Virtual AHRA | Overimaging | Generalizable CV19 AI

“What we’re doing is similar to, say, where the PC world was in the 1970s or 1980s . . .”

Exo Imaging CEO, Sandeep Akkaraju, comparing his prediction that every household will eventually have its own handheld ultrasound to early forecasts that every home would have its own personal computer.

Imaging Wire Sponsors

  • Bayer Radiology – Providing a portfolio of radiology products, solutions, and services that enable radiologists to get the clear answers they need.
  • 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

Virtual AHRA 2020

AHRA just wrapped up its 48th annual meeting. It also happened to be AHRA’s first virtual meeting, which is quite a change for an event that’s become known as a “family reunion” for imaging administrators. However, a post-show call with Bayer Radiology’s Richard Dewit revealed that AHRA 2020 achieved its main education and business priorities, while providing some benefits that can only happen with a virtual conference. Here are the big takeaways:

  • All About Education and Certification – AHRA’s annual meetings are always focused on education, and that focus is amplified when there aren’t any cocktail receptions or breakfast buffets. With that, AHRA filled its virtual schedule with a solid mix of presentations (included a panel w/ Bayer), keynotes, and exhibitor symposiums, plus a digital exhibitor hall. AHRA 2020 also took advantage of a silver lining for virtual conferences, as the show’s online format allowed it to make these sessions available for another 30 days and reach a much wider audience.
  • Attendee Perspectives – AHRA 2020 brought the same mix of radiology department leaders as previous years, although many had uniquely-2020 interests. As you might expect, Dewit and his colleagues fielded a range of COVID-related questions about how to manage their operations during the crisis (change management, training procedures, supporting staff and patients) and how to work within their financial constraints (flexibility during spending freezes, maximizing efficiency, service options, etc.).
  • Virtual Booths – In previous years, AHRA shrewdly positioned its lunch buffet behind the exhibitor booths to help ensure booth traffic. That’s tougher to pull off when virtual attendees are within feet of their own kitchens, so exhibitors had to lean in on the virtual experience. Bayer achieved this by allowing attendees to take self-guided tours to learn about its products and services, while making virtual staff available for live conversations. Bayer also welcomed attendees to its virtual Innovation Hub, featuring its new and highlighted products / services, with a particular focus on its updated Tech Care package.
  • Takeaways – Even if this year’s AHRA “family reunion” was virtual, the event still delivered on its educational and business priorities, with some added digital-only benefits. We’ll just have to catch up on all the missing social stuff at next year’s meeting in Nashville.

Neuro Imaging Overuse

New research from Emory revealed massive increases in ED neurodiagnostic imaging for patients with seizures and epilepsy, adding more evidence of emergency imaging overuse with these patients.

  • The Study – The researchers reviewed data from 9 million patients (27% pediatric, 73% adult) who visited the ED due to seizures / epilepsy between 2006 and 2014.
  • The Results – The study revealed significant increases in head CT (+27.8% pediatric, +95% adult), brain MRI (+300%, +400%), and electroencephalography (+220%, +650%) exams. To put that into context, over the same period pediatric seizure / epilepsy ED visits fell by 1.2% and adult visits increased by 8.2%.
  • Overimaged Groups – Neurodiagnostic testing was particularly high among patients who are male, higher income, and privately insured, while imaging volumes tended to be higher at nonteaching hospitals (vs. teaching hospitals) and the Northeast and South (vs. West).
  • The Significance – This is the latest study to reveal emergency imaging overuse among patients with seizures / epilepsy (here’s another one), even though imaging rarely leads to changes in care for these patients. However, it does drive up imaging costs, as patients with seizures / epilepsy represent just 1% of adult ED visits and 2% of pediatric visits but carry a cost of $500b annually.

Generalizable COVID AI

A NIH and NVIDIA-led team developed a series of AI tools that can detect COVID-19 pneumonia in chest CT scans with up to 90.8% accuracy, while achieving greater generalizability than other COVID AI solutions.

  • The Algorithms – The team developed a series of algorithms using CTs from an intentionally diverse group of 1,280 patients to develop generalizable algorithms to localize parietal pleura/lung parenchyma and classify COVID-19 pneumonia. To create this diverse dataset, the team sourced the images from four hospitals and three countries (China, Japan, and Italy), while using scans captured at different phases of the patients’ COVID care (e.g. screening, initial diagnosis, and advanced/critical stages) and used non-COVID patient scans from a variety departments (acute care, trauma, oncology, and inpatient).
  • The Test – Using an independent test set with CTs from 1,337 other patients (not associated with the training or validation sets) the algorithms achieved up to 90.8% accuracy, 84% sensitivity, 93% specificity, a 0.949 AUC, and a 10% false positive rate.
  • The Significance –Most in the industry agree that CT shouldn’t be used for initial COVID-19 diagnosis, so these algorithms may only support niche use cases (e.g. research or diagnosing certain populations). However, the algorithms’ generalizability is what makes them significant, noting that other COVID AI solutions have struggled to perform in the real world due to a lack of diversity in their training sets.

