Perry Pickhardt, MD, on the potential of opportunistic screening.

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How will changes in Medicare reimbursement and payment rules affect radiology in 2024? Find out in this Imaging Wire Show interview with Sandy Coffta, vice president of client services at revenue cycle management company Healthcare Administrative Partners (HAP USA).

CT Scanners

AI Automates Liver Fat Detection

An automated AI algorithm that analyzes CT scans for signs of hepatic steatosis could make it possible to perform opportunistic screening for liver disease. In a study in AJR, researchers described their tool and the optimal CT parameters it needs for highest accuracy. 

Hepatic steatosis (fatty liver) is a common condition that can represent non-alcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD). Imaging is the only noninvasive tool for detecting steatosis and quantifying liver fat, with CT having an advantage due to its widespread availability. 

Furthermore, abdominal CT data acquired for other clinical indications could be analyzed for signs of fatty liver – the classic definition of opportunistic screening. Patients could then be moved into treatment or intervention.

But who would read all those CT scans? Not who, but what – an AI algorithm trained to identify hepatic steatosis. To that end, researchers from the US, UK, and Israel tested an algorithm from Nanox AI that was trained to detect moderate hepatic steatosis on either non-contrast or post-contrast CT images. (Nanox AI was formed when Israeli X-ray vendor Nanox bought AI developer Zebra Medical Vision in 2021.)

The group’s study population included 2,777 patients with portal venous phase CT images acquired for different indications. AI was used to analyze the scans, and researchers noted the algorithm’s performance for detecting moderate steatosis under a variety of circumstances, such as liver attenuation in Hounsfield units (HU). 

• The AI algorithm’s performance was higher for post-contrast liver attenuation than post-contrast liver-spleen attenuation difference (AUC=0.938 vs. 0.832)
• Post-contrast liver attenuation at <80 HU had sensitivity for moderate steatosis of 77.8% and specificity of 93.2%
• High specificity could be key to opportunistic screening as it enables clinicians to rule out individuals who don’t have disease without requiring diagnostic work-up that might lead to false positives

The authors point out that opportunistic screening would make abdominal CT scans more cost-effective by using them to identify additional pathology at minimal additional cost to the healthcare system. 

The Takeaway

This study represents another step forward in showing how AI can make opportunistic screening a reality. AI algorithms can comb through CT scans acquired for a variety of reasons, identifying at-risk individuals and alerting radiologists that additional work-up is needed. The only question is what’s needed to put opportunistic screening into clinical practice. 

How Imaging Partners of OC Eliminated CDs

Imaging Partners of Orange County was using CD-ROMs to share with patients many of the over 70,000 imaging exams they perform annually. Find out how PocketHealth helped them eliminate CDs and provide a better patient experience.

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 Wire

• Nurses Sue to Be Called ‘Doctor’: Three California nurses who have PhDs are suing the State of California for the right to use “doctor” as part of their professional title. An article in Medscape describes how, in a complaint filed in federal court in California, the nurses claim that state regulators fined another nurse $20,000 for violating state rules by using the term “Doctor Sarah” in online advertising and on social media. The lawsuit illustrates the ongoing turf battle over scope of practice by non-physician practitioners. 

• HIV Status Impacts Lung Screening: People living with HIV are less likely to undergo CT lung cancer screening, say researchers in a new study in Preventive Medicine Reports. The group found that among 365 Florida residents, those living with HIV had lower lung screening rates than those who were HIV negative (12% vs. 17%) and were more likely to be diagnosed with lung cancer after their first screening exam (8% vs. 0%). Due to smoking, people with HIV have higher lung cancer rates, making them good candidates for screening. 

• SIIM 2023 by the Numbers: SIIM posted an infographic detailing the growth in the group’s 2023 annual meeting compared to 2022. Year over year, SIIM 2023 saw growth in in-person attendance (+24%), number of exhibiting companies (+22%), and number of new companies exhibiting (+20%). The meeting also recorded 2.6k program session views and Twitter reach of 6M. This year’s conference focused heavily on AI and its impact on radiology interpretation and workflow.

