Imaging Gets Back to Work

“The RSNA 2020 Virtual Meeting will be held completely online.”

RSNA President James P. Borgstede, MD.

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The Imaging Wire

Imaging Gets Back to Work

Hospitals’ return to “normal” operations started to feel a lot more realistic this week, as coronavirus storylines shifted away from how to treat COVID-19 patients and towards treating everyone else. It’s not going to be an easy transition, but there’s some good info coming out on how to navigate our comeback and what to expect along the way.

  • UWs Slow Ramp-Up Plan – A new JACR paper detailed the University of Washington’s “slow ramp-up” plan for their post-COVID imaging operations, suggesting that despite the urge to quickly recapture delayed imaging volumes, providers should continue to follow and improve upon the practices they developed during the COVID-19 emergency. The paper suggested that providers should continue to evaluate imaging policies based on biweekly CV19 infection rates, maintain all protective procedures (PPEs, social distancing, patient screening, reorganizing waiting rooms, cleaning imaging rooms), and look for new ways to reduce exposure (e.g. using online forms).
  • Imaging’s New Normal – Hitachi Healthcare Americas’ latest blog provides some insights into what “normal” imaging operations will look like as we emerge from the COVID-19 pandemic. Looking forward into the post-COVID world, Hitachi expects: 1) The adoption of new screening and cleaning policies; 2) A reallocation of resources (staff, hours, imaging systems) as hospitals brace for the post-COVID imaging surge; 3) The introduction of new patient and imaging workflows to avoid contamination; 4) PPE becoming standard attire for most healthcare workers and many patients; 5) Hospital layouts and procedures embrace social distancing (including more virtual care); 6) Teleradiology becomes an all-day option; 7) “Recovery marketing” ramps up to bring patients back to hospitals and clinics; and 8) Providers prepare for another COVID-19 spike in the winter months.
  • LA Patient Recovery – Understanding that patients are going to need some encouragement to venture back into hospitals, we’re starting to see more health systems ramp-up their patient recovery marketing efforts (like Hitachi forecast above). The latest and arguably most significant recovery effort came from six of LA’s largest systems (Cedars Sinai, Dignity, KP, USC, Providence, UCLA), which launched a large-scale public education campaign focused on making sure patients continue to seek and receive care. We’re almost certainly going to see more of this across the country over the coming weeks.
  • Beaumont’s Backlog – Even as many healthcare systems hustle to bring patients back in, Michigan’s Beaumont Health System revealed that its backlog of ~8,500 surgical procedures and ~9,500 imaging procedures could take “six months or more” to catch up with. Michigan’s largest health care system explained that the combination of ongoing COVID-19 cases, the threat of new cases, and the workflow hangover from the last three months will make it difficult to work through its pending procedures, even if patients are open to coming back in.

