Tag: radiology

Software Closes Radiology Reporting Loop

Posted on by Brian Casey

In the never-ending quest to get referring physicians to follow radiologist recommendations for follow-up imaging, Massachusetts researchers in JAMA Network Open offer an IT-based solution: Structured reporting software that was found to triple the number of radiology reports judged to be complete. 

A recent study found that 65% of radiologist recommendations for follow-up imaging aren’t followed by referring physicians. Authors of that study found that recommendations that were strongly worded and communicated directly to referring doctors had higher uptake. 

But what if radiologists don’t follow this advice? In the new paper, researchers from Brigham and Women’s Hospital and Harvard Medical School offer a more structured solution thanks to software developed as part of their Addressing Radiologist Recommendations Collaboratively project. 

The ARCC software is a closed-loop communication system that’s designed to channel radiologist recommendations into a structured format that’s clearly understood, while also tracking whether they were accepted and fulfilled. The ARCC tool runs separately from the radiologist’s dictation software, so while it asks them to include a standardized recommendation sequence in their report, it leaves the specific free-text language up to them. 

Under the ARCC criteria, the main factors that make up a complete follow-up recommendation are:

  • Reason for imaging study
  • Timeframe when study should be completed
  • Imaging modality to be used

The researchers implemented the ARCC software in October 2019 in thoracic imaging, and rolled it out to other departments through December 2020. Use of the software was “strongly encouraged but voluntary.” 

In testing the ARCC software’s effectiveness, the researchers found that the number of follow-up recommendations considered to be complete – with all three key elements – rose from 14% to 46%. Even so, one-third of reports filed with ARCC “still contained ambiguous language” in the free-text section – indicating that old habits are hard to break.

The Takeaway

Radiologists may hate it when their recommendations for follow-up imaging are ignored, but referring physicians are also frustrated with free-text radiology reports that are wishy-washy and contain vague impressions. The ARCC software could bridge the gap by steering radiologists toward recommendations that are more concrete and specific – and more likely to be followed.

Is CCTA Set for Cardiac Screening?

Posted on by Brian Casey

A new study out of Denmark suggests that coronary CTA could be headed for population-based screening for heart disease. Researchers found that CCTA was remarkably effective in identifying individuals without symptoms who were more likely to experience heart attacks in years to come.

CCTA has proven so effective for cardiac imaging that it’s become a first-line test for stable chest pain, usually for those with symptoms. But researchers have debated whether CCTA’s value could be extended to asymptomatic individuals – which could set the stage for broad-based heart disease screening programs.

To investigate CCTA’s potential in the asymptomatic, researchers in Denmark scanned 9,533 individuals 40 years and older as part of the Copenhagen General Population Study, reporting their results in Annals of Internal Medicine. CCTA scans were conducted with Canon Medical’s 320-detector-row Aquilion One Vision scanner. 

Atherosclerosis was characterized as either obstructive (a luminal stenosis ≥ 50%), extensive (stenoses widely prevalent but not obstructive), or both. Researchers then tracked myocardial events over a median follow-up of 3.5 years. 

They found that 46% of study subjects had evidence of subclinical coronary atherosclerosis, with the type of atherosclerosis impacting risk of myocardial infarction: 

  • Extensive atherosclerosis had eight times higher risk 
  • Obstructive atherosclerosis had nine times higher risk
  • Both extensive and obstructive disease had 12 times higher risk

What’s more, researchers found that 10% of their study population had obstructive disease – which is just 10 percentage points under the 60% atherosclerosis threshold at which therapeutic intervention should be considered for asymptomatic people. 

Participants in the CGPS study did not receive treatment as part of the study, but the researchers have a follow-up study underway – DANE-HEART – in which asymptomatic people will get CCTA scans and some will be directed to preventive treatment if they meet clinical guidelines.

The Takeaway

This study demonstrates not only the widespread incidence of subclinical coronary atherosclerosis, but also CCTA’s ability to detect CAD before symptoms appear. Preventive treatment initiated and directed by CT findings could have a major impact on heart disease morbidity and mortality.

Given CCTA’s prognostic ability and the heavy burden of heart disease on society (more women die of heart disease than breast cancer, for example), how long before calls emerge to add CT-based heart screening to the arsenal of population-based screening programs? DANE-HEART may offer a clue.

Radiology Bucks Doctor Salary Decline

Posted on by Brian Casey

The latest news on physician salaries is out, and it’s not pretty. A new Doximity survey found that average physician pay declined 2.4% last year, compared to an increase of 3.8% in 2021. The drop was exacerbated by high inflation rates that took a bite out of physician salaries. 

