Goel N et al, in JAMA Network Open

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Breast Imaging

Health Inequity & Breast Cancer

The last several years have seen growing awareness of how structural inequities can impact individual health outcomes. Two powerful new JAMA Network Open studies reinforced what we know about structural inequity, particularly as it relates to breast cancer. 

In the first study on April 19 addressing racial differences in breast cancer mortality, researchers looked at over 415k women from 2011 to 2020, finding:

• Black women between 40 and 49 years old had the highest breast cancer mortality rates per 100,000 person years, at 27 deaths. This compares to 15 deaths for White women, and 11 deaths for other ethnicities.
• If breast screening were tailored based on risk at age 50, Black women should start screening eight years earlier than White women, at 42 years of age versus 51. 
• Biennial mammography screening of Black women starting at age 40 would reduce the gap in breast cancer mortality compared to White women by 57%. 

In the second study on April 21, researchers drilled even deeper into structural inequity, focusing on breast cancer outcomes in disadvantaged neighborhoods in a large, racially diverse region in southern Florida that’s home to 6.2M people. 

In all, their study covered 5,027 women with breast cancer, and they categorized neighborhoods into three levels based on socioeconomic status. Findings included:

• Patients living in the second most disadvantaged neighborhoods were 36% more likely to die of breast cancer (HR=1.36).  
• Women living in the most disadvantaged neighborhoods were 77% more likely to die (HR=1.77).

The researchers pointed out that their results went beyond merely linking race to health outcomes, as they adjusted for race and ethnicity “as a proxy for structural racism.” They suggested that there could be “unaccounted,” biologic mechanisms related to neighborhood disadvantage that lead to shorter breast cancer survival. The findings echo other studies that have linked patient location to access to imaging.

The Takeaway

Over the past several decades, breast cancer’s dropping mortality rate has been a health policy success story. But the new studies indicate that progress has been uneven, and more attention is needed to ensure that the benefits of improved breast cancer diagnosis and treatment are distributed more equitably.

Choice and Control throughout AI Adoption

More AI applications are becoming available, but many healthcare organizations are reporting challenges to achieving the benefits of the technology. Learn how Merge AI Orchestrator can provide access to AI without disrupting workflow.

Diving into AI for Radiology Operations

Learn how Enlitic’s Curie|ENDEX solution has impacted operations at TMC, Europe’s leading subspecialty radiology center, in this April 25 webinar featuring Ernest Montañà, AI project manager at TMC.

The Wire

• Radiology’s Role in Climate Change: Earth Day was April 22, prompting radiology to examine its role in climate change. Radiology is a “substantial contributor” to greenhouse gas emissions, says a new article in Radiology that looks at how imaging can mitigate emissions. Some of the suggestions are uniquely individual, like a more plant-based diet or alternative transportation, but radiology can take concrete steps like powering down equipment overnight, switching to LED lighting, and replacing fossil fuels with electricity for heating buildings. 

• Powering Radiology Down: In a related article in Radiology, researchers from Switzerland offer their method for monitoring and powering down medical imaging devices that consume energy while not being productive. A Python script queries the network status of each connected imaging device every 15 minutes. This data is fed to a live dashboard that shows which devices were left on during off-hours, as well as their energy cost and CO₂ savings if they were powered down.

• Editors Flee Elsevier Neuro Journal: High publication fees at the Elsevier-published journals NeuroImage and NeuroImage:Reports have prompted its editors to resign and start their own nonprofit journal, Imaging Neuroscience. The editors say they tried to convince Elsevier to reduce the journal’s $3,540 publication fee, as “large profit is unethical and unsustainable.” When the publishing behemoth refused, over 40 academic editors resigned and launched the new publication. The move reflects the growing unease over for-profit academic publishing. 

• ARRS Sues Marriott: ARRS has filed a lawsuit against Marriott asking for $665,523, charging that the hotel giant shut down its Marriott Wardman Park Hotel in Washington, DC, where the society was due to hold its 2023 annual meeting. ARRS charges in a complaint that the hotel’s franchisee owner filed for bankruptcy in 2021, and Marriott received a settlement of $18M to compensate groups like ARRS. But the hotel chain allegedly never passed on the money, and ARRS was forced to find a new conference locale.

• Envision Mulls Creditor Takeover: Envision Healthcare could file for chapter 11 bankruptcy, giving control of the physician staffing company to its creditors, says the Wall Street Journal. Envision is a massive mega-practice that employs over 25k clinicians, but has been struggling under debt since it was taken over by private equity giant KKR in 2018. The WSJ article says Envision is discussing a debt restructuring deal with lenders that would lead to a write-down of KKR’s stake.

• Timing Counts in Contrast Mammo: It’s all about timing when it comes to contrast-enhanced mammography, according to a study presented this week at ARRS 2023. Researchers examined seven different CEM protocols, finding that cancerous lesions are clearer on images obtained earlier in image acquisition. Craniocaudal images also were preferred over mediolateral oblique projections. The findings illustrate that more standardization of CEM protocols between institutions could benefit patients. 

