Tag: radiologists

Real-World Stroke AI Implementation

Posted on by Brian Casey

Time is brain. That simple saying encapsulates the urgency in diagnosing and treating stroke, when just a few hours can mean a huge difference in a patient’s recovery. A new study in Clinical Radiology shows the potential for Nicolab’s StrokeViewer AI software to improve stroke diagnosis, but also underscores the challenges of real-world AI implementation.

Early stroke research recommended that patients receive treatment – such as with mechanical thrombectomy – within 6-8 hours of stroke onset. 

  • CT is a favored modality to diagnose patients, and the time element is so crucial that some health networks have implemented mobile stroke units with ambulances outfitted with on-board CT scanners. 

AI is another technology that can help speed time to diagnosis. 

  • AI analysis of CT angiography scans can help identify cases of acute ischemic stroke missed by radiologists, in particular cases of large vessel occlusion, for which one study found a 20% miss rate. 

The U.K.’s National Health Service has been looking closely at AI to provide 24/7 LVO detection and improve accuracy in an era of workforce shortages.

  • StrokeView is a cloud-based AI solution that analyzes non-contrast CT, CT angiography, and CT perfusion scans and notifies clinicians when a suspected LVO is detected. Reports can be viewed via PACS or with a smartphone.  

In the study, NHS researchers shared their experiences with StrokeView, which included difficulties with its initial implementation but ultimately improved performance after tweaks to the software.  

  • For example, researchers encountered what they called “technical failures” in the first phase of implementation, mostly related to issues like different protocol names radiographers used for CTA scans that weren’t recognized by the software. 

Nicolab was notified of the issue, and the company performed training sessions with radiographers. A second implementation took place, and researchers found that across 125 suspected stroke cases  … 

  • Sensitivity was 93% in both phases of the study.
  • Specificity rose from the first to second implementation (91% to 94%).
  • The technical failure rate dropped (25% to 17%).
  • Only two cases of technical failure occurred in the last month of the study.

The Takeaway

The new study is a warts-and-all description of a real-world AI implementation. It shows the potential of AI to improve clinical care for a debilitating condition, but also that success may require additional work on the part of both clinicians and AI developers.

Studies Support Breast Ultrasound for Screening

Posted on by Brian Casey

A pair of new research studies offers guidance on when and where to use ultrasound for breast screening. The publications highlight the important advances being made in one of radiology’s most versatile modalities. 

Ultrasound is used in developed countries for supplementary breast cancer screening in women who may not be suitable for X-ray-based mammography due to issues like dense breast tissue.

  • Ultrasound is also being examined as a primary screening tool in developing regions like China and Africa, where access to mammography may be limited.

But despite growing use, there are still many questions about exactly when and where ultrasound is best employed in a breast screening role – and this week’s studies shed some light. 

First up is a study in Academic Radiology in which researchers compared second-look ultrasound to mammography in women with suspicious lesions found on breast MRI. 

  • Their goal was to find the best clinical path for working up MRI-detected lesions without performing too many unnecessary biopsies. 

In a group of 221 women, second-look ultrasound was largely superior to mammography with… 

  • Higher detection rates for mass lesions (56% vs. 17%).
  • A much higher detection rate for malignant mass lesions > 10 mm (89%).
  • But worse performance with malignant non-mass lesions (22% vs. 38%).

They concluded second-look ultrasound is a great tool for assessment and biopsy of MRI-detected lesions > 10 mm without calcifications. 

  • It’s not so great for suspicious non-mass lesions, which might be better sent to mammography for further workup. 

Breast ultrasound of non-mass lesions was also the focus of a second study, this one published in Radiology. 

  • Non-mass lesions are becoming more frequent as more women with dense breast tissue get supplemental screening, but incidence and malignancy rates are low. 

So how should they be managed? In a study of 993 women with non-mass lesions found on whole-breast handheld screening ultrasound, researchers classified by odds ratios the factors indicating malignancy…

  • Associated calcifications (OR=21.6).
  • Posterior shadowing (OR=6.9).
  • Segmental distribution (OR=6.2).
  • Mixed echogenicity (OR=5.0).
  • Larger size (2.6 vs. 1.9 mm).
  • Negative mammography (2.8% vs. 29%).

The Takeaway

Ultrasound’s value comes from its high prevalence, low cost, and ease of use, but in many ways clinicians are still exploring its optimal role in breast cancer screening. This week’s research studies should help.

