Trained to Overtreat | X-Ray Evolution | Future PACS

“The best way to avoid a diagnostic error is to avoid an unnecessary test.”

Johns Hopkins radiology professor, Pamela Johnson, on the importance of appropriate testing and the need for med schools to teach restraint.

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The Imaging Wire

Trained to Overtreat
“The habit of ordering unneeded tests and treatments drives up medical costs,” and “it’s a pattern doctors often learn in medical school and residency.” This is from a recent NPR story that’s quickly circulating around healthcare social media, with a lot more confirmations than objections in the comments section. The story covers the unnecessary test/treatment usual suspects (colonoscopy, C-sections, antibiotics, etc.) and it places a big focus on radiology.

The story suggests that med schools’ emphasis on thorough examinations and exposing students to numerous procedures and treatments (sometimes for ordinary problems) has unintentionally “hardwired” many physicians and led to an “epidemic of overtreatment.”

Some educators are exploring ways to avoid producing another generation of physicians who are hardwired for testing and treatment, particularly by harnessing aspiring doctors’ competitive spirit through peer comparisons and personalized reporting.

Konica Minolta’s X-Ray Evolution
Konica Minolta Healthcare Americas announced the FDA clearance of its Dynamic Digital Radiography (DDR) technology, calling it the “next evolution in X-ray imaging.” DDR allows clinicians to view anatomical movement from rapidly-acquired X-ray images (not fluoroscopy), which indeed represents a major change in how radiography can be used. Konica Minolta will initially target MSK (e.g. viewing full range of joint motion), thoracic imaging (e.g. viewing lung and organ movement during respiratory cycle), and pulmonary applications (determining the cause of dyspnea, detecting lung asymmetry).

X-ray doesn’t get a lot of publicity these days and DDR still has work to do in order to earn its clinical role, but DDR’s potential to expand the functionality of X-ray machines installed across the world feels like a pretty big deal from a care, accessibility, and cost perspective. The next step toward DDR earning its clinical role will come from a series of clinical studies followed by a commercial release later this year, both of which are worth keeping an eye on.

Days of the Future PACS
OTech’s Herman Oosterwijk took to AuntMinnie.com to detail how PACS is evolving and to share the changes he expects over the next 10 years, forecasting a next-generation PACS that is EMR-driven, supports more specialties, and will leverage AI for efficiency improvements. He goes into solid detail, so check it out if you’re PACS-focused. Here are some of his main points:

  • Architecture – PACS architecture will continue to expand horizontally across the enterprise (different departments and specialties, including pathology) and vertically within radiology, driven by the ever-increasing use of images in healthcare, POCUS ultrasound’s expanding application and user base, and the flexibility provided by VNAs and zero footprint viewers.
  • Workflow – The need for radiology workflow improvements will continue to grow as a result of significant increases in images per study and the still relatively common need for radiologists to support multiple sites with different PACS systems. It’s no surprise that Oosterwijk expects AI to have the greatest impact on workflow, such as supporting the “mundane task of optimizing and automating the workflow” and prioritizing cases.
  • Non-DICOM data – Oosterwijk sees an increasing need to manage non-DICOM data (reports, notes, measurements, ECGs, non-DICOM images), voicing his support for using separate document management systems for non-DICOM data that are linked to the EMR portal.

Synaptive’s Head-Only Point-of-Care MRI
Surgical planning and navigation company, Synaptive Medical, announced plans to get into the modality business with the upcoming launch of its Evry dedicated head MRI system. Evry uses a custom head coil to allow placement in areas that were previously inaccessible to MRI systems (EDs, ICUs) and enable scanning at the point-of-care for patients that require immediate diagnosis and decisions (e.g. acute stroke).

The new head-only MRI will initially be installed at Halifax’s QEII Health Sciences Centre for ongoing research to explore Evry’s impact and applications. After that, Synaptive is targeting regulatory approval and planning global commercialization.

Maybe this product shouldn’t be so unexpected, given that some of the biggest names in healthcare and imaging have been working on head-only MRIs for years and considering that point-of-care MRI has already seen niche adoption. Still, Evry’s positioning as a head-only point-of-care MR system is pretty unprecedented and quite interesting, even if the chances of its widespread adoption are slim.

The Cost of High-Deductible Plans
Regardless of income level, women with high-deductible health plans delay their breast cancer diagnosis and treatment. That’s according to research from a Harvard Medical-led team who studied data from over 300k women whose employers switched them to high-deductible plans and compared the group to data from over 3 million women with low-deductible plans.

