LDCT Expands | Multispecialists | AI 101

“If this tipping point is achieved, there will be a major shift of radiologists from independent owners to shift workers . . .”

Lawrence R. Muroff, MD, warning radiologists what could happen if the corporate practice expansion trend continues.

The Imaging Wire made its podcast debut on the 2 Healthcare Guys show this week. Tune in for our takes on imaging AI, the POCUS expansion, radiology practice corporatization, and the pros & cons of imaging lifers.

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The Imaging Wire

LDCT Screening Expands

The US Preventive Services Task Force expanded its annual lung cancer screening guidelines to adults between 50 and 80-years old (down from 55-80yrs) with a 20 pack-year smoking history (down from 30yrs) who currently smoke or quit within the last 15 years (unchanged).

  • The Impact – This screening guideline expansion means that 14.5m Americans are now eligible for low-dose CT lung cancer screening. That’s an 81% increase from the previous 2013 guidelines and suggests that big LDCT volume increases are coming.
  • The Reactions – Although the major radiology societies would have preferred even wider guidelines (eliminating smoking quit dates & max age limits), they’ve quickly shifted to encouraging providers to adhere to the new recommendations. Meanwhile, health equity advocates warned that it will take more than expanded guidelines to improve screening among traditionally under screened groups.
  • The Takeaway – It’s not every week that ~8m Americans become eligible for annual cancer screening. In addition to catching a lot more early-stage lung cancers, this expansion will require providers to process far more LDCT scans, manage a surge of incidentals, and evolve how they handle care coordination and screening equity.

