Terminator, in response to a question on the radHQ.net forums on the longest list of unread imaging exams they’ve seen.

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Brain Imaging

CT Changes Headache Workup

Recent studies have raised concerns about whether CT is overused in the emergency setting for patients with symptoms like headache, but a new study in JAMA Network Open suggests that higher CT utilization could be contributing to a decline in more invasive procedures like lumbar puncture. 

Earlier this month, we covered a study documenting the rapid rise of emergency head CT for patients presenting with acute-onset headache – which could be an indication of subarachnoid hemorrhage or other serious issues. 

• Researchers theorized that higher CTA utilization could be a sign of overuse because the rate of positive findings over time fell 38%.

But the new study suggests that the growth in cerebral CTA use could have beneficial effects, by reducing the use of more invasive procedures and by detecting unruptured intracranial aneurysm. 

• Some 5% of acute-onset headaches in emergency patients are caused by subarachnoid hemorrhage; these cases have a 50% risk of death or serious disability at one year, making accurate detection and workup a serious issue.

Researchers from Kaiser Permanente in Northern California analyzed 198k encounters for patients with headache at 21 community EDs from 2015 to 2021. 

• They compared multiple workup protocols, ranging from CT only to others in which CT was used first, with nondiagnostic cases sent to either lumbar puncture or cerebral CTA. 

Dramatic changes occurred in headache workup over the study period, including … 

• Overall use of CT grew at an average annual percent change of 5.4%
• Cerebral CTA use grew 19% annually
• Lumbar puncture use fell 11% annually
• Detection of unruptured intracranial aneurysms grew 33%
• The ratio of unruptured aneurysms to subarachnoid hemorrhage grew

The authors noted that the findings show clinicians are shifting away from a headache workup protocol that includes lumbar puncture to one that relies more on cerebral CTA.

• The researchers were equivocal on the increase in detection of unruptured aneurysms; on the one hand, the absolute risk of rupture is low, but on the other, the consequences of rupture are severe.  

The Takeaway

The new study offers a more nuanced – and perhaps more positive – view of growing cerebral CTA use in the ED. In the end, it’s possible that two conflicting statements can be true: CT indeed may be overused in the emergency department, but its growing use is also having a beneficial impact on patient care.

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.

Leveraging a Proven Echo AI Platform

Us2.ai has developed a promising new pathway for bringing custom echo AI applications into widespread clinical and commercial use – historically a challenge for algorithms produced by health systems and academic institutions. Find out how it worked in Uganda in this article.

The Wire

• Reimbursement and AI Adoption: What drives real-world adoption of medical AI? A new article in NEJM AI examines the role of reimbursement in getting AI tools in front of patients. The authors look at different reimbursement models, including fee-for-service and value-based care, and offer a new approach based on Medicare’s Part B model, which reimburses drugs administered in an outpatient setting based on a “cost plus” markup. Providers would acquire the rights to use AI, then get reimbursed based on the average cost of the service plus a specified margin. Read an analysis on our sister site Digital Health Wire. 

• FDA Clears Philips Zenition 30 C-Arm: Philips has received FDA clearance for its Zenition 30 mobile C-arm for image guidance during interventional procedures. First debuted in September 2023, Zenition 30 addresses budgetary constraints at hospital systems while also improving workflow efficiency with tableside controls and advanced protocols like Philips’ MetalSmart software for reducing artifacts when imaging patients with metal implants. It joins Zenition 90, 70, 50, and 10 in the company’s mobile C-arm product line. 

• MRI of Veterans with mTBI: In a small study of military veterans in JAMA Network Open, researchers used advanced MRI techniques to show that those with mild TBI had changes in brain structure areas like white matter. Researchers used protocols like DTI and neurite orientation dispersion and density imaging (NODDI) in a study of 98 veterans, finding that those with mTBI had alterations in white matter microstructure and more severe PTSD-like symptoms. The changes could represent neurodegeneration as well as post-injury scarring and brain reorganization.