• Merative Taps Leader for Merge: Merative has named Ashish Sant as general manager of its Merge imaging business. Sant brings three decades of experience in healthcare technology to Merge, starting his imaging career at ALI Technologies and most recently serving in management roles at Change Healthcare and Bracco. Merative has been focused on rebuilding the Merge brand since the company was formed last year when Francisco Partners bought IBM Watson Health’s healthcare data and analytics assets.

• Overworked Residents Affect Patient Safety: A study in BMJ Medicine links longer resident work hours to adverse safety events. The study of 4,826 senior residents found that those who worked over 48 hours a week had higher rates of medical errors and adverse events. For those working 60-70 hours a week, the risk was double (OR=2.36) for medical errors and triple (OR=2.93) for preventable adverse events. The findings are relevant to the ongoing debate over physician overwork and burnout.

• Caristo Adds CCTA AI Funding: CCTA AI startup Caristo Diagnostics completed a $16.3M Series A round to support the commercialization of its CaRi-Heart technology, including its expansion in the UK and EU and its entry into the US. Caristo is among a handful of venture-backed CCTA AI startups (also: HeartFlow, Cleerly, Elucid, Artrya), but uniquely focuses on coronary inflammation burden to assess cardiac mortality risk, in addition to the presence of coronary plaques.

• Leaders Lean in to AI: Philips released its Future Health Index 2023 global report, which found that healthcare leaders are investing heavily in AI for both decision support and operational efficiency, and that these execs are leaning into outside partnerships to help provide the best possible care. Interest in AI for decision support has risen from 24% in 2021 to 39% in 2023; meanwhile the percentage who plan to invest in AI for operational efficiency is stable, at 37%.

• Scan.com Raises $12M: UK-based patient referral service Scan.com has raised $12M to fund its expansion and continued penetration of the US market. Scan.com provides a portal that clinicians and patients use to schedule imaging exams and view results, and completed a Series A round in 2022. Originally launched to help patients bypass the heavily impacted NHS in the UK, it began US operations two months ago with a pilot project in Georgia, according to an article in TechCrunch.

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.

Building a Mobile Lung Cancer CT Screening Program

The number of patients eligible for low-dose CT lung cancer screening has expanded, and so has the need to reach at-risk patients closer to where they live. That’s why Siemens Healthineers’ Mobile Lung Screening Solution combines the quality, ease of use, and flexibility needed to create a program that meets the real-life needs of your community.

The Resource Wire

• 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).  

• What’s behind healthcare’s shift from legacy PACS to cloud-based enterprise imaging? We talked to Brad Levin of Visage Imaging at HIMSS 2023, and he explains the change and the benefits of Visage’s Visage 7 | CloudPACS solution. 

• Because of United Imaging’s Software Upgrades for Life program, every time United Imaging launches a new solution it can automatically be installed in every compatible system at no cost.

• 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. We know from prostate and breast cancer screening that clear guidelines and increased screening saves lives. 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.

• Watch industry leaders and trendsetters in radiology, Dr. Krishna Nallamshetty, CMO at Radiology Partners, and Dr. Ron Shnier, CMO at I-MED Radiology Network, share their perspectives on the CARPL platform, from clinical trials to clinical deployment.

• How does point-of-care MRI benefit neurocritical patients? Learn about the inherent advantages of portable MRI and how it has impacted patient care decision in this informative webinar hosted by Hyperfine. 

• Patient-centric care was one of the major highlights at HIMSS 2023. What role does medical imaging play in this patient care pathway? We talked to Morris Panner and A.J. Watson of Intelerad at the meeting.

• 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. 

• Bayer’s cloud-based Calantic Digital Solutions AI platform features a suite of disease-specific AI apps that integrate into radiologist workflows, helping radiology teams scale AI deployment and improve efficiency and quality of care.

• Different tests for different breasts. Visit the GE HealthCare booth at SBI 2023 to learn about their comprehensive suite of breast care solutions that help personalize screening and provide a positive experience for patients. Click here to learn more about what you can expect at GE’s booth.

• In today’s hyper-competitive radiologist job market, radiologist recruiting and retention is more important than ever. Learn from industry experts and practice leaders in this on-demand Medality webinar as they reveal how to overcome hiring challenges, keep your team engaged, and provide opportunities for growth.

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

• How can AI be mobilized to automate the fight against heart disease? Us2.ai President Yoran Hummel, PhD, discusses how echocardiography can be optimized in an interview on The Medical AI Podcast. 

• Clinical applications for healthcare AI are rapidly expanding, but many barriers are still preventing widespread adoption. This Nuance post explores a critical set of questions: what happens after an AI model goes into production, and how to know if it continues to perform as expected?

• Check out this Change Healthcare video explaining the difference between single-tenant and multitenant cloud architecture, and how multitenant solutions can improve your efficiency and flexibility.