Ernst Kuipers, MD, PhD and Manon Spaander, MD, PhD, in an editorial in JAMA Internal Medicine on a controversial 2023 study that questioned the value of cancer screening.

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  •  TeraRecon  •  United Imaging  •  Us2.ai  •  Visage Imaging

CT Scanners

CT Lung Screening’s Downstream Costs

The growing momentum of CT lung cancer screening was a major radiology news story in 2023. And while things are looking up as 2024 begins, there are still important issues to be sorted out for CT lung screening to achieve the same level of acceptance as other major cancer screening tests. 

A new study called PROSPR in Annals of Internal Medicine highlights some of these challenges. 

• Researchers found a higher rate of invasive procedures and complications after CT screening compared to the National Lung Screening Trial, the landmark study that showed that low-dose CT screening reduces lung cancer mortality by 20%. 

The PROSPR researchers studied 9.3k individuals who got baseline LDCT lung screening scans from 2014 to 2018 across five US healthcare systems, finding: 

• Abnormalities on baseline CT scans for 1.5k individuals (16%)
• Of these, 9.5% were diagnosed with lung cancer within 12 months 
• A 32% rate of downstream imaging of screened individuals 
• A 2.8% rate of invasive procedures such as needle biopsy and bronchoscopy 
• In those who got invasive procedures, rates were higher than NLST for all complications (31% vs. 18%) and for major complications (21% vs. 9.4%)

What gives with the higher complication rates? 

• One explanation is that the PROSPR population was older and sicker than in NLST, with more individuals 65 and over (52% vs. 27%) and higher rates of current smoking (55% vs. 48%) and COPD (35% vs. 18%). 

Another reason could be that PROSPR’s population was more racially diverse, with fewer Whites than NLST (73% vs. 91%) and with a higher proportion of women (47% vs. 41%) – a sign of healthcare disparities. 

The PROSPR authors acknowledged that their findings could shift the debate over the benefits and harms of CT lung cancer screening in community practice – a debate that has raged in breast screening for decades.

The Takeaway

The PROSPR findings are something of a wake-up call amid the growing enthusiasm worldwide for CT lung cancer screening. It’s no surprise that real-world results will differ from the highly controlled environment of a clinical study like NLST, but lung screening proponents will need to be prepared with a plan for managing downstream findings and a response to screening skeptics who would use results like PROSPR to question whether lung screening should be performed at all.

Experience the Healthcare Revolution

Did you experience the healthcare revolution with United Imaging at RSNA 2023? From the uAIFI Technology Platform to the uDR 380i Pro mobile X-ray system, check out how United Imaging technologies are reshaping healthcare in this video.

Clearly Superior Chest X-Ray Imaging

Chest X-rays can help identify many abnormalities, but interpretation is often difficult due to obstructing bone, patient positioning, and image quality. Book a demo to see how Riverain’s ClearRead Xray with Clear Visual Intelligence provides a clearly superior view of the chest.

The Wire

• Blowback to Cancer Screening Study: While we’re on the subject of screening skeptics, several letters in JAMA Internal Medicine criticized a controversial 2023 study that made headlines questioning the lifetime gains of most cancer screening exams. The letters challenged the research methodology used by Bretthauer et al to conclude that most screening exams lack justification because they weren’t proven to reduce all-cause mortality. The letters claim that Bretthauer et al itself was underpowered, had too short a follow-up period, and underestimated the proven drop in cancer mortality since the screening era began.

• Volpara Touts Breast Imaging Studies: Volpara Health is highlighting two recently published studies using its technology for mammogram quality and breast density assessment. In a paper in European Radiology, Italian radiographers using the company’s Volpara Analytics software saw up to a 16% improvement in image quality. In the second study, in Medical Physics, researchers discussed a new model for breast radiation dosimetry that will use more realistic estimates of breast density; the model will be incorporated into Volpara’s TrudRadDose algorithm for analyzing patient radiation exposure from mammograms. 

