Curtis Langlotz, MD, PhD, Stanford University

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Cardiac Imaging

Is CCTA Set for Cardiac Screening?

A new study out of Denmark suggests that coronary CTA could be headed for population-based screening for heart disease. Researchers found that CCTA was remarkably effective in identifying individuals without symptoms who were more likely to experience heart attacks in years to come.

CCTA has proven so effective for cardiac imaging that it’s become a first-line test for stable chest pain, usually for those with symptoms. But researchers have debated whether CCTA’s value could be extended to asymptomatic individuals – which could set the stage for broad-based heart disease screening programs.

To investigate CCTA’s potential in the asymptomatic, researchers in Denmark scanned 9,533 individuals 40 years and older as part of the Copenhagen General Population Study, reporting their results in Annals of Internal Medicine. CCTA scans were conducted with Canon Medical’s 320-detector-row Aquilion One Vision scanner. 

Atherosclerosis was characterized as either obstructive (a luminal stenosis ≥ 50%), extensive (stenoses widely prevalent but not obstructive), or both. Researchers then tracked myocardial events over a median follow-up of 3.5 years. 

They found that 46% of study subjects had evidence of subclinical coronary atherosclerosis, with the type of atherosclerosis impacting risk of myocardial infarction: 

• Extensive atherosclerosis had eight times higher risk 
• Obstructive atherosclerosis had nine times higher risk
• Both extensive and obstructive disease had 12 times higher risk

What’s more, researchers found that 10% of their study population had obstructive disease – which is just 10 percentage points under the 60% atherosclerosis threshold at which therapeutic intervention should be considered for asymptomatic people. 

Participants in the CGPS study did not receive treatment as part of the study, but the researchers have a follow-up study underway – DANE-HEART – in which asymptomatic people will get CCTA scans and some will be directed to preventive treatment if they meet clinical guidelines.

The Takeaway

This study demonstrates not only the widespread incidence of subclinical coronary atherosclerosis, but also CCTA’s ability to detect CAD before symptoms appear. Preventive treatment initiated and directed by CT findings could have a major impact on heart disease morbidity and mortality.

Given CCTA’s prognostic ability and the heavy burden of heart disease on society (more women die of heart disease than breast cancer, for example), how long before calls emerge to add CT-based heart screening to the arsenal of population-based screening programs? DANE-HEART may offer a clue.

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See how United Imaging’s new uCT ATLAS combines advancements in image quality, patient comfort, and operator efficiency to bring you one step closer to your masterpiece.

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. 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

• Letter Calls for AI Halt: A letter signed by a number of technology leaders is calling for a halt to training AI algorithms more powerful than GPT-4. The letter claims that AI that’s competitive with human intelligence “can pose profound risks to society and humanity.” Signatories include luminaries like Steve Wozniak, Elon Musk, and Stuart Russell. But at least one radiology AI expert – Curtis Langlotz, MD, PhD – has declined to sign, calling for more research into AI, not less.

• Weekends Lead to Errors: Interpreting imaging cases on the weekend was one of a handful of factors that can lead to errors in neuroradiology exams. In American Journal of Roentgenology, researchers looked at diagnostic errors in 564 CT and MRI brain studies: weekend interpretation had the highest association with errors (odds ratio=1.69), followed by higher shift volume (OR=1.27) and longer interpretation time (OR=1.18). 

• ACR to Hike Accreditation Fees 9%: The ACR plans to raise accreditation fees 9% for all modalities except mammography and radiation oncology on July 1 as part of its modernization of the program. The group notes that the increase – the first fee change in a decade for some modalities – comes after the ACR launched a new accreditation system in 2022, as well as an updated website. 

• Why Don’t Referring Docs Listen? Why don’t referring physicians follow radiologists’ recommendations for follow-up imaging of incidental findings? This existential question strikes at the soul of many radiologists, but new findings in JACR indicate that 65% of recommendations were followed up on. Recommendations were more likely to be followed when they were more strongly worded, as well as when they were made directly to the referring physician. So don’t be shy and pick up the phone. 

• Subtle Gets Distributor Down Under: Subtle Medical has signed on Getz Healthcare to distribute its software in Australia and New Zealand. Getz will distribute the SubtlePET and SubtleMR applications to hospitals and private radiology clinics. The deal expands Subtle’s geographic footprint, an expansion supported by the company’s recent $45M Series B funding. 

• iCAD Lays Off 28%: Breast AI developer iCAD has laid off 28% of its workforce as part of a restructuring, according to SEC filings. In all, 23 employees were let go from iCAD, and another 12 (50%) from its Xoft subsidiary. The layoffs came about two weeks after iCAD announced a 17% drop in Q4 revenues, and that president and CEO Stacey Stevens was being replaced by Dana Brown, who has been the company’s chairman. 

• Preoperative Breast MRI Inconclusive: The jury is still out on benefits of preoperative breast MRI in younger women. Indeed, a Radiology study by researchers from South Korea found that breast MRI before surgery in women 35 years and younger did not impact recurrence-free survival, nor did it have a statistically significant impact on overall survival. More studies may be needed to demonstrate a clinical benefit in these younger women.

