Imaging in 2021 | POCUS Turf War

“They’re welcome to PPE up and come in to the covid positive patients rooms to show us how lung ultrasound should be done….. I won’t hold my breath.”

One non-radiologists’ response to the European Society of Paediatric Radiology’s position statement on non-radiologists’ POCUS use.

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The Imaging Wire

Imaging in 2021

Happy New Year, everyone. For those of you working on your 2021 strategy over the next few weeks, here are some major imaging themes to keep in mind.

  • The COVID Countdown – Nothing will have more influence on imaging in 2021 than when / how we get the COVID pandemic under control. Let’s just hope we’re currently in the 6th inning of the COVID ballgame and not the 3rd.
  • Managing the Surge – Imaging-related screening and electives are still way down. So, making sure patients stay involved in their care during COVID and getting radiology teams prepared to handle the post-COVID imaging surge will both be major 2021 themes.
  • Managing the Squeeze – COVID’s volume-reducing impact combined with the new Medicare reimbursement cuts will place even greater strain on radiology practice / department revenue streams this year, while also pressuring the companies who sell to them.
  • AI Expands – You can bet that AI adoption will continue to grow this year as AI companies enhance their offerings (applications, accuracy, usability, integration, ROI) and providers grow more open to adopting AI (mindset, policies, infrastructure).
  • Big Get Bigger – Industry consolidation will continue to play a major role, and it may even intensify this year given COVID’s financial toll on many imaging companies. Keep an eye out for more hospital consolidations and more radiology practice corporatization, while the biggest imaging OEMs and solutions companies (AI, PACS, etc.) extend their leads over their smaller competitors (and probably acquire a few of them).
  • Imaging on the Move – The portable imaging trend will also continue to gain momentum this year, as POCUS expands to more clinician hands, portable MRI sheds its niche positioning, and more AI-embedded mobile X-rays get wheeled up and down hospital halls.
  • Imaging Resilience – There were some scary moments last year, but imaging teams and companies are a resilient bunch and they will be resilient this year too.

POCUS Turf War

The European Society of Paediatric Radiology’s position statement on pediatric POCUS drew backlash from “non-radiologist” POCUS users, exposing a POCUS divide that still exists across departments.

  • ESPR’s Position – The ESPR believes that point-of-care ultrasound’s expansion across hospital departments has outpaced the creation of POCUS best practices, and (you guessed it) they say radiologists should play a central role in the training, accreditation, and governance of “non-radiologist point-of-care US.”
  • “Non-Radiologist” Backlash – The point-of-care clinicians who rely on POCUS every day didn’t take kindly to many parts of the ESPR position statement (e.g. POCUS causes missed dx/delayed care, education is “a gimmick,” radiologist oversight) and suggested that radiologists’ POCUS interest is more about turf and money than patient care.
  • Shared Positions – The Canadian Association of Radiologists’ 2019 statement similarly voiced concern over POCUS’ expansion to “non-imager” clinicians and called for restrictions on how and by whom POCUS is used. Meanwhile, the Society of Hospital Medicine’s POCUS position statement included similar calls for training and certification, just without the radiologist-led angle found in the ESPR and CAR statements.

Maybe we need a position statement authored by both rads and non-rads to jumpstart actual multi-specialty POCUS collaboration.

