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A Case for mp Ultrasound | Overestimated Overdiagnosis
March 2, 2022
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Together with
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A new Lancet study out of the UK provided the strongest evidence yet that multiparametric ultrasound might deserve a core role in prostate cancer screening, either as a complement or alternative to multiparametric MRI. That could be a big deal given mpMRI’s cost, time, and accessibility challenges, and makes this study worth a deeper look.
The Study – The researchers performed mpUS and mpMRI exams on 306 patients with signs of prostate cancer (either elevated PSAs or abnormal rectal exams), and then conducted targeted biopsies on the 257 patients who had positive imaging findings.
The biopsy results revealed cancer in 133 patients, including 83 clinically significant cancers, while showing how mpUS might contribute to prostate cancer diagnosis:
- mpUS was positive in 272 patients (89%)
- mpMRI was positive in 238 patients (78%)
- mpUS identified 66 clinically significant cases (79%)
- mPMRI identified 77 clinically significant cases (93%)
- mpMRI and mpUS combined to detect all 83 clinically significant cancers
- mpUS exclusively detected 6 clinically significant cancers
- mpMRI exclusively detected 17 clinically significant cancers
In other words, mpUS was only slightly less accurate than mpMRI for clinically significant cancer detection (-4.3%), but led to far more biopsies (+11.1%), while the combined modalities notably improved clinically significant cancer detection (+7.2%).
The Takeaway
mpMRI’s role in prostate cancer screening is still secure, but this study shows that mpUS could improve cancer detection if the modalities are used together. Perhaps more importantly, it suggests that mpUS could be a valid prostate cancer detection option for the half of the world that doesn’t have access to advanced imaging or for the many patients who can’t/won’t undergo MRI (orthopedic implants, claustrophobia etc.).
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Overcoming Cardiac CT Challenges
Variable heart rates and organ motion can make cardiac imaging a challenge for CT technologists. Discover how intelligent imaging guidance with Siemens Healthineers’ myExam Companion can help overcome these challenges, without compromising quality and consistency.
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Becoming Imaging AI Adopters
We talk a lot about radiology practices’ AI adoption, but usually don’t have much evidence to back it up. That changes with this new Arterys report detailing how and why 30 US radiology groups became imaging AI adopters.
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- Canon Acquires NRT: Canon Medical Systems announced its acquisition of Danish X-ray manufacturer and long-time business partner, Nordisk Røntgen Teknik A/S (NRT). The acquisition strengthens Canon’s European DR and fluoroscopy capabilities (R&D, manufacturing, regulatory, product portfolio), while allowing Canon to offer NRT’s higher-end flouro/interventional systems in its other global markets. Although this is a relatively small acquisition (NRT has 40 employees), it’s confirmation that Canon remains among the more aggressive acquirers in medical imaging.
- Overestimated Overdiagnosis: A recent Annals of Internal Medicine study suggests that breast cancer overdiagnosis might be far less common than previously believed. The researchers analyzed mammography screenings from 35,986 women (2010-2018, 82.6k mammograms, 718 breast cancers, ages 50-74yrs), finding that 15.4% of screen-detected cancers are overdiagnosed (would have remained asymptomatic or women would have died of other causes while asymptomatic). That’s roughly half previous estimates (30%) and could influence shared and informed decision making.
- Samsung’s Boston Imaging: Samsung’s NeuroLogica subsidiary announced that its U.S. X-ray and ultrasound business will now operate under the Boston Imaging brand, making the NeuroLogica brand exclusive to its mobile stroke CT business. This move seems to align with Samsung’s global healthcare business structure and adds linguistic clarity (NeuroLogica = stroke business), but it doesn’t appear to change their internal operating structure (same US/DR leadership, Boston Imaging is a DBA).
- Imaging Inequity: A new JACR study review (n = 206 studies, 179 US-focused) added even more evidence that minority patients are commonly subjected to insufficient and inappropriate imaging. The vast majority of studies found decreased or inappropriate imaging use in minority groups (72% of studies), while nearly half of the studies (46%) showed that minority screening disparities are common even after controlling for socioeconomic factors. They also revealed a need for more research on ways to improve imaging equity, noting that just 8% of the studies evaluated strategies to mitigate imaging disparities.
- Surprise Billing Reversal: Radiologist and other physician lobbyist groups celebrated after a U.S. District Court in Texas ruled that the federal Surprise Billing Interim Final Rule’s arbitration process violates the Administrative Procedure Act. This component of the No Surprises Act favored payors by making health plans’ calculated ‘qualifying payment amount’ the primary factor considered when surprise billing cases go to arbitration (these are often lower than real-world rates). The other components of the Surprise Billing law are still intact and this ruling could still face appeals.
