RSNA 2019

“The answer is within you.”

Konica Minolta Healthcare president, Kiyotaka Fujii, discussing the promise of precision medicine at RSNA 2019.

Happy to announce this year’s Imaging Wire Award honorees, who did such great work to elevate radiology this year, and many thanks to our judges and everyone who submitted nominations.

  • Insights to Action: Jay Bronner, MD, President and Chief Medical Officer, Radiology Partners
  • Diagnostic Humanitarian: Wendell A. Gibby, MD, Chairman of the Board, GlobalRad
  • AI Activator: Woojin Kim, MD, Chief Medical Information Officer, Healthcare Division, Nuance Communications
  • Burnout Fighter: Syam Reddy, MD, Clinical Chairman, University of Chicago Ingalls Memorial, Radiology Partners Chicago
  • Cornerstone: Apollo Exconde, MRI Radiographer, Croydon University Hospital, UK

Imaging Wire Sponsors

  • Carestream – Focused on delivering innovation that is life changing – for patients, customers, employees, communities and other stakeholders
  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound
  • 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

RSNA 2019

Welcome home from RSNA 2019, everyone. Hope you had a blast and you’re well on your way to a relaxing weekend. Once you’re ready to reflect, here are The Imaging Wire’s big RSNA takeaways:

It Was Big and Positive – One unnamed colleague told me, “In our industry, we don’t celebrate Thanksgiving, we celebrate RSNA,” and this week really was a celebration. This is an industry that people stay in for life, help save lives, and earn pretty good livings, making RSNA about as positive as trade shows get. Sure, some folks were concerned when Sunday felt slow or when they noticed some big-name absences, but just about everyone left RSNA with plenty of new experiences, connections, and opportunities.

Showcase or Cellar – The AI Showcase’s downstairs location wasn’t intended as a metaphor, but feelings were mixed about whether this ‘special’ treatment served the AI vendors well. On the bright side, everyone who ventured down to the Showcase was there for a reason, but these AI exhibitors missed out on foot traffic created by the major brands and you could argue that the separate positioning didn’t help break down perceptions that radiology AI is separate from traditional radiology.

Machines Are Still Cool – Regardless of the fact that most folks at RSNA aren’t hands-on modality users, the big imaging systems still drew a crowd at nearly every booth. Conversations are changing in those crowds to more of a focus on operator usability and patient satisfaction but there were still plenty of old school conversations about specs and horsepower (and there’s nothing wrong with that).

Everyone Gets a Marketplace – Arterys and IBM jumped into the marketplace game, while the major modality guys introduced (Philips) or expanded (GE, Siemens) their respective AI suites/platforms that they could call Marketplaces if they chose to. Meanwhile, most of the AI developers seemed to have come to agree that this model makes the most sense for their business structure and for clinical workflows. This also means that having a marketplace or being on a marketplace is no longer a differentiator on its own, making the relevance, performance, and integration quality of these marketplaces much more important.

What’s Hot – In addition to marketplaces, a number of trends intensified at this year’s show including: AI-enabled image reconstruction (pretty much every CT/MR company), point of care imaging (Butterfly ultrasound, Hyperfine head MRI, Siemens head CT, mobile x-ray, all the POCUS brands), workflow-integrated AI, and an increased focus on cloud-enabled enterprise imaging.

Bravo to all the exhibitors who spent the last 3-4 months preparing for this show and had some awesome booths and crowds to show for it. Same goes for the RSNA convention team and all the presenters. This was a solid show.

A Case for Supplemental MRI Screening

A study published in NEJM found that breast MRI is a valuable supplement to mammography for women with extremely dense breasts and it may be even more effective. Here are some details:

The Study – The study assigned 40,373 Dutch women (50 and 75 years old) with extremely dense breasts and normal mammography results to either undergo supplemental MRI (n = 8,061, 59% participated) or only receive mammography screening (n = 32,312), evaluating both groups for interval cancer over a 2-year screening period.

The Results – The MRI-assigned group had a lower interval cancer rate than the mammography-only group (2.5/1k screenings vs. 5/1k), and the women from the MRI group who actually participated in the supplemental MRI screenings had significantly lower interval cancer rates than those in the group who declined MRI screening (0.8/1k screenings vs. 4.9/1k).

There’s going to be differing positions on these results given the scrutiny that DBT screening is still experiencing, but this study at the very least suggests that breast MRI might deserve a greater role in screening for women with extremely dense breasts.

Philips Gets Solutions-Centric at RSNA 2019

Philips focused on solutions at RSNA 2019, highlighted by the introduction of its new IntelliSpace AI Workflow Suite and its “next-generation enterprise imaging solution,” while showing off a number of new and forthcoming imaging systems.

AI Suite – Philips built upon its AI capabilities with the launch of the IntelliSpace AI Workflow Suite, allowing users to integrate a range of 3rd party applications (Aidoc, MaxQ AI, Quibim, Riverain Technologies and Zebra Medical) into existing workflows. Philips was among a number of major brands to either launch or expand their AI marketplaces/suites at RSNA.

Enterprise Imaging Platform – Philips introduced its “next-generation enterprise imaging solution,” coming as a result of several years of R&D and “complementary acquisitions” (namely Carestream’s HCIS business). The updated enterprise imaging platform will support a broad range of specialties and include a number of new and carried-over features, highlighted by support for the Philips IntelliSpace AI Workflow Suite and features from Carestream’s Clinical Collaboration Platform.

