Patrick Jackson, MD, in a Twitter thread on Neko Health’s whole-body screening strategy.

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Imaging Service

Undermining the Argument for NPPs

If you think you’ve been seeing more non-physician practitioners (NPPs) reading medical imaging exams, you’re not alone. A new study in Current Problems in Diagnostic Radiology found that the rate of NPP interpretations went up almost 27% over four years. 

US radiologists have zealously guarded their position as the primary readers of imaging exams, even as allied health professionals like nurses and physician assistants clamor to extend their scope of practice (SOP) into image interpretation. The struggle often plays out in state legislatures, with each side pushing laws benefiting their positions.

How has this dynamic affected NPP interpretation rates? In the current study, researchers looked at NPP interpretations of 110 million imaging claims from 2016 to 2020. They also examined how NPP rates changed by geographic location, and whether state laws on NPP practice authority affected rates. Findings included:

• The rate of NPP interpretation for imaging studies went from 2.6% to 3.3% in the study period – growth of 26.9%.
• Metropolitan areas saw the highest growth rate in NPP interpretation, with growth of 31.3%, compared to micropolitan areas (18.8%), while rates in rural areas did not grow at a statistically significant rate.
• Rates of NPP interpretation tended to grow more in states with less restrictive versus more restrictive practice-authority laws (45% vs. 16.6%).
• NPP interpretation was focused on radiography/fluoroscopy (53%), ultrasound (24%), and CT and MRI (21%). 

The findings are particularly interesting because they run counter to one of the main arguments made by NPPs for expanding their scope of practice into imaging: to alleviate workforce shortages in rural areas. Instead, NPPs (like physicians themselves) tend to gravitate to urban areas – where their services may not be as needed. 

The study also raises questions about whether the training that NPPs receive is adequate for a highly subspecialized area like medical imaging, particularly given the study’s findings that advanced imaging like CT and MRI make up one in five exams being read by NPPs. 

The Takeaway    

The findings undermine one of the main arguments in favor of using non-physician practitioners – to address access-to-care issues. The question is whether the study has an impact on the ongoing turf battle between radiologists and NPPs over image interpretation playing out in state legislatures. 

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.

New Developments in Enterprise Imaging

What’s the latest news from Merge by Merative? Get an update on the company’s activities in enterprise imaging, VNA and viewers, workflow orchestration, and radiology departmental solutions from General Manager Ashish Sant in this interview from SIIM 2023.

AI-Powered Protection for PHI

Medical images contain some of the most sensitive protected health information (PHI), so it’s essential to keep PHI secure. Learn how to use AI-powered software to protect PHI in this white paper from Enlitic.

The Wire

• Neko Strategy Sparks Controversy: Neko Health’s $65M fundraising round has generated an online firestorm over the company and its whole-body screening strategy. In a lengthy Twitter thread by Alex Valaitis of Big Brain Daily, tech enthusiasts supported the firm while medical practitioners worried about cost and potential complications from following up incidental findings. Some pundits even questioned whether Neko’s “scans” were comparable to other whole-body screening services like Prenuvo, as cardiac ultrasound is the only imaging service mentioned on Neko’s website. 

• Second Opinion Platform Launches: One new direct-to-consumer service that definitely involves medical imaging has been launched by MDView, a Florida firm that debuted a platform enabling patients to get second opinions on their imaging exams. Patients upload medical images and records to MDView, and these are matched to a set of independent subspecialty radiologists from whom patients can pick for second opinions and optional video consultations. The service is currently available only in Florida, with rollouts coming for additional states. 

• Leqembi Gets Full Approval: The FDA has granted traditional approval to Eisai’s Leqembi, a drug for treating Alzheimer’s disease that previously was approved under an accelerated pathway. Leqembi was developed to reduce amyloid plaques in the brain, and could lead to increased use of neuroimaging as its indication calls for PET scans for diagnosis and brain MRIs for treatment monitoring. CMS followed the FDA’s lead by opening up the clinical registry in which clinicians must participate to receive Medicare payment.

• AI of Chest X-Ray Detects Heart Disease: Could AI turn the common chest X-ray into a heart imaging tool? In a new article in Lancet Digital Health, researchers from Japan describe how they tested an AI algorithm that classifies cardiac function and valvular disease on chest radiographs. After training the model on over 22k chest radiographs from nearly 17k patients, they found it was able to characterize six types of valvular heart disease with AUCs ranging from 0.83 to 0.92. 

• X-Ray Takes Center Stage at AHRA: The annual AHRA meeting is turning into a showcase for X-ray technology, and this week’s show is no exception. KA Imaging is debuting Reveal Mobi Pro, a new dual-energy mobile X-ray system with more advanced features than its Reveal Mobi Lite system. Fujifilm Healthcare Americas is launching D-EVO Suite OTCx, a new digital radiography system in an overhead tube crane configuration. Meanwhile Shimadzu Medical Systems USA has two product launches, one a dynamic digital radiography (DDR) function for its MobileDaRt Evolution MX8 k type mobile x-ray unit and the other a new V series of glass-free flat-panel digital detectors. 

• Boosting Breast Screening: Breast screening rates could be boosted by promoting mammography to women getting acute care at hospitals and urgent care centers. So says a new article in JACR in which researchers found that among over 9k women aged 40-74, 44.9% had not been screened in the last year. But many had experienced acute care in different settings, such as at an urgent care center (29.2%), emergency room (21.8%), or hospital (9.6%), making them good candidates for outreach promoting mammography.

