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RSNA 2020 | Another NTAP | COVID Burnout

“I ask what they do, tell them their profession will be replaced as well, and watch as they explode with skepticism.”

One radiologist’s go-to response every time someone tells him that AI will replace radiologists.



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Avicenna.AI’s LVO NTAP

Avicenna.AI announced that its CINA Head software (analyzes CTAs for large vessel occlusion) “qualifies for” Medicare’s new technology add-on payment (NTAP), potentially giving Avicenna.AI a huge value prop boost while creating new questions about how NTAP qualifications actually work.

  • Avicenna’s LVO NTAP – Avicenna.AI’s NTAP announcement suggests that providers who use CINA Head to triage suspected strokes will receive reimbursements as high as $1,040 for each qualified use.
  • The LVO NTAP Trend – When Viz.ai announced its Viz LVO solution’s NTAP in September, the radiology internet quickly hailed it as an AI game changer. Within three months, RapidAI, Aidoc, and now Avicenna all announced their own LVO NTAP qualifications.
  • Qualifying Qualified – If you ask anyone at Viz.ai they’d probably tell you that Viz LVO is the only AI software granted a CMS NTAP, and that CMS hasn’t actually determined whether these other LVO solutions are eligible for reimbursements. If you ask the folks at Avicenna.AI, Aidoc, or RapidAI, they would probably say that their LVO solutions are “substantially similar” to Viz LVO and therefore qualify for the same NTAP reimbursements.
  • NTAP Playbook – It will be super interesting to see how this works out. If Viz.ai proves correct, then healthcare providers who opt for the other LVO products might not get the NTAP reimbursements they are expecting. If the other LVO providers prove right, then it seems that every future AI NTAP will eventually support a range of “substantially similar” products.



Siemens’ New Hardware, and Companions

Siemens Healthineers kicked-off RSNA 2020 with a modality-expanding MRI, a trio of DR launches, a new AI-Rad Companion solution, and a major focus on its MyExam Companion intelligent UI concept.

  • Magnetom Free.Max – Hailed as Siemens Healthineers’ “smallest and most lightweight whole-body MRI,” the 0.55T Magnetom Free.Max is intended to help expand the modality into new clinical fields (urgent care, orthopedics, ICU). In order to achieve its modality expansion goals, the Magnetom Free.Max boasts very low helium (1 liter, no quench pipe) and installation requirements (“no harder to install than a CT,” 3 metric tons), Siemens’ myExam Companion UI (guides/automates rad tech operations), and an 80 cm bore.
  • MULTIX Impact C & VA20 – Siemens Healthineers debuted the MULTIX Impact C ceiling-mounted DR system and MULTIX Impact VA20 floor-mounted DR system. The two new DR systems share many of the same features (wireless detectors, motorized tube heads, floating flat table, in-room touch UI) and are clearly highlighted by their new MyExam Companion intelligent UI concept (guides/automates rad tech operations). MyExam Companion was also the hallmark feature in Siemens’ YSIO X.pree X-ray system announced in June, underscoring the importance the company is placing on usability.
  • LUMINOS Lotus Max – RSNA 2020 also brought the debut of Siemens Healthineers’ new LUMINOS Lotus Max fluoroscopy/radiography system, highlighted by its remote-controlled operation, 2-in-1 functionality, and the radiation-reducing benefits of its dedicated organ programs.
  • AI-Rad Companion Organs RT – Siemens continued to build out its AI portfolio, announcing the FDA approval of its AI-Rad Companion Organs RT, which automates the contouring process for at-risk organs on CT scans during radiation therapy planning. The new Organs RT solution joins AI-Rad Companion solutions for brain MR, prostate MR, and chest CT, with more brain and cardiac tools on the way.