Hardware – Philips’ hardware lineup at RSNA was highlighted by its Incisive CT platform (launched in the U.S. in October), its forthcoming 256-slice CT 6000 iCT and 64/128-slice CT 5000 Ingenuity CT systems, its relatively new Epiq Elite ultrasound family (launched in February), and its new MobileDiagnost wDR mobile X-ray system.

Circular Economy – Philips also highlighted its progress transitioning to a ‘circular economy’ in healthcare, revealing that it’s on track to repurpose all the large medical system equipment that its customers return by 2020 (via trade-ins etc).

The Wire

  • Amazon Web Services expanded its two-year-old Amazon Transcribe service to healthcare this week with the launch of Amazon Transcribe Medical. The real-time transcription service allows developers to create healthcare solutions that transcribe medical speech and then send the text to EHRs and other AWS tools (e.g. Amazon Comprehend Medical language service), prompting some to suggest that the solutions may replace (aka “Amazon”) transcriptionists, scribes, and transcription software.
  • New research published in JAMA Network Open (n=184,694 ED patients) found that adopting a visual decision support aid in ED EHR ordering systems (adding a red highlight around order box if imaging was already ordered during visit) reduced unintended duplicate lab tests by 49% and cut duplicate radiology orders by 40%. The Beth Israel Deaconess team plans to adjust the feature for other care settings as it continues its evaluation of EHR visual decision support.
  • US Radiology Specialists expanded to Arizona with its partnership with Tucson-based radiology practice and imaging center Radiology Ltd (40 radiologists, >400 employees, 9 centers, largest in Tucson). Although quiet for most of 2019 (here are its last two acquisitions), US Radiology Specialists has certainly been on an aggressive growth pace since launching in early 2018 (now 2,500 team members, > 130 imaging centers, 13 states).
  • One of this week’s RSNA presentations detailed how a Canadian hospital drastically reduced imaging recalls by staffing radiologists in the ED during overnight shifts. After recording 54 overnight radiology recalls in 2016 and 61 recalls in 2017, adopting overnight radiologist shifts cut recalls to seven in 2018 despite an 8.8% increase in imaging volume. Without the staffing change there would have been roughly 69 overnight recalls in 2018.
  • IBM Watson Health had plenty to share at RSNA, highlighted by the launch of the IBM Imaging AI Marketplace. Similar to other marketplaces that have come on the scene over the last few years, the IBM Imaging AI Marketplace connects its clients with IBM-developed and partner-developed AI solutions (initially Circle Cardiovascular Imaging, DiA Imaging Analysis, MaxQ AI, Quantib, VIDA LungPrint) through its Merge iConnect Enterprise Archive VNA platform.
  • A new study from The Doctors Company (n= 596 malpractice claims from 2013 – 2018) found that misinterpretations are the leading cause of malpractice claims involving diagnostic radiologists (78% of DR cases) and CT is the most common modality (34% of cases). Meanwhile, improper performance of treatments/procedures was the top source of interventional radiology malpractice claims (59% of cases) and technical performance issues were associated with 76% of IR cases.
  • Hyland Healthcare unveiled a number of new and enhanced solutions at RSNA including its PACSgear Video Touch 4K (allows clinicians to capture videos/images from visible light modalities, associate them with patient records, and archive them), its new ImageNext workflow optimizer (consolidates studies from across the enterprise into one universal worklist and routes them to radiologists), its updated Acuo VNA (improved usability, storage management, cloud connectivity, and browser-based monitoring), and updated Nilread enterprise viewer (improved image stitching, breast implant masking, worklist and folders, among others).
  • A RSNA presentation from a University of Michigan student detailed an AI algorithm that can predict patients’ future healthcare costs from their chest X-rays. The researchers trained and tested two computer vision models on 16,533 chest X-rays and corresponded each X-ray with patients’ 5-year healthcare costs, identifying the 50% highest-cost patients with a 0.85 AUC (notable given that the top-50% are responsible for 97% of healthcare costs).
  • Agfa entered exclusive negotiations to sell its HealthCare IT business to Italian software company Dedalus (not CompuGroup Medical as previously rumored) for over $1 billion, representing a solid multiple given the division’s $288m in annual revenue. The deal will include Agfa’s Imaging IT business in Germany, Austria, Switzerland, France, and Brazil (~17% of its imaging IT revenue) because the two divisions are so tightly integrated in these regions.
  • San Diego-based parts and service company, DirectMed Parts & Service put its private equity funding to use with its acquisition of Colorado-based MRI/CT component repair and testing company Medical Systems Technologies. The acquisition advances DirectMed towards its goal to vertically integrate and expand its component repair capabilities.

The Resource Wire

  • If you weren’t already following along, Qure.ai, RAD-AID, and Saurabh Jha have an excellent tweetchat going about the use of imaging AI to fight TB and other diseases in developing regions.
  • This Carestream Special Report details how providers can get the greatest ROI from their X-ray technology as radiography demands increase and budgets head the other direction.
  • The Focused Ultrasound Foundation’s 2019 State of the Field Report details FUSF’s initiatives and achievements and the state of the focused ultrasound market.
  • 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.

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