Opening AI’s Black Box

“Look Closer…”

The headline for GE Healthcare’s new online ad announcing the Vscan Extend handheld ultrasound’s price drop to just $2,995.

 


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The Imaging Wire


Opening AI’s Black Box
Researchers from Yale University developed a 3D CNN algorithm that outperforms radiologists in classifying liver lesions in MRI scans, which is a pretty typical study result these days, but stands out for its ability to explain its findings to radiologists. The CNN model achieved greater average accuracy (92% vs. 80% to 85%), sensitivity (92% vs. 82.5%), and specificity (98% vs. 96.5%) versus a pair of radiologists in the study (296 patients, 494 lesions), while helping to overcome the “black box” nature of AI by explaining the reasoning behind its findings. It’s this last “black box” part that is of particular value, as the algorithm’s ability to explain its findings are expected to improve accuracy and build trust in AI applications in clinical settings, helping to drive adoption.


GE and Spectrum Dynamics’ SPECT Fight
Spectrum Dynamics filed a lawsuit against GE Healthcare, claiming that the healthcare giant “deliberately, repeatedly and with fraudulent intent” misappropriated its intellectual property, resulting in GE filing patents for technology that were eventually used in Spectrum Dynamics’ VERITON SPECT system. Spectrum Dynamics seeks to stop GE from “developing, commercializing or otherwise using” this IP as well as to correct “inventorship” on the GE patents in question. GE of course didn’t comment on these charges, but it has a formidable legal team and will be ready for a fight if it believes it has a case. There certainly appears to be some shared DNA between Spectrum Dynamics and GE Healthcare’s SPECT lines, as they both use dedicated cardiac CZT cameras, Spectrum Dynamics lists GE’s Discovery SPECT systems as predicate devices in its FDA filings, and both Spectrum Dynamics and GE’s SPECT division have long histories in Israel’s nuclear imaging industry.


A Win for Patient Centric Imaging
Swedish researchers notched another win for patient centricity, publishing a study (n=3,532) that suggests cardiovascular disease patients who are shown their atherosclerosis ultrasound scans and are supported with follow-ups are more likely to make risk-reducing lifestyle changes than patients who don’t see their scans or receive follow-ups. This makes sense. The study’s 1,749 “intervention group” patients were shown an image of plaque formation in their arteries (marked to compare biological and chronological age), followed by a call from a nurse to confirm understanding 2-4 weeks later, while the same ultrasound images were also shared with the patients’ primary care doctors. The study’s 1,783 unfortunate “control group” patients did not view their ultrasound results nor receive any additional communication efforts. As expected, one-year follow-ups revealed that the interventional group patients significantly out-performed the control group in FRS scores (-0.58 vs. +0.35), SCORE levels (0.27 vs. 0.13), and total and LDL cholesterol. Although this study has more direct clinical implications, it brings to mind a recent study from University of Washington Seattle that found patients view learning about their imaging results as a valuable part of their healthcare journey.


Little GE Vscan Extend’s Big Price Drop
Americans within GE Healthcare’s digital marketing reach recently learned that the company’s once-$8,000+ Vscan Extend handheld ultrasound systems were reduced to a $2,995 starting price. Chances are they learned about this price cut in numerous ways, including remarketing ads on non-radiology/medical websites, posts on GE’s Twitter feed, and even through paid Google search ads. There’s not a lot of pricing-related news in radiology, which makes sense given the nature of the specialty, but this price cut and associated marketing push is a great example of the key role pricing currently plays in the handheld ultrasound space. This trend has particularly intensified since the emergence of low-cost systems like the $1,000 Butterfly iQ, placing competitive pressure on medical imaging’s major players who’ve largely kept their handhelds north of $6,000. Although GE’s price cut could be seen as a testament to the pressure Butterfly and other startups have been able to create, any pride they feel from GE’s reaction may be overshadowed by the challenges price drops like this pose against Butterfly and other handheld players’ low-cost value proposition.


Ultrasound, the Superior DBT Follow-Up
Mayo Clinic researchers found that ultrasound assessments may be a sufficient follow-up after digital breast tomosynthesis screening identifies suspicious masses, potentially making follow-up mammograms unnecessary. The study (n=212) found no significant difference between ultrasound post-DBT and 2D mammography, which has historically been the go-to follow-up after DBT, with diagnostic ultrasound serving as a third step. The researchers argue that eliminating this middle mammography step can help save costs, reduce radiation, and improve patient and workflow efficiency.

 


The Wire

 

  • In other bad news for 2D mammography, two studies presented at RSNA highlighted DBT’s screening and diagnostic advantages over mammography. On the screening side, a Yale-led study (n=45,251) among 40 to 54-year-old women found that DBT had much lower recall rates for all-aged women and greater cancer detection rates among women between 40 and 49 (but lower rates at 50-54 yrs). Meanwhile, Johns Hopkins researchers (n=10,845) found DBT significantly outperformed mammography in diagnosis, specifically for cancer detection (45.4% vs. 28.9%) and positive predictive value rates (34% vs. 21.3%).
  • US healthcare spending grew by 3.9% in 2017 to $3.5 to trillion ($10,739 per person), marking the second straight year of slowing spending growth (2016: +4.8%, 2015: +5.8%), and returning growth to levels seen before health care expansion and during the great recession (2008-2013). The CMS healthcare spending report attributed the slowdown to drops in physician and clinical services (down 1.4 percentage points), hospital spending (down 1 point), and retail prescriptions (down 1.9 points).
  • iCAD announced the FDA clearance of its ProFound AI digital breast tomosynthesis cancer detection software, trained to detect malignant soft-tissue densities and calcifications. The AI-based software’s clearance follows a clinical study with 24 radiologists who read 260 tomosynthesis cases with and without iCAD’s ProFound AI solution, resulting in increased cancer detection rates (+8% avg.), reduced false positives and patient recalls (-7% avg.), and a “significant decrease” in interpretation times (more than 50% avg.).

 


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