The Wire

  • GE’s ETT AI: GE Healthcare announced a new X-ray AI tool used to assess Endotracheal Tube (ETT) placements in intubated patients, automatically detecting ETTs in chest X-rays and providing clinicians with positioning measurements “within seconds.” The new ETT tool expands GE’s Critical Care Suite 2.0 to five solutions, all of which come embedded on its mobile X-ray systems.
  • Structured Preferences: Many radiologists might prefer unstructured reporting, but their colleagues in other departments prefer structured radiology reports. A Beaumont Health survey (n = 394) found that although the highest share of clinicians prefer expanded structured reporting (47%), there’s a notable divide between non-radiologists (51% prefer expanded structured) and radiologists (41% prefer unstructured reporting), while emergency medicine physicians prefer minimized structured reporting (51%). The study urged radiologists to adopt structured reporting and to use minimized normal statements for ED reads.
  • Nuance Integrates CDE: Nuance Communications announced the integration of the RSNA and ACR’s Common Data Elements (CDE) standards into PowerScribe One (standardizes terms, data types, values, etc.), helping radiologists turn information in radiology reports into actionable data. With the CDE standards integration, radiologists using PowerScribe One can automatically extract structured clinical data while dictating findings / recommendations and then share this data across a range of healthcare platforms.
  • CT DLR Benefits: New research out of Cincinnati Children’s Hospital revealed that Canon’s AiCE deep learning reconstruction (DLR) software improved pediatric CT image quality and radiation dosage without sacrificing noise texture and spatial resolution. Three radiologists compared scans from 19 patients using AiCE DLR as well as a range of other Canon projection and reconstruction methods. The radiologists found that AiCE DLR improved object detectability (+51% vs. FBP, +18% vs. SBIR, +11% vs. MBIR), achieved greater image quality ratings (7 out of 10 rating vs. 4.6, 6.2, 6.2), allowed lower radiation dosage (>52% reduction vs. SBIR), and achieved higher radiologist confidence / preference levels.
  • Stark Law’s Value-Based Changes: CMS took a major step towards breaking down the Stark Law’s “bureaucratic barriers” that were originally intended to curb financially influenced physician self-referrals, but no longer reflect many healthcare systems’ value-based focus. Changes to the Stark Law include making exceptions for value-based arrangements, setting protections for “nonabusive” physicians, and making it easier for physicians to make sure they comply with the law.
  • PE Imaging Growth: A new JAMA Open study detailed the continued rise of CT and CTPA imaging for suspected PE between 2004 and 2016. Data from 3.6m to 4.8m patients scanned for PE during each of the years revealed that CTPA use grew by 450% and chest CT volumes increased by 66.3%, while V/Q scan volumes fell by 47%. These 12-year growth numbers are staggering, but the use of CTPA and chest CT for suspected PE has slowed in recent years (CTPA’s annual growth was just 3% to 4.3% since 2010).
  • MGH’s Head-Only MRI: MGH researchers unveiled a prototype “head only” 80mT MRI, highlighting its low-cost, compact size, portability (350-500 lb. system), and low-power requirements (uses wall outlet), and emphasizing its potential to expand brain MRI access. The MGH team is among a number of groups targeting the portable MRI arena, as Vanderbilt recently announced a similar effort, Synaptive Medical is working on a head MRI, and Hyperfine’s Swoop MRI is now commercially available.
  • Telerad Settlement: Florida radiology practice, Mori, Bean and Brooks (MBB), agreed to pay $1.4m to resolve allegations that it fraudulently billed Medicare and Medicaid for teleradiology interpretations that were performed outside of the U.S (CMS only reimburses for in-country telerad). The settlement originated from a whistleblower lawsuit by a radiologist who previously worked at MBB, so that rad will get 19% of the settlement. MBB was acquired by RP in October 2018, about five months before the feds notified MBB of its investigation.
  • CT Drives On-Call Volumes: A new study in Insights into Imaging detailed a fourfold increase in a Dutch hospital’s on-call radiologist workload between 2006 and 2020, largely driven by CT growth. A review of the hospital’s on-call interpretations (nights, weekends, holidays) found that off-hours RVUs for CT studies increased by >500%, while X-ray studies decreased, and ultrasound studies didn’t change significantly.
  • Zebra & Storm ID’s Osteoporosis Solution: Zebra Medical Vision and Scottish digital transformation consultancy Storm ID announced plans to co-develop an AI-based osteoporosis prevention solution. The solution will analyze medical imaging data and patient records to help clinical teams identify at-risk people and treat them before fractures occur.
  • Konica Minolta’s New SONIMAGE HS2: Konica Minolta announced its new SONIMAGE HS2 compact ultrasound, replacing the HS1, and launching with improvements to image quality, operability, needle guidance, deep tissue and blood flow imaging, and its touchscreen monitor.
  • COVID Burnout: Last week brought more details on how the COVID-19 pandemic is negatively affecting radiology teams. A survey of 228 radiology technicians in Turkey found that the COVID-19 pandemic has hurt their moral and overall work happiness, taking the greatest toll on respondents who are female, older, work more hours, and received less training on COVID imaging. A separate paper in Clinical Imaging suggested that COVID-19 grew radiologist burnout from “a smoldering ember into a blazing fire,” particularly among female radiologists, encouraging radiologists and practice leaders to seek procedural and cultural solutions for their burnout problems.
  • Reading in The Dark: After a Irish radiology department realized that 40% of its 15 reading rooms had inadequate lighting and 33% were too bright, they reviewed previous studies and then established 15-50 lux as their hospital’s new reading room lighting standard.

The Resource Wire

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  • Vessel suppression from Riverain Technologies’ ClearRead CT software was found to significantly improve nodule detection, interreader agreement, and reading time with oncologic chest CT scans.

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-- The Imaging Wire team