Fazekas T et al, in a meta-analysis in JAMA Oncology of MRI-directed prostate screening.

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MR Scanners

MRI Makes Prostate Screening More Precise

Prostate cancer screening isn’t a guideline-directed screening test yet, but this could change with the use of MRI and other tools. A series of papers published in several JAMA journals late last week indicates the progress that’s being made. 

As we’ve discussed in previous issues, prostate screening with PSA tests hasn’t met the threshold for clinical benefit achieved by other population-based screening exams.

• PSA-based screening has been characterized by lower mortality benefits and relatively high rates of overdiagnosis and complications from follow-up procedures. 

But some researchers believe that PSA screening could be made more effective by using additional diagnostic tools like imaging and blood tests to focus on potentially high-risk disease for biopsy while active surveillance is used for less threatening prostate lesions. 

In the ProScreen trial in Finland, researchers tested the combination of PSA, a kallikrein four-panel blood test, and MRI in selecting patients for biopsy. 

• Patients were sent to MRI if they had PSA scores of 3.0 ng/mL or higher and kallikrein scores of 7.5% or higher; those with abnormal MRI scans got targeted biopsy. 

The researchers tested the ProScreen protocol in a study of 61.2k men, with 15.3k invited to screening and 7.7k getting screened. Over a preliminary three-year follow-up period, researchers found …

• 9.7% of men met the PSA threshold for a suspicious lesion; this fell to 6.8% after the kallikrein test and 2.7% after MRI, illustrating the protocol’s ability to reduce biopsies
• Biopsy yield for high-grade cancer was 1.7%, which an editorial called a “remarkably high yield”
• Overdetection of low-grade disease was 0.4%, compared to 3.2% in a comparable previous study

In a second study, this one in JAMA Oncology, researchers performed a meta-analysis of 80.1k men from 12 studies in which MRI was used to direct patients to prostate biopsy after PSA testing, finding that MRI-directed protocols had …

• Higher odds of detecting clinically significant prostate cancer (OR=4.15) compared to PSA screening alone
• Lower odds ratio for biopsy (OR=0.28)
• Lower odds ratio for detecting clinically insignificant cancer (OR=0.34)

Finally, a secondary analysis in JAMA of a large UK trial illustrates the challenges of prostate screening without MRI guidance. Researchers reviewed 15-year outcomes of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), a study of 415k men,196k of whom were screened from 2002 to 2009 without the use of MRI, finding … 

• PSA screening increased detection of low-grade cancer (2.2% vs. 1.6%) but not intermediate or high-grade disease
• Screening reduced prostate cancer mortality by a small amount (0.69% vs. 0.78%)

The Takeaway

Taken together, new studies offer a roadmap toward making MRI an integral part of prostate screening, such that perhaps in years to come it can join other cancer tests as a population-based screening tool.

Transforming Cardiovascular Ultrasound Analysis

Learn how cardiovascular ultrasound is on the verge of transformation with the latest version of Us2.ai’s new echo AI analysis software, featuring 45 automated echo parameters for streamlining clinical workflow.

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.

The Wire

• Us2.ai Gets FDA Nod for V2: Echo AI leader Us2.ai has received FDA clearance for Us2.v2, the newest version of its flagship software featuring 45 automated echocardiography parameters, including strain analysis. Other features of the new version include region strain analysis for detecting coronary artery disease, aortic stenosis measurements, and comprehensive quantitative analysis of cardiac structure and function. Us2.ai sees the new version as furthering its mission to automate echo and improve detection of cardiovascular diseases like aortic stenosis, HFpEF, and amyloidosis.

• Imaging News at ACC 2024: The ACC 2024 show is wrapping up today, and the meeting offers an insightful look at the state of cardiology and in particular cardiac imaging. The meeting’s scientific program includes 15 lecture tracks on cardiac MR, 17 on CT, and 18 on echocardiography, but only six on nuclear cardiology, perhaps a sign of cardiology’s waning interest in what used to be a staple of in-office cardiac imaging. 

