Tag: radiologists

Has Breast Cancer Mortality Bottomed Out?

Posted on by Brian Casey

The decades-long decline in breast cancer mortality has been lauded as a major public health success story. But a new study in Journal of Breast Imaging suggests that the long decline in breast cancer death rates may be coming to an end, at least for some women.

Breast cancer mortality’s drop has been well-documented, with studies estimating the drop to range between 44% to 58% over the last three to four decades – saving at least 500k lives. 

  • Most experts believe the breast cancer mortality decline has been driven by a combination of organized mammography screening and better cancer treatments.

But amid the success are disturbing signs. Cancer incidence rates are increasing for women younger than 40 – the established starting age for screening. 

  • Mammography screening also has seen disparities in care that have resulted in higher incidence and death rates for women of color. 

In the new study, researchers examined U.S. data for breast cancer mortality from 1990 to 2022, finding that over the study period breast cancer mortality …

  • Fell by 44% for women of all ages and ethnicities over the full study period.
  • Decreased by -1.7% to -3.3% annually from 1990 to 2010, but the decline slowed to -1.2% a year from 2010 to 2022. 
  • Declined -2.8% per year for women 20-39 years old from 1990-2010, but showed no decline from 2010-2022.
  • Lowered by -1.3% per year for women older than 75 from 1993-2014, but showed no decline from 2013-2022. 
  • Declined for White and Black women of all ages, but not for Asian, Hispanic, and Native American women.
  • Was 39% higher for Black women compared to White women from 2004-2022.   

The authors acknowledge that much of their data pertain to women who are outside current screening guidelines. 

  • But they see this as an opportunity to revisit whether screening guidelines should be extended – especially to women 75 and older – to realize the benefits of early breast cancer detection. 

The Takeaway

The new findings on breast cancer mortality indicate that even as mammography’s successes are celebrated, more work remains to be done to ensure that breast screening’s benefits are enjoyed by as many women as possible. 

Screening Takes Center Stage at ECR 2025

Posted on by Brian Casey

New advances in cancer screening were among the major trends at last week’s ECR 2025 conference in Vienna. From traditional screening exams like mammography to up-and-coming tests like CT lung cancer exams, radiologists are emerging at the forefront of efforts to improve population health through early detection.

CT lung cancer screening is gaining momentum in Europe, and a Friday afternoon session explored the experiences of multiple sites…

  • U.K. researchers used DeepHealth’s Lung Nodules AI solution for automated triage of lung nodules found on non-screening CT chest exams, finding the approach could save £25k-£37k annually.
  • A German team documented technical lung CT acquisition parameters for screening centers in the SOLACE consortium across 10 countries, finding some room for improvement. 
  • Preliminary results from an Italian lung screening project were reported, with 2k people scanned with a 1.5% cancer detection rate (77% stage I-II) and 17% recall rate. Smoking cessation advice was also given.
  • Early results from a pilot screening project in Poland were given, with a 1.9% cancer detection rate in 3.1k people screened. They recommend screening be implemented nationwide. 
  • In a secondary analysis of 23.4k people in the NLST study, CT-derived body composition metrics predicted mortality beyond traditional risk factors.

Meanwhile, new ECR cancer screening research builds on the landmark accomplishments from 2024 in AI for breast screening. A Saturday afternoon session explored the progress being made…

  • German breast screening programs that deployed ScreenPoint Medical’s Transpara AI algorithm for 119k women saw their cancer detection rate grow (6 vs. 4.8 cancers per 1k) while the recall rate remained stable at around 2.5%. 
  • AI-supported double-reading in Italy for 120k women led to more breast cancers detected on baseline exams compared to subsequent screening rounds, as well as a 42% lower recall rate.
  • Patients found an AI chatbot based on GPT-4 generated responses to their questions that were more empathetic and readable than those of radiologists.
  • Another Italian study found that using AI for double-reading mammograms of 266k women led to a 21% increase in cancer detection rate and 15% drop in recall rate.
  • A secondary analysis of the MASAI trial suggested that double-reading with two radiologists continue to be used for high-risk women. Single reading of 3.8k high-risk exams resulted in 8.9% fewer detected cancers and 5.9% fewer recalls.

The Takeaway

Last week’s research on cancer screening at ECR 2025 shows that imaging experts see screening as a way to not only improve population health on a broad scale, but also to give radiologists the opportunity to raise their profile with patients and take a more direct role in patient care. The question is whether it’s an opportunity radiologists are ready to take.