• PocketHealth Lands UofL Health: Patients in the UofL Health system in Louisville, KY, will get faster and more convenient access to their medical images and reports thanks to a partnership UofL has signed with PocketHealth. UofL serves 1.5M patients and has an annual imaging volume of 400k studies; the deal includes PocketHealth’s Report Reader feature, which defines complex terms found in radiology reports. The agreement adds to PocketHealth’s growing stable of clients, which includes Guadalupe Regional Medical Center in Texas and Southern Illinois Healthcare. 

• AI’s Cybersecurity Risk: Does the rise of AI create new cybersecurity risks for healthcare facilities? In a review paper in European Radiology, authors from the US and Ireland review the intersection of AI and cybersecurity. They note that AI models are often built using open-source software applications and libraries, which are regularly targeted by cyberattacks. But healthcare facilities can mitigate risk through strategies like regular audits, federated learning, and asset and lifecycle management programs for legacy systems. 

• Early Liver Disease, a CVD Warning Sign: Chronic liver disease is known to come with increased CVD risks, and a new Journal of Hepatology study suggests that this is the case even with early signs of liver disease. Researchers analyzed liver MRIs and outcomes from 33,616 UK biobank participants, finding that early liver disease activity on MRI was associated with greater 2.5-year risks for any major CVD event, Afib, heart failure, CVD hospitalization, and all-cause mortality (HRs: 1.14, 1.30, 1.30, 1.27, 1.19).

• FDA Clears DeepTek AI: India-based AI startup DeepTek.ai has received FDA clearance for its Augmento radiology workflow management software. The application is already in use in India, where over 350 hospitals and imaging centers are using it for workflow optimization as well as PACS and AI orchestration. The company also developed its own AI algorithms, such as Genki for analyzing chest CT and X-ray images for infectious diseases, and completed a funding round in 2022.

• MRI Workup for Dizziness: In patients presenting to the emergency department with dizziness, MRI might be a better option than CT where available. In AJR, researchers compared brain MRI with an abbreviated protocol to head CT and CTA scans together in over 1.9k patients from 2018 to 2021. They found that the MRI protocol beat CT, with greater change in secondary stroke prevention medication (9.6% vs. 3.2%), greater use of subsequent echo (6.4% vs. 1.0%), and lower frequency of 90-day ED readmission (12.0% vs. 28.0%).

Blackford’s AI Value Matrix

Working out your AI business case? Check out this helpful Blackford Analysis post detailing how to create your AI Value Matrix based on your organizational objectives and value indicators.

Top Trends and Themes at SIIM 2023

In this article, PocketHealth Co-Founder and CEO Rishi Nayyar sees three major themes at SIIM 2023: 1. The development of holistic enterprise imaging strategies. 2. The use of AI to improve radiology workflow and patient outcomes. 3. New solutions for interoperability challenges.

The Resource Wire

• At this week’s AHRA 2023 meeting, United Imaging Healthcare is celebrating five years in the US with the launch of three new medical imaging scanners. Learn more about the company and its sponsorship of AHRA’s Leaders of Choice program. 

• A new platform from Clearpath now enables healthcare providers to delight their patients by sharing images and medical records digitally. Find out how it integrates simply into your practice. 

• How is dual-energy for chest X-ray advancing patient care in military and federal healthcare facilities? Learn more in this GE HealthCare webinar featuring Gilbert E. Boswell, MD, FACR, on Wednesday, July 12 at 2pm CDT. 

• 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. 

• With burnout and staffing shortages on the rise, and the increasing volume of imaging, radiology teams are searching for solutions. This interactive guide from Nuance can help you create an environment where radiologists thrive by building a powerful imaging strategy with AI-driven, real-time intelligence.

• Imaging AI’s clinical and productivity benefits are becoming increasingly clear, but selecting and implementing the right solution can be difficult. This Arterys paper details how an AI platform strategy allows providers to efficiently and accurately evaluate AI applications, so they can start realizing their targeted AI benefits.

• Check out our Cardiac Wire publication’s latest Q&A with Us2.ai president and co-founder, Yoran Hummel, discussing how his career as a sonographer led him to echo AI, and how Us2.ai’s upcoming automated strain analysis feature brings the company even closer to democratizing echo.

• How can radiology practices use innovative training and education techniques to grow and overcome the ongoing shortage of radiologists? Find out in this Imaging Wire Show interview with Daniel Arnold and Deanna Heier of Medality.

• Crouse Hospital is a nationally recognized cardiac care center in the Syracuse, NY, area, but the hospital’s cardiovascular service relied on separate data islands. That is, until Crouse Hospital adopted the HealthView CVIS from Intelerad’s Lumedx business. 

• Looking for a way to do faster MRI scans without losing image quality? Learn about the impact of Subtle Medical’s SubtleMR software on accelerated MRI sequences in this case review image series.

• The quality and appearance of CT scans can vary considerably. In this white paper from Riverain Technologies, find out how image normalization can standardize CT images, making them easier to analyze and interpret. 

• 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).  

• 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.

• See how cloud-native imaging avoids traditional software’s resource utilization constraints and eliminates unexpected disruptions in this Change Healthcare animation.

• 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.