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Cardiac Imaging

Chest Pain Imaging Guidance

If it seemed like coronary imaging folks were more excited than usual last week, it’s because the AHA/ACC’s long-awaited chest pain guidelines just set the stage for a lot more imaging.

The Guidelines – The American Heart Association (AHA) and the American College of Cardiology (ACC) released their first clinical guidelines for the assessment and diagnosis of chest pain, outlining a range of new standards, processes, and pathways, while giving coronary imaging a central diagnostic role.

Front-Line Coronary CTA – The new guidelines made coronary CTA a front-line coronary artery disease test, assigning CCTA their highest recommendation level and proposing it for a large group of patients (mid-high risk of CAD, stable chest pain, <65yrs).

FFRct Next in Line – HeartFlow’s FFRct analysis will often serve as the next diagnostic step when CCTA exams reveal obstructive CAD (40-90% stenosis) or are inconclusive, with FFRct results either clarifying diagnosis or supporting treatment decisions. 

Stress Imaging Pathways – The AHA/ACC guidelines also gave stress imaging (e.g. TTE, echo, CMRI, PET, etc.) their highest recommendation level, positioning stress imaging for more serious cases (likely or confirmed obstructive CAD, ≥65yrs) as well as for diagnosing myocardial ischemia and estimating risks of major cardiac events among patients with less severe cases (intermediate risk, no known CAD, acute chest pain).

Takeaway – These new guidelines are a big deal for coronary imaging, given the millions of people who show up at US emergency departments with chest pain each year. It’s also going to require some big changes across EDs, imaging centers, and radiology departments/practices, who will have to retool their imaging protocols/fleets and be able to expertly interpret a wave of coronary imaging exams (and handle a wave of incidentals).

Siemens Healthineers’ Syngo Carbon Connection

Generate actionable insights by consolidating your data into one place, organized around the patient with Syngo Carbon.

Riverain’s Lung Cancer Guideline Kit

Did you know that November is Lung Cancer Awareness Month?

The USPSTF guidelines for lung cancer screening were updated in May 2021, and driving compliance to such guidelines is a long, slow, repetitive process.

The Riverain team saw supporting guideline compliance and education as an opportunity to further their mission of saving lives through the early detection, diagnosis, and management of lung disease. So, they’ve put together a kit to help hospitals and imaging centers educate either referring physicians or patients on the new guidelines either via branded tools or through the media.

Interested in sharing this message? Riverain has the tools to do it.

The Wire

• Samsung’s CXR Nodule AI: Samsung NeuroLogica announced the FDA clearance of its Auto Lung Nodule Detection AI tool, which is intended to help physicians detect 10mm-30mm lung nodules in CXR scans, and will come embedded in Samsung X-ray systems. Samsung has more AI on the way, revealing that its collaboration with Vuno will bring more chest CADe tools.

• CAC Scores, Better with Age: A new JAMA study revealed that physicians might not be able to rely on CAC scores to rule out obstructive coronary artery disease (CAD), especially among younger patients. Analysis of 23,759 symptomatic patients with obstructive CAD found that many younger participants had no coronary artery calcium (Zero CAC = 58% of <40yrs, 34% of 41-49yrs, 18% of 50-59yrs), while these <60yr-old patients without CAC still had higher risks of heart attack and all-cause death.

• Repair Rights Granted: After years of fierce OEM and ISO lobbying, the U.S. Copyright Office ruled that 3rd party service providers and device owners can legally access medical device software, as long as it’s necessary to diagnose, repair, or maintain a device. Unsurprisingly, OEMs and servicers have very different feelings about this ruling.

• LDCT for HNC Survivors: A new JAMA study found that head and neck cancer survivors with a long smoking history have a 2.5 times higher rate of lung cancer than smokers who never had head and neck cancer. The study also found that low-dose CT screening was more effective than CXR screening for these patients, supporting their conclusion that regular LDCT screening is particularly important for HNC survivors. These screenings could also allow earlier detection of future head and neck cancers. 

• GE & Circle NVI’s Stroke AI: GE Healthcare will integrate Circle Neurovascular Imaging’s stroke AI tools into the GE FastStroke processing platform, adding Circle NVI’s AI-based stroke triage and detection tools to FastStroke’s automated stroke CT workflow and communication features. Circle Neurovascular Imaging is a subsidiary of longtime GE partner, Circle Cardiovascular Imaging.

