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Federal Flexibility | Protecting the Techs

“. . . it’s yet another stellar example of the ABR’s heavy-handed tone-deaf approach to just about everything within its tiny little purview”

Ben White on the ABR’s new end-user licensing agreement.


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  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging .
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire



Federal Flexibility

The U.S. federal government loosened a number of imaging restrictions to help support the coronavirus fight, including some restrictions that the imaging industry has fought against for years.

  • CMS Waives PA – CMS is now encouraging all Medicare Advantage (MA) organizations and Part D plans to waive or relax prior authorization requirements during the COVID-19 pandemic. The ACR of course applauded this move and “encouraged” CMS to also keep this flexibility going throughout the anticipated “post COVID-19 surge” of backlogged elective studies.
  • CMS Now Pro-IFED – CMS issued a new critical guidance allowing independent freestanding emergency departments (IFEDs) in certain states (CO, DE, RI, TX) to provide care to Medicare and Medicaid patients during the CV19 emergency. IFEDs generally provide imaging (XR, CT, US) and lab services, but were not able to bill Medicare and Medicaid before this new guidance.
  • FDA OK’s Modifications – The FDA joined in on the imaging flexibility trend, issuing a new guidance that reduces restrictions on imaging modifications during the CV19 emergency. The new guidance allows providers to modify imaging systems (e.g. make them mobile), and adopt new techniques (e.g. scanning through glass), or use systems in new environments without approval from the FDA.
  • Interoperability Delayed – CMS also delayed the enforcement of the new final interoperability rules for another 6 months in an effort to streamline providers’ operations.



Nuance’s Riverain Q&A

Riverain Technologies’ CEO, Steve Worrell, sat down with Nuance for a Q&A to discuss the companies’ partnership and Riverain’s solutions and strategy. Here are some of the big takeaways:

  • ClearRead Suite – Riverain Technologies’ suite of ClearRead AI tools for the detection of lung diseases and other clinical conditions are in use across a number of major institutions (Duke, Mayo, U of Chicago, U of Michigan, VA). Riverain’s portfolio includes its ClearRead Xray Bone Suppress solution and ClearRead CT, a concurrent-read solution that automatically detects and measures properties of solid, part-solid, and ground-glass nodules using vessel suppression technology (results in 26% reduction in nodule search time, cuts missed nodules by 29%).
  • Riverain & Nuance – Riverain and Nuance have a relatively long history together across several Nuance platforms. Noting that history, Worrell highlighted the Nuance AI Marketplace’s advantage as a single platform to consume different AI applications, and how the platform improves ClearRead users’ workflows.
  • Riverain Vision – Over the next five years, Riverain will continue to advance the ClearRead platform, both in terms of depth and breadth, with a focus on automation and precision.



Protecting the Techs

A new paper in the European Journal of Radiology outlined best practices to protect radiologic technologists from COVID-19 transmission. Here are some of the big ones:

  • Set Up Teams – Organize techs into separately scheduled teams to limit exposure, isolate different groups, and keep techs rested.
  • Monitor for Symptoms – Monitor technologists for exposure and symptoms, test them if any symptoms present, and isolate/quarantine them if they test CV19-positive.
  • Establish Boundaries – Dedicate specific scanners and travel/waiting areas for CV19 patients, while maintaining “clean” areas for other patients and for radiographers to travel.
  • Protect the Techs – Provide appropriate PPEs and require radiographers to wear them.
  • Clean Up Well – Disinfect all scanners and scanning areas with disinfectants and UV lamps, turn off air conditioners and use air purifiers in the scanning room.

