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Imaging & Defenses Up | AI Heart Attack Predictor | CAR’s Place for POCUS

“Counting imaging examinations is easier than measuring imaging outcomes, and that is why more work is needed.”

Deborah Levine and Richard Duszak Jr. in response to some headline-grabbing research on rising imaging volumes and their associated costs.


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The Imaging Wire


Imaging & Defenses Up

New research published in JAMA revealed significant increases in imaging utilization between 2000 and 2016 and prompted new debates over whether healthcare’s growing imaging volume is appropriate.

The UCSF-led team reviewed 135.7 million imaging exams from seven US and Canadian healthcare systems, revealing the following highlights (below growth rates measured in per 1k person years):

  • Adults and older adults saw the greatest increases, although pediatric imaging also grew across most metrics
  • CT, MRI, and ultrasound growth rates peaked between 2000 and 2006, before falling to slower annual rates from 2007 to 2016
  • CT imaging rates increased from 56 U.S. / 52 CA in 2000 to 141 U.S. / 135 CA in 2016
  • MRI imaging rates increased from 16 U.S. / 10 CA in 2000 to 64 U.S. / 60 CA in 2016
  • Ultrasound imaging rates increased from 177 U.S. / 188 CA in 2000 to 347 U.S. / 386 CA in 2016
  • Nuclear medicine imaging rates fell from 28 U.S. / 33 CA in 2000 to 22 U.S. / 25 CA in 2016

The study gave imaging plenty of credit for its role in patient care but its estimate that 30% or more of imaging exams may be unnecessary and that those exams carry $30 billion in annual costs (along with the above utilization growth rates), got way more attention than any of the study’s mentions of imaging’s benefits.

All of this was enough to prompt responses from the ACR and a follow-up JAMA editorial from radiologists Deborah Levine and Richard Duszak Jr. The ACR response was pretty broad, emphasizing imaging’s slowing growth rates, the role of situational appropriateness (vs. just looking at volume), imaging’s advantages over invasive procedures, and the benefits of imaging decision support tools. Meanwhile, Levine and Duszak argued that although rising utilization is an important trend to monitor, it’s not necessarily bad, and called for more research into how utilization is driving outcomes.



AI Heart Attack Predictor

University of Oxford researchers developed a new AI-based method to predict future heart attacks by analyzing the radiomic profile of coronary perivascular adipose tissue (PVAT) in CCTA images. The team ran three studies, resulting in one key finding:

  • The First Study – The team obtained adipose tissue biopsies from 167 patients undergoing cardiac surgery and then linked genes representing inflammation, fibrosis, and vascularity to radiomic features in tissue CT images.
  • The Second Study – The researchers analyzed 1,391 coronary PVAT radiomic features in 101 patients who experienced major adverse cardiac events (MACE) within 5 years of a CCTA scan, plus 101 matched controls. They trained an ML algorithm to differentiate the fat radiomic profile (FRP) of the MACE patients from the controls and then tested the coronary FRP signature with 1,575 trial participants, finding that FRP significantly improved MACE predictions.
  • The Third Study – The team found that FRP was significantly higher in 44 patients with acute myocardial infarction compared with 44 matched controls and that FRP remained unchanged for 6 months, confirming that FRP detects persistent PVAT changes that are not captured by Fat Attenuation Index (FAI).
  • One Key Finding – Analyzing FRP with machine learning may represent a major step forward in personalized cardiac care and “could be saving lives within the next year.”



CAR’s Place for POCUS

A new position statement from the Canadian Association of Radiologists on point-of-care ultrasound expressed concern over POCUS’ expansion to “non-imager” clinicians and to a broader range of medical applications, calling for restrictions on how and by whom POCUS is used. Here’s how CAR views POCUS’ place in healthcare:

  • Limited & Adjunct – CAR warned of POCUS’ “significant limitations” compared to ultrasound, making it “easy to see that POCUS is an adjunct to—not a replacement for—a dedicated diagnostic sonographic exam performed by a qualified imaging specialist.”
  • Training – CAR viewed POCUS’ use by untrained (or less-trained) clinicians with the greatest concern, suggesting that the location POCUS is used (bedside, ambulance, etc.) should not influence whether it’s operated by a specialist.
  • Situation Specific – The CAR position statement argued that it’s “essential to limit the use of POCUS to specific situations,” listing a number of “approved” applications within emergency, MSK, and pediatric settings, and also making it clear where POCUS isn’t appropriate.

