University Radiology Group’s Roger Yang, MD on workflow integration’s role as AI’s “next frontier.”

University Radiology Group’s Alberto Goldszal, PhD and Roger Yang, MD star in the latest Imaging Wire Show, detailing their clinical and technological approaches to AI adoption and the impact of URG’s ScreenPoint Transpara implementation.

Considering how often we all talk and write about AI adoption, it’s still exceptionally rare to hear from a major practice’s CTO and clinical leader about their own AI efforts, which makes this a must-watch episode.

Imaging Wire Sponsors

Arterys  •  Bayer Radiology  •  Blackford Analysis  •  Canon Medical Systems  •  CARPL.ai  •  Change Healthcare  •  Fujifilm Healthcare  •  GE Healthcare  •  Intelerad  •  Novarad  •  Nuance  •  Riverain Technologies  •  Siemens Healthineers  •  United Imaging  •  Us2.ai

Cardiac Imaging

Chest CT’s Untapped Potential

A new AJR study out of Toronto General Hospital highlighted the largely-untapped potential of non-gated chest CT CAC scoring, and the significant impact it could have with widespread adoption.

Current guidelines recommend visual CAC evaluations with all non-gated non-contrast chest CTs. However, these guidelines aren’t consistently followed and they exclude contrast-enhanced chest CTs.

The researchers challenged these practices, performing visual CAC assessments on 260 patients’ non-gated chest CT exams (116 contrast-enhanced, 144 non-contrast) and comparing them to the same patients’ cardiac CT CAC scores (performed within 12-months) and ~6-year cardiac event outcomes.

As you might expect, visual contrast-enhanced and non-contrast chest CT CAC scoring:  

• Detected CAC with high sensitivity (83% & 90%) and specificity (both 100%)
• Accurately predicted major cardiac events (Hazard ratios: 4.5 & 3.4)
• Had relatively benign false negatives (0 of 26 had cardiac events)
• Achieved high inter-observer agreement (κ=0.89 & 0.95)

The Takeaway

Considering that CAC scores were only noted in 37% of the patients’ original non-contrast chest CT reports and 23% of their contrast-enhanced chest CT reports, this study adds solid evidence in favor of more widespread CAC score reporting in non-gated CT exams.

That might also prove to be good news for the folks working on opportunistic CAC AI solutions, noting that AI has (so far) seen the greatest adoption when it supports processes that most radiologists are actually doing.

Creating Your AI Platform Strategy

Adopting a platform strategy can simplify the deployment and management of imaging applications and AI algorithms, but there’s a lot to consider. In this eBook, Blackford Analysis and its clients detail how AI platforms can benefit clinical and IT teams, and share guidelines to consider when selecting a platform.

Lung Cancer Programs: Go, Grow and Flow

Over 9 out of 10 people who should be screened for lung cancer aren’t, and nearly 50% of lung cancer cases are caught in the advanced stages. We know from prostate and breast cancer screening that clear guidelines and increased screening saves lives. But lung cancer screening has been challenging. Riverain strives to make everything about the lungs clearer, so they assembled this resource page for anyone interested in starting or improving their lung screening program.

The Wire

• GE Healthcare & Medtronic’s ASC Alliance: GE Healthcare and Medtronic will combine their portfolios for a new cardiovascular offering targeted at the fast-growing Ambulatory Surgery Center and Office Based Lab segments. GE’s contribution will center around its cardiac and peripheral vascular products (C-arms, ultrasound, monitoring), as well as its digital solutions and consultative services. Medtronic will provide a range of products (cardiac rhythm, pain management, peripheral vascular, kyphoplasty) in addition to its field and business services.

• Portal Positives: A new JMIR study highlighted patients’ overwhelmingly positive response to University of Colorado Anschutz’s addition of radiology report and image viewing to its online portal. A survey of patients who used the portal’s new radiology features (n = 299 responses out of 1,825 requests) revealed that the vast majority had favorable experiences (86.3%), found reading their reports and viewing their images to be valuable (96.3% & 89.3%), and believed viewing their images improved their understanding of their condition (82.9%). Although all negative survey questions had <7% agreement rates (e.g. errors, confusion, anxiety), 26.7% of patients experienced technical difficulties.

• Nanox.AI’s VCF Analysis FDA: Nanox.AI announced the FDA clearance of its HealthOST AI solution, which produces qualitative and quantitative analysis of vertebral compression fractures and low bone density using CT exams. HealthOST builds upon Nanox.AI’s AI Health Bone population health solution, which detects vertebral compression fractures in existing chest CTs, and gained FDA clearance in May 2020.

• Tech’s Growing Role: An Elsevier Health survey of nearly 3k clinicians found that “technology literacy” is expected to become clinicians’ most valuable capability over the next decade, ranking even higher than “clinical knowledge.” Despite technology’s growing role within medicine, 69% reported feeling overwhelmed with their current data volume, while the same share predicted that the burden will become greater in the future. As a result, 83% said that training needs to be overhauled to keep pace with changing tech.

• Intelerad’s New Chiefs: Intelerad named software and consulting leader AJ Watson as its new Chief Product Officer and made digital health veteran Paul Johnson its new Chief Delivery Officer, highlighting their focus on integrating Intelerad’s recently-acquired solutions and advancing its product and client service operations. Intelerad appears to be placing an emphasis on expanding its client services leadership team, as it similarly appointed Jean Boyle (formerly of Sectra) to lead its global professional services in late 2021.

