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The Diagnostic Gap | New Nodule Threshold

“This tiny storm became a typhoon and blew every scientist’s mind.”

Yu Xue of Huazhong University of Science and Technology describing Chinese researchers’ pro-AI mindset shift.


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The Imaging Wire


The Diagnostic Gap

The Lancet Commission on Diagnostics just put a spotlight on the developing world’s alarmingly low access to diagnostics and how this situation can be addressed.

The LMIC Gap – An unbelievable 47% of the global population has little to no access to diagnostics, with the vast majority of this diagnostic gap concentrated in low and middle-income countries (LMICs). This problem is greatest through LMICs’ primary care facilities (19% of people can access PCs w/ diagnostics), but also exists in hospitals (60%-70% of people can access hospitals w/ diagnostics).

The Impact – About 50% of people living with any of six key conditions in LMICs are undiagnosed (hypertension, type 2 diabetes, HIV, tuberculosis, syphilis & hepatitis B virus infection in pregnant women), making diagnostic access the world’s single greatest barrier to care. If undiagnosed rates for these six conditions were reduced to 10% in LMICs, it would avoid 1.1m premature deaths annually.

The Imaging Gap – There is a significant lack of imaging access in LMICs. Imaging access is lowest in primary care where only 5% of basic facilities and 12% of advanced facilities have ultrasound (never mind more advanced imaging). Meanwhile only 36% to 87% of hospitals in LMICs have working X-ray systems and just 2% to 29% of hospitals have a CT scanner (depending on the country).

The Problem – The authors largely blamed the developing world’s diagnostic gap on a lack of visibility and prioritization, although there’s a long list of other factors (corruption, costs, infrastructure, workforce).

The Solutions – The Lancet Commission believes that recent technology and informatics innovations could accelerate government efforts to improve diagnostic access. Until then, they recommend that LMICs develop national diagnostics strategies, ensure that standard diagnostic tests are available at various healthcare tiers (e.g. ultrasound at all primary care facilities), and prioritize improving diagnostic access through primary care facilities.

One Takeaway – Half the world doesn’t have access to diagnostics. This is mainly an economic problem, but imaging could play an outsized role in the solution considering that many of the latest imaging innovations are well suited for low-resource areas (e.g. handheld POCUS, AI diagnostics/guidance, portable MRI, teleradiology, etc.).


Fujifilm’s VidiStar Benefits

See how VidiStar users have benefitted from the Fujifilm Healthcare’s cardiovascular information system’s flexible SaaS-based model and leveraged its productivity advantages to increase reimbursements.

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Arterys’ 4D Flow Enhancement

This American College of Cardiology case report details how Arterys’ 4D Flow enhances visualization of blood flow and pulmonary venous anatomy in cardiac MRI, improving diagnosis and surgical planning for partial anomalous pulmonary venous return.

