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ARRS 2021 Virtual Annual Meeting: April 18 to April 22, 2021

Chest X-rays aren’t just for diagnosing COVID-19. Newly published research now shows that these images can be part of a system that accurately predicts which patients will develop life-threatening conditions within four days.

By combining a deep neural network trained on chest X-rays with routine clinical variables, researchers from New York University Langone (NYU Langone) have created a system that performs comparably to interpreting radiologists and that can predict with 80-percent accuracy which COVID-19-positive patients will deteriorate, including mortality, intubation, and ICU admission.

“We develop[ed] an AI system that performs an automatic evaluation of deterioration risk, based on chest X-ray imaging, combined with other routinely collected non-imaging clinical variables,” said the team led by Krzysztof Geras, Ph.D., assistant professor of radiology at NYU Langone. “The goal is to provide support for critical clinical decision-making involving patients arriving at the [emergency department] in need of immediate care, based on the need for efficient patient triage.”

Chest X-ray Can Predict Outcomes for Patients With COVID-19

The team published details of their investigation on May 12 in 

. They also published their code and trained models 

. By being able to predict mortality, morbidity, and other outcomes, not only does the system improve triage, but it also alerts bed management teams on expected demands, provides situational awareness across individual patient care teams, and informs the general allocation of resources, the team said.

“Emergency room physicians and radiologists need effective tools like our program to quickly identify those COVID-19 patients whose condition is most likely to deteriorate quickly so that healthcare providers can monitor them more closely and intervene earlier,” said co-lead investigators Farah Shamout, Ph.D., assistant professor of computer engineering at New York University’s Abu Dhabi campus.

To create the neural network, the team used a training set of 5,224 chest X-rays from 2,943 patients who had severe COVID-19. With those images, they trained two models – one based on the Globally-Aware Multiple Instance Classifier (COVID-GMIC) and another based on a gradient boosting model (COVID-GBM).

Alongside details from the X-rays, the team incorporated patient age, race, and gender, as well as laboratory test results, such as weight, body temperature, and blood immune cell levels. They also factored in the need for a mechanical ventilator and whether the patient survived (2,405) or died (538).

Their test set consisted of 770 images from 718 patients who were admitted to NYU Langone between March 3, 2020, and June 28, 2020.

AI-Fueled Chest X-ray Can Provide Near-Perfect COVID-19 Identification

Based on their analysis, the team calculated the area under the receiver operating characteristic curve (AUC) and the area under the precision-recall curve (PR AUC) for deterioration prediction within 24, 48, 72, and 96 hours from the time of the chest X-ray. They, then, compared the system’s performance to outcomes produced by two radiologists.

Chest X-ray from patient severely ill from COVID-19, showing (in white patches) infected tissue spread across the lungs

CREDIT Courtesy of Nature Publishing or npj Digital Medicine

Their main outcome, the team said, is that the deep neural network system outperforms the radiologists in terms of AUC and PR AUC at 48, 72, and 96 hours. Specifically, the COVID-GMIC achieved an AUC of 0.808 at 96 hours compared to 0.741 of both radiologists. This performance shows that the computer program accurately predicts four out of five cases where an infected patient will either require intensive care or mechanical ventilation or die within four days of admission.

“We hypothesize that COVID-GMIC outperforms radiologists on this task due to the currently limited clinical understanding of which pulmonary parenchymal patterns predict clinical deterioration, rather than the severity of lung involvement,” the team explained.

The team also modified the COVID-GMIC model to assess the probability that the first adverse event will happen within a certain time frame. At 96 hours, they said, the concordance index is 0.713, indicating that the modified model can effectively discriminate between patients.

“The system aims to provide clinicians with a quantitative estimate of the risk of deterioration, and how it is expected to evolve over time, in order to enable efficient triage and prioritization of patients at the high risk of deterioration,” the team explained. “The tool may be of particular interest for pandemic hotspots where triage at admission is critical to allocate limited resources, such as hospital beds.”

Geras’s team also sought to take their deep neural network one step further, pushing it to overcome the existing clinical implementation hurdle. On May 22, 2020, they silently deployed their system into the hospital where it was able to produce predictions in real-time in approximately two seconds.

Between the launch date and June 24, 2020, they collected 375 chest X-rays – 38 of which (10.1 percent) were associated with a positive 96-hour deterioration outcome. This outcome is lower than the 20.3 percent in the retrospective test set, but the differences are expected, the team said, due to potential patient differences and changing treatment guidelines as the pandemic progressed.

