“You can’t fly back from an extended mission to get a CAT scan,”
University of Washington emergency physician, Dr. M. Kennedy Hall, sharing the background behind his collaboration with NASA to study using portable ultrasound technology to diagnose kidney stones in space.
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- Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time.
- Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation technology to disrupt the industry.
The Imaging Wire
Lung Cancer Screening’s Freemium Model
Free lung cancer screening programs not only save lives, they also help boost healthcare providers’ bottom lines. That’s from a team at Augusta University Medical Center, who set out to prove that free screening programs are a “win for the communities we serve and for the hospital system.” The study (n=705 patients, 418 referred for follow-ups and evaluations) found that free low-dose CT screening programs initially hurt profitability (Yr1 $212 net loss per-patient) but reach break-even by the second year and deliver a solid profit by year three (Yr3 $177 net profit per-patient) due to downstream revenue from positive scans and other findings. The Augusta team calculated a $211 final gross margin per patient, which is a solid turnaround from the first year’s loss, not to mention the fact that CT screenings yield a 20% increase in survival rates.
Breast Ultrasound CAD Works
South Korean researchers found that breast ultrasound combined with computer-aided diagnosis (CAD) improves the diagnostic capabilities of both experienced and inexperienced radiologists (particularly less experienced rads), suggesting that CAD may serve as a useful second opinion and a valuable way to reduce diagnostic inconsistency. The researchers had three less experienced radiologists and two experienced radiologists review ultrasound scans from of 92 women with 100 breast masses (41 malignant, 59 benign), both with and without CAD support. The study revealed that CAD significantly improves less experienced radiologists’ performance in all areas (specifically negative predictive value and AUC), while experienced radiologists’ saw the greatest improvements in specificity and positive predictive value.
600k Labeled Chest X-rays
Stanford University and MIT jointly-released a pair of chest X-ray datasets, providing the research community with a combined 600k labeled images for use in AI algorithm development. Stanford’s CheXpert dataset includes 224,316 anonymized chest radiographs and radiology reports from 65,240 Stanford Hospital patients, labeled to show the presence of 14 observations (either positive, negative, or uncertain) using Stanford’s CheXpert automated rules-based NLP labeler (also publicly available). MIT matched this release, making its own MIMIC-CXR dataset available (371,920 chest x-rays from 227,943 patients), labeled with the same 14 observations using the Stanford CheXpert labeler. The Stanford CheXpert team coupled this release with an AI development competition, inviting developers to test their CheXpert-based algorithms against a panel of radiologists.
A Call to End Shielding
An article from a pair of UC Denver radiology professors called for the end of patient shielding in radiology, arguing that the “associated risks [of shielding] are substantial, whereas the benefits are negligible or nonexistent.” The article specifically noted that:
- There are no examples of hereditary effects of radiation (the original reason for shielding)
- Radiation dosage continues to decline
- Exposure outside the imaging field of view (FOV) is almost entirely due to internal scatter generated within a patient
- Issues from shielding often lead to repeat scans, and therefore more radiation exposure
Here’s a separate Mayo Clinic study with more evidence for the argument against shielding.
Nuance and URMC’s Follow-up Success
Nuance highlighted the University of Rochester Medical Center’s adoption of its mPower Clinical Analytics and PowerScribe Follow-up Manager solutions, and specifically how the solutions led to improvements to URMC’s Backstop follow-up tracking program. As a result of the Nuance solutions, the URMC program now satisfactorily closes 91% of its 500 tracked monthly recommendations, reducing the risk of delayed diagnosis by 80%, and increasing the provider’s examination completion rate by 29% (from 55% to 71%). Nuance leaned-in on this announcement, coupling its press release with a white paper and a published Q&A with URMC, detailing the industry’s “failed follow-up” problem (30% to 70% of incidental findings lost or incomplete), the Backstop program, and the role of mPower Clinical Analytics and PowerScribe Follow-up Manager.
- Shortly after UPenn and Johns Hopkins published a pair of studies suggesting that the language used in radiology reports is too complex, research from a team at Rhode Island Hospital reveals that dense breast notifications are also written well above the HHS/NIH/AMA’s suggested 6th grade reading level. Each of the 30 states that require dense breast notifications use text above the 8th grade level, led by Connecticut at the high-end with an impressive 19.4 grade level, while Alabama and New York got the closest with a 7.2 grade level. The study suggested that radiologist should work together to draft a standard notification letter that states can use. That seems like a reasonable and efficient solution.