The Wire

  • A Trainee on Radiology AI Training: It’s become quite clear that radiologists need more comprehensive AI training, and just as clear that many medical schools and academic hospitals are still figuring out their AI curriculums. To help address these needs, one radiology resident just outlined how AI curriculums should work: 1) Define AI/ML terminology; 2) Introduce ML basics (data collection, annotation, validation, AI shortcomings); 3) Review the AI regulatory process; 4) Understand AI ethics (bias, privacy, data protection, role in interpretations); 5) Get an overview on AI economics (justifying investments, defining ROI, purchasing considerations, role of reimbursements); 6) Learn informatics with a focus on AI integration; and 7) Participate in research projects for real-world AI experience.
  • Siemens’ Wide FoV PET/CT: Siemens Healthineers announced the FDA approval of its Biograph Vision Quadra Extended Axial FoV PET/CT (already CE marked), positioning it for both clinical and research use. Siemens highlighted how the PET/CT scanner’s 106cm axial PET field (4x the Biograph Vision 600) and high sensitivity will help clinicians/researchers better understand disease “by simultaneously imaging all vital organs in a single field of view.”
  • Imaging Trolled: People tend to complain on Twitter, and that includes tweets about patients’ medical imaging experiences. An Atlanta-based research team reviewed roughly 1,000 imaging-related tweets, analyzing 99 tweets with either positive or negative sentiments, and finding that 90 of those tweets were negative (that’s 91% of sentiment tweets, ~9% of all imaging tweets). The negative tweets most commonly targeted imaging costs (42), followed by care delivery (21), insurance issues (21), and missing/incomplete information (6).
  • Promaxo’s PoC MRI FDA: Promaxo’s unique single-sided MRI system just gained FDA 510(k) approval, potentially allowing urologists and interventional/urologic radiologists to surgically localize prostatic lesions at physician offices or outpatient surgery settings. In addition to being a key milestone for point-of-care imaging, the new MRI is highlighted by its limited fringe field (allows office use without shielding or facility upgrades), patient comfort (small, quiet, no endorectal coils), and lower cost.
  • Radiologists, The Lumbar Puncture Leaders: Radiologists performed 54% of Medicare lumbar puncture procedures (LPs) in 2017, up from 37% in 2004 and roughly 10% in 1991. That’s from an AJNR-published study (n = 2.5m) that also revealed radiologists’ LP procedure growth largely came at the expense of neurologists (24% in 2004 to 10% in 2017), and partially attributed the shift to the use of fluoroscopic guidance in more complex LP procedures. Although the researchers questioned whether radiologists’ LP procedure growth was justified, they still noted that radiologists and other specialists should prepare for even more LP procedures in the future.
  • Micro-X’s Brain CT Ambitions: Micro-X landed an AUD$8m grant from the Australian Stroke Alliance (ASA) to develop a brain CT scanner for ambulance stroke care. Micro-X will use its cold cathode x-ray technology (currently found in its mobile X-ray systems) to develop an ambulance-based CT that’s smaller, lower-cost, more durable (no moving parts), and equal-to-more effective than current ambulance CT systems.
  • SAIO’s Vascular Advantages: New research out of South Korea highlights the cerebro-cardiovascular imaging advantages of the new non-gadolinium MRI contrast agent, SAIO (Supramolecular Amorphous-like Iron Oxide). SAIO’s tiny 5nm nanoparticles (w/ polysaccharide core & iron oxide surface) are far smaller than current agents, allowing them to circulate across the body’s blood vessels and create 3D brain vascular maps that identify microvessels as thin as 100 micros. In studies with rodents and rabbits, SAIO produced 10-times more precise T1 MRI images than current contrast agents, with enhancements lasting far longer than Dotarem (>10 min vs. 2 min).
  • Keeping AI Regulated: The major imaging societies (ACR, RSNA, SIIM) called for the HHS to reject a proposal that would limit how healthcare AI devices are regulated. The proposal was part of a wave of anti-regulatory moves during the final weeks of the Trump administration that proposed permanently exempting a wide range of healthcare device categories from FDA premarket approvals (including a number of key imaging AI categories). Given the new presidential administration, the societies don’t actually expect this proposal to be implemented, but it’s still “extraordinarily concerning” enough to follow up with an official letter.
  • Philips & openDoctor: Philips just added radiology patient self-scheduling capabilities to its Patient Management Solution through a partnership with openDoctor. The combined patient solution (now includes: scheduling, contactless registration, mobile communications/reminders, education) is intended to reduce no-shows and make scheduling and appointment prep more efficient. The partnership is also another example of Philips’ growing focus on managing/improving patient and clinical workflows.
  • Another Corporatization Warning: A new JACR editorial provided the latest argument against the ongoing radiology practice corporatization trend, warning that continued VC-backed practice expansion could change the radiologist career path from “from independent owners to shift workers.” Until then, the editorial encouraged radiologists who are considering corporate ownership to question how often the promised benefits of corporate ownership (e.g. efficiencies, national contracts, purchasing/negotiation advantages) actually prove to be true.
  • SubtleMR 2.0: Subtle Medical announced the FDA approval of its SubtleMR 2.0 MRI image processing software, which can now reduce image noise across 99% of MRI procedures (previously: brain, knee, spine), and features improved head MRI image sharpness. The solution integrates with MRI scanners and PACS systems, allowing imaging departments to either reduce scan times or improve image quality.
  • Solis’ Miami Expansion: Solis Mammography just expanded into its 10th major U.S. metro through a partnership with Miami Breast Institute (2 radiologists, 1 location). The new partners plan to expand across Southeast Florida, leveraging Solis Mammography’s technology and infrastructure. Solis’ Miami partnership comes less than two months after the major breast imaging group expanded into the Washington D.C. area through its acquisition of Progressive Radiology.
  • The Multispecialist Path: Noting general radiologists’ diversifying workload, a new JACR editorial proposed repositioning this role as “multispecialists.” The authors highlighted the momentum towards multispecialty reading (85% of “generalists” represent ≥2 specialties) and the flexibility that multispecialists bring (help with emergency, rural, overnight, teleradiology, and less-complex specialty reads), encouraging the industry to make this shift official by actively training and staffing multispecialists.
  • Brainlab Buys Mint Medical: Brainlab announced its acquisition of German image reading and reporting software company Mint Medical, calling Mint’s ability to produce consistent/quality data a key part of Brainlab’s goal to improve disease diagnosis, analysis, and treatment. The acquisition appears to specifically improve Brainlab’s oncology treatment planning/management workflow, while also allowing the merging companies to integrate various solutions and leverage their respective customer bases and industry expertise.

The Resource Wire

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