Highlights from ECR 2025

Posted on by Brian Casey

This week’s European Congress of Radiology is underway in Vienna, and things are heating up in the cozy confines of Austria Center Vienna. 

The theme of this week’s meeting is Planet Radiology, and conference organizers have made sustainability a major priority. 

  • As one of healthcare’s biggest consumers of energy, radiology has a responsibility to lead efforts to reduce greenhouse gases – a challenge that ECR 2025 president Prof. Andrea Rockall compared to the discipline’s successful effort to reduce radiation exposure.

Planetary health was the focus of a glitzy opening ceremony on February 26 before a standing-room-only crowd.

  • The program featured not only the musical and dance performances that are an ECR hallmark but also awe-inspiring videos that focused on each of the four planetary elements: water, air, fire, and earth. 

But scientific content has always been ECR’s main draw, and ECR 2025 so far hasn’t disappointed. Below are some highlights from the first two days of clinical presentations … 

  • New data from the MASAI study of AI for mammography screening were presented Wednesday, finding that ScreenPoint Medical’s Transpara algorithm cut interval cancers 12%.
  • Using AI instead of double-reading for biennial digital mammography screening saved $64k per 1k patients thanks to lower cancer treatment costs. 
  • The MA-DETECT study of 350 women used breast MRI on women with negative mammograms, with a cancer detection rate of 26 additional cancers per 1k women.
  • Aidoc’s AI algorithm for detecting cervical spine fractures on CT found 23 fractures missed by radiologists out of 2.3k scans, saving €6k per missed fracture.
  • Gleamer’s BoneView AI algorithm for fracture detection detected 81% of fractures missed by radiologists in patients who had filed compensation claims, potentially saving €265k.
  • The percentage of AI research studies with peer-reviewed evidence grew in 2023 compared to 2020 (67% vs. 35%) but the ratio showing clinical efficacy fell (52% vs. 55%).
  • Subtle Medical’s SubtleHD MRI enhancement algorithm improved signal-to-noise ratio by 73% and image sharpness by 27% in 205 MRI scans.
  • In a secondary analysis of the MIDAS study of clinical decision support in Germany, requests for inappropriate imaging were more frequent in women than men (7.3% vs. 6.1%). 
  • A majority of patients in Italy preferred ChatGPT-authored reports over those penned by radiologists (61%), with 70% saying they were more readable and 58% saying they were easier to understand. 
  • Researchers found that oral glucosamine could be used for breast MRI exams with a chemical exchange saturation transfer sequence. They found higher CEST values in tumor regions in a small study of 16 patients.
  • Italian researchers combined CT and contrast-enhanced mammography with the same contrast agent, finding higher sensitivity and specificity for detecting metastases than traditional methods.
  • German researchers ran a 0.4T permanent magnet MRI scanner off the grid for a year with solar panels and a generator-supported battery system. 
  • Using deep-learning reconstruction for MRI scans reduced energy consumption 65% thanks to shorter scan times while maintaining image quality. 
  • More patients preferred contrast-enhanced mammography (72%) compared to breast MRI (26%), mostly due to faster exam times and lack of claustrophobia. 

The Takeaway

This week’s ECR 2025 demonstrates the rich scientific research being conducted across Europe – much of which will eventually translate into commercial products. As the U.S. experiences regulatory turbulence and uncertainty around long-term funding for academic research, the focal point of radiology innovation could soon shift across the Atlantic.

Are CT Lung Screening Patients Sicker?

Posted on by Brian Casey

Amid the rush of enthusiasm for CT lung cancer screening, a new study published in JAMA Health Forum offers a cautionary note. Researchers found that in the real world, people eligible for lung screening were sicker than those in research studies, and thus may not enjoy screening’s benefits to the same extent. 

Support for CT lung cancer screening is based on randomized controlled trials published in 2011 (NLST) and NELSON (2020) that showed screening reduced lung cancer mortality among high-risk individuals who typically had long smoking histories. 

  • The studies have spurred momentum for large-scale CT lung cancer screening programs, with a number of European and Asian countries starting national initiatives. 

But how generalizable are these results? Researchers noted that people who participated in the NLST study tended to be younger and healthier than individuals who qualify for screening in the real world. 

