Mandatory Referrals | Fracture AI | Flint X-Ray

“We don’t really have a clue what we’re doing: but here are some models!”

One of the many fake academic papers “types” that we’ve been seeing pop up online over the last few weeks.

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The Imaging Wire

Consolidation’s Imaging Impact

Three seemingly unrelated reports just combined to tell an interesting story about healthcare consolidation’s affect on medical imaging.

  • AMA’s In-Hospital Shift – The AMA set up this story, revealing that the U.S.’ share of hospital-employed physicians jumped from 29% in 2012 to 39.8% in 2020, while physicians working within private practices fell below 50% for the first time ever (49.1%).
  • Internal Referral Increases – Meanwhile, a Health Affairs study showed that this hospital employment shift could be driving a lot more low-value imaging. Their review of Massachusetts’ 2009-2016 data found that orthopedic patients (w/ lower back, knee, and shoulder pain) were more likely to be referred for an MRI (+31%) and/or an inappropriate MRI (+26%) after their physician became hospital-employed.
  • Acquiring Referrals – Tying it together, a federal case against East Texas Medical Center suggests that in-hospital referrals could be influencing practice acquisitions and physician compensation plans. The case alleged that ETMC based the value of its practice acquisitions on future referrals and then created a “mandatory referral system” by tying the newly-acquired physicians’ compensation to their referrals.
  • The Takeaway – Some might debate correlation and causation, but the big takeaway seems to be that healthcare consolidation is having a measurable influence on imaging volumes, potentially with legal, financial, and ethical ramifications.

Arterys’ AI Journey

Check out this Imaging Wire Q&A, where Arterys CEO John Axerio-Cilies, PhD discusses medical imaging’s AI and cloud evolution and how Arterys works with its Center of Excellence partners to make AI real.

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Fracture AI

French researchers detailed how AI could help emergency physicians catch more skeletal fractures and improve productivity.

  • The Background – Emergency X-ray interpretation workflows are increasingly constrained (especially in Europe) and missed fractures represent 80% of emergency departments’ diagnostic errors.
  • The Model – The researchers developed an appendicular fracture detection and localization system (w/ 60k images – 70% training, 10% validation, 20% testing) that highlights potential fractures in radiographs.
  • The Study – To test the model, they had six radiologists and six emergency physicians detect and localize fractures in 600 X-rays (50% with fractures, from 17 medical centers, 6 X-ray system brands) with and without AI support.
  • The Results – When the physicians used AI, sensitivity increased by 8.7% (70.8% to 79.4%), specificity increased by 4.1% (89.5% to 93.6%), average reading time dropped by 15% (67 to 57 seconds), and average false positives fell by 41.9% (0.113 to 0.066 per patient without fractures).
  • The Takeaway – There’s been a string of recent calls for more evidence that AI can help both patients and physicians – and this as evidence.

Benchmark Your Practice

Know how your practice measures up? In its latest post, Healthcare Administrative Partners details the key benchmarking quality metrics and how they can help radiology practices improve.