The Doximity report paints a picture of physicians beset by rising burnout, shortages, and a persistent gender pay gap. Doctors across multiple specialties report feeling more stressed even as wage growth has stalled.

To compile the 2022 data, Doximity got responses from 31,000 US physicians. There was a wide range of average annual compensation across medical specialties, with radiology landing at number 10 on the top 20 list, while nuclear medicine occupied the 20th spot:

  • Radiation oncology: $547k vs. $544k in 2021
  • Radiology: $504k vs. $495k 
  • Nuclear medicine: $392k vs. $399k

In other findings of the report:

  • Male physicians made $110,000 more than women doctors. At a gap of 26%, this is actually an improvement compared to 28% in 2021.
  • Men physicians over their career make over $2 million more than women.
  • Nuclear medicine had the smallest pay gap ($394k vs. $382k)
  • The pay gap could contribute to higher burnout rates, with 92% of women reporting overwork compared to 83% of men. 
  • Two-thirds of physicians are considering an employment change due to overwork. 

Ironically, Doximity cited results of a recent survey in which 71% of physicians said they would accept lower compensation for better work-life balance. 

The Takeaway

The news about salaries could be a gut punch to many physicians, who are already dealing with epidemic levels of burnout. Radiology salaries bucked the trend by rising 1.6%, which could explain its popularity among medical students over the last three years. 

The question remains, is the money worth it? Rising imaging volumes have been tied to burnout in radiology, and the Doximity report indicates that some physicians are willing to forgo money for better quality of life.

Moral Distress in Radiology

Posted on by Brian Casey

The rising volume of medical imaging studies isn’t just a data point. It’s causing moral distress among radiologists and is a major systemic cause of the specialty’s burnout epidemic. 

Radiology’s problem with burnout is no secret, with a recent analysis disclosing that 54% of all radiologists identify as burned out. Studies have found that a cause of burnout can be moral distress, defined within healthcare as when a clinician knows the right course of action for a patient, but is prevented from taking it due to systemic factors.

In a March 22 study in American Journal of Roentgenology, researchers describe findings from a survey of 93 radiologists on their feelings of moral distress in different clinical scenarios and the impact it had on their careers. In short:

  • 98% reported some degree of moral distress
  • 48% thought the COVID-19 pandemic influenced their moral distress
  • 28% considered leaving their jobs
  • 18% actually did leave a job

Several factors contribute to moral distress in radiology: 

  • Case volumes that are higher than can be read safely
  • Higher case volumes that prevent resident teaching
  • A lack of action and support among administration

These latter issues lead to burnout in specific ways, the authors wrote. Institutional constraints to providing high-quality care can prompt physicians to spend more time at work. Error rates can also grow during shifts with high study volumes or that last longer than 10 hours. And orders for unnecessary imaging exams can be seen as disregard for professional expertise. 

The Takeaway

This study rips the Band-Aid off the burnout problem in radiology, pointing out that inexorably rising imaging volumes rather than bad bosses or lazy colleagues are a root cause, one that’s been exacerbated by the COVID-19 pandemic.  

A further implication is that no amount of “self-care” – often prescribed as a solution for burnout – will cure the problem in the long run as long as radiologists will have ever-growing worklists to return to after their sabbaticals and motivational staff meetings. The researchers recommended “urgent action” to address the issue.

Medical Students Return to Radiology

Posted on by Brian Casey

Medical students are flocking to apply to U.S. radiology residency programs, with diagnostic radiology seeing the most growth among nearly two-dozen medical specialties. The trend underscores the strong job market for radiologists.

The number of applications to diagnostic radiology residency programs has grown more than 10% a year over the past three years, according to an analysis by Dr. Francis Deng of Johns Hopkins Medicine. Deng has been tracking applicants for 23 medical specialties, and posted a now-viral table containing his analysis on March 13. 

The annual growth rates for diagnostic radiology and the related fields of radiation oncology and interventional radiology exceeded every other medical specialty for the past three years:

  • Diagnostic radiology: 10.5%
  • Radiation oncology: 8.9%
  • Interventional radiology: 6.8%

Diagnostic radiology’s growth is all the more intriguing given the decline it saw in residency applications from 2018 to 2020. Applications fell by 9.5% from 2,033 in 2018 to 1,839 in 2020, before rebounding to 2,409 applicants in 2023. 

What’s behind radiology’s rebound? RadTwitter offered multiple reasons:

  • Generational shifts in preference among medical students.
  • Medical students favoring “money or lifestyle over human interactions.”
  • Reduced worries about the impact of AI on radiologist jobs.
  • The trickle-down effect of a good job market.

