Rasu Shrestha, MD, of Advocate Health, on RSNA 2023.

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Artificial Intelligence

AI’s Incremental Revolution

So AI dominated the discussion at last week’s RSNA 2023 meeting. But does that mean it’s finally on the path to widespread clinical use? 

Maybe not so much. For a technology that’s supposed to have a revolutionary impact on medicine, AI is taking a frustratingly long time to arrive. 

Indeed, there was plenty of skepticism about AI in the halls of McCormick Place last week. (For two interesting looks at AI at RSNA 2023, also see Hugh Harvey, MD’s list of takeaways in a post on X/Twitter and Herman Oosterwijk’s post on LinkedIn.) 

But as one executive we talked to pointed out, AI’s advance to routine clinical use in radiology is likely to be more incremental than all at once. 

• And from that perspective, last week’s RSNA meeting was undoubtedly positive for AI. Scientific sessions were full of talks on practical clinical applications of AI, from breast AI to CT lung screening. 

Researchers also discussed the use of AI apart from image interpretation, with generative AI and large language models taking on tasks from answering patient questions about their reports to helping radiologists with dictation.

It’s fine to be a skeptic (especially when it comes to things you hear at RSNA), but for perspective look at many of the past arguments casting doubt on AI: 

• AI algorithms don’t have FDA clearance (the FDA authorized 171 algorithms in just the past year)
• You can’t get paid for using AI clinically (16 algorithms have CPT codes, with more on the way) 
• There isn’t enough clinical evidence backing the use of AI (tell that to the authors of MASAI, PERFORMS, and a number of other recent studies with positive findings)
• The AI market is overcrowded with companies and ripe for consolidation (what exciting new growth market isn’t?)

The Takeaway

Sure, it’s taking longer than expected for AI to take hold in radiology. But last week’s conference showed that AI’s incremental revolution is not only advancing but expanding in ways no one expected when IBM Watson was unveiled to an RSNA audience a mere 6-7 years ago. One can only imagine what the field will look like at RSNA 2030.

Looking for more coverage of RSNA 2023? Be sure to check out our videos from the technical exhibit floor, which you can find on our new Shows page.

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The Wire

• RSNA 2023 Attendance Grows: Are you a glass half full or glass half empty kind of person? That could affect how you interpret preliminary attendance figures from RSNA 2023, which pegged attendance at 34.2k in-person attendees, of whom 17.7k were professional attendees. The good news is that total 2023 advance attendance was up 11% compared to the same point in 2022 (30.9k) and up sharply from 2021 (23k); the bad news is that 2023 was still far below advance registration at RSNA’s last pre-pandemic show in 2019 (47k total, 21.8k professional). The numbers should edge up when RSNA releases final figures.

• Wide-Bore MRI Leads GE at RSNA 2023: A new wide-bore 1.5T MRI scanner called Signa Champion led GE HealthCare’s new product introductions at RSNA 2023. Champion sports a 70cm bore and the company’s AIR Coils, and is compatible with AIR Recon DL reconstruction. Other GE RSNA highlights included clearance of its Critical Care Suite 2.1 with a pneumothorax mobile X-ray AI algorithm, and the release of the MyBreastAI Suite of AI algorithms, including three from iCAD. In CT, GE added TrueEnhance DL to its Effortless Recon DL portfolio of reconstruction algorithms, and expanded its TrueFidelity DL to lung and extremity imaging. In ultrasound, GE expanded its Verisound reporting and collaboration tools to the Logiq E10 scanner, and showed AI guidance from Caption Health on its Venue POCUS scanners.    

• Mammography Saves Lives: Women who attended mammography screening had a 72% lower risk of breast cancer death versus those with no screening. In an RSNA 2023 paper presented by the American Cancer Society’s Robert Smith, PhD, researchers looked at 36k Swedish women with breast cancer from 1992 to 2016; 4.6k women died of the disease. In addition to the lower breast cancer death rate, survival rates were higher for women who got all five screening rounds compared to those who got no screening (range of 83-87% vs. 59-78%). 

