Jonathan Mezrich, MD, JD, in an editorial in Radiology on malpractice claims in teleradiology.

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Teleradiology Malpractice Risk

A new study in Radiology comes to an explosive conclusion: medical malpractice cases involving teleradiology interpretation of medical images more frequently involved patient death and had higher payment amounts. 

Perhaps no technology has wrought greater changes on the field of medical imaging than teleradiology. 

• By leveraging radiology’s conversion to digital imaging and the rapid expansion of Internet bandwidth, teleradiology makes it possible for medical images to be interpreted independent of the radiologist’s location, with studies sometimes literally sent around the world. 

But teleradiology has had its share of unintended consequences, such as the emergence of nighthawk and specialty teleradiology firms that have seized hospital contracts from traditional radiology groups. 

• What’s more, allegations have occasionally surfaced accusing some telerad firms of “ghosting” (when images read overseas aren’t adequately supervised by US-licensed radiologists).

But this week’s study in Radiology adds a new wrinkle, suggesting that teleradiology could actually have an additional malpractice risk. Researchers analyzed 3,609 malpractice claims, of which 135 involved teleradiology, finding that teleradiology cases…

• Saw patient death occur more often (36% vs. 20%)
• More frequently saw communication problems among providers (26% vs. 13%)
• More often closed with indemnity payments (59% vs. 41%)
• Had higher median indemnity payments ($339k vs. $214k) 

Why might problems be more frequent in teleradiology? The authors offered several reasons, including …

• Teleradiologists may not have access to EMR and other patient data
• Teleradiology interpretations are often provided at night and on weekends/holidays
• Claims involving neurology and the emergency setting were more common, illustrating the challenges in these areas

Potential solutions could involve making sure that teleradiologists have access to EMR data, and by performing overreads of interpretations delivered on nights and weekends. 

The Takeaway
The findings have disturbing implications, not only for dedicated teleradiology providers but also for traditional radiology practices that use teleradiology as part of their service offerings. And as noted in an accompanying editorial, they could provide ammunition to teleradiology’s opponents, who continue to rail against the technology that has done so much to change radiology. 

Celebrating Happy Customers

There’s nothing better than happy customers. Find out what radiology personnel at Western New York MRI in Buffalo had to say about their new uMR 680 scanner from United Imaging.

Starting a CT Lung Cancer Screening Program

There’s no doubt CT lung cancer screening reduces lung cancer mortality. In this Imaging Wire Show, we discuss how to set up a lung screening program and the technologies available to help with Chip Gilkeson, MD, of University Hospitals Cleveland Medical Center and Steve Worrell of Riverain Technologies.

The Wire

• Havana Syndrome Gets Even Weirder: If you thought things couldn’t get any weirder in the “Havana Syndrome” mystery – in which North American government personnel have reported mysterious neurological ailments – think again. A 60 Minutes investigation that aired March 31 theorized that the cases are part of a decade-long secret campaign by the Russian government to use acoustic weapons against US personnel worldwide. A paper published last month claimed to find no evidence of brain changes on MRI scans of victims – a finding they have challenged. 

• French Center Unveils 11.7T Brain MRI: A selection of stunning brain images acquired with a powerful 11.7T MRI scanner has been unveiled by the French Alternative Energies and Atomic Energy Commission (CEA). CEA has been working on the Iseult actively shielded whole-body magnet – which it’s calling the world’s most powerful clinical MRI scanner – for the past 20 years, using components supplied by Siemens Healthineers and GE HealthCare and contrast from Guerbet. This week CEA released brain images with 0.2mm in-plane resolution and 1mm slice thickness acquired in just four minutes. Iseult will be used to research neurodegenerative diseases like Alzheimer’s. 

• MRI Links Menopause to Brain Changes: Women who transitioned to menopause had negative changes in brain activity that were detectable on functional MRI exams. Writing in a small study in Aging, South Korean researchers performed T1-weighted and fMRI exams on 21 women, finding that postmenopausal women had smaller cortical surface area and decreased functional activity between brain regions. They suggested that diminished brain volume and functional connectivity could be caused by menopause-related symptoms due to lower levels of sex hormones such as estrogen, and recommended follow-up research. 

