Joshua Hirsch, MD, on a new study evaluating the growth of CTA imaging in the emergency setting.

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Brain Imaging

Is Head CT Overused in the ED?

A new study suggests that head CT could be overused in the emergency department for patients presenting with conditions like headache and dizziness. Writing in a paper in Internal and Emergency Medicine, researchers looking at CT angiography use at a large medical center found a big increase in CTA utilization – even as the rate of positive findings dropped. 

CTA is a powerful tool that can quickly and efficiently give clinicians information to guide treatment of acute neurovascular conditions like aneurysm and stroke. 

• As such, many emergency departments have been installing their own CT scanners to enable them to scan emergent patients without transporting them to the radiology department. 

But with great power comes great responsibility, and there is always the temptation to scan first and ask questions later. 

• To better understand changing CTA use in the emergency setting, researchers from the Harvey L. Neiman Health Policy Institute analyzed CTA exams at a level 1 trauma center that sees about 110k emergency patients a year.

Researchers analyzed 25k ED visits from 2017 to 2021 and correlated them to head and neck CTA exams for headache and/or dizziness, finding …

• The rate of CTA exams rose 64%, from 7.9% of ED visits to 13%
• Symptomatic patients were 15% more likely to have a CTA in 2021 versus 2017
• The rate of positive CTA findings fell 38%, from 17% to 10%
• Patients with private insurance were more likely to have CTA (OR=1.44)
• Black patients were less likely to be scanned (OR=0.69)

The researchers said the findings indicate the need for better clinical decision support tools, which they believe can help emergency physicians provide an accurate diagnosis without exposing patients to unnecessary radiation and incurring additional cost. 

The Takeaway

This study further confirms widespread accounts that head and neck CTA is overused and on the rise. As the US government backs off on its attempt to force clinical decision support on referring physicians, it may be up to health systems and providers themselves to ensure more appropriate utilization – in a way that doesn’t rely on heavy-handed tools like prior authorization. 

AI and Matters of the Heart

As clinicians face increasing pressure from all sides, can AI provide some much-needed breathing space? In this article from Blackford, learn more about how AI is assisting with cardiac imaging with modalities ranging from CT to echocardiography.

Simplifying Image Exchange to Generate Savings

Guadalupe Regional Medical Center (GRMC) and Methodist Hospital implemented a PocketHealth Community Gateway that saved over 1,700 staff hours. Read how they streamlined image exchange, improved operational efficiencies, and ensured seamless continuity of care for patients at both sites.

The Wire

• Telerad Group to Pay $3.1M Over Ghosting Claims: A teleradiology provider based in Atlanta has agreed to pay $3.1M to settle federal charges that it practiced “ghosting” by using contractors in India to interpret imaging exams that allegedly were “rubber stamped” by US radiologists. US officials charged that The Radiology Group and its CEO Anand Lalaji, MD, did not adequately ensure that US radiologists reviewed the contractors’ findings. Legal expert Tom Greeson offers a review of the legal ramifications of the case. 

• MRI+PSA Test=Fewer Prostate Biopsies: Researchers writing in JAMA Network Open concluded the combination of MRI scans and PSA tests can reduce prostate cancer biopsies. A group from Brigham and Women’s Hospital reviewed 72 studies covering 36k patients, finding biopsies were reduced by avoiding procedures in patients with prostate lesions graded on MRI as PI-RADS 3 or less and with PSA density of less than 0.10 ng/mL² (30% reduction) or 0.15 ng/mL² (48% reduction). Sensitivity at the two levels was 97% and 95%, respectively. 

• AI Finds Interval Breast Cancers: Notch another win for ScreenPoint Medical’s Transpara AI algorithm. In a new study in Clinical Radiology, researchers from Turkey used the solution to analyze 2.1M screening mammograms originally classified as low risk (BI-RADS 1 and 2) to find interval breast cancers. Transpara labeled 53% of interval cancers with its highest-risk score – 10 – indicating that AI could be used to detect cancers that escaped radiologist detection on initial review. The findings come after the MASAI study showed Transpara could reduce second reading in Europe. 