CT Lung Screening’s Weak Link

Posted on by Brian Casey

CT lung cancer screening rates in the U.S. remain abysmally low, over a decade after the exam was recommended. Is part of lung screening’s problem its reliance on provider referrals? A new research letter in JAMA Network Open examines this question. 

Unlike breast screening, in which eligible women are able to self-refer themselves for exams, CT lung screening revolves around provider referrals to start the process. 

  • CMS requires a shared decision-making session that results in a written order from a practitioner for a CT lung screening exam in order to pay for screening through Medicare and Medicaid. 

When CMS created the rules in 2015, provider referrals and shared decision-making were seen as ways to get patients involved in their own care by making choices in coordination with their caregivers.

  • But many are starting to see the requirements as a barrier, especially given low CT lung screening rates in the U.S.

In the new article, researchers investigated how easy it would be for an eligible individual to secure a CT lung screening appointment by just calling hospitals – without a provider referral. 

  • They note that one-third of Americans don’t have primary care clinicians, and are often told to call hospitals directly to set up appointments.

So they did just that, placing phone calls to 527 hospitals asking to arrange CT lung screening appointments, finding …

  • 317 calls (60%) failed because the caller did not have a primary care provider’s order.
  • Only 51 hospitals (9.7%) were able to connect callers to any component of a lung cancer screening process. 

The study authors note that the provider referral requirement isn’t the only thing holding CT lung cancer screening back, as even patients with primary care providers aren’t getting screened, and managing nodule follow-up can also be challenging. 

  • But Medicare’s cumbersome reimbursement rules certainly don’t help bring new people into the fold.

The Takeaway

Given CT lung cancer screening’s undisputed life-saving value, there’s no reason to put unnecessary barriers in its way. The provider referral and shared decision-making requirements are lung screening’s weak link to securing greater adoption, and CMS should rescind them to put CT lung cancer screening on the path to greater adoption.

MRI Predicts Cognitive Decline

Posted on by Brian Casey

Early detection of cognitive decline is becoming increasingly important as new therapies become available for conditions like Alzheimer’s disease. A new 20-year study in JAMA Network Open shows that MRI can detect structural brain changes indicating future cognitive decline – years before symptoms occur. 

Longitudinal research has shown that subtle changes in body structure – be they in the heart, brain, or other organs – can predict future disease risk, in some cases decades in advance.

  • That enables the possibility of targeted treatments or behavioral interventions to reduce risk before sick patients experience a cascade of expensive and invasive therapies. 

Mild cognitive impairment is an excellent example. MCI can be a transition to more serious diseases like Alzheimer’s, and previous research has connected it to vascular risk factors that are signs of brain atrophy. 

  • In the current paper, researchers analyzed MRI scans acquired as part of the BIOCARD cohort, a longitudinal study started in 1995 in which cognitively normal participants got baseline brain MRI scans and follow-up exams. 

In a group of 185 BIOCARD participants, researchers tracked how many transitioned to MCI over a mean follow-up period of 20 years, then compared structural brain changes on MRI, finding …

  • 60 participants (32%) progressed to MCI, eight of whom later developed dementia (4.3%).
  • Those with white-matter atrophy on MRI had an 86% higher chance of progression to MCI, the highest rate of any variable studied.
  • Participants with enlargement of the ventricles on MRI had 71% higher risk.
  • Other variables like diabetes and amyloid pathology also had higher risk, but not at the rate of the MRI-detected variables. 

The findings indicate that white-matter volume is closely associated with cognitive function in aging, and that people with higher rates of change are more likely to develop MCI. 

  • The association of diabetes with MCI was not a shock, but researchers said they were surprised there was no association from risk factors like hypertension, dyslipidemia, and smoking.

The Takeaway

The new findings demonstrate the power of MRI to predict pathology years in advance – the question is how and whether to put this knowledge into clinical practice. One could almost see structural brain scans incorporated into whole-body MRI screening exams (if anyone’s listening).

ABUS Flies Solo for Breast Screening

Posted on by Brian Casey

Is breast ultrasound ready for use as a primary breast screening modality – without mammography? Maybe not in developed countries, but researchers in China gave automated breast ultrasound a try, with results that are worth checking out in a new study in AJR. 

Mammography is unquestionably the primary imaging modality for first-line breast screening, with other technologies like ultrasound and MRI taking a supplemental role, such as for working up questionable cases or for women with dense breast tissue.

  • But the standard mammography-dominated paradigm might not be suitable for some resource-challenged countries that have yet to build an installed base of X-ray-based mammography systems. 

