COVID-19 Gets Serious

“there is no current role for CT in the diagnostic assessment of patients with suspected coronavirus infection in the UK.”

The Royal College of Radiology clarifying that COVID-19 should be diagnosed with COVID-19 tests and CT imaging decisions should be based on each patient’s specific clinical need. Makes sense.


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COVID-19 Gets Serious

Most of you have known that coronavirus is extremely serious for a while now, but its seriousness just became a reality for the majority of Americans. People are very worried about their jobs and retirements, they’re concerned about their health and the health of their loved ones, their kids are home from school indefinitely, and half of Linkedin just became a “how to work from home” guru. Coronavirus just got very serious.

Coronavirus-related imaging news of course continued to flow this week, bringing a shift towards educational content (hospital best practices) and greater good messaging (cancel non-urgent imaging), as well as some clarifications on how imaging should and shouldn’t be used with COVID-19. Stay safe and healthy, everyone, and bravo to everyone fighting COVID-19.

  • Stable in SeattleA chest radiologist’s reports from COVID-19’s Seattle frontlines caught Radiology Twitter’s attention this week. The radiologist (via a proxy) shared that things are tough in Seattle “but not apocalyptic” and revealed a number of insights into how the hospital has adapted. Here are the takeaways: 1. Imaging volumes are actually down due to cancellations of elective procedures; 2. CT isn’t used to confirm, diagnose or exclude coronavirus (they use RT-PCR tests); 3. They are using some chest X-ray for guidance; 4. To avoid transmission, CT & X-ray machines are cleaned for 20 minutes between patients; 5. Also to avoid transmission, they are using portable X-ray for AP scans (sometimes through a glass window), while avoiding lateral scans (they take longer and can’t be captured through a window).
  • Radiology Dept Best Practice – For those still preparing their coronavirus plans, the journal Radiology assembled a panel from six major hospital systems to detail their COVID-19 preparedness best practices. Each hospital shared a relatively long list of best practices, but the general themes involved: 1. Creating an operational plan and communicating it; 2. Ensuring that patients w/ COVID-19 are quickly identified, isolated, and masked; 3. Ensuring that staff and other patients aren’t exposed; and 4. Defining imaging policies to support effective care and avoid transmission.
  • No Role for CTA statement from the UK’s Royal College of Radiology clarified that they see “no current role for CT” in the diagnostic assessment of patients with suspected coronavirus because there isn’t enough evidence that CT results in “definitive and positive management change.” This doesn’t mean that patients with COVID-19 shouldn’t be scanned, just that scanning decisions should be based on clinical need, regardless of whether it’s due to COVID-19 or the flu. It also aligns with the ACR’s statement last week.
  • New COVID-19 AIA new CT image analysis algorithm developed by a RadLogics and U of Maryland team, and developed from multiple international datasets, was able to differentiate 157 patients with and without COVID-19 with a 0.996 AUC (plus, 98.2% sensitivity and 92.2% specificity). The tool could also measure the disease’s burden and progression within a patient over time, defined by a Corona score. The team has more testing to do on this new algorithm and isn’t even talking about commercialization yet (at least publicly).
  • Lung US Strongly RecommendedA study out of Italy found that bedside lung ultrasound could be a potential option for the diagnosis and assessment of COVID-19 pneumonia, particularly in situations where CT is unavailable. The study performed CT and ultrasound on 12 patients with COVID-19 pneumonia, revealing a high correlation between the two modalities, and “strongly” recommending bedside US for emergency patients with flu-like symptoms during the “COVID-19 era.”
  • Reschedule It – The ACR and CDC both urged healthcare providers to reschedule all non-urgent imaging to help curb the spread of COVID-19 and free up capacity, including everything from mammography and lung cancer screenings to image-guided procedures. Susan G. Komen followed with a similar message, asking healthy women without signs of breast cancer to delay their screenings for the same reasons.
  • RSNA2020 ContingencySpeaking of rescheduling, RSNA already launched a FAQ site to help potential 2020 exhibitors understand how committing to the show will work in the COVID-19 era and how they are protected if it’s canceled or rescheduled.

