Low-Value Tests & Reopening Steps

“Sure, providing a diagnostic report is not your job, but examining your images for abnormalities for patient safety? That is 100% your job.”

Radiopaedia’s Andrew Murphy reminding radiographers that preliminary image evaluation is indeed their job.

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  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
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The Imaging Wire

Low-Value Tests & Downstream Costs

A new study in JAMA Internal Medicine finds that low-value testing during annual health exams (yes, including imaging) are likely to drive additional tests and increase healthcare costs.

  • The Study – The study reviewed data from low-risk Canadian patients who received “low-value screening” (chest X-ray = 43.5k; ECG = 245k; Papanicolaou test = 29k) during or shortly after their annual exams. They then measured the patients’ ongoing testing and care at 90 and 180 days.
  • The Results – Patients who received chest X-ray screenings actually had the lowest downstream exams, with 0.87 per 100 patients attending an outpatient pulmonology visit and 1.96 per 100 receiving an abdominal or thoracic CT scan. The low-risk ECG patients were much more likely to follow up with an outpatient cardiologist visit (1.92 / 100), receive a transthoracic echocardiogram (5.49 / 100), or a cardiac stress test (4.46 / 100). The low-risk Papanicolaou test patients had between 1.31/100 and 52.8 /100 follow up rates. However, the total number of actual clinical events within a year of these tests was low.
  • The Takeaway – The big takeaway here is that testing low-risk patients often leads to more tests, driving up healthcare costs (up to $101b) and inconveniencing patients, while rarely leading to early detection. If that sounds familiar, that’s because there have been numerous recent low-value imaging studies with the same findings.

Imaging’s Reopening & Rebound

We’re another week into imaging’s post-COVID reopening and we’re starting to see a new wave of helpful guidelines on how to manage this reentry and how the return of non-urgent imaging is driving volumes.

  • USC’s Imaging Roadmap – A new paper from USC shared their roadmap for resuming non-urgent imaging during Phase II. The detailed plan calls for a “phased and triaged approach” to work through the imaging backlog including: 1) The development of a formal ramp-up review process; 2) Incremental and consistently evaluated volume increases; 3) Expanding operations by adding days/hours and remote reading; 4) Increasing physician communication; 5) Expanding infection control methods; and 6) Ongoing preparation for future COVID surges.
  • Mammography Rebounds – Mammography experienced the steepest declines when the COVID-19 emergency halted all non-urgent imaging, but it’s on the way back up. A new Volpara Solutions report finds that 75% of hospitals and imaging centers have now commenced mammography screening, with volumes rebounding to within 10% of pre-pandemic levels at “many sites” and even exceeding normal levels at about 5% of facilities.
  • Practice Guidelines – Healthcare Administrative Partners shared safety and workflow guidelines for radiology practices as they return to work. The detailed guidelines touched on workplace sanitization and protection, communication policies, patient pre-screening and testing, social distancing design and workflows, strategic staffing and scheduling, and modality use (among other recommendations).
  • COVID-19 Rebounding Too – Practice reopenings and volume rebounds feel like good news – and they are – but we’re also seeing COVID-19 cases on the rise in 21 states, making the above safety guidelines more than just precautionary and suggesting that the rising imaging volumes might come back down again.

