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First Photon-Counting CT | AI ROI | Skeletal Milestone

“On a farm, you can get very bored,”

Godfrey Hounsfield on how growing up on a farm led to his career as an inventor, and eventually to his creation of the first CT scanner 50 years ago last week.



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Imaging Wire Sponsors

Arterys | Bayer Radiology | Blackford Analysis
Canon Medical Systems | Fujifilm Healthcare Americas
GE Healthcare | Novarad | Nuance
Riverain Technologies | Siemens Healthineers
United Imaging | Zebra Medical Vision



The Imaging Wire


Siemens’ First Photon-Counting CT

The FDA announced the 510(k) clearance of Siemens Healthineers’ NAEOTOM Alpha photon-counting CT scanner, calling it “the first new major technological improvement for Computed Tomography (CT) imaging in nearly a decade.” Those are some big words from a federal agency not known for hyperbole, and it doesn’t appear they are exaggerating.

About Photon-Counting CTs – Photon-counting CTs (PCCTs) produce far higher quality images than traditional CTs, with lower radiation and contrast dosage. Unlike standard CTs that simultaneously measure the total energy from many X-rays (at the expense of image info, clarity, and contrast), photon-counting CT detectors directly convert each individual X-ray photon into digital electrical signals that are then “counted.”

The NAEOTOM Alpha – The NAEOTOM Alpha might be the first PCCT scanner, but the star of this announcement is its detector. The new photon-counting detector leverages a CdTe active detection layer to achieve PCCT’s targeted image/dosage/contrast advantages, and it could be the foundation of Siemens’ PCCT portfolio for years to come.

The PCCT Race – The other major OEMs seem to be doing everything they can to earn a spot among the PCCT leaders. GE Healthcare and Canon both acquired PCCT detector makers within the last year and are planning their own PCCT launches, while Philips appears to have ramped up its PCCT R&D.

The Takeaway – PCCT has been viewed as the “future” of CT technology for quite a while, and that future just became a lot closer with last week’s announcement. We’re going to see similar PCCT launches from the other major OEMs, but Siemens Healthineers will enjoy its role as the only player with an FDA-approved PCCT scanner until then.


COPC’s Case for Novarad

See how Novarad’s CryptoChart solution allowed Central Ohio Primary Care (COPC, 70 practices, 400 physicians) to make the transition to digital imaging sharing in this Healthcare IT News case study.

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Biograph Vision Quadra’s Extending FOV

Be at the forefront of PET/CT with an extended field of view. Download this Siemens Healthineers clinical case gallery to see how the extended field of view on Biograph Vision Quadra could reshape clinical outcomes.

