A new study out of Cedars Sinai provided what might be the strongest evidence yet that imaging AI triage and prioritization tools can shorten inpatient hospitalizations, potentially bolstering AI’s economic and patient care value propositions outside of the radiology department.
The researchers analyzed patient length of stay (LOS) before and after Cedars Sinai adopted Aidoc’s triage AI solutions for intracranial hemorrhage (Nov 2017) and pulmonary embolism (Dec 2018), using 2016-2019 data from all inpatients who received noncontrast head CTs or chest CTAs.
- ICH Results – Among Cedars Sinai’s 1,718 ICH patients (795 after ICH AI adoption), average LOS dropped by 11.9% from 10.92 to 9.62 days (vs. -5% for other head CT patients).
- PE Results – Among Cedars Sinai’s 400 patients diagnosed with PE (170 after PE AI adoption), average LOS dropped by a massive 26.3% from 7.91 to 5.83 days (vs. +5.2% for other CCTA patients).
- Control Results – Control group patients with hip fractures saw smaller LOS decreases during the respective post-AI periods (-3% & -8.3%), while hospital-wide LOS seemed to trend upward (-2.5% & +10%).
These results were strong enough for the authors to conclude that Cedars Sinai’s LOS improvements were likely “due to the triage software implementation.”
Perhaps more importantly, some could also interpret these LOS reductions as evidence that Cedars Sinai’s triage AI adoption also improved its overall patient care and inpatient operating costs, given how these LOS reductions were likely achieved (faster diagnosis & treatment), the typical associations between hospital long stays and negative outcomes, and the fact that inpatient stays have a significant impact on hospital costs.
A new European Radiology study out of France highlighted how Aidoc’s pulmonary embolism AI solution can serve as a valuable emergency radiology safety net, catching PE cases that otherwise might have been missed and increasing radiologists’ confidence.
Even if that’s technically what PE AI products are supposed to do, studies using commercially available products and focusing on how AI complements radiologists (vs. comparing AI and rad accuracy) are still rare and worth a closer look.
The Diagnostic Study – A team from French telerad provider, IMADIS, analyzed AI and radiologist CTPA interpretations from patients with suspected PE (n = 1,202 patients), finding that:
- Aidoc PE achieved higher sensitivity (0.926 vs. 0.9 AUCs) and negative predictive value (0.986 vs. 0.981 AUCs)
- Radiologists achieved higher specificity (0.991 vs. 0.958 AUCs), positive predictive value (0.95 vs. 0.804 AUCs), and accuracy (0.977 vs. 0.953 AUCs)
- The AI tool flagged 219 suspicious PEs, with 176 true positives, including 19 cases that were missed by radiologists
- The radiologists detected 180 suspicious PEs, with 171 true positives, including 14 cases that were missed by AI
- Aidoc PE would have helped IMADIS catch 285 misdiagnosed PE cases in 2020 based on the above AI-only PE detection ratio (19 per 1,202 patients)
The Radiologist Survey – Nine months after IMADIS implemented Aidoc PE, a survey of its radiologists (n = 79) and a comparison versus its pre-implementation PE CTPAs revealed that:
- 72% of radiologists believed Aidoc PE improved their diagnostic confidence and comfort
- 52% of radiologists the said the AI solution didn’t impact their interpretation times
- 14% indicated that Aidoc PE reduced interpretation times
- 34% of radiologists believed the AI tool added time to their workflow
- The solution actually increased interpretation times by an average of 7.2% (+1:03 minutes)
Now that we’re getting better at not obsessing over AI replacing humans, this is a solid example of how AI can complement radiologists by helping them catch more PE cases and make more confident diagnoses. Some radiologists might be concerned with false positives and added interpretation times, but the authors noted that AI’s PE detection advantages (and the risks of missed PEs) outweigh these potential tradeoffs.
A new Radiology: Artificial Intelligence study out of Switzerland highlighted how Aidoc’s Intracranial Hemorrhage AI solution improved emergency department workflows, without hurting patient care. Even if that’s exactly what solutions like this are supposed to do, real world AI studies that go beyond sensitivity and specificity are still rare and worth some extra attention.
The Study – The researchers analyzed University Hospital of Basel’s non-contrast CT intracranial hemorrhage (ICH) exams before and after adopting the Aidoc ICH solution (n = 1,433 before & 3,017 after; ~14% ICH incidence w/ both groups).
Diagnostic Results – The Aidoc solution produced “practicable” overall diagnostic results (93% accuracy, 87.2% sensitivity, 93.9% specificity, and 97.8% NPV), although accuracy was lower with certain ICH subtypes (e.g. subdural hemorrhage 69.2%, 74/107).
Efficiency Results – More notably, the Aidoc ICH solution “positively impacted” UBS’ ED workflows, with improvements across a range of key metrics:
- Communicating critical findings: 63 vs. 70 minutes
- Communicating acute ICH: 58 vs. 73 minutes
- Overall turnaround time to rule out ICH: 164 vs. 175 minutes
- Turnaround time to rule out ICH during working hours: 167 vs. 205 minutes
Next Steps – The authors called for further efforts to streamline their stroke workflows and to create a clear ICH AI framework, accurately noting that “AI tools are only as reliable as the environment they are deployed in.”
The internet hasn’t always been kind to emergency AI tools, and academic studies have rarely focused on the workflow efficiency outcomes that many radiologists and emergency teams care about. That’s not the case with this study, which did a good job showing the diagnostic and workflow upsides of ICH AI adoption, and added a nice reminder that imaging teams share responsibility for AI outcomes.
Aidoc and Riverain Technologies announced a new partnership that will make Riverain’s ClearRead CT and ClearRead Xray solutions available on the Aidoc platform, while advancing the companies’ respective platform strategies.
The Chest AI Package – In addition to offering Riverain’s AI tools individually, Aidoc will provide them as part of an ‘integrated chest AI package’ that also includes Aidoc’s modules for PE, incidental PE, and rib fractures.
Riverain’s Platform Push – Riverain has amassed a solid network of AI marketplace and OEM partners over the years, and it now appears to be expanding its channel to complementary AI vendors. Riverain’s new Aidoc alliance comes just a few weeks after a similar partnership with Volpara that combines ClearRead CT with the Volpara Lung platform.
Aidoc’s Platform Portfolio – After years of building out its homegrown AI portfolio (7 products) and customer base (600 health centers), Aidoc is evolving into an AI platform company. Over the last year, Aidoc has assembled a solid AI portfolio that combines its own triage products with solutions that it doesn’t offer (Imbio, Icometrix, Subtle Medical, Riverain), allowing its clients to expand their AI stack without overhauling their infrastructure with each new tool.
The Takeaway – We’re at an interesting time in the AI space with a small handful of diversified AI players (e.g. Aidoc, Qure.ai), a group of focused category leaders (e.g. Riverain w/ thoracic, ScreenPoint w/ mammography), and an AI customer base that would prefer not to support multiple AI infrastructures. Although marketplaces also solve this problem, it’s easy to see how complementary vendor partnerships like these could play a growing role in how AI is delivered going forward.