UK Radiologist Dr. Paul McCoubrie, on how to play Radiology Report Bingo.

Check out the latest Imaging Wire Show featuring Novarad founder and CEO, Wendell Gibby, MD. We dive into Novarad’s technological evolution and how its recent augmented reality expansion is bringing medical imaging into completely new clinical settings.

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Imaging Policy & Legislation

ACR Grants NPPs’ Contrast Supervision

The American College of Radiology (ACR) rolled out a significant change to its imaging contrast guidelines, allowing non-radiologists and non-physician practitioners (NPPs) to supervise intravenous CT and MRI contrast administration at accredited imaging centers.

A range of NPPs (NPs, PAs, RNs) and qualifying non-radiologist physicians will be able to directly supervise contrast administration under the “general supervision” of on-site radiologists, as long as it’s supported by state scope of practice laws. 

• Superving radiologists must be available for “assistance or direction” and trained to handle acute contrast reactions/situations, but they won’t have to be in the same room as the patient.

These guidelines mirror the ACR’s new practice parameters for contrast supervision (adopted in May), and follow CMS’ recent efforts to expand more diagnostic tasks to non-physicians.

• CMS granted radiology assistants the ability perform a range of imaging tasks in 2020 and permitted NPPs to directly supervise Level 2 tests in 2021 (like contrast-enhanced CT and MRI), in both cases requiring “general” radiologist supervision (on-site, but not in room… and virtual during the pandemic).

Although NPPs’ radiology expansion has historically sparked heated debates, the new ACR contrast supervision guidelines hasn’t faced many public objections so far. 

• That’s potentially because some (busy) radiologists don’t view directly supervising contrast administration as a practical or efficient use of their time (even if they still have to drive to the imaging center), especially considering that technologists often spot adverse reactions before anyone else.

• However, there’s surely plenty of radiologists who are concerned about whether these new guidelines might exacerbate scope creep, cut their earning potential (especially trainees), reduce radiologists’ patient-facing opportunities, and undermine patient care.

The Takeaway

The ACR’s decision to grant NPPs greater contrast supervision rights and loosen radiologists’ contrast supervision requirements might not be surprising to folks paying attention to recent ACR and CMS policies. That said, it’s still a notable step (and potential contributor) in the NPPs’ expanding role within radiology – and opinions might differ regarding whether that’s a good thing.

What it Means to be Built for the Modern World

Find out what built for the modern world means — and why it matters — in this Aunt Minnie profile on United Imaging’s more modern approach to vertical integration, leadership, and culture.

Us2.ai Launches Globally

Us2.ai recently 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).

The Wire

• Can AI Solve Incidental PE’s Reporting Problem? A new study out of Sweden highlighted one institution’s significant challenges detecting incidental pulmonary embolism (iPE) in cancer patients, while showing how AI might be able to help solve this problem. Researchers reviewed 1,892 chest CTs from 1,069 cancer patients, finding iPE in 75 exams (4%), but only 16 iPEs that were reported to care teams (21.3%). When the researchers reviewed the same dataset using Aidoc’s incidental iPE AI algorithm, they correctly identified 68 out of the 75 iPE cases, while producing just 3 false positives.

• Hackers Aim Small: Critical Insight’s 2022 Healthcare Data Breach report revealed that cybercriminals are refocusing from large health systems to smaller providers, as “specialty clinics” became the top source of data breaches in H1 2022 (31% vs. 23% of breaches in 2021). The report forecasts that cyber attackers will continue to target smaller facilities due to their greater vulnerability, and because these breaches generate less media attention and law enforcement escalation. Although the report didn’t define “specialty clinics,” imaging centers seem to qualify.

• DL Pancreatic Lesion Assessments: A new Radiology study highlighted deep learnings’ potential to improve pancreatic cancer assessments. The researchers trained a deep learning model using CTs from 852 patients and tested it against two CT datasets (603 & 589), identifying lesions with high accuracy (AUCs: 0.91 & 0.87), while achieving high sensitivity identifying solid lesions of any size (98% & 100%) and cystic lesions measuring ≥1cm (92% & 93%). The model’s lesion detection sensitivity was comparable to the study’s two participating radiologists (solid lesions: 95% & 100%; cystic lesions ≥1cm: 93% & 98%).

• Prestige Acquires MedServ and XRV: Prestige Medical Imaging (PMI) used its new private equity funding to continue its regional expansion, acquiring Ohio-based imaging dealer MedServ Plus and Virginia-based dealer XRV Healthcare. The acquisition solidifies PMI’s role as the Eastern US’ largest independent radiology service and solutions provider, noting that it’s “actively seeking” more acquisitions to further expand its portfolio and geographic reach.

• FFR-CT Hubbub: A recent study revealed a diverse set of opinions regarding FFR-CT’s validity and appropriate use cases. In contrast to previous favorable FFR-CT results, the new UK-based study found that FFR-CT actually reduced the accuracy of CAD-RADS 2-4 grades from 91% to 78.4% (n = 245 patients). The study fueled a lively MedTwitter debate, with some commenters calling the poor results “totally unsurprising,” and others blaming the results on bad study design and incorrect comparisons (anatomy vs. hemodynamic flow).

