Tag: radiologist

Patients Unclear on Imaging Costs

Posted on by Brian Casey

A new study in Health Policy and Technology shows that patients are surprisingly unclear on how much their imaging exams will cost them. Researchers found that few knew their imaging facilities had price estimator tools and even fewer were aware of their out-of-pocket estimates.

The U.S. government has been trying to make healthcare more transparent and understandable for patients through a variety of new rules it’s implemented in recent years, such as “information blocking” rules that prevent providers from withholding patient data.

  • In 2021, CMS required health systems to notify patients of out-of-pocket expenses and make available tools for estimating prices. 

But how knowledgeable are patients about these initiatives? 

  • Researchers from UC Irvine and the University of Michigan surveyed 423 patients scheduled for CT, PET/CT, or MRI scans in Southern California to find out how much they knew about their out-of-pocket costs. 

Researchers discovered that …

  • Only 11% of patients were aware of their out-of-pocket estimates before getting their scans.
  • Only 17% knew their imaging facilities had price estimator tools.
  • 53% said their illness has been a financial hardship, but only 34% were worried about their out-of-pocket costs for imaging.
  • No patient used the hospital’s estimator tool.
  • Patients were less likely to know their out-of-pocket costs if they had lower income (<$50,000), more financial hardship, and no comorbidities. 

The results show that, two years after out-of-pocket transparency rules went into effect, patients are still unclear on their imaging costs. 

  • This is a major problem due to the high variation in imaging prices that’s been documented in other studies, such as 2023 research that found MRI scans ranging in price from $878 to $3,403.

More outreach could help patients better understand costs. 

  • Such outreach could be made through automated calls or even messages through patient portals prior to their exams.

The Takeaway
The new study – when coupled with recent research on patient reports – shows that radiology still has a ways to go when it comes to keeping patients informed about their imaging exams. Getting patients more involved not only will have economic benefits, but could also help patients participate in their own care.

Better Prostate MRI with AI

Posted on by Brian Casey

A homegrown AI algorithm was able to detect clinically significant prostate cancer on MRI scans with the same accuracy as experienced radiologists. In a new study in Radiology, researchers say the algorithm could improve radiologists’ ability to detect prostate cancer on MRI, with fewer false positives.

In past issues of The Imaging Wire, we’ve discussed the need to improve on existing tools like PSA tests to make prostate cancer screening more precise with fewer false positives and less need for patient work-up.

  • Adding MRI to prostate screening protocols is a step forward, but MRI is an expensive technology that requires experienced radiologists to interpret.

Could AI help? In the new study, researchers tested a deep learning algorithm developed at the Mayo Clinic to detect clinically significant prostate cancer on multiparametric (mpMRI) scans.

  • In an interesting wrinkle, the Mayo algorithm does not indicate tumor location, so a second algorithm – called Grad-CAM – was employed to localize tumors.

The Mayo algorithm was trained on a population of 5k patients with a cancer prevalence similar to a screening population, then tested in an external test set of 204 patients, finding …

  • No statistically significant difference in performance between the Mayo algorithm and radiologists based on AUC (0.86 vs. 0.84, p=0.68)
  • The highest AUC was with the combination of AI and radiologists (0.89, p<0.001)
  • The Grad-CAM algorithm was accurate in localizing 56 of 58 true-positive exams

An editorial noted that the study employed the Mayo algorithm on multiparametric MRI exams.

  • Prostate cancer imaging is moving from mpMRI toward biparametric MRI (bpMRI) due to its faster scan times and lack of contrast, and if validated on bpMRI, AI’s impact could be even more dramatic.

The Takeaway
The current study illustrates the exciting developments underway to make prostate imaging more accurate and easier to perform. They also support the technology evolution that could one day make prostate cancer screening a more widely accepted test.

Indies Surge in Imaging IT

Posted on by Brian Casey

The market for medical imaging IT technology continues to shift, with a pair of surging independent players growing rapidly in a sector that’s long been dominated by multinational OEMs. That’s according to the latest report on the imaging IT market by UK market intelligence firm Signify Research. 

The new report is projecting that the global market for imaging information technology will grow 18% over the next few years, from $5.6B in 2023 to $6.6B in 2028. 

  • Radiology will continue to dominate with a majority of sales, with cardiology IT a distant – but growing – second. Advanced visualization and operational workflow tools will make up the rest.

In terms of vendors, the top three market leaders of 2023 were GE HealthCare, Philips, and Fujifilm, but more recently, Visage Imaging and Sectra have been gaining market share. 

  • The report echoes recent news that has seen some of the largest multi-site enterprise imaging installations going to Visage and Sectra; a recent KLAS Research report also showed both companies’ growing momentum. 

