Ronald Coase, Nobel Prize-winning British economist.

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Oncology Imaging

Screening Foes Strike Back

Opponents of population-based cancer screening aren’t going away anytime soon. Just weeks after publication of a landmark study claiming that cancer screening has saved $7T over 25 years, screening foes published a counterattack in JAMA Internal Medicine casting doubt on whether screening has any value at all. 

Population-based cancer screening has been controversial since the first programs were launched decades ago. 

• A vocal minority of skeptics continues to raise concerns about screening, despite the fact that mortality rates have dropped and survival rates have increased for the four cancers targeted by population screening.

This week’s JAMA Internal Medicine featured a series of articles that cast doubt on screening. In the main study, researchers performed a meta-analysis of 18 randomized clinical trials (RCTs) covering 2.1M people for six major screening tests, including mammography, CT lung cancer screening, and colon and PSA tests. 

• The authors, led by Norwegian gastroenterologist Michael Bretthauer, MD, PhD, concluded that only flexible sigmoidoscopy for colon cancer produced a gain in lifetimes. They conclude that RCTs to date haven’t included enough patients who were followed over enough years to show screening has an effect on all-cause mortality.

But a deeper dive into the study produces interesting revelations. For CT lung cancer screening, Bretthauer et al didn’t include the landmark National Lung Screening Trial, an RCT that showed a 20% mortality reduction from screening.

• With respect to breast imaging, the researchers only included three studies, even though there have been eight major mammography RCTs performed. And one of the three included was the controversial Canadian National Breast Screening Study, originally conducted in the 1980s.

When it comes to colon screening, Bretthauer included his own controversial 2022 NordICC study in his meta-analysis. 

• The NordICC study found that if a person is invited to colon screening but doesn’t follow through, they don’t experience a mortality benefit. But those who actually got colon screening saw a 50% mortality reduction.  

Other articles in this week’s JAMA Internal Medicine series were penned by researchers well known for their opposition to population-based screening, including Gilbert Welch, MD, and Rita Redberg, MD.

The Takeaway

There’s an old saying in statistics: “If you torture the data long enough, it will confess to anything.” Among major academic journals, JAMA Internal Medicine – which Redberg guided for 14 years as editor until she stepped down in June – has consistently been the most hostile toward screening and new medical technology.

In the end, the arguments being made by screening’s foes would carry more weight if they were coming from researchers and journals that haven’t already demonstrated a longstanding, ingrained bias against population-based cancer screening.

Converting Clinical Documentation into Actionable Data

Is your department struggling with how to convert analog clinical documentation notes into actionable data that can be used in the EHR? Find out how Duke University turned that legacy information into structured data that can be used for registry reporting and analytics in this Intelerad white paper.

Unveiling the Power of Synthetic Medical Image Generation

Cutting-edge software solutions are transforming radiology by enabling the generation of synthetic medical images. Learn more about the potential of Subtle Medical’s SubtleMR and SubtleSYNTH applications in this September 21 webinar.

The Wire

• Ultra-Low-Dose Photon-Counting CT: In a new study in AJR, Swiss researchers generated pelvic CT exams at ultra-low radiation dose by combining photon-counting CT with image denoising. In a phantom study, researchers found that Siemens Healthineers’ Naeotom Alpha photon-counting CT scanner could acquire images at 0.05 mGy; after ClariPi’s ClariCT.AI denoising algorithm was applied, radiologists said they had better image quality than the lowest acceptable dose (0.1 mGy) on a conventional CT scanner. RadiologyInfo.org lists the radiation dose for conventional pelvic CT as 7.7 mSv.

• Reducing CT Scatter Radiation: In a related study, Japanese researchers found that imaging facilities can reduce scatter radiation that healthcare personnel are exposed to by performing CT scans with lower tube voltage. In Radiation Protection Dosimetry, researchers measured scatter radiation in a room in which CT scans were conducted at various tube voltages; lowering voltage from 120kVp to 80kVp produced a 30% drop in scatter radiation. The study follows recent research indicating that exposure to low doses of radiation – such as at occupational levels – could be more carcinogenic than previously thought.

