Attack of the Mid-Levels

“Quick, quantified, precise.”

Dr. Mark Michalski, Director of Center for Clinical Data Science at Massachusetts General and Brigham and Women’s Hospitals, sharing his three-word vision of the future of healthcare.



Attack of the Mid-Levels
We’ve known for a few months that CMS’ 2019 schedule will allow registered radiologist assistants (RRAs) and radiology practitioner assistants (RPAs) to perform outpatient diagnostic imaging procedures under physician supervision, but with that day approaching, this new rule has some of the folks on the Auntminnie.com message boards riled up. These radiologists have seen lower-cost mid-levels (PAs, NPs, CRNAs, etc.) encroach into anesthesia and dermatology and are not excited about that happening in radiology. One warned that when “mid-levels get their foot in the door, they push for greater autonomy and independence and it becomes one big goddamn problem,” calling on fellow radiologists to “prevent the problem before it occurs.” These reactions may not be coming from a place of abundance, but it’s important to know they exist and should be considered if/when providers integrate RRAs and RPAs into their radiologist workflows.


Another Reason to be Paranoid about AI
Swiss researchers created a deep learning neural network algorithm capable of manipulating mammograms by either inserting or removing lesions from the images. The researchers had both good and bad news about their CycleGAN-based algorithm, suggesting that it could help radiologists evaluate scans for cancer but might also allow cyber attackers to cause misdiagnoses by adding or hiding lesions. The researchers trained the CycleGAN algorithm on 680 mammograms from 334 patients (resized to a lower resolution) and then used the algorithm to create altered mammogram images that a three-radiologist panel was unable to distinguish from real images. However, CycleGAN wasn’t able to accurately mimic natural breast patterns when trained with higher-resolution images, suggesting that there’s little threat of algorithm-influenced misdiagnoses today, but it’s something to prepare against in five to ten years.


Should GE Tell You About its AI Platform?
GE Healthcare just published a star-studded interview on LinkedIn Pulse. The interviewer, who happens to be company president and CEO Kieran Murphy, started off by addressing the hyperbole and fatigue swirling around AI, followed by a quick rundown of GE’s AI activities (mainly its new Edison AI platform and new pneumothorax algorithm), before kicking-off a Q&A session with MGH/BWH’s clinical data science guru, Dr. Mark Michalski. Dr. Michalski shared his perspective on AI’s opportunities (care and efficiency), hype (doubt is natural, but AI will deliver), its fit with radiology (AI is good with images; radiology has well-structured data and a solid IT infrastructure), AI ethics (AI needs to be unbiased and democratized), and the future of healthcare (“Quick, quantified, precise.”). With GE’s spinoff looming and the evolution of AI arguably coming faster, you can’t blame GE for working to build its top executive’s brand (here’s another example) and reinforce its position as an AI leader. This can be a hard trick to pull off in an organic and value-added way (especially within a single piece), but in this case GE stuck the landing.


CCTA Before ICA
New research found that coronary CT angiography (CCTA) may be the appropriate first step to determine whether patients with suspected coronary artery disease would benefit from invasive coronary angiography (ICA), potentially reducing the number of patients who undergo the invasive and costly procedure. The study grouped 1,600 patients who were referred for invasive coronary angiography (ICA), with half receiving a CCTA as a first step to determine if ICA was necessary (23% still received ICA, 77% avoided ICA) and the other half immediately receiving an ICA (61.1% of those ended up being unnecessary). After 12 months, 4.6% of patients from both groups had major adverse cardiovascular events, but the CCTA group had a lower rate of coronary revascularization (13% vs. 18%) and saved an average of 57% in initial diagnostic costs ($1,183 vs. $2,755).


The Future of Telemedicine
A new survey (n=283) from Reaction Data suggests that although 67% of physicians and healthcare executives are not aware of CMS’ upcoming telemedicine reimbursement increases, knowledge of these increases is enough to encourage 63% of respondents to speed-up their telemedicine adoption. The survey revealed significant overall growth potential for telemedicine, as 53% of respondents are still not involved with telemedicine at all, with the remaining 23% contracted with a telemedicine provider and 24% using a homegrown solution. Understanding that telemedicine adoption and awareness is almost certainly higher in radiology, it makes sense that these healthcare-wide increases in telemedicine adoption will still have an impact on the uses, perspectives,and expectation of teleradiology.



The Wire

  • Canadian breast cancer researcher, Martin Yaffe, took a stand against The Canadian Task Force on Preventive Health Care’s (CTF) recently-suggested screening guidelines, claiming that 400 avoidable breast cancer deaths will happen in the country each year if the recommendations are adopted. Yaffe called for earlier screening standards (CTF recommended against screening before 50 years) and a greater focus on informing women with dense breasts so they can seek alternate screening methods such as ultrasound.

  • 24x7mag.com published a wide-ranging roundtable discussion on the ultrasound market with leaders from Canon, GE Healthcare, Trisonics, and Philips. The discussion touched on the market’s recent and future evolution (rapid growth, price and application expansion, user/ology expansion, improved image quality, shrinking form factors, automation), top current technological advancements (AI, clinical solutions, resolution, size), and future clinical segment expansion (breast, MSK, liver, acute care, “all”). The article is big, so check it out if you’re interested in going deeper.




The Resource Wire

– This is sponsored content.

  • Visage Imaging’s Top Five of RSNA2018 blog highlights a major health systems win, some Enterprise Imaging enhancements, an AI entry, a focus on “proving it,” and a shift to FHIRcast. Check it out here.

  • 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.




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