Some of the other major points from the report include … 

  • Major growth in cloud deployment will occur – by 2028, 37% of the global imaging IT market will be in either hybrid or fully hosted environments
  • Cloud will represent 44% of the total radiology IT market by 2028
  • On a regional basis, the Middle East will see “significant growth” in imaging IT from 2024 to 2026, particularly in the Gulf States
  • Recovery is expected in China and the ASEAN nations, while India’s growing economy is driving healthcare digitization
  • Latin America is showing rising interest in AI and cloud technologies, but national elections could complicate matters

The Takeaway
The new Signify Research report underscores the evolving nature of the imaging IT market, as independent vendors rise to challenge multinational OEMs that dominated the sector for years. Be sure to check out Signify’s helpful infographic on LinkedIn that succinctly wraps up the changes.

AI Detects Incidental PE

Posted on by Brian Casey

In one of the most famous quotes about radiology and artificial intelligence, Curtis Langlotz, MD, PhD, once said that AI will not replace radiologists, but radiologists with AI will replace those without it. A new study in AJR illustrates his point, showing that radiologists using a commercially available AI algorithm had higher rates of detecting incidental pulmonary embolism on CT scans. 

AI is being applied to many clinical use cases in radiology, but one of the more promising is for detecting and triaging emergent conditions that might have escaped the radiologist’s attention on initial interpretations.

  • Pulmonary embolism is one such condition. PE can be life-threatening and occurs in 1.3-2.6% of routine contrast-enhanced CT exams, but radiologist miss rates range from 10-75% depending on patient population.

AI can help by automatically analyzing CT scans and alerting radiologists to PEs when they can be treated quickly; the FDA has authorized several algorithms for this clinical use. 

  • In the new paper, researchers conducted a prospective real-world study of Aidoc’s BriefCase for iPE Triage at the University of Alabama at Birmingham. 

Researchers tracked rates of PE detection in 4.3k patients before and after AI implementation in 2021, finding … 

  • Radiologists saw their sensitivity for PE detection go up after AI implementation (80% vs. 96%) 
  • Specificity was unchanged (99.1% vs. 99.9%, p=0.58)
  • The PE incidence rate went up (1.4% vs. 1.6%)
  • There was no statistically significant difference in report turnaround time before and after AI (65 vs. 78 minutes, p=0.26)

The study echoes findings from 2023, when researchers from UT Southwestern also used the Aidoc algorithm for PE detection, in that case finding that AI cut times for report turnaround and patient waits. 

The Takeaway

While studies showing AI’s value to radiologists are commonplace, many of them are performed under controlled conditions that don’t translate to the real world. The current study is significant because it shows that with AI, radiologists can achieve near-perfect detection of a potentially life-threatening condition without a negative impact on workflow.

Lung Screening Narrows Disparities

Posted on by Brian Casey

New research confirms that not only does low-dose CT screening reduce lung cancer mortality, it can also narrow health disparities. Researchers found that screening’s beneficial impact was greater at lower socioeconomic levels in a new study published in Lancet Regional Health – Europe.

As we mentioned in our last issue, CT lung cancer screening is gaining momentum globally; at the same time, researchers have documented greater mortality and morbidity for a variety of diseases among racial minorities and at lower socioeconomic levels.

  • This difference can be especially profound when it comes to lung disease, given higher smoking rates among some minority groups and economically disadvantaged populations.

In the original UK Lung Cancer Screening Trial (UKLS) in 2021, researchers found that a single CT screening round produced a 16% lung cancer mortality reduction. 

  • The new study is a secondary analysis of UKLS to investigate whether CT lung screening’s impact differed by socioeconomic status, which is important given that smoking occurs in England at higher rates in the most deprived neighborhoods compared to wealthier ones (24% vs. 6.8%).

UKLS researchers compared lung cancer mortality rates in 4k individuals in different groups classified by a widely used socioeconomic barometer. They found that … 

  • CT lung screening had the same lung cancer mortality benefit in both low and high socioeconomic groups (-19% vs. -20%)
  • But there was a bigger reduction in death from COPD in lower socioeconomic groups (-34% vs. +4%)
  • And fewer deaths from other lung diseases (-32% vs. +10%)
  • While cardiovascular mortality was also lower (-30% vs. -13%)
  • All-cause mortality was lower in lower socioeconomic groups – a benefit not seen at higher levels

Lung screening’s reduction in all-cause mortality is particularly intriguing, as this is an accomplishment that has eluded most other cancer screening tests – a point that has been repeatedly hammered home by screening skeptics.

The Takeaway

The new findings highlight how – to a greater degree than other major cancer screening tests – CT lung screening has the potential to address ongoing racial and socioeconomic healthcare disparities. It’s yet another reason to press for broader adoption of lung screening.