• Radiaction Raises $13M: Israeli radiation protection developer Radiaction Medical has raised $12.6M in private equity funding that the company will use to boost its entry into the US market. The company has developed Radiaction Shield System, which proactively blocks over 90% of scatter radiation at the source of X-ray fluoroscopy systems like cardiac cath labs. The system got FDA clearance in 2022 and Radiaction has been signing on sales agents such as Cassling Partners. 

• Decision Aid Drives CT Lung Screening: In 140 veterans eligible for CT lung cancer screening, a web-based program explaining the concepts behind screening led to an increase in those who got screened over a control group (38% vs. 21%). In JAMA Network Open, researchers said their LCS Decision Tool (LCSDecTool) was used prior to a primary care appointment and could be a better way to implement shared decision-making than previous efforts. If implemented widely, the LCSDecTool could drive higher lung screening rates in the VA system. 

• MRI Shows Prenatal Antidepressant Changes: Women who used antidepressants in pregnancy gave birth to children who had differences in brain structure on MRI scans that persisted until age 15, says a new study in JAMA Psychiatry. Dutch researchers studied 3.2k mother-child pairs who were scanned from 2002 to 2006; the children of women who used selective serotonin reuptake inhibitors (SSRIs) during pregnancy had less cerebral gray matter and greater increases in volumes of the amygdala and fusiform gyrus. More research is needed on the implications of the findings.

• GE Partners on MRI Research: GE HealthCare has partnered with Mohawk College and McMaster University in Canada on the Centre for Integrated and Advanced Medical Imaging (CIAMI), a new facility in Hamilton, Ontario dedicated to MRI research, education, and patient care. The center will investigate a pilot approach to cutting patient wait times for MRI services, a major issue in Ontario. CIAMI is being funded in part by a $5M grant from the Ontario Ministry of Health.

• AI Combo Predicts Breast Cancer Risk: Combining ScreenPoint Medical’s Transpara AI software (V.1.7.0) with a homegrown algorithm for analyzing breast texture patterns led to better prediction of interval and long-term breast cancer risk in a study of nearly 120k Danish women in Radiology. With an AUC of 0.73, the combo model worked better than either Transpara AI (0.70) or the texture algorithm (0.66) working alone. Transpara was also key in the recent MASAI study showing AI’s usefulness for mammography screening in Sweden.

• Ferrum Platform on Oracle Cloud: AI platform developer Ferrum Health said its AI Platform has gone live on the Oracle Cloud Marketplace, giving Oracle customers access to AI algorithms ranging from cardiovascular to orthopedic specialties. Ferrum claims it is the first healthcare AI platform on Oracle’s marketplace. The company raised $6M in January 2023 and has been focusing on signing AI application developers like Riverain Technologies. 

• IVUS Shows Plaque Regression: In a new study in JAMA Cardiology, researchers performed a meta-analysis of 7.4k patients in 23 studies to investigate the link between lipid-lowering therapies, plaque regression, and rates of major adverse cardiac events (MACE). Intravascular ultrasound measurements of percent atheroma volume showed that every 1% reduction in plaque volume was associated with 17% lower odds of MACE. The analysis offers direct proof via IVUS of the effectiveness of pharmacological lipid-lowering therapies through plaque regression. 

• Siemens Launches Echo Scanner: Siemens Healthineers launched Acuson Origin, a new dedicated cardiovascular ultrasound scanner, at ESC 2023. The Acuson Origin includes a number of AI-powered features to improve consistency, reproducibility, and efficiency, such as auto-tracking on contrast images and 2D and 4D HeartAI tools that provide automated contouring and quantification of all four heart chambers. Siemens notes that heart failure incidence should grow 46% from 2012 to 2030, creating the need for new diagnostic and interventional tools.

