Predictive POCUS | Imaging Confidence | DBT Size Matters

“Why are we clinging to this medical relic with minimal utility and known infection risk?”

Larry Istrail MD questioning clinician’s continued loyalty to the stethoscope, despite the advantages of point-of-care ultrasound.

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

Predictive POCUS

A new study out of Italy revealed that lung point-of-care ultrasound (LUS) can help determine COVID-19 patients’ need for ICU admission and predict their mortality risk.

  • The Study – In the prospective study, clinicians performed LUS on 41 CV19-positive patients in the ED, finding that 38 patients had signs of COVID-19 in at least one lung area and three patients had normal LUS results (they were also negative on CXR). The researchers assigned a 0-3 severity score to each of the patients’ 14 lung areas (0 = negative; 3 = severe). The patients had a median of 6 lung areas with pathological findings (areas with ≥ 1 scores), a 71% median rate of lung area involvement, and a median average LUS score of 1.14.
  • Mortality Risk – The patients who died had far higher average scores (1.43 vs. 1.0) and lung area involvement rates (100% vs. 50%) compared to those who survived, but they had similar levels of lung areas with pathological findings. All patients who died had a LUS score above 1.1 and an average pathology rate above 70%.
  • ICU Admission – Patients admitted into the ICU had higher average scores (1.36 vs. 1.0), higher lung area involvement rates (93% vs. 20%), and more areas of lung involvement (difference = ~4) than those not admitted. However, these metrics did not predict which patients would require ventilation upon admission.
  • COVID-19 Pneumonia Defined – Based on these findings, the researchers suggested that the cutoff for COVID-19 pneumonia is a LUS score of 0.4 and a lung area involvement rate of at least 20%.
  • Significance – LUS’ advantages for COVID-19 assessment are well documented, but this appears to be the first prospective study focused on its predictive capabilities, and supports the use of POCUS on suspected CV19 patients as they arrive in the ED.