One of these countries is China, which not only has fewer mammography systems in rural areas but also has a population of women who have denser breast tissue, which can cause problems with conventional mammography. 

  • As a result, the Chinese National Breast Cancer Screening Program has adopted ultrasound as its primary screening modality, with women ages 35-69 eligible for screening breast ultrasound every 2-3 years. Mammography is reserved for additional workup. 

But handheld ultrasound has challenges of its own. It’s operator-dependent, and image interpretation requires experienced radiologists – also in short supply in some Chinese regions.

  • So the AJR researchers performed a study of 6k women who were screened with GE HealthCare’s Invenia ABUS 2.0 scanner, which uses ultrasound to scan women lying in the supine position. Images were sent via teleradiology to expert radiologists at a remote institution.

How did ABUS perform as a primary screening modality? The researchers found that after a single round of screening …

  • ABUS had a cancer detection rate of 4.0 cancers per 1k women (4.4 for women 40-69).
  • Sensitivity was 92% and specificity was 88%.
  • Abnormal interpretation rate was 12%.
  • 96% of detected cancers were invasive, and 74% were node-negative.
  • Two interval cancers were detected (rate of 0.33 per 1k).

How do the numbers compare to mammography? 

  • The cancer detection rate in the Breast Cancer Surveillance Consortium study was 5.1 cancers per 1k women, so not far off. 

The Takeaway

The results offer an interesting look at an alternative to the mammography-first breast screening paradigm used in developed countries, where ABUS is mostly used as a supplemental technology. For resource-challenged areas around the world, ABUS with teleradiology could solve multiple problems at once.

PSMA-PET Reduces Prostate Deaths

Posted on by Brian Casey

Using PSMA-PET instead of conventional imaging to stage patients with recurrent prostate cancer could reduce deaths by 13% and lead to improved quality of life. The new paper in JAMA Network Open confirms the value of PSMA imaging compared to traditional imaging approaches. 

Recurrent prostate cancer is one of the trickiest cancers to manage, especially as biochemical recurrence can occur in up to half of patients getting local treatment. 

  • PSA tests work well for detecting rising prostate antigen levels that could signify recurrence, but it can be difficult to locate recurrent cancer with existing imaging tools like CT and bone scans.

PET using a new generation of PSMA tracers offers a better solution thanks to tracers that target the PSMA protein that builds up on the surface of prostate cancer cells.

  • Previous studies have shown that PSMA-PET is more sensitive and specific for detecting recurrent prostate cancer, especially at lower PSA levels – but the modality’s long-term effects haven’t been explored. 

In the new study, researchers wanted to investigate the impact of switching to PSMA-PET on mortality and quality of life using statistical modeling to predict outcomes from three imaging approaches …

  • Conventional imaging with CT and bone scan.
  • CT and bone scan followed by PSMA-PET for negative or equivocal cases.
  • PSMA-PET alone.

They then projected outcomes for a hypothetical population of 1k patients with biochemically recurrent prostate cancer, defined as a persistent or rising PSA of 0.20 ng/mL after prostatectomy or PSA 2.0 ng/mL or higher following radiation therapy. They found …

  • PSMA-PET had the lowest number of prostate cancer deaths at 512, compared to conventional imaging plus PSMA-PET (520) or just conventional imaging (587).
  • PSMA-PET diagnosed 611 patients with metastasis compared to 630 with conventional imaging plus PSMA-PET and 297 with only conventional imaging.
  • PSMA-PET yielded 824 more quality-adjusted life years per 1k patients than conventional imaging.

The Takeaway

The findings are not only good news for patients with recurrent prostate cancer, they are also a boon for developers of commercially available PSMA-PET radiotracers like Lantheus Medical Imaging’s Pylarify (approved in 2021), Telix Pharmaceuticals’ Illuccix (approved in 2021), and Blue Earth Diagnostics’ Posluma (approved in 2023). 

FFR-CT Reduces Invasive Angiography Rates

Posted on by Brian Casey

Performing automated CT-derived fractional flow reserve with Shukun Technology’s software reduced referrals to invasive coronary angiography by 19% in a new study in Radiology. The findings suggest that software-based FFR-CT can serve a gatekeeper role in managing workup of patients with suspected coronary artery disease. 

Cardiac CT has been a revolutionary tool for assessing people with heart problems, evolving rapidly into a first-line modality that’s eclipsed other more traditional imaging technologies. 

  • But CCTA’s prowess also has a downside – more referrals to invasive coronary angiography, in some cases for patients without obstructive disease.