• Radiologists Getting Industry Payments: When it comes to industry payments to physicians, radiology ranked #12 on a list of 39 medical specialties published in JAMA. Radiologists were paid $391M from 2013 to 2022, which sounds like a lot but pales in comparison to the $1.4B raked in by orthopedic physicians and $1.3B by neurology and psychiatry doctors. In all, 50% of radiologists received payments over that time period, amounting to 34.4k radiologists receiving an average amount of $11.4k each. 

• Another Ferrum/Gleamer Install: AI platform provider Ferrum Health has landed another client, this time Community Health Network in Indiana. Ferrum’s platform will be implemented within Community’s existing IT infrastructure, allowing radiologists to deploy AI algorithms directly from their workflow. The first algorithm to be deployed is Gleamer’s BoneView for fracture detection, with more to follow. The deal follows a similar agreement Ferrum signed with teleradiology services provider Premier Radiology. 

• Patient Access to Radiology Reports: Patients reading their own radiology reports can be a thorny issue. But Mayo Clinic researchers found that patient access rose when they released data immediately through patient portals rather than holding it so referring physicians could see it first. In a study in AJR, they reported that more patients accessed their data (80% vs. 78%) and got access more quickly (5.5 vs. 45 hours), but also the percentage viewing their reports before referring physicians rose (44% vs. 19%). Radiologists may want to tailor their reports accordingly. 

• AI for Head CT Study Wins BIR Prize: A UK research study investigating Qure.ai’s qER algorithm for AI-assisted analysis of head CT exams won the top abstract award at the recent British Institute of Radiology AI Congress 2024. Researchers presented interim results from the AI-REACT study, which is investigating the use of qER for  interpreting non-contrast CT head scans in the emergency setting using a dataset of 150 CT scans. Participating in the study are emergency medicine physicians, radiologists, and radiographers who read CT exams.

• GE Launches AI for Urology Ultrasound: GE HealthCare has launched an AI-assist feature for urology ultrasound called Prostate Volume Assist, designed to help clinicians with prostate imaging and biopsies, as well as guiding treatment. The solution automates what previously was a manual process in determining prostate volume that involved multiple measurements and applying math formulas. PVA will be available on the company’s bkActiv, bk3000/5000, and bkSpecto ultrasound scanners.

• CT Lung Screening Improves Survival in Poland: Researchers in Poland appear to have achieved screening’s holy grail in a study of CT lung cancer screening – a decline in all-cause mortality. Researchers for 10 years tracked 7.3k people ages 50-75 who got screened between 2009-2011, finding those who participated in screening had higher overall survival rates compared to matched controls (87% vs. 81%) and lower hazard ratio for mortality (HR=0.853). Results were presented last month at the European Lung Cancer Congress and add support for national lung screening programs. 

• Lung Cancer Survival Remains ‘Suboptimal’: But detecting lung cancer is only one part of the equation – patients also need to be treated, and researchers found “suboptimal” survival of individuals with early-stage cancer detected in the NLST screening trial. In Annals of Thoracic Surgery, researchers found NLST participants with screen-detected stage IA cancer treated with lobectomy had 2.5 times the rate of all-cause mortality after 10 years compared to NLST participants without cancer. Lung cancer was the leading cause of death, killing 23% of patients after surgery. 

• Avicenna Nabs Two FDA Clearances: Avicenna.AI has received FDA clearance for two AI algorithms for detecting life-threatening conditions: pulmonary embolism and stroke. CINA-iPE detects incidental PE on routine chest CT scans, while CINA-Aspects automatically processes non-contrast CT scans to calculate a score for stroke severity. Avicenna has been successful in having the algorithms added to AI platforms like Blackford and TeraRecon in recent months. 