  • Co-morbidities like COPD, diabetes, and heart disease, as well as age and racial background, can have an impact on survival after treatment for lung cancer, and thus could reduce screening’s risk/benefit calculation. 

In the new Personalized Lung Cancer Screening study, researchers analyzed the comorbidity profiles of 31.8k people who got screened between 2016 and 2021 in California, Florida, and South Carolina. 

  • They noted that their PLuS study cohort was more diverse in terms of age, race, and ethnicity than that used in NLST, and potentially had more comorbid conditions. 

In analyzing their population, PLuS researchers found that compared to NLST participants, people screened in their real-world programs had …

  • Higher rates of COPD (33% vs. 18%).
  • Higher rates of diabetes (25% vs. 9.7%).
  • Higher rates of heart disease (16% vs. 13%).
  • Were more likely to be aged 70 and over (25% vs. 8.8%).
  • Had high scores on various metrics of comorbidity and frailty. 

Older, sicker patients are less likely to have good health outcomes after lung cancer surgery, and might also succumb to conditions like COPD, diabetes, and heart disease before lung cancer, which could also reduce lung screening’s benefits.

The Takeaway

While the new findings aren’t likely to seriously dampen CT lung cancer screening’s growing momentum, they do illustrate a point that should always be kept in mind when looking at research results: in the real world, your mileage may vary. 

Will FDA Staff Cuts Slow AI Adoption?

Posted on by Brian Casey

The Trump Administration’s campaign to cut the federal workforce arrived at the FDA last weekend – in particular its division regulating AI in healthcare. Multiple staff cuts were reported at the Center for Devices and Radiological Health, which had been in the midst of a major overhaul of AI regulation. 

A February 15 article in STAT News first reported the layoffs, which as with other recent staff reductions concentrated on FDA employees with probationary status and was part of a larger initiative that has also affected the CDC and NIH. 

The rapid growth of medical AI has had a major impact on the center, which as of its last report had given regulatory authorization to over 1k AI-enabled devices (76% of which are for radiology). 

  • To deal with the deluge, CDRH reportedly had been hiring many new staffers who were still on probationary status, making them targets for layoffs (permanent federal employees have civil service protections that make them harder to fire). 

FDA also has been retooling its regulatory approach to AI with new initiatives that reflect the fact that AI products continue learning (and changing) after they’ve been approved, and thus require more aggressive post-market surveillance than other medical devices…

So what impact – if any – will the layoffs have on the rapidly growing medical AI segment? 

  • The FDA may simply scale back its new AI initiatives and regulate the field under more traditional avenues that have served the medical device industry well for decades.

In another scenario, the FDA’s frenzied pace of AI approvals and initiatives could slow as the agency struggles to handle a growing number of product submissions with less staff. 

The Takeaway

The FDA layoffs couldn’t have come at a worse time for medical AI, which is on the cusp of wider clinical acceptance but still suffers from shaky confidence and poor understanding on the part of both providers and patients (see story below). The question is whether providers, organized radiology, or developers themselves will be able to step into the gap being left.

Forecasting Radiologist Supply

Posted on by Brian Casey

Two new studies published this week in JACR raise the provocative question: Will there be a radiologist shortage in the future given growing demand for medical imaging services?

It’s a question that’s become commonplace across healthcare as burnout and other issues prompt many physicians to leave the field. 

  • This has caused workforce shortages that raise questions about whether the U.S. – and other advanced economies – will be able to meet growing demand for healthcare services by an aging population.

The new studies were conducted by Harvey L. Neiman Health Policy Institute researchers and each tackles one aspect of the supply/demand equation over the next 30 years. 

The first study analyzed past growth in the radiologist workforce to find …

  • There were 37.5k radiologists enrolled to provide care to Medicare patients in 2023. 
  • With no growth in the number of residency positions, there will be 47.1k radiologists in 2055, an increase of 26%.
  • If residency positions grow, there will be 52.6k radiologists, an increase of 40%.

The wildcard here is growth in residency positions, which are mostly controlled by Medicare through its graduate medical education program – and it literally takes an act of Congress to increase the number of trainee positions. 

  • Another factor is whether the higher physician attrition rate seen during the COVID-19 pandemic continues into the future. 