• Cardiac CT’s Impact on Patients: An important paper at ACC 2024 documents how the rising use of cardiac CT has impacted management of patients with chest pain. Researchers tracked 683k patients who got either coronary CTA or stress tests from 2016 to 2018, finding that use of CCTA rose (0.095% to 0.13%) while stress testing fell slightly (2.77% to 2.64%). Use of percutaneous coronary intervention grew in the CCTA group (1.45% to 1.7%) while staying flat in the stress test group. Patient length of stay also fell in the CCTA group (1.86 to 1.7 vs. days) but was unchanged with stress testing (2 days).

• Racial Disparities in CAC Scoring: But the benefits of cardiac CT aren’t being shared equally. In another ACC 2024 presentation, researchers analyzed the racial makeup of 1.4k patients who got CT coronary artery calcium scoring from 2019 to 2022, finding that Whites were 8.3X more likely to get scoring than African Americans, even though Blacks have higher risk of atherosclerotic cardiovascular disease (70% vs. 56%). Blacks were also less likely to get care after CAC scoring such as a clinic visit (56% vs. 40%). 

• Uneven Gains in Cardiovascular Health: Likewise, a new study has found that gains in cardiovascular health have been limited to wealthier people. In Circulation: Cardiovascular Quality and Outcomes, George Washington University researchers found in a study of 27k people with no previous heart attack or stroke from 1988 to 2018 that the 10-year risk of cardiovascular disease for low-income people was stagnant at over 8%. At the same time, the wealthiest segment saw risk decline (7.7% to 5.1%), as did the second wealthiest group (7.6% to 6.1%). 

• A Better View with Ultra-High-Res CT: In another ACC 2024 paper, Johns Hopkins researchers presented data showing that CCTA with an ultra-high-resolution CT scanner may portray cardiac pathology more accurately. Twenty-one patients were scanned with a UHR-CT scanner at a 0.25mm detector width with 0.25/0.125mm reconstruction; while minimal stenosis per vessel was the same with UHR versus conventional CT (23% vs. 25%), maximum stenosis measurement was lower with UHR-CT (43% vs. 38%). UHR-CT may give a more realistic, less overestimated analysis of atherosclerotic disease.

• Alcohol and Cardiovascular Disease: It may be okay to have another glass of wine – for now. Research at ACC 2024 using CT CAC scoring didn’t show an association between alcohol consumption and CAC buildup. Researchers from Lundquist Institute in Los Angeles performed CAC testing on 12k people from 2016 to 2023, finding that after adjusting for other risk factors, the presence of coronary artery calcification was not associated with alcohol consumption in light versus moderate drinkers (OR=1.03) or light versus heavy drinkers (OR=1.011). 

• Fixing the Radiologist Shortage: There are many reasons for the US shortage of radiologists, but a new article in AJR offers some short-term solutions to bridge the gap until long-term fixes can be applied. Top of the list is tapping into retired radiologists to work a few days a week, getting part-time radiologists to work one additional day per week, and employing reading room assistants and non-physician providers. Other suggestions address radiology workflow processes and reducing volumes for low-value studies. Definitely food for thought. 

• NHS Rolls Out AI for Head CT: The UK’s NHS is rolling out Qure.ai’s qER AI algorithm for non-contrast CT head scans, using it to create prioritized reporting worklists for critical findings in the emergency setting. qER is already being used at NHS Greater Glasgow and Clyde, where over the winter it analyzed 651 non-contrast head CT scans and detected 128 head injuries, and will be expanded to three other sites as part of the ACcEPT project. NHS has been looking closely at AI to improve efficiency. 

