Dr. Emily Conant, University of Pennsylvania

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Breast Imaging

Breast Screening’s New Gold Standard?

A new study in Radiology on the use of digital breast tomosynthesis for breast screening makes the case that DBT has so many advantages over conventional 2D digital mammography that it should be considered the gold standard for breast screening. 

Unlike 2D mammography, DBT systems scan around the breast in an arc, acquiring multiple breast images that are combined into 3D volumes. The technique is believed to be more effective in revealing pathology that might be obscured on 2D projections.

Previous research already demonstrated the effectiveness of DBT for certain uses, but the new study is notable for its large patient population, as well as its focus on general screening rather than subgroups like women with cancer risk factors such as dense breast tissue.

Researchers led by Dr. Emily Conant of the University of Pennsylvania reviewed DBT’s performance in five large U.S. healthcare systems, with a total study population of over 1 million women. 

The advantages of DBT were notable:

• Higher cancer detection rate: 5.5 vs. 4.5 per 1k women screened
• Lower recall rate:  8.9% vs. 10.3%
• Higher recall PPV: 5.9% vs. 4.3%.

On the negative side, DBT had higher biopsy rates, of 17.6 biopsies per 1,000 women versus 14.5 biopsies for 2D digital mammography. But PPV of biopsy for both techniques was largely the same. 

Researchers note that breast cancer mortality rates have fallen 41% since 1989, a development attributed to earlier diagnosis and better treatment. DBT could help accelerate this trend as it finds more cancers relative to 2D digital mammography.

The Takeaway

This study reinforces the idea that DBT is now the gold standard for breast screening. While mammography vendors have already seen high market penetration for DBT systems, the new study is likely to convince any remaining holdouts that 3D mammography is a necessary technology for any breast imaging facility. 

Validating ClearRead CT

It says a lot when a solution works so well for a radiology department that they decide to perform a study to quantify its benefits. In this Imaging Wire Q&A, University Hospital of Zurich’s Thomas Frauenfelder discusses his experience and study on Riverain Technologies ClearRead CT.

Why SyntheticMR Went with CARPL.ai

When SyntheticMR validated its SyMRI MSK solution, they leveraged the CARPL platform to compare conventional knee and spine MRI image quality with SyntheticMR images. Check out their validation process and results here.

The Wire

• MRI Turns 50: March 16 marks 50 years since Paul Lauterbur, PhD, published a landmark paper in Nature on what he called zeugmatography – later to be known as MRI. The irony is that the journal turned down his first submission. Lauterbur – along with British physicist Sir Peter Mansfield, PhD – later received the Nobel Prize, which led to controversy as the Nobel Committee snubbed Raymond Damadian, MD, also an early MRI pioneer.  

• Lung Screening Coverage Drops: A new study in AJR reviewed over a decade of CT lung cancer screening newspaper coverage, starting with the landmark National Lung Screening Trial in 2010. The volume of coverage peaked in 2014 at 130 articles, and has been declining ever since, to 33 stories in 2020. Researchers say radiologists should take a more active role to optimize awareness. Lung screening could use all the help it can get, as screening uptake has consistently lagged expectations. 

• Eagerly Awaiting Match Day: Match Day is the happiest day on the calendar for medical students – at least, most medical students – when they learn which residency programs they have matched to. Match Day this year is March 17, with U.S. medical schools holding joyous ceremonies as their students move on. Follow along on Twitter tomorrow at #Match2023, or visit the NRMP’s website for a calendar of this year’s events.

• Location, Location, Location: An individual’s ZIP code can affect their access to medical imaging, says a new study in Radiology. People living in ZIP codes classified as “extremely disadvantaged” (many of which were in the rural southern U.S.) were less likely to have access to facilities with advanced imaging services like CT (21% versus 32%), MRI (19% versus 32%), and PET (7% versus 13%). The results are part of a growing wave of research on the impact of racial and economic disparities in healthcare.

• ACR Issues MRI Safety Manual: The ACR is inviting comment on a draft version of its ACR Manual on Magnetic Resonance Safety. The updated manual includes several changes, including new recommendations on staffing, training levels, and guidance on emergency situations. MRI safety has come into focus after a recent accident at a hospital in Northern California, as well as a fatal accident in Brazil. 

• ECR Attendee Rebound: In final statistics for ECR 2023, the European Society of Radiology reported that 17,262 attendees were on hand in Vienna last week. The figures represent a dip compared to 23,200 on-site attendees at the last pre-COVID ECR in 2019, but were a 14% rebound compared to ECR 2022 summer edition. In general, this year’s congress seemed to exceed expectations. 

