Microwave Mammography | DBT’s Costly Benefits | Sticking to Medicine

“If this country needs more gun control and climate change activists, medical schools are not the right place to produce them.”

Former UPenn Perelman School of Medicine associate dean, Dr. Stanley Goldfarb, telling U.S. med schools to stay in their lane and focus on teaching medicine.

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The Imaging Wire

Microwave Mammography

A Japanese research team developed a microwave-based mammography screening technique that is reportedly less painful, safer, more accurate, and better with smaller tumors than current X-ray or ultrasound-based technology. That’s a pretty big claim and here’s the background.

  • Microwave Mammography – The Kobe University-developed technique uses an antenna to beam microwaves over the surface of the breast, producing “highly accurate” 3D images of breast tumors. The new technique reportedly fared well versus X-ray mammography and breast ultrasound scans in a 300-person study. However, because microwave can’t pass through muscle, the new tech may not be applicable to other cancers.
  • Next Steps – The team is planning clinical tests next year and may commercialize the new technology in Japan as early as fall 2021, after receiving the country’s “fast track” designation. The announcement didn’t mention plans to expand to the rest of the world, although if this new microwave-based mammography approach truly achieves the above advantages, global expansion seems inevitable.

DBT’s Costly Benefits

New research published in the Journal of the National Cancer Institute confirmed that DBT screening reduces false-positive exams and has similar or slightly greater health benefits compared to DM. However, its benefits don’t justify its higher costs. At least not at current reimbursement rates.

  • Study – The researchers used three CISNET breast cancer models to simulate DBT and DM screening on U.S. women aged ≥40 years, starting in 2011 and continuing until each reached 80 years old.
  • Results – The study found that DBT reduced false-positive exams by between 24% and 28%, slightly reduced breast cancer deaths (between 0 and 0.21 per 1k women), and slightly improved quality-adjusted life-years (QALY, between 1.97 and 3.27 per 1k women) compared to DM. However, DBT’s incremental cost-effectiveness ratio range ($195,026 to $270,135 per QALY) positions it well above healthcare’s standard $50k-$150k QALY threshold, suggesting that DBT would only make financial sense at lower reimbursement rates or if only used with specific groups of women.

Sticking to Medicine

Former UPenn Perelman School of Medicine associate dean, Dr. Stanley Goldfarb, took to WSJ’s opinion page to criticize medical schools’ increased focus on social justice topics “that relate to health care only tangentially.” Goldfarb warned that this “politicized medical education should worry all Americans” as more curricula is focused on progressive causes (e.g. climate change, social inequities, gun violence) at the expense of actual medical training.

Backlash against Goldfarb’s editorial came fast and fierce enough for Perelman to publicly clarify that they’re still “woke” enough to realize that the most serious social issues often have medical consequences. Meanwhile, others pointed out that medical science education and social determinants education isn’t an either-or scenario.

No matter where you stand on this issue (emphasizing medical education seems pretty reasonable), most would agree that mixing medicine and politics is tricky these days.

The Wire

  • ProPublica made the fact that millions of people’s medical images are publicly available on the internet a lot more public this week. ProPublica identified 187 Internet-accessible servers holding medical images of over 5 million Americans and 16 million people worldwide that “are so insecure that anyone with a web browser or a few lines of computer code can view.”
  • Siemens Healthineers announced the FDA clearance of its Artis icono angiography systems, expanding and diversifying the company’s interventional portfolio with the “Artis icono” biplane system (for neuroradiology and abdominal procedures) and “ARTIS icono floor” single-plane floor-mounted system (for vascular, interventional cardiology, surgical, and oncology procedures). Siemens highlighted the ARTIS icono platform’s OPTIQ image chain image processing technology (increases image quality, allows lower dosage) and the models’ improved Case Flows support (creates personalized workflows).
  • North Carolina State University scientists identified a new ultrasound technique that might be able to help clinicians differentiate between healthy bone and osteoporosis. The technique turns one of ultrasound’s shortcomings (US usually struggles with complex media like bone) into an advantage by measuring the rate that ultrasound waves diffused from a bone site to assess the number, size, and density of bone pores. The technique is “at least years from clinical applications,” but could serve as a common way to monitor bone health without radiation. Although the bone health application got most of the attention, a variation of the same technique could also be used to spot tumors.
  • Canon Medical announced a range of tools and options intended to help its customers create lung cancer screening programs based around its CT systems (most are approved for low-dose LCS). Canon’s LCS portfolio includes its Vitality XT protocol management solution (manages CT dose, protocols, and equipment), Image Maker marketing platform (gives access to co-branded LCS marketing materials), Visia CT Lung CAD Vitrea CT CT Lung Analysis tools (automatic nodule tracking using advanced visualization), Aquilion family CTs, and Celestion PET/CT system. Nearly all of these products/solutions were already available (maybe all were), making this more of a marketing effort than an actual product launch. Not that there’s anything wrong with that.
  • Australian drug discovery and development company AdAlta announced a licensing deal with GE Healthcare that will allow GE to use AdAlta’s i-body platform to develop a portfolio of PET imaging agents. AdAlta will identify i-bodies (a new class of therapeutic protein) that GE can use as PET imaging agents for the selection and monitoring of patients receiving immunotherapy.
  • Riverain Technologies landed $15 million in funding that it will use to expand its product development (including a possible expansion beyond lung disease detection) and scale up its global commercialization efforts. Riverain’s ClearRead tools help clinicians detect cancer and other cell anomalies in thoracic CT and X-ray images and are in use at an impressive list of providers (Duke, Mayo, U of Chicago, U of Michigan, the VA).

The Resource Wire

  • How much does an MRI 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 MRI costs between $225 and $700.
  • This Carestream case study compares images of foot trauma captured using the OnSight 3D Extremity System to images captured on 2D X-rays.

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