Rorschach Imaging Test

“Is this a Rorschach test for NNX bulls and bears?”

A YouTube commenter on confirmation bias’ role in the reviews of Nanox’s big RSNA demo.

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The Imaging Wire

Nanox Does it Live

Nanox addressed (one of) its critics’ main arguments, performing a live imaging demonstration at RSNA. Here’s how it went down:

  • The Demo – The demo featured Nanox’s CEO performing a 2D scan on his hand and a series of 3D scans performed on human phantoms and a sheep’s leg. Both imaging sessions were followed by praise-filled image analysis delivered by a pair of radiologists (at least one Nanox-affiliated).
  • Big Buzz – Nanox’s RSNA demo might not be all that notable to many Imaging Wire readers, but it was actually the most widely covered event from RSNA 2020. The demo gained coverage from a range of tech, business, and healthcare publications, while over 12k people have watched its video so far (plus >4.2k who watched it live).
  • Here’s The Catch – Like nearly every Nanox story, it seems like the audience was mainly home traders who want their NNOX stocks to surge or Nanox critics looking for evidence that they’ve been right all along (and they both still think they are right). You know who still isn’t talking about Nanox? Most clinicians, imaging leaders, and radiology academics who would determine Nanox’s success if/when it launches.


It’s pretty rare to see competitive feuds go public in healthcare, but we got one last week when RapidAI’s CEO posted a letter calling out Viz.ai’s “false claims and distortions” of CMS’ reimbursement policy for the new LVO AI NTAP.

  • An NTAP Background – CMS granted Viz.ai’s Viz LVO stroke triage solution a special NTAP reimbursement (up to $1,040 per use) in September and since then RapidAI, Aidoc, and Avicenna all announced that their respective LVO solutions are also covered by the NTAP.
  • RapidAI’s NTAP Letter –RapidAI’s public letter argued that its stroke AI rival is distorting CMS policies to convince providers that only Viz.ai’s Viz LVO solution qualifies for the NTAP reimbursements and is discouraging them from using the CMS code with any other LVO solution. RapidAI countered that the CMS NTAP was intended to cover “LVO triage and notification for stroke” (not for any particular brand/solution) and called Viz.ai’s efforts “a desperate attempt to increase lagging market share.”
  • NTAP Evidence – Viz.ai did indeed file for and receive the LVO NTAP and its rivals’ qualifications are based on how you interpret what CMS meant by “substantially similar.” That “up to $1,040” reimbursement figure that everyone keeps referencing is based on Viz.ai’s subscription model, so any other LVO AI company who references that reimbursement value either has the same exact pricing model as Viz.ai or hasn’t confirmed how reimbursements would work with CMS.
  • Where’s CMS? – CMS could clear this up by either clarifying what it meant by “substantially similar” and/or granting qualifying companies their own NTAPs.

Canon’s Big RSNA

Canon Medical had an incredibly active RSNA, launching a wide range of new products and solutions and continuing its emphasis on deep learning-based image reconstruction.

  • AiCE Expansion – Canon continued to expand its AiCE deep learning technology across its modalities, showcasing an AiCE-equipped version of its Cartesion Prime Digital PET/CT system (FDA-pending), expanding AiCE across its CT lineup, and making AiCE scanning available for a wider range of exams with its Vantage Orian 1.5T MRI system (originally prostate and shoulders – now all joints, cardiac, pelvis, abdomen and spine).
  • X-Ray Addition – Canon’s X-ray team highlighted the new OMNERA 500A DR system, bringing a range of enhancements intended to improve technologist workflow (new: ergonomics, auto-positioning, auto tube/detector tracking, detector charging, tilting wall stand synchronization, infection control).
  • Vascular Detector – Canon introduced its new 12×16 panel detector for its Alphenix Sky + and Alphenix 4D CT with Sky + angiography systems (joining its 12×12 detector), which achieves 2-times higher spatial resolution than conventional flat panels.
  • CT Updates – Canon continued to update and expand its CT portfolio, introducing Deep Learning Spectral CT scanning to its Aquilion ONE / PRISM Edition scanner (allows one-beat spectral cardiac CT imaging, images the heart in as fast as 0.275 seconds) and expanding AiCE reconstruction across its CT lineup (originally high-end models). Canon also showed off its new Aquilion Exceed LB CT radiation therapy planning system (launched in October, AiCE, 90cm bore, 90cm FoV, 4cm detector coverage).
  • MRI Upgrades – In addition to expanding the Vantage Orian 1.5T MRI’s supported AiCE applications (see above), the new system will add Canon’s Compressed SPEEDER for 3D sequences (FDA-pending), which helps reduce scan times during 3D MR exams by reconstructing full resolution images from under-sampled data. Canon Medical also introduced a new fat fraction quantification tool to help identify and quantify fatty liver disease using MRI.
  • Ultrasound Enhancements – Canon announced updates to its premium Aplio i-series ultrasounds intended to improve sonographer workflow (new: ergonomics, customization) and aid diagnostic confidence (provides Sonographers wider image view). Canon also introduced a new Liver Reporting Tool for the same models (displays liver measurements based on reporting guidelines).
  • Service Partnerships – Canon expanded its service offering, launching service partnerships with Glassbeam (service data analytics), Barracuda (multi-vendor cybersecurity), and PartsSource (parts e-commerce platform).