The second study addressed growth in imaging volume by analyzing trends in claims data for Medicare, Medicaid, and private insurance, finding …

  • Imaging utilization will be 17-27% higher by modality by 2055 assuming no continuation of recent utilization trends.
  • Most utilization growth will be seen in nuclear medicine (27%), CT (25%), interventional radiology (23%), X-ray (18%), and MRI and ultrasound (17% each).
  • Adding recent utilization trends to the model finds utilization by 2055 either -5.6% lower or up by 45%.

Factors affecting future utilization include population growth (73-88% of increase) and population aging (12-27%). 

The Takeaway

So will there be a radiologist shortage in the future? The new studies indicate that there are too many variables to make an accurate prediction right now. But they do provide a foundation for future research – and debate. 

Are CT Scans Too Slow?

Posted on by Brian Casey

Is your imaging practice paying attention to the acquisition speed of your CT scans? A new study in AJR suggests that CT pulmonary angiography patients are being scanned at an average speed that’s 30% slower than optimal, resulting in unnecessary imaging artifacts. 

CT is radiology’s workhorse modality, but recent studies have found wide variation in CT scanning parameters, sometimes between scanners in the same health system or even the same facility. 

  • This can result in patients getting different levels of radiation dose for the same type of study, or differences in image quality that can make image comparisons more difficult. 

To even out the variation, imaging groups have proposed best-practice scanning protocols for different exams and anatomical regions. 

  • Most of these protocols focus on reducing radiation dose, but there are other elements – such as scan acquisition speed –  that are also important.

For CT pulmonary angiography exams, scans that are performed too slowly run the risk of motion artifacts caused by patients breathing.

  • Imaging sites, therefore, should try to optimize scan speed, which is determined by a mix of collimation, pitch, and gantry rotation time. 

Researchers in the new study — from UC San Francisco and University of Wisconsin — found that many sites were using a fixed scan speed for CTPA regardless of patient characteristics. 

  • They analyzed data for 167k CTPA scans acquired from 2016 to 2021, with data coming from 121 sites using 28 different scanner models from various manufacturers.

Researchers compared scan speeds to best-practice levels, revealing … 

  • Scans on average were 30% slower than the best-practice speed.
  • 87% of acquisitions were slower.
  • 62% were more than 20% slower.
  • Scan speeds varied widely by vendor and by scanner model.

Researchers concluded that CT sites weren’t optimizing their equipment and not implementing the fastest scan speeds available.  

  • As a result, they could be generating widespread motion artifacts, especially for smaller patients. 

The Takeaway

The new findings show that radiation dose isn’t the only CT scanning parameter that needs optimization. Imaging practices should take a look at their CT protocols to ensure they have the optimal settings, especially for CTPA scans of smaller patients. 

Mammography Rates Fall for Women in 40s

Posted on by Brian Casey

A new study on mammography screening confirms the worst fears of women’s health advocates: screening rates fell for women ages 40-49 after the USPSTF in 2009 withdrew its recommendation that younger women get biennial screening.

Breast screening has long been the most controversial cancer screening exam, with screening’s opponents claiming that its “harms” – such as breast biopsies and overdiagnosis – don’t justify its benefits.

  • The anti-mammography wave crested in 2009 when the USPSTF withdrew its screening recommendation for women ages 40-49 and older than 75, instead advising them to consult with their physicians. 

The change prompted confusion and anger that persisted until the task force in 2024 rescinded the 2009 guidance and returned to a broad recommendation in favor of biennial screening for women in their 40s (screening still isn’t recommended for women over 74).

  • This left the breast imaging community pondering the impact that 15 years of the more restrictive guidance had on breast screening rates.

Researchers address that question in a new study in JAMA Network Open, in which they analyzed screening records for 1.6M women, finding the probability of getting a biennial mammogram …

  • Fell -1.1 percentage points for all women ages 40-49.
  • Fell -3 percentage points for non-Hispanic Black women 40-49, the biggest decline among younger women.
  • Fell -4.8 percentage points for all women 75 years and older.
  • Fell -6.2 percentage points for Hispanic women over age 75, the biggest decline among all age groups.

The new research confirms other studies finding that the USPSTF 2009 guidance led to a small – but statistically significant – decline in overall breast screening rates. 

  • What’s new is its discovery of demographic variations in the magnitude of the change, an important finding given recent studies showing that Black women have a 39% higher breast cancer mortality rate. 

In fact, rising cancer risk in Black women was cited by the USPSTF as one of its reasons for changing its guidance in 2024. 

