Imaging is Not Going Anywhere

“Imaging is not going anywhere. . .”

RadNet CFO, Mark Stolper, with a confident outlook on imaging’s rebound and return to normal.

A few weeks ago, I incorrectly covered Strategic Radiology’s move to “one class of membership – ownership” and suggested that this meant SR was absorbing its members to create a new nationwide practice. This was completely wrong. In reality, SR is shifting from two membership classes (Core & Affiliate) to a single class that gives all members the same level of benefits and influence over the organization, while keeping the practices independent. All previous coverage of this is now corrected and I apologize for getting this so wrong.

– Jake

Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire

Rebound Perspectives

This week brought a new round of insights into COVID-19’s impact on healthcare / imaging and wide-ranging perspectives on how a rebound will take place. This week’s rebound perspectives were a bit more pessimistic than we’ve seen in recent weeks, but considering we’re coming off the greatest health and economic disruption in recent history that shouldn’t be too surprising. Here they are:

  • Bumpy Recovery – New analysis from S&P Global Ratings forecast a “bumpy recovery” for hospitals and other healthcare providers, predicting reduced margins into early 2021 despite the ramp up of delayed procedures and relief from the federal government. The ratings agency shared a particularly negative view for dental companies, followed by physical therapy and ambulatory surgery centers, and medical staffing and physician groups (specifically citing radiology).
  • RadNet’s Rebound – RadNet’s CFO shared a far more positive outlook at this week’s Jefferies 2020 Virtual Global Healthcare Conference, revealing that the company’s imaging volumes are currently about 40% below normal, but they are improving in many markets, and the imaging giant could complete its rebound by 2021. The executive also revealed that he’s expecting an increase in radiology M&A (largely targeting smaller firms) and more joint-venture interest from hospitals as the post-COVID rebound continues. RadNet isn’t alone in forecasting a post-COVID M&A surge.
  • Imaging Pessimism Index – AHRA’s quarterly Medical Imaging Confidence Index (MICI) is usually pretty stable (and pretty positive), but its new Q2 2020 survey of imaging managers and directors (n = 179) revealed widespread pessimism over their departments’ expected Q2 performance. The leaders’ overall confidence score was a dismal 72 out of 150, way down from their 116 score in Q1 2020. The respondents were least confident that they would grow their scan/IR volumes (59/150), but were also pessimistic about their ability to access capital for IT and imaging systems (65/150), grow as a profit center (76/150), receive adequate reimbursements (80/150), or that internal costs will remain stable (84/150). No big surprises here, but still remarkable.

The COVID-19 Modality Lineup

A new paper in Radiology: Cardiothoracic Imaging from Mount Sinai provided a helpful review of COVID-19’s imaging features / applications across modalities with the goal of helping guide other radiologists’ CV19 diagnosis and management. Here are some of the big takeaways:

  • Chest X-Ray – CXR is often CV19 patients’ initial modality due to availability and mobility, but it has a relatively high risk of false negatives. Positive CXRs often show hazy opacification.
  • CT – CT is widely viewed as the go-to CV19 modality due to its relatively high sensitivity (up to 97%), ability to monitor progression, and value for spotting comorbidities. CT positives often show multiple bilateral GGOs with or without consolidation.
  • MRI – MRI is not a standard CV19 modality, but it’s a common source of incidental findings that are often consistent with findings from CT and CXR scans.
  • PET/CT – Although PET/CT isn’t a common CV19 modality, FDG PET/CT could be used to identify lung inflammation, monitor disease progression, and evaluate treatment response.
  • Ultrasound – Ultrasound has been “useful as a point of care (POC) evaluation” modality for CV19 due to its commonly cited advantages (ease of use, repeatability, low cost, no radiation). US CV19 findings generally include thickened pleural lines, B lines, consolidative patterns, and A lines during the recovery phase.
  • Echocardiography – Because pulmonary embolisms are common CV19 complications, the authors expect an increase in CV19-related echocardiography going forward.
  • CV19 AI – The paper also touted the benefits of CV19 AI, given its ability to support patient triage and ongoing monitoring, particularly for low-resource hospitals or hospitals experiencing a surge of CV19 patients.