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  • MedPAC Imaging Up, Slightly: The Medicare Payment Advisory Commission’s (MedPAC) latest report to congress found that medical imaging procedure volume per Medicare beneficiary grew by 0.7% in 2018 (vs. +1.3% in 2017, +0.7% 2013-2017 avg.). Imaging’s modest 2018 growth was driven by X-ray (+1.5% vs. 1.3% 2013-2017 avg.), CT (+4.7% vs. +3.7% 2013-2017 avg.), MRI (+2% vs. -3.6% 2013-2017 avg.), and nuclear imaging (+2.6% vs. +0.2% 2013-2017 avg.).
  • CT for Appendicitis: A Michigan Medicine study found that one of the reasons that appendicitis is often missed during initial emergency department visits (missed w/ 6% of adults, 4.4% of children) is the inaccuracy of abdominal X-ray scans. The study (n = 123.7k patients) revealed that patients who only received abdominal X-rays were less likely to have their appendicitis properly diagnosed during their initial ED visit, while patients who received CT scans were more likely to have their appendicitis diagnosed.
  • How Scale Helps: A JACR paper from a team of Radiology Partners leaders detailed how the massive practice uses its scale to improve patient value. Here’s what they mean by that: 1. Creating a culture of learning and collaboration to promote best practices; 2. Using AI to improve performance and clinician satisfaction; 3. Providing feedback to promote performance; 4. Reducing unnecessary imaging or invasive procedures; 5. Using evidence-based follow ups to improve outcomes; and 6. Having access to advanced data, analytics, project management, and machine learning tools.
  • A Reason for Shielding: New research into X-ray’s impact on the body’s molecular structures led to a theory that shielding all parts of a patient that are not being imaged could help protect against both radiation damage and potential harm from metals in imaging agents. The study is pretty complex for non-physicists, but it’s available for those who’d like more details.
  • UST Cancer Detection: Whole breast ultrasound tomography (UST) could help assess breast cancer risk among younger women with dense breasts by measuring the sound speed of breast tissue. That’s from a new study in the Journal of Clinical Medicine (n = 165 women w/o BC history, 61 w/ recent BC diagnosis) that found women with higher UST-based sound speeds had a much greater risk of breast cancer (1.83 odds ratio) than women with high density (1.27 OR).
  • Aris Closes: A new report on Auntminnie.com revealed that the relatively large radiology/teleradiology group, Aris Radiology (previously had >250 radiologists), closed its doors after it couldn’t access additional funding. The once PE-backed practice made at least three acquisitions in previous years.
  • ARIETTA 750: Hitachi Medical Systems Europe launched the ARIETTA 750 diagnostic ultrasound system, which is positioned below the flagship ARIETTA 850 and leverages a similar design. The announcement placed a specific focus on the new ARIETTA 750’s image quality, ergonomics and ease of use, and range of specific clinical applications. The new ultrasound is already registered with the FDA and is expected to ship stateside as well.
  • Dosage Down: The U.S.’s annual per capita imaging radiation dose fell by 20% between 2006 and 2016 (2.9 mSv – 2.3 mSv), after a six-fold increase between 1980 and 2006. That’s from a new study in Radiology, which attributed the decline to a drop in overall radiologic exams (877m to 691m) and technology improvements among high-dose modalities.
  • USFRF vs. Hologic: The University of South Florida Research Foundation filed a patent infringement lawsuit against Hologic, alleging that Hologic’s SecurView DX Mammography System infringes USFRF’s patent for a workstation that displays and manipulates digitized mammograms and their images. USFRF is seeking compensation from Hologic (which is no stranger to patent legislation) and an order blocking further unauthorized use of its inventions.
  • US MAC Predictions: Chinese researchers found that ultrasound-based medial arterial calcification (MAC) assessments can also help predict the potential diabetes complications: peripheral arterial disease and nephropathy. The researchers performed ultrasound on 359 patients with type 2 diabetes (37% w/ MAC), scoring the patients based on length of MAC (0–8 score) and number of arterial segmentations with MAC (0–6 score), finding that arterial segmentation MAC score can be used to predict peripheral arterial disease and nephropathy (but not neuropathy or retinopathy).
  • Siemens & Marienhaus: Siemens Healthineers landed a 10-year, €40m agreement with Marienhaus Hospital Group (German, 18 hospitals) that will involve the upgrade and service of its 130-device imaging fleet, digitalization of its clinical processes, and the introduction of online tools for professional development.

The Resource Wire

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