• Does MIPS Overlook Radiologists? Medicare’s Merit-based Incentive Payment System is designed to promote healthcare quality and efficiency. But is radiology at a disadvantage in meeting MIPS measures? That’s the suggestion of a new AJR study in which Harvey L. Neiman Health Policy Institute researchers found that because there are so few MIPS measures for diagnostic radiology (9 vs. 65 for family medicine), radiologists in multi-specialty practices were more likely to report non-radiology measures like blood pressure control than measures such as radiation dose exposure time – making it harder to meet MIPS targets.   

• GE Launches Caption AI on POCUS: GE HealthCare has migrated its Caption AI technology to its Vscan Air SL wireless POCUS scanner. GE previously launched Caption AI on the Venue scanner family; the new rollout makes Caption AI guidance available on the pocket-sized Vscan platform. Caption AI gives users real-time guidance with features like AutoCapture and Save Best Clip, and can automatically calculate important cardiac imaging parameters such as LVEF. GE will be highlighting the technology at next week’s ACC 2024. 

• X-Ray Deep Learning of CVD Risk: In a great example of opportunistic screening, MGH researchers in Annals of Internal Medicine found their chest X-ray deep learning algorithm predicted patients at risk of major adverse cardiac events. In 8.9k patients who didn’t have enough data to calculate a traditional risk score, those with a 7.5% risk on the CXR CVD-Risk tool had higher hazard ratio for MACE after 10 years (HR=1.73). CXR CVD-Risk could enable cardiac risk scoring with radiographs where traditional data isn’t available. 

• Radiology’s Rank on Overworked Docs Poll: In a new poll of 2.7k physicians by Doximity, radiologists ranked about in the middle in terms of the percentage of doctors who reported feeling overworked. In all, 82% of radiologists reported being overworked, #14 out of 26 medical specialties. At the top of the list were cardiologists (93%), while at the bottom were neurosurgeons at 69%. The overall level for all physicians was 81%, down from 86% in 2022 but higher than 73% in 2021.

• AI Improves DBT Interpretation: Radiologists who were assisted by an AI algorithm when interpreting DBT mammography exams had faster reading times with higher sensitivity. In a paper in Radiology: Artificial Intelligence, researchers measured the impact of Lunit’s Insight DBT algorithm on 258 DBT exams from 14 institutions in the US and South Korea from 2010 to 2021; radiologists using AI saw their sensitivity increase (85% to 88%) while reading times fell (54 seconds to 49 seconds). Specificity was unchanged. Lunit got FDA clearance for Insight DBT in November 2023. 

• Group Questions Digital Mammography: Australian researchers are questioning whether the transition from film to digital mammography had a positive impact on patient care. In a meta-analysis in Journal of Clinical Epidemiology, researchers analyzed 18 studies covering 11.6M mammography exams, finding that digital mammography produced a slight increase in DCIS detection (of 0.47 per 1k screens) but a statistically insignificant decline in invasive cancer detection (of -0.10 per 1k screens). The results echo the group’s previous research questioning the transition to digital mammography. 

• 3M Completes Solventum Spin-Off: Industrial conglomerate 3M has completed the spin-off of its healthcare business into Solventum, a new publicly traded stand-alone company. Solventum’s business lines produced $8.2B in 2023 revenues and include products in healthcare information systems, medical-surgical supplies, dental products, and purification and filtration offerings. In radiology, Solventum’s solutions include the M*Modal Fluency for Imaging AI-powered reporting and workflow management software, which 3M acquired by buying M*Modal in 2019.