CT Lung Screening Shows Progress at ATS 2024

Posted on by Brian Casey

Making CT lung cancer screening more effective has been a hot topic at the American Thoracic Society meeting, which convened this weekend in San Diego. Presentations at ATS 2024 have ranged from improving screening compliance rates to eliminating racial disparities in screening attendance.

After years of fits and starts, low-dose CT lung cancer screening appears to be finally making progress. 

  • While the US still struggles with overly restrictive screening criteria and convoluted reimbursement rules, the rest of the world – including Australia, Germany, and Taiwan – is moving ahead with population-based screening programs designed to counter the tobacco epidemic’s deadly scourge.

At ATS 2024, investigators are presenting research to ensure that the benefits of CT lung cancer screening are delivered to those who need it, with the following highlights …

  • Researchers at the University of Minnesota saw a 7.2% completion rate for screening-specific low-dose CT among 91k eligible individuals – an indication of “overall poor uptake of screening” 
  • To improve uptake, another group implemented a centralized nurse coordinator for lung screening, resulting in a 23-day reduction in time from initial consultation to report delivery as well as better adherence to eligibility criteria
  • Patients who self-identify as Black are more likely to miss a scheduled CT screening appointment (OR=2.05), while Hispanic patients also have high miss rates (OR=1.92) as do those with limited English proficiency (OR=1.72). The numbers highlight the need for patient conversations to boost completion rates
  • Incidence rates of lung and bronchus cancer dropped from 2007-2019 compared to 1999-2006, underscoring the importance of smoking cessation and supporting current USPSTF age criteria for lung screening
  • Pulmonary physicians significantly overestimated their patients’ lung screening completion rates, with almost half thinking the rate was higher than 60% when it was actually 17%. Researchers suggested interventions for improving completion rates

The Takeaway

The fact that ATS 2024 has seen so many presentations on CT lung cancer screening – the vast majority presented by US authors – indicates that low screening rates haven’t discouraged American researchers and clinicians. The presentations underscore the progress being made toward making the benefits of lung screening available to Americans who would benefit from it.

Slashing CT Radiation Dose

Posted on by Brian Casey

Cutting CT radiation dose should be the goal of every medical imaging facility. A new paper in European Radiology offers a promising technique that slashed CT dose to one-tenth of conventional CT – and just twice that of a standard chest X-ray.

CT’s wide availability, excellent image quality, and relatively low cost make it an invaluable modality for many clinical applications.

  • CT proved particularly useful during the COVID-19 pandemic for diagnosing lung pathology caused by the virus, and it continues to be used to track cases of long COVID.

But patient monitoring can involve multiple CT scans, leading to cumulative radiation exposure that can be concerning, especially for younger people.

  • Researchers in Austria wanted to see if they could use commercially available tools to produce ultra-low-dose CT scans, and then assess how they compared to conventional CT for tracking patients with long COVID.

Using Siemens Healthineers’ Somatom Drive third-generation dual-source CT scanner, they adjusted the parameters on the system’s CAREDose automated exposure control and ADMIRE iterative reconstruction to drive down dose as much as possible.

  • Other ultra-low-dose CT settings versus conventional CT included fixed tube voltage (100 kVp vs. 110 kVp), tin filtration (enabled vs. disabled), and CAREDose tube current modulation (enabled – weak vs. enabled – normal). 

They then tested the settings in a group of 153 patients with long COVID seen from 2020 to 2021; both ultra-low-dose and conventional CT scans were compared by radiologists, finding … 

  • Mean entrance-dose radiation levels with ultra-low-dose CT were less than one-tenth those of conventional CT in (0.21 mSv vs. 2.24 mSv); a two-view chest X-ray is 0.1 mSv
  • Image quality was rated 40% lower on a five-point scale (3.0 vs. 5.0)
  • But all ultra-low-dose scans were rated as diagnostic quality
  • Intra-reader agreement between the two techniques was “excellent,” at 93%

The findings led the researchers to conclude that ultra-low-dose CT could be a good option for tracking long COVID, such as in younger patients. 

The Takeaway

The study demonstrates that CT radiation dose can be driven down dramatically through existing commercially available tools. While this study covers just one niche clinical application, such tools could be applied to a wider range of uses, ensuring that the benefits of CT will continue to be made available at lower radiation doses than ever.

Radiologist Pay Grows 3%

Posted on by Brian Casey

Annual salaries for US radiologists grew 3.1% in 2023 in the most recent physician salary report by Medscape. Although radiologist salaries are nearing the half-million-dollar mark, the increase actually represents a slowdown compared to 11% growth last year. 

The Medscape report shows that US radiologists had an average annual salary of $498k in 2023, compared to $483k in 2023 and $437k in 2022.