- Medical AR company Augmedics got a major publicity boost last week when Bloomberg ran a profile on the company and its Xvision surgical “X-ray” headset, which superimposes medical imaging over a patient’s body during an operation, helping surgeons map an operation without looking away. Augmedics currently has clinical trials under way in Israel and is targeting an early 2019 FDA clearance for use in spinal surgery.
- Radiology reports made legal news again, as a 49-year-old male patient’s colon cancer was incorrectly diagnosed and treated as kidney stones after a urologist missed the radiologist’s conclusion that colon cancer was suspected… because it was on the second page of the faxed report. The patient sued the urologist (for not reading the second page), the radiologist (for not personally conveying the findings), and hospital (for being vicariously liable for the radiologist’s negligence), claiming that because his diagnosis was delayed by 19 months, his 5-year survival chances were 0% (vs. 50% to 80%). The lawsuit resulted in a $4.5 million settlement and may lead to a greater focus on clearly communicating these kinds of findings, personally and on the first page.
- A new executive healthcare survey (n=64 vendor and provider execs) published by Damo Consulting, found that healthcare IT budgets are expected to increase by 20% in 2019, with EHR continuing to dominate spending, and healthcare execs placing the highest spending priorities on digital health (79%), advanced analytics and AI (58%), modernizing infrastructure (25%), and optimizing EHR systems (21%). There’s a lot of info in this report (and plenty of charts), so check it out for a deeper look.
- New research confirms breast MRI’s role as an effective supplement for high-risk women following negative findings from both 2D mammography and DBT scans, suggesting that the shift to DBT screening doesn’t negate the value of MRI among higher-risk patients. The study looked at 4,418 breast MRI exams, including 2,291 that followed negative 2D DMs and 2,127 after negative DBTs, revealing similar cancer detection rates for both groups (MRI after 2D DM = 11 cancers per 1k exams, MRI after DBT = 16 cancers per 1k exams).
- PE-backed medical asset management company, The InterMed Group, acquired North Carolina-based biomedical and imaging service provider, Horizon CSA, expanding its mid-Atlantic presence and leading to the creation of a new HTM program called “New Horizons.” The acquisition follows InterMed’s acquisition of Florida-based 3rd party imaging service company, Medical Imaging Technologies Inc. (M.I.T.) last May.
- CDC data reveals that traditional physician office visits are declining in the US, falling from 990.8 million in 2015 to 883.7 visits in 2016 (313 office visits per 100 people vs. 278 visits per 100), due in part to the growing popularity of telehealth and retail clinics. This isn’t directly a radiology story, but it does highlight how patient care is shifting and underscores the growing role of telehealth, which are relevant trends across healthcare.
- Researchers from the Columbia University Medical Center trained a CNN deep learning algorithm to predict whether patients’ axillary lymph nodes will metastasize with 84.3% accuracy, using a relatively small breast MRI dataset to train the algorithm (n= 133 scans w/ metastatic axillary lymph nodes, 142 scans w/ benign lymph nodes, 42 from healthy patients).
- New research reveals that the Vancouver Risk Calculator (VRC) is more accurate at predicting malignancy from CT lung cancer screening images than the ACR Lung Imaging Reporting and Data System (Lung-RADS). The study scored 4,408 nodule images (4,078 solid, 330 subsolid) from 2,813 patients, with VRC achieving far greater sensitivity, specificity, and accuracy (93%, 90%, 90% overall, 93%, 85%, 85% per-patient) than Lung-RADS (87%, 83%, 83% overall, 87%, 76%, 76% per-patient). However, the researchers did not call for VRC to replace Lung-RADS, instead suggesting that it should initially serve as a second/complementary method and later contribute to future Lung-RADS revisions.
- College of Health Care Professions (CHCP) bolstered its continuing education and training capabilities with its acquisition of Medical Technology Management (MTMI), while bringing together two major imaging tech training institutions.
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- A new Gallup poll revealed that 13.7% of American adults are uninsured, representing the highest rate since 2013 when it was 18% (before most of ACA went into effect). These are the exact patients who can be helped by the Medmo platform, which connects high-deductible or uninsured patients with radiology centers, ensuring the best value for patients and a profitable revenue stream for imaging centers.
- In this article, a UC San Francisco team details how it is using high-intensity focused ultrasound (HIFU) technology in a new thermal ablation technique able to completely, noninvasively destroy tumors within the body.
- Carestream will showcase the latest version of its Vue Clinical Collaboration Platform at HIMSS 2019, a platform that manages millions of images and is in use at a growing number of large healthcare organizations.
- POCUS Systems is approved as a Veteran Owned Business with the US Government Office of Veterans Business Development, paving the way for partnerships with the federal healthcare delivery system