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DBT Detects Earlier Cancers | CTC Use Doubles
August 1, 2024
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Together with
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“Achieving modern radiology’s triple aim – diagnostic quality, economic performance & staff well-being – requires more than just good intentions. We need a frictionless workflow, optimal IT with AI, smart facilities design & proper ergonomics. Let’s make it happen.”
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The always-quotable Amine Korchi, MD.
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A new analysis of a landmark DBT study from Sweden offers more support for the effectiveness of tomosynthesis mammography screening. Published in Radiology, researchers found that DBT screening seems to detect earlier cancers, most likely before they become more aggressive.
Most U.S. mammography practices have embraced DBT since its approval in 2011, such that 48% of all certified mammography units are DBT and 90% of all facilities have at least one tomosynthesis unit.
- But doubts about DBT have persisted, particularly by mammography skeptics who charge that the technology was adopted without conducting randomized controlled trials to prove its value.
But apart from RCTs, there have been plenty of observational studies in which DBT showed a benefit, one of them being the Malmö Breast Tomosynthesis Screening Trial of almost 15k women in Sweden.
- First results from MBTST were published in 2018 and showed that single-view DBT screening had a 34% higher cancer detection rate per 1k women than digital mammography (8.7 vs. 6.5), but with a higher recall rate as well (3.6% vs. 2.5%).
In the new study, researchers wanted to see if DBT’s screening benefits persisted over two subsequent screening rounds with conventional digital mammography.
- Their assumption was that the cancer detection rate would be lower in subsequent rounds, and there would be fewer slow-growing, less aggressive cancers – a sign of early cancer detection.
Their analysis found …
- The cancer detection rate per 1k women was lower in the first (4.6) and second (5.3) rounds compared to the original MBTST
- Recall rate was 2.1% – also lower
- The odds ratio of cancer detection was lower than MBTST in the first (OR=0.46) and second (OR=0.53) follow-up rounds
- Invasive cancers were less prevalent in the first round compared to the second round (66% vs. 83%)
What do the results mean? The implication is that because DBT detected cancers in the initial screening round, there was lower cancer prevalence and less aggressive cancer in follow-up rounds, an effect that wore off as time went on.
The Takeaway
There may never be a randomized controlled trial of DBT due to the ethical problem of denying a live-saving technology to women in a control group. But studies like the MBTST follow-up are important in adding to the body of evidence showing that DBT actually does work.
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Unlocking Value in Healthcare
How can the Value Realization Pyramid help you unlock value from your technological investments? The pyramid outlines how high-quality data from advanced technologies like AI can drive enterprise-wide workflows and better decisions. Learn more on this page from Enlitic.
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Fewer Missed Lung Nodules
Riverain Technologies’ ClearRead CT solution helped radiologists detect 29% of previously missed actionable lung nodules. Ready to see clearly and decide confidently? Book a demo today.
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- CT Colonography Use Doubles: As the U.S. prepares for Medicare payments for CT colonography screening, a new paper in Clinical Imaging documents the exam’s growing momentum. Researchers from UT Southwestern Medical Center found that the percentage of CTC use among 58k adults in the NHIS survey spiked nationwide in 2021 versus 2019 (3.5% vs. 1.4%) after remaining stagnant since 2010 (1.3%). The growth occurred during the COVID-19 pandemic, perhaps because CTC requires less time in a healthcare facility compared to optical colonoscopy.
- Radiologist License Revoked: A radiologist who ran a teleradiology company accused of “ghosting” had his medical license revoked by the Kentucky medical board. State authorities acted after Anand Lalaji, MD, had his hospital privileges at Mercy Health Lourdes Hospital in Paducah suspended due to “poor quality readings of imaging studies.” Lalaji’s telerad firm, The Radiology Group, paid $3.1M earlier this year to settle federal charges that it practiced ghosting by using contractors in India to interpret medical images that allegedly were “rubber stamped” by U.S. radiologists.
- AI for PE Detection, Redux: Another research study analyzed Avicenna.ai’s CINA-PE AI algorithm for pulmonary embolism detection. In a paper in Clinical Imaging, researchers applied CINA-PE to 1.2k CT pulmonary angiograms acquired at 230 U.S. sites; it had per-case sensitivity of 94% and specificity of 95%. CINA-PE also found an additional 12% of PEs missed by on-call radiologists, and would have reduced their miss rate from 16% to 3.8%. The results are more positive than another study with the Avicenna algorithm published earlier this month.