The Wire

  • Knee MRI AI for CVD: A new University of Washington study found that AI can be used to score cardiovascular risk using knee MRIs, potentially matching specialists’ accuracy in much less time (7 minutes). Using scans from 4,796 patients’ knees, the researchers developed an AI algorithm that delineates the popliteal artery’s inner and outer boundaries, which the researchers believe could help score and track cardiovascular health.
  • QME Works: A new study in the Cancer Research Journal revealed that quantitative micro-elastography (QME) can help assess tumor margin involvement in breast-conserving surgery (BCS), potentially reducing breast cancer recurrence. The researchers used OCT and QME to image the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy, finding that blinded readers achieved far greater sensitivity (92.9% vs. 69%) and specificity (96.4% vs. 79%) with QME versus OCT.
  • Brainlab ExacTrac Dynamic CE Marked: Brainlab announced the CE Mark of its new ExacTrac Dynamic radiotherapy patient positioning and monitoring system, replacing Brainlab’s current ExacTrac X-Ray system and adding a new 4D thermal surface tracking feature. The new ExacTrac Dynamic system could also allow for a wider range of future applications including extra-cranial applications, deep inspiration breath-hold, and markerless tracking in the lung.
  • iViz air Goes Linear: Fujifilm announced the Japan launch of a new linear probe-equipped iViz air wireless ultrasound system, joining the initial convex probe configuration launched in Japan in December (iViz air still hasn’t expanded to Western markets). The new wireless linear probe allows the iViz air to support a wider range of procedures that require a puncture (dialysis, nerve block, drip) and is 20% lighter than the iViz air’s convex probe (147g vs. 190g), while adopting most of the other features found in the convex version.
  • Hot Take on the ABR EULA: Radiologist and very entertaining radiology / economics blogger, Ben White, shared his thoughts on the ABR’s new end-user licensing agreements (EULA). White’s many criticisms range from the fact that the EULA is mandatory, its blatant efforts to protect the ABR’s MOC monopoly, the EULA’s requirement that you accept people “spying on you” on behalf of the ABR, and that you promise to not sue the ABR. He also suggested that the ABR “flush this turd back where it came from. . . and then create a new reasonable agreement.”
  • Imaging Down, Stabilizing: New data from Quinsite finds that daily U.S. imaging volumes are down by 52.9% as of last week, but declines are stabilizing, as the previous three weeks were down by a similar 50.6% – 52.6% range. Still, there’s plenty of bad news for imaging companies, as mammography is down 77.8%, MRI volumes are down 46%, ultrasound fell by 43.3%, and X-ray is down 41.8%.
  • Project MONAI: Nvidia and King’s College London announced the open source alpha release of Nvidia’ new Project MONAI AI framework for health care research (Medical Open Network for AI). The framework is optimized for health care researchers and for deep learning frameworks like PyTorch and Ignite, with the main goal of helping researchers reproduce their experiments in order to build upon each other’s work. MONAI will also be tied into Nvidia’s Clara medical imaging tools in the future.
  • EMVision Encouraged: Electromagnetic RF imaging developer EMVision Medical Devices announced “encouraging” results from its stroke imaging clinical trial, which produced images that had a strong correlation with ground truth MRI and CT scans (specifically detection and correlation). EMVision is developing a “portable, cost-effective and non-invasive” brain scanner that’s designed to speed up the diagnosis and monitoring of neurological disorders.
  • Siemens AIDAN FDA Cleared: The FDA cleared Siemens Healthineer’s AIDAN artificial intelligence solution for use with its Biograph PET/CT portfolio. AIDAN enables a range of new features for the Biograph systems including FlowMotion AI (automatically applies scanning protocols), OncoFreeze AI (reduces respiratory motion), PET FAST Workflow AI (automates post-scan tasks), and Multiparametric PET Suite AI (automates arterial workflow), while also adding new cybersecurity capabilities.
  • Smart Reporting’s €15M: German structured medical reporting startup, Smart Reporting, wrapped up a €15M Series B round that it will use to expand to new specialties including surgery, oncology and cardiology (previously focused on radiology and pathology).

The Resource Wire

– This is sponsored content.

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  • 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.
  • Ready to future proof your organization? Catch Nuance Diagnostic Solutions GM & SVP, Karen Holzberger, and VA radiologist Woojin Kim, MD at the Aunt Minnie Virtual Conference (Friday 5/1, 12pm EDT) as they discuss how the industry can regain momentum and begin its evolution using the power of structured data, AI and ambient technology.
  • This Qure.ai blog post details how it repurposed its qXR chest X-ray AI tool to detect signs of COVID-19, creating a CV19 detection tool that is now in use at 28 global sites.
  • 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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-- The Imaging Wire team