Auto LC Referrals | COVID Impacts | Big AI


“Someone who can correlate chest X-ray readings with art, and can also enjoy a dive bar. I’ve found the one.”

Balaji Pandian realized he “found the one” during a Michigan Medical lecture when his future wife (Dr. Mary Oakley Strasser) compared the dots in a TB-positive chest X-ray to the work of French post-impressionist, Georges-Pierre Seurat.



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The Imaging Wire



Automatic Lung Cancer Referrals

Using a standardized radiology reporting system that automatically refers patients with suspicious lung nodules can improve early-stage lung cancer diagnosis rates. That’s from a new Kaiser Permanente study and here are some details:

  • The System – Inspired by a similar mammography reporting system, KP’s new lung cancer reporting system standardizes how chest CT scan reports classify pulmonary findings (into categories) and automatically refers patients with suspicious nodules to a multidisciplinary care team.
  • The Study – The study reviewed data from 99k patients who received chest CTs, including 40% who were processed using the new KP radiology reporting system.
  • The Results – Overall, 2,856 of the patients were diagnosed with lung cancer (2.9%), including about 800 at early stages (28%), while patients reviewed with the new reporting system had 24% greater odds of early-stage lung cancer diagnosis.
  • The Takeaway – This study reveals a way to catch more early-stage lung cancers and shows that chest CT reporting can be automated, despite the scan’s greater complexities. Systems like this should also improve the patient experience, as they are informed that experts are evaluating their scan and creating a plan rather than just learning that “something was found on your scan.”