• Cleerly’s Ischemia Advantage: A new JACC: Cardiovascular Imaging analysis highlighted Cleerly’s advantages identifying coronary ischemia in CT scans, and predicting long-term MACE risk. Using data from the CREDENCE and PACIFIC-1 trials from a combined 513 patients, Cleerly’s AI-QCT detected ischemia with far higher AUCs (0.80 and 0.85) than FFRCT (0.69 and 0.78), MPI (0.65), and SPECT (0.72) … but below PET (0.89). After adjusting for clinical risk factors and coronary CTA-determined obstructive stenosis, a positive Cleerly AI-QCT ISCHEMIA test was associated with a 7X higher risk of MACE over 8 years.

• FDA Clears Siemens 2D Mammo System: Siemens Healthineers has received FDA clearance for 2D mammography use of Mammomat B.brilliant, a new digital mammography system introduced in September 2023. The company has also filed a PMA application for a 3D/DBT mode on the system called PlatinumTomo, which acquires tomo volumes with a wide 50° arc. This version will include a new detector and X-ray tube design based on flying focal spot technology similar to what’s used on Siemens CT scanners.  

• Viz.ai & iCardio.ai’s Echo AI Alliance: Viz.ai announced the addition of iCardio.ai’s ultrasound AI-based aortic stenosis detection solution to the Viz.ai Cardio Suite, joining Us2.ai’s echo solution along with a range of ECG and CT-based AI. iCardio.ai’s solution supports AS screening outside of the echo lab, which could make Viz.ai’s care coordination capabilities particularly useful, assuming iCardio.ai continues on its path towards FDA clearance.

Making Advanced Cardiac CT Accessible Everywhere

How do you bring cardiac CT to high-risk patients in rural areas? Watch this video from Siemens Healthineers to learn insights into setting up a cardiovascular CT program in a rural area – and how to overcome associated challenges.

Learn about the Benefits of CloudPACS

CloudPACS has finally arrived. Learn more about the benefits that cloud-based PACS can have for your radiology practice and how Visage 7 was built from the ground up to ensure maximum performance, security, and scale.

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 Resource Wire

• The Importance of Simplified Data to Research: The availability of high-quality data is indispensable for driving research advancements that can improve patient care. In this article from Enlitic, learn how standardized, searchable data  can usher in a new era of precision medicine and personalized healthcare. 

• Generating Savings by Putting Patients First: A major U.S. healthcare provider faced challenges in simplifying imaging workflows while ensuring cost-effectiveness. Learn how PocketHealth improved patient experience and efficiency, and saved $130,000 in annual costs. 

• 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. 

• CT and Radiation Benchmarking: This Bayer case study details how radiation benchmarking programs can help push CT dose exposure reduction initiatives from achieving compliance to driving quality.

• The Smooth Deployment of Lung AI: Seamless use of AI wouldn’t be possible without workflow integration, made possible in collaboration with hospital IT teams. Learn about the smooth deployment of DeepHealth’s Saige Lung solution at Portsmouth Hospitals University NHS Trust in the UK.

• 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.

• Nuance’s PIN Helps Identifies Emphysema: Emphysema is often underdiagnosed, and this can make treatment more difficult. FirstHealth of the Carolinas was able to improve its diagnosis of emphysema and enhance its CT lung screening service with AI algorithms available through Nuance Precision Imaging Network (PIN).

• Gain Clarity at Speed in MRI: Acquire images faster per MRI machine per day with STAGE from SpinTech MRI. STAGE reduces the time for MRI brain protocols by 30% for your most common exams. 

• A New Solution for Cardiac MR Programs: Intelerad is making advanced cardiac solutions available whenever you want them. Learn more about the company’s new Precession application, which enables you to view, analyze, and report cardiac MR exams – all within a standard web browser. 

• 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.

• 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.

• An Update on CARPL from HIMSS 2024: What’s the latest news from AI platform company CARPL.ai? Check out this video from HIMSS 2024 to discover how the company is making it easier than ever to deploy and use radiology AI. 

• Visit Clearpath in Vegas: If you’re heading to Las Vegas for the Radiology Business Management Association (RBMA) annual conference in a few weeks, be sure to schedule a meeting with Clearpath to learn about their solutions for giving patients better access to their data and images. 

• 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.