• US2.ai Cuts Scottish Echo Waits: In other news from ESC 2023, results from the OPERA study showed how US2.ai’s echo AI solution improved heart failure (HF) screening in the NHS Greater Glasgow and Clyde in Scotland. The study of 900 patients with suspected HF scanned between January and August 2021 found the US2.ai-enabled screening pathway reduced echo waiting times from 12 months to under 6 weeks, which would allow 9x more suspected HF patients to be screened each year, while giving physicians more time for diagnosis and patient care.

• Imaging Detects Parasitic Worm: Australian researchers used CT and MRI to diagnose a woman with an 8cm parasitic roundworm in her brain. She was originally treated for fever and persistent cough; chest CT revealed hepatic and splenic lesions and migratory pulmonary opacities, but lab tests showed no evidence of parasites. The next year, she returned with symptoms of forgetfulness and depression; MRI showed a frontal lobe lesion that on removal was a living roundworm. The case study was covered in Emerging Infectious Diseases and fortunately includes images.

Second Opinions from 140+ Expert Radiologists

As a radiologist, have you ever wanted a second opinion? Now picture receiving a unified assessment from 140+ expert radiologists. That’s what you get from the Annalise.ai Enterprise AI solution. Discover how Annalise.ai can serve as your second reader.

AI in Radiology and the Considerations for Regulation

AI in healthcare has grown quickly, as have discussions about AI regulation. Listen to this on-demand webinar from Bayer and Calantic Digital Solutions to hear expert perspectives on the current and future state of AI governance in healthcare and radiology.

How Optellum Is Catching Cancer Early

Optellum has collaborated with GE HealthCare to get its software into more clinical settings around the world, and eventually integrate its precision lung cancer care platform with existing GE HealthCare imaging devices and cloud platforms. Read more on how Optellum is helping catch cancer at the earliest and most treatable stage.

The Resource Wire

• When it began implementing its AimSG nationwide AI program, Singapore’s Synapxe health technology agency relied on the CARPL.ai platform to make everything work. Learn more in this article. 

• 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. 

• Driven by a focus on R&D, United Imaging has increased its brand influence and market share worldwide. Get the details in the company’s first annual report since going public. 

• 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.

• Adding cardiac PET to your PET/CT practice may present challenges, but the potential clinical and operational benefits make it worthwhile. Learn how to get started in this webinar from Siemens Healthineers. 

• The flow of new AI applications makes it hard for radiology groups to determine which tools would help them and how IT teams can handle increased AI adoption. In this Blackford Analysis white paper, radiology and IT leaders from NYU and Canopy Partners share how a platform approach alongside a curated marketplace can help solve these challenges.

• EHRs are more than just digital filing cabinets – they are trusted tools that can help providers build and maintain engage and retain patients. Learn more about the benefits of EHRs in this article from PocketHealth. 

• Radiology follows a structured workflow to ensure accurate and timely imaging studies. Where workflow can break down – and where Enlitic’s Curie|ENDEX technology can help – is explained in this article.

• Strain imaging is the most sensitive parameter for determining myocardial deformation and systolic left ventricular function. In this video, see how echo AI from Us2.ai was used to analyze myocardial global longitudinal strain. 

• Arterys’ Cardio AI solution recently added a new Atrial Volumes feature that allows cardiologists and radiologists to easily quantify volumes for both left and right atria in cardiac MRI images.

• AI automates what radiologists can’t stand, surfaces what radiologists can’t see, and identifies what radiologists can’t miss. But only if it’s implemented in the way radiologists work. See how Nuance helps radiologists achieve these results through a single, streamlined, end-to-end AI experience.

• What were the top five topics from SIIM 2023? Brad Levin of Visage Imaging takes a look at what was hot in Austin this summer, with interest in CloudPACS topping the list. 

• What tools are available to help radiologists work remotely? In this case study, teleradiology provider 4ways Healthcare of the UK describes how they used Merative’s Merge PACS 8.0 platform to improve their service to clients while supporting remote radiologists.

• Imaging Partners of Orange County has renewed its relationship with Riverain Technologies for ClearRead CT with Clear Visual Intelligence (CVI). Find out how ClearRead CT can help you focus on actionable data for lung abnormalities in this article. 

• 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.