“While it can be a bit unsettling to think that the computer is analyzing what we as radiologists cannot see or put intuitive names to, it would behoove us to become comfortable with this,”

Boston Medical Center radiologist, Kitt Shaffer, MD, on coming to terms with AI.

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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.

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The Imaging Wire

Ultrasound’s COVID-19 Momentum

Ultrasound’s momentum as a key COVID-19 tool got another boost from a wave of new pro-US studies and a notable FDA clearance. Here are the highlights:

• LUS, the Safe CV19 CT Alternative – A new study in Ultrasound in Medicine & Biology found that bedside lung ultrasound (LUS) scans can nearly eliminate the need to transport patients for CT and CXR imaging, thus reducing exposure. The study focused on an Italian ICU unit that adopted an ultrasound-based approach for monitoring patients with CV19-caused acute respiratory failure (ARF), finding that this approach significantly reduced the number of ARF patients who received chest X-rays (1 vs. 3 ARF patients) and CT scans (3.6% vs. 31.8% of ARF patients) compared to the same period in 2019.

• POCUS’ CV19 Advantages – A new paper in Clinical Radiology touted POCUS’ role for COVID-19 assessment due to its high sensitivity for pulmonary manifestations, its lower risk of viral transmission (used at patient beds, easier decontamination), its ability to forecast and assess therapy response, and its lower costs than other modalities. The review also touched on POCUS’ ability to detect key COVID-19 findings (interstitial syndrome & consolidation) and differentiate acute respiratory distress and pleural effusion.

• Another Pro-POCUS Paper – A paper in Academic Emergency Medicine came to many of the same conclusions, noting that although CT and CXR both have solid roles for COVID-19 imaging (and solid disadvantages), POCUS is an attractive option due to its portability, lack of radiation, ability to be used at patient bedsides, and lower transmission risks. The paper noted lung ultrasound’s historical value with similar viruses (ARDS, H1N1) and detailed how POCUS has already proven to help with CV19 including: 1) Triaging non-critical patients; 2) Allowing quick and easy lung imaging when it’s needed; 3) Monitoring for other pulmonary diseases and cardiac complications; and 4) Reducing transmission risks and decontamination efforts by using handheld POCUS systems inside plastic bags.

• Philips US Cleared for CV19 – Much of Philips’ ultrasound portfolio just gained FDA approval for the management of COVID-19-related lung and cardiac complications, allowing Philips to provide more specific guidance to clinicians using its US systems/software for COVID-19 care (and sell/market them specifically for CV19). This was a high profile announcement for Philips, which emphasized the major role of handheld and portable ultrasound in CV19 care, and revealed plans to increase its ultrasound manufacturing capacity to meet this growing demand.

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The Wire

• Risk Preferences: The vast majority of women (87%) want to be informed of their lifetime risk of breast cancer, although communication preferences vary widely depending risk levels and socioeconomics. That’s from a recent UMass Medical-led survey (n = 683) that found that the majority of women prefer to be notified by mail if they are of “average risk” (57%), while preferences shift to face-to-face communication for learning that they have higher-risks (43% F2F, 43% mail). The study also revealed that younger women prefer phone communications, black and older women preferred less detailed communications, and older and lower-income prefer non-electronic communications.

• Butterfly’s First System: Butterfly Network reached a major milestone last week after Atrium Health became the first major health system to use the Butterfly iQ ultrasound in practice (now active at 30 Atrium locations). Butterfly Atrium dad jokes aside, this is a big deal for Butterfly, which has done an excellent job building its brand and creating a following of end-users, and now has the validation and revenue contribution that comes from adding a major health system on its client list. In the announcement, Atrium even made the “stethoscope of the future” analogy that has everyone so excited about handheld ultrasound systems.

• E/M’s $10b Impact: The ACR continued its fight against the recent changes to Evaluation and Management (E/M) reimbursements, this time revealing that the policy change could cut Medicare payments for outpatient imaging by $770m in its first year and by $10b over a decade. With the new structure, the E/M changes create $5b in additional provider reimbursements, but this increase will largely go to other specialties and would therefore require cuts to radiology reimbursements due to CMS’ budget-neutral mandates.

• NVIDIA’s CV19 AI: NVIDIA released a pair of Clara AI models that analyze chest CT scans and are intended to help researchers develop new AI-based tools to better understand, measure, and detect COVID-19 infections. The models were jointly developed with the NIH in less than three weeks using the NVIDIA Clara application framework.

• Radiologists Top Earners, Again: According to a new Medscape survey (n = 17,461 physicians), radiologists remain among the top-earning specialists (up 2% to $427k avg.), trailing only orthopedic surgeons ($511k), plastic surgeons ($479k), otolaryngologists ($455k), and cardiologists ($438k). However, this pre-COVID survey is unlikely to represent 2020’s earnings, as the emergency continues to hold back procedure volumes.