The Wire

  • Exo’s $40m: Exo Imaging continued its impressive fundraising progress, completing a $40m round (nearly $100m so far, almost exactly 1yr after a $35m round) that it will use to develop its handheld ultrasound and software platform. Although we cover handheld ultrasounds on nearly a weekly basis these days, Exo contends that its forthcoming ultrasound’s piezoelectric transducer technology will help the company to stand out by solving a number of today’s handheld imaging challenges (cost, portability, image quality, software, and imaging denser body compositions).
  • Dangerous Declines: A new study published in JACR revealed a sharp 42% decline in emergency abdominal CT scans at the start of the COVID-19 crisis and concerning increases in serious cases. The researchers compared cohorts from the March 15th – April 15th period in 2019 and 2020 (n = 733 & 422 patients), discovering that patients with positive abdominal CT findings increased from 32.7% to 50.5%, complications jumped from 7.9% to 19.7%, and patients requiring surgery nearly doubled from 26.3% to 47.6%.
  • Privacy Warning: The ACR warned radiologists that recent changes in search engine technology could expose patient identifiers hidden in medical images featured on presentation slides (even if they were considered anonymized). The ACR urged radiologists to anonymize images used in their publicly available presentations and provided detailed instructions on how to do that.
  • COVID’s US Drag: A new survey from IMV Medical revealed that the COVID-19 pandemic drove a 49% reduction in general ultrasound exam volumes in April 2020 (to ~1.15m exams) largely due to a drop in electives. As of January 2020, 35% of hospitals were planning to add at least one general US system over the next three years, but IMV now expects more hospitals to delay or reduce their orders.
  • Defensive Medicine: A new study out of Emory concluded that the association between paid malpractice claims and advanced Medicare imaging utilization is evidence that “US physicians use medical imaging as a defensive medicine strategy.” Their review of 2004-2016 data revealed declines in Medicare imaging utilization and spending (-31.4% & -47.2%) and paid malpractice claims and payout amounts (-46.4% & -39.6%) and found that every 1% increase in paid malpractice claims came with a subsequent 0.20% increase in advanced imaging volumes.
  • Nanox IPO: Nanox completed its IPO on the Nasdaq exchange, closing at $21.70 per share and raising $165.2m (up from its $18/share opening and initial $125m IPO target). The IPO comes shortly after a $110m round and nearly doubles the company’s $137m raised before the IPO, which Nanox will need in order to pull off its ambitious market disruption strategy.
  • Rad Specificity: A new study in The Journal of Digital Imaging (642k reports from 171 radiologists) found that radiologists used uncertain or “hedging” terms in 33.8% of their reports, with some radiologists using uncertain terms in 55% of their reports. Uncertain terms were more likely with certain patient admission status (inpatient 40.3%, emergency 34.6%), imaged anatomy (thoracic 55%, abdominal 54.1%), and radiologist subspecialty, while reports with uncertain terms were often much longer.
  • Prostate Segmentation AI: A UC Irvine-led team developed a deep learning CNN capable of automatically locating and segmenting the prostate in mpMRI images, potentially streamlining a post-processing step required for prostate fusion biopsy planning. The team trained their CNN on mpMRIs from 287 patients (299 MRIs, 7,774 total images) that were manually segmented by two abdominal radiologists. The CNN achieved a Dice score of 0.898 (0.890 – 0.908) and a Pearson correlation coefficient of 0.974, which might not mean much to most people but does suggest that a CNN like this could be effective.
  • Aspen & Huami Partner: Texas-based and South Korean-owned X-ray device manufacturer Aspen Imaging Healthcare (formerly known as Aspenstate) and Chinese wellness-focused consumer electronics company Huami Corp announced a partnership intended to bring Huami into healthcare. The partnership will initially focus on new product development and global distribution/marketing, and could lead to Huami investing in Aspen.
  • Excellent Electronic Consultations: New research in AJR detailed how one Ottawa-based network benefited from implementing an electronic consultation system to support PCP-to-radiologist consults. The study reviewed 302 consultations finding that the system avoided 84 unnecessary scans (28% of cases) and altered patient management in 167 cases (55%), while PCPs rated the system as “excellent” in 227 cases (75%).
  • GBCA Retention & Effects: A study in RSNA Radiology provided new insights into the effects of gadolinium administration and retention. The researchers injected either gadodiamide (linear contrast agent), gadoterate meglumine (macrocyclic contrast agent), or saline into 70 rats for 20 days, finding significant gadolinium retention in the rats’ spinal cord and peripheral nerves for from GBCA types. The rats with gadodiamide retention had pain hypersensitivity (not gadoterate meglumine), while neither GBCA type altered the rats’ cognitive function or their production of new nervous system cells.
  • RADCAT: A Brown University / Rhode Island Hospital study detailed the successful launch of their RADCAT radiology report categorization system (organizes reports into five categories, automates communication), suggesting that it could be implemented in any healthcare setting. In RADCAT’s first 18 months, it categorized 740,625 reports (42% from ED), while nearly 100% of non-urgent imaging follow-up recommendations in 2019 were successfully communicated (38,692 of 38,701).

The Resource Wire

– This is sponsored content.

  • In this Bayer Radiology video, East Texas Medical Center Radiology Director, Bill Tobin, details how they used Bayer’s MEDRAD Stellant Smart Injector and contrast dose management to reduce contrast volumes and repeat scans.
  • Patients have become savvy healthcare shoppers who increasingly rely on price information to make decisions about their care. Join Healthcare Administrative Partners’ CRO, Rebecca Farrington, as she discusses price transparency & consumerism in radiology in this upcoming RBMA webinar.
  • Hitachi Healthcare Americas’ latest blog detailed COVID-19’s recent and future impact, warning cardiac practices and clinics of an upcoming wave of patients with cardiovascular issues that worsened due to delayed treatments, followed by a “third wave” of patients who developed heart complications from COVID-19 infections. Hitachi also shared some guidance on how to manage and minimize these waves.
  • It says a lot when a solution works so well for a radiology department that they decide to perform a study to quantify its benefits. In this Imaging Wire Q&A, University Hospital of Zurich’s Thomas Frauenfelder discusses his experience and study on Riverain Technologies ClearRead CT.

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