Keys to AI Success | Screening’s Better with DBT | Neuroimaging Breakthrough

“If AI earns a place in breast imaging, its best opportunity is to decrease false-positive flags.”

A pair of MD Anderson Cancer Center radiologists.

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The Imaging Wire

Agfa DR 800 Adds Another Function
The capabilities of Agfa’s “multi-purpose” DR 800 became even more diverse with the FDA clearance of the DR 800 With Tomosynthesis, adding the image reconstruction technique to the system’s existing support for radiography, fluoroscopy, and advanced clinical applications. The system’s MUSICA Digital Tomosynthesis software, which was first introduced before RSNA, features tomosynthesis algorithms that produce multi-slice images with less noise and fewer artifacts in under a minute. Even before adding tomosynthesis, Agfa has placed an extremely high level of emphasis on the DR 800’s multifunctional capabilities, using swiss army knife imagery across its product materials and emphasizing versatility as the core of the system’s value proposition.

The Keys to AI Success
An editorial from pair of MD Anderson Cancer Center radiologists outlined the four areas where AI must excel in order to “earn a role” in women’s imaging: performance, time, workflow, and cost. The authors highlighted mammography performance as the greatest AI-related requirement, specifically emphasizing the need to reduce false positives compared to the current performance of CAD programs. Efficiency was next on their list, demanding that AI must not increase interpretation times or delay the availability of images to radiologists. The third item was a bit more futuristic, calling for AI to seamlessly integrate into clinical workflows, including leveraging EHR records to ID patients that require imaging, automatically ordering and scheduling the exam on behalf of physicians, and then supporting radiologists’ diagnoses. Finally, the radiologists emphasized that the cost of AI must not be so high that it outweighs the value it provides. This is a solid list, and not just for breast imaging.

Screening’s Better with DBT
A study from team of Norwegian researchers (n=24,000) found that the inclusion of digital breast tomosynthesis (DBT) in breast cancer screening programs resulted in significant sensitivity and specificity improvements. The study also found that synthetic mammography (SM) may be a viable alternative to digital mammography (DM) when combined with DBT, while finding that adding CAD to DM did little to improve screening effectiveness, especially in comparison to DM+DBT.

  • DM Alone: 54.1% sensitivity, 94.2% specificity
  • DM+CAD: 56.2% sensitivity, 94.2 specificity
  • SM+DBT: 69% sensitivity, 95.4% specificity
  • DM+DBT: 70.5% sensitivity, 95% specificity

This study certainly isn’t the first to highlight the benefits of DBT+DM compared to just DM (here’s another example of DM+DBT’s recall rate advantage) or SM+DBT’s potential as a DM+DBT alternative (here’s another example of that), but it certainly helps support these two arguments.

MIT’s Neuroimaging Breakthrough
MIT researchers developed a new MRI sensor that can image calcium activity deep within the brain, potentially leading to new understanding of how neurons communicate and new insights into neurons’ roles in human behaviors. The MIT team has been working on MRI-based calcium imaging for some time, achieving the ability to measure calcium on the outside of brain cells last year and is now able to image calcium within brain cells due to a new manganese-based contrast agent. This may be word soup to Imaging Wire readers who don’t happen to be neuroscientists. However, this appears to be a significant neuroimaging breakthrough, imaging far deeper into the brain than current microscopy-based calcium imaging techniques and potentially providing far more precise data on the location and timing of neuron activity compared to traditional functional MRI (fMRI) imaging.

Breast MRI Referrals Helped by Legislation and Education
Research from Beth Israel Deaconess Medical Center and Harvard found that although referrals for breast MRI remain rare, a combination of breast density legislation and breast MRI education can drive adoption. The study (n=134) revealed that a respectable 42% of referring physicians actively order breast MRIs, 30% of those physicians have increased their breast MRI referrals since Massachusetts began requiring density notifications in 2015, and 29% would make even more breast MRI referrals for women with dense breasts if costs were lower. However, the overall volume of breast MRI orders is still low, as 79% of MRI-comfortable referrers order fewer than 10 exams per year. Among the physicians who don’t order breast MRIs, 42% cited a lack of familiarity with the modality, prompting the researchers to encourage efforts to educate referring physicians on the utility of breast MRI.

The Wire

  • Research from the VCU health system revealed that 70% of women (n= 2,245) prefer to receive their mammogram screening results within 48 hours of their exam and 55% percent prefer to be contacted about their results via a phone call (followed by text, letter, and then email), suggesting that prompt and personal notifications are key to improving patient-centricity in this part of the screening process.

  • Dutch medical imaging AI developer, Aidence, generated €10 million from a series A funding round, bringing its total funding to €12.5 million ($11.3m, $14.2m). Aidence will use the new funding to expand its Veye Chest lung cancer detection solution across Europe, support the solution’s FDA approval process, and fund further development.

  • A team of University of Washington researchers tackled lung cancer screening’s participation problem in a recent JACR paper, which is apparently significant given that only about 5% of people who are eligible for LCS participate in such programs. The team started by defining LCS’ problems, including inadvertently screening ineligible participants, an insufficient effort to encourage smoking cessation, and omitting patients of lower socioeconomic status. The team’s solutions had a similar focus, including investing in patient navigation roles/practices (for participant outreach, eligibility evaluation, and decision support) and ensuring that participants are eligible based on their actual smoking history (and not necessarily what their EHR records say about smoking).

The Resource Wire

This is sponsored content.

  • The Focused Ultrasound Foundation published its 2018 Year in Review, detailing the organization’s impressive research and clinical achievements over the last year.

  • How much does a CT scan cost? According to Medmo, that depends. Scans made with the exact same device on the exact same body part could cost $225 at one facility and $2,500 at another. Medmo also provides some advice to make sure patients don’t pay too much for their scans, including using the Medmo Marketplace, where the average CT costs between $225 and $700.

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