“The head is a black box, and it’s a scary black box. In the absence of having guidelines with regard to imaging, the natural tendency is to want to do everything.”
Oregon Health & Science University’s Martin Salinsky, MD, explaining that even though his research finds emergency departments may overuse neuroimaging with epileptic seizure patients, it’s because of missing guidelines not ED recklessness.
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Radiologists Should Feel Okay About MPFS 2019
As expected, CMS’ 2019 Medicare Physician Fee Schedule (MPFS) spared radiology from major Medicare cuts, keeping reimbursements for radiology unchanged, while slightly reducing nuclear medicine (-1%), and increasing payments for interventional radiology (+2%). The decision eases concerns that arose after the Medicare Payment Advisory Commission (MedPAC) recommended that congress reduce Medicare reimbursements for radiology by 3.8%. The final CMS ruling also confirms that in 2019 radiologist assistants will be able to perform diagnostic tests (under radiologist supervision) and made it official that in 2020 physicians will have to include appropriate use criteria when ordering advanced imaging.
Epilepsy Neuroimaging Overused
Research from Oregon shows that emergency departments may overutilize neuroimaging scans. The study looked at 882 seizure-related ED visits by patients who were already diagnosed with epilepsy, finding that 46% of all patients received a neuroimaging scan during their visit (381, mostly CT), with just 10% of scans (41) revealing a new clinical problem and only 2% of scans leading to an acute change in management (9, two were false positives). Noting that 90% of these patients had previous neuroimaging results available (with most results less a year old) and that the nine cases that led to acute changes were due to three very defined situations (head trauma, prolonged alteration of consciousness, focal neurological exam), the researchers found that “absent any of those three factors, . . . the yield [of CT] was essentially zero.” In fact, the researchers suggested that many of these patients didn’t even need to go to the ED, nevermind receive scans. However, the researchers were sure to clarify that they don’t blame the ED doctors, instead pointing out that the American Academy of Neurology hasn’t published guidelines for patients who’ve had a prior seizure diagnosis.
A Different Perspective on Imaging’s Value
Here’s the new perspective amid the weekly flow of imaging overuse stories. Research from the University of Washington in Seattle found that patients view learning about their imaging results as a valuable part of their healthcare journey, even if the results do not impact their treatment. The research found that patients want to understand their situation and appreciate diagnostic certainty, suggesting that other studies focused on imaging overuse may not take into account how patients define “value.”
Visla Labs Targets the Bureaucratic Beast
Medical imaging diagnostics AI startup, Visla Labs, completed a $3 million seed round that it will use to grow its team, enhance its radiology diagnostics platform, gain regulatory approval, and eventually “reimage the process of radiology.” Visla Labs’ platform aims to help teleradiology firms and urgent care centers deliver diagnosis at significantly lower costs and with faster turnaround times than standard methods, leveraging its self-improving AI engine and one-click installation as core components of its solution. Visla Labs already enjoys decent cachet due to its founders’ big-name origins (Apple, Twitter, Stanford) and appears to be trying (hard) to position itself as an disruptor, particularly through outsider-themed messaging and Erlich Bachman-esque quotes (we really like this one: “. . . empowering the practitioner not feeding the bureaucratic beast of status quo healthcare IT,”), making it an interesting company to watch as we head into 2019.
Q3 Financial Season off to Mixed Start
The first round of medical imaging company financials from the July-September period hit the press, revealing mixed results from Canon, GE, Hitachi, and Philips.
- Canon – After a strong Q2, Canon’s overall financials declined in Q3 (revenue -6.8% to $8.18b, OP -9.8% to $603m), prompting the company to reduce its FY2018 forecasts. Canon Medical saw revenue decline by 4% to ¥107.6 billion ($950m) due to sluggish domestic sales, while the division’s operating profit climbed by 7.6% to ¥8.1 billion ($71m), marking its second straight quarter of solid medical OP growth.
- GE – Healthcare remained a positive part of GE’s disappointing financials (Q3 overall revenue -4% to $29.6b, OP -23% to $2.2b, dividend now a penny). GE Healthcare’s revenue was flat at $4.7 billion (with $5.1 billion in orders), while operating profit increased by 2% to $900 million (18.3% margin), giving the healthcare division the second highest OP among all GE businesses after Aviation. However, each of these were down slightly compared to Q2 2018.
- Philips – Driven by 6% comparable revenue growth in its Diagnosis & Treatment (imaging) business to €1.75 billion ($1.99b), Philips achieved 4% overall comparable sales growth to €4.3 billion ($4.89b) and an 11% increase in orders during Q3. However, currency headwinds brought a hefty 31% drop in profits to €292 million and a combination of missed targets and Brexit fears caused a major hit to its stock prices.
