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Chest Pain Implications | Interval AI
May 4, 2022
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“I would never volunteer to be an expert witness against a fellow radiologist, but I may have to rethink my stance if NPs and PAs interpret imaging.”
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An Aunt Minnie forum commenter following New York state’s decision to grant nurse practitioners full practice authority.
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Photo Credit: Circulation Journal |
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The major cardiac imaging societies weighed-in on the AHA/ACC’s new Chest Pain Guidelines, highlighting the notable shifts coming to cardiac imaging, and the adjustments they could require.
The cardiac CT and MRI societies took a victory lap, highlighting CCTA and CMR’s now-greater role in chest pain diagnosis, while forecasting that the new guideline will bring:
- Increased demand for cardiac CT & MR exams and scanners
- A need for more cardiac CT & MR staff, training, and infrastructure
- Requests for more cardiac CT & MR funding and reimbursements
- More collaborations across radiology, cardiology, and emergency medicine
The angiography and nuclear cardiology societies were less celebratory. Rather than warning providers to start buying more scanners and training more techs (like CT & MR), they focused on defending their roles in chest pain diagnosis, reiterating their advantages, and pointing out how the new guidelines might incorrectly steer patients to unnecessary or insufficient tests.
FFR-CT’s new role as a key post-CT diagnostic step made headlines when the guidelines came out, but the cardiac imaging societies don’t seem to be ready to welcome the AI approach. The nuclear cardiology and radiology societies called out FFR-CT’s low adoption and limited supporting evidence, while the SCCT didn’t even mention FFR-CT in its statement (and they’re the cardiac CT society!).
Echocardiography maintained its core role in chest pain diagnosis, but the echo society clearly wanted more specific guidelines around who can perform echo and how well they’re trained to perform those exams. That reaction is understandable given the sonographer workforce challenges and the expansion of cardiac POCUS to new clinical roles (w/ less echo training), although some might argue that echo AI tools might help address these problems.
The Takeaway
Imaging and shared decision-making play a prominent role in the new chest pain guidelines, which seems like good news for patient-specific care (and imaging department/vendor revenues), but it also leaves room for debate within the clinic and across clinical societies.
The JACC seems to understand that it needs to clear up many of these gray areas in future versions of the chest pain guidelines. Until then, it will be up to providers to create decision-making and care pathways that work best for them, and evolve their teams and technologies accordingly.
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Ready to Update Your PACS?
This Novarad blog outlines the product, vendor, future-proofing, and support considerations to help make sure you select the right system.
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- POCUS for AAA Follow-Ups: A new Sacramento VA study showed that point-of-care ultrasound could be valuable for abdominal Aortic Aneurysm (AAA) follow-up assessments, in addition to its proven role in AAA diagnosis. The researchers had a non-physician perform AAA follow-up POCUS exams on 80 patients after receiving three hours of training, finding that the average POCUS-based AAA measurements closely matched standard-of-care measurements from trained vascular technologists (4.1cm vs. 4.0cm).
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- Screening Inconsistencies: A new JAMA study revealed significant inconsistencies between U.S. states’ breast cancer screening plans and the federal USPSTF recommendations. Only 16 (31%) states’ plans matched the USPSTF recommendations for average-risk women’s mammography screening starting age and frequency, while 26 (51%) states were partially consistent, and 9 state plans (18%) were not consistent with any guideline components. The authors attributed these inconsistencies to a variety of factors, but suggested that specifying age/frequency guidelines for higher-risk women might create more overall consistency.
- The Saliency Map Effect: A University of Sydney-led study revealed new insights into how AI-based saliency maps impact radiologist diagnostic decisions, and what could make these tools more effective. The researchers had 36 radiologists add annotations to 20 LD-CT exams that used saliency maps to highlight relevant image areas (10 benign & 10 malignant; 3 false positives & 2 false negatives). The radiologists’ annotations varied widely (only 12% agreement), suggesting that AI-based annotations using common radiologist descriptions could be valuable additions. The researchers also found that radiologists weren’t influenced by the AI false positives, but were more likely to miss AI false negatives.
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- Us2.ai announced the global launch of its flagship echocardiography AI solution, leveraging a new $15M Series A round, and its unique abilities to completely automate echo reporting (complete editable/explainable reports in 2 minutes) and analyze every chamber of the heart (vs. just left ventricle with some vendors).
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- Ready to purchase your first MRI or replace an existing one? Estimate the return on your investment by using Siemens Healthineers’ interactive value calculator. Try it out today and receive a personalized brief with our findings.
- See how Dubai-based healthcare leader Aster DM Healthcare leveraged the CARPL platform to connect its doctors, data scientists, and imaging workflows, and support its AI projects and development infrastructure.
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