• Can Genetic Tests Delay Breast Screening? Can genetic tests be used to delay the start of mammography screening in women at low breast cancer risk? In JAMA Oncology, researchers tested this concept in 25.6k women, finding that those classified as low risk took six years longer to hit an initial threshold level of breast cancer incidence compared to average-risk women (51 vs. 45 years), and eight years longer to hit a second threshold (58 vs. 50 years). Researchers said mammography could be delayed 5-10 years in low-risk women. 

• Siemens Gets Dual-Source CT Clearance: Siemens Healthineers has received FDA 510(k) clearance for Somatom Pro.Plus, a new dual-source CT scanner designed to make dual-source imaging available to a wide range of imaging facilities, including community and rural hospitals. Pro.Pulse sports a smaller footprint and uses an air-cooled design that enables it to be sited in a 31% smaller space than water-cooled DSCT scanners. It also consumes less power than conventional DSCT systems. 

• Nurea Adds Platform Partners: French imaging software developer Nurea closed 2023 with a bang, signing two new AI platform partners for its PRAEVAorta 2 application for analyzing cardiovascular CT images. First, Blackford is adding PRAEVAorta 2 to its Blackford Platform, integrating it with the company’s enterprise AI offering. Next, deepc said it is adding PRAEVAorta 2 to its deepcOS platform. PRAEVAorta 2 gives users the ability to visualize aorta status through geometrical data; the deals are a major boost to Nurea’s commercialization efforts.

• Software Helps Liver Lesion Reporting: Kailo Medical’s SonoReview software for liver lesion reporting helped researchers cut reporting time by almost 50% in a study in Journal of Ultrasound in Medicine. Researchers aided by SonoReview read contrast-enhanced ultrasound exams of focal liver masses in 147 patients; instead of prose reporting they used synoptic reporting, defined as AI-enabled reporting and LI-RADS categorization. Turnaround times for synoptic reporting were much faster (11 vs. 20 minutes), and researchers reported benefits with consistency and accuracy in documentation, as well as report completeness. 

• Enlitic Partners with Infinitt: Enlitic and Infinitt have joined forces in a partnership that will make Enlitic’s ENDEX data standardization solution available to customers of Infinitt’s PACS software. ENDEX will be integrated into Infinitt’s PACS applications, standardizing image presentation and improving efficiency and diagnostic workflow. The deal is also expected to streamline the AI orchestration process, further saving time for medical professionals.

• Quibim Launches Brain AI Software: Quibim is launching its new QP-Brain AI software for quantitative analysis of brain MRI scans to detect neurodegenerative disease after receiving regulatory approvals in the US, European Union, and UK. QP-Brain measures brain regions to detect subtle alterations and provides quantitative information via the PACS. The new application complements Quibim’s QP-Prostate solution, which has been approved in the US and Europe and is being integrated into Philips MRI protocols through a deal announced in late 2023. 

• Final RSNA Attendance up 7%: RSNA has released final attendance numbers for RSNA 2023 showing attendance breaking through the 40k barrier, to 40,661 registrants. That’s up 7% compared to almost 38,000 final registrants at RSNA 2022. The numbers continue a positive rebound from 2021, when only 23,000 attendees showed up at McCormick Place for the first in-person show after the pandemic, but it’s still a far cry from attendance figures for the last pre-pandemic show, which had 47,000 attendees.

• AI Improves Breast Ultrasound: Koios Medical’s AI software for analyzing breast ultrasound scans for cancer could serve as a second opinion to radiologists, turning in high sensitivity (99%) without evidence of racial or ethnic bias. In Journal of Medical Imaging, researchers reported on their use of breast ultrasound AI in 1.8k biopsy-proven cases from nine imaging facilities. Although it was a highly diverse patient population, the software did not show racial or ethnic bias in its results, which has been an issue for AI in general. 

• Philips Recalls 1T MRI Scanner: The FDA reports that Philips is recalling Panorama 1.0T HFO MRI scanners due to “risk of explosion” during a quench procedure — the FDA said the recall affects 150 scanners in the field. The FDA notes that there has been one explosion in 22 years of use, and no reports of injury or death. This model of scanner was involved in an adverse event report filed with the FDA’s MAUDE database in October 2023 in which a broken quench pipe caused a helium buildup.

