PACS Vulnerability & Security | Custom Drug Discovery | MBI Processing

“Finding a needle in a haystack is much easier when you have a machine made to find needles,”

Penn professor, Andrew Siderowf, MD, on his team’s efforts to develop a breakthrough PET agent to detect and track Parkinson’s Disease.

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  • Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter
  • Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation genuine AI technology to disrupt the industry
  • Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging

The Imaging Wire

PACS Security

PACS vulnerability and security was in the spotlight again this week following a discovery that a massive number of PACS servers are accessible over the internet and a separate report outlining PACS security concerns and safeguards.

Greenbone NetworksA report from German security firm, Greenbone Networks, analyzed over 2,300 PACS servers between July and September 2019, finding that 590 were openly accessible over the internet. These internet-accessible servers contained a whopping 24.3 million data records (names, SSNs, birth dates, exam dates, details on reasons for the exam) and 737 million images (399m easily downloadable) belonging to patients across 52 different countries. Greenbone attributed the servers’ accessibility to “careless configurations,” including a significant number that didn’t have password protection or encryption.

NCCOE – The National Cybersecurity Center of Excellence released an overview of PACS’ security concerns, and a number of recommendations on how to protect PACS systems, while urging healthcare systems to address vulnerabilities. Noting that PACS are widely connected across healthcare networks, NCCOE recommended a defense-in-depth solution that includes network zoning (controls traffic flows/communication), access authentication (for both providers and devices), limiting vendors’ remote support, a holistic risk management approach, and expanded enterprise security.

Considering that just a month ago ProPublica identified 187 Internet-accessible servers with images from 16 million people, it’s safe to say PACS security should be top of mind right now for most healthcare IT (and legal) departments.

Custom Drug Discovery

A Boston Children’s Hospital team’s creation of a custom drug to correct errors in a young girl’s DNA and slow the progression of her Batten disease is creating new optimism over what can be achieved through truly personalized medicine.

Mila Makovec – Mila was diagnosed with Batten disease at the age of six, prompting her family to set out to find a cure for this “fatal and untreatable” genetic brain disease. The family eventually connected with the Boston Children’s team, who performed whole-genome sequencing on Mila’s DNA to identify the unique mutation that caused her disease. With the cause identified, the team designed a custom drug (naming it “Milasen”) and tested it on Mila’s cells and on lab animals before receiving FDA approval and treating her in early 2018. Milasen wasn’t able to reverse all of the earlier damage, but it apparently stopped progression of the disease and significantly reduced her symptoms, which is a major accomplishment.

Reason for Optimism – The case of Mila Makovec reveals that customized genetic drugs, known as antisense oligonucleotides, can be genetically personalized. These custom drugs can also be used in treatment in far less time than a standard commercial drug (15 years vs. 1 year). This could be welcome news for the people suffering from the over 7,000 rare and often untreatable genetic diseases.

Ethical Conflicts – There are some lingering questions regarding the high costs to save a single patient and the potential to harm a patient after such a short development and trial period. However, some believe that the process used to create Milasen can be leveraged for other custom drugs (reducing costs) and the risk of harm might be viewed as justified by people who would otherwise die.

This story doesn’t directly involve imaging, but it’s fascinating, and imaging was involved throughout Mila’s treatments as well as for future patients like her.

MBI Processing

A Mayo Clinic-led team found that an image-processing algorithm could allow reduced-dose molecular breast imaging (MBI) examinations without compromising imaging quality or lesion conspicuity.

The Study – Using images from 50 standard-dose MBI exams showing at least one breast lesion, the team simulated half-dose MBI exams and processed them with the new algorithm (in “default” and “preferred filtered” modes), and then had both sets reviewed by a pair of radiologists.

The Results – Although the simulated half-dose MBI images were found to have poor image quality (92 out of 100 were deemed “poorer” than standard dose MBI images), the algorithm’s “default” images (13 better, 73 equivalent) and “preferred filtered” images (55 better, 34 equivalent) performed well compared to the full-dose images.

MBI is still a niche breast cancer screening modality, but its benefits for higher-risk and high-density women is clear, and image-processing algorithms like this may help reduce adoption-hindering concerns over radiopharmaceutical exposure.