• Pros and Cons of Whole-Body MRI Screening: One of the most controversial topics in radiology – or healthcare for that matter – is whole-body MRI screening from firms like Ezra and Prenuvo. Healthcare journalist Christina Farr tackles the issue in a round table-style article on Substack in which she gets the opinions – pro, con, and neutral – of eight physicians. None of them are radiologists, but maybe that’s for the best. 

• New MRI Contrast Agent: Austrian specialty pharmaceutical developer Sanochemia Pharmazeutika has gained licensing rights to Ferrotran, an MRI contrast agent based on ferumoxtran. Ferrotran is being developed to detect lymph node metastases in prostate cancer patients and is in late phase III studies at European centers. Sanochemia licensed Ferrotran from Dutch firm SPL Medical in a deal that includes worldwide manufacture and distribution rights except for German-speaking countries. 

• MR Elastography for Liver Disease: A new study in AJR suggests there could be a role for MR elastography in monitoring liver stiffness – an indicator of fibrosis – in younger patients with autoimmune liver disease. Researchers from Cincinnati Children’s performed MRE studies with a 1.5T scanner on 46 children and young adults; liver stiffness measurements worked well in identifying advanced liver fibrosis (AUC=0.81). MRE could be used for noninvasive monitoring of liver stiffness in younger patients.

• Photon-Counting CT Excels for PE: Researchers found that photon-counting CT can scan patients with suspected pulmonary embolism at half the radiation dose of conventional CT. Writing in European Radiology, researchers found that in 330 patients, photon-counting CT with Siemens Healthineers’ Naeotom Alpha scanner had shorter scan times (0.9 vs. 4 seconds) at just 48% of the radiation dose. Also, more patients could be scanned in spectral mode with photon-counting CT (100% vs. 67%). Researchers said the study shows the benefits of photon-counting CT under real-world conditions. 

• Predicting Breast Cancer Recurrence: In women diagnosed with breast cancer, what predicts which patients might experience recurrence years later? Swedish researchers addressed this question in a paper in The Breast in which they followed 1.1k women for 10 years after diagnosis. In all, 24% had recurrent disease; women with high breast density at diagnosis were 32% more likely to have lower recurrence-free survival; risk rose to 2.1X for those with screen-detected cancer. There was no association between tumor characteristics and recurrence. 

• GE Launches US Scanners: GE HealthCare is launching new ultrasound scanners for women’s health applications. The company’s Voluson Signature 20 and 18 systems include new AI tools and functionality, such as a “HeyVoluson” voice command feature and the SonoLyst suite of tools for identifying, annotating, and measuring fetal anatomy. Other features include tools for pelvic floor measurements and fibroid mapping, as well as faster fetal heart assessments. GE’s Vscan Air CL wireless probe can be integrated with the new scanners. 

• SPECT/CT Tracks Prostate Cancer Theranostic: SPECT/CT showed the potential of a new theranostic radiopharmaceutical for prostate cancer that could lead to more personalized treatments. Writing in a paper in JNM, researchers reported on the first-in-human use of lead-212 (Pb-212) in a patient with metastatic-resistant prostate cancer. The patient was administered a therapeutic dose of Pb-212, and SPECT/CT was used to track treatment effectiveness as the radiotracer decayed. The study shows SPECT could be a good alternative to PET for theranostics due to greater gamma camera availability. 

• Glioma PET Agent Gets on FDA’s Fast Track: A new PET radiopharmaceutical for glioma imaging could soon be arriving at a nuclear medicine center near you. The FDA granted fast-track review status to Telix Pharmaceuticals’ Pixclara tracer (18-fluorine floretyrosine), an amino acid-based tracer the company licensed from UCSF. The company notes that clinical guidelines recommend amino acid PET for gliomas, but there is no FDA-approved PET tracer for targeted brain cancer imaging in the US. 