The Right Approach to AI Adoption

Discover the right approach to AI adoption and the transformative impact of CARPL.ai in accelerating the clinical implementation of AI, driving ROI, and revolutionizing patient care in this video featuring leaders from Radiology Partners and University Hospitals, Cleveland.

Give Your Patients the Experience They Want

Empower patients to take control of their healthcare journey by giving them mobile access to their records and images with Clearpath, the world’s first digital fulfillment platform for records and films. Book a demo today.

Lessons of Cloud Image Management

What has radiology learned so far as it adopts wider use of cloud-based medical image management? In this Imaging Wire Show, we talked to Ran Rumianek of Change Healthcare about how now is the right time to begin moving imaging data to the cloud.

The Resource Wire

• AI Improves Hand and Wrist Fracture Detection: Learn how Gleamer’s BoneView AI algorithm for detecting fractures in the hand and wrist on X-ray improved radiologist performance in a recent paper in European Radiology. 

• AI’s Rapidly Growing Role in Medical Imaging: AI holds immense potential to drive productivity and efficiency gains for organizations, including healthcare. In this downloadable white paper from TeraRecon, learn about AI’s rapidly growing role in medical imaging.

• Exploring the Full Potential of Photon-Counting CT: The potential of photon-counting CT is creating continued excitement in radiology. New detector technology along with AI and image reconstruction techniques will push the frontiers of CT and promise game-changing innovations. Read how GE HealthCare is exploring the full potential of photon-counting CT.

• AI Applications in Neuroradiology: What are the most common AI applications in neuroradiology? This downloadable e-book from Bayer and Calantic Digital Solutions reviews the most common AI applications for brain imaging and the evidence behind them.  

• A Milestone Study for Cardiac Strain Analysis: Us2.ai’s deep learning algorithm was able to interpret echo AI left ventricular strain images with similar accuracy as conventional measurements. Read all about this milestone study and its implications for patient management in EHJ-Digital Health. 

• 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.

• Start at the Source to Improve MRI: Looking for ways to improve MRI speed and image quality while addressing broader concerns in healthcare? The answer may lie in proven MRI physics in your existing scanner – learn how to unlock it with STAGE from SpinTech MRI. 

• Radiology’s Changing Training Needs: Radiology is getting more sub-specialized — but is that contributing to the growing workforce shortage? And how can radiologists get the training they need to match changing requirements? We talked about these trends with Daniel Arnold, founder and CEO of Medality, in The Imaging Wire Show.

• 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.

• How Valley View’s Integrated Healthcare Network Uses PocketHealth in Parallel with PowerShare: Valley View Hospital in Colorado wanted to share images and records with patients while continuing to use its existing PowerShare implementation for providers. Find out how PocketHealth helped them do it in this article. 

• New Industry Research on Cloud in Imaging: 77% of imaging organizations rely on cloud – but most still haven’t fully integrated cloud or maximized its potential. Check out the new industry research report from Merge by Merative on enterprise cloud adoption and its challenges.

• Do You Spend Too Much Time Routing Data? Find out how to automate image data routing in Enlitic’s Live Fast 5, a 5-minute live presentation at 12 pm ET on January 11 where you can get your questions answered. 

• The Benefits of Breast Imaging AI: Breast imaging AI can help providers reduce their workload and improve patient care. Blackford Analysis offers a wide selection of breast imaging AI apps on its Blackford Platform – find out how they could benefit your organization. 

• Top 5 Trends from RSNA 2023: What were the top 5 trends from RSNA 2023? Check out this review from Brad Levin of Visage Imaging on the topics and technologies that took center stage in Chicago. 

• The Complete, In-Office MRI Solution: Looking for a way to improve your orthopedic practice’s service to existing patients while attracting new ones and drive ancillary business? Discover how the MAGNETOM Free.Max MRI scanner from Siemens Healthineers is the complete, in-office MRI solution.