The Wire

  • MEDNAX announced plans to sell its MedData healthcare management services business (2k employees, 3k managed facilities, 10k supported physicians) to Frazier Healthcare Partners for $250 to $300 million. This is part of the “transformation” that MEDNAX has been discussing for a while (in addition to a pause in its radiology practice acquisitions), as it will allow the company to focus on its core physician services business, pay down its liabilities, and fund future acquisitions that better align with its ongoing strategy.
  • A team of Swedish researchers found that ultra-low-dose CT is a viable alternative to DR for extremity fractures, detecting “significantly more fractures” and providing more important information at a comparable radiation dose. The researchers scanned 207 extremities using a 256-slice ULD-CT (ID’d 109 fractures) and a DR system (ID’d 73 fractures), with CT detecting additional fracture-related findings in 33 cases (15.9%) and confirming or ruling out suspected fractures in 19 cases (9.2%), although they did note that ULD-CT scans are 2-times more expensive than DR.
  • UC San Francisco announced the launch of its new Center for Intelligent Imaging (ci2), created in partnership with NVIDIA with the goal of building infrastructure and tools to help bring imaging AI into clinical practice. ci2 researchers will combine patient images and clinical data from UCSF Health and other institutions with NVIDIA’s DGX-2 supercomputer (one of the first installed) to develop, test, and validate deep learning algorithms. The center will also promote collaboration with the startup community, initially through a partnership with Kheiron Medical.
  • A Penn Medicine-led research team landed a $20 million NIH grant to fund the development of a specialized PET tracer used to diagnose and track Parkinson’s and other neurodegenerative diseases, supporting early diagnosis and speeding up clinical trials for potential treatments. The researchers plan to develop two tracers, one that binds to alpha-synuclein proteins for the imaging of Parkinson’s and multiple system atrophy, and another that will bind to 4R tau protein for the imaging of frontotemporal degeneration and progressive supranuclear palsy.
  • Guerbet will distribute icometrix’s icobrain neuroimaging AI solution in France, Italy, and Brazil. Icobrain helps diagnose and monitor patients with neurological disorders using information from brain CT or MRI scans, which aligns with Guerbet’s focus on contrast agents for these modalities. The alliance also continues Guerbet’s focus on AI partnerships, following a pair of AI collaboration announcements with IBM Watson Health for liver and prostate cancer detection.
  • Researchers from Germany found that a deep learning algorithm performs similarly to radiologists’ clinical PI-RADS assessments among men suspected of having clinically significant prostate cancer. In a retrospective study of T2-weighted and diffusion 3T MRI sequences, the team trained their U-Net algorithm on data from 250 men and tested it on data from 62 men. At a ≥0.33 probability threshold, U-Net achieved 92% sensitivity and 31% specificity, both statistically similar to PI-RADS.
  • Oregon Tech launched its new $1.85 million Radiologic Science lab that will use a range of Konica Minolta and Shimadzu technologies (DR systems and panels, IT, and analytics) for hands-on experience and project-based learning at one of the country’s few 4-year radiologic science programs. This is more than a typical educational X-ray lab deal, as Konica Minolta will use Oregon Tech as a beta site for software upgrades and will work with some students as they start their careers.

The Resource Wire

  • In this post Nuance Diagnostics SVP & GM, Karen Holzberger, shares how Nuance’s mPower Clinical Analytics Healthcheck service scours unstructured data in radiology reports to generate detailed analyses that improve financial and patient outcomes.
  • Yale University research reveals that the average patient drives past six lower-cost providers on the way to an imaging procedure, due in large part to patients’ and physicians’ limited cost consciousness. Medmo helps address this issue by letting patients enter what they can afford for their scan, then booking them at a nearby imaging center willing to accept that rate
  • In this Carestream blog post, an imaging leader at North Colorado Medical Center details the evaluation process that led to them upgrading to Carestream ceiling mounted X-ray systems.
  • POCUS Systems is approved as a Veteran Owned Business with the US Government Office of Veterans Business Development, paving the way for partnerships with the federal healthcare delivery systems.

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