• Imaging Projects Aid Africa: A number of projects to bring advanced medical imaging to Africa made headlines this month. First, RSNA and GE HealthCare partnered to improve mammography in Tanzania through a project with the MUHAS public hospital in Dar es Salaam that includes the installation of GE’s Pristina Mammography Suite. Next, Butterfly Network entered phase 2 of its project to deliver 1k iQ+ POCUS scanners in Sub-Saharan Africa. Finally, the ACR Foundation presented its Global Humanitarian Award to radiologist Dr. Boyd N. Hatton for his work in Kenya.

AI-Based X-Ray Fracture Analysis

Gleamer’s BoneView AI fracture analysis tool performed well in detecting distal radius fractures on musculoskeletal radiographs in a study published in BMJ. Learn more in this study summary.

How to Help Radiologists Thrive

With burnout and staffing shortages on the rise, and the increasing volume of imaging, radiology teams are searching for solutions. This interactive guide from Nuance can help you create an environment where radiologists thrive by building a powerful imaging strategy with AI-driven, real-time intelligence.

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 this edition of The Imaging Wire Show.

The Resource Wire

• 4 Reasons Why Subscription Is Better: The KLAS-leading Intuition advanced visualization solution from TeraRecon includes all the clinical features you need, plus a growing list of exclusive subscription-only content. Learn more about what’s included. 

• Approaches to Deploying Clinical AI: Join this April 30 educational webinar hosted by Aidoc and Merge by Merative to learn about real-world approaches to deploying AI solutions. Don’t miss this chance to learn how AI can be integrated into your workflows and help transform patient care. 

• Clinical Excellence on the Move: Healthcare providers are striving to deliver faster, better care for patients, no matter where they are. Learn how the MAGNETOM Viato.Mobile 1.5T MRI scanner from Siemens Healthineers delivers high-quality care where your services are needed most.  

• Predicting Physician Burnout from EHR Activity: EHRs are becoming a source of frustration for physicians, and the COVID-19 pandemic accelerated this trend. Learn how PocketHealth can give patients control and ownership of their records, reducing the burden on clinicians. 

• Monetizing Medical Imaging with a Real-World Database: Data-driven decision-making is more important than ever. In this article from Enlitic, learn how you can leverage your medical imaging data by creating a real-world database. 

• A Step-by-Step Approach to Radiology AI Adoption: Widespread adoption of radiology AI has the potential to revolutionize patient care, but the path to success requires a systematic approach. Blackford offers a step-by-step guide for healthcare providers looking to get started. 

• Best in KLAS PACS: Intelerad’s InSight PACS has been named Best in KLAS for UK and Ireland PACS by KLAS Research. Learn more about the solution that’s been adopted by over 250 healthcare providers across the UK and Ireland. 

• Solutions to Transform Medical Image Delivery: Medical providers and health systems are looking to ditch the disc and modernize their patients’ journey. Learn how Clearpath helps them reduce the cost of retrieving and fulfilling patient requests for imaging and medical records.

• Automating Abdominal CT Contrast: This Bayer Radiology case study details how its Certegra P3T Software automates contrast-enhanced abdominal CT injection protocols based on patient characteristics and contrast concentration.

• 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.

• Visit United Imaging at ISMRM 2024: If you’re attending ISMRM 2024 in Singapore next month, be sure to visit with United Imaging in booth A18, and don’t miss their May 9 lunch symposium on the clinical benefits of ultrahigh-field 5T MRI. 

• Unlocking the Potential of Radiology AI: How is AI revolutionizing radiology to enhance patient outcomes and streamline workflow? Find out in this video discussion between CARPL.ai CEO Vidur Mahajan and Mitchell Goldburgh of NTT Data USA.

• The Clinical Value of Soft-Tissue Chest X-Ray: Soft-tissue techniques can improve the visibility and accuracy of chest X-ray.  Learn about two important soft-tissue methods – bone suppression and dual-energy subtraction – in this white paper from Riverain Technologies.

• 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.