The Missing Piece

“Where would I put it? How would I run it? What would the output be?”

ACR’s data science CMO, Bibb Allen, on the challenges physicians face when implementing COVID-19 imaging AI solutions (and other imaging AI solutions).

Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire

Mobile MRI’s Missing Piece

Researchers from the University of Sydney identified “the missing piece” that could allow low-cost mobile MRIs to produce high-quality images.

  • The Missing Piece – In their search for a mobile MRI contrast agent, the team found that superparamagnetic iron oxide nanoparticles (SPIONs) are 3,000-times more magnetic than conventional MRI contrast agents. That’s good news, because patients would require 1,000-times larger gadolinium-based agent injections than currently approved to in order to enhance low-field MRIs.
  • The Study – The researchers scanned healthy mice with an ultra-low field (0.0065 T) MRI, then injected them with SPIONs and re-scanned them. The SPION-enhanced images showed a “striking difference” in the mouse kidneys, livers, and other organs.
  • About SPIONS – SPIONs have already been approved for treating anemia and can be prescribed “off label” for low-field MRI scans, but they still need to be specifically approved for use as contrast agents.
  • The Significance – We’re seeing more buzz about how mobile MRIs can help patient care, but they also have low image quality and haven’t been able to take advantage of contrast agents like standard MRIs. SPION-based contrast agents could address these challenges, potentially expanding MRI access within hospitals and across the world.

HAP Redefines Partnership

They say that in times of crisis, you get to know who your real friends and partners are. This adage gained new significance for Triad Radiology Associates earlier this year, as the COVID-19 pandemic upended its operations and Healthcare Administrative Partners (HAP) stepped up to help guide the practice through this disruption.

In the latest Imaging Wire Q&A, we sat down with Darlene Clagett of Triad Radiology Associates and HAP’s Rebecca Farrington to discuss how their partnership evolved during the COVID-19 emergency. Here are some of the big takeaways:

  • Origins – In their two years working together, Triad Radiology experienced a range of benefits from its revenue cycle partnership with HAP including fewer write-offs, improved coding accuracy, fewer AR days, and increased collections.
  • Pandemic Partnership – Triad’s list of benefits quickly evolved during the COVID-19 emergency, as HAP guided Triad through the relief program application process to help the practice weather the shutdown.
  • Rebound Plan – As the shutdown subsided, HAP also supported Triad’s return plan, providing regular revenue projections, weekly volume comparisons versus pre-COVID dates, and benchmarking versus other practices.

Retiring the Daily CXR

A new JAMA paper urged physicians to drop the outdated practice of daily chest X-rays (CXRs) in the ICU, suggesting that evidence-based CXR policies can help curb unnecessary tests and procedures.

  • One Story, 10 Scans – The paper told the story of one patient in their 40s with respiratory failure due to pneumonia who showed significant improvements after seven days in the ICU, until the 7th daily CXR was incorrectly flagged for a potential collapsed lung. After confirmation by another incorrect CXR, the patient almost received an unnecessary thoracostomy before a lung ultrasound and follow-up chest CT revealed that there was no collapsed lung, just a skinfold mimicking a collapsed lung.
  • Takeaway – The authors noted that daily CXRs are well intended, but they are also antiquated and provide little value, suggesting that the daily CXR should be removed from standard ICU practice.
  • Significance – This is the latest effort against performing daily chest x-rays in the ICU, coming just a few weeks after a NYC hospital published a success story on how it ended daily ICU CXRs and nearly a decade after similar studies began arguing against daily CXRs.

