Voice Assisted Radiology | VR for IR | Evidence of Overuse

“This technology will allow physicians to travel inside a patient’s body instead of relying solely on 2D, black and white images.”

University of Washington radiology professor, Wayne Monsky, MD, PhD, regarding virtual reality’s potential impact on interventional radiology. Watch out, fluoroscopy.

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The Imaging Wire

Voice Assisted Radiology
A lot happened at last week’s Society of Interventional Radiology Meeting, but a demonstration of how smart speakers (Amazon Echo, Google Home, etc.), could add value to IR procedures clearly generated the biggest headlines. The demonstration used a UCSF-led team’s Google Home application to show how interventional radiologists can “ask questions and retrieve information needed for their patient treatments without breaking sterile scrub.” The application is programmed to provide recommendations on the device sizes that interventional radiologists should consider for a specific patient/procedure (e.g. sheath size to implant a stent). This seems like a valid use case, given IRs’ simultaneous need to access info and stay sterile. Kind of like asking Alexa to change a song while you’re cooking dinner.

The researchers plan to continue to develop this technology, next by expanding its scope to include material cost and inventory info, followed by potentially supporting other specialties and/or allowing access to patient EHR data. Although there may be more regulatory and privacy hurdles in healthcare, the use of voice assistants in the workplace isn’t as far-fetched as some may think, noting that last year brought a number of Alexa-controlled business devices (copiers, projectors, etc.) and understanding that Amazon and Google’s IOT ambitions go way beyond the smart home

Philips Adds Teleradiology
Philips announced its expansion to teleradiology services, made possible by its acquisition of Direct Radiology’s teleradiology platform. The move adds teleradiology viewing/reporting and on-call radiologist services to Philips’ cloud-based radiology informatics portfolio (PACS, VNA, and application suite), connecting Philips and its enterprise imaging clients with one of the fastest growing segments in radiology. It also advances Philips further into the diagnostic radiology wing of telehealth, noting that the company’s HealthSuite platform appeared to place a greater focus on information sharing and clinical collaboration up until now. It’s unclear how integrated Philips’ new teleradiology platform will be with its core informatics portfolio. However, Philips and its new team members who were brought on from Direct Radiology clearly position this as a longer-term strategic move, so it’s a safe bet that ongoing technological and clinical enhancements are planned.

Scans Up, Costs Flat, Reimbursements and Capital Uncertain
The AHRA’s Q1 2019 Medical Imaging Confidence Index survey revealed that hospital imaging managers and directors (n=182) are relatively confident in their departments’ Q1 business performance, despite negative Medicare expectations. The imaging leaders were particularly optimistic that their radiology scan volume will grow (118 out of 150 score), their operating costs will remain stable (128), and their departments will maintain or grow their role as a hospital profit center (132). However, the respondents were far less confident that they’ll receive adequate Medicaid reimbursements (80) and were neutral on the likelihood of being able to access capital for new imaging systems and other imaging IT (101), resulting in a neutral overall composite score (111) for the quarter. The survey has been pretty consistent for the last few years, so this is more of a confirmation that imaging managers expect Q1 to be pretty normal and it’s likely that Q2 will be too.

VR Bringing Big Changes to IR
A study presented at the Society of Interventional Radiology’s 2019 meeting revealed some compelling evidence and solid soundbites underscoring virtual reality’s potential impact on interventional radiology and the technology’s specific advantages over fluoroscopy. The University of Washington-led study demonstrated how physicians could use a VR headset, running software from Pyrus Medical, to view and navigate a sensor-equipped catheter from the femoral artery to a trio of targeted blood vessels. The study used a 3D printed model and a holographic image of abdominal and pelvic blood vessels (all based on a CT angiography scan), performing 18 different simulated procedures and revealing much faster average VR-guided procedure times compared to fluoroscopy. The VR-guided procedure took an average of 17.6 seconds, compared to 70.3 seconds using fluoroscopy on the 3D model, and 171.2 seconds for real-life procedures. It’s early, but the researchers were pretty confident that VR will “change how we look at a patient’s anatomy during an IR treatment . . . (allowing) physicians to travel inside a patient’s body instead of relying solely on 2D, black and white images.”

Evidence of Overuse
A team of Dublin-based radiologists found that their adoption of the Royal College of Radiologists’ evidence-based “iRefer” guidelines four years ago was ineffective at reducing inappropriate imaging. The team looked at 1,124 X-rays referred from ED, inpatient, and general physicians, finding that inappropriate X-ray orders actually increased from 42% before adopting iRefer to 43% after. These 784 inappropriate scans exposed patients to a median of 65.1 mSv in unnecessary radiation and generating €8,036 in unnecessary costs for each scan. There’s evidence of appropriate use criteria working elsewhere, and it’s possible other UK hospitals had better results from iRefer, but this Dublin team proposes that “interventions are needed to decrease inappropriate referrals.”

The Wire

  • The US Senate health committee backed new regulations that should make it easier for patients to access their electronic medical records, while requiring new accommodations from EHR and healthcare organizations. The new rule specifically targets so-called “information blocking” practices. Health IT companies and healthcare providers have used these practices to limit the sharing or transfer of medical info with patients, but EHR providers will soon be required to develop software that can “readily export a patient’s entire medical record” and health care systems will be forced to provide these records electronically to patients at no cost.

  • Dicom Systems announced an enterprise imaging deal with Radiology Partners, allowing the massive US radiology practice to integrate IT and clinical workflows across its network of 1,200 radiologists and the 850-plus hospitals and imaging centers that they service. There’s always a story behind a deal of this size, and this one has origins in Dicom Systems’ existing relationships with Desert Radiology (joined RP in January) and Scottsdale Diagnostic Imaging (Joined RP in Sep. 2017) as well as Dicom Systems’ direct relationship with Radiology Partners, independent of these acquisitions. With the deal now set, RP will use Dicom Systems’ Unifier enterprise imaging platform as its central integration engine, combined with a custom feature set that includes DICOM/HL7 transformation, relevant priors, high availability failover, and its DICOMweb API.

  • A Washington woman filed a $4.6 million lawsuit against Astoria, Oregon’s Columbia Memorial Hospital, claiming that a two-day MRI wait time led to a stroke that left her severely disabled. The woman visited the hospital complaining of neurological symptoms consistent with a stroke, returned to the hospital after two days of persistent symptoms, and suffered the stroke while waiting for her scheduled scan. Noting Astoria’s sub-10,000 population, some might see this as both a rural MRI access story and an alleged negligence story, and they may be right.

  • The FDA proposed a change to the Mammography Quality Standards Act of 1992 (MQSA) that it believes will modernize breast cancer screening. The federal government’s move to require density notifications (first announced in February) serves as the cornerstone of the new proposal, although the FDA took this opportunity to a range of proposed changes related to mammography assessments and follow-ups, patient notifications when mammography facilities fail certain standards, increased FDA oversight of mammography components, and improved record keeping requirements.

  • Oldelft Ultrasound landed a new private equity parent company after Belgian PE firm, Smile Invest, bought a majority stake in the TEE ultrasound probe manufacturer from fellow Belgian investment house, Gimv. Oldelft Ultrasound is the only global independent maker of transesophageal echocardiography probes, reportedly supplying a number of cardio ultrasound OEMs, and is planning to leverage its new funding to support the rollout of its next generation miniaturized 2D and 3D probes.

  • Mentice and RAD-AID announced a partnership to provide interventional radiology training in resource-constrained countries. Mentice will donate its high-fidelity simulator software, hardware, and expertise that RAD-AID’s IR educational teams will use when training local providers.

The Resource Wire

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