- Stryker Buys MOLLI: Stryker has completed its acquisition of MOLLI Surgical, a developer of wire-free soft-tissue localization devices for breast-conserving surgery. MOLLI’s technology includes a 3.2mm marker that’s implanted in breast tissue and can be detected with a wand and tablet during interventional procedures; MOLLI last year introduced MOLLI 2, the second generation of its flagship technology. Styker will add MOLLI’s products to its breast cancer portfolio, which includes the SPY fluorescence technology for lymphatic mapping.
- Salary Equity in Radiology: Radiology may have an issue attracting more female medical students, but pay doesn’t seem to be one of the problems, at least when it comes to U.S. academic radiology. A new survey in Academic Radiology of faculty salaries for 97.2k clinical specialists found that radiology actually has one of the lowest pay gaps among specialties, trailing only pathology and psychiatry. Still, salaries were lower for female academic faculty ranging by title, including assistant professors (-6%), associate professors (-3%), professors (-4%), and section chiefs (-6%).
- Bracco’s US Contrast Deal: Bracco Imaging has signed a deal with portable ultrasound developer BURL Concepts to make microbubble ultrasound contrast for diagnosing stroke using BURL’s SONAS system. SONAS is a headphone-like device that uses transcranial ultrasound to detect acoustic signals indicating cerebral blood perfusion; observers have likened it to an ECG for the brain. BURL believes the technology will be more cost-effective and faster than CT or MRI for stroke detection. SONAS is CE Marked and FDA trials should start in 2025.
- Us2.ai Expands to Japan: Echo AI leader Us2.ai is expanding to Japan, through a partnership with local healthcare AI platform company M3 AI and with Juntendo University, including optimizing the solution for Japanese clinicians. Japan will be Us2.ai’s 26th country, and it has the potential to be one of its biggest markets, noting its aging population, huge echo volumes (9.47M /yr; 1.3X the U.S.’s volume), and sonographer shortages.
- Dutch Isotope Project Moves Ahead: There’s more good news on the medical isotope supply front. The European Commission has approved a €2B project in the Netherlands to build the Pallas research reactor to produce medical radioisotopes. Pallas would replace the Petten High Flux Reactor, which went online in 1961; interruptions at the reactor can disrupt global supplies of isotopes like molybdenum-99. Pallas is one of several projects underway to create a more stable isotope network. The downside – Pallas won’t start operation until the early 2030s.
- Radiopharmacist Sentenced: A South Carolina radiopharmacy owner has been sentenced to two years of probation and ordered to forfeit $166k in revenues after pleading guilty to charges that he split doses of Technescan MAG23, a radiopharmaceutical for assessing renal function. Federal authorities accused Richard Sheriff of Shertech Pharmacy Services of fractionating Technescan without telling customers that it was diluted, running the risk of poor-quality scans.
- PET/CT of Spontaneous Cancer Regression: Is it possible for cancer in a patient to regress without treatment? As crazy as it sounds, spontaneous regression does occur in 1 in every 60k-100k cases, and Japanese researchers used PET/CT to document one such case in Radiology Case Reports. An 80-year-old man had stage IVA primary lung cancer with metastases to a rib and lymph node. Without treatment, the rib tumor disappeared and the lymph node metastasis regressed partially, changes that were documented on serial PET/CT scans.
- Austria Eyes CT Lung Screening: Add Austria to the list of countries that could benefit from nationwide CT lung cancer screening. A new modeling study in MDPI assessed annual low-dose CT screening for high-risk individuals, finding that a national program would prevent 11.9k premature deaths with a 24% mortality reduction at a cost of €945M ($1.02B) over 17 screening rounds. LDCT screening would result in an ICER of €16.4k ($17.7k) per life-year gained, numbers that compare favorably to other tests like colorectal cancer (€15k or $16.2k) and mammography screening (€20k or $21.6k).
- What Makes Olympic Athletes Go? Just in time for the Paris 2024 Olympics, the folks at industrial imaging company Lumafield revealed their analysis of high-end running shoes in an article in Financial Times. They conducted CT scans with 3D rendering of Nike’s $285 Alphafly 3 shoe for marathon runners and $500 Adidas Adizero Adios Pro Evo 1; the Nike shoe had “intricate internal construction” with a 40mm heel stack height that cushions the impact of 26.2 miles on Paris streets, while the Adidas shoe focused on lightweight design.