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The Wire

  • MEDO’s Thyroid Ultrasound FDA: Ultrasound AI startup MEDO announced the FDA approval of its Medo-Thyroid ultrasound workflow solution, which analyzes thyroid ultrasound exams and automatically creates TI-RADS-based reports featuring thyroid measurements and nodule characteristics.
  • COVID Imaging’s Long Haul: Chinese researchers found that 24% of patients who had severe COVID-19 infections still show lung CT abnormalities after 12 months (n = 83), particularly patients that had high CT pneumonia scores when hospitalized.
  • A Flint X-Ray Controversy: X-ray technology found its way into the Flint water controversy after attorneys began performing X-ray fluorescence (XRF) scans to prove their claimants’ lead exposure levels and justify their share of the crisis’ $641m settlement. Health experts are concerned about exposing these (already lead-exposed) people to unnecessary radiation.
  • Mammogram Texture AI: A pair of New Zealand-based researchers made the news for their machine learning technique that was able to detect/locate microcalcifications and assess breast density with 92% and 87% accuracy using mammogram texture features (n = 700). These algorithms are still early stage, but the researchers are optimistic about their texture-based approach.
  • A 14-Year Hiatus: Here’s an interesting story about Michigan Medicine’s Susan Hamman, MD’s return to radiology after a 14-year hiatus. Hamman started her comeback in 2017 before starting a “mini-fellowship” and passing her board exams. Even with radiology’s many changes, everything “came back very quickly” for her.
  • Bone Density Predicts Heart Disease: A new study (n = 12,681, 50-80yrs) found that women with lower DEXA-based bone mineral density have higher risk of atherosclerotic cardiovascular disease (ASCVD). The study adds more evidence that DEXA bone scans could predict heart disease, following another study that suggested AI-based DEXA analysis could be used in heart disease population health programs.
  • Unauthorized Tech: A Chicago area imaging center exec is facing charges (battery, forgery, fraud) for administering CT contrasts, performing CT scans, and filing for reimbursements with forged technologist credentials. The 41-year-old man (w/ HR and pharmacy tech training) was discovered when a patient called the police after an adverse contrast reaction.
  • Radiology’s Private Leadership: A new AMA survey found that radiologists are among the most likely U.S. physicians to work at a private practice (55.4% vs. 49.1% overall), have “owner” employment status (54.1% vs. 44%), and work within a single-specialty physician group (52.8% vs. 42.6%).
  • GE’s PET Acquisition: GE Healthcare acquired French radiopharmaceutical biomarker developer, Zionexa SAS, adding Zionexa’s Cerianna late-stage breast cancer F-18 PET agent to its precision health portfolio. GE plans to expand Cerianna’s availability, noting that the agent is only available to a quarter of U.S. patients who could benefit from it.
  • Lung Nodule AI: A new study out of China detailed a CT-based deep learning model that assessed pulmonary nodule malignancy with similar accuracy as radiologists. The researchers analyzed 150 nodules (60% malignant), finding that the DL model characterized the nodules (as benign, intermediate, or malignant) with 70% accuracy (vs. radiologists’ 64%).
  • Dissatisfied Rads: A new JACR survey (n = 456) found that 37.4% of radiologists have burnout, 45% experienced sleep-related impairment, just 35.6% are professionally fulfilled, and 33.3% intend to leave their jobs. Female rads had higher burnout (44% vs. 31%), lower professional fulfillment (30% vs. 42%), but also lower intentions to leave (26% vs. 38%) than their male peers.
  • The Patient-Centered Radiology Report: A University of Wisconsin study confirmed that “patient-friendly” radiology reports should be understandable, easy to use, include image and notes sections, and work with all exams and modalities. The team developed this new report based on their previous research into patients’ radiology report preferences and questions, and then confirmed the new designs’ effectiveness via their latest study.
  • A Contrast Shock Inquiry: An investigation is underway after an Australian woman suffered a fatal CTA contrast reaction without receiving an adrenaline shot. The onsite radiologist initially treated the woman for an intracranial reaction because he wasn’t aware seizures are an anaphylaxis symptom. Upon realizing adrenaline was required, he prioritized airway support because none of the onsite staff were clinicians and he couldn’t do “two things at once.”

United Imaging in Growth Mode

United Imaging took another step in its growth strategy this month, announcing its first U.S. channel partnerships with Radon Medical Imaging (mid-Atlantic), Imaging Solutions (mid & northern U.S.), and Medimax (Puerto Rico).

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The Resource Wire

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  • This new paper in Entrepreneur details the impact that AI can have on population health programs, touching on Zebra-Med’s own efforts to expand population health AI.
  • Novarad’s COVID-19 AI Diagnostic Assistant was just named the 2021 MedTech Breakthrough Awards’ ‘Best New Radiology Solution,’ for its ability to quickly and accurately diagnose COVID-19 patients.
  • It says a lot when a solution works so well for a radiology department that they decide to perform a study to quantify its benefits. In this Imaging Wire Q&A, University Hospital of Zurich’s Thomas Frauenfelder discusses his experience and study on Riverain Technologies ClearRead CT.
  • Radiology is among the top five specialties reporting significant burnout. Join The Nuance Challenge to discover how to optimize workflow to improve provider satisfaction and accelerate care delivery.
  • See how Einstein Healthcare Network reduced its syringe costs, enhanced its syringe loading, and improved its contrast documentation when it upgraded to Bayer Radiology’s MEDRAD Stellant FLEX CT Injection System.
  • New ergonomics and enhanced auto-positioning are just a few of the ways that Canon Medical System’s new OMNERA 500A DR system improves technologist workflow and patient care. Check out the rest here.

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