• United Plans Product Launches: United Imaging is planning to launch four new systems in coming months. The company said it will be debuting new CT and MRI scanners, as well as a new DR system, most likely in the first half of 2023, with a major marketing effort planned for AHRA 2023. The identity of the fourth system is “top secret” until summer, according to Imaging Wire sources at United. Three of the systems have FDA clearance.

• Echocardiographers Exposed to Radiation: Even though ultrasound is a radiation-free modality, echocardiographers who assist with interventional cardiology studies are exposed to high doses of scatter radiation from C-arms used to guide procedures. Exposure tended to be highest on the right side of the body, said researchers in JACC: Asia. They advised that echocardiographers – especially young women of childbearing age – be warned of the risk. Additional shielding was also recommended.

• Medality Signs Penn MSK Radiology: Online education and training provider Medality will be providing online training to the Penn Radiology Division of Musculoskeletal Radiology. Penn MSK Radiology will be adding Medality’s case-based learning platform into its MSK curriculum to support radiology residents. The partnership demonstrates Medality’s continuing evolution from its original focus on MRI as MRI Online to a broader purview following a rebranding in December. 

• Yunu opens Yunuverse: Clinical trial technology provider Yunu has opened up the Yunuverse, a new network designed to make it easier to incorporate medical imaging into clinical trials. The Yunuverse helps trial teams augment staff with radiologists and technologists, while also offering other services such as improving patient access and collaboration among trial stakeholders, including cancer centers, sponsors, and CROs. The launch is a sign of the growing importance of medical imaging in drug development and clinical trials. 

Solving the AI Adoption Challenge

Imaging AI is evolving fast, but radiology leaders’ expectations for their AI technologies might be evolving even faster. In this Imaging Wire Show with Dr. Charlene Liew of SingHealth and Dr. Nina Kottler of Radiology Partners, we explore radiology leaders’ current and future expectations for AI, and the central role platforms play in their AI roadmaps.

Swoop Portable MRI at Cure Hospital in Uganda

The Hyperfine Swoop Portable MRI has been used to care for children with hydrocephalus at Uganda’s Cure Hospital since 2021, improving imaging access without exposing patients to ionizing radiation. Learn more about the Swoop’s hydrocephalus impact here.

The Resource Wire

• Is your in-office MRI service prepared for the future? See how three macro trends will impact your in-office orthopedic MRI service, and the MRI capabilities you’ll need in the future in this Siemens Healthineers report.

• Is your department struggling with how to convert analog clinical documentation notes into actionable data that can be used in the EHR? Find out how Duke University turned that legacy information into structured data that can be used for registry reporting and analytics in this white paper from Intelerad. 

• Cardiac CT has transformed the detection, characterization, and stratification of coronary artery disease. Coronary CT angiography is a noninvasive procedure that helps identify plaque and blockages in the arteries and is used as a first-line test for patients presenting with chest pain.  Learn more in this GE HealthCare white paper.

• Imaging’s cloud evolution didn’t happen all at once. This Change Healthcare animation details the history of digital imaging architectures, and how cloud-native imaging improves stability and scalability, ease of management, patient data security, and operating costs.

• We talk a lot about radiology practices’ AI adoption, but usually don’t have much evidence to back it up. That changes with this new Arterys report detailing how and why 30 US radiology groups became imaging AI adopters.

• Radiology faces numerous challenges to more efficient workflow, from the siloed nature of healthcare enterprises to mundane tasks that are ripe for automation. In this Imaging Wire Show, we talked to Dr. Matthew Lungren and Calum Cunningham of Nuance Communications.

• Is AI a friend or foe to medical imaging and healthcare professionals? In this all-star panel discussion hosted by Merative, radiology key opinion leaders discuss why AI adoption seems to be going slower than expected, and what lessons have been learned that will pave the way for increased AI deployment in the years to come.

• Check out this Imaging Wire Show featuring Us2.ai’s co-founders – James Hare and Dr. Carolyn Lam – for a great discussion about Us2.ai’s continued clinical and commercial expansion, and their efforts to improve echocardiography accuracy, efficiency, and accessibility.

• Novarad’s COVID-19 AI Diagnostic Assistant analyzes chest CT scans in seconds, helping physicians quickly identify COVID-19 patients and get them into care. The best news – it’s available to clinicians worldwide free of charge.

• See Dr. Brian Goldner of UC Davis Sacramento detail his experience with Canon’s Ultra High Resolution CT and how it can be applied to cardiothoracic interpretations.

• Working out your AI business case? Check out this helpful Blackford Analysis report on how to calculate AI’s clinical, IT, administrative, and financial value to your organization.

• Over a three-year proof of concept study, UT Health San Antonio found that Enlitic’s Curie Standardize solution would reduce its average CT (head, chest, abdomen) study organization time from 25 to 9 seconds. That adds up when multiplied over 480k annual studies.

• What are some of the latest innovations in neuroimaging that can lead to workflow improvements at imaging facilities? Learn more in this presentation from the ASNR webinar series, supported by Subtle Medical. 

• Annalise.ai doubled down on its comprehensive AI strategy with the launch of its Annalise Enterprise CTB solution, which identifies a whopping 130 different non-contrast brain CT findings. Annalise Enterprise CTB analyzes brain CTs as they are acquired, prioritizes urgent cases, and provides radiologists with details on each finding (types, locations, likelihood).  

• With radiation dose management now largely considered best practice, this Bayer white paper details the top five benefits of adopting contrast dose management.