The Wire

  • RSNA Goes Virtual: RSNA surprised few this week when it announced that RSNA 2020 will be held as an “all-virtual event” due to coronavirus health concerns. RSNA 2020 becomes the latest in a long list of conferences to fall victim to COVID-19, but this one feels different given the massive industry role that it serves. On the bright side, RSNA’s virtual shift will create some real opportunities for imaging’s marketing innovators to shine as they work to ensure virtual is still valuable. Plus, many of us will get a bit more of our Thanksgiving weekends back.
  • POCUS Evidence: An Israeli study provided new evidence that point-of-care ultrasound (POCUS) improves diagnosis and reduces time to care. The study of 60 patients with chest pain or dyspnea (30 triaged with POCUS) found that POCUS uncovered clinically relevant findings in 79% of patients, led to a change in primary diagnosis in 28% of patients, led to additional diagnosis in 14% of patients, and cut the time to appropriate treatment to 5 hours (vs. 24 hours in control group).
  • United Imaging’s Ultra-Wide MR: United Imaging announced the FDA approval of its uMR OMEGA ultra-wide MRI-system, emphasizing how the 3T MRI’s ultra-wide 75-cm bore (the “world’s first”) and 680 lb. table can improve care for obese patients. UIH also touted the uMR OMEGA’s fast scan speed, positioning it as ideal for pediatric and geriatric patients, as well as its ability to allow providers to add new services such as 5-minute stroke protocol and cardiac imaging with a single breath-hold.
  • A Remote Readouts Lesson: A new study in Academic Radiology revealed that social distancing-compliant readouts (traditionally a side-by-side training practice) can be successfully implemented in academic settings by: 1) Creating decentralized reading rooms (moving from 14 shared reading rooms to 36 reading pods) and 2) Introducing virtual remote readouts (using videoconferencing and screen sharing). An open-ended follow up survey of 39 trainees and 42 attendings resulted in 148 positive comments (e.g. effective social distancing, speed and efficiency) and 97 negative comments (e.g. worsened relationships, greater isolation, less camaraderie, less direct feedback).
  • Quality Measures Cut Duplicate CTs: New research in AJR found that CMS’ 2011 move to require reporting of duplicative CT scans did indeed reduce the duplicate CT procedures that it targeted. The study reviewed 2011 to 2018 Medicare data finding that the mean rate of duplicate OP-10 scans (abdomen CT w/ contrast) imaging fell from 18.9% to 7.7%, duplicate OP-11 rates (thorax CT w/ contrast) fell from 5.6% to 2%, and duplicate OP-14 rates (simultaneous brain & sinus CT) fell from 2.5% to 1%.
  • Ferric Funded: Ferric Contrast landed $750k in R&D funding from the National Science Foundation (following previous public funding events) that it will use to develop iron-based MRI contrast agents that could serve as an alternative to gadolinium-based agents. The University of Buffalo spinoff will use the funding to improve the chemical properties of its iron-based contrast agents and to scale up production in preparation for future toxicity studies.
  • Low Paperwork, High Resubmissions: Medscape’s 2020 Radiologist Compensation Report revealed that radiologists have among the least paperwork and administrative work of any specialty at 12.3 hours per week (3rd lowest, vs. 15.6hr / week avg.). However, 20% of radiologists’ claims are denied or have to be resubmitted, giving the specialty the third highest denial/resubmission rate after emergency (22%) and plastic surgery (28%).
  • Cerianna FDA Approved: PETNET Solutions (a Siemens Healthineers subsidiary) and Zionexa USA announced the FDA approval of their Cerianna (fluoroestradiol F 18) PET imaging radiopharmaceutical for the detection of estrogen receptor-positive lesions in patients with metastatic breast cancer. PETNET will be Cerianna’s exclusive U.S. commercial supplier when it launches in late 2020/early 2021.
  • How to Reschedule 30k Imaging Studies: A new JACR paper detailed how University of Cincinnati Health rescheduled 30k nonurgent exams during the COVID-19 emergency and the lessons that they learned along the way. To do this, UCH created a prioritization system to evaluate what patients were appropriate to postpone, held daily scrum-based meetings to guide their postponement activities, scaled-down their available imaging facilities as imaging volumes declined, and communicated across the system as their strategy progressed and pivoted. UCH’s biggest takeaways were the importance of proactive and consistent communication, the value of creating a diverse rescheduling team, and the challenges created by EMR inconsistency during such a major disruption.
  • ContextVision Launches Rivent: ContextVision announced the launch of its new Rivent 2D ultrasound image enhancement solution, which optimizes image quality in both near and far field and supports automatic adaption to line density. ContextVision’s 7th generation 2D ultrasound enhancement software is further highlighted by improvements to processing power, noise reduction, clear tissue differentiation, smooth tissue imaging, and black area imaging.
  • Abdominal Imaging Down: New research in AJR revealed a notable decline in abdominal imaging utilization rates due to a combination of code bundling, reduced reimbursements, and a shift away from some imaging techniques. The review of Medicare Part B data found that total abdominal imaging utilization fell by 20.8% between 2004 and 2016 (from 558 to 441.9 exams per 1k beneficiaries), with the greatest declines seen in abdominal radiography (−29.4%), gastrointestinal fluoroscopy (−40.5%), and nuclear imaging (−32.1%). Although abdominal CT and CTA use increased, code bundling in 2011 changed its trajectory (+22% 2004-2010 vs. +7.2% 2011-2016).
  • Radiographic Thriller: Imaging techs found their way into the literary spotlight after the new “radiographic thriller,” Time, Distance, and Shielding, debuted on the Kindle platform. The book’s x-ray tech protagonist uses her “powers of detection” to save herself and her patients from a psychopathic surgeon. This may be a sign of an international pop culture trend, as the popular Japanese television show Radiation House is based on a radiographer and radiologist.
  • Two-Way MR: UC Davis researchers developed a new double-contrast MRI technique, dubbed two-way magnetic resonance tuning (TMRET), that detects “very small early-stage tumors” amid normal tissue. TMRET relies on a UC Davis-developed probe that generates two MR signals that suppress each other until they reach the target, at which point they both increase contrast between the tumor and surrounding tissue. Using specially developed imaging analysis software, the team was able to leverage these double signals to spot brain tumors in a mouse model with up to 5-times greater sensitivity.
  • XV Tech Cleared for CV19: 4DMedical’s XV Technology lung imaging software received FDA clearance for COVID-19 quantification and management. The XV Technology software uses a single X-ray scan to analyze lung impairment and provide information on the functional and structural state of a patient’s lungs.

The Resource Wire

– This is sponsored content.

  • Watch a recording of Healthcare Administrative Partners’ webinar, “Reentering the Post-COVID-19 Radiology Market,” to learn about several factors radiology practices should take into consideration to ensure safe and successful reentry into the market.
  • As the COVID-19 emergency brings tele-health and tele-radiology to new levels of prominence, this Hitachi blog outlines the key considerations for hospitals and practices that are about to make this transition.
  • In this GE Healthcare video, ultrasound users and educators discuss how the Vscan Extend handheld ultrasound combines portability and intuitive design so you can use it in the moment to potentially change patient outcomes.

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