MRI PCa Screening | Rethinking Liability | Aduhelm’s Bad Start

“PACS guy wasn’t impressed when I suggested a ‘Trash’ folder for studies with questionable indications.”

A tweet from Dr. Longissimus.

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The Imaging Wire

Prostate Cancer Screening Potential

A new NEJM study revealed that combining MRI-based prostate cancer screening with MRI-targeted biopsies could make population-scale prostate cancer screening feasible.

  • The Study – The Swedish research team enrolled 1,532 men with elevated PSAs (≥3 ng per ml), performing standard ultrasound-targeted biopsies on 603 men and MRI screening exams on 929 men. The men who showed signs of prostate cancer in their screening MRIs also underwent MRI-targeted biopsies.
  • The Results – The experimental MRI screening and biopsy approach detected more clinically significant cancers than ultrasound-guided biopsy screening (21% vs. 18% of men in each group), but flagged far less clinically insignificant cancers (4% vs. 12%), and produced a far lower overall biopsy rate.
  • The Takeaway – Population health prostate cancer screening has traditionally been challenged by ultrasound’s high overdiagnosis rates and concerns about MRI-based screening costs. However, the researchers suggest that the savings from reducing unnecessary biopsies and avoiding overtreatment of insignificant cancers could offset MRI screening’s added costs, potentially making MRI-based prostate screening programs both clinically and economically feasible.

GE’s Case for Quantitative SPECT/CT

See what early users of GE Healthcare’s new StarGuide SPECT/CT have to say about how the system is bringing quantitative SPECT/CT into routine clinical practice.

– Sponsored.

OLGH’s PowerScribe One Improvements

See how the Ochsner Lafayette General health system improved its radiology report quality and efficiency when it migrated to PowerScribe One.