The Wire

  • A Call for Radiographer Interpretations: A recent post in Medradresearch called for the adoption of radiographer image interpretation across radiology workflows (at least in Australia), suggesting that it’s their duty to flag and communicate abnormalities and failure to do violates the Medical Radiation Practice Board of Australia. The post acknowledged the ongoing debate over radiographer interpretations, but placed its focus on the radiographer’s duty to their patients and their institution to flag/report abnormalities and emphasized that this should not be seen as a threat to diagnostic reports.
  • Nanox in Italy: Nanox signed a 4-to-7 year distribution agreement with Italy’s Promedica Bioelectronics to deploy 500 Nanox.ARC units in across the country. The deal expands Nanox’s distribution network to Europe and connects it with a relatively established partner, as Promedica has provided imaging equipment across Italy for over 30 years and worked with GE and Fujifilm.
  • ACR’s Supervision Position: The ACR has been pretty active calling for loosened imaging regulations during the COVID-19 emergency, particularly for its longtime targets like prior authorizations. However, the ACR just made it clear that it’s less open to CMS’ loosened physician supervision requirements, asking CMS to reverse its supervision changes once the pandemic ends. The ACR specifically called for CMS to reverse its moves to allow the use of telecommunication for direct supervision of medical procedures and to reduce physician supervision requirements for outpatient hospital therapy.
  • Virtual Readouts: A new paper in Academic Radiology detailed how NYU worked to preserve the educational value of its radiology resident program during the COVID-19 emergency by introducing simulated daily resident readouts (SDRs). To support the virtual readout process, the NYU radiology team selected cases from their daily worklist (mix of normal & abnormal, modalities) and made them accessible to the residents for their daily readouts. Thirty-two participating residents reviewed 3,682 cases over the initiative’s first 20 days and a follow-up survey of 25 residents found that “SDR effectively mimics a resident’s daily work on rotations and preserves resident education during the COVID-19 crisis.”
  • MUSE DWI: A Memorial Sloan Kettering Cancer Center-led study found that Multishot multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE DWI) could enhance breast MRI protocols without contrast for breast cancer screening due to its reduced motion sensitivity. The study (n = 30 women, 37 lesions) compared MUSE DWI and standard DWI, finding that MUSE DWI produced greater image quality, improving lesion visibility (κ = 0.70) and differentiation of malignant and benign lesions (P < .001). The technique could also reduce scan times.
  • CorTechs & HealthLytix Merge: CorTechs Labs and HealthLytix announced plans to merge, combining their respective imaging AI presence and capabilities under the CorTechs brand and leadership team. The merger expands CorTechs’ portfolio (adds two FDA cleared products, and solid pipeline), brings on a team with deep imaging AI expertise, and gives their respective lineups new go-to-market options. Plus, the “sister companies” already shared a founder and are located across the street from each other so they have a cultural and geographic head start compared to most mergers.
  • Quantifying Eye Strain: A new study in Academic Radiology quantified widespread digital eye strain across all radiology subspecialties. A survey of 198 Saudi Arabian radiologists (111 men and 87 women, 71% below 40yrs) found that 50.5% experienced digital eye strain in the last year, with the highest rates of eye strain found among female radiologists (3.9 times more likely), radiologists who only take one break a day (15.1x), and radiologists who take two daily breaks (5.5x).
  • PA Screening Bill: The Pennsylvania House of Representatives unanimously approved a new bill that would require MRI and ultrasound screening coverage for women with dense breasts, a personal or family history of breast cancer, or genetic risk factors. The bill was first introduced nearly 10 years ago and just needs to make it through a vote with the state’s full House in order to become a law.
  • MERCC Takes on ABR: It didn’t take long for complaints about the ABR’s move to delay many of its exams until 2021 to expand from blogs and social media posts, to major imaging groups. The newly-formed Multispecialty Early Radiologic Career Coalition (backed by 17 imaging groups) began circulating a petition urging the ABR to figure out how to hold substitute tests this year (either locally or virtually), warning that the delay could have a devastating impact on radiologist careers and patient care.
  • RapidAI Acquires EndoVantage: Stroke imaging solutions company RapidAI expanded its cerebrovascular imaging portfolio with its acquisition of cerebral aneurysm management company EndoVantage (now includes: ischemic stroke, hemorrhagic stroke, and cerebral aneurysms). EndoVantage’s “Find, Track and Treat” platform automates the aneurysm management workflow (assessment, monitoring, treatment planning) using CTA and MRA scans.
  • A Lead Alternative: NC State scientists developed a novel composite material with bismuth trioxide particles that they say could replace lead for radiation shielding. The new material can efficiently scatter and absorb ionizing electromagnetic radiation, and could become a lead alternative because it is non-toxic, lightweight, and easy to manufacture.
  • Siemens & Geisinger: Siemens Healthineers and Geisinger announced a 10-year value partnership that will provide the Pennsylvania health system with Siemens’ imaging equipment, on-site staff to support improvements over the life of the agreement, and education and workflow resources.

The Resource Wire

– This is sponsored content.

  • The introduction of ultrasound into musculoskeletal care has been a game-changer, revolutionizing the level of precision MSK physicians can bring to patient care. This GE Healthcare profile details how one physician used point of care ultrasound to help improve performance and effectiveness.
  • 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%.
  • 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.
  • 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.

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