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The Wire

  • AI’s Downstream ROI: Since accuracy studies don’t seem to be driving AI adoption, a team of Dutch researchers applied the Early Health Technology Assessment method (HTA) to measure healthcare AI’s downstream ROI. Their evaluation of an LVO stroke detection tool found that if it cut physicians’ missed LVO stroke rates in half (from 6% to 3%, a conservative estimate) it would eliminate $11m in annual costs in the UK (avoided care costs + QALYs). That would certainly help justify adopting the AI tool, although this study is intended to help inspire fact-based AI ROI discussions (not serve as an LVO AI endorsement).
  • GE MyoSPECT: GE Healthcare unveiled its new MyoSPECT cardiac-dedicated nuclear scanner, highlighting its support for a wider variety of patients, enhanced scanning capabilities, and streamlined workflow. MyoSPECT achieves these improvements through its wider table and 76% higher field-of-view volume (for positioning weak or high-BMI patients), its CZT detector and multi-pinhole collimator design (allows complete picture of heart anatomy), and its new patient positioning and motion detection/correction tools.
  • The PTSD-Heart Connection: A new Emory study quantified the link between PTSD and heart disease, performing PET MPI exams and PTSD assessments on 275 twin Vietnam War veterans (at baseline and after 12yrs). The exams revealed that individuals with late-onset PTSD and longstanding PTSD were far more likely to have reduced myocardial flow reserve ratios (MFR <2.0) than participants without PTSD (56% & 72% vs. 40%). These results were consistent within pairs of twins, suggesting that the MFR variations were not due to genetic or environmental factors.
  • RadNet M&A: RadNet informed investors that it remains an “aggressive” imaging center acquirer, revealing that it made 15 “very small acquisitions” in H1 2021, and confirming that imaging center M&A will continue to be a core part of its strategy. None of RadNet’s H1 acquisitions were solicited or competitive, which it attributed to its role as the dominant player in its markets (CA, AZ, NY, NJ, DE, MD).
  • The Cardiac Imaging Shift: A Thomas Jefferson University study detailed a series of major cardiac imaging shifts. Between 2010 and 2019, there was a transition away from cardiologist offices and towards hospital outpatient departments for TTE echo exams, MPI exams, and CCTA exams (office: -23% & −52% & -57%; HOPD: +107% & +71% & +211%), while cardiologists performed more in-office CPET exams (+193%). Increases in advanced cardiac imaging coincided with radiologists’ growing cardiac imaging role, as radiologists’ CCTA volumes increased across all locations (HOPDs: +355%, inpatient: +150%, office: +75%) and CMRI utilization increased significantly for both cardiologists and radiologists (+209% & +207% in HOPDs).
  • Fujifilm Integrates: FUJIFILM Medical Systems U.S.A. and FUJIFILM Healthcare Americas Corporation (formerly Hitachi Healthcare Americas) have now officially merged and are operating as FUJIFILM Healthcare Americas Corporation. This acquisition milestone officially combines the companies’ branding, portfolios, customer bases, and employees, while creating a new executive team led by Fujifilm veteran Henry Izawa. With this step complete, Fujifilm can further take advantage of the merged companies’ respective strengths.
  • A Skeletal Age AI Milestone: Radiology Journal just published one of the first prospective / multicenter / randomized / controlled clinical AI trials, which is a big deal on its own, but also showed that AI can improve radiologists’ skeletal age assessments. Ninety-three radiologists from six centers perform skeletal age assessments using hand X-rays (n = 792 with AI, 739 without AI), finding that AI-aided age assessments were closer to patients’ actual ages (5.36 vs. 5.95 months avg. variations) and were less likely to be off by more than 12 or 24 months (>12mo: 9.3% vs. 13%; >24mo: 0.5% vs. 1.8%). The AI tool also reduced median interpretation times (102 vs. 142 seconds).
  • Siemens & MD Anderson Promote qMRI: Siemens Healthineers and MD Anderson are working together to drive quantitative MRI adoption in radiation oncology. The collaboration will largely focus on developing a qMRI global education program, but Siemens and MD Anderson will also create standardized qMRI protocols and establish remote qMRI monitoring operations.
  • 18F-FES PET’s BC Clarifications: 18F-FES PET might be able to solve 87% of diagnostic dilemmas after breast cancer workups, such as when a biopsy can’t be performed or estrogen receptor status is unclear. That’s the result of a new JNM study that performed 100 18F-FES PET scans on 83 women with ER-positive metastatic BC (or were suspected) and physicians still faced a clinical dilemma after a standard workup. 18F-FES PET solved the dilemma in 87 of 100 scans (87%) and treatment plans were based directly on 81 of the 18F-FES PET results (83%).
  • Free-Text CDS AI: A new JACR study found that physicians might embrace an AI-based tool that analyzes free-text imaging orders and proposes structured indications to use in Clinical Decision Support systems. Three months after the UVA Health System added the free-text tool to its advanced imaging order workflow (n = 40k orders), providers were more likely to use it than their established structured indication search process (59% vs. 41%), and the free-text tool produced an indication with 91.7% of text entries (providers used 57.7% them).
  • The Case for BMRI Screenings: Breast MRI screening has already shown to be more clinically effective than mammography for women with extremely dense breasts, and it might also be more cost-effective at the right cadence. A team of Dutch researchers found that the additional cancer detections from 4-year breast MRI screenings added 2x more quality of life years (QALYs) than biannual mammograms among women with extremely dense breasts (100 vs. 500). Four-year MRI screenings’ €15,620 cost per QALY was 12% below biannual mammograms and well below the US’s $100k per QALY standard.
  • The Value of an Extra Year: Speaking of adding years, a recent Nature study found that the average American would pay $242k for one extra year of good health. Researchers calculated that an intervention that slows biological aging (lowering both mortality and frailty) while increasing life expectancy by one year would create approximately $38t in value (more than 3% of US GDP). The calculations focus on quantity of life as well as quality of life, underscoring the need to shift attention from the pursuit of a longer lifespan (just time) to healthspan (years spent in good health).
  • Intelerad & SR: Intelerad Medical Systems and Strategic Radiology announced a new partnership that will make Intelerad’s image management solutions available to SR member practices. Intelerad’s InteleOne XE platform and nuage Cloud Imaging Platform are now available to SR member practices, either by accessing the associations’ SR Enterprise License or through their own Individual Practice License.

AI’s Past, Present, and Path Forward

Check out this Imaging Wire Show interview with Riverain Technology’s Chief Science Officer, Jason Knapp, where we discuss the evolution of imaging AI, how to get generalizability right, AI’s path forward, and much more.

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The Resource Wire

  • Check out this Blackford Analysis video detailing how its AI platform streamlines AI adoption and workflows, allowing radiology teams to achieve AI’s clinical benefits without operational sacrifices.
  • Some small imaging centers haven’t been getting a fair chance with AI – here’s how GE Healthcare plans to change that.
  • Check out this talk from Eliot Siegel, MD on the “Hype, Myth, Reality and Next Steps” of imaging AI, including a profile on Canon’s AiCE Deep Learning Reconstruction solution at around the 4-minute mark.
  • This Journal of Neuroimaging study found that 4D Flow MRI effectively supports cerebrovascular vasoreactivity analysis for extracranial‐to‐intracranial bypass planning and post-surgery evaluation, revealing a new use case for Arterys’ Cardio AI software.
  • Here’s the first session in Nuance’s latest Fireside Chat series, featuring Healthcare Diagnostics leader, Karen Holzberger and new CMIO, Dr. Sheela Agarwal, and detailing how Nuance’s latest innovations are impacting the patient journey and outcomes.
  • See how researchers used United Imaging’s TOF PET/MR uPMR 790 system and PMNs-II-813 imaging to discover that PTT and RIT inhibits prostate cancer growth.
  • This Bayer case study details how radiation benchmarking programs can help push CT dose exposure reduction initiatives from achieving compliance to driving quality.
  • Learn how Fujifilm Healthcare’s VidiStar PACS system evolved to meet the needs of pediatric cardiologists in this Imaging Wire Q&A.
  • This Zebra-Med post details how AI is revolutionizing population health programs through automation, workflow integration, and significantly expanding early disease detection.


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