Rising to this challenge is FFR-CT, which uses automated software to calculate maximum blood flow in the coronary arteries and detect dangerous coronary lesions that could be early signs of a cardiac event. 

  • The segment to date has been dominated by HeartFlow, thanks to its early start in the field: its FFRCT software got FDA clearance in 2014 and the company has used its dominance to build a massive cash position.

In the new China CT-FFR Study 3, researchers in China used another FFR-CT application, Shukun’s skCT-FFR, and compared angio referral rates for 5.3k patients with suspected coronary artery disease who were scanned with either CCTA alone or CCTA and FFR-CT. They found …

  • Referral rates were lower for those who got FFR-CT (10% vs. 12.4%), a 19% relative difference.
  • Fewer cardiac events occurred in the FFR-CT group at one year (0.5% vs. 1.1%).
  • There was no statistically significant difference in major adverse cardiac event rates at 90 days (0.5% vs. 0.8%, p=0.12) and one year (2.9% vs. 2.8%, p=0.9).

Shukun is not as well known in the West as other developers of FFR-CT software like HeartFlow, but the company has raised over $250M to date – enough to land it in the top echelon of AI developers. 

  • One advantage of Shukun that was evident with the new study is that image processing was performed on-site, rather than being shipped off-site as is the case with other applications. 

The Takeaway

The study shows that FFR-CT can make cardiac CT more precise while tamping down on referrals to invasive angiography that have come from growing CT use. The results should also help put Shukun on the radar of many industry observers in a segment that so far has been dominated by HeartFlow.

Reduce the Mess, Reduce the Stress: Automating and Accelerating Efficiency in Complex Medical Imaging Environments

Posted on by Partner Content

Repetitive, arduous tasks are a major contributor to burnout – an increasingly prevalent issue in healthcare. While digital innovation is transformative, introducing more technology to workflows often creates additional layers of complexity, hindering efficiency, performance monitoring, and ultimately the quality of care.

As a result, once-simple traditional workflows have grown cumbersome over time, filled with many interconnected tasks that are difficult to manage. 

  • As these processes become more complex, it’s clear that healthcare needs to reduce, subtract, and simplify to maintain high standards of care.

Every traditional (or macro) workflow consists of multiple smaller tasks or steps (micro-workflows), many of which are still performed manually. 

  • Consider a wound care scenario where a practitioner takes images, searches for the patient’s record in the EHR, uploads the images, and manually enters encounter details. 

While each individual task may seem small, when multiplied by dozens of similar interactions each day, these repetitive steps …

  • Decrease the time providers have for meaningful patient interactions.
  • Lower overall productivity.
  • Increase the potential for human error.
  • Contribute to burnout and fatigue.

Micro-workflows address this by breaking down processes into discrete, manageable steps. For example, by …

  • Identifying the patient within the EHR.
  • Capturing the image.
  • Automatically inputting relevant metadata.
  • Seamlessly sharing the image with the care team.

This granular approach enables automation, allowing individual components to be optimized or modified without disrupting the entire process. 

  • Micro-workflows offer adaptability, efficiency, and responsiveness, meeting evolving clinical requirements while reducing complexity.

Moreover, micro-workflows make it possible to monitor individual tasks with precision. 

  • This approach allows healthcare organizations to pinpoint workflow gaps, troubleshoot issues, and resolve performance bottlenecks. 
  • In multi-vendor environments, where integrating various systems and applications can be a challenge, the ability to streamline processes and automate tasks becomes especially valuable.

Strings by Paragon is a platform specifically designed to help healthcare organizations harness the power of micro-workflows. 

  • By breaking traditional workflows into smaller, more manageable steps, Strings enables automation, real-time performance tracking, and monitoring across a wide range of applications and infrastructure. 

The platform’s single-pane-of-glass interface provides visibility into complex, multi-vendor environments.

  • Strings offers actionable insights and automated optimizations tailored to specific clinical workflows.

With Strings, organizations can proactively identify workflow bottlenecks, implement targeted optimizations, and measure performance and ROI with precision – leading to improved efficiency, enhanced imaging quality, better patient outcomes, and a value-driven approach to care.

Learn more about Strings by visiting Paragon Health IT’s website, or visit them at RSNA 2024 at booth #1849.

Do Imaging Costs Scare Patients?

Posted on by Brian Casey

A new study in JACR reveals an uncomfortable reality about medical imaging price transparency: Patients who knew how much they would have to pay for their imaging exam were less likely to complete their study. 