The Wire

  • A CV19 AI Profile: A new statnews.com article detailed one silver lining to our struggle to curb the COVID-19 pandemic: it’s giving AI developers more images to develop COVID-19 AI tools in advance of a future surge. The article noted the growing number of CV19 AI solutions and suggested that demand for these tools might increase in the months ahead, but also brought up the challenges that are common across many imaging AI solutions (workflow, real world performance, etc.).
  • Zebra HealthMammo Cleared: Zebra Medical Vision announced the FDA approval of its HealthMammo algorithm, which is Zebra’s first mammography solution, first oncology solution, and sixth FDA-cleared AI tool. HealthMammo (already CE Marked) prioritizes and identifies suspicious 2D mammograms and is available through the company’s AI1 “All-In-One” bundle.
  • Subspecialist Versatility: A new paper in Clinical Imaging suggests that one of radiology’s big takeaways from the COVID-19 pandemic so far is that sub-specialist radiologists should develop/maintain a general radiology skillset in preparation for future healthcare crises. The authors believe that sub-specialists should be able to interpret general radiology studies in an acute care setting, while warning that many academic radiologists aren’t getting enough practice outside of their subspecialty to do this (private practice subspecialists are).
  • AD Blood Test: Researchers from the Washington University School of medicine (the St. Louis one) are advancing towards a blood test for early Alzheimer’s disease diagnosis, which could potentially replace current PET imaging-based processes. The study found that plasma p-tau in blood samples can be used to identify early signs of Alzheimer’s, avoiding the costs and time consuming processes required for PET imaging.
  • Emory On Time: A new Emory University paper detailed how they significantly improved their daily outpatient CT start time consistency (from 11% on-time starts to 82%) and reduced their per-patient turnaround times (71.5 to 15.9 minutes). An Emory quality improvement project team first identified factors causing the delays and then they implemented, tested, and refined 14 workflow changes over 20 weeks. In the end, they created a standardized process map with time allotments and role assignments (plus, they achieved those time improvements).
  • DBT’s Mixed Benefits: DBT has a solid advantage over digital mammography for baseline screening mammograms, but DBT’s advantages are mixed for subsequent screenings. That’s from a new JAMA Open Network study (n = 1.27 DM exams, 310k DBT) that found that DBT does improve recall and/or cancer detection rates in subsequent screenings for many groups, but not the 10% of women with extremely dense breasts, who had the same cancer detection and recall rates with DM and DBT.
  • Nanox’s $59m: Nanox continued its fundraising progress, raising another $59m to close its $110m series B round that it will use for the development and rollout of its Nanox.ARC system. This is reportedly Nanox’s final funding round before it goes public, as it hopes to take advantage of a number of trends (AI, 5G, cloud, teleradiology, imaging democratization) along with its unique digital X-ray technology to disrupt imaging. There have been plenty of Nanox sceptics since it came on the scene, and Nanox still has a lot to prove, but the company deserves credit for continuing to hit milestones and make headlines.
  • Swedish Sensitivity: New research out of Sweden detailed the country’s broad screening mammogram reading sensitivity range, but tight specificity range. The retrospective study (n = 418k 40-74yr women, 973k scans read by 110 high-volume breast radiologists) found that Sweden’s lowest quartile radiologists archived 63% sensitivity and its highest-quartile radiologists recorded 84% sensitivity (73% overall), with even wider sensitivity variation for basal cancers (53% – 89%). Meanwhile, specificity fell within a tight 95% to 98% range.
  • Ziehm Acquires Therenva: Ziehm Imaging acquired Therenva, combining Ziehm’s C-arm portfolio with Therenva’s cardiovascular procedure planning and 3D imaging software tools. The acquisition will allow Ziehm to offer Therenva’s products globally (Ziehm already sold Therenva in Europe) and will allow the companies to co-develop new solutions.
  • MRbrainS: The EU-funded ATTRACT consortium is exploring how to combine MRI scans with mixed reality headsets to help guide neurosurgery. The MRbrainS project feeds brain activity data from fMRI scans into holographic brain mapping software integrated into MR headsets, which highlights and labels important areas and blood vessels for the surgeon. The consortium is also supporting an MR-based approach that uses imaging (MRI, US, endoscopy) to guide in-utero surgery.
  • Micro-X Rover: Australian mobile X-ray manufacturer, Micro-X, announced the FDA approval of its new Rover mobile X-ray system designed for military medical facilities. Micro-X originally developed the Rover for the Australian military, highlighting its combination of a low 210 lb. weight and high power.
  • Thrown Out in FL: Florida courts affirmed a previous decision to throw out a malpractice claim against a Mednax-affiliated interventional radiologist because the plaintiff’s legal team changed their complaint after the statute of limitations expired. The woman and her husband originally filed the malpractice lawsuit in 2015 citing her “injuries” and damages to their spousal relationship related to the alleged malpractice in 2011/2012, but added her three minor children as plaintiffs in 2019 so they could seek damages (well after the 2-year statue) .

The Resource Wire

– This is sponsored content.

  • This Nuance white paper details how Baptist Health South Florida used PowerScribe Workflow Orchestration and PowerConnect Communicator to optimize its radiology workflow and streamline its communication.
  • Check out Riverain Technologies’ on-demand webinar demonstrating how its AI solutions integrated into LucidHealth’s radiology workflow and sharing best practices on how to combine AI with radiologist expertise.
  • This Hitachi blog details the benefits of multi-parametric MRI (mpMRI) for prostate imaging, including insights on how its Oasis 1.2T High Field Open MR allows more diagnostic-quality exams with reduced metal susceptibility artifacts on the diffusion sequence compared to a 3T magnet.
  • As the world navigates the unprecedented challenge presented by the COVID-19 pandemic, GE Healthcare supports healthcare providers, partners, communities and patients around the world in addressing it. Find information on GE Healthcare’s COVID-19 Resources here.
  • If you’re in the mood for a good success story, this video details how MRI-guided focused ultrasound treatment helped one patient recover from essential tremor.

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