- Hitachi – Hitachi’s revenue and earnings continued to grow during its fiscal Q2, which included a 2% increase in revenue to ¥2.325 trillion ($20b) and a 6% rise in net income to ¥118.7 billion ($1.04b). As usual, the company did not disclose financials for its healthcare business, although it did say that healthcare achieved increased revenue and operating profit.
- Researchers from Michigan Tech and Penn State developed MRI radio frequency probes designed like microstrip patch antennas (MPA) that may prove to be a higher-resolution alternative to traditional MRI surface coils (conventional coils, and birdcage coils). The new design targets the problem of magnetic field uniformity (with coils, higher frequencies mean shorter wavelengths), and as a bonus the new design may also prove to be less complex, lower-cost, and result in less radiation losses than current coils.
- Israeli startup iNNOGING introduced a new system that allows physicians to manipulate captured ultrasound video and perform exams without the patient present, potentially reducing misdiagnosis and unnecessary call-backs, while supporting rural regions with few available doctors. iNNOGING’s software “takes apart” ultrasound video and “builds it again,” converting it to a 3D model, while doctors use the company’s Probe & Pad hardware attached to a PC to maneuver through the 3D model. The company is in talks with several Chinese players and system could reportedly reach the US in three years.
- PaxeraHealth announced the development of PaxeraAI, a new AI module integrated with its PaxeraUltima PACS system that learns from radiologists and stores collected information for use in future ML-based suggestions. The solution will go live in early 2019 and will include mammography and x-ray chest studies, expanding to other areas as the project grows.
- Swiss researchers developed an ultrasound system that can help distinguish between benign and malignant breast tumors. In addition to measuring ultrasound wave intensity the new device measures the duration of reflected sound waves, which may be particularly helpful for cancer diagnosis, given that malignant tissues transmit sound 3% faster than healthy tissue and 1.5% faster than benign tissue.
- The Society of Nuclear Medicine and Molecular Imaging (SNMMI) warned that there will be a “significant shortage” of molybdenum-99 (Mo-99) during the first half of November due to issues at facilities in South Africa and Australia.
- Mednax acquired Chattanooga, Tennessee radiology group, Associates in Diagnostic Radiology (14 radiologists), revealing plans to integrate it with Mednax’s Radiology Alliance practice in Nashville. Mednax is certainly intensifying its radiologist practice acquisition strategy, as four of the eight radiologist practice acquisitions in the company’s history have taken place in the last year.
- University of Southern California’s ultra-high-field 7T Terra MRI received FDA approval for clinical use, following a number of minor hardware and software updates, making it available for the treatment and monitoring of neurological diseases after about 18 months serving as USC’s research system. USC’s clinical 7T MRI begins operations about two months after a similar 7T MRI went live at Boston’s Brigham and Women’s Hospital and almost exactly a year after Mayo Clinic ramped up the first clinical use 7T MRI in the US.
- Focal Healthcare announced that its Fusion Bx 2.0 system achieved FDA clearance and Health Canada approval. The 2nd generation system uses MRI to identify lesions and fuses this information with live ultrasound images to create a 3D model of the prostate, allowing urologists to target specific regions for biopsy.
- Carestream announced that Gila Regional Medical of Silver City, New Mexico implemented the Carestream Clinical Collaboration Platform through a managed service agreement. The platform combines enterprise imaging, 3D viewing, lesion management, VNA, multimedia reporting, analytics, and the CARESTREAM Vue Motion enterprise viewer.
- A Dutch study (n=114) found that 4D flow MRI with automated cardiac valve tracking achieves valvular flow quantification faster (14 min. vs. 25 min.) and more reliably (4.9% variation vs. 9.8%) than manual valve tracking.
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- The Focused Ultrasound Foundation landed a spot on Charity Navigator’s list of America’s 10 Best Medical Research Organizations. The Focused Ultrasound Foundation achieved a four star rating, the highest rating awarded by the site, for its commitment to funding cutting-edge research, finding breakthroughs for a spectrum of conditions and diseases, and using donors’ funds wisely.
- OpenMarkets Exchange makes it easy to compare and order imaging tables, providing its clients savings of 10% or more for these popular items.
- POCUS Systems’ forthcoming ultrasounds will combine ease of use, durability, and reliability, allowing clinicians to focus on their patients.
- This Medmo video details how its healthcare marketplace platform and network of participating radiologists help underinsured patients pay as little as possible for their imaging procedures.
- This Carestream video demonstrates pediatric wrist imaging with the OnSight 3D Extremity System, which is particularly suitable for children due to its high resolution, low dose, and ability to image all planes at the same resolution.