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Molecular Imaging

The Case for 18F-NaF PET/CT Bone Metastases Detection

Results from the MITNEC-A1 trial are in, and they further support using 18F-NaF PET/CT to detect bone metastases in patients with prostate and breast cancer, while bolstering its case for replacing 99mTc-MDP as the “bone imaging radiopharmaceutical of choice.”

The prospective, multicenter, single-cohort, phase 3 trial enrolled 261 breast and prostate cancer patients (57 & 204) who had high risk or suspected bone metastasis, scanning each participant with 18F-NaF PET/CT and 99mTc-MDP SPECT. 

Two experts interpreted the scans, which were later compared to 24-month follow-up results, revealing that 42% of the patients had bone metastases (109), and finding that 18F-NaF PET/CT diagnosed bone metastases with far higher…

• Accuracy – 84.3% vs. 77.4%
• Sensitivity – 78.9% vs. 63.3%
• Negative Predictive Value – 85.4% vs. 76.9%

The MITNEC-A1 trial stands on the shoulders of a growing list of studies that support 18F-NaF PET/CT for bone metastases detection, and these latest results make the transition to 18F-NaF PET/CT “appealing” to this study’s authors. 

The next step in that transition process will likely be exploring 18F-NaF PET/CT’s cost-effectiveness versus bone scintigraphy with 99mTc-MDP SPECT, potentially leading to more widespread adoption.

The Takeaway

It’s historically been a challenge to detect prostate and breast cancer bone metastases. Although there’s more research to be done, it appears that 18F-NaF PET/CT might help overcome that challenge, and become bone imaging’s new radiopharmaceutical of choice.

Democratizing Enterprise Imaging

Enterprise imaging is mainly adopted in the largest hospitals, but that doesn’t have to be the case. Check out this Imaging Wire Show featuring Novarad product leader Dave GrandPre, where we discuss what’s caused this divide and why smaller hospitals should adopt enterprise imaging.

Adopting An AI Platform Strategy

Imaging AI’s clinical and productivity benefits are becoming increasingly clear, but selecting and implementing the right solution can be difficult. This Arterys paper details how an AI platform strategy allows providers to efficiently and accurately evaluate AI applications, so they can start realizing their targeted AI benefits.

The Wire

• HeartFlow’s PRECISE Outcomes: For patients with stable symptoms and suspected coronary artery disease, HeartFlow’s coronary CTA + FFRct strategy resulted in a four-fold reduction in unnecessary referrals to the cath lab, compared to traditional approaches. That’s from a randomized clinical trial (n=2.1k) that also found providers who used HeartFlow’s Precision Pathway FFRct solution were 75% more likely to identify patients in need of intervention. The FFRct Analysis uses AI coupled with highly trained analysts to create an interactive 3D model that quantifies blood flow and blockages.

• GE DaTscan’s Dementia Expansion: GE Healthcare announced the FDA approval of its DaTscan radiopharmaceutical (Ioflupane I 123 Injection) for patients with suspected Dementia with Lewy Bodies (DLB), making it the first FDA-cleared tracer of its kind. DaTscan’s new indication allows clinicians to use the injection to help differentiate DLB from other forms of dementia, and expands upon DatScan’s approval for patients with suspected Parkinson’s. 

• Mammography AI Perceptions: A new survey published in the British Journal of Radiology highlighted women’s positive overall perceptions of AI-supported breast cancer screening, as long as radiologists are involved and accountable. Among 800 women (mainly Italian), 77% agreed that AI should be used as a second reader, although 94% believe radiologists should always produce their own mammogram reports, and 52% believe AI developers and radiologists should be held accountable for AI errors. Perhaps most notably, 88% of women who knew about AI approved of its clinical use.

• Healthcare Lobbying Up 70%: New research in JAMA showed that healthcare lobbying spending rose 70% over the past two decades, with U.S. lobbying expenditures totaling almost $714M in 2020 (up from $358M in 2000). Lobbying increases were driven primarily by pharmaceutical companies, device manufacturers, and healthcare providers. Lobbying was also extremely concentrated, as the top 10% of companies were responsible for 70% of payor lobbying, 69% of manufacturer lobbying, and 59% of provider lobbying.

• US Radiology Specialists Class Action: US Radiology Specialists is facing a class action lawsuit over its December 2021 data breach. The 59-page lawsuit alleges that the major imaging center company failed to sufficiently protect patient information, waited too long to notify patients (almost 9 months), omitted important details in the notifications, and offered “woefully inadequate” remedial services.

• Stroke Costs’ Non-Imaging Rise: Medicare costs for ischemic stroke patients jumped by 4.9% between 2012 to 2019 ($9,509 to $9,973 per episode), and stroke treatments were the main cost driver (not neuroimaging). Analysis of 75.5k hospitalizations showed that ischemic stroke episodes treated with endovascular thrombectomy or intravenous thrombolysis were the most likely to cost more than $20k (odds ratios: 4.34 & 3.19), while the share of patients who received these treatments more than doubled from 7.3% to 18.5%. Treatments did help reduce median hospital stays (5 to 4 days) and in-hospital mortality rates (6.3% to 4.1%).