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Women’s Health and AI
With new breast density reporting requirements coming in the US, there’s a need for objective density assessment and reporting. Check out this article from Blackford Analysis on the AI solutions that can help.
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Top 5 Topics from SIIM 2024
What were the hot topics from SIIM 2024? Check out this article from Visage Imaging that breaks down the biggest trends in National Harbor, MD, from the growth of cloudPACS to spatial computing.
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Keep Patients Engaged with Your Healthcare System
After using PocketHealth, 94% of patients are more confident about their healthcare experience. Learn how to increase follow-up adherence and patient experience with PocketHealth’s MyCare Navigator.
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- Learn the Basics of CT Colonography: Medicare will soon be paying for CT colonography exams for colon cancer screening. Get up to speed today with Medality’s comprehensive CT colonography course, led by experts Judy Yee, MD, and Kevin Chang, MD.
- Turning Medical Imaging into Great Medicine: TeraRecon is continually innovating to bring the latest in advanced visualization capabilities to radiology. Intuition 4.7 includes a variety of new features, from structural heart workflow to the ability to trigger AI on demand. Learn more about them on this page.
- Advancing Enterprise Imaging: Learn about the transformative impact of AI and cloud-based solutions for enterprise imaging in this August 1 webinar hosted by the HIMSS-SIIM Enterprise Imaging Community and supported by AGFA HealthCare. Continuing Education (CE) credit available.
- Visit United Imaging at AHRA 2024: You won’t need to know their booth number to find United Imaging at AHRA 2024. Stop by United’s booth in the middle of the exhibit hall to learn how their mission of Equal Healthcare for All and brand promise of Passion for Change are part of every decision they make.
- Your In-Workflow Copilot Experience: Nuance’s PowerScribe Smart Impression harnesses generative AI to automatically generate draft impressions and recommendations, saving you time and reducing workload-related stress. Learn how it can become your in-workflow copilot today.
- How a New PACS Helped Regional Medical Imaging: Regional Medical Imaging in Michigan was looking for a partner to help them streamline PACS workflows for breast imaging. Learn how Merge by Merative helped them break up the logjam created by different PACS silos to create a workflow tailored to their needs.
- Presenting Unboxing AI: Check out CARPL’s video series, Unboxing AI, featuring experts discussing AI and its future in radiology. The next episode on August 2 features Larry Sitka of PaxeraHealth – reserve your seat today.
- Fully Automated AI Echo vs. 3D and Human Readers: While 3D echo is becoming more accurate, 2D still dominates clinical care. A new study evaluates agreement in measures of LV volume and function between human readers, echo AI from Us2.ai, and the 3D Heart Model.
- Preparing for the Future of Enterprise Imaging: Check out this white paper from Optum to learn what you need to know when moving your enterprise imaging to the cloud. Learn how to assess the various approaches and develop a strategy that works for you.
- AI and Cancer Screening: Cancer screening saves lives, but right now screening is limited to a few cancer types. That could change with AI, which opens new possibilities for earlier disease detection. Learn more in this article by DeepHealth Clinical AI Leader Greg Sorensen, MD.
- Delighting Patients with Medical Image Sharing: A new platform from Clearpath now enables healthcare providers to delight their patients by sharing images and medical records digitally. Find out how it integrates simply into your practice.
- Visit Calantic by Bayer at AHRA 2024: Going to AHRA 2024 in Orlando? Be sure to visit booth #819 to learn how orchestrated AI solutions from Calantic Digital Solutions by Bayer can help your radiology practice. Schedule your meeting today.
- Reducing Bottlenecks in Radiology Workflows: Radiologists face bottlenecks every day that slow them down, from managing worklists and accessing images to collaborating with colleagues. Learn how Intelerad’s solutions like IntelePACS tackle these issues through comprehensive integrations with third-party EMR, RIS, and HIS.
- Visit SpinTech at AHRA 2024: If you’re attending AHRA 2024, be sure to visit SpinTech at booth #431 to learn about their STAGE software for accelerating your MRI scans and creating revenue for your institution.
- 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.
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