• GPT-4 Hot Out the Gates: It’s been less than 48 hours since OpenAI took the lid off GPT-4 and nimble entrepreneurs have already started flooding the internet with products leveraging the multimodal model’s new capabilities. The ability to transform text and picture inputs into functioning solutions has already led to some mind blowing GPT-4 use cases: turning a sketch into a functioning website, coding video games from descriptions, and best of all (so far) – drug discovery.

• Low-Field MRI for Africa: Researchers from the Netherlands and Uganda are collaborating on the development of a low-field MRI scanner that can be assembled in the field from a kit, and discuss the project in a new paper in Nature. The project supports the concept of low-field MRI as an inexpensive imaging option for remote locations as well as areas with less access to healthcare resources. 

• Annalise Goes 4/4 on ECR AI Test: Annalise.ai’s algorithm platform solved all four cases in a faceoff test between AI developers at ECR 2023. The challenge pitted algorithms from four AI vendors against each other in assessing neuro emergency CT scans of four acute intracranial pathology cases. The annalise.ai algorithm detected pathology on all four cases.

• Radiation Oncology Workforce Finds Balance: The U.S. radiation oncology workforce has achieved balance between the supply of radiation oncologists and demand for radiation therapy services, at least according to a new survey by ASTRO that projects labor trends through 2030. The rising number of Medicare beneficiaries has been matched by growth in radiation oncologists, as well as rising efficiency through procedures like hypofractionation. 

• Ferrum Partners with Riverain: AI platform developer Ferrum Health added Riverain Technologies to its network of AI algorithms. Ferrum will add Riverain algorithms like ClearRead CT and ClearRead Xray to its Private AI Hub, a platform that gives users a secure, standardized way to deploy and use AI. The deal demonstrates the growing importance of AI platform firms in radiology.

Bedside MRI’s ICH Impact

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.

Reinventing How Medical Imaging is Done

Explore how United Imaging is reinventing the medical imaging business, including downtime rebates, lifetime upgrades, and making sure their customers truly are successful.

The Resource Wire

• Faced with rising scan volumes and many elderly patients, Lake Medical Imaging implemented Subtle Medical’s Subtle MR efficiency solution across its eight MR scanners, allowing it to scan 40 additional patients per day while maintaining quality of care.

• Learn how to optimize your CT workflow from scan to reconstruction in this free webinar on March 27. Find out how NYU Langone Health leverages technologies from Siemens Healthineers to streamline their workflow and improve patient care.

• Change Healthcare’s cloud-native, zero-footprint Stratus Imaging PACS is live in clinical use. See how Stratus Imaging PACS is helping radiology practices improve productivity and patient care, while eliminating the cost and resource constraints of on-premise systems.

• Learn how Us2.ai is bringing simplicity and clarity to the world of cardiac ultrasound on the latest episode of The Bleeding Edge of Digital Health featuring Us2.ai’s founders, James Hare and Dr. Carolyn Lam. 

• Emphysema is often underdiagnosed, and this can make treatment more difficult. FirstHealth of the Carolinas was able to improve its diagnosis of emphysema and enhance its CT lung screening service with AI algorithms available through Nuance Precision Imaging Network.

• Managing imaging exams brought in by patients on CDs was slowing down the workflow at Boston Children’s Hospital, the largest pediatric trauma center in New England. Find out how the hospital’s pediatric trauma service turned to Intelerad to solve the problem in this case study.

• Working out your AI business case? Check out this helpful Blackford Analysis post detailing how to create your AI Value Matrix based on your organizational objectives and value indicators.
  
• Check out this talk from Eliot Siegel, MD on the “Hype, Myth, Reality and Next Steps” of imaging AI, including a profile on Canon’s AiCE Deep Learning Reconstruction solution at around the 4-minute mark.

• Easy access to patient records, reduced inefficiencies and costs, improved collaboration and compliance, and enhanced security. These are just a few of the benefits of Novarad’s enterprise imaging solution detailed right here.

• 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.  

• How can patients, healthcare providers, and medical students benefit from 3D-printed anatomic models? Learn how in this case study presented by Merative in partnership with Ricoh USA. 

• How did New York Cancer & Blood Specialists build a successful prostate MRI program on Long Island? They found that technology from GE HealthCare enables them to scan more quickly, giving them time to focus on what matters most: patients. Learn more in this case study. 

• 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.

• In this Bayer Radiology video, East Texas Medical Center Radiology Director Bill Tobin details how they used Bayer’s MEDRAD Stellant Smart Injector and contrast dose management to reduce contrast volumes and repeat scans.

• Healthcare is rife with data quality issues, creating a range of workflow and financial challenges, and placing increased responsibilities on PACS administrators. See how Enlitic’s Curie|ENDEX data governance solution addresses these challenges, while improving radiology teams’ AI adoption readiness.