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The Wire

  • Lowering the Nodule Growth Threshold: A new study out of the UK suggests that lung nodule volume increases of ≥15% should be flagged as true growth and more closely monitored (not ≥25% growth). The researchers performed two same-day chest CTs on 45 adults with pulmonary nodules (100 nodules, 30–150 mm3), finding lower limit volume variations up to 16.4% and upper limit variations up to 14.6%. Those variations are far below previous studies that recorded interscan variations as high as 25% and created our current ≥25% growth threshold.
  • The Graphite Marketplace: Piloting new digital health tools will soon be a lot easier, at least if Graphite Health has anything to say about it. Intermountain Healthcare, Presbyterian Healthcare Services, and SSM Health teamed up to launch Graphite Health, a member-led nonprofit aiming to create an interoperable data platform that will allow health systems to adopt new technologies “as easily as anyone can download an app from an app store to a smartphone.”
  • Kromek to the Moon: Kromek is getting more investor attention following Canon’s acquisition of its main CZT detector competitor, Redlen Technologies. Cenkos Securities called Kromek “materially undervalued” now that it’s the only independent CZT producer, suggesting that Kromek should be trading at £50 per share (vs. £16.85 on Friday). Cenkos might have a point, considering that Photon-counting CTs are viewed as “the next big thing” and GE (Prismatic Sensors in 2020, OMS in 2010) and Siemens (Acrorad in 2013) already acquired the other major PCCT detector tech companies.
  • Mammography AI Evidence: The JACR just added to the small but growing field of real-world AI studies, detailing one Southern California outpatient imaging center’s positive experience with CureMetrix’s mammography AI tools (cmTriage & cmAssist). In the two years since implementation, the imaging center achieved significantly faster 2D mammography turnaround times (9.6 to 3.9 days) and fewer flags per exam (2.26 to 0.65), allowing exams with suspicious findings to usually be interpreted in one day. Perhaps just as notably, after initial skepticism all radiologists now prefer the AI tools over their traditional CAD and view cmTriage as the preferred way to manage their worklists.
  • China’s AI Evolution: If you’ve ever wondered why so many AI studies and 8-to-9-figure AI funding rounds come out of China, a new Nature article has some answers. China’s AI evolution gained momentum in 2011 when significant increases in government funding drove a surge in AI initiatives (infrastructure, research projects, programs), leading to a positive AI mindset shift among its scientists, and more AI collaborations between researchers and clinicians.
  • CRA & TMC: Massachusetts practice Commonwealth Radiology Associates (CRA, 71 radiologists) launched an interesting new partnership with Tufts Medical Center (TMC, 20 radiologists) that will integrate their radiologists at the academic medical center. This “first-in-the-market model” will provide a number of advantages for patient care (more subspecialists, broader coverage, improved service, more resident trainers) while making CRA a more attractive employer (ability to work in urban /academic or suburban environments, new teaching/training opportunities).
  • SubtlePET Cuts 18F-FDG: Stanford researchers found that Subtle Medical’s PET image reconstruction solution can significantly reduce 18F-FDG PET/MRI radiotracer dosage for assessing pediatric lymphoma treatment response. The researchers simulated low-dose 18F-FDG PET/MRI scans using 20 patients’ full-dose exams (at baseline and after induction chemo) and then used SubtlePET to enhance the simulated low-dose scans. After SubtlePET enhancement, the 50% and 75% low-dose exams led to correct assessments with 100% patients (vs. 7% and 57% correct before enhancement).
  • Rezolut Adds MD Imaging: Imaging center company, Rezolut, expanded into New York’s Hudson Valley with its acquisition of MD Imaging (2 imaging centers, most modalities), giving it 24 locations in six states (NY, NJ, PA, CA, AZ, NM). Rezolut has taken advantage of its PE funding, acquiring eight imaging center and mobile imaging companies in the last three years.
  • 68Ga-NOTA’s PSMA Promise: A new JNM study found that the novel 68Ga-NOTA (68Ga-NGUL) PET/CT tracer performs similarly to the established 68Ga-PSMA-11 tracer, and could become a valuable option for prostate cancer imaging. The prospective study performed 68Ga-NGUL and 68Ga-PSMA-11 PET/CT scans on 11 patients with metastatic prostate cancer, finding that the two tracers had identical detection of PSMA-positive primary and metastatic lesions, while 68Ga-NGUL had significantly lower normal-organ uptake and rapid urinary clearance.
  • Hospital Turnover: Nearly 1 in 5 healthcare workers have quit their jobs since February 2020, according to a September survey from Morning Consult. Among healthcare workers that did not quit, 31% have considered leaving, citing the pandemic, monetary concerns, and burnout as their top reasons. Hospitals have been leaning heavily on staff to work overtime, with 79% of healthcare workers saying that the workforce shortage has impacted their place of work, sometimes leading to “rushed or subpar care for patients.”
  • VUNO & Samsung Expand Alliance: VUNO and Samsung expanded their global AI alliance, embedding VUNO’s Med-Chest X-ray AI product (flags thoracic abnormalities) into Samsung’s GC85A premium ceiling X-ray system. The companies previously made VUNO’s Med-Chest X-ray available with Samsung’s GM85 mobile X-ray system in July and VUNO announced a similar embedded AI alliance with LG Electronics in June.
  • Cancer Costs: Caring for the 15 most prevalent cancers cost private payors $156.2b in 2018 (n = 402k US adults <65yrs), largely driven by breast, lung, lymphoma, and colorectal cancer treatment. Radiology contributed 19.4% of documented procedure code costs ($2.1 of $10.8b), behind medical supplies and non-physician services (37%, $4b) and ahead of surgery (16.7%, $1.8b).

Canon AiCE’s Cardiovascular Imaging Evolution

See how Canon AiCE DLR is achieving new levels of cardiovascular imaging in this presentation from Jeannie Yu MD, FACC, FSCCT.

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The Resource Wire

  • Why migrate to PowerScribe One? Tune in to Nuance’s next Fireside Chat (Oct 12th, 2pm Eastern), where they’ll explore how PowerScribe One allows radiologists to achieve unprecedented levels of accuracy, efficiency, and quality.
  • Check out this Imaging Wire Show interview with Blackford Analysis founder and CEO, Ben Panter, detailing how to solve AI’s assessment and deployment problem, AI’s downstream value, and what it will take for AI to have its greatest impact.
  • See how Novarad’s CryptoChart allows patients to easily access and share their medical images using personalized, highly secure QR codes (not CDs).
  • We’ve heard a lot about the AMA’s new Category III CPT codes for artificial intelligence. Check out this post from Zebra-Med CEO, Zohar Elhanani, about how these codes bring the next step in Zebra-Med’s population health mission.