• Canada Postpones New Breast Screening Guidelines: Canadian breast imaging specialists will have to wait a little longer for an update of the country’s breast screening guidelines. The Canadian Task Force on Preventive Health Care said it would be publishing the updated guidelines in spring 2024 rather than late 2023 due to “the volume and complexity of the workload.” Current national guidelines call for breast screening to start at 50, but the USPSTF and Canadian provinces are lowering the age to 40, prompting the Canadian group to open a review. 

• Ultrasound Paces Siemens at RSNA: Siemens Healthineers at RSNA 2023 launched Acuson Maple, a new ultrasound scanner that extends the company’s cart-based line to the private practice and multi-disciplinary imaging segment. In CT, the company touted the Somatom Pro.Pulse scanner it released just prior to the show, and announced that 500k patients have been scanned with its Naeotom Alpha photon-counting CT scanners. The Biograph Vision.X PET/CT scanner that recently got FDA clearance was highlighted, while Ciartic Move is a new mobile C-arm system. The Ysio X.pree radiography system has received new high-resolution detectors in three sizes, while in MRI the company is awaiting FDA clearance on the Magnetom Cima.X 3T and Terra.X 7T scanners.  

• Stronger Muscles Stave Off Knee Replacement: It may be a bad idea to skip leg day at the gym. A study presented at last week’s RSNA 2023 meeting used 3T MRI to evaluate the thigh muscles of 134 people in an osteoarthritis study, half of whom underwent single total knee replacements and half who were controls. Those with a higher ratio of quadriceps muscle to hamstring volume had lower odds of total knee replacement. 

• FDA Reports Gun Incident in MRI Suite: While we’re on the subject of bad ideas, a 57-year-old US woman learned first-hand why you don’t walk into an MRI suite with a loaded gun (or any kind of gun for that matter). An adverse event report on the FDA’s website details the incident, in which the weapon discharged after it was drawn into the magnet and fired a bullet into the patient’s right buttock. Fortunately the wound was superficial and she was discharged after treatment. The episode echoes a fatal accident earlier this year in which a Brazilian man was fatally shot. 

• Nuance Adds Impressions to PowerScribe: Nuance Communications at RSNA 2023 introduced PowerScribe Smart Impression, a tool that uses generative AI to draft impressions for radiology reports created with the company’s PowerScribe reporting tool. Nuance says users of the new tool report that it’s saving up to 1 minute per case, time savings that can help alleviate radiologist burnout. Smart Impression is already being used at Mass General Brigham and Quantum Radiology, among others. 

• 4DMedical Signs MOU with Philips: Australian lung imaging developer 4DMedical has signed an MOU with Philips covering sales of its XV technology in North America, with XV added to Philips’ catalog as a third-party solution. XV offers a unique way to image lung diseases by giving radiologists 4D color-coded views of lung airflow and blood flow. The company sees XV as useful for military veterans exposed to toxic chemicals such as burn pits, and Philips is a major supplier of imaging systems to the US Veterans Health Administration. 

• Philips Helium-Free Mobile MRI: Among the Philips highlights at RSNA 2023 was a 1.5T helium-free MRI magnet installed in a mobile coach; the scanner uses the company’s BlueSeal technology and offers lower operating costs. Philips also introduced AI Manager, and displayed the cloud-based HealthSuite Imaging software it launched at HIMSS 2023. In X-ray the company featured the Radiography 7000 M mobile and Radiography 7300 C premium digital radiography systems, while in ultrasound the Epiq Elite 10.0 and Affiniti scanners were highlighted. Finally, Philips debuted a new biplane configuration of the Azurion 7 image-guided therapy system.

• Bayer Adds AI Partners, Touts Contrast Study: Bayer has made several new additions to its stable of AI partners in radiology. The company cemented deals with Perspectum, Brainomix, Qure.ai, Keya Medical, and ImagineSoftware, giving its users access to new AI applications in liver, neurology, and thoracic imaging. Bayer also touted its Calantic SPARK AI accelerator program. On the contrast side, Bayer highlighted results from the phase II QUANTI study presented at RSNA 2023 on gadoquatrane, a high-relaxivity MRI contrast agent. The study found that a half-dose of gadoquatrane was equivalent to a full dose of gadobutrol; a phase III study will follow. 

