Ultrasound Screening | Imaging Backlogs | PE in the ER

“It is an absolute catastrophe.”

A UK NHS radiologist on the country’s post-COVID imaging backlog.

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

A Case for Ultrasound Breast Screening

A new study out of China provided a solid case for using ultrasound as either a primary or secondary breast screening tool, citing its comparable performance to mammography, advantages with invasive cancers, and effectiveness among women with dense breasts.

  • The Study – The team reviewed 23 studies, including 12 that performed supplemental ultrasound (S-US) after a negative mammogram and 11 studies that used both ultrasound and mammogram as primary screening tools (2003 – 2018).
  • Primary US Screening Benefits – Those who want to make a case for using ultrasound as a primary breast cancer screening tool would point to its impressive 4.6 per 1k exam cancer detection rate (vs. mammography’s 4.6 and S-US’s 3.0 per 1k), its 87% invasive cancer detection rate (vs. mammography’s 65% and S-US’s 74%), and it’s 68% detection rate for all cancers (vs. mammography’s 65%). However, primary ultrasound screening also had relatively high recall rates (5.9% vs. mammography’s 4.6% and S-US’s 8.8%) and biopsy rates (2.3% vs. mammography’s 1.5% and S-US’s 3.9%).
  • Takeaway – Although breast ultrasound’s limitations are well known, this study helps to bolster the value of both primary and secondary ultrasound screening and calls for continued research to validate whether ultrasound could indeed serve as a primary screening tool.

