Mammography Evidence | Rads Ready to Reopen

“. . . the irony is that they get more money because they’re more dishonest,”

Harvard professor, Malcolm Sparrow, on how some of the leading COVID-19 HHS bailout recipients also have checkered pasts.

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The Imaging Wire

Mammography Evidence

New research out of Sweden added even more evidence that mammography screening substantially reduces breast cancer mortality rates, while addressing one of the key arguments that screening critics have made against previous mammography studies.

  • The Study – The researchers reviewed screening and cancer occurrence data from 549k Swedish women between 1992 and 2016, including 9,737 women who developed advanced breast cancers and 2,473 breast cancer cases that proved to be fatal within 10 years of diagnosis.
  • The Results – The study found that women who participated in regular screening had a 41% lower risk of dying from breast cancer within 10 years and a 25% lower rate of advanced breast cancers compared to women who were not regularly screened.
  • Controls Count – The fact that this study focused on screened and unscreened women within the same time period addresses a key criticism often cited by screening deniers. In the past, mammography screening studies typically compared their screening effectiveness results to historical controls, even though treatment methods (and therefore mortality rates) evolved over time. It also counters arguments that advancements in therapies make early breast cancer detection less important.

Rads Ready to Reopen

Whether or not you believe COVID-19 is subsiding, states are starting to reopen, nonurgent procedures are starting to resume, and many radiology/imaging practices are more than ready to get back at it. In response to this progress, this week brought a new flow of activities intended to make the most of healthcare and radiology’s return to business.

  • RadNet’s Remote Check-in – RadNet launched its new text-based Remote Check-In solution that allows patients to check-in from their vehicles outside of a RadNet imaging center and receive a notification when they can come inside for their scan. We’re seeing more of this approach, including a similar launch from Connecticut’s Advanced Radiology Partners last week.
  • Ascension’s Mobile Labs – Texas’ Ascension health system marked its return to performing nonurgent surgeries with the launch of its first mobile labs, deploying the vans to patients’ houses to perform pre-surgery lab work while allowing the patients to remain quarantined until their surgeries. The vans are relatively well equipped, with X-ray and ultrasound systems, as well as full blood work setups and PPE-equipped staff.
  • CAR Ready to Resume – The Canadian Association of Radiologists’ National Task Force produced a new report on “how radiology services can be resumed” as COVID-19 subsides. The report’s initial focus is on avoiding transmission, but it’s also largely intended to outline how to effectively handle the surge in delayed cases and get Canada’s radiology workforce back to work.

