Supplemental US | No POCUS Vacuum

“Whoever heard of 30min cardiac MRI in an outpatient center next to a Walmart? Next you’ll be telling me that stents can be placed in an ASC next to a Walmart.”

Cardiothoracic Radiologist, Giovanni Lorenz, DO, on what might come from CMS’ apparent efforts to shift more cardiac MRI to outpatient settings.

Imaging Wire Sponsors

Arterys | Bayer Radiology | Blackford Analysis
Canon Medical Systems | Fujifilm Healthcare Americas
GE Healthcare | Novarad | Nuance
Riverain Technologies | Siemens Healthineers
United Imaging | Zebra Medical Vision

The Imaging Wire

Another Case for Breast Ultrasound

A new JAMA study provided more evidence for adding breast ultrasound to mammography screening, finding that it improves cancer detection among women with average risks and various density levels (in addition to high-risk / density).

DM+US Advantages – The researchers analyzed screening and outcomes from 19.2k Japanese women (ages 40-49, 59.3% extremely dense, 130 total cancers) who underwent either DM+US or DM-only screening from 2007 to 2020, revealing a number of DM+US detection advantages…

  • DM+US’ sensitivity was much higher than DM-only (93.2% vs. 66.7%)
  • DM+US’ sensitivity was higher across densities (dense: 93.2% vs. 70.6%; non-dense: 93.1% vs. 60.9%)
  • DM+US allowed far fewer interval cancers (0.5 vs. 2 per 1k screenings)
  • Within the DM+US screening group, ultrasound detected far more invasive cancers than DM (dense: 82.4% vs. 41.7%; non-dense: 85.7% vs. 25%)

DM+US Compromises – DM+US’ higher detection rates came with more false positives (specificity: 86.8% vs. 91.8%), resulting in much higher recall (13.8% vs. 8.6%) and biopsy rates (5.5% vs. 2.1%).

The Takeaway – Even if many screening operations have moved on to DBT, this study provides some solid evidence on how supplemental breast ultrasound can help detect more early and invasive cancers, and not just among high-risk and high-density women.

Ramapo Radiology’s Case for Novarad CryptoChart

See how New Jersey’s Ramapo Radiology Associates overcame their CD burning problems and improved their physician and patient experiences with Novarad CryptoChart.

– Sponsored.

Biograph Vision Quadra’s Extended FOV

Be at the forefront of PET/CT with an extended field of view. Download this Siemens Healthineers clinical case gallery to see how the extended field of view on Biograph Vision Quadra could reshape clinical outcomes.

– Sponsored.

