Hugh Harvey, MD, and Mike Pogose, Hardian Health

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Ultrasound

Ultrasound Spots Breech Pregnancies

Performing routine third-trimester ultrasound scans on pregnant women could help identify breech pregnancies, giving women the opportunity to consider alternative birth options. UK researchers in PLOS Medicine said the impact was found with both conventional and POCUS ultrasound scanners. 

While the incidence of breech presentation at full term is only 3-4%, when breech births do occur they can result in higher morbidity and mortality for both babies and mothers. 

In the UK, third-trimester ultrasound scans aren’t routinely performed for low-risk women, missing a chance to give them other options like Cesarean birth.

• Therefore, researchers investigated the effectiveness and impact of these scans at two hospitals, one that used conventional ultrasound scanners and the other employing POCUS units (GE HealthCare’s Vscan Air).

• At the POCUS facility, scans were typically performed by trained midwives. Women were scanned between 2016 to 2021 at both hospitals.

Performing routine ultrasound scans at 36 weeks reduced the incidence of undiagnosed breech presentation by 71% at the hospital using conventional ultrasound and 69% at the POCUS hospital.

• The rate of undiagnosed breech presentation dropped from 14.2% to 2.8% with conventional ultrasound and from 16.2% to 3.5% with POCUS.

• The scans also had an impact on babies’ health. Infants born at either facility had less likelihood of a lower Apgar score (<7) five minutes after birth, and babies were less likely to be sent to the neonatal care unit.

The researchers believe their findings suggest a revision of the UK’s clinical guidelines, which don’t currently call for routine third-trimester ultrasound scans for low-risk women. With respect to POCUS, they said their research was the first to investigate the technology for diagnosing fetal presentation, and their findings support wider use of POCUS in areas where conventional ultrasound isn’t available. 

The Takeaway

What’s really exciting about this study are the findings about POCUS. Maternal-fetal complications are a huge problem in developing countries and places with less access to imaging technology. POCUS scanners could be used by trained personnel like midwives – perhaps with AI assistance –  to identify problems before birth.

Laying Your AI Foundation

Discover how Enlitic’s Curie|ENDEX application transforms medical imaging data to a standard nomenclature to form a foundation for successful artificial intelligence strategies.

Understanding the Platform Approach to AI

Here’s a quick introduction to Blackford Analysis’ dedicated AI platform and its service for the selection, deployment, orchestration, and use of imaging applications and AI.

The Wire

• Reality Check on ChatGPT: Lost in all the talk about using ChatGPT for healthcare is a hard-nosed discussion of what really needs to happen for large language models to become actual medical products. Fortunately, Hugh Harvey, MD, and Mike Pogose of Hardian Health provide that perspective in a new blog post. ChatGPT at present simply isn’t ready for prime time in medicine, and its use could violate both ethical and legal standards. But Harvey and Pogose do offer a way forward.

• Portable MRI Guides ECMO for Kids: A portable MRI scanner located at the bedside of neonatal patients was able to guide extracorporeal membrane oxygenation treatment. In Critical Care, researchers from Germany describe their use of Hyperfine’s Swoop scanner to monitor ECMO therapy in four patients who could not be transported to radiology due to their condition. Portable MRI diagnosed a major brain hemorrhage in one patient, who was treated immediately. 

• HHS Streamlines Prior Auth for MA: Prior authorization should get less onerous for Medicare Advantage beneficiaries (and their doctors) under new rules issued by HHS on April 5. The rules state that once a prior authorization approval has been granted, it remains in effect “as long as medically necessary.” The rules also include stricter oversight of denial-of-care decisions. In addition to overburdening physicians, prior authorization has been linked to delays in care. 

• Breast Screening in a Box? Namida Lab is banking there’s demand for its at-home Auria breast cancer diagnostic test, which it debuted at the recent NCoBC meeting. The proteomics test analyzes the content of tears for biomarkers of breast disease. Namida touts Auria as a “breast cancer screening test” for women as young as 30, even as the company’s website specifies that it’s not for diagnostic purposes, nor is it intended as a replacement screening mammograms.

• FDA Posts Report on MRI Accident: The FDA has posted an adverse event report on the recent MRI accident at a Kaiser Permanente hospital in Northern California. The report doesn’t provide many additional details on the February 23 incident, other than that it involved a 3-tesla scanner from GE HealthCare. Previous reports on the accident stated that a hospital bed was drawn to the magnet when a staffer wheeled it into the scanning room. The staff member required medical treatment.