  • The USPSTF estimated that lowering screening’s starting age to 40 would avert 1.8 additional deaths per 1k Black women screened every two years

The Takeaway

Hopefully, we’ve seen the end of the “mammography wars” that led to the USPSTF’s 2009 guideline change. A better future is one in which breast screening decisions are made with consideration for factors like cancer risk in addition to just age.

PE Practice Purchases Tick Up

Posted on by Brian Casey

Private equity acquisitions of radiology practices ticked up in 2024 after two years of declines. A new paper in JACR sheds light on PE purchases in radiology, which have raised concerns about the corporatization of medical imaging in the U.S.

Private-sector radiology historically consisted of independent imaging practices run largely by radiologist-owners who contracted with hospitals to read imaging exams.

  • That model has begun to break down as radiology attracts investment from private equity investors eager to roll up what they see as a fragmented industry into larger companies that can leverage market power.

But what’s good for PE investors may not be good for radiologists – or for healthcare. 

  • Private equity investment in healthcare providers has raised concerns that investors may be putting profits before patients.

The new study documents the rate of private equity investment in radiology from 2013 to 2024, based on queries of the Pitchbook and CB Insights databases, finding …

  • There were 113 PE-led radiology acquisitions over the full study period (out of a total of 4.3k radiology practices in the U.S. in 2023). 
  • PE radiology acquisitions peaked at 18 in 2021, fell for the next two years, and ticked back up to 10 in 2024.
  • Most of the radiology practices being acquired employed 50-99 radiologists.
  • PE-led acquisitions were most common in the South.

So what’s to make of the numbers? A total of 113 acquisitions over 10 years isn’t that many (although the authors caution that acquisitions of multi-state or national practices and imaging chains would be counted as a single deal). 

  • And the researchers acknowledge that there’s little data on the impact of corporatization on healthcare quality, at least in radiology (although they do cite a study showing that PE ownership was associated with an 8.2% increase in radiology prices).  

The Takeaway

Private equity investment in radiology practices may still be in the early stages relative to other medical specialties, but radiologists will watch PE acquisitions closely for signs of how the trend may impact them. The new study serves as an important baseline for tracking future activity.   

Radiology’s VC Funding Boom?

Posted on by Brian Casey

Radiology venture capital funding appears to be gaining momentum in the first few weeks of 2025. This past week has seen the release of six funding rounds, led by a massive $260M Series B from preventive medicine firm Neko Health. 

Venture capital funding is a closely watched barometer for any industry built on innovation, and radiology is no exception, especially the imaging AI sector. 

  • Radiology venture capital funding got off to a particularly slow start in 2024, and by year end funding specifically for imaging AI was down 48% compared to 2023 ($335M vs. $646M according to Signify Research). This raised concerns about whether imaging startups might face a decline in VC investment – the equivalent of choking off their air supply before products in development could begin generating commercial sales. 

A CB Insights report earlier this month found that the nature of venture capital investment in digital health has indeed changed, with fewer but larger deals getting done.

  • This was widely seen as VC firms pivoting to quality, with investors demanding proof of progress in the clinical, regulatory, and commercial realms.

That brings us to the recent funding rounds …

  • Neko Health raised $260M that it will use to expand its Neko Body Scan from its current beachheads in Stockholm and London to other locations in Europe and the U.S.
  • Rad AI raised $60M in a round that follows on a $50M Series B less than a year ago as it moves to commercialize its AI-powered radiology reporting software. 
  • Quibim raised $50M in a Series A round to advance its work in imaging biomarkers through AI foundation models that analyze MRI, CT, and PET scans.
  • Annalise.ai parent Harrison.ai received $20M (USD) in funding from an Australian government investment fund to further develop its radiology and pathology AI.
  • Springbok Analytics raised $5M in a Series A round to fund its AI technology for analyzing muscle health from MRI scans.
  • Sycai Medical raised $3.1M for its AI for detecting abdominal cancers.

These six deals – combined with other recent funding rounds from Median Technologies, Core Sound, and BrainSightAI – show that January 2025 has already exceeded the five radiology venture capital deals recorded during the first four months of 2024.

The Takeaway

Do this week’s developments in radiology venture capital funding represent a boom, a boomlet, or just a string of coincidences? Whichever it is, startups would have to acknowledge that any interest from VC investors is better than the alternative.

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