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The Wire

  • Aidoc’s $66M: Aidoc completed an impressive $66m Series C round, increasing its total funding to $140m, and revealing plans to further expand its AI platform. Nine-figure funding totals have historically been reserved for care-connected AI players (e.g. Viz.ai’s $151m & HeartFlow’s $577m), so this is a milestone for the triage/detection side of AI and a testament to Aidoc’s accomplishments (portfolio, regulatory, adoption, partnerships …. and expanding to care coordination).
  • Inpatient Mammograms: A Johns Hopkins study shared the latest evidence in favor of offering screening mammograms to hospitalized women (here’s a similar study). The researchers offered mammography exams to 101 past-due hospitalized women, performing mammograms on of the 79 women. The process received positive reviews from the involved patients (100% satisfied), nurses (100% support making it a standard), and physicians (66% agree this is feasible).
  • Imaging’s Executive Order: President Biden’s recent “Promoting Competition” executive order caught the medical imaging industry’s attention, revealing the administration’s goals to prevent industry consolidation (specifically referencing healthcare), fight excessive healthcare costs, and address unfair restrictions on third-party equipment repair. The U.S. FTC was already probing healthcare consolidation and the medical device right-to-repair debate has been raging for some time, but these statements provide a clearer indication of where the White House stands on these issues.
  • POCUS Training Gap: Bedside ultrasound is a critical tool for pulmonary critical care physicians, but a recent Chest Journal study revealed that many PCC fellows have to develop POCUS expertise on their own. The survey (n = 475 fellows) found that PCC fellows usually learn ultrasonography independently at patient bedsides due to a lack of trained faculty experts and formal curriculum.
  • Nanox in Nigeria: Nanox announced that Nigeria’s EiLEENO Pharma will distribute 1,000 Nanox.ARC systems, adding to Nanox’s growing list of pre-launch distribution partners. However, as Nanox critics have pointed out, many of these global partners (including EiLEENO) seem to have small or unestablished medical imaging businesses and might not have the relationships or experience required to actually sell all these units.
  • Rethinking AI Liability: A HBR editorial proposed overhauling government liability systems because the current systems aren’t constructed to handle AI-related errors, and this mismatch is hindering AI innovation and adoption. The UPenn-based authors proposed shifting liability upstream from end-users (e.g. physicians or drivers) to developers and manufacturers, by adding AI to standards of care, changing who compensates injured parties, and creating new insurance, liability, and regulatory structures (among other changes).
  • Vue PACS Vulnerabilities: The U.S. federal cybersecurity agency (CISA) reported 15 security flaws in various Philips’ Vue PACS products that hackers could use to remotely access and control the systems. Philips already addressed some vulnerabilities in its previous software updates, but the remaining patches aren’t scheduled until Q1 2022. Until then, the CISA encouraged administrators to apply workarounds and additional security measures.
  • Communicating LCS Results: A Weill Cornell study found that many referring providers are okay with radiologists communicating lung cancer screening results to their patients, but patient preferences were mixed. The 2016-2017 surveys (n = 47 providers, 140 patients) found that most providers approved of radiologists sharing normal and abnormal results with patients after reviewing with them first (74% & 81%), while far fewer patients prefer to receive their results from radiologists (25%).
  • RAYUS’ FL and Research Expansion: Just a week after announcing plans to expand nationwide, RAYUS Radiology (formerly CDI) acquired Sand Lake Imaging (3 Orlando imaging centers, 3 radiologists) and took a majority stake in Sand Lake’s clinical trial business (now relaunched as The Radiology Research Institute). Although the new imaging centers certainly support RAYUS’ nationwide imaging strategy, the announcement largely focused on how this acquisition expands RAYUS’ clinical trial business.
  • The VA’s Failed LCS Follow-Ups: A JAMA study revealed significant challenges with the VA’s lung cancer screening follow-up performance. Among 28,294 veterans who received lung cancer screenings, 3,696 (13.1%) had late follow-up evaluations and 4,439 (15.7%) had no follow-up tests. Follow-up rates were greatest among veterans with high-risk findings and those attending high-volume / academic centers, while disadvantaged veterans (black, poor, mental disorders) were more likely to have no or delayed follow-ups.
  • Telerad’s Fall & Rise: Signify Research revealed that the COVID pandemic drove a 22% decline in global teleradiology volumes in 2020. However, the firm forecast a rebound to pre-pandemic levels in 2021 and 2x growth through 2025 due to: 1) Vaccination progress; 2) Elective backlogs; 3) Radiologist shortages; 4) Demand for CT & MRI reads; 5) Continued after-hours demand; and 6) Increasing emphasis on efficiency.
  • Low-Risk PCa Surveillance: Surveillance methods for men with low-risk prostate cancers can vary widely, but a new Radiology Journal study suggests that its most effective to combine annual MRI exams with PI-RADS-based biopsy decision making. The various surveillance methods involving annual MRI and/or annual biopsy produced similar quality-adjusted life-years (16.15 to 16.19) and overall life years (23.03 to 23.05 years). However, performing annual MRI exams and biopsies on patients with ≥4 PI-RADS sores led to far fewer biopsies (42% less than PI-RADS 3), giving it the best balance of clinical and economic effectiveness.
  • Aduhelm’s Rough Start: The June FDA approval of Biogen’s new Alzheimer’s drug, Aduhelm, would typically be cause for celebration (it could slow Alzheimer’s, heavily reliant on imaging). However, it was immediately met with fierce criticism that has now led to the FDA narrowing its usage recommendation to only patients with mild symptoms (reducing eligible Americans from 6m to 1.5m) and new investigations into how Biogen influenced the drug’s approval.

The Potential of Population Health Cardiac AI

Cardiovascular disease is the number one global cause of death, but it’s also preventable, which is one of the reasons why Zebra-Med views AI-powered cardiovascular screening as the next frontier in population health.

– Sponsored.

How Duke Uses ClearRead CT

Watch Jared Christensen, MD, MBA explain how Duke University Health uses Riverain Technology’s ClearRead CT Vessel Suppress and ClearRead CT Detect in its daily practice.

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The Resource Wire

  • United Imaging’s “all-in” approach means that every system ships with its entire suite of features and capabilities (no options), giving its clients more clinical flexibility and predictability.
  • This Bayer case study details how radiation benchmarking programs can help push CT dose exposure reduction initiatives from achieving compliance to driving quality.
  • 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.
  • Check out this Radiographics study detailing 4D Flow MRI’s (found in Arterys’ Cardiac AI) blood flow assessment advantages over standard 2D phase-contrast MRI.
  • Know how your practice measures up? In this post, Healthcare Administrative Partners details the key benchmarking quality metrics and how they can help radiology practices improve.
  • A new study in European Radiology highlighted Riverain Technologies’ ClearRead Xray – Detect as one of just two imaging AI products to achieve the FDA’s most stringent premarket approval level. See how they measured up against the other 99 AI tools here.
  • Do your patients text more than they use CDs? Find out how Novarad’s CryptoChart simplifies image access, combining secure QR codes and text and email communications to help providers and patients ditch the disk.

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