• Avenda Series B: Prostate cancer AI startup Avenda Health secured $10M in Series B funding that it will primarily use to expand its iQuest solution’s clinical evidence. iQuest uses deep learning to analyze MRI and pathology data, allowing clinicians to visualize prostate cancer for treatment and mapping tasks, while also supporting Avenda’s ultrasound-guided FocalPoint laser ablation system. FocalPoint is FDA cleared for soft tissue ablation, but iQuest and its use with FocalPoint are currently only allowed for investigational use. 

• Physician Substance Use: APN’s Mental Health in Healthcare 2022 report revealed shockingly high levels of substance use among healthcare workers, with 14% of physicians admitting to drinking or using controlled substances while on the job. The survey of 1k healthcare workers found that 49% are either at their breaking point or seeking less stressful work, yet few of the respondents pursue mental healthcare due to perceived stigma and fear of getting their licenses revoked.

• Body Composition for CRC Survival: A new AJR study highlighted automated CT-based body composition analysis’ potential to improve colorectal cancer risk assessments. Researchers analyzed 1,766 CRC patients’ pretreatment abdominal CTs using an automated AI-based system, finding that patients who died within five years had higher median abdominal aorta Agatston scores (620 vs. 182), as well as lower median muscle attenuation (19.2 vs. 26.2 HU) and subcutaneous adipose tissue measurements (168.4 vs. 197.6 cm2).

• New Zealand Imaging Dispute: A dispute between New Zealand’s radiologists and surgeons is making headlines, as the country’s radiologists fight back against surgeons creating their own in-house medical imaging businesses. New Zealand’s Institute of Independent Radiologists (NZIIR) filed suit against the Accident Compensation Corporation (ACC, which funds traumatic injury exams), calling for an independent review of how ACC is managing any referrals that aren’t “arm’s-length,” potentially cutting off funding for the surgeons’ new imaging businesses. 

• BPE and Second Breast Cancers: A team of South Korean researchers found that breast MRI-based background parenchymal enhancement (BPE) can be used to identify women who are likely to develop a second breast cancer in the future. The researchers analyzed surveillance breast MRIs from 2,688 post-operative breast cancer survivors (109 developed 2nd BCa), finding that women with BPE present in their MRIs had a far higher risk of developing a second breast cancer within a 5.8-year median follow up period (Hazard ratio: 2.1).

• Cortechs.ai’s Early Alzheimer’s Grant: Cortechs.ai landed a $1.35M, 2.5-year NIH grant to expand its Alzheimer’s assessment technology into clinical use. Cortechs.ai’s brain MRI-based Restriction Spectrum Imaging technique quantifies subtle microstructural changes that occur during Alzheimer’s early stages, allowing physicians to determine future AD risks, monitor disease progression, and evaluate treatment response.

Ready to improve your mammography workflows?

Arterys is the first and only cloud-native Breast AI provider, and its solution dramatically reduces 3D Mammography reading times, while supporting breast cancer detection, density measurements, and personalized risk assessments. 

Novarad’s VisAR Vision

See how Novarad’s new VisAR augmented reality surgical navigation system enables physicians to find and reach their target destination more quickly – without the expense, footprint, and setup time of conventional navigation systems and robots.

The Resource Wire

• This Riverain Technologies case study details how the University of Colorado Hospital enhanced its chest X-ray workflow with ClearRead Bone Suppress.

• annalise.ai’s Annalise CXR solution detects up to 124 findings in a single chest X-ray. See how it detects such a wide range of abnormalities using these demo studies…  or upload your own CXR images.

• Digitization and AI are an era-defining reality for radiology, and GE Healthcare is rising to the challenge by creating tools to build a world that works better for healthcare. Check out this report detailing GE’s digitization and AI innovations and its vision for precision healthcare.

• See how Thomas Jefferson University relied on CARPL.ai to accelerate its AI validation and clinical adoption in this presentation by informatics and AI leader, Dr. Paras Lakhani.

• See how the Hyperfine Swoop Portable MRI is able to bring neuroimaging to the point of care, improving healthcare operations and patient outcomes.

• Ready to solve your hanging protocol consistency problem? Join Enlitic on September 8th to see how data routing can address one of radiology’s biggest frustrations. 

• Check out this Change Healthcare video explaining the difference between single-tenant and multitenant cloud architecture, and how multitenant solutions can improve your efficiency and flexibility.

• After years of expansion, Montreal’s Imagix Radiology moved to Intelerad, allowing it to unify and modernize its radiology IT infrastructure, while improving its efficiency and data exchange capabilities. See what Imagix had to say about making the move to Intelerad here.

• 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.

• Working on your organization’s AI strategy? This Blackford Analysis post outlines the key considerations for creating your AI goals and strategy, including some you might not have considered.

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

• When Geisinger Health set a goal to improve access to care, it leveraged Siemens Healthineers’ syngo Virtual Cockpit to ensure that its expert radiologic technologists were accessible to all 11 of its radiology facilities. Hear what Geisinger’s technologists and administrators had to say about how the remote scanning solution allowed them to extend hours and improve patient throughput.