The Wire

  • Secondary Benefits: A new Yale survey revealed that emergency clinicians heavily utilize secondary imaging reading and find them beneficial for a range of reasons. The survey of 58 attending emergency physicians found that 80.8% of them request secondary interpretations either “always” or “most of the time” and most believed second interpretations: improve patient care (92.3%), support disposition (84.6%), and reduce imaging utilization (88.5%). In cases where interpretations conflict, 50% of emergency physicians would request additional scans, while 73% of physicians would order secondary interpretations even if they were unsure of the patient’s coverage.
  • Distortion Matrix Ultrasound: A team of French researchers proposed a new distortion matrix ultrasound method to help reduce image distortion/blurring that occurs when scanning multiple organs that have diverse tissue structures, going beyond image improvements achieved by adaptive focusing. Calling it the “holy grail for imaging,” the distortion matrix ultrasound method “connects” the targeted tissue/organ with its associated ultrasound wave distortion, allowing the system to create images with less distortion.
  • Radiologist Job Rebound: Radiology Business Solutions (RBS) shared an optimistic view on the radiologist job market, suggesting that although COVID-19’s impact on imaging volumes and some radiologists’ decision to delay retirement will temporarily slow hiring, practices’ demand for new radiologists will rebound along with volumes. In fact, RBS forecasts that the radiologist shortage will “continue and maybe even deepen in the short term once hospitals become busy and outpatient imaging demands are met.”
  • More AB-MRI Evidence: A new study in the Journal of Breast Imaging found that abbreviated breast MRI (AB-MRI) screening can be effective for women with a higher-risk of breast cancer, as long as their previous full protocol MRI (FPMR) was normal. A review of AB-MRI and FPMR exams (n = 481 & 440) among women who previously had normal FPMR results found no statistical difference in abnormal interpretation (6% vs. 6.8%) or cancer detection rates (8.3 vs. 11 cancers per 1k exams). This is the latest study highlighting the benefits of abbreviated breast MRI exams (10-11 minutes), following a high-profile study that came out in March.
  • Samsung’s New RS85 Prestige: Samsung announced the US launch of its new RS85 Prestige ultrasound, building on the previous RS85 model with improved image quality / clarity, higher processing power, and new clinical applications to support viewing blood flow, liver tissue, and attenuated regions behind bony structures.
  • Projecting Portal Savings: New research out of Italy finds that online image access portals could reduce costs for both patients and hospitals. The researchers analyzed two years of exams (9,068 exams, 6,720 patients), finding that 446 exams (4.4%) were accessed through the portal, and calculating that hospitals and patients could have saved €255,808 if all reports were accessed via the portal. That might seem like a big “if” considering that 95% of exams we’re not accessed online, but it does help quantify the financial (in addition to convenience) savings that would come with complete adoption. It’s also encouraging that more patients’ accessed the portal in the second year than the first (5.4% vs. 4.4%).
  • Scientifically Pro-Pocus: There’s been plenty of pro-POCUS coverage related to COVID-19 diagnosis and management, and Scientific American just brought this message to its 10+ million monthly online readers. Although the article was less “scientific” than many of the CV19 POCUS studies we’ve covered, it hit on many of the same points (speed, availability, portability, transmission safety, no radiation) and suggested that POCUS definitely belongs in clinicians’ CV19 “toolbox.”
  • UK Imaging Backlog: Reports from the UK reveal mounting diagnosis delays as NHS hospitals and radiologists try to handle a surge in COVID-delayed scans. The Royal College of Radiologists warns that in order to avoid dangerous diagnostic delays, the NHS would have to increase its radiologist workforce by a third (adding 1,900 new rads) and expand its imaging fleet in order to work through the 850,000 CT and MRI scans that were postponed during the emergency.
  • Another Mobile MRI: Researchers at Finland’s Aalto University are developing a smaller and lower-cost mobile MRI than can be transported in a van (vs. large tractor trailer), expanding the modality to hard to access emergency areas and potentially new wellness applications (e.g. body fat testing at gyms). The mobile MRI, which uses permanent magnets (vs. superconducting electromagnets) and has a weaker magnetic field, has been in development for several years and is about to begin testing.
  • UIH Settlement: The University of Illinois Hospital will pay a $7.5m settlement for a delayed lung cancer diagnosis that proved to be fatal. Although a radiologist identified a mass on the man’s right lung in a 2017 CT scan and recommended testing, the hospital did not inform the man or his family of the incidental finding. Another CT scan in May 2019 revealed metastatic lung cancer and the man died two months later.
  • MRI AI for Knee OA: A University of Cambridge team developed a 3D cartilage surface mapping (3D‐CaSM) algorithm that can analyze knee MRI images for small changes in knee joints over time to help guide osteoarthritis treatment. To test 3D‐CaSM, the team used four cadaveric knees and scans from 14 participants with mild–moderate knee osteoarthritis (OA) and 6 healthy participants (40–60yrs), finding that 3D‐CaSM did indeed help track changes in the participants’ knee joint cartilage thickness and relaxation times over six months.
  • PE ER Exposè: A new expose from Propublica detailed how marked-up ER bills generally benefit private equity investors far more than doctors, even if doctors serve as the “face” of the surprise medical billing fight. A deep dive into TeamHealth’s tax and legal records revealed how the massive Blackstone-backed medical staffing firm “charges multiples more than the cost of ER care” (up to 7.7x more than physician costs), keeps the bulk of their profits, and potentially violate state licensing rules in the process.
  • HR & Staffing Considerations: Healthcare Administrative Partners shared a set of HR and patient scheduling recommendations for radiology practices as they continue their post-COVID reentries. HAP’s human resource guide suggests that practices create staffing plans based on their expected workload and volumes, carefully manage the return of furloughed or laid off workers, create staffing and communication policies, and ensure safety policy compliance. HAP’s patient scheduling guide encourages practices to keep in contact with delayed patients, assure returning patients of their safety, adopt flexible rescheduling tactics (e.g. offering multiple dates), and adopt policies to triage patients based on their potential CV19 exposure and reduce exposure during their visit.
  • Lumify with Reacts in Japan: Philips announced the Japanese regulatory approval and launch of its Lumify with Reacts handheld tele-ultrasound solution, expanding the solution to the world’s third largest healthcare market. Noting Japan’s growing elderly population, Philips highlighted how the Lumify with Reacts supports remote collaboration during diagnosis and can be used in both hospital and community settings.

The Resource Wire

– This is sponsored content.

  • This Riverain Technologies case study details how Einstein Medical Center adopted ClearRead CT enterprise-wide (all 13 CT scanners) and how the solution allowed Einstein radiologists to identify small nodules faster and more reliably.
  • With orthopedic care growing with the aging population, orthopedic imaging is growing along with it. This Hitachi blog details how more orthopedic practices are bringing imaging in-house and what factors they should take into account as they decide how/whether to add imaging to their suite of services.
  • This Nuance white paper shares insights from radiologists across nine U.S. healthcare systems on how AI is supporting their evolving roles and changing needs.

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