no consensus among academic radiologists on how to handle second opinion consultations on outside studies (OSS). In a survey of 91 members of the Society of Chairs of Academic Radiology Departments (SCARD), 70 respondents (76.9%) added OSS to their institutional PACS, 74 (81.3%) allowed at least some OSS into their PACS without requiring an internal report, 34 (37.4%) required formal internal reports on all OSS, and 15 (16.5%) preferred repeating studies rather than including OSS in their PACS. Most respondents (67/91 – 73.6%) billed insurers but not patients (61/91 – 67.0%) for the second opinion consultations.

• Turner Imaging Systems announced the FDA clearance of its long-awaited Smart-C Mini-C Arm portable fluoroscopy and X-ray device. Weighing in at just 16 pounds, Turner believes that the Smart-C’s portability will “revolutionize how and where doctors use X-rays,” particularly targeting humanitarian aid, on-site sports medicine, military battlefield, orthopedic surgery, and mobile radiology applications. Turner is funded by RadNet, a relationship that gives it more credibility and structure than most imaging hardware startups with “revolutionary” ambitions.

• One year after a Pennsylvania law began requiring imaging providers to directly notify patients about abnormal imaging results, a new UPenn article contrasted several PA imaging practices’ efforts to adhere to this law. The adopted measures included: requiring rads to note whether patient notification is required during dictation, instituting a system to automatically create patient letters based on radiologist report content, allowing radiologists to add standardized language to reports for follow-up patients, integrating compliance into an existing notification system with follow-ups performed by reading room coordinators, and developing a standard notification system for all imaging-related departments and applications.

• ControlRad secured $15 million in Series B funding that it will use to support the commercial launch of its ControlRad Trace system. The FDA-cleared Trace system is retrofitted onto existing mobile C-arms and combines a semi-transparent filter, tablet, and image processing technology to reduce unnecessary radiation by up to 89% without compromising image quality.

• The UK’s The Royal College of Radiologists (RCR) and Association of Breast Clinicians (ABC) launched a new three-year accreditation program intended to train more doctors as holistic breast clinicians. The program curriculum covers breast examination and imaging, disease management, and genetic risk factors and is intended to improve the structure of breast clinician training and ensure a future supply of breast health experts, noting the risk of a future breast radiologist shortage in the UK.

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The Resource Wire

• Carestream Health received India’s “Most Trusted Healthcare Brand” Award, based on a review of its growth, reach, Infrastructure, innovation and other key metrics.

• In this interview, Nuance Chief Medical Officer, Woojin Kim, MD, discusses the evolving role of blockchain in healthcare.

• Qure.ai got solution-oriented in its latest blog, analyzing how acquisition artifacts are responsible for AI performance degradation, and introducing two methods to solve this problem.

• The Focused Ultrasound Foundation’s 2019 State of the Field Report is now available, detailing FUSF’s initiatives and achievements and the state of the focused ultrasound market.

• Did you know that imaging patients are most likely to no-show for their procedures on Mondays and Saturdays? By partnering with Medmo, imaging centers can keep their schedules full, despite the inevitable Monday no-shows.

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