• Dr. Glaucomflecken Goes to Washington: One of MedTwitter’s favorite voices – Dr. Glaucomflecken – will be giving a named lecture at ACR 2023 May 6-10 in Washington, DC. By day an ophthalmologist named Dr. William Flanary, Dr. Glaucomflecken has been using social media since 2016 to offer satirical takes on healthcare, such as his recent takedown of private equity in radiology. A true friend of radiology, he always provides an adequate clinical history on all his imaging orders.

• AI Slashes CT Turnaround: An AI tool that triaged CT cases with suspected pulmonary embolism – and elevated the most serious cases – helped slash report turnaround times. Researchers in American Journal of Roentgenology used Aidoc’s BriefCase for iPE Triage algorithm to analyze CT pulmonary angiography exams and flag suspicious cases for priority review. The algorithm cut report turnaround times for positive PE cases by 12 minutes, and cut wait times by 12 minutes as well. 

• Second-Gen Breast Localization: Canadian breast interventional device developer MOLLI Surgical has launched MOLLI 2, the second generation of its wire-free breast localization technology. MOLLI 2 is more precise than the first generation, and now includes directional feedback built into the device’s wand and tablet display. Another new product, MOLLI re.markable, ensures that the locations of breast lesions are correctly marked. 

• US Goes it Alone for Breast Complaints: For women with focal breast complaints, ultrasound scans may be sufficient on their own, without the need for DBT scans as well. In Radiology, Dutch researchers reported on a study of 1,961 younger women (30 years and up) from 2017 to 2019, finding that their targeted ultrasound protocol was able to obtain an accurate diagnosis in the vast majority of cases. Cutting out DBT for them would save healthcare costs and workup time. 

• Subtle Gets RBMA Award: Subtle Medical was recognized at this week’s RBMA PaRADigm meeting for its collaboration with Lake Medical Imaging, a Florida imaging center operator that installed the company’s SubtleMR software in 2022. Lake has been able to scan an additional 41 patients per day across its six sites; the partnership was recognized with RBMA’s RAD Honors Collaborative Achievement Award, which is given to collaborations between radiology practices and vendors.

• Simpler MRI Implant Screening: Is it safe to do an MRI scan on that patient with a pacemaker? Medtronic is hoping to take some of the delays out of the decision with MRI Care Pathway, a new system that streamlines the process of screening patients with implanted Medtronic cardiac devices before MRI scans. The system includes a website and tablet-based app that clinicians can use to see if a patient’s Medtronic implant is compatible with MRI.

Imaging IT and Radiology Efficiency

What kind of pressures are radiologists seeing, and how can imaging IT help? And what role will AI play? We talked to Peter Shen of Siemens Healthineers in this Imaging Wire Show.

Meet Merge at HIMSS 2023

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.

The Resource Wire

• What impact is Visage 7 Enterprise Imaging Platform having on healthcare enterprises? Find out from Visage customers in their own words how Visage 7 can help you eliminate your legacy PACS.

• 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.

• When Sao Paolo’s Diagnosticos da America SA (DASA, the world’s fourth largest diagnostics company) set out to evaluate Qure.ai’s QXR solution for their pediatric chest X-ray workflows, they leveraged CARPL.ai’s platform to streamline their evaluation. See how it worked here.

• 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.

• “It has changed the face of neuroimaging.” That’s one of the takeaways from Christ Hospital’s experience becoming the first healthcare system in New Jersey to implement point-of-care MR imaging into neurocritical care. Learn about their implementation process and the impact of providing quick bedside MRIs in this Hyperfine webinar. 

• Did you know one-quarter of healthcare organizations have experienced a cyber-attack in the last year? This Change Healthcare animation explains how third party-certified cloud-native enterprise imaging can help secure IT infrastructure that might be exposed with re-platformed imaging systems.

• 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.

• 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.

• Creating your AI adoption plan? This Arterys report details what clinical, efficiency, and regulatory factors to look for in radiology AI vendors.

• 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.

• Faced with two aging legacy PACS systems, South Jersey Radiology Associates moved to Intelerad’s IntelePACS, allowing its 12 sites to operate as a single, more-efficient entity. See how SJRA has since improved its radiologist efficiency by 8% to 10% and achieved a unified experience across its locations.

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

• 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.

• Did you know that 43% of women recommended for diagnostic breast follow-up opt out of additional breast care? Find out how to bring them back with GE HealthCare’s Pristina mammography system with SenoBright HD contrast-enhanced mammography.

• How can your imaging facility create a foundation for MRI safety? Learn from safety expert Tobias Gilk on the best practices for building a safe MRI environment in this podcast from Medality.