POCUS Complements | PET Setback | Siemens’ Step

“it’s a very fair question — why should we even do this testing?”

Washington University in St. Louis neurologist Dr. Suzanne Schindler on using brain PET scans for Alzheimer’s disease detection if there aren’t any proven AD treatments. Then she shared some solid justifications.

Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire

Complementary POCUS

When clinicians use point-of-care ultrasound in the emergency department, it doesn’t reduce downstream radiology ultrasound volumes (Rad US) and might actually help increase Rad US volumes. That’s from a new JACR study and here are the details:

  • The Study – The researchers reviewed Rad US volumes before and after a pediatric hospital adopted emergency POCUS between 2011 and 2017 (n = 648k EM visits, 49.9k Rad US exams, 2.77k POCUS exams). Interestingly, this is the first (or one of the first) studies looking at the relation between POCUS adoption and Rad US volumes.
  • Rad US Volumes – The study found that overall Rad US volumes remained unchanged during the early stages of POCUS adoption and grew as ED POCUS volumes increased.
  • SSTI Volumes – The researchers also looked at skin and soft tissue infection (SSTI) US volumes, which can be diagnosed using both Rad US and POCUS. SSTI-related Rad US volumes increased significantly early after POCUS adoption but didn’t change as POCUS use expanded.
  • Takeaways – The main takeaway is that emergency POCUS is a complement to radiology ultrasound, not a threat, even for SSTI scans. It’s also an encouraging step towards understanding how POCUS and Rad US (or other modalities) can work together.

PET’s Failed Test

A major study intended to help Medicare decide whether to cover costly PET brain scans ($4k – $5k each) for early Alzheimer’s disease detection found that the scans did not reduce future emergency room visits and hospitalizations.

  • The Study – The massive study ($100m, 25k Medicare recipients), detailed at the Alzheimer’s Association International Conference, scanned 12,684 people with dementia or mild cognitive impairment and compared their future ED visits and hospitalizations to a similar control group who didn’t receive scans.
  • The Results – Although initial results from the study four years ago found that the scans allowed early diagnosis and altered care in up to 60% of cases, this second study phase was unable to prove that early detection lowered future care / costs. Study participants who received scans only had slightly fewer first-year hospitalizations (24% vs. 25%) and fell well short of the study’s goal of reducing hospitalizations by 10%.
  • The Significance – CMS already decided against covering these scans in 2013 and this study might make it a long shot that Medicare will start covering them any time soon. It could also influence private coverage decisions. However, advocates note that there are other benefits to early detection beyond reducing downstream costs (planning, preventative efforts).