The Wire

  • Telerad Growth: After growing by 9% to $1.2b in 2019, Signify Research forecasts that by 2024 the global teleradiology reading services market will surpass $2b and represent 2% of all diagnostic imaging reads (that’s 2% of 5.5b exams). Signify expects that this growth will be driven by: 1. A radiologist and sub-specialist shortage in many countries; 2. Growing demand for advanced modalities (e.g. CT/MRI); 3. These advanced modalities’ longer read times; 4. Continued demand for urgent “out-of-hours” interpretations; and 5. The increased use of cloud-based tech makes teleradiology less complex.
  • Brain Imaging Overuse: A new Harvard and MGH-led study discovered overuse of brain imaging among patients with Stage IA Non–Small Cell Lung Cancer. The review of Medicare claims found that one out of every four patients diagnosed with stage IA NSCLC between 2004 and 2013 (n = 13,809) received brain imaging at the time of diagnosis, with NSCLC brain imaging increasing from 23.5% to 28.7% during the study period. Separate studies have found that only 1.3% of patients with stage I NSCLC also had brain metastases and 60% of those patients also had neurological symptoms, suggesting that most of these brain scans were unnecessary.
  • Intel & Penn Federated Learning: Intel announced a partnership with Penn Medicine to develop a federated learning system used to develop a brain tumor detection algorithm that’s based on decentralized brain MRI data (29 health systems) but won’t expose patient or site-specific data. The new initiative will build upon Penn and Intel’s previous federated learning efforts, this time focusing on bolstering data and algorithm privacy.
  • Stroke Imaging Down: New research from Washington University School of Medicine in St. Louis found that stroke evaluations fell by 39% during the COVID-19 emergency. The study analyzed stroke evaluation data from iSchemaView’s RAPID software (231,753 patients, 856 hospitals, 7/1/2019 – 4/27/2020), finding that the rate of patients receiving stroke imaging per day / per hospital fell from 1.18 during February 2020 to 0.72 during the 2-week period between March 26 and April 8, 2020.
  • New Prostate Tracer: New research from a Tel Aviv-based team found that the novel radiotracer 18F-PSMA-1007 matched the proven 68Ga-PSMA-11 tracer for staging prostate cancer, potentially giving clinicians another tool for prostate PET/CT imaging. The study scanned 16 patients with intermediate- or high-risk prostate cancer using each radiotracer within 15 days, with each tracer identifying tumor locations with the same accuracy, and the novel 18F-PSMA-1007 tracer detecting additional signs of tumors in four patients (3 that proved to be lesions).
  • Aspenstate’s Portable XR Approved: Aspenstate announced the FDA approval of its AiRTouch portable X-ray system, highlighting the AiRTouch’s built-in touch screen workstation, which allows the user to acquire images directly onto the device and transmit to PACS without a PC. Developed by Aspenstate parent company, Livermoretech Korea, the AiRTouch also leads with its low weight (5.5 lbs), handheld design, and battery power (2hrs / 300 exposures).
  • Post-Processing CT AI: An international team of researchers led by Barcelona’s Open University of Catalonia (UOC) developed a new post-processing algorithm that improves the image quality and reduces the noise of reconstructed CT images. The algorithm could allow radiologists to better distinguish the body’s tissue types by 60% and potentially reduce patients’ radiation exposure.
  • Geriatric Imaging’s CV19 Value: A review of COVID-19 studies focused on elderly patients (n = 22 testing studies, n = 15 treatment, n = 13 prognosis) found that although Viral-PCR and serology are the mainstays of testing, treatment and prognosis of CV19 among older patients “may be increasingly supported by radiological findings.” Although only 46% of cases had radiological signs during the first two days, 97% of severe cases had early radiological signs, giving imaging a high prognostic value for older patients.
  • RadNet Perseveres: RadNet announced that it used nearly $15m in funding from the first round of the CARES Act and almost $40m in accelerated Medicare advance payments, combined with millions in cost cutting (restructuring rent, closing locations, over 3,900 employee furloughs, salary reductions) to help it endure CV19’s drop in imaging volumes. However, the imaging center giant revealed that it’s “beginning to see some signs of recovery” and is confident that it will emerge from CV19 as an even stronger industry leader.
  • Caption Cleared Again: An updated version of Caption Health’s newly FDA-cleared Caption Guidance software just landed additional FDA approval, adding 88% more types of guidance, improved algorithm performance, and optimized workflow. The new version was expedited through the FDA process in just 25 days due to its ability to allow healthcare providers without specialized training to perform cardiac ultrasounds, thus speeding up care and minimizing exposure during the COVID-19 emergency.
  • Bailouts and Payouts: There are few things that khn.org hates to see (but loves to cover) more than healthcare companies unjustly profiting from their operations and KHN got another chance to do just that this week. KHN’s latest story reviews the relatively long and high profile list of providers who raked in millions in COVID-19 bailouts despite their checkered histories (antitrust judgments, false claims, improper billing). In fact, these organizations represent half of the top-10 healthcare bailout recipients.
  • CAD4COVID Effective: A Dutch study found that Thirona’s new CAD4COVID AI system (available free of charge) can detect COVID-19 in chest X-ray images comparably to radiologists. The study trained the AI system on 24,678 CXR images (1,540 for validation) and tested it on 454 CXR images from patients (223 RT-PCR positive, 231 RT-PCR negative) that were also independently analyzed by six readers. The AI system correctly classified CXR images as COVID-19 pneumonia with an AUC of 0.81, outperforming each reader (p < 0.001) at their highest possible sensitivity setting, while only one reader outperformed the AI system at the lowest sensitivity setting.
  • HAP Highlights Assistance: Healthcare Administrative Partners detailed the latest federal assistance efforts available to radiology practices and outlined how groups can make the most of them. The government’s latest efforts include the Paycheck Protection Program and Health Care Enhancement Act (launched April 24th, $484b for CARES Act w/ $310b for PPP), as well as revisions to the Medicare Accelerated and Advance Payment Program (applications closed as of April 26th) and expansion of the HHS “Lost Revenue/Increased Cost” Grants.
  • WBCT for PTOA: New research in the Journal of Bone and Joint Surgery reveals that weight-bearing CT scans can help clinicians quantify early progression of posttraumatic osteoarthritis (PTOA) after tibial pilon fractures and assess the impact of PTOA interventions. The prospective study scanned 20 patients with intra-articular tibial pilon fractures six months after injury, finding that mean tibiotalar joint space was 21% less in patients’ injured ankles compared with their uninjured ankles (p < 0.0001).

The Resource Wire

– This is sponsored content.

  • Severe sepsis strikes more than a million Americans every year at an annual cost of more than $20 billion. Learn how point of care ultrasound can help improve sepsis outcomes in this GE Healthcare paper.
  • This Hitachi blog details how the COVID-19 pandemic created new urgency for healthcare systems to adopt and expand tele-health and tele-radiology, while outlining the key considerations for those about to make this transition.
  • This blog article from Healthcare Administrative Partners outlines the legislation passed that can help support radiology practices during the COVID-19 pandemic.
  • Learn how Riverain’s ClearRead CT Vessel Suppress provides a powerful and intuitive view for clinicians through the suppression of vascular structures.
  • This Caltech team found that certain focused ultrasound frequencies can selectively kill cancer cells.

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