• EDAP & Exact Imaging: EDAP became Exact Imaging’s exclusive global distributor, offering the ExactVu micro-ultrasound imaging technologies alongside its Focal One high intensity focused ultrasound (HIFU) treatment solution for prostate cancer across its channels and client base.

• Structured Preferences: Patients find structured radiology reports easier to understand, while using specific language could help reduce unnecessary patient follow-ups. That’s from an Emory University survey (n = 5,155, 18 questions) that presented respondents with a pair of freestyle and structured chest radiograph reports (both negative), revealing that the participants found the structured reports to be easier to understand (P < .001) but didn’t influence their confidence in the radiologist (P = .21) or overall comprehension (P = .083 vs. .077). The survey also found that understandable descriptions like “no acute disease” gave respondents more confidence and made them less likely to follow up compared to descriptions like “unremarkable” or “negative chest.”

• MITA Urges CMS to Help: Noting the strains that the COVID-19 emergency has placed on imaging and the continued challenges that await in the post-CV19 era, MITA urged CMS to introduce new policies to support infection control, reduce prior authorizations, postpone previously-approved payment cuts, and launch public campaigns to encourage patients to reschedule their CV19-delayed imaging appointments.

• Reconstruction’s Instabilities: A new study warned that the emergence of AI-based image reconstruction might have unintended consequences due to its instabilities. The researchers tested six medical imaging reconstruction methods, finding that: 1) Small movements may result in severe artifacts in the reconstruction; 2) Small structural changes, like a tumor, may not be captured in the reconstructed image; 3) The use of larger samples may actual yield poorer performance; and 4) Instabilities are not rare and not easily fixed.

• Mount Sinai’s Post-CV19 Center: Mount Sinai Health System (MSHS) announced the launch of its new Center for Post-COVID Care, supporting recovering CV19 patients (including imaging) as they transition from hospital to home and potentially face ongoing respiratory symptoms or systemic complications. The first of its kind center will also support ongoing CV19 studies, as researchers work to understand the virus’s long-term impact.

• HAP & SR-PSO Follow Up: Healthcare Administrative Partners (HAP) and the Strategic Radiology Patient Safety Organization (SR–PSO) launched a collaboration to improve the communication of incidental findings uncovered in emergency departments. Participating Strategic Radiology practices will leverage HAP’s Deep Dive Analytics (DDA) service to identify and notify patients at risk of missing their follow-ups and SR–PSO plans to share the results of their collaboration in late 2020.

• Lung Cancer Survival Algorithm: A South Korean team developed a deep learning model that can predict lung adenocarcinoma patients’ risk of disease-free survival using preoperative CT scans. The model was trained and internally tested with data from 800 patients (2.5 survival hazard ratio) and later tested externally using data from 108 patients (3.6 survival hazard ratio), rivaling smoking status as the best predictor of disease-free survival (3.4 hazard ratio).

• CV19 Safety Steps: A new AJR paper detailed how a Chinese hospital adjusted its protocols to reduce transmission risks in its CT room and protect its radiographers. The changes included: 1) Installing a CT in its CV19 “fever clinic; 2) Modifying its CT exam process (making pathways 1-way, only allowing one radiographer in contaminated CT room, reducing waiting room time); 3) Expanding its CT room disinfection processes (air & UV light disinfection, cleaning solutions); 4) Adopting new radiographer protection measures (training, PPEs); and 5) Using a patient positioning AI tool to limit the need for radiographers to enter the CT room.

• Canon & Surfacide’s Decontamination Deal: Canon Medical announced that it will offer Surfacide’s Helios decontamination system to its healthcare clients as a rapid UV-C imaging system decontamination tool. The announcement comes just a few weeks after Canon launched a UV-C decontamination-equipped version of its Aquilion Prime SP CT (presumably based on the Helios) and this new announcement appears to represent an expansion of Canon and Surfacide’s partnership.

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The Resource Wire

– This is sponsored content.

• In its latest Q&A, Nuance sat down with MaxQ AI’s Randy Rohmer to discuss how its AI platform helps hospitals reduce misdiagnosis and healthcare costs, and share about it’s AI Marketplace partnership with Nuance.

• This Hitachi blog details how the COVID-19 pandemic created new urgency for healthcare systems to adopt and expand tele-health and tele-radiology, while outlining the key considerations for those about to make this transition.

• Severe sepsis strikes more than a million Americans every year at an annual cost of more than $20 billion. Learn how point of care ultrasound can help improve sepsis outcomes in this GE Healthcare paper.

• The pressures driving radiology practice consolidation are significant, but there’s a strong case for staying independent. Healthcare Administrative Partners explains how independent practices can thrive by building relationships, relying on outside support, and leveraging capital.

• ClearRead CT from Riverain Technologies is the first FDA-cleared system for the automatic detection of all lung nodule types, allowing radiologists to reduce search and reporting time and improve nodule detection rates.

• The latest Focused Ultrasound Foundation newsletter is highlighted by a pair of new studies on using focused ultrasound to treat OCD and depression and using FUS for gene therapy delivery.

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