• Life Expectancy Increases: US life expectancy in 2022 was 77.5 years, up over an entire year from 2021 (76.4). Although we’d love to point to a medical breakthrough for the progress, the CDC report attributes the increase to fewer deaths from COVID and drug overdoses. Heart disease and cancer remained the leading causes of death, while COVID was replaced by “accidental injuries” in the third slot. US life expectancy has yet to recover to its prepandemic peak of 78.8 years in 2019.

AI-Powered Solutions to Drive Efficiency

Explore Nuance’s latest virtual series, Home for Dinner, showcasing AI-powered solutions to drive efficiency – saving radiology teams time at work so they can be home for dinner – or whatever matters most. The next demo on April 23 will feature Nuance Precision Imaging Network for seamlessly integrating AI into your existing reporting workflow. Sign up today.

Best in KLAS for Cardiovascular Imaging

The Merge Cardio and Merge Hemo solutions from Merge by Merative have been named Best in KLAS 2024 for Cardiology and Hemodynamics. Learn more about the solutions that have dominated both KLAS categories since 2007.

Prioritizing Efficiency in Healthcare IT

Health IT teams are bombarded with projects and initiatives aimed at improving patient care, and prioritizing projects can be a challenge. In this white paper from Enlitic, learn how to efficiently manage and prioritize the introduction of new technologies.

The Resource Wire

• Radiology Automation Simplified: A recent statement by top radiology societies states that there should be close collaboration between the developers and users of AI. Find out in this video how CARPL.ai worked with University Hospitals, Cleveland for AI testing, deployment, and monitoring. 

• 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, MD, of echo AI developer Us2.ai. 

• Growing Your Practice When It’s Impossible to Recruit and Retain: How can radiology practices address the pressing need for multi-specialized radiologists? In this fireside chat, Medality CEO and Co-Founder Daniel Arnold talks to Dr. Catherine Jones of I-MED Radiology about the challenge. 

• 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. 

• 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. 

• Data Sourcing for Medical AI: Join Gleamer and its partner Gradient Health for a webinar on data sourcing for medical AI at 10 am ET on April 3. Learn from Remi Quilliet of Gleamer and Rod Greco of Gradient how they worked together to speed up AI development.

• Modern Technology for Better Patient Outcomes: 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.

• AI-Powered Informatics to Drive Healthcare Value: The DeepHealth OS is a cloud-native operating system that orchestrates all data to drive value across the healthcare enterprise. Learn more about how DeepHealth elevates the radiologist beyond radiology and across the entire care pathway. 

• Two Questions about AI for Radiology Leaders: Are today’s radiology AI solutions solving the right problems? And are there other solutions available for AI of brain MRI? Read this article from SpinTech MRI to learn how its STAGE solution can optimize MRI utilization. 

• Achieve Your Dose Management Goals: This Bayer Radiology white paper details how the right people, plan, and systems can help imaging teams achieve their dose management goals.

• Why and How Leaders Fail – Traps to Avoid: What are the pitfalls faced by healthcare leaders, and how can you avoid them? Join Anu Brixey, MD, in the next #RadEqual webinar on April 10, sponsored by Intelerad and the American Association for Women in Radiology. 

• Seamless Integration and Efficient Reading: TeraRecon’s latest Intuition advanced visualization solution now features seamless integration with Mirada Medical’s Mirada XD, providing efficient diagnostic reading with automatic multi-modality and multi-time point registration capabilities. Schedule a demo to learn more. 

• The Importance of Workflow in SPECT/CT: SPECT/CT can impact everything from patient satisfaction to exam efficiency. In this video, learn from two technologists and a physician how Siemens Healthineers’ Symbia Pro.specta SPECT/CT system impacts their daily work, their patients, and their department’s efficiency. 

• Revolutionizing Radiology with Clear Visual Intelligence: The University of New Mexico Hospital is partnering with Riverain Technologies to revolutionize radiology with the use of ClearRead CT with Clear Visual Intelligence for chest CT scans. Get details about the partnership on this page.