Price transparency has been touted as a patient-friendly tool that can get patients engaged with their care while also helping them avoid nasty billing surprises for out-of-pocket costs. 

  • Price transparency is considered to be so important that CMS in 2021 implemented rules requiring hospitals to disclose their standard charges online, as well as post a user-friendly list of their services that includes prices. 

But given that the rules were implemented relatively recently, not much is known about how they might affect patient behavior, such as compliance with recommended follow-up imaging exams.

  • Indeed, a recent study by some of the same authors found that patients are largely unaware of how much their imaging exams will cost them. 

So researchers analyzed data from two previously published studies of patients who either completed or were scheduled for outpatient imaging exams in Southern California. 

  • Patients were asked if they had been told how much their exam would cost them out-of-pocket when they scheduled it. 

Of the 532 patients who were surveyed, researchers found …

  • Only 15% said they knew about their out-of-pocket costs before their imaging exam. 
  • Fewer patients who completed their exams knew their costs compared to those who canceled (12% vs. 22%).
  • Patients who knew their costs were 67% less likely to complete their appointment than those who didn’t (OR=0.33).

So what’s the solution? The researchers suggested that healthcare providers may need to take a more proactive approach to disclosing price information to patients.

  • One possibility would be to integrate pricing discussions into patient-provider communications when ordering imaging exams, rather than relying on patients to seek pricing information on their own. 

The Takeaway

The findings show that medical imaging price transparency is more complicated than just posting a list of prices online and expecting patients to do the rest of the work. Imaging providers may need to get more involved in pricing discussions – the question is whether many of them are ready for it.

Optimizing Front Office Operations through Integrated Apps and Cloud-Based RIS/PACS

Posted on by Partner Content

Paradox of High Patient Volumes

At first glance, it may appear having more patients should naturally lead to higher revenue. When you consider extra labor costs and the fact that reimbursements are decreasing, increased volume can turn into diminishing returns.

  • Basically, the cost of adding more staff can end up being higher than the value of additional patient volumes.

Optimal management of growing patient volumes requires a new way of working with automation and cloud-based apps that replace the heavy burden of manual processes.

  • By using technology to eliminate processes, medical facilities manage patient loads better without the need for more labor costs. 

This proactive approach not only improves efficiencies but also lets front office staff focus on patient needs instead of getting bogged down with administrative tasks. 

  • Ultimately, shifting towards automation and consolidation of tasks is key to maintaining clinic profitability and keeping high standards of care, especially with increasing medical demands.

How RamSoft Can Help Simplify Front Office Operations 

Achieving workflow excellence starts with a single sign-on into a unified RIS/PACS and providing access to complementary medical imaging apps via a single worklist in the cloud. 

  • By leveraging cloud applications with scalability across facilities, organizations can “build as they grow,” while maintaining control and flexibility.

RamSoft PowerServer and OmegaAI RIS/PACS platforms reduce administrative burdens and costs associated with manual processes. Here’s how…

  • Blume – Patient Portal: Patient access to diagnostic images and reports, imaging sharing with referring clinicians and family, self-scheduling, intake forms, and appointment notifications. These self-service features decrease the number of phone calls, the time needed for patient registration, and the manual process of intake form completion and filing. 
  • pVerify: Batch verification and real-time eligibility (authorization available soon) eliminates the need to call multiple insurance providers, freeing up staff time while reducing denials. 
  • PracticeSuite: An embedded solution including workflow options to accommodate entries from the RIS/PACS worklist or within the billing module. Quickly accesses top billing functions, Payment Ledger for balances and eligibility, and Payment Entry to add payment and print a receipt. 
  • openDoctor: Automated appointment notifications through SMS and email which replaces lists of confirmation calls and reduces missed appointments. 
  • InterFAX by Upland: Integrated digital workflow for inbound (available soon) and outbound faxes, reducing the need for manual acceptance and processing of referral or report faxes. 

Mobile Applications Are Building a Patient-Centric Experience

Protecting patient data is business-critical for all medical practices, as it is for RamSoft. We’re using Microsoft Azure Cloud to ensure all data and applications are secure.

  • Workflow optimization in medical imaging can significantly impact the patient experience, leading to increased loyalty and satisfaction. 

Is Your Practice Operating Optimally?

Explore how RamSoft’s new automation applications, including patient engagement tools, integrated with cloud-based RIS/PACS can improve operations and profitability of your practice. 

Learn more on the company’s website or book a demo at RSNA 2024 for booth #6513 in the North Hall.  

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