• Deep Learning Recon Tools Compared: Deep learning-based MRI acceleration has been in the news of late, and a new study in Radiology: Artificial Intelligence offers support. Researchers tested two commercially available algorithms, one that works on k-space data (GE HealthCare’s AIR Recon DL) and one on DICOM data (Subtle Medical’s SubtleMR). In 7.3k scans, DICOM-based reconstruction reduced scan times 14-53% and room times 10-41%, while k-space-based reconstruction saw a 12-27% reduction in scan times but no demonstrated reduction in room times. 

• AI Firm Moves from Kazakhstan to California: AI developer CerebraAI has moved its headquarters from Kazakhstan to Silicon Valley, California, joining a number of other Central Asia startups at the growing Silkroad Innovation Hub in Palo Alto. CerebraAI is developing algorithms for analyzing non-contrast CT brain exams for signs of tissue abnormalities like stroke; the technology uses AI-generated images of a patient’s pseudo-healthy brain to enhance CT scans and improve ischemic stroke detection. The algorithm was developed with scans of some 130k patients in Kazakhstan.

Presenting Unboxing AI

Check out CARPL’s brand-new video series, Unboxing AI, featuring experts discussing AI and its future in radiology. The inaugural episode includes Piyush Mathur, MD from the Cleveland Clinic and Mitchell Goldburgh from NTT DATA speaking with CARPL CEO Vidur Mahajan, MD.

Stop Shipping Discs!

By pivoting to a 100% digital fulfillment model for patient images and records, you can improve their experience while significantly reducing labor and shipping costs. Find out how on this page from Clearpath.

The Resource Wire

• 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.

• Understanding PET/CT’s Expansion: If your work is impacted by PET/CT, you should be aware of the rapid growth that’s predicted for this imaging exam. Learn more on this page from Siemens Healthineers about the exciting clinical applications fueling the technology. 

• 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. 

• White Paper on Structural Heart Imaging: How can AI help improve care for patients with structural heart issues? Learn more about new enhancements for procedures like TAVR and TMVR, as well as LAA closure, in this downloadable white paper from TeraRecon.

• To Pay or Not to Pay for AI in Radiology: AI-supported digital applications are expected to transform radiology, but providers need motivation and incentives to adopt them. In this article, authors including executives from Bayer propose a framework to guide payers and AI developers in adoption of radiology 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. 

• Meet DeepHealth this Month: DeepHealth is coming to a conference near you! Schedule a meeting to learn more about their innovative AI-powered health informatics portfolio and explore how they can tailor their offerings to meet your healthcare needs.

• Echo AI Hits the High Notes in OPERA Study: New results from the OPERA study show how Us2.ai’s echo AI solution improved heart failure screening in the NHS, reducing echo waiting times from 12 months to under 6 weeks. Find out more in this article.

• An Easier Way to Manage Training and CME: Medality’s new Admin Portal offers radiology practices a single location to manage radiologist training development needs and CME requirements. Request a demo today. 

• 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 Imaging Wire Show.

• Get to Know Gleamer this Spring: Gleamer will be showcasing their AI solutions for revolutionizing standard radiology practices at a conference near you this spring. Join them and take advantage of this opportunity to discover the future of radiology by scheduling a meeting today.

• Top 5 Obstacles to Radiology AI Adoption: AI is reshaping healthcare, but some healthcare providers are encountering hurdles that demand strategic approaches for successful implementation. Learn the top 5 obstacles to radiology AI adoption – and how to avoid them – in this blog post from Blackford. 

• Best in KLAS for Image Exchange: With over 15k connected facilities and a dedicated outreach team building new connections every day, it’s no wonder Nuance PowerShare Image Sharing was named #1 Best in KLAS 2024 for image exchange. Learn more about this award-winning solution.

• Challenges of Messy Data in Healthcare Research: Data is the lifeblood of healthcare research, but one hurdle faced by researchers is messy data. Learn the top five strategies for effective data management in healthcare research in this article from Enlitic. 

• Improving Access and Efficiency at William Osler Health: Watch how PocketHealth helped William Osler Health System improve access and efficiency through patient-driven image exchange in this video interview with Aimee Langan, Director, Diagnostic Imaging, Laboratory, Neurodiagnostics.