Isaac Kohane, MD, PhD, Editor-in-Chief of the New England Journal of Medicine’s new NEJM AI journal.

What were some of the hot topics at RSNA 2023? In this edition of The Imaging Wire Show, we caught up with Dave Wilson, vice president of marketing and communications at Enlitic, to discuss major trends at the meeting and new technologies the company was highlighting.

Imaging Wire Sponsors

Bayer  •  Blackford  •  CARPL.ai  •  Change Healthcare  •  Clearpath  •  Enlitic  •  GE HealthCare  •  Gleamer  •  Intelerad  •  Medality  •  Merge by Merative  •  Nuance  •  PocketHealth  •  Riverain Technologies  •  Siemens Healthineers  •  SpinTech MRI  •  Subtle Medical  •  United Imaging  •  Us2.ai  •  Visage Imaging

CT Scanners

How to Improve CT Lung Cancer Screening

As the US grapples with low CT lung cancer screening rates, researchers and clinicians around the world are pressing ahead with ways to make the exam more effective – especially in countries with high smoking rates. Two new studies published this week show the progress that’s being made.

In Brazil, researchers in JAMA Network Open found that using broader criteria to determine who should get CT lung screening not only expanded the eligible population, but it also reduced racial disparities in screening’s effectiveness. 

Researchers compared three strategies for determining screening eligibility: two based on 2013 and 2021 USPSTF criteria, and one in which all ever-smokers ages 50-80 were screened, finding: 

• Screening all ever-smokers generated the largest possible screening population (27.3M people) compared to USPSTF criteria for 2013 (5.1M) and 2021 (8.4M)
• Number of life-years gained if lung cancer is averted due to screening was highest with all-screening (23 vs. 19 & 21)
• But the all-screening strategy also had the highest number needed to screen to prevent one lung cancer death (472 vs 177 & 242)
• The USPSTF 2021 criteria reduced (but did not eliminate) racial disparities; the USPSTF 2013 criteria produced the greatest disparity 

The authors said the results showed that CT lung cancer screening in Brazil could identify 57% of preventable lung cancer deaths if 22% of ever-smokers are screened. Their study should help the country decide which screening strategy to adopt. 

In a second paper in the same journal, researchers from China described how they performed CT lung cancer screening via opportunistic screening, offering low-dose CT scans to patients visiting their doctor for other reasons, such as a routine checkup or a health problem other than a pulmonary issue. Among 5.2k patients, researchers found that people who got opportunistic LDCT screening had:

• 34% lower risk of lung cancer death by hazard ratio
• 28% lower risk of all-cause mortality
• 43% received their lung cancer diagnosis through opportunistic screening

The Takeaway

This week’s studies continue the positive progress toward CT lung cancer screening that’s being made around the world. Both offer different strategies for making screening even more effective, and add to the growing weight of evidence in favor of population-based lung screening.

The Complete Guide to Radiology AI

Radiology is leading healthcare’s AI revolution, and yet many people in radiology are just starting to build their understanding of AI. That’s why Bayer published its truly Complete Guide to Artificial Intelligence in Radiology, detailing how AI can address radiology’s challenges, AI’s core use cases, and AI’s path towards adoption.

Theranostics – The Future of Personalized Care

Join your peers and leadership from GE HealthCare to hear how advances in precise diagnostics and therapies are evolving to deliver Theranostics. GE HealthCare’s comprehensive solutions connect every step in molecular medicine, helping to create a world where healthcare has no limits.

The Wire

• No-Contrast CT Project Launches: A European project has been launched to develop methods for eliminating the use of iodinated contrast media for CT scans. Called the NetZeroAICT Consortium, the coalition of 20 members sees environmental and patient-care benefits to reducing contrast, which is used in 60% of CT scans. They are focusing on a University of Oxford-developed technique called CT Digital Contrast, which uses AI to synthesize contrast-like images from non-contrast scans. NetZeroAICT is creating a repository of 1M cases to be available for research.  

• Gadopiclenol MRI Contrast Milestone in Europe: In other European contrast news, the European Commission has granted marketing authorizations to Bracco and Guerbet for their formulations of gadopiclenol, a high-relaxivity MRI contrast agent that can be used at half the dose of other gadolinium-based contrast agents. The companies co-developed gadopiclenol and each has marketing rights; Bracco is selling its version as Vueway while Guerbet’s formulation is Elucirem. They received US marketing authorizations in September 2022. 