The Wire

  • NVIDIA’s Accelerator Alliance: NVIDIA launched its new Inception Alliance for Healthcare, allowing premier members of its current NVIDIA Inception program to join the GE Healthcare Edison Developer Program and the Nuance AI Marketplace as their startups advance.
  • DBT Survival Evidence: DBT screening has been widely proven to improve breast cancer detection and recall rates, and a new Radiology study showed that the still-young technology improves survival rates too. The review of 380k DBT and DM screenings found that DBT had lower false negative rates (0.6 per 1k vs. 0.7 per 1k), found more invasive cancers with positive prognoses (w/ fewer nodal or distant metastases), and missed fewer advanced cancers.
  • Riverain’s Platform Push: Riverain Technologies significantly expanded its distribution at RSNA 2020, revealing new platform/marketplace partnerships with Blackford (ClearRead CT & Xray), Philips (ClearRead CT), Sectra (ClearRead CT & Xray), and Agfa (ClearRead CT). These new marketplaces add to Riverain’s already solid relationships with Nuance, Terarecon, and GE (among others).
  • CXR COVID Predictor: A new study in European Radiology found that chest X-ray COVID scores produced by Qure.ai’s qXR tool accurately predicted patient outcomes. The researchers reviewed outcomes from 697 COVID-positive patients, finding that patients with a ≥ 30 qXR COVID score when admitted into the ED had a higher risk of death (HR 2.60) or ICU admission (HR 3.40), matching the predictive performance of radiologist-produced scoring (≥ 12 RALE score).
  • Agfa’s Smart X-Rays: Agfa announced its new SmartXR X-ray option, integrating cameras, sensors, and AI into its X-ray systems to reduce retakes, streamline radiographer workloads, and support image acquisition. Available as upgrades to Agfa’s DR 600 and DR 100s, SmartXR includes tools to manage dosage, detector alignment, patient positioning, and image orientation.
  • Relaxed MQSAs: The U.S. FDA temporarily loosened some Mammography Quality Standards Act (MQSA) guidelines as the COVID-19 emergency continues. The updates will allow breast imaging facilities to complete their annual inspections up to six months beyond their original timeframes and let them continue operations even if their COVID-related changes might not comply with MQSA standards (e.g. training, remote reading).
  • Siemens’ Cios Flow: Siemens Healthineers unveiled its FDA-pending Cios Flow mobile C-arm, highlighting its low weight, maneuverability, and intuitive touch interface. The Cios Flow also features Siemens’ new SpotAdapt (FDA-pending, helps visualize difficult anatomical areas), adds new security functions, and supports Siemens’ capability-expanding CiosOpenApps.
  • Verdict Reinstated: A Maryland appeals court reinstated a $2.6m verdict against a local radiologist after a missed early-stage breast cancer diagnosis eventually led to a woman’s death. The woman scheduled a 2012 exam after discovering a breast lump, but the radiologist didn’t find evidence of her stage 1 cancer, leaving her untreated for 15 months as it progressed to stage 3 cancer. The appeals court ruling overturns a county judge’s original decision to toss the $2.6m verdict.
  • United Imaging’s RSNA: United Imaging’s RSNA brought its new uCT ATLAS CT (FDA-pending, 640-slice, 16cm detector, 0.25 second rotation, 60 kVp), which leads with its ultra-wide bore and high table weight (82-cm, 700 lbs.), its integrated 3D camera, and AI workflow. The company also launched partnerships with Resoundant (adds MR Elastography to UI MRI systems) and Intalere (provides Intalere members with UI scanners at negotiated rates).
  • COVID Robot: An Egyptian inventor is trialing a remote-controlled healthcare robot that can perform a range of diagnostic and patient monitoring procedures (RT-PCR and blood tests, and… echocardiograms and X-rays), while limiting transmission risks. The Cira-03 robot features a human-like face, head, and robotic arms, and displays test results on a screen attached to its body.
  • Guerbet’s Bulk Optiray FDA: Guerbet announced the FDA approval of its Optiray (Ioversol Injection) Imaging Bulk Package and its LF IBP Transfer Set. Guerbet’s Optiray IBP (500mL w/ Optiray 320 and Optiray 350) allows CT suite staff to fill sterile single-use syringes with a power injector and contrast media transfer set, reducing the number of single dose vials opened without requiring preparation in a laminar flow hood or pharmacy facility.
  • CDI Expands in WI: The Center for Diagnostic Imaging (CDI, >130 imaging centers in 22 states) expanded across Wisconsin with its acquisition of Smart Choice MRI’s locations in Appleton, De Pere, Kenosha, and La Crosse. Meanwhile, Smart Choice MRI closed its remaining locations in Minnesota, Wisconsin, and Illinois as part of the innovative imaging chain’s bankruptcy. The acquisition comes shortly after CDI expanded to Salt Lake City and appears to be part of a more aggressive M&A phase a year after CDI’s own private equity acquisition.
  • Riverain’s Aussie Approval: Australia’s Therapeutic Good Administration (TGA) approved Riverain Technologies’ ClearRead Xray Confirm (Enhanced) and ClearRead CT lung nodule detection applications, which will join Riverain’s TGA-approved ClearRead Xray Bone Suppress and ClearRead Xray Compare solutions.

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