Charlotte J. Haug, MD, PhD, and Jeffrey M. Drazen, MD, in New England Journal of Medicine

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Artificial Intelligence

Radiology Puts ChatGPT to Work

ChatGPT has taken the world by storm since the AI technology was first introduced in November 2022. In medicine, radiology is taking the lead in putting ChatGPT to work to address the specialty’s many efficiency and workflow challenges. 

Both ChatGPT and its newest iteration, GPT-4, are forms of AI known as large language models – essentially neural networks that are trained on massive volumes of unlabeled text and are able to learn on their own how to predict the structure and syntax of human language. 

A flood of papers have appeared in just the last week or so investigating ChatGPT’s potential:

• ChatGPT could be used to improve patient engagement with radiology providers, such as by creating layperson reports that are more understandable, or by answering patient questions in a chatbot function, says an American Journal of Roentgenology article.
• ChatGPT offered up accurate information about breast cancer prevention and screening to patients in a study in Radiology. But ChatGPT also gave some inappropriate and inconsistent recommendations – perhaps no surprise given that many experts themselves often disagree on breast screening guidelines.
• ChatGPT was able to produce a report on a PET/CT scan of a patient – including technical terms like SUV_max and TNM stage – without special training, found researchers writing in Journal of Nuclear Medicine.
• GPT-4 translated free-text radiology reports into structured reports that better lend themselves to standardization and data extraction for research in another paper published in Radiology. Best of all, the service cost 10 cents a report.

Where is all this headed? A review article on AI in medicine in New England Journal of Medicine gave the opinion – often stated in radiology – that AI has the potential to take over mundane tasks and give health professionals more time for human-to-human interactions. 

They compared the arrival of ChatGPT to the onset of digital imaging in radiology in the 1990s, and offered a tantalizing future in which chatbots like ChatGPT and GPT-4 replace outdated technologies like x-ray file rooms and lost images – remember those?

The Takeaway

Radiology’s embrace of ChatGPT and GPT-4 is heartening given the specialty’s initial skeptical response to AI in years past. As the most technologically advanced medical specialty, it’s only fitting that radiology takes the lead in putting this transformative technology to work – as it did with digital imaging.

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The Wire

• Study Confirms Burnout Prevalence: A new study of over 43k healthcare workers confirms that about half are burned out. The highest burnout rate – 56% – was found among nurses, while rates were 54.1% among other clinical staff and 47.3% among physicians, say researchers from Brigham and Women’s Hospital in Journal of General Internal Medicine. Researchers advise a more standardized approach to burnout that focuses on workload – which other studies have found to be a cause of work stress.

• HHS to Appeal Texas Screening Decision: Attorneys for HHS plan to appeal a controversial decision by a Texas federal judge to throw out portions of the Affordable Care Act that bar insurers from requiring out-of-pocket payments for preventive care like cancer screening exams. An article in Fierce Healthcare predicts the Supreme Court could end up reviewing the ruling, which imaging advocates believe could devastate cancer screening programs. 

• AI for Cardiac Function: An AI algorithm produced more accurate assessments of cardiac function on echocardiograms than sonographers. In Nature, researchers from Cedars-Sinai tested their algorithm for measuring left ventricular ejection fraction in 3,495 patients, finding that cardiologists made corrections less often to findings of the AI (16.8%) than the sonographers (27.2%). Cardiologists were also faster with the AI assessments in hand. Ultrasound AI tools like the Cedars-Sinai model could help alleviate the persistent shortage of sonographers.

• Handheld X-Ray Firm Raises $23M: OXOS has raised $23M to help the company commercialize its handheld dynamic digital radiography technology. Investors included Parkway Venture Capital and Intel Capital, and bring the company’s total funding to $45M. OXOS got FDA clearance in 2021 for Micro C, a DDR unit designed to make low-radiation-dose x-ray more accessible and affordable. 

• Prostate Cancer Surveillance: Clinicians are choosing active surveillance of low-risk prostate cancer over aggressive treatment, say researchers in JAMA Internal Medicine. They found that active surveillance was used in 59.9% of low-risk cases in 2018, up from 16.4% in 2010, and from 8% to 22% for favorable intermediate-risk cases.  While imaging can be used for active surveillance, the authors say a worrying trend is the growing use of MRI-directed prostate biopsy, which could shift patients into more aggressive management.