The Wire

  • Siemens & Varian: Siemens Healthineers took a major step into cancer care and made its biggest move since its 2018 spinoff, acquiring Varian Medical Systems for $16.4b (a 24% to 42% premium). With the companies’ combined imaging and radiation therapy strengths, Siemens Healthineers plans to become the global leader in cancer care solutions.
  • No Surprises, Please: Surprise billing legislation lost its momentum amid the COVID-19 emergency and a new letter from the ACR and 100+ other medical societies/associations is trying to keep it that way. The group urged U.S. House and Senate leaders to keep surprise billing legislation out of the COVID relief package and to delay any legislation until healthcare has stabilized.
  • Breast MRI Cost Effective: A new study in JAMA found that breast MRI screening every 18 months is cost-effective for 35-60yr-old women with a family history of breast cancer. The economic modeling study (n = 10m women with 20% or more family risk) found that 18mo MRI screens added 79 additional quality of life years (QALY) per 1k women compared to mammography. Using a value of $24,795 per QALY, breast MRI’s value just surpasses its added costs ($24,097).
  • Hip Fracture AI: Researchers from Japan developed a hip fracture detection algorithm that was trained using annotated CT and MRI images (the gold standard for hip fractures), and can be used to analyze pelvic X-rays. The algorithm was trained using CT and MRI scans from 302 patients with proximal femoral fractures (plus 25 for testing and 25 controls). During testing, seven radiologists achieved an 0.832 AUC without AI and an 0.876 AUC with AI support, while the algorithm had a 0.905 AUC on its own. The two most experienced radiologists were more accurate than the algorithm.
  • Read & Respond: A study published in JACR revealed that revising mammography recall letters down to a 6th grade reading level significant improves patient follow up. The retrospective study (n = 1,987 w/ standard letter, 2,211 w/ 6th grade letter) found that patients who receive the revised 6th grade level letter had 1.78-times greater odds of returning for a diagnostic follow up within 60 days. The Imaging Wire will always agree about the benefits of readability.
  • NHS Selects Bleepa: UK imaging software company Feedback Plc announced that it will provide its Bleepa app to the UK NHS. Bleepa allows secure “medical grade” image messaging and viewing on mobile devices and will be used as part of the NHS’ clinical communication tool framework.
  • WHO Guidance: The WHO just published a new guide on using chest imaging to diagnose and manage COVID-19. The guide recommended using chest imaging to diagnose symptomatic patients only when RT-PCR tests aren’t available or if the RT-PCR test is negative, but the patient is still suspected to have coronavirus. For COVID-19 management, the guide recommends using imaging for: 1) Deciding whether to admit and/or discharge patients with mild symptoms; 2) Deciding whether patients with moderate-to-severe symptoms should be admitted to a regular ward or ICU; 3) Guiding therapy for patients with moderate-to-severe symptoms; but not for guiding discharge decisions for patients with resolved symptoms.
  • Parkinson’s Tracer Grant: AC Immune scored an up to $3.2m grant that it will use to develop PET tracers for Parkinson’s disease diagnosis and monitoring. AC Immune is hopeful that its alpha-synuclein-PET tracers could become the first imaging agents able to detect and monitor Parkinson’s disease progression.
  • Nanox Going IPO: Nanox is keeping its funding push going, filing a $125m Nasdaq IPO that could value the company at $500m or more. Nanox’s official IPO announcement (it’s been rumored for a while) comes on the heels of a $110m round and the IPO would nearly double the company’s $137m raised to date.
  • Federated Learning Evidence: UPenn and Intel published the first results from their Federated Learning brain cancer detection collaboration. The study essentially reveals that their Federated Learning approach achieved its intended results of protecting patient privacy and supporting the development of more generalizable algorithms. They used FL to access data from 10 institutions (n = 2,600 brain MRIs, 660 patients) and created a multi-center algorithm that can identify brain tumors with 99% of the accuracy of models trained/tested on a hospital’s own internal data.
  • APRN Fight in GA: The Medical Association of Georgia and the AMA spoke out against a Georgia State Senate bill that would allow advanced practice registered nurses (APRNs) to order advanced imaging (CTs, MRIs, etc.). The groups urged Georgia Governor Brian Kemp to veto the bill, warning that it will increase health care costs and threaten patient health/safety, citing studies that APRNs order more scans than doctors.
  • EMVision’s $6.4m: EMVision Medical Devices will issue $6.4m in shares that it will use to develop and commercialize its portable electro-magnetic brain scanner. The “portable, cost-effective and non-invasive” Electromagnetic RF brain scanner previously proved to have strong correlation with MRI and CT scans and could help speed up the diagnosis and monitoring of neurological disorders.

The Resource Wire

– This is sponsored content.

  • In this GE Healthcare video, ultrasound users and educators discuss how the Vscan Extend handheld ultrasound combines portability and intuitive design so you can use it in the moment to potentially change patient outcomes.
  • Acknowledging the pressures that hospitals and imaging centers are under during the COVID-19 emergency, Hitachi’s latest blog details the equipment financing programs have become most in demand and unveils its new post-COVID programs launched in partnership with Key Equipment Finance.
  • 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.
  • This Nuance blog details how the speed of radiology’s post-COVID road to recovery will depend on how the specialty accelerates its digital transformation, including its adoption of AI, NLP, and follow up tools.
  • This Focused Ultrasound Foundation article details a new study on how FUS could be used to treat depression.

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