• Arineta Gets FDA Nod, Taps Ryan As CEO: Cardiac CT developer Arineta Cardio Imaging has received FDA 510(k) clearance for a new deep learning imaging reconstruction (DLIR) protocol for its SpotLight family of CT scanners. DLIR uses a convolutional neural network algorithm to process images, improving image quality and reducing noise. Separately, the company announced that longtime imaging executive Doug Ryan has joined the firm as CEO. Ryan has served leadership stints at Siemens Healthineers, Samsung, and Toshiba America Medical Systems. 

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The Resource Wire

• Expanding Your Talent Pool with Teleradiology: Teleradiology can be a force multiplier in radiology. Watch this Medality webinar recording with Daniel Corbett of Radiology Business Solutions to learn the pros, cons, and essential factors for private practice leaders considering teleradiology integration.

• Improving the Patient Experience: How is Clearpath improving the healthcare experience for patients? Learn more about the company and its solutions for ditching the disc when sharing images and records with patients. 

• Circulation on the Run: Looking for a weekly summary of hot cardiovascular topics in the journal Circulation? Check out Circulation on the Run, a podcast series featuring Carolyn Lam, MBBS, of echo AI developer Us2.ai. 

• Clearer MRI for Alzheimer’s Disease: Clinicians and patients are encouraged by new drugs available to slow or reduce cognitive decline and Alzheimer’s disease. Learn how 30% faster MRI scans and clearer images enabled by SpinTech MRI’s STAGE software can help address imaging challenges. 

• The Clinical Value of Soft-Tissue Chest X-Ray: Soft-tissue techniques can improve the visibility and accuracy of chest X-ray.  Learn about two important soft-tissue methods – bone suppression and dual-energy subtraction – in this white paper from Riverain Technologies.

• The Journey to Cloud-Based PACS: Radiology is looking closely at cloud-based PACS as an alternative to on-premises digital image management. We discuss this emerging trend with key opinion leaders who have made the switch with Visage Imaging in the latest edition of The Imaging Wire Show.

• The Case for Enterprise Cloud: Is your organization ready to move enterprise imaging to the cloud? Check out this Change Healthcare and ACHE webinar detailing cloud-native imaging’s benefits, best practices, and ROI.

• Next-Generation Radiology Reporting: Join the conversation in this webinar recording and hear from PACS administrator Griff R. Van Dusen of Memorial Health System how Nuance PowerScribe One’s next-generation reporting experience helps streamline workflow and improve report quality so radiologists can get more done in less time. 

• Clinical Decision-Making with CEM: Learn more about contrast-enhanced mammography (CEM) in this on-demand recording of a GE HealthCare Clinical Conversations webinar featuring Gaelyn Scuderi, MD, in which she discusses impactful cases and the value she sees in CEM.

• The Power of Enterprise Image Exchange: Exchange medical data across the enterprise and grow your referrals and patient transfers. Share images in real-time – no VPN or CDs required – with Intelerad’s Enterprise Image Exchange.

• A Commitment to Innovation: Gleamer is now featured in the AlbionVC European HealthTech Market Map 2023! This showcases Gleamer’s commitment to innovation in digital care and pharma across Europe. 

• 5 Questions about Lung Cancer and AI: Lung cancer causes more deaths globally than colon, breast, and colon cancer combined. But technologies like AI and low-dose CT screening can help. Learn more in this Q&A with Ankur Sharma, MD, head medical affairs digital radiology at Bayer. 

• Memorial MRI’s Choice for Patient Comfort: Texas has one of the highest obesity rates in the US. So to best serve its patients, Memorial MRI & Diagnostic in Houston turned to United Imaging and its 3.0T uMR OMEGA MRI scanner with 75cm ultra-wide-bore. Learn more about their story. 

• How Thomas Jefferson Leveraged CARPL.ai: See how Thomas Jefferson University relied on CARPL.ai to accelerate its AI validation and clinical adoption in this presentation by informatics and AI leader Dr. Paras Lakhani.

• How AI Tools Enable Fast, Low-Dose Imaging: 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.