The Wire

  • Alignment AI: German researchers developed an AI algorithm that automates leg alignment analysis and is “fast enough to enhance and accelerate clinical workflows.” The researchers used long-leg radiographs from 255 patients (109 for training, 40 validation, 106 testing vs. two rads), measuring femoral anatomic-mechanical and hip-knee-ankle angles with high interreader correlation coefficients (0.918 – 0.995) and “almost perfect” agreement (0.87–0.99). The automated analysis was also far faster than the radiologists’ manual measurements (3 vs. 36 seconds).
  • Transparency Rules Upheld: Federal appeals judges surprised few by unanimously rejecting the AHA’s lawsuit attempting to block the healthcare price transparency rules that went into effect on January 1st. With the new rules, hospitals must post their standard charges for 300 “shoppable services” online (including a range of imaging procedures).
  • Vuno’s AD AI: Researchers from AI company Vuno and Seoul’s Asan Medical Center developed an MRI-based algorithm that can “predict Alzheimer’s Disease in 1 minute,” positioning the algorithm as a pre-screening step before PET imaging (once it’s refined). Developed with MRI scans from 2,727 patients, the algorithm predicted Alzheimer’s Disease with AUCs ranging 0.840-0.982 and predicted mild cognitive impairment with 0.668-0.870 AUCs, while notifying physicians of signs of microscopic brain atrophy in one minute (vs. 7 hours).
  • Profound Medical & GE: Profound Medical announced a co-development agreement with GE Healthcare to combine its TULSA-PRO prostate cancer thermal ultrasound ablation system with select GE MRI scanners. Profound already maintained MRI relationships with Philips and Siemens, and this new GE alliance significantly expands its MRI market coverage.
  • NIST’s Secure PACS Guide: The National Institute of Standards and Technology (NIST) released a nearly 400-page PACS security guidance document. Here’s the short version: 1) Adopt “defense-in-depth” solutions to provide multiple layers of security; 2) Implement access control mechanisms including multifactor authentication for staff, certificate-based authentication for other technology, and limiting remote support; and 3) Adopting a holistic risk management approach that covers devices, enterprise security, and behavioral analytics.
  • Lunit’s ED Evidence: New research out of South Korea demonstrated how Lunit’s INSIGHT CXR could improve emergency department chest X-ray accuracy and timeliness. In a simulated ED reading session (6 rads, 202 CXRs, 4 critical, 52 urgent), the radiologists identified far more critical (70.8% vs. 29.2%) and urgent (82.7% vs. 78.2%) abnormalities when aided by INSIGHT CXR, while reducing reporting times for critical (10.6 vs. 56 minutes) and urgent (30 vs. 35 minutes) cases.
  • ProHance’ Pediatric FDA: The FDA approved Bracco Diagnostics’ ProHance MRI agent (279.3 mg/mL) for patients under two years old to visualize areas with disrupted blood brain barrier, abnormal brain vascularity, or spine and associated tissues. ProHance’s expanded FDA approval (it was already approved for >2yr-olds) is based on a study showing that the MRI agent improves image quality and is as safe for <2yr patients as older patients.
  • Oregon Tech Fee Fight: Oregon’s imaging technologists and sonographers are pushing back against the Oregon Board of Medical Imaging’s move to increase licensing fees by 77% (from $124 to $220 for 2yr license). Over 1,550 people have already signed an online petition against the increase, while the OBMI maintains that these increases (its first in over 10 years) are necessary to maintain operations.
  • An MBI Acquisition: Breast imaging startup, Smart Breast Corporation acquired a range of molecular breast imaging (MBI) assets from Dilon Technologies, including the Dilon 6800 MBI scanner and a range of MBI imaging and guidance-related technologies / patents (many FDA-cleared). The asset acquisition paves the way for SmartBreast’s commercial launch (the 6800 MBI is FDA cleared, installed in 10 countries).
  • Image that Emotion: Researchers from Finland’s University of Turku found that different neural mechanisms drive our emotional responses to music and film. The researchers performed fMRI scans on 102 subjects while they listened to instrumental music, finding that emotional responses to music are most closely linked to activation in the auditory and motor cortex. Meanwhile, the patients’ emotional responses to film showed activation in the brain’s limbic and cortical regions (both typically associated with emotions).
  • A Big Cardiac Imaging Fraud: A Florida cardiologist pleaded guilty to billing insurers for at least $29m worth of imaging-related procedures that weren’t necessary or never happened. Over the last four years, the doctor performed angiographies on both legs of hundreds of patients (regardless of medical need), and when they came in for follow-ups he billed their insurers for atherectomies that he didn’t perform.
  • Shimadzu’s RADspeed Pro Style Edition: Shimadzu Medical Systems USA unveiled its new RADspeed Pro style edition X-ray, highlighted by its new POWER GLIDE Technology, which reduces technologists’ physical exertion when moving the X-ray tube.

The Resource Wire

– This is sponsored content.

  • With orthopedic care growing with the aging population, orthopedic imaging is growing along with it. This Hitachi blog details how more orthopedic practices are bringing imaging in-house and what factors they should take into account as they decide how/whether to add imaging to their suite of services.
  • Ever wonder how secure your ultrasound systems are? This GE Healthcare Insight details how outdated operating systems might make many ultrasound systems more vulnerable than other devices and outlined the steps organizations can take to keep their ultrasounds protected.
  • In this Nuance video, Penn Medicine professor, Warren B. Gefter, shares how PowerScribe One leverages AI, structured data, and automation to drive improved patient care.
  • CPT updates, E/M services changes, CDS, and MIPS are just some of the topics covered in Healthcare Administrative Partners’ upcoming 2021 MPFS Updates & Radiology Reimbursement Impact webinar. Register today!
  • This Riverain Technologies case study details how Duke University Medical Center integrated ClearRead CT into its chest CT workflows, reducing read times by 26% and improving nodule detection by 29%.

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