• MRI Guidance of Rad Therapy: Using MRI to guide radiation therapy for prostate cancer patients can avoid side effects, say researchers in a meta-analysis published in Cancer. The group analyzed data from 29 clinical trials covering a total of 2,547 prostate cancer patients who received MR-guided daily adaptive stereotactic body radiotherapy (MRg-A-SBRT), and compared results to CT-guided treatment that wasn’t adjusted daily. MRg-A-SBRT was associated with fewer urinary and bowel side effects (44% and 60%, respectively). Questions remain about MRg-A-SBRT’s impact on long-term benefits, however. 

• MRI Combo for Heart Condition: A combination of two MRI scanning protocols works well in detecting early signs of hypertrophic cardiomyopathy (HCM) before symptoms appear. Writing in Circulation, UK researchers performed cardiac diffusion tensor imaging (cDTI) and cardiac perfusion MRI in 206 patients, finding that people with HCM had altered heart microstructure and microvascular disease compared to healthy controls (P<0.01). They also compared MRI findings to data from genetic tests to correlate microstructural cardiac abnormalities with carriers of a genetic mutation for HCM. 

• AUC Isn’t Dead Yet: The idea that advanced imaging exams should be ordered based on appropriate use criteria (AUC) isn’t quite dead yet, despite CMS’ decision to pause its plan for implementing AUC. ACR continues to back the idea of AUC as a tool to reduce inappropriate utilization, but one sticking point has been statutory requirements for real-time claims processing. ACR points out that AUC has been proposed as an alternative to prior authorization – which no one likes – and as such may be worth saving.

• Gallium PET Tracer Face-Off: A pair of radiotracers based on gallium-68 were tested for their ability to detect neuroendocrine tumors (NETs) on PET/CT scans in a paper in JNM. Chinese researchers found that the somatostatin receptor (SSTR) antagonist  ⁶⁸Ga-NODAGA-JR11 outperformed the SSTR agonist  ⁶⁸Ga-DOTATATE in 48 patients. ⁶⁸Ga-NODAGA-JR11 had much higher sensitivity in detecting lesions (91.7% vs. 77.2%), lower background uptake in normal tissue, and affected patient management in 14.5% of cases. 

• Don’t Try This At Home: The FDA has issued a warning to consumers against home use of ultrasound devices developed by RoyalVibe Health and several related companies. The devices have been marketed to consumers as treatments for a variety of ailments, including cancer, diabetes, heart disease, and depression, but the FDA says they do not have 510(k) clearance to be sold in the US. The FDA in November 2022 issued a warning letter to RoyalVibe and its CEO, Raymond L. Venter, PhD. 

• Big Tech Fights AI Healthcare Regulation: Tech giants including Google, Amazon, and Epic are pushing back against proposed AI regulation that would increase oversight of tools guiding patient care. While the ONC wants training data publicly disclosed as part of federal certification, Epic argues that there would be less “incentive to innovate” if certified health IT developers “have to disclose publicly their intellectual property, while non-certified predictive model developers are not required to make the same disclosure.”

• TTE AI for LAT Detection: A Poland-based team in European Heart Journal described their AI model that uses transthoracic echo (TTE) images to detect left atrial appendage thrombus in patients on chronic oral anticoagulants, potentially avoiding uncomfortable transesophageal echo exams (TEE). The researchers trained the model using 2,827 TEE exams and tested it with TTEs from 1,284 patients at two sites, finding that the TTE AI model spotted LAT in 5.5% of patients and could spare 40% of patients from undergoing TEE exams without missing any thrombus. 