The Wire

  • Pancreatic Cancer AI: Researchers in Taiwan developed a CNN algorithm that effectively detected pancreatic cancer in CT scans, suggesting that an accurate CT-based pancreatic cancer CAD system is possible. The paper detailed the steps that went into developing of this algorithm, while the big takeaways are that it outperformed a team of radiologists using a pair of local datasets (sensitivity: 97.3% and 99% AI vs. 94.4% and 91.7% Rads) and had encouraging performance with a U.S. dataset (79% sensitivity, 97.1% specificity, 0.92 AUC).
  • Visage Lands Northwestern: Visage Imaging announced a 5-year, $14.45m Visage 7 enterprise imaging contract with Chicago’s Northwestern Memorial HealthCare (NMHC, 10 hospitals, 1.5k physicians) where it will replace eight different PACS systems (from Agfa, Merge, GE, Change, Sectra, Hologic). The deal adds to Visage’s impressive list of recently-signed major hospital system clients (including OSU, Duke Health, Partners, Mayo Clinic, Mercy Health, and Yale-New Haven), which now includes 6 of the top 20 ranked U.S. hospitals.
  • COVID-Adjacent Deaths: A new NYT story reveals that New York and New Jersey experienced major increases in non-CV19 deaths between March 15 and May 2 either because their comorbidities were triggered by undiagnosed COVID-19 or because they avoided treatment during the emergency. Although COVID-19 was responsible for 68% of NY/NJ’s 44k “deaths above normal” during that 6-week period, heart disease and diabetes (15%), the flu (5%), Alzheimer’s (1%), and “other diseases” (10%) all contributed to the states’ higher death rate.
  • Vara’s $7m: German AI startup Vara announced a $7m Series A round (increasing its total to €9.5M) that it will use to support the expansion of its AI-powered breast cancer screening software across Europe. The CE-certified machine learning software supports radiologist workflows by filtering out healthy studies, so they can focus on the more complex / urgent cases on their worklist.
  • Pediatric CV19 CTs Often Negative: New research in AJR revealed that pediatric CT results are often negative for COVID-19, even among children who are CV19-positive. The study of 30 CV19-positive pediatric patients (aged 10 months to 18 years) found that 77% of their initial chest CT results were negative, while 10 out of the 11 children who underwent follow-up CTs (91%) had no sign of change in the second scans. The children’s positive CT results were most commonly related to bilateral, lower lobe–predominant ground-glass opacities.
  • Siemens’ India Incubator Collab: Siemens Healthineers and Indian tech innovation hub, NASSCOM, launched a partnership intended to support Indian startups focused on imaging, diagnostics, and digital health technologies. The partnership could lead to joint development deals, commercial partnerships, and / or supplier arrangements between Siemens Healthineers and the startups. Siemens Healthineers is the latest of a number of major companies to partner with NASSCOM, following GE Healthcare last year and previous alliances with Intel, IBM, Qualcomm, and Microsoft.
  • PET/CT + PSA for mCRPC: The combination of PET/CT metabolic imaging and PSA testing could prove to be a useful way to evaluate metastatic castration-resistant prostate cancer (mCRPC) treatment and disease progression. A Mayo Clinic study covered by Renal & Urology News (n = 123) found that 39.6% of men receiving second-generation hormone therapy for mCRPC experienced disease progression despite stable / declining PSA levels.
  • Lunit’s CE Marking: Lunit announced the CE Mark approval of its INSIGHT MMG AI solution for breast cancer detection, making it available across Europe. INSIGHT MMG analyzes mammography images with 97% accuracy, providing the location of suspicious lesions and showing an abnormality score that estimates the probability that the detected lesions exist.
  • Questioning fMRI: A Duke researcher who spent 15 years studying how functional MRI (fMRI) could be used to understand and predict human thoughts and feelings is now questioning his own findings. The researcher reviewed 56 papers and examined the Human Connectome Project, finding that although fMRI does accurately show what parts of the brain are involved in a given task (e.g. remembering names), images are different each time a person performs the same task, making it a poor predictor of future mental health or behavior.
  • CuraCloud’s Incidental CV19 Solution: CuraCloud announced the FDA approval of a new deep learning algorithm for the detection and prioritization of incidental COVID-19 pneumonia findings from non-contrast chest CT images. The new solution expands upon CuraCloud’s CT triage platform, which also includes CuraRad-ICH (FDA cleared in April, detects intracranial hemorrhage in non-contrast head CTs). It also comes just a few weeks after Aidoc launched the first FDA-cleared solution for incidental CV19 findings in CT scans.
  • Riverain’s New CPO: Riverain Technologies welcomed Ofer Pinhasi as its new chief product officer, giving Pinhasi responsibility for the development and global deployment of Riverain Technologies’ products, establishing governance processes, and leading strategic planning efforts. Pinhasi joins Riverain from MaxQ AI, and previously served a variety of engineering, product, and operations roles at Philips and GE.
  • Ezra Funded: Unique direct-to-consumer imaging screening company, Ezra, completed an $18m Series A round (increasing its total to $22m) that it will use to expand its AI solution portfolio that supports its MRI-based cancer screening program and to fund its new Ezra COVID 360 program. Ezra COVID 360 combines low-dose lung CT (to identify damage from CV19) with an antibody blood test to help individuals understand the potential long-term health impact of COVID-19 and check their antibody status ($390 per assessment).
  • CTTB Complication Predictor: New research in Academic Radiology found that machine learning can be used to predict which patients are at risk of experiencing complications during CT-guided transthoracic biopsy (CTTB). The retrospective study used imaging and CTTB outcome data from 796 patients (14.7% complication rate, 2% major), predicting complication severity with between 65.5% and 83.5% accuracy using a multivariate logistic regression model and between 77% and 94.2% accuracy using a neural network model. Smaller lesion dimension proved to be the strongest predictor of complications.
  • KM KDR Advanced U-Arm Launches: Konica Minolta Healthcare announced the commercial launch of its KDR Advanced U-Arm, equipped with its DDR moving X-ray technology. The new U-Arm is clearly highlighted by its DDR technology, which captures a series of individual digital images, allowing orthopedic clinicians to image patients while they move and observe changes over time.

The Resource Wire

– This is sponsored content.

  • This Nuance blog details how it helped Northwell Health quickly expand its use of PowerShare to support New York City radiologists in their response to COVID-19.
  • The GE Healthcare Venue Go features a uniquely adaptable design, a simple interface, and streamlined probe layout so you can go through your day quickly, efficiently, confidently.
  • Vessel suppression from Riverain Technologies’ ClearRead CT software was recently found to significantly improve nodule detection, interreader agreement, and reading time with oncologic chest CT scans.
  • Hitachi Healthcare Americas’ latest blog provides some insights into what “normal” imaging operations will look like as we emerge from the COVID-19 pandemic.

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