• CXR’s Post-COVID Value: A new study out of Italy highlighted chest X-ray’s value for monitoring recovering COVID patients. The prospective study had 119 COVID patients undergo CXR exams three months after their hospital discharge, finding that roughly half of the patients still had lung abnormalities, and patients with higher CXR scores also had more severe cases while hospitalized.

• AI Principles: The US FDA, Health Canada, and the UK MHRA published their 10 guiding principles for medical device “Good Machine Learning Practice,” setting the foundation for future international AL/ML regulatory collaborations (e.g. creating standards, resources, guidelines). The principles largely target: applying clinical expertise to product design, following software/security best practices, following training/evaluation/monitoring best practices, building for specific medical use cases and for AI+human operation, and providing users all necessary info. 

• DBT Waste: A new Clinical Imaging editorial called for the NCI to cancel their $100m DBT trial (TMIST), suggesting that its unnecessary (DBT is already widely adopted & effective) and poorly designed (too small; should focus on reducing mortality; should include 40-44yr old women). Instead, the editorial argued that this funding should be used to improve breast cancer detection or for evaluating breast MRI. This isn’t the first criticism of the TMIST trial, reportedly leading to the NCI considering canceling it last year.

• Atlantic Upskills: New Jersey’s Atlantic Health System (6 hospitals, 18k employees) announced a pair of interesting new radiologic technologist and pharmacy tech training programs intended to upskill its workforce. The radiology “tech school” will be offered to 120 current trained/certified RTs each year, allowing them to gain certifications for CT, MRI, mammography within 5 to 10 weeks, while giving Atlantic a multi-modal imaging workforce.

• Pelvic CT Misreads: Radiologists commonly misread pubic root fractures as more serious anterior column fractures in pelvic CT scans, leading to unnecessary scans and evaluations. That’s from a new Clinical Orthopedics and Trauma study that analyzed 155 patients with pelvic or acetabular fractures at a single institution (83 & 72), finding that radiologists mistook 85% of the pubic root fractures as anterior column fractures.

• AZmed Funding: French imaging AI startup AZmed secured a €3.5m funding round (total now €4.4m) that it will likely use to commercialize its Rayvolve AI tool (fracture and chest abnormality detection) and to support future product development.

Ramapo Radiology’s Case for Novarad CryptoChart

See how New Jersey’s Ramapo Radiology Associates overcame their CD burning problems and improved their physician and patient experiences with Novarad CryptoChart.

The Resource Wire

• Watch CriticalCare’s Dr. Yusuf Karrar, MD discuss how Canon’s CT Fluoro touch interface allows “Simple, Streamlined CT Fluoroscopy.”

• There might be more “advanced” imaging modalities, but X-ray keeps growing and will be a mainstay modality for the foreseeable future. See the factors driving X-ray’s growth in this GE Healthcare report.

• See how and why Zebra Medical Vision sees a much bigger future for public health AI than many of us imagine in this Imaging Wire Q&A with company CEO, Zohar Elhanani.

• This Blackford Analysis video details how imaging AI can improve radiology efficiency and patient care, and discusses the key role that AI assessments and curation plays in achieving these improvements.

• Check out this Imaging Wire Show interview with Fujifilm Healthcare Americas’ Dave Wilson, detailing what we can expect as Hitachi Healthcare becomes part of Fujifilm.

• This Bayer Radiology case study details how its Certegra P3T Software automates contrast enhanced abdominal CT injection protocols based on patient characteristics and contrast concentration.

• See Ochsner Lafayette General’s Director of Radiology, Emily Broussard, describe their “seamless” transition to Nuance PowerScribe One and how it has improved their reporting efficiency and quality.

• This study by Paris’ Hospital of Valenciennes highlights how effective Arterys Chest MSK AI is for finding X-ray abnormalities.

• No blueprint? No problem. Live Site Planning Sessions are one of United Imaging’s favorite collaboration moments, giving customers and their design team an opportunity to discuss preliminary equipment layout, adjust equipment placement, make changes to the floor plan, and review equipment specifications in a live virtual environment.