“The results suggest that the implementation of our AI system in the existing clinical workflows is feasible. Our model does not incur any overhead operational costs on data collection, since chest X-ray images are routinely collected from COVID-19 patients,” they said. “Additionally, the model can process the image efficiently in real-time, without requiring extensive computational resources, such as GPUs.”

But, there is still more work to be done, Geras said. Future work will examine whether employing a multi-modal strategy and including additional clinical data will improve performance. The team is also drafting clinical guidelines for the use of their classification test, and they hope to deploy it to emergency physicians and radiologists soon.

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Articles

Computer program can accurately predict 80 percent of cases where COVID-19 patients will develop life-threatening conditions within four days. 

Chest X-ray Plus Artificial Intelligence Can Predict Worst Outcomes for COVID-19-Positive Patients

Providers can use a new ultrasound technique to more accurately detect blood flow problems in the placenta, potentially leading to an improvement in the diagnosis of fetal pathologies.

Placental problems happen in more than half of the cases of fetal growth restriction (FGR) or stillbirth annually. FGR affects up to 10 percent of pregnancies each year, and it is present in roughly 20 percent of stillbirths. Consequently, being able to effectively detect blood flow problems is critical.

Currently, providers use Doppler ultrasound to assess part of fetal health by measuring the pulsality of the umbilical artery blood velocity waveforms. But, several factors, including the fetal heartbeat can make an accurate examination and determination difficult.

a team of investigators from The Hospital for Sick Children in Toronto tested a new technique called wave reflection analysis that isolates the part of the pulsation that is specific to the placenta. When combined with conventional ultrasound scans, this method can diagnose circulatory problems that impact both the maternal and the fetal portions of the placenta during pregnancy.

“In this study, we found that wave reflections were larger in women with placental vascular pathology compared to healthy pregnancies,” said the team led by John G. Sled, Ph.D., senior scientist in the Program of Translational Medicine in obstetrics and gynecology department at The Hospital. “This was true for both maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM).”

To assess whether using wave reflection analysis with Doppler ultrasound could augment placental pathology diagnosis, the team, funded by the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, performed standard clinical ultrasound on 241 women between ages 18 and 45 who were between the 26

 weeks of pregnancy. Of this group, 36 women had been diagnosed with MVM, 16 had received FVM diagnoses, and 40 were considered healthy controls. The remaining 149 women had non-diagnostic findings or rare placental diagnoses.

Based on their analysis, women with MVM or FVM were significantly more likely to have adverse pregnancy outcomes, such as preeclampsia or small for gestational age births, than were women with no placental pathologies. In addition, women with FVM also had high rates of umbilical cord abnormalities, including entanglement at delivery, small cord diameter (less than 8 mm), and hyper-coiling.

In addition, they found that women with placental vascular pathologies had larger wave reflections than the healthy controls. According to their evaluation, the first harmonic coefficients were elevated in women with MVM and FVM by 55 percent and 41 percent, respectively. These higher coefficients indicated that there was one or more distal site of high hemodynamic impedance and/or a large impedance mismatch, the team said. They suspected the capillaries within the terminal villi because the structure of the villi are abnormal in both MVM and FVM.

With the clinical ultrasound-derived parameters, the team determined the umbilical artery pulsality index was significantly increased by 48 percent over the healthy controls, and the uterine artery pulsality index was increased by 77 percent, and the cerebroplacental ratio was significantly decreased by 35 percent in the MVM group. In addition, FVM women had no significant differences in umbilical or uterine artery pulsality index or the cerebroplacental ratio.

When viewed together, the team said, these findings offer diagnostic benefit.

“The predictive performance of the first harmonic reflection co-efficient was moderate. Combining the wave reflection coefficient with other metrics used clinically for surveillance (i.e., umbilical and uterine artery pulsality index, fetal biometry, and maternal blood testing) has the potential to improve diagnosis of placental pathologies,” they said.

If it is confirmed that a woman has an increased first harmonic wave reflection coefficient, a differential diagnosis can determine whether she had MVM or FVM pathology based upon whether she had an elevated umbilical or uterine pulsality index. Gestational age would then determine the next course of action, such as more intensive fetal monitoring or emergency C-section.

Overall, the team said, these findings are particularly promising for women with FVM because there is no current reliable method for detection.

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By combining a wave reflection analysis with standard Doppler ultrasound, providers can better identify whether a pregnant woman is experiencing impeded blood flow to the placenta, potentially improving pregnancy outcomes.



New Technique Plus Conventional Ultrasound Scans Improve Fetal Circulation Pathology Detection

Executive Director of Medical Imaging & Technology Alliance (MITA)

For decades, the United States has prided itself as the global leader of medical innovation. From record-breaking vaccine production and advanced nuclear imaging modalities to cutting-edge focused ultrasound technologies, America has been at the forefront of the modern world’s most watershed medical breakthroughs.

