Pain Imaging | CT for OP | Stethoscope Extinction

“It is time to admit that our trusty analog listening device should be put out to pasture.”

Inova Health System hospitalist Larry Istrail MD, encouraging doctors to finally replace their stethoscopes with point-of-care ultrasounds.


Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire



Showing Where it Hurts

A Stanford-led study presented at SNMMI 2020 revealed a new 18F-FDG PET/MRI approach that can identify the location of pain generators in chronic pain sufferers, potentially improving how pain is managed.

  • The Study – The researchers performed whole-body 18F-FDG PET/MRI scans on 65 chronic pain patients. Two radiologists then evaluated the images to identify where increased 18F-FDG uptake occurred and discussed the results with referring physicians.
  • The Results – The radiologists identified increased 18F-FDG uptake in the affected nerves and muscle of 58 patients, resulting in mild pain management changes among 16 patients (e.g. diagnostic tests) and significant modifications for 36 patients (e.g. new invasive procedures). Overall, the exams led to 40 management plan changes that weren’t anticipated by the referring physicians.
  • The Significance – This technique could lead to improved pain management and could “lay the groundwork for the birth of a new subspecialty in nuclear medicine and radiology.”



Cardiac CT for Osteoporosis

A study published in RSNA revealed that cardiac CT scans can be used for both cardiac and osteoporosis exams, after discovering that thoracic vertebrae bone mineral density (BMD) can predict future fracture risk.

  • The Study – The researchers analyzed 1,487 participants’ cardiac CT scans (originally intended to evaluate ischemic heart disease), finding that 179 (12%) had very low BMD (< 80 mg/cm3).
  • The Results – After three years, 80 of the patients experienced an incidental fracture, including 31 that were osteoporosis-related. The researchers found that low-BMD patients were 2-times more likely to have any type of fracture and 8.1-times more likely to have osteoporosis-related fractures.
  • The Big Takeaway – Although chest CT might not be a direct replacement for DEXA, it could be used to expand bone density screening, while also assessing heart health.

The Wire

  • Stethoscope Extinction: A statnews.com opinion column reintroduced the idea of point-of-care ultrasound replacing the stethoscope, suggesting that the COVID-19 crisis could “be the straw that breaks” the iconic 200+ year-old instrument’s back. Hospitalist Larry Istrail suggested that the pandemic and the emergence of handheld ultrasound technology are highlighting stethoscopes’ diagnostic and contamination disadvantages, while positioning POCUS as its successor across hospital departments.
  • Bayer Intego PET Smart Package: Bayer unveiled enhancements to its MEDRAD Intego PET Infusion System that improve workflow connectivity and add new radiation dose tracking capabilities. Developed in collaboration with ec2 Software Solutions and Numa, the new MEDRAD Intego PET Smart Package adds HIS, DICOM, and PACS connectivity / functionality including workflow, scheduling, record exchange, and dosage info.
  • English Backlog: The UK NHS revealed an urgent need for more scanners and radiology staff to work through an imaging backlog that is forcing over half of its patients to wait six weeks or more for their scans. The coronavirus crisis exacerbated the UK NHS’ strained radiology workflow, as 600k patients are currently waiting for scans and 326k have been waiting for more than six weeks (vs. 21k patients >6 weeks in May 2019).
  • Caption’s $53M: Caption Health just closed a hefty $53 Series B round (total now: $60.9m) that it will use to fund development (expand platform, add clinical capabilities) and commercialization (scale operations, add partners). Caption’s FDA-cleared AI-guided ultrasound technology focuses on expanding ultrasound to less-trained clinicians, which it suggests is especially necessary as the COVID-19 pandemic strains hospital capacity.
  • MACs’ CTP Feedback: Three of the seven Medicare Administrative Contractors (MACs) are seeking input from physicians and subject matter experts to determine whether CT Perfusion (CTP) for Cerebral Perfusion Analysis should be reimbursed by Medicare. They are considering whether CTP is medically reasonable and necessary in small acute ischemic stroke (AIS) patients and evaluating what conditions must be fulfilled to warrant reimbursement.
  • ProFound AI Risk Gets CE Mark: iCAD announced the EU CE Mark approval of its ProFound AI Risk solution, a clinical decision support tool that provides personalized two-year breast cancer risk estimates based on 2D screening mammograms. ProFound AI Risk combines a range of risk factors (age, density, subtle mammographic features) to produce short-term risk assessments that physicians can use to create customized screening plans and catch early-stage cancers.
  • How to Handle the COVID Backlog: The Italian Society of Medical Radiology (SIRM) shared some tips to help radiologists work through breast cancer screening backlogs created during the COVID-19 pandemic. Here they are: 1) Confirm or reschedule pending appointments; 2) Prioritize scheduling patients with suspicious symptoms; 3) Schedule women who are asymptomatic 1-year after breast cancer treatment and haven’t had an exam in at least three months; 4) Follow up with and reschedule asymptomatic women within three months of their missed their exams; and 5) use PPE, social distancing and strict sanitation for all imaging.
  • Messy in Milwaukee: Milwaukee Radiologists is suing Ascension Wisconsin after Ascension formed an imaging center joint venture with Premier Radiology and ended its contract with Milwaukee Radiologists. Milwaukee Radiologists alleges that this move violated their contract, citing a multi-year phase-out agreement that was supposed to run through 2026.
  • PET/MRI Knee Assessments: A Stanford University presentation at SNMMI detailed a new PET/MRI functional bone imaging method that could improve knee osteoarthritis assessment and management. Using 18F NaF PET/MRI to evaluate structural and physiological changes in knee osteoarthritis in 12 subjects, the researchers found that bone metabolism is abnormally high among patients with knee osteoarthritis.
  • Butterfly Basics: Butterfly Network now has an option for potential users who aren’t ready to commit to the Butterfly iQ’s +$420 annual fees, with the new $0 Butterfly Basic package. Users who buy the $2k Butterfly iQ can now start off without a commitment, but they also have to give up capture, storage, sharing, and M-Mode & Power Doppler, as well as Butterfly’s education, tele-guidance, and workflow solutions.
  • Hyland & Life Image: Hyland Healthcare announced a partnership with Life Image, combining Hyland’s enterprise imaging suite with Life Image’s digital image exchange network to improve interoperability and expand patient access.

The Resource Wire

– This is sponsored content.

  • GE Healthcare’s Venue Go ultrasound system has a uniquely adaptable design, built to go from cart to wall to table so you can take it almost anywhere at the point of care.
  • This Hitachi blog details how the COVID-19 pandemic created new urgency for healthcare systems to adopt and expand tele-health and tele-radiology, while outlining the key considerations for those about to make this transition.
  • This Riverain Technologies case study details how Einstein Medical Center adopted ClearRead CT enterprise-wide (all 13 CT scanners) and how the solution allowed Einstein radiologists to identify small nodules faster and more reliably.
  • The Focused Ultrasound Foundation’s July newsletter features an in-depth discussion about how focused ultrasound could revolutionize therapy.

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