• New Google AI Foundation Model: Hot off its launch of the Gemini generative AI algorithm, Google this week upped the ante by debuting MedLM, a family of foundational generative AI algorithms fine-tuned for healthcare applications. The family was built on the company’s Med-Palm2 model and is available in two flavors: one for larger, more complex tasks, and a second version that can be fine-tuned for “scaling across tasks.” Google partners that have been working with MedLM – including Augmedix, HCA Healthcare, and Accenture – have already built it into specific healthcare applications. 

• Self-Scheduling Mammograms: Letting patients schedule their own screening mammograms through an EHR portal led to a big increase in breast screening rates. In a study in American Journal of Preventive Medicine, UPenn researchers analyzed completion and screening rates over 35k patient visits before and after they added self-scheduling to their EHR for women with a clinician referral (women were not allowed to self-refer). They found that mammogram completion rates rose by 15 percentage points, and the overall screening rate more than doubled (50% vs. 22%). 

• Benign Breast Disease Linked to Cancer Risk: A diagnosis of benign breast disease may not be so benign. In JAMA Surgery, researchers found that in a population of 4.8k women, those diagnosed with benign breast disease via percutaneous breast biopsy had nearly two times the standard incidence ratio of breast cancer (SIR=1.95) over an 11-year follow-up period. The findings could affect the debate around overdiagnosis with screening mammography, and whether benign findings should really be considered overdiagnosis because they can help stratify future cancer risk.

• Sectra Lands Big Scottish Contract: Sectra has received a massive contract from NHS National Services Scotland to provide its Sectra One Cloud cloud-based enterprise image management technology to NHS trusts throughout Scotland. The deal covers 15 NHS boards that handle some 5M radiology exams a year, and replaces a contract with Scotland’s current supplier that’s due to end in 2026. Sectra will provide its technology on a SaaS basis, and will migrate 55M imaging exams to a single instance of Sectra’s enterprise imaging service.

• Chest X-Ray AI Makes Rads Faster, Better: Radiologists in France who used Gleamer’s ChestView AI algorithm to interpret chest X-rays read images 31% faster with better accuracy. In Radiology, researchers had radiologists use ChestView AI to retrospectively interpret 500 radiographs; they saw an absolute increase in sensitivity for five lung pathologies (range of 6-26 percentage points) while specificity improved for all five conditions (2.1 to 3.9 percentage points) except pneumothorax (-0.2 percentage point). Mean reading time also fell (56 vs. 81 seconds).

• GPT-4 Beats Clinicians for Disease Prediction: GPT-4 performed better than clinicians across five clinical indications in predicting disease probability. In JAMA Network Open, researchers gave patient clinical histories to GPT-4 and asked it to predict their probability of disease before and after diagnostic tests. GPT-4 had lower mean absolute percentage error than clinicians after a negative result for chest X-ray of pneumonia (11% vs. 40%) and breast screening (0.2% vs. 11%), as well as other non-imaging tests. GPT-4 did not perform as well for positive tests.

• Chest Imaging Studies to Watch in 2024: Two ongoing clinical studies investigating chest imaging were featured on Nature Medicine’s list of top 11 clinical trials to watch in 2024. In the LungIMPACT study in the UK, researchers are using Qure.ai’s qXR AI algorithm to analyze chest X-rays in 150k patients to find early signs of lung cancer. In the 4-IN THE LUNG RUN study in five countries in Europe, 24k patients will be analyzed to find the best screening interval after negative initial CT lung cancer screening.

• Imaging Vendors Join AdvaMed: Multiple medical imaging vendors that were members of Medical Imaging & Technology Alliance (MITA) have joined a new medical imaging division at medical device trade group AdvaMed. The companies include Bayer, Fujifilm Sonosite, GE HealthCare, Hologic, Philips, and Siemens Healthineers, and GE HealthCare CEO Peter Arduini has been elected chair. What’s more, former MITA executives Patrick Hope and Peter Weems left to join the new AdvaMed division. MITA’s parent, the National Electrical Manufacturers Association, said it is maintaining MITA and vendors can be members of both groups. 