The Wire

  • Imaging Confidence Index: AHRA’s quarterly Medical Imaging Confidence Index (MICI) continued its rollercoaster year, as its new Q3 2020 survey of imaging managers and directors (n = 161) revealed significantly improved optimism about their expected Q3 performance. The new report detailed on Auntminnie.com revealed a “neutral” 103 overall confidence score (vs. 72 in Q2, 116 in Q1; out of 150), as confidence in scan/IR volume growth hit 125 (vs. 59 in Q2), their role as a profit center grew to 131 (vs. 76 in Q2), and internal cost stability reached 121 (vs. 84 in Q2). However, the respondents were not as confident that access to capital (67 vs. 65) and adequate reimbursements (88 vs. 80) would improve.
  • Radboud’s AI Database: To help the radiology community keep track of the growing list of available imaging AI solutions, Radboud University Medical Center’s Diagnostic Image Analysis Group (DIAG, in the Netherlands) just rolled out the AI for Radiology database. The online database features the vast majority of commercially available imaging AI products (especially CE-marked tools) with details on each product’s subspecialty and modality, FDA / CE approval type, and key specifications.
  • Self Ultrasound Training: A Singapore-based academic radiology team detailed their move to have residents perform ultrasounds on themselves in order to continue teaching during the COVID-19 pandemic (in addition to standard webinar and video training). The department provided residents with ultrasound systems and a list of their body parts to image (bowel, vessels, neck, MSK), finding that the residents who trained via “self ultrasound” achieved similar accuracy as previous residents trained on patients.
  • First Ultrasound Biosensor: A CalTech team developed a new ultrasound marker that can indicate when certain enzymes are active inside cells, making it the first ultrasound biosensor. This breakthrough comes after the team discovered that gas vesicles (tiny air-filled protein shells in bacteria) are conducive for ultrasound imaging, suggesting that the biomarker could be modified to study a wide range of cellular enzyme activity (and therefore a wide range of bioprocesses).
  • Canon’s CV CT: Canon Medical introduced its new Aquilion ONE / GENESIS SP cardiovascular CT system. The new addition to Canon’s Aquilion ONE / GENESIS wide-area CT platform is designed for structural and coronary imaging, using Canon’s AiCE solution for “one-beat, whole-heart acquisition” and adopting a range of other cardiovascular solutions (e.g. SURECardio and Vitrea Advanced Visualization) to better support cardiac patients and physicians.
  • Siemens & ImageBiopsy Lab: Siemens Healthineers and ImageBiopsy Lab launched a partnership that will make ImageBiopsy Lab’s AI-based KOALA solution for X-ray knee-osteoarthritis analysis available through Siemens Healthineers’ syngo.via platform in Europe and the U.S.
  • DBT’s Size Advantage: DBT provides the most accurate tumor size measurements among all mammographic imaging techniques (DBT, digital mammography, synthetic mammography) and therefore should be the preferred technique for measuring tumor size. That’s from a new study in Clinical Imaging that had an experienced radiologist read DM, DBT and SM scans from 71 breast cancer patients, finding that DBT had the highest correlation with histological tumor sizes, regardless of density.
  • Essential in Louisiana: The American Society of Radiologic Technologists (ASRT) is fighting a Louisiana state bill that would provide a $250 tax rebate to a range of essential personnel involved in the COVID-19 response, but omitted radiologic technologists and radiation therapists. Given that the majority of rad techs/therapists in Louisiana earn too much to qualify for the rebate (must be under $50k/yr), the ASRT might have other reasons to make sure its constituents are viewed as “essential.”
  • Sonosite PX: Fujifilm Sonosite announced the launch of its new flagship Sonosite PX ultrasound system. The new system is highlighted by its image clarity (Sonosite’s “most advanced, ever”), its suite of workflow efficiency features (simplified UI, EHR & workflow integration), and adaptable form factor (horizontal or vertical work surface, adjustable stand, small footprint), while launching with a new family of transducers.
  • AI for LC CXR: A team of South Korean researchers found that a deep learning chest X-ray algorithm can identify overlooked lung cancers without increasing unnecessary follow-up chest CTs. The researchers had nine observers review chest X-rays from 117 patients with visible lung cancer (105 that were overlooked) and 234 healthy control patients. As you might have guessed, the algorithm improved the observers’ average AUC (0.76 vs. 0.67), detection of overlooked cancers (56 of 105 vs. 42 of 105), and follow-up CT rates for overlooked patients (66 of 105 vs. 49 of 105).
  • Walmart Expands: Walmart is continuing its Walmart Health clinic expansion, announcing plans to open its first Florida locations later this year, starting in Jacksonville. The new Florida clinics will join clinics in Georgia, Arkansas, and Illinois, all offering a range of services (yes, including imaging). Although not really an imaging story, it appears that Walmart is leaning-in to its clinic strategy (previous clinics were “test locations”), which is notable given that it’s not the only big box chain moving into healthcare.
  • CT Radiation: A new study in the European Journal of Medical Physics estimated that 2.5 million patients in the 35 OECD countries received CT scans with at least 100 mSv in radiation over five years (0.21% of the countries’ population), suggesting that this widespread radiation exposure deserves attention. The study also revealed that the majority of countries have medium (24 countries w/ 2 patients per 1k people ) or high (9 countries w/ >2 patients per 1k people) rates of ≥100 mSv CT scans.
  • QUIBIM’s €8m: Spanish imaging AI company QUIBIM completed an €8m seed round that it will use to develop its COVID-19 detection software, which it claims can detect COVID-19 in CT scans with 91% accuracy. Although CT’s role in COVID-19 diagnosis has been questioned, QUIBIM suggests imaging is necessary given the potential for user error and false positives with PCR testing.

The Resource Wire

– This is sponsored content.

  • This Riverain Technologies case study details how Einstein Medical Center adopted ClearRead CT enterprise-wide (all 13 CT scanners) and how the solution allowed Einstein radiologists to identify small nodules faster and more reliably.
  • This Nuance case study details how PowerShare Image Sharing helped Navicent Health cut its mammography reporting time by 38%.
  • This Hitachi blog details how the COVID-19 pandemic created new urgency for healthcare systems to adopt and expand tele-health and tele-radiology, while outlining the key considerations for those about to make this transition.
  • GE Healthcare’s Venue Go ultrasound system has a uniquely adaptable design, built to go from cart to wall to table so you can take it almost anywhere at the point of care.
  • The Focused Ultrasound Foundation’s July newsletter features an in-depth discussion about how focused ultrasound could revolutionize therapy.

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