Radiologist Nina Vincoff, MD, on the USPSTF’s change to mammography guidelines.

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Breast Imaging

A New Day for Breast Screening

In a breathtaking about-face, the USPSTF said it would reverse 14 years of guidance in breast screening and lower its recommended starting age for routine mammography to 40.

In a proposed guidance, USPSTF said it would recommend screening for women every other year starting at age 40 and continuing through 74. The task force called for research into additional screening with breast ultrasound or MRI for women with dense breasts, and on screening in women older than 75.

The move will reverse a policy USPSTF put in place in 2009, when it withdrew its recommendation that all women start screening at 40, instead advising women in their 40s to consult with their physicians about starting screening. Routine mammography was advised starting at age 50. The move drew widespread condemnation from women’s health advocates, but the USPSTF stuck to the policy even through a 2016 revision.

The task force remained steadfast even as studies showed that the 2009 policy change led to confusion and lower breast screening attendance. The change also gave fuel to anti-mammography extremists who questioned whether any breast screening was a good idea.

That all changes now. In its announcement of the 2023 guidance, USPSTF said it based the new policy on its review of the 2016 update. No new RCTs on breast screening have been conducted for decades (it’s considered unethical to deny screening to women in a control group), so the task force commissioned collaborative modeling studies from CISNET.

USPSTF said the following findings factored into its decision to change the guidance: 

• Biennial screening from 40-74 would avert 1.3 additional breast cancer deaths per 1,000 women screened compared to biennial screening of women 50-74.
• The benefits of screening at 40 would be even greater for Black women, at 1.8 deaths averted. 
• The incidence rate of invasive breast cancer for women 40-49 has increased 2.0% annually from 2015-2019, a higher rate than in previous years. 
• Biennial screening results in greater incremental life-years gained and mortality reduction per mammogram and better balance of benefits to harms compared to annual screening.

The Takeaway 

As with the FDA’s recent decision to require density reporting nationwide, the USPSTF’s proposal to move the starting age for mammography screening to 40 was long overdue. The question now is how long it will take to repair 14 years of lost momentum and eliminate confusion about breast screening.

Duke’s Case for ClearRead CT

This Riverain Technologies case study details how Duke University Medical Center integrated ClearRead CT into its chest CT workflows, reducing read times by 26% and improving nodule detection by 29%.

RP and I-MED’s Perspectives on CARPL.ai

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.

The Wire

• Decision Draws Praise, Questions: The USPSTF’s decision on mammography screening is drawing praise from radiology and women’s health advocates, although some aspects are being questioned. ACR and SBI believe that USPSTF should recommend annual screening, as well as screening past age 74; they recently recommended that all women get risk assessments at age 25. Nina Vincoff, MD, also explains that more can be done for Black women and those with dense breasts in an article in MedPage Today. 

• Fibroid Prevalence Differs by Race: Researchers in JAMA Network Open found uterine fibroids are more common in African-American and Asian-Chinese women. Researchers used transvaginal ultrasound to examine fibroid prevalence in 996 women of child-bearing age of different races from 2006 to 2012. Fibroid prevalence rates varied by race: Black or African-American (35.7%), Asian-Chinese (21.8%), Hispanic or Latina (12.7%), and White (10.7%). Higher fibroid burden contributes to advanced disease severity and increased risk of surgical complications, researchers said.

• Envision Plans Chapter 11 Filing: Envision Healthcare is planning to file for chapter 11 bankruptcy, says a May 9 story in the Wall Street Journal. The company, which employs some 800 radiologists, is said to be beset by debt, high labor costs, and expenses from its legal battle with UnitedHealthcare over billing rates. Envision won a $91.3M arbitration ruling in that battle, but the funds are clearly not enough to solve its liquidity problem. The filing could come as early as this weekend. 

• Recurring Trauma Boosts Alzheimer’s Risk: In a study in Radiology, researchers used PET to find that soldiers who were exposed to multiple brain traumas due to explosions had abnormal accumulation of beta-amyloid – an Alzheimer’s disease risk factor. Of nine soldiers frequently exposed to blast events, six had beta-amyloid buildup in four brain regions versus no buildup in controls (67% vs. 0%). The findings show PET could be used to identify early-stage beta-amyloid in people exposed to TBI. 