• Qure links with Medtronic: Qure.ai has signed an agreement with Medtronic’s subsidiary in India to integrate its stroke management AI algorithms into Medtronic neurosciences offerings in the country. Qure will provide its qER algorithm and Qure app, which will help providers in India diagnose stroke more quickly and share data between facilities. Qure recently telegraphed its intention to sign more partnerships with medical device firms. 

• Ultrasound Boosts Breast Cancer Detection: Adding ultrasound to screening mammography boosts breast cancer detection rates – whether it’s handheld or automated breast ultrasound. In a massive Academic Radiology study of 35,500 women in China, researchers found that combining either handheld or ABUS with mammography found 3.66 cancers per 1,000 women, versus 2.69 for mammography alone. The findings were especially dramatic in women aged 45 to 54 with dense breast tissue, which is more common among women in China.

• Riverain Signs Calif. VA Hospital: Riverain Technologies is installing its ClearRead CT software at Fresno Veterans Affairs Medical Center in California. ClearRead CT analyzes chest CT scans and alerts radiologists to lung nodules that could indicate cancer. Riverain has been making inroads into the VA health system – the company late last year was chosen to provide ClearRead CT to VA sites as part of the agency’s Lung Precision Oncology Program. 

• PET Shows Higher Tau in Women: Researchers have speculated why women have higher rates of Alzheimer’s disease than men, and a new study in JAMA Neurology offers insight. In a study of 292 cognitively unimpaired people, women who experienced menopause earlier – as well as those who started hormone therapy later – had higher levels of tau on PET scans than men. The findings support the use of hormone therapy close to the start of menopause, rather than after a delay. 

• TeraRecon Adds Algorithms: TeraRecon has added new AI-based algorithms to its Eureka Clinical AI platform. The company partnered with Coreline Soft for its AVIEW heart and AVIEW LCS+ CT lung screening algorithms, while it struck a deal with Radiobiotics for its RBknee for osteoarthritis and RBFracture for fractures algorithms. Other recent partnerships from TeraRecon include Avicenna.ai, Cercare Medical, Combinostics, Imaging Biometrics, Infervision, and Riverain Technologies.

• FDA Clears Butterfly Tool: The FDA has cleared a lung analysis tool from Butterfly Network for use with its point-of-care handheld ultrasound scanners. Butterfly’s Auto B-line Counter requires just a six-second ultrasound clip to produce a B-line count, a measure of wetness in the lungs. The feature is more reliable than individual line-counting methods, and will prove useful for diagnosing lung pathologies such as congestive heart failure and COVID-19.

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The Resource Wire

• Today’s employment environment in radiology has never been more challenging. But there are tools you can use to keep your radiologists happy and engaged, according to this white paper from Medality. 

• 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.

• What kind of pressures are radiologists seeing, and how can imaging IT help? And what role will AI play? Learn more in this Imaging Wire Show interview with Peter Shen of Siemens Healthineers.

• “It completely changes the way we think about MRI imaging.” Take a look at this video interview with Mass General’s Chief of Neurocritical Care to see how clinicians can use Hyperfine’s Swoop Portable MRI to eliminate care disruptions in the ICU by keeping critically ill patients in the unit throughout the neuroimaging process.

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• Have more echo studies than sonographers? See how Us2.ai was able to classify, segment, and annotate echocardiographic videos with similar accuracy as expert sonographers. 

• Arterys’ Cardio AI solution recently added a new Atrial Volumes feature that allows cardiologists and radiologists to easily quantify volumes for both left and right atria in cardiac MRI images.

• AI automates what radiologists can’t stand, surfaces what radiologists can’t see, and identifies what radiologists can’t miss. But only if it’s implemented in the way radiologists work. See how Nuance helps radiologists achieve these results through a single, streamlined, end-to-end AI experience.

• Check out this Blackford Analysis white paper detailing how children’s hospital imaging teams can leverage AI to improve modality throughput and imaging device availability.

• Meet Merge at HIMSS 2023. Visit booth #3831 for a firsthand look at how Merge solutions from Merative can help you address your enterprise imaging and interoperability needs today, and face your future with confidence. Schedule a meeting today.

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

• United Imaging’s “all-in” approach means that every system ships with its entire suite of features and capabilities (no options), giving its clients more clinical flexibility and predictability.

• Why should your health system/imaging organization be considering cloud-based PACS? Find out from real-world, live customers in this video why Visage Imaging’s Visage 7 CloudPACS offers major benefits over the limitations of legacy PACS.