- CAC and Opacity COVID Predictions: A new Academic Radiology study revealed that CT-based CAC scores and pulmonary involvement calculations (“Opacity Scores”) could combine to predict COVID patient outcomes. The researchers produced CAC and Opacity scores using chest CTs from 142 patients with COVID pneumonia, finding that the scores predicted which patients would die from respiratory failure (0.938 AUC) far more accurately than when the CAC and Opacity scores were used independently (0.785 & 0.870 AUCs).
- Butterfly’s Blueprint Launch: Butterfly Network officially announced its Butterfly Blueprint platform, which is intended to make it easier for health systems to adopt the Butterfly iQ+ handheld ultrasound across clinical departments and to integrate PoC exams into enterprise systems and workflows. Although Butterfly Blueprint technically already launched at the University of Rochester Medical Center in January, this week’s announcement appears to suggest widespread availability and an increased strategic focus on system-wide deals.
- VascuViz: Johns Hopkins researchers developed a new multimodal imaging technique that produces more detailed vascular images and could allow scientists to better understand the role of blood flow in disease development. The researchers’ new VascuViz technique combines CT, MRI, and optical microscopy, allowing far more detailed vascular 3D visualizations than any of the modalities on their own.
- Dr. Ben on the ABR: Neuroradiologist and very worthwhile medicine economics follow, Ben White MD, detailed all the drama from the ABR’s day in 7th District Court and reiterated why so many radiologists seem to feel ripped off by the ABR Maintenance of Certification process (MOC). It’s too early to tell whether the MOCs will be deemed a misuse of the ABR’s maintenance and certification monopoly, but Dr. White’s commentary makes it quite clear that radiologists don’t find it clinically valuable.
- LV Hypertrophy Echo AI: Cedars-Sinai and Stanford researchers developed an ultrasound AI system that can identify patients with hypertrophic cardiomyopathy and cardiac amyloidosis, two particularly difficult-to-detect heart diseases that look similar in echocardiograms. In a test using a domestic external dataset, the algorithm automatically measured left ventricular dimensions to detect patients with increased LV wall thickness (1.7mm to 3.8mm mean error rates), and then identified patients likely to have hypertrophic cardiomyopathy and cardiac amyloidosis (0.89 & 0.79 AUCs).
- Profound Medical & GE Integrate: Profound Medical’s TULSA-PRO prostate cancer thermal ultrasound ablation system is now officially available integrated with GE Healthcare’s 3T MRIs, following their first site agreement at Brigham and Women’s Hospital. The companies first announced a co-development agreement in late 2020, adding GE to Profound Medical’s existing MRI relationships with Philips and Siemens.
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Bringing Interoperability into Focus
Imaging Wire readers have been following along as Intelerad created a truly comprehensive Enterprise Imaging and Informatics Suite. Here’s how to see it in person at HIMSS 22.
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- Riverain joined the exclusive group of AI vendors to receive Europe’s more-demanding Medical Device Regulations (MDR) certification, which requires healthcare AI products to attain higher risk classifications and provide far more validation evidence.
- Discover how Magnolia Regional Health Center started catching more cancers sooner when it adopted Nuance’s PowerScribe Lung Cancer Screening Program and PowerScribe Follow-up Manager.
- Working on your enterprise imaging cloud strategy? Hear how two healthcare IT leaders are moving their enterprise imaging to the cloud and the lessons they learned along the way in this Change Healthcare podcast.
- See how SPECT/CT substantially improved health outcomes for non-small-cell lung cancer treatment planning compared to planar imaging, while remaining highly cost-effective, in this new GE Healthcare-supported study.
- Thinking about AI ROI? Check out this AIMed conversation featuring Blackford CEO, Ben Panter and Lahey Hospital & Medical Center’s radiology Chairman, Dr. Christoph Wald discussing how to demonstrate the value of healthcare AI.
- Check out this Imaging Wire Show, featuring Nanox AI strategy leader, Dr. Orit Wimpfheimer, where we discuss building an international telerad practice, what’s wrong with triage AI, and pivoting to population health AI.
- Midwest Radiology Outpatient Imaging of St. Paul, Minnesota recently became the proud owner of United Imaging’s uMI 550, giving its team and patients a PET/CT system that combines clinical flexibility with digital technology that prevents obsolescence.
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