The researchers found that low-income women who switched to high-deductible plans delayed their first breast imaging exams by 1.6 months, first biopsy by 2.7 months, incident early-stage breast cancer diagnosis by 6.6 months, and first chemotherapy treatment by 8.7 months. High-income women had shorter delays, but not significantly different from their low-income counterparts. This research is at least adjacently supported by research funded by Susan Komen that found women often delay or decline follow-ups due to high expected costs.

The Wire

  • Philips accused a former design engineer of stealing trade secrets related to its Philips/Dunlee replacement CT tubes that he used to provide his next employer, competing component manufacturer GL Leading Technologies, with a “decades-long head start.” Philips alleges that in December 2017, the 20-year employee loaded over 800 confidential files (with design, manufacturing techniques, specification, etc. info) onto a thumb drive and joined GL Leading Technologies to head up a CT tube design team a month later.

  • Esaote announced the U.S. launch of its MyLab X5 ultrasound system, representing a net new addition to its cart-based lineup between the MyLab Six and MyLab Seven. The MyLab X5 is the first model from Esaote’s MyLab X5/X6/X7 series to sell stateside and it will eventually be joined by the FDA-pending MyLab X7 (the X6 is not expected to sell in the US). The MyLab X5 launches with an emphasis on its low-labor functionality, while also touting its clinical tools and compatible probe portfolio.

  • Mach7 Technologies announced a PACS replacement deal with Virginia/North Carolina-based Sentara Healthcare (100 sites, 12 acute care hospitals, 1,911 total beds), replacing seven legacy PACS systems. Mach7 won the deal through a competitive tender, but the two definitely have a history together, as Sentara Healthcare already used Mach7’s Enterprise Imaging Platform, Diagnostic Studio, and Client Outlook’s eUnity diagnostic viewer. Sentara, Mach7, and Client Outlook are also jointly developing an “Imaging Innovations Lab” at Sentara’s Virginia Beach campus that will be used to provide onsite training and demonstrations of the Mach7/Client Outlook solution to their prospective customers.

  • GE Healthcare announced the FDA clearance of its Deep Learning Image Reconstruction DNN-based engine for its new Revolution Apex CT (or as an option for GE’s Revolution CTs), which combines the image quality of filtered back projection (FBP) with the low dose of iterative reconstruction “to produce TrueFidelity CT Images.” GE has high goals for DLIR, suggesting that the TrueFidelity images will make radiologists more confident reading a range of CT applications (head, whole-body, CV), while maintaining image sharpness and noise texture advantages over iterative reconstruction techniques.

  • GE Healthcare also announced the FDA clearance of its Bone VCAR (identifies and labels vertebrae) and SnapShot Freeze 2 (motion correction algorithm) Edison AI platform applications, as well as its Thoracic VCAR with GSI Pulmonary Perfusion solution (automates thoracic disease segmentation and measurement).

  • A new study in Clinical Cancer Research details a number of deep learning models that were able to predict lung cancer survival rates from CT scans with greater accuracy than standard clinical models. The dataset was based on CT scans from 179 patients with stage III NSCLC (captured before chemoradiation and at their 1, 3, and 6-mo follow-ups) and then validated the models against a 178-image dataset from 89 patients who were treated with chemoradiation and surgery. The study found that the models’ ability to predict 2-year survival rates improved with each follow-up scan (before treatment = AUC 0.58, after 6-months = AUC 0.74), accurately organized patients into low and high mortality risk groups, and were better than the clinical models at predicting metastasis, progression, and local regional recurrence.

  • Visage Imaging added yet another major logo, signing a 7-year $14 million contract with Duke Health. The deal will implement Visage 7 across all of Duke’s radiology departments, eliminating all legacy PACS systems, while enabling EHR-driven workflow and integrating with Duke’s existing VNA. Duke Health joins an increasingly noteworthy list of Visage clients (including Partners, Mayo Clinic, Mercy Health, and Yale-New Haven).

  • Radiology Partners and Phoenix-based health system, Banner Health, announced a partnership that will create Banner Imaging, a 23-location imaging center group with locations across the Phoenix area. The deal will transition RP’s East Valley Diagnostic Imaging (EVDI) and Valley Radiologists (VRL) centers and their employees to Banner Imaging, which will be a wholly-owned subsidiary of Banner Health.

  • NorthStar Medical Technologies completed a $100 million funding round that it will use to increase its Mo-99 production, improve its RadioGenix System separation platform, and pursue growth in research and development. NorthStar is about to complete a 20,000 square foot expansion at its Wisconsin facility, that it expects will double the company’s Mo-99 Source Vessel processing capacity, with plans to launch two additional Mo-99 Source Vessel lines in Missouri.

The Resource Wire

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