The Wire

  • Pandemic Impacts: A JAMA study detailed major declines in preventive and elective care during the first two months of the COVID-19 pandemic, including notable drops in imaging volumes. The study of 6.8m commercially insured patients during March and April 2020 revealed massive declines in mammograms (-41.6% & -90.4%) and MRI scans (-28% % -62.6%), while telemedicine services surged (+1,270% & +4,081%).
  • Big AI Expectations: A new Optum survey revealed that 59% of senior health care executives (n = 500) are expecting a return on their healthcare AI investments in under three years (up from 31% in 2018). The vast majority of these execs plan to hire staff with AI development experience (95%) and expect their employees who receive AI-driven insights to understand how AI works (92%). These big AI expectations go way beyond imaging, as the health executives’ most common AI targets included monitoring IOT devices (40%), accelerating research (37%), and assigning codes for accurate diagnosis and reimbursement (37%).
  • New COVID LUS Protocol: An Italian team unveiled a new bedside lung ultrasound (LUS) protocol (evaluation of 14 anatomic landmarks, scores graded 0–3) that can predict whether patients’ COVID-19 pneumonia will worsen. The team performed the LUS exams on 52 CV19-positive patients at admission, finding that the 29 patients with worse outcomes had higher mean LUS scores than the patients who didn’t deteriorate (29.4 vs. 20.4). Patients with LUS scores higher than 24 had 6-times greater odds of worsening than those below 24.
  • Humana’s Fusion Limitations: Humana revealed that it won’t cover PET/CT exams for a wide range of indications (cardiac, gastric or esophageal oncologic, neurologic, total body screening) or most other fusion modalities for any indications (MRI/CT, PET/MRI, SPECT/CT, SPECT/MRI) because they are “experimental / investigational” exams that are not “widely used and generally accepted.” As you might expect, physician and imaging groups are not pleased with this decision.
  • Sonic Incytes’ FDA: Sonic Incytes Medical announced the launch and FDA approval of its Velacur handheld 3D ultrasound solution, which assesses fatty liver disease in 5-minutes with accuracy that’s “comparable to” MRI elastography. The Velacur solution combines a handheld ultrasound that is placed between a patient’s ribs and an activation pad positioned underneath the patient, creating steady waves to quantify steatosis (fat content) and stage fibrosis (tissue stiffness) in the liver.
  • A Call for Obstetric Ultrasound Access: A paper in Radiography called for new regulations to expand obstetric ultrasound access in low-resource regions (particularly rural areas in developing countries) “to address the huge burden of avoidable maternal and child morbidity and mortality.” Noting advancements in POC ultrasound (size, portability, cost, quality), the Nigeria-based authors suggested that these longstanding rural access barriers could be overcome with the right regulations and funding / training.
  • Imaging Revenues Up: After the COVID emergency brought widespread revenue declines during the April-June quarter, July-Sept financials reveal post-shutdown revenue rebounds from nearly all major OEMs’ imaging / healthcare divisions. Siemens Healthineers’ imaging business led the rebound ($2.48b to $2.9b), followed closely by GE Healthcare ($3.9b to $4.1), Philips’ diagnostics division ($2.26b to $2.34b), Canon Medical ($962m to $1.02b), Hologic’s breast imaging division ($193m to $235.5m), and Konica Minolta’s healthcare division ($154m to $184m). These revenue numbers are still down compared to Q3 2019 (-10.45% avg.) and the COVID emergency continues, but it’s still good timing for improved quarterly revenues.
  • Quiet Comfort MRIs: Reducing acoustic noise during MRI scans reduces patient discomfort, without affecting image quality. That’s from a Swiss study that performed standard MRIs and noise-reduced MRIs on 174 consecutive patients (half w/ noise reduction), finding that the reduced noise MRIs improved comfort and helped patients hear the music from their headphones during their scans. A pair of radiologists found no significant image quality difference between the two groups.
  • Radres Programs Internationalize: A new Academic Radiology study detailed the growing presence of international medical graduates (IMGs) in U.S. radiology residency programs, potentially contributing rad residency competition. The proportion of IMGs in U.S. radres programs (4.4% to 9.4%) and IMGs’ match rates (7.6% to 14.9%) both roughly doubled from 2006 to 2020.
  • AB-MRI’s HCC Advantages: A new paper in Radiographics highlighted the upsides of using Abbreviated MRI for hepatocellular carcinoma (HCC) surveillance in adults with cirrhosis or chronic hepatitis B. The authors backed this up noting its 15-minute scan times (vs. 40 for abdominal MRI, 30 for US), higher sensitivity and specificity (vs. ultrasound), the fact that it doesn’t use contrast (like ultrasound or other MRI protocols), and its cost effectiveness (vs. other MRI protocols).
  • CMS’ Ordering Documentation: CMS launched a pilot process that allows Medicare Administrative Contractors (MACs) to request documentation from treating / ordering providers during medical review to evaluate the necessity and payment of the radiology services they ordered. The ACR voiced its support for this new guidance, which they’ve “been pushing for years,” as it streamlines processes and reduces the risk that payments to radiologists are denied.
  • LDCT for BMD: New research out of China found that low‐dose CT scans obtained for other clinical exams (e.g. LC screening) creates an opportunity to also measure bone mineral density (BMD) and osteoporosis prevalence. Using data from 69k adults who received lung cancer screening LD-CT scans, the researchers measured lumbar spine volumetric bone mineral density (vBMD) using quantitative CT software, finding similar osteoporosis rates among women (28.9% vs. 29.1%) and 2x higher rates among men (13.5% vs. 6.5%) compared to a study that used DXA to measure osteoporosis in the same regions. This study comes just a few months after similar research supported using cardiac CT to screen for osteoporosis.
  • AI Godfather Q&A: In a recent interview, AI pioneer Geoff Hinton assured that AI will “be able to do everything” once we achieve “a few conceptual breakthroughs” (similar to NLP Transformers in 2017) and “a massive increase in scale” (1000x more parameters than GPT-3). He also touched on AI’s next big things (common sense, fine motor control), how human brains work, and how his contrarian views tend to come true.
  • 68Ga-FAPI PET/CT for PDAC: A new study out of Germany found that 68Ga-FAPI PET/CT imaging could improve pancreatic ductal carcinoma (PDAC) treatment compared to contrast-enhanced CT. The study of 19 patients with PDAC (7 primary, 12 progressive/recurrent) found that 68Ga-FAPI PET/CT led to changes in TNM (tumor, node, and metastases) staging for 10 patients and changed seven patients’ oncological management plans (from initial CT staging).

The Resource Wire

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