The Wire

  • No POCUS Vacuum: Point-of-care ultrasound’s clinical evidence momentum seemed to hit a setback last week, after a University of Wisconsin study found that POCUS-equipped PICU physicians could only identify the cause of acute respiratory failure in 56% of pediatric patients (n = 88). However, folks on Medical Twitter quickly pointed out that these physicians were “blinded to all clinical information,” which isn’t how POCUS is used in the real world, so this study might actually highlight the important role clinical info plays in POCUS accuracy.
  • WVU’s Mobile LCS: WVU launched the US’ first fully mobile lung cancer screening unit, which they’ll use to perform screening across rural West Virginia. The “LUCAS” van features a Canon low-dose CT scanner that uses an in-van power source (making it “fully mobile”) and has support from Johnson & Johnson’s Lung Cancer Initiative. The collaborators also plan to use LUCAS as a pilot for a national mobile LCS program and to support early lung cancer detection research.
  • CMS’ CMRI Outpatient Shift: CMS’ proposed 2022 Medicare and Hospital Outpatient schedules (MPFS & OPPS) seem to reveal a federal effort to shift cardiac MRI reimbursements to favor outpatient imaging. In-hospital CMRI code payments would fall by -8.5% to -12%, as large cuts to CMRI “technical component” payments (-10.9% to -19.3%) outweigh mixed changes for CMRI “professional component” payments (three codes down -3.75% to -4.1%; five codes up +2.6% to +5.2%). Meanwhile, outpatient CMRI would see all “technical component” reimbursements increase by 2.6% and share the same “professional component” rates as in-hospital scans.
  • Google’s Healthcare Disruption: Google is reportedly shutting down Google Health and moving its various healthcare projects into other company divisions, following a series of challenges (unclear strategy, slow progress, privacy pushback, healthcare is complex). Google clarified that this move makes healthcare a “company-wide effort,” which is pretty logical from a tech perspective (e.g. Health-AI moves within AI group), even if that’s not how other conglomerates have typically found healthcare success.
  • What Orthopedists Want: A new JCOT paper detailed orthopedic surgeons’ radiology report preferences, which combine pretty reasonable attributes (timely, accurate, consistent, descriptive, structured, has summaries) with value-added insights (gives clinical feedback, advice about differential diagnosis, suggestions about further investigation / management). Considering orthopedists’ reputation as inconsistent report readers, communication like this seems necessary.
  • EchoNous Adds Extremities: EchoNous announced the FDA approval of its Lexsa linear probe, adding extremity imaging to the Kosmos POCUS platform, and combining with EchoNous’ two other probes to allow whole-body POCUS imaging.
  • Early is On Time with Lung-RADS 3: A new JACR study found that scheduling patients with Lung-RADS 3 nodules for 5-month follow-ups (instead of 6 months) could save lives. Using a lung cancer outcomes simulator, the researchers found that 5-month follow-ups would avert more deaths (36 vs. 27) and detect more cancers (13 vs. 7) per 1 million people in the general population. They found that Lung-RADS 4A’s recommended 3-month follow-up is still optimal.
  • Anthem Acquiesces: After strong radiology society pushback, Anthem updated its advanced imaging site of care policy to once again allow <19yr patients to receive advanced diagnostic imaging in hospitals. Anthem previously limited onsite advanced imaging to patients ≤10 years.
  • COVID Delays Continue: A new Urban Institute study revealed that COVID concerns caused over 10% of US patients to delay or forgo healthcare visits in Spring 2021, continuing a trend that’s often talked about in the past tense (and that was pre-Delta). The study found the highest delay/cancellation rates among Hispanic, Black, and low-income patients, as well as patients with multiple chronic health conditions (16.2%, 13.3%, 14.9%, 16.7%). These delays surely had an imaging impact, while showing that telehealth still has room to expand.
  • SpinTech’s FDA: SpinTech announced the FDA 510(k) approval of its STAGE MRI acquisition and post-processing software, which allows entire brain MRI scans in roughly 5 minutes, and adds quantitative data to support diagnosis and highlight changes over subsequent exams. STAGE has been used for research purposes for some time, making its clinical approval notable for SpinTech and potentially for neuroimaging.
  • A Waiting Room Education: Playing informative videos in radiology waiting rooms helps patients understand imaging team roles and improves their experiences. Surveys of 278 Belgian patients (107 who watched the video) found that the video corrected misconceptions that radiologists perform scans (19% w/ video vs. 50% w/o video) and primary care physicians interpret exams (10% w/ video vs. 36% w/o video). The videos also increased patients’ respect for radiologists’ work (67%), reduced their anxiety (52%), and added value to their visit (65%).
  • Nanox’s FDA Setback: Nanox’s stock tumbled after the FDA asked the startup to address a “list of deficiencies” in its multi-source Nanox.ARC scanner’s 510(k) submission. Nanox plans to provide this info within the FDA’s 180-day timeline and might file another submission for an updated version of the multi-source Nanox.ARC later this year. Although this wouldn’t be a newsworthy event for most pre-commercialization startups, Nanox has consistently cited the multi-source Nanox.ARC’s 2021 approval as a key milestone in its strategy to disrupt medical imaging.

Duke’s Case for ClearRead CT

This Riverain Technologies case study details how Duke University Medical Center integrated ClearRead CT into its chest CT workflows, reducing read times by 26% and improving nodule detection by 29%.

– Sponsored.

The Resource Wire

  • This Blackford Analysis video details how imaging AI can improve radiology efficiency and patient care, and discusses the key role that AI assessments and curation plays in achieving these improvements.
  • Check out this blog from the NIH’s Dr. Francis Collins, where he discusses how United Imaging’s “groundbreaking” Explorer total-body PET/CT “opens a new window into human biology.”
  • Check out this talk from Eliot Siegel, MD on the “Hype, Myth, Reality and Next Steps” of imaging AI, including a profile on Canon’s AiCE Deep Learning Reconstruction solution at around the 4-minute mark.
  • Can Cloud Security keep healthcare data secure? Read this whitepaper to find out how Arterys utilizes the cloud to keep this data private and protected.
  • Learn how Salem Regional Medical Center improved its radiology workflows and cut service and syringe expenses after adopting Bayer’s MEDRAD Stellant FLEX system.

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