• Omnipaque Shortage: GE Healthcare recently informed its imaging clients of an Omnipaque iodinated contrast shortage, prompting the OEM to limit orders to 15% of typical volumes. Like many COVID era supply chain issues, the Omnipaque shortage was caused by China’s recent government-mandated shutdowns. However, the Omnipaque issue seemed to raise more alarm than previous imaging hardware shortages. GE expects supply levels to rebound by late June.

• CTC’s Unique Utilization: A new JACR study showed that CT colonography utilization remains very low, but is more common among racial minorities that typically receive less imaging. Analysis of 13,709 individuals (2019 data, 50-75yrs, no colon cancer history) found that just 1.4% had ever undergone a CTC exam. However, CTC appeared to be gaining adoption, with 40% of those patients receiving CTC exams within the previous year and another 18.5% between 1-2 years. Interestingly, Hispanic and Black patients were far more likely to have undergone CTC exams (odds ratios: 2.67 & 2.47), which is quite different from most screening studies.

• Zepp Adds Imaging Stake: Zepp Health further expanded its imaging holdings, announcing an additional investment in point-of-care MRI startup Promaxo (its second) that will expand their alliance to include sharing AI resources, Chinese regulatory support, and product manufacturing. In just a few years, Zepp Health has evolved from a large Chinese smartwatch company (when it was known as Huami) to becoming a stakeholder in the three biggest PoC MRI companies (Promaxo, neuro42, Hyperfine) and partnering with two portable X-ray companies (Aspen Imaging & Rouumtech).

• AB-MRI’s Economic Threshold: A new study in European Radiology suggests that Abbreviated Breast MRI (AB-MRI) exams must have at least 20% lower costs than full protocol breast MRI in order to offset AB-MRI’s lower specificity, higher recalls and false positives, and impact on future quality-adjusted life years (QALYs). The authors compared AB-MRI and bMRI screening scenarios across various costs and QALY willingness-to-pay levels, finding that the economics of AB-MRI become superior to bMRI at or below $259 per exam (80% of bMRI).

• Mobile Fraud: The president of Ohio-based mobile imaging company, Portable Radiology Services, was found guilty of healthcare fraud after billing Medicare and Medicaid for roughly $2M in X-ray services at nursing homes that didn’t take place (including 151 on patients that were already deceased). Mobile imaging providers have a long history of fraud (here are some previous cases), due to their vulnerable clientele and the fact that these scans can be done without physician authorization.

• NYU’s AI Breakthrough: NYU’s Center for Data Science achieved what might be a key step towards understanding AI decision making, and could support the creation of more robust and clinical-ready AI. Their proposed framework measures how AI and radiologist performance varies when image features are altered, allowing developers to confirm if AI is making predictions for clinically-valid reasons. When using the framework to evaluate a mammography AI model, they found that its analytical process was consistent with radiologists when detecting microcalcifications, but flagged soft tissue lesions for very different reasons (different image features & areas of images). 

Canon Across America

Canon Medical is making its way through the US on its 2022 Mobile Tour, bringing its products and solutions directly to hospitals and providers in 50 US cities. Tune in to see when Canon is coming to you and watch highlights from its tour stops along the way.

The Resource Wire

• Enterprise Imaging has come a long way, and it has a long way to go. This Intelerad white paper details the five pillars organizations should prioritize in order to realize the full potential of EI’s next evolution.

• Pediatric patients can’t always accurately describe their orthopedic-related pain. Read how Lorenzo Biassnoi, MD, describes how SPECT/CT can help in this SPECT/CT and pediatric orthopedic surgery story.

• See how East Texas Medical Center reduced its abdominal CT contrast volumes by 30% after adopting Bayer Radiology’s contrast dose management software.

• Faced with the task of monitoring the thousands of exams its algorithms analyze each day, Qure.ai leveraged CARPL.ai’s validation workflow to create a real-time performance dashboard. See how they did it here.
  
• See how cloud-native imaging avoids traditional software’s resource utilization constraints and eliminates unexpected disruptions in this Change Healthcare animation.

• Check out this Imaging Wire Show featuring Arterys’ Director of Product Management, Maya Khalifé, PhD, discussing how to deliver clinical value with AI, Arterys’ platform approach to neuro AI, and how AI can serve radiologists today and into the future.

• PACS efficiency and accuracy can have a major impact on radiologist workflows, but these qualities aren’t guaranteed. Check out this Novarad report detailing how to improve your PACS efficiency and accuracy.

• Associated Urologists of North Carolina became one of the latest homes of United Imaging’s uCT 530 CT. See why Associated Urologists’ Cary, NC office called United Imaging’s CT team “the best.”

• See how GE Healthcare’s AIR Anterior Array MRI Coil proved to be a pediatric Crohn’s disease gamechanger, improving patient comfort and cooperation during MR exams.

• Do your radiologists want faster and less manual access to imaging studies? See how the Indiana Health Information Exchange (IHIE), the largest inter-organizational clinical data repository in the US, cut its imaging study retrieval time by 94% when it adopted Nuance PowerShare.

• Think your imaging center patients and staff might be open to a better check-in process? See how Radiology Associates of Daytona (RA) streamlined patient check-ins with Fujifilm’s Synapse RIS-integrated Royal Kiosks.

• See how Dr. Carolyn Lam evolved from a women’s heart health trailblazer to co-founding Us2.ai and automating the fight against heart disease.