• Philips Buys Echo AI Firm: Philips has acquired DiA Imaging Analysis, an Israeli developer of AI software for echocardiography. The deal expands a partnership started in 2020, with DiA providing applications to automate and quantify point-of-care ultrasound measurements on Philips devices; Philips already had a minority stake in DiA. DiA develops echo AI applications for echo exams to support both experienced and novice users. The deal comes three months after GE HealthCare acquired Caption Health, another echo AI software developer. 

• Cancer Mortality’s Regional Shift: Cancer mortality is declining in the US, but the drop isn’t distributed equally. In Cancer, American Cancer Society researchers broke down cancer mortality over 25 years by Congressional district, finding that while most districts saw cancer mortality fall 20-45% for men and 10-40% for women, the smallest declines were in the Midwest and central parts of the South, including Appalachia. While Black men saw the highest mortality drop, Black people still have higher death rates.

• Dr. G. Wows ACR 2023: MedTwitter personality Dr. Glaucomflecken is drawing rave reviews for this week’s Moreton Lecture address at ACR 2023. An ophthalmologist by training named William Flanary, MD, he focused on the use of social media as a tool for physician advocacy, and also touched on preauthorization and the No Surprises Act. RadTwitter godfather Rich Duszak, MD, called it the “best ever @RadiologyACR Moreton Lecture.” ACR said a recording of the talk would be available to members soon.

• Lung Screening Incidental Findings: How often do incidental findings occur on CT lung cancer screening exams? In a new study in JAMA Internal Medicine that analyzed 26k people screened in the NLST, researchers found that significant incidental findings were common (33.8%), and 89.1% should be reported to referring clinicians. Incidental findings were more common in positive-screen cases versus negative (94.1% vs. 81.8%). The results highlight the need for more robust methods for tracking incidental findings.

• RadEqual, AAWR Strengthen Ties: Advocacy and mentoring groups RadEqual and the American Association for Women in Radiology have signed an MOU that expands their partnership for the next two years. RadEqual and AAWR plan to promote educational opportunities for the radiology community, including for women radiologists and the next generation of radiology leaders. The partnership is supported by Intelerad. 

• Bayer Rides with Bicycle on Radionuclides: Bayer has signed a deal with Bicycle Therapeutics for the discovery and development of radiopharmaceuticals for therapeutic oncology. Bayer will develop radionuclides based on Bicycle’s synthetic bicyclic peptides for multiple oncology targets. Bicycle will receive a $45M upfront payment and is eligible for milestone fees and other payments of up to $1.7B. Therapeutic radiopharmaceuticals are drawing interest as a more targeted way to treat cancer compared to existing therapies.

• Carestream Launches Mobile X-Ray: Carestream Health has launched DRX-Rise, a new mobile digital X-ray system designed to give imaging sites an affordable path to digital imaging, or as a replacement for existing mobile digital systems. DRX-Rise provides features found on high-end mobile digital X-ray systems but at a lower price point. It includes Carestream’s ImageView software with Eclipse engine, two touchscreens for better productivity, long-lasting lithium battery, and in-bin battery charging.

Point-of-Care MRI in the Real World

Point-of-care MRI is being used in real-world situations to impact patient care decisions. In this recorded webinar, Hyperfine Senior Medical Director Dr. Chip Truwit discusses four cases in which portable MRI was used to answer clinical questions in the intensive care unit. 

Unleash the Power of the Cloud

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.

Total Body PET Advantage

See how 2-meter total body PET gives molecular imaging teams a diagnostic advantage compared to other “eyes to thighs” PET options in this editorial by United Imaging CEO Jeffrey M. Bundy.

The Resource Wire

• Efficiency and quality are the name of the game at RadNet, and that’s exactly what the imaging center giant achieved when it adopted Subtle Medical’s SubtleMR solution, optimizing its already-accelerated MRI protocols by 33-45% while maintaining consistent diagnostic image quality.

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• Us2.ai just published what might be the most comprehensive paper we’ve seen on AI echo, detailing the benefits of AI-automated echocardiography, the global need for more scalable and flexible CVD assessments, and how its technology is fit for the future. 

• Arterys and Tempus have an ambitious vision for their combined diagnostic portfolios, starting with the integration of their radiology and pathology AI platforms. That’s a big deal for both physicians and researchers, and it’s detailed in this post from Tempus COO Ryan Fukushima.

• 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?

• Did you know that healthcare generates 30% of all global data created every year? Learn more facts like this – and how Enlitic’s Curie platform can help you deal with the data deluge – in this infographic.