Folks on the different sides of imaging are going to have very different takes on this, but CAR brings up some important points that have to be dealt with regardless of where one stands on the future of POCUS imaging.


The Wire

  • Stryker pushed deeper into the robotics and imaging segments with its acquisition of Mobius Imaging and Mobius’ Cardan Robotics subsidiary (aka GYS Tech) for $500 million ($130m of it based on future milestones). Mobius is best known for its Airo Mobile TruCT intraoperative scanner, while Cardan is developing robotics and navigation tech for spinal procedures, both of which align with Stryker’s vision to lead in the neurotechnology, orthopedics, and spine segments.
  • A Yale University multidisciplinary study of 232 research articles found that either ultrasound (31% of reviewed cases) or no-imaging (45% of reviewed cases) can be used to effectively diagnose kidney stones and guide treatment in most scenarios, while limiting reduced-dose CT scans to only specific cases (24% of reviewed cases). This is a major change from current kidney stone diagnostic practice (CT >90%, ultrasound <7%). The study noted that although CT scans can accurately identify renal colic, it exposes patients to radiation, adds costs, and increases the risk of incidental findings, but still doesn’t change most patient management decisions.
  • Magnetic Insight unveiled its new MOMENTUM CT system, calling it the first commercial magnetic particle imaging (MPI) system with an integrated CT scanner, and offering it alongside its standard MOMENTUM MPI system. Magnetic Insight highlighted the system’s combination of MPI for high contrast detection of functional events (e.g. cell trafficking to disease sites and inflammation) and CT to identify the precise locations of these events.
  • New research published in Academic Radiology (n= 45 attendings, 24 residents, 13 fellows) found that the true cost of diagnostic radiology residents ($99k/yr) is 34% higher than their direct salary/benefits ($74k) and represents 27% of the costs of attending physicians, while increasing the overall labor costs of patient care. As expected, DR residents had slower radiology report turnaround times than attendings working alone (213min vs. 51min avg.), although residents do help improve patient care and add efficiency to after-hours reading.
  • Groupon deals for medical imaging scans have been available for years, but they finally caught the attention of social media discussions and the imaging press in recent weeks, leading to an NPR/Kaiser Health News article yesterday. The NPR/KHN story shared a range of perspectives, with some calling the deals a symptom of a broken healthcare system and others suggesting its just a sign of how commerce is evolving to support those without coverage.
  • The Department of Homeland Security revealed that Philips’ HDI 4000 Ultrasound systems could be exploited by hackers to access ultrasound images or even change patient images to cause a misdiagnosis. Philips ended support for the long-discontinued systems at the end of 2013 and will not issue a patch, leaving units that are still in operation vulnerable. Because of this, DHS suggests that access to HDI 4000 should be restricted and is advising providers to replace the systems.
  • New research in JAMA Neurology revealed that Mobile Stroke Unit ambulances (w/ vascular imaging, point-of-care labs, and telecommunication capabilities) triage patients and bring them to properly-equipped hospitals with 100% accuracy, representing a significant improvement versus standard ambulances’ 70% accuracy. Just 37 of the 53 patients in the standard ambulances reached the right hospital with an accurate triage decision (vs. 63/63 in the MSU), with 7 of 17 of the standard ambulance patients with LVO or ICH requiring transfer to a more-appropriate hospital (vs. 0/11 in the MSU).
  • Ilumina launched its new Bespoke Concierge Diagnostic Medical Imaging Service, which provides law firms and insurers with imaging-based predictions of patients’ long-term prognosis to use when validating claims. IIumina uses its telemedicine portal to provide patients with diagnostic medical imaging services within 24 hours, then provides results within an additional 24-hour timeframe.
  • New research published in JAMA Network Open found that low-dose ionizing radiation from diagnostic imaging is associated with increased incidence of pediatric cancer, suggesting that imaging with ionizing radiation should be limited to situations where it’s clearly necessary. The study of over than 12 million South Korean youths found that those exposed to diagnostic low-dose ionizing radiation (1.27m) had a greater cancer incidence (1.64 incidence rate ratio), particularly those that underwent CT scans.

The Resource Wire

– This is sponsored content.

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-- The Imaging Wire team