Screening at 30 | Past Imaging History | X-Ray Influencer

“That is a pretty gnarly chest X-ray and I would not want to have that disease.”

Minnesota medical resident and social influencer, Dr. Rose Marie Leslie, describing an X-ray of an e-cigarette user’s lungs in her viral TikTok video. This may not be the best approach for patient consultations, but it proved to be effective for TikTok.

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The Imaging Wire

Screening at 30

Research published in JACR found that women with a family history of breast cancer, a personal history of breast cancer, and/or dense breasts would likely benefit from mammography screening starting at age 30, not 40.

If this Sounds Familiar – It’s because the same team shared results from an earlier version of this study at RSNA 2018, leading to some debates about age vs. risk screening qualifications and criticisms of the current screening standards.

Updated Study – Using data from 5.98m screening mammograms (2.64m women), the team calculated four screening performance metrics (recall rate, cancer detection rate, PPV for biopsy recommended, and PPV for biopsy performed) for each risk group and 5yr age group.

Similar Results – The study found that 30-39yr women with at least one of the above risk factors had similar diagnostic metrics as 40-49yr women with average risk factors, who are already recommended for screening in the US (suggesting that they are equally qualified for screening). Additionally, women with these risk factors in the 30-34yr age group had similar diagnostic metrics as at-risk women in the 35-39yr group (suggesting that screening should start at 30).

The Case for Past Imaging History

An editorial from an Italian team declared that “Past Imaging History” should be a standard part of patients’ medical history. Here’s some support for that:

Stuck in History – The article called for an evolution in medical histories and PACS usage, arguing that “the way a medical history is taken hasn’t changed a lot” for decades, and even with the growth of multi-modality imaging, PACS remains “underrated and not fully exploited.”

Adopting Past Imaging History – The team believes making PACS with Past Imaging History available to all clinicians has “enormous potential” to reveal important information that might not otherwise be communicated to clinicians (e.g. reveal presence of prosthetic materials or the date of previous procedures) and help avoid unnecessary exams.

Some may not be as bullish about the short-term technological/procedural feasibility of making Past Imaging History a standard, and some might not love making this information available to all clinicians, but it’s harder to argue against the fact that there are millions of historical images/reports going largely unused and unreferenced.

X-Ray Influencer

There’s been a lot of imaging-related coverage of vaping’s effects on the lungs lately, but a viral TikTok video detailing vapers’ chest X-rays might have the greatest public awareness impact we’ve seen to-date. Here’s how it went down:

Going Viral – A video from Dr. Rose Marie Leslie ( 2nd-year, Minnesota’s North Memorial Health Hospital) comparing healthy and vaper chest X-rays generated 570k likes and 3.5 million views (probably more by now), while gaining coverage across a wide range of mainstream media.

Simple & Serious – Dr. Leslie pointed out how the vaper’s X-ray showed signs of inflammation, fluid, infection, and/or bleeding, describing it as “pretty gnarly.” There’s a medical way to describe these symptoms, but Dr. Leslie’s conversational and social-savvy style allowed this video to have far more influence on TikTok’s young audience than the dozens of articles we’ve seen in mainstream and medical pubs over the last few months. It’s probably the first time a lot of these >3.5 million viewers got a glimpse of how an X-ray is interpreted, too.

The Wire

  • An article from the University of Pennsylvania and University of Washington found that adding a default order to EHR systems (aka a “nudge”) can improve clinician decision making for imaging-based cancer screening and help them avoid “predictably irrational behaviors” (e.g. prioritizing short-term factors or overweighting low probability events). The team outlined the types of nudges that can be used (e.g. encourage discussion, follow guidelines, automatically schedule appointments, encourage patient screening adherence) and urged healthcare organizations and radiologists to work to implement EHR nudges. This UPenn team is becoming a nudge research leader, as it previously used the method to cut unnecessary imaging for palliative radiation therapy in half.
  • Guerbet and IBM Watson Health expanded their year-old strategic AI partnership, announcing plans to co-develop and commercialize a new AI tool that helps radiologists/oncologists detect, segment, characterize, and monitor prostate cancer lesions. The new prostate cancer tool is designed for PACS compatibility and will leverage technology developed in Guerbet and IBM’s previously-launched liver cancer diagnostic solution.
  • The ethical AI debate made it all the way to Fast Company, which recently published “5 Simple Rules to Make AI a Force for Good.” Here they are as fast and simple as possible: 1) Create an FDA for algorithms; 2) Open up AI’s blackbox; 3) Value human wisdom over #AI wizardry; 4) Make privacy the default; 5) Compete by promoting, not infringing, civil rights.
  • French healthcare AI company Incepto announced a €5.6 million series A round, calling the funding “a first step in accelerating the large-scale rollout of [its] solutions throughout France” and towards it goal of becoming one of Europe’s medical imaging AI leaders. Although imaging AI funding announcements are pretty common these days, Incepto gets credit for having a unique strategy. Incepto intends to build a “Netflix of AI” platform that connects AI companies with hospitals for co-development and positions Incepto as both an AI developer and distributor (it already distributes solutions from Screenpoint and Qure.ai).
  • MITA, the ACR, and a list of medtech heavyweights teamed up for one last big message, asking congress to repeal the 2.3% medical device tax before its latest 2-year suspension expires on January 1, 2020 (previously suspended 2016-17, 2018-19). The letter attributed thousands of lost jobs to the tax’s 2013-2015 active run and warned that it could lead to another 21,000 job cuts if it’s reinstated.
  • The Mount Sinai Health System introduced its new Biomedical Engineering and Imaging Institute (BMEII), representing a merger and expansion of its imaging, nanomedicine, and biomedical engineering programs. Launching in early 2020, the Mount Sinai BMEII will staff at least nine principal investigators and student teams focused on developing novel technologies in 1) Artificial Intelligence in Advanced Imaging; 2) Next Generation Medical Technologies; and 3) Virtual, Augmented, and Extended Reality (VR/AR/XR).

The Resource Wire

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  • Focused ultrasound researchers at the University of Michigan were awarded a $2.4M grant from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) to study using histotripsy for brain applications. Histotripsy is a form of focused ultrasound that mechanically destroys tissue without heat.
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