Screening the Rich | Ditching the Apron | Paging Dr. Google

“I came here to make people healthy, I’m not here to sell them ads,”

Google Health head, Dr. David Feinberg, defending the tech giant’s healthcare motivations.

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The Imaging Wire

Screening the Rich

Although rich people generally stay healthy about a decade longer than poor people, new research in JAMA Internal Medicine finds that hospitals’ executive health programs have plenty of healthcare downsides too.

Executive Health Programs – A growing number of hospitals have developed imaging-intensive screening programs for wealthy (and healthy) folks who are willing to pay for proactive screening tests that generally aren’t recommended/covered but may allow early detection.

The Study – The researchers reviewed data on 12 different executive cardiac screening tests performed at 18 top U.S. cardiology hospitals, finding that none of the $1k to $25k tests met standard screening recommendations. Although lipid panel and cardiac stress tests were most common (71% and 68%), CT CAC scoring tests were included in 43% of exams.

Strong Reactions – These executive screening programs were found to be on the wrong side of most healthcare priorities, as they aren’t evidence-based, cost-effective, nor equitable and they send “the message to trainees that a two-tier healthcare system is acceptable, and that evidence is not important.” The study also suggested that the cascading effect of incidental findings actually violates physicians’ principal to do no harm.

Ditching the Apron

The humble lead X-ray apron became a bit humbler this week after the New York Times detailed how hospitals are shifting away from the “decades-old practice of shielding patients from radiation with lead aprons.”

The Shift – Calling gonadal and fetal shielding a “ritual” and a “feel-good measure,” the NYT detailed how aprons have been found to impair image quality and sometimes even increase radiation exposure, causing some hospitals to shift away from using them. Here are some previous studies to support that.

Resistance – Despite mounting evidence, the NYT suggests that this shift will require a “major effort to reassure regulators, health care workers and the public that it’s better not to shield.” This is largely due to a deep-seated fear of radiation and the fact that dentists (who perform over half of all X-rays) have been much slower to ditch their aprons than doctors.

Progress – Efforts to retire the X-ray apron are progressing, as the Physicists’ Association recommended discontinuation last year and the FDA recently proposed removing a shielding recommendation from the federal code. We’re also seeing similar efforts from other industry groups and within some states (as many as 46 still require shielding), but there’s a long way to go.

Paging Dr. Google

There’s been a lot of coverage of Google’s healthcare expansion, but The Wall Street Journal just published arguably the deepest dive into the tech giant’s healthcare activities and intentions.

Cerner – The story starts with a revealing anecdote about how far Google was willing to go to become Cerner’s storage partner ($250m in incentives), why Google was so interested in working with Cerner (access to its 250m health records for use in product development), and why Cerner decided to pay more to go with Amazon instead (they “could never pin down Google on what their true business model was”).

Partnerships – Not everyone declined Google’s proposals, as the company has partnered with some of the country’s largest hospital systems (e.g. Mayo, Ascension, Intermountain, U of Chicago), giving it “the ability to view or analyze tens of millions of patient health records in at least three-quarters of U.S. states.”

Health Search – The WSJ detailed how Google is using this data to develop a search tool that would store, collate, and analyze patient information for use by clinicians and maybe even patients. Google has long seen health data as a natural extension of its mission to organize information, and this tool is one of the latest (but unlikely the last) of its healthcare products.

Concerns – Not everyone is excited about Google’s health record stockpile, given concerns over patient privacy, debates over permission, and the overall secrecy that Google has maintained within this part of its business. These concerns made their way to the HHS Office of Civil Rights, which recently began interviewing people close to Google’s deal with Ascension (code named “Project Nightingale”).

Google’s Take – Many readers have heard about this before, but what makes this story unique is Google actually participated in this story, including making Dr. David Feinberg (head of Google Health) available for an interview. Dr. Feinberg maintained that Google’s push into health care is motivated more by the greater good than profits, assured that the company is moving away from its previous non-transparent approach, and even admitted “mistakes” in the way it previously operated. Now Google just has to prove that these statements are true and/or come out with a product that’s worth all of this.