RadTwitter pundit Dr. Saurabh Jha expanded on this latter point. A rising volume of imaging studies in the 2010s led to calls to expand the number of residency lots; these calls were ignored, leading to today’s scarcity of radiologists. 

Indeed, other data confirm his analysis. The ACR’s job board last year had the highest number of open radiologist positions ever, while recruiters have been flooding radiologists with job proposals for at least the last two years.

The Takeaway

The medical students entering radiology who celebrated Match Day on March 17 are likely to encounter a robust job market 5-6 years from now, as imaging volume grows while radiology residency slots remain static. Fear of AI’s impact on radiologist jobs appears to be receding, as evidenced by strong growth in radiology applications since 2020.  

ECR 2023 Bounces Back As AI Tops Clinical Program

Posted on by Brian Casey

The European Congress of Radiology is back. European radiologists returned to Vienna in force last week for ECR 2023, surprising many naysayers with crowded presentation rooms and exhibit booths.

Due to the COVID-19 pandemic, it was the first ECR meeting since 2019 to be held in the conference’s traditional timeframe of early March. And after a lightly attended ECR 2022, held during Europe’s July vacation season, many were watching with bated breath to see if the conference could mount a comeback. 

Fortunately, ECR 2023 didn’t disappoint. While attendance didn’t hit the high water mark set prior to the pandemic, it was strong enough to satisfy most that the show was indeed healthy, with chatter on-site placing attendance at around 17,000.

As with RSNA 2022, interest in AI was strong. AI-based content permeated the scientific sessions as well as the exhibit floor, and the show’s AI Theatre was packed for nearly every presentation. 

In his opening address, ECR 2023 President Dr. Adrian Brady of Ireland addressed concerns about AI’s impact on radiology in the years to come, characterizing it as one of the “winds of change” that should be embraced rather than shunned. 

Other major trends at ECR 2023 included: 

Patient Safety – Many sessions discussed how to reduce risk when scanning patients, ranging from lowering radiation dose to limiting the amount of contrast media to MRI scanning of patients with metallic implants.

Sustainability – Energy challenges have gripped the European continent since the Russian invasion of Ukraine in 2022, and imaging energy conservation was a key focus across several sessions. 

Workhorse Modalities – Unlike RSNA, where new product launches were focused on high-end premium systems, scanner introductions at ECR 2023 concentrated on workhorse offerings like mid-range CT and 1.5-tesla MRI.

The Takeaway

ECR is indeed back. It may not yet be a mandatory show for most U.S. radiologists, but it has regained its importance for anyone interested in a more global look at medical imaging. And given the European emphasis on research, it’s a great place to learn about new technologies before they appear in North America.

Radiology in 2040

Posted on by Jake Fishman

A new Radiology Journal editorial shared a radical vision for how the specialty will operate in 2040, warning that “seismic” changes will require radiologists to overhaul their roles in order to thrive, or even stay relevant.

Here’s what the authors expect:

Super Reporting – Radiology reporting will become far more automatic and dynamic, as reports embrace multimedia formats, become far more accessible and patient-friendly, and integrate into automatic follow-up systems.

Disease Focus – The growth of at-home care and the emergence of mobile and self-examination imaging technologies will force radiology workflows to become organized by diseases, rather than by patients’ “location” (ED, ICU, etc.).

Inevitable AI – “AI will not replace radiology,” but it will “profoundly affect [radiologists’] relevance and workflow” as algorithms become more comprehensive, autonomous, and accurate.

The AI Threat – AI will eliminate many current radiologist tasks, but its greatest threat to radiology would come from referring physicians using imaging AI independently. 

Multi-Diagnostics – The rise of non–imaging precision diagnostics (ie, “liquid biopsies”) and multimodal/multiomic diagnostics will reduce imaging’s role in disease detection, and lead to a more-integrated diagnostic and treatment planning process.

Future Therapy – Major advances in precision imaging, image-guided technology, and theranostics would allow radiology to increase its clinical value by owning image-related procedures.

Those are some major changes, and would require radiologists to take similarly major actions in order to thrive in 2040 and beyond:

  • Understand that image interpretation will become a commodity, and maybe “obsolete”
  • Maintain a “laser-sharp” focus on adding value across the healthcare continuum 
  • Actively embrace radiologists’ role as AI’s primary users, owners, and managers
  • “Extensively cultivate” radiology’s interventional and theranostics capabilities

The Takeaway
It’s impossible to accurately predict how medicine will evolve over the next two decades, and there’s surely plenty of readers who are growing tired of obsolescence warnings.