• LifeVoxel Debuts GPU-Based Platform: LifeVoxel has debuted AImagine, an imaging IT platform designed to provide multiple radiology clinical applications to imaging centers on a SaaS basis, including a viewer, RIS, revenue cycle management, 3D/4D imaging, and VNA. The company claims the platform can render 8k 3D images with zero latency over its AI Cloud technology, which is based on three GPU servers located in the US. LifeVoxel raised $5M in a seed round in 2021.

• NY Hospital Hit with $120M Malpractice Verdict: Westchester Medical Center in New York was hit with a massive $120M malpractice verdict after a jury trial in which plaintiff’s attorneys claimed that a three-hour delay in stroke diagnosis caused extensive brain damage to a 41-year-old man now living in a residential care facility. Attorneys said resident physicians were on call when the man arrived at the hospital in the early morning, and they allegedly missed a basilar artery occlusion on a CT scan that was later found by an attending radiologist.

The Big Picture at Intelerad at RSNA 2023

What was in the big picture at Intelerad Medical Systems at RSNA 2023? Check out this video interview with President Morris Panner about the company’s accomplishments in 2023 and its plans for 2024, including a big focus on image exchange.

Innovations in Neuroimaging

What are some of the latest innovations in neuroimaging that can lead to workflow improvements at imaging facilities? Learn more in this presentation from the ASNR webinar series, supported by Subtle Medical.

Revolutionizing Chest X-Ray Reporting

A new study in Radiology shows how Gleamer’s ChestView AI solution is revolutionizing chest X-ray reporting by helping radiologists detect lung abnormalities with greater accuracy while also reducing interpretation times.

The Resource Wire

• What Does Improved MRI Efficiency Mean? There’s a growing need for practical, cost-effective solutions to improve efficiency in MRI and other modalities. Read this article from Karen Holzberger of SpinTech MRI and James Backstrom, MD, to learn how the company’s STAGE software can help. 

• Overcoming Challenges to Achieving Quadruple Aim Goals: Watch a highlight from RSNA explaining how to overcome barriers and achieve your quadruple aim goals like population health, patient experience, avoiding revenue loss and increasing staff wellness. Presented by PocketHealth CEO Rishi Nayyar.

• What’s the Latest News from United Imaging? 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. 

• Focus on Actionable Data: Riverain Technologies’ ClearRead technology is the first FDA-cleared Clear Visual Intelligence (CVI) system that improves both detection and reading time for lung abnormalities. Learn more in this article. 

• Benefits of Cloud and AI for Medical Imaging: Check out this white paper from Merge by Merative to learn how a cloud-first approach for modern imaging solutions can ensure accessibility and efficiency, addressing the pressing need for change in radiology.

• Automated Solutions for Patient and Provider Sharing: What’s the latest news from Clearpath? Find out how its fully automated patient and provider solutions for sharing medical records and images are making waves in healthcare.

• CARPL adopted in Singapore: 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. 

• New Guidelines on Heart Failure Management: The ESC has updated its heart failure guidelines, for the first time including a guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF). Learn how to trust echo AI to find these cases earlier in this video from Us2.ai. 

• An Integrated Approach to Radiology AI: 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.

• The Benefits of an AI Accelerator: What is an AI accelerator, and how can it impact your practice? Learn about the Visage AI Accelerator program and its impact on research and clinical practice in this video from Visage Imaging. 

• Overcoming the Radiologist Shortage: 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.

• 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.

• The Immense Potential of Photon-Counting CT: Early adopters of photon-counting CT impacted patient care by performing scans that were previously impossible. Check out this Siemens Healthineers resource of peer-reviewed papers showing the immense potential of photon-counting CT.

• Major Milestones in Platform AI: It’s been a busy year for AI platform developer Blackford. We reviewed the company’s major milestones in this video interview from RSNA 2023, in which we talked to Blackford executives David Hilderbrand and Anthony Cammack. 

• Calculate Your Cost Savings: Instantly calculate your savings from data standardization with the Curie|ENDEX solution using Enlitic’s ROI Calculator. ENDEX conforms messy metadata to a standard convention, making it searchable and making hanging protocols more reliable.