• B-Mode AI Stenosis Detection: A new Circulation study highlighted an AI algorithm that can accurately identify and characterize aortic stenosis (AS) using B-mode ultrasound views (not echos), potentially improving AS detection in low-resource and screening settings. Researchers developed the AI algorithm using 30k labeled echo exams and tested it with B-mode views from 40 patients, achieving high agreement across three echo-trained cardiologists (k = 0.95), and detecting moderate/severe AS with high sensitivity (91%) and specificity (94%). 

• September Hospital Margins: Hospitals continued to operate in the red during September, with Kauffman Hall’s latest National Flash Report showing that we’re now in our tenth straight month of negative operating margins. Hospital margins stand at -0.1% year-to-date through September, with slight expense decreases doing little to offset a 3% month-over-month decline in admissions, ED visits, and patient days.

• Retesting the Amyloid Theory: A few months after the leading Alzheimer’s disease theory (beta-amyloid buildup) was found to be based on fraudulent research, and following numerous failed amyloid prevention studies, Washington University researchers are launching a new trial exploring whether avoiding amyloid buildup might prevent Alzheimer’s. Although there’s another positive amyloid trial on the way, further confirming or debunking beta-amyloid’s role in AD would have a major imaging impact.

• Viz.ai Launches Cardio Suite: Viz.ai launched its new Cardio Suite, combining its existing cardiology AI tools (PE detection, aortic disease detection, Us2.ai’s echo AI reporting) and its new mobile ECG and mobile/web cardiac imaging viewers, with Viz.ai’s trademark care coordination capabilities (in-app cardiology consultation, CVIS and EHR patient data acquisition). The Cardio Suite is a milestone for Viz.ai, which established its business in neuro care coordination, and has been building out its cardiology-related capabilities over the last year. 

• Getting Radical with Imaging Demand: A new BMJ editorial suggested that most factors driving the UK’s significant imaging volume growth originate from outside of the radiology department. The author admitted radiologists’ role in unnecessary incidental follow-ups, but suggested that much of the UK’s imaging growth is driven by ED imaging misuse (e.g. using imaging as replacement for exams) and the adoption of “defensive medicine” policies. Because of the societal factors behind this trend, the author contends that any attempt to lower imaging demand would need to be “more radical than a new set of guidelines.”

Automating Echo Strain Analysis

Check out our Cardiac Wire publication’s latest Q&A with Us2.ai president and co-founder, Yoran Hummel, discussing how his career as a sonographer led him to echo AI, and how Us2.ai’s upcoming automated strain analysis feature brings the company even closer to democratizing echo.

United Imaging Innovation

Check out this Imaging Wire Show with United Imaging’s Jeffrey Bundy and Mike Coulter, who detail their unique approach to medical imaging innovations. If you’re trying to figure out a simpler and more scalable way to run your imaging organization, this interview is a great way to start.

The Resource Wire

• 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.

• If you’re in the business of using or providing AI, there’s a good chance you spend a lot of time managing AI evaluations. But are your evaluations as efficient or effective as they could be? Check out this Imaging Wire Show with Riverain Technologies CEO, Steve Worrell, detailing the best practices for mitigating AI adoption risks, today and into the future.

• A recent Nature paper detailed how Yale’s successful deployment of Hyperfine’s Swoop portable MRI allowed “for a reversal in the clinical paradigm,” while achieving accurate ICH detection and demonstrating its ease-of-use in ICU environments. Explore the study’s other key takeaways and next steps in this Hyperfine summary.

• Is your organization ready to move enterprise imaging to the cloud? Check out this Change Healthcare and ACHE webinar detailing cloud-native imaging’s benefits, best practices, and ROI.

• 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.

• “When will I be back?” is athletes’ first question following a sports-related injury, and New York’s Hospital for Special Surgery increasingly relies on GE Healthcare MR technology for its answers. See how HSS is leveraging GE’s MR scanners, coils, and solutions to achieve more accurate assessments and better patient experiences.

• Curious how certain your AI is about its own finding? annalise.ai’s confidence bar displays the likelihood of each finding and the AI model’s level of certainty, helping clinicians perform their interpretations with greater confidence.

• Learn how Salem Regional Medical Center improved its radiology workflows and cut service and syringe expenses after adopting Bayer’s MEDRAD Stellant FLEX system.

• Siemens Healthineers’ NAEOTOM Alpha made headlines as the world’s first photon-counting CT system, a technology that’s poised to redefine CT imaging. Check out this whitepaper detailing how the NAEOTOM Alpha’s unique resolution, contrast-to-noise ratio, and spectral sensitivity advantages could change CT forever.

• See how Canon AiCE DLR is achieving new levels of cardiovascular imaging in this presentation from Jeannie Yu MD, FACC, FSCCT.

• Ready to solve your imaging standardization problem? Join UTHSA’s Informatics Vice Chair, Dr. Kal Clark, today (November 10th) at 1pm EST, when he’ll discuss his experience as one of the first systems to use Enlitic’s Curie|ENDEX software.

• Raising awareness about breast cancer is an important mission, but this Intelerad editorial highlights the need to match awareness with action, helped by technology to improve screening workflows.