That said, the authors are very well-respected and each of their forecasts can be directly linked to today’s emerging trends, suggesting that radiologists who follow their advice might be more likely to “thrive” in 2040 regardless of how the future unfolds.

Medical Imaging in 2022

Posted on by Jake Fishman

For our final issue of 2022 we’re reflecting on some of the year’s biggest radiology storylines, including some trends that might have a major impact in 2023 and beyond.

“Post-COVID” – Radiology teams thankfully scanned and assessed far fewer COVID patients in 2022, but the pandemic was still partially responsible for most of the trends included in this recap.

Imaging Labor Crunch – Many organizations still didn’t have enough radiologists and technologists to keep up with their imaging volumes this year, driving up labor costs and making efficiency even more important.

Hospital Margin Crunch – There’s a very good chance that the hospitals you work for or sell to had a tough financial year in 2022, placing greater importance on initiatives/technologies that earn or save them money (and address their labor challenges).

AI Evolution – If a radiology outsider read a random Imaging Wire issue they might think that radiologists already use AI every day. We know that isn’t true, but imaging AI’s 2022 progress suggests that we’re slowly heading in that direction.

New Mega Practice Paradigm – After years of massive national expansions, recent unfavorable shifts in surprise billing reimbursements, radiologist staffing (costs & shortages), and the lending environment seemed to have caused large PE-backed radiology groups to pivot their 2022 strategies from practice growth to practice optimization.

The Patient Engagement Push – Radiology patient engagement gained momentum in 2022, as imaging teams and vendors worked to make imaging more accessible and understandable, more patient-centric imaging startups emerged, and radiology departments continued to get better at follow-up management.

The AI Shakeup – Everyone who has been predicting AI consolidation took a victory lap in 2022, which brought at least two strategic pivots (MaxQ AI & Kheiron) and the acquisitions of Aidence and Quantib (by RadNet), Nines (by Sirona), Arterys (by Tempus), MedoAI (by Exo), and Predible (by nference). This trend should continue in 2023, as VCs remain selective and larger AI players extend their lead over their smaller competitors.

Imaging Leaves the Hospital – Between the surge of hospital-at-home initiatives and payors’ efforts to move imaging exams to outpatient settings, imaging’s shift beyond hospital walls continued throughout 2022 and doesn’t seem to be slowing as we head into 2023.

Imaging in 2022

Posted on by Jake Fishman

Happy New Year, and welcome to the first Imaging Wire of 2022. For those of you working on your annual gameplans, here are some major imaging themes to keep in mind.

COVID Wave Watch – Nothing will have more influence on imaging in 2022 than how / when the COVID pandemic subsides, and how many more waves and variants emerge until we get there.

Efficiency Focus – It’s abundantly clear that imaging must become more efficient, making workflow improvements arguably the top priority for radiology teams and the folks who sell to them.

AI Matures – Imaging AI should mature at an even faster pace this year, bringing greater clinical adoption (and expectations), better workflow integration, improved use cases and business models, and the emergence of clear AI leaders. We’ll also likely see an initial wave of consolidation due to acquisitions and/or VC-prompted shutdowns.

More M&A – Imaging’s extremely active M&A climate should continue into 2022. Based on recent trends, this year’s M&A hotspots are likely to include PE-backed rad practice and imaging center acquisitions, enterprise imaging vendors adding to their tech and “ology” stacks, and more modality and solution expansions from the major OEMs.

Advanced Imaging Advancements – 2022 is shaping up to be a milestone year for MR and CT technology. On the MRI side, recent breakthroughs in magnet strength, helium requirements, portability, and image enhancement (among others) should lead to big changes in how / where MRI can be used. On the CT side, we’ll see OEMs increase their focus on achieving photon-counting CT leadership, even if most of that focus will be from their R&D and future product marketing teams in 2022.

The Patient Engagement Push – Digital patient engagement continues to gain momentum across healthcare, placing pressure on radiology teams to keep up. In 2022, that might mean getting better at radiology’s current patient engagement methods (e.g. image sharing, patient-friendly reporting, follow-up management), although patients’ expectations will likely evolve at an even faster pace.

Imaging Leaves the Hospital – A lot more imaging exams could be performed outside hospital walls in 2022, as payors continue to incentivize outpatient imaging (and image-related procedures) and at-home care continues its massive growth. 

While it’s hard to say which, if any, of these trends will be the top story of the next 12 months, it seems likely that we’re heading into another year with more big news than can fit into a seven-bullet roundup. Wishing you the best in 2022, Imaging Wire readers!

Get every issue of The Imaging Wire, delivered right to your inbox.

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Imaging Wire team

You're all set!