• Cleerly & Cenegenics’s Precision Plaque Alliance: Cardiac CT AI leader Cleerly announced an interesting new alliance with “performance health age management” company Cenegenics. Through the partnership, Cenegenics will offer its wellness- and longevity-focused clientele access to Cleerly’s CCTA AI analysis, allowing its members and their physicians to identify plaque buildup and create personalized treatment plans. Cleerly services will be available in all 21 Cenegenics Centers within the U.S. 

Stories of Imaging Resilience

Healthcare providers can’t feel confident in the impact they make for their patients without feeling their IT environments are resilient and reliable. This eBook from Merge by Merative breaks down 3 essential ingredients of a resilient imaging IT environment: hybrid cloud, reliable uptime, and zero-trust security.

Making Radiology Workflow More Efficient

What can be done to make radiology workflow more efficient? In this Imaging Wire Show, we talked to Ernest Montañà of teleradiology services provider TMC about their adoption of Enlitic’s Curie|ENDEX technology to help radiologists do their jobs more efficiently.

Why AI in Radiology Is a Game-Changer

What are the benefits of AI in radiology? Quite simply, they are game-changing and will drive improved hospital efficiency, according to this article that features Blackford Analysis CEO Ben Panter. 

The Resource Wire

• When RWJBarnabas Health wanted to boost its percentage of radial-access interventional cardiology procedures being performed, they leveraged data from HealthView Analytics, a business intelligence platform by Intelerad subsidiary Lumedx. 

• What’s the best way to eliminate patient frustration and get them engaged with healthcare again? Find out how technology can revamp the patient engagement experience in this article produced in collaboration with Nuance in Becker’s Hospital Review.

• Check out this Imaging Wire Show featuring Arterys’ Director of Product Management, Maya Khalifé, PhD, discussing how to deliver clinical value with AI, Arterys’ platform approach to neuro AI, and how AI can serve radiologists today and into the future.

• Transthyretin (ATTR) amyloidosis is emerging as an under-recognized form of heart failure, especially in the elderly. In this video, Marianna Fontana, MD, PhD, of UCL describes how Us2.ai technology was used to assess ATTR. 

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

• It says a lot when a solution works so well for a radiology department that they decide to perform a study to quantify its benefits. In this Imaging Wire Q&A, University Hospital of Zurich’s Thomas Frauenfelder discusses his experience and study on Riverain Technologies ClearRead CT.

• When SyntheticMR validated its SyMRI MSK solution, they leveraged the CARPL platform to compare conventional knee and spine MRI image quality with SyntheticMR images. Check out their validation process and results here.

• 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.

• CloudPACS has finally arrived. Learn more about the benefits that cloud-based PACS can have for your radiology practice and how Visage Imaging’s Visage 7 was built from the ground up to ensure maximum performance, security, and scale. 

• Increasing demand for healthcare has led to a boom in imaging exam volume, with studies such as CT requiring complex scanning protocols. Learn how GE HealthCare is evolving CT workflows with its efficient scanning solutions.

• What’s the latest on the ongoing collaboration between Bayer and Blackford Analysis? Get an update from Bayer’s Thanos Karras and Blackford’s Ben Panter in this video interview from SIIM 2023. 

• We may be entering a third wave of imaging AI’s rapid evolution, one that brings a shift from narrow point solutions to comprehensive multi-finding AI systems. Hear this discussion with Annalise.ai Chief Medical Officer Rick Abramson, MD, exploring how this transition could take place, how radiologist and VC perspectives on AI are changing, and how AI might continue to evolve in the future.

• Get to know Clearpath and its novel approach to empowering patients by giving them digital access to their images and medical records in this video interview from SIIM 2023. 

• United Imaging is developing modern medical imaging technology for better patient outcomes. CEO Jeffrey Bundy, PhD, explains the company’s unique philosophy in this interview with Healthcare Tech Outlook. 

• New AI-based reconstruction tools are making it possible to perform imaging exams that are faster and at lower radiation dose. Learn from the experts how it’s done in this webinar recording hosted by Subtle Medical and Incepto.