The Wire

  • Canon Medical Systems announced the Japan launch of its high-end Aquilion ONE / PRISM Edition CT (320-row, dual energy Spectral Imaging System, AiCE reconstruction) and helical Aquilion Lightning / Helios i Edition CT (80-row / 160-slice, AiCE reconstruction). The Aquilion ONE / PRISM Edition was included in Canon’s RSNA introductions and the Japan launch should be the first phase in a worldwide rollout, while the previously-unknown Aquilion Lightning / Helios i Edition CT may take its place atop Canon’s global Helical CT lineup (currently an 80-row max, no AiCE).
  • A Clemson-led study found that clinical disagreements could be the main reason for radiologists’ CT measurement variability, rather than random errors that could be addressed with a peer benchmarking tool. Thirteen radiologists repeatedly reviewed 10 CT sets of lung lesions and hepatic metastases during three different time periods, providing the radiologists with a benchmarking tool prior to the third review period. The study revealed statistically similar measurement deviations during the three periods (20.0%, 23.1%, 17.7%), despite introducing peer benchmarking before the third round, while finding that clinical disagreements among radiologists had the greatest association with variability.
  • A new study in AJR found that a CNN deep learning method can effectively support the evaluation of small solid renal masses in dynamic CT images. The researchers studied 1,807 image sets from 168 pathologically diagnosed small (≤ 4 cm) solid renal masses (n= 136 malignant, 32 benign; from 159 patients) with four CT phases (unenhanced, corticomedullary, nephrogenic, and excretory). The team then divided the dataset into five subsets, using four to create an augmented training set and one for testing (48,832 & 281 images). Although there was no significant size difference between the malignant and benign lesions, they found that the corticomedullary phase images were most accurate (88%) and a “significant predictor for malignancy” compared with other models or metrics.
  • IHS Markit recently detailed how the use of hybrid operating rooms (fixed C-arm in a surgical suite used for open or minimally-invasive procedures) will accelerate due to the aging population, ongoing hybrid OR technological advancements (robotics, AI, 3D printing, AR), and the increased role of minimally-invasive surgeries in healthcare. Cardiac and vascular surgery continue to represent the majority of hybrid OR applications (51%), although usage has increased for neurosurgery (24%), ortho-trauma spine surgery (12%), thoracic and abdominal surgery (4%), and “other” surgeries (9%).
  • Carestream announced the FDA clearance of its Digital Tomosynthesis (DT) technology, an upgradeable option for its DRX-Evolution Plus System that adds 3D imaging capabilities. Digital Tomosynthesis uses a single sweep of X-ray exposures, streamlining operator workflow by separating the process of DT exposure acquisition from image volume formation and generating data from a series of low dose X-ray images of the same organ (at the same X-ray exposure from different angles).
  • A Chicago area family won an $8.1 million lawsuit against a radiologist after a 13-month delayed lung cancer diagnosis led to a 64-year-old woman’s death. The woman’s August 2013 X-ray revealed a rounded density in her left lung, but the radiologist “failed to identify or document the presence of the mass or any abnormality” and the cancer progressed from stage I to stage III by the time it was diagnosed in October 2014.
  • HealthLytix’s CT CoPilot software for head CT exams is now available on the Nuance AI Marketplace, making the solution available to Nuance’s massive PowerScribe customer base (80% of radiologists, over 7,000 connected healthcare facilities). The FDA-cleared CT CoPilot solution is intended to help improve reading efficiency, measurement accuracy, and clinical confidence.

The Resource Wire

  • In this GE Healthcare video, ultrasound users and educators discuss how the Vscan Extend handheld ultrasound combines portability and intuitive design so you can use it in the moment to potentially change patient outcomes.
  • This NYU Langone Health article details how high-intensity Focused Ultrasound provides minimally invasive, targeted treatment for patients with essential tremor.
  • Did you know that imaging patients are most likely to no-show for their scans on Mondays and Saturdays? By partnering with Medmo, imaging centers can keep their schedules full, despite the inevitable Monday no-shows.

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