  • Radiologists ranked sixth on a list of 29 medical specialties, with orthopedic physicians topping the charts at $558k and diabetes and endocrinology doctors at the bottom at $256k. 

The report surveyed 7k practicing US physicians from October 2023 to January 2024, finding … 

  • 61% of those surveyed thought physicians overall are underpaid
  • 49% believe that they themselves are fairly paid
  • 83% said that pay was either no factor or only a minor factor in the specialty they chose, with only 14% saying it was the leading factor
  • Male specialists earned 31% more than female specialists, indicating a widening gender gap compared to 27% last year
  • 57% of radiologists were happy with their compensation, sixth among 29 medical specialties

Physician comments submitted to Medscape focused on the significant stress being experienced by many physicians, a phenomenon that’s been linked to burnout in other surveys. 

The Takeaway

Underlying this year’s Medscape data is an inconvenient truth for radiologists: their 3.1% pay gains for the year were not enough to keep pace with the US inflation rate of 3.4%. In that respect, radiologists find themselves in the same situation as most Americans.

Is Head CT Overused in the ED?

Posted on by Brian Casey

A new study suggests that head CT could be overused in the emergency department for patients presenting with conditions like headache and dizziness. Writing in a paper in Internal and Emergency Medicine, researchers looking at CT angiography use at a large medical center found a big increase in CTA utilization – even as the rate of positive findings dropped. 

CTA is a powerful tool that can quickly and efficiently give clinicians information to guide treatment of acute neurovascular conditions like aneurysm and stroke. 

  • As such, many emergency departments have been installing their own CT scanners to enable them to scan emergent patients without transporting them to the radiology department. 

But with great power comes great responsibility, and there is always the temptation to scan first and ask questions later. 

  • To better understand changing CTA use in the emergency setting, researchers from the Harvey L. Neiman Health Policy Institute analyzed CTA exams at a level 1 trauma center that sees about 110k emergency patients a year.

Researchers analyzed 25k ED visits from 2017 to 2021 and correlated them to head and neck CTA exams for headache and/or dizziness, finding …

  • The rate of CTA exams rose 64%, from 7.9% of ED visits to 13%
  • Symptomatic patients were 15% more likely to have a CTA in 2021 versus 2017
  • The rate of positive CTA findings fell 38%, from 17% to 10%
  • Patients with private insurance were more likely to have CTA (OR=1.44)
  • Black patients were less likely to be scanned (OR=0.69)

The researchers said the findings indicate the need for better clinical decision support tools, which they believe can help emergency physicians provide an accurate diagnosis without exposing patients to unnecessary radiation and incurring additional cost. 

The Takeaway

This study further confirms widespread accounts that head and neck CTA is overused and on the rise. As the US government backs off on its attempt to force clinical decision support on referring physicians, it may be up to health systems and providers themselves to ensure more appropriate utilization – in a way that doesn’t rely on heavy-handed tools like prior authorization. 

Out-of-Network Radiology Claims Fall

Posted on by Brian Casey

Is out-of-network billing – when a patient receives care outside their insurance network – still a problem in radiology? A new study in JACR shows that out-of-network commercial claims have dropped dramatically since 2007.

Out-of-network healthcare has been the focus of a number of legislative efforts in recent years as lawmakers try to protect patients from the financial sting of getting a big bill for services rendered outside their provider’s network.

  • Probably the centerpiece of this effort is the federal No Surprises Act, which went into effect in January 2022; not only did it cap the amount that patients can be billed for out-of-network services, but it created an independent dispute resolution mechanism for adjudicating disagreement between providers and payors over how much they should be paid.

The IDR mechanism has been the focus of legal wrangling in recent months, but the new study in JACR indicates that it might not be getting much use after all, at least in radiology.

Researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed 80M commercial claims for radiology services from 2007 to 2021, finding…

  • Out-of-network radiology claims fell dramatically (to 1.1% vs. 13%)
  • Out-of-network claims fell for inpatient stays (to 1.4% vs. 10%)
  • Claims also fell for emergency visits (to 0.4% vs. 3.9%)
  • By modality, most claims were for X-ray (57%), followed by ultrasound and CT (15% each) 
  • By 2021, radiologists practiced almost exclusively in-network

What’s the reason for the dramatic decline? The study authors credit good-faith negotiations between radiology practices and commercial payors, as well as the impact of state surprise billing laws (the study period occurred before the federal No Surprises Act went into effect).

  • Other possible factors include consolidation among practices, hospitals, and payors; expansion of academic centers into communities; and the COVID-19 pandemic.   

The Takeaway

The JACR study is welcome news for both patients and radiology practices. Patients are less likely to be hit with surprise medical charges, while practices are less likely to have to fight through the IDR process to resolve claims. In the end, everybody wins – even insurance companies.

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