Recognizing the value of the nation’s most recent medical innovations, stakeholders across the healthcare continuum found cause for celebration in early 2021 when the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Coverage of Innovative Technology (MCIT) program. As proposed, the program would eliminate the gap between Food & Drug Administration (FDA) approval processes and CMS Medicare coverage decisions for the most innovative medical devices, providing more certainty to manufacturers, more tools in clinicians’ toolboxes to treat disease, and more universal and equitable treatment options for patients.

Above all, the program aligns well with the spirit of President Joe Biden’s policy approach to healthcare: expand access, encourage innovation, and support patients grappling with life-altering diseases.

Unfortunately, despite significant enthusiasm for the program, CMS 

 on March 17, 2021, that delayed implementation of the MCIT program by 60 days. The announcement also provided a 30-day public comment period to solicit additional feedback on the rule.

In the strongest possible terms, we urge CMS to implement the MCIT program following the 60-day delay period. Here is why:

MCIT Provides a Clear – and Necessary – Public Health Benefit

Nearly five years ago, Congress passed the 21st Century Cures Act. The law established a new pathway for the FDA to fast-track the development, review, and approval of cutting-edge medical devices, which the agency designated as “breakthrough.” As the name implies, this designation is only given to medical technologies that address debilitating and largely unmet health needs.

As important as the new FDA “breakthrough” pathway was, most of the devices that received expedited approval would soon collide with a substantial roadblock at CMS. That’s because Congress, while giving the FDA the power to fast-track the approval of advanced medical devices, did not allocate similar authority to CMS to expedite Medicare coverage for these devices following their approval.

The result – referred to by some as the “valley of death” – is that breakthrough medical devices sulk in limbo as CMS determines whether to cover them, a process that takes years. Meanwhile, Medicare beneficiaries battling chronic conditions, such as diabetes, Parkinson’s disease, heart disease, and advanced cancers are unable to access the latest innovations the Medical Technology (MedTech) sector has to offer. Since breakthrough coverage often varies across regions and different public and private payers, this also creates access disparities that forces many beneficiaries to pay high out-of-pocket costs to receive care.

By providing patients with immediate, four-year coverage for “breakthrough” designated medical technologies, MCIT would bridge the gap between FDA approval and subsequent Medicare coverage of innovative diagnostics and treatments. MCIT would also support more equitable treatment access for Medicare beneficiaries and reduce out-of-pocket expenses for vulnerable patients seeking advanced care. Accounting for these advantages, the program provides clear public health benefits by increasing access to new medical innovations that can improve outcomes and reduce costs.

MCIT Would Catalyze Future Innovations Across the MedTech Sector

In years past, limited beneficiary access to breakthrough medical devices undermined the ability of clinicians and product developers to collect the requisite data needed to establish that their devices met Medicare’s “reasonable and necessary” coverage criteria. This created an incentive structure in which innovators were better off focusing on developing cheaper products that utilized existing reimbursement codes rather than truly “breakthrough” technologies that would need to clear antiquated bureaucratic approval hurdles and require new reimbursement codes and policies.

If implemented, the MCIT program would improve the current incentive structure by modernizing the CMS “reasonable and necessary” criteria to ensure innovators can obtain coverage for their devices. At the same time, it would allow these innovators to collect the necessary clinical evidence to demonstrate that their devices offer clear and discernible benefits for patients. In other words, by doing away with previous regulatory snags, the streamlined coverage process outlined by MCIT would create strong incentives for companies and investors to devote additional resources towards the development of future breakthrough products.

Taken together, MCIT represents a much-needed regulatory upgrade that further solidifies the remarkable legacy of the 21st Century Cures Act. While further expansion of the program is welcomed, implementation of the MCIT rule would hasten the equitable delivery of medical innovations to patients while ensuring that important safety and efficacy standards remain intact. It is our sincere belief CMS should expeditiously finalize this program.

Move would support patients and encourage innovation.



CMS Must Provide Coverage for Breakthrough Medical Technologies  

https://texasradiology.com/doctors/w-nelson-elkins-m-d/

Middle-Aged Man Presents with Left-Sided Weakness

Dense basilar artery sign indicating occlusion of the basilar artery



- Strong predictor of basilar artery thrombosis if there is strong clinical concern for posterior circulation stroke
- The CTA demonstrates focal occlusion of the mid-to-distal basilar artery, with partial reconstitution distally (possibly from left posterior communicating artery)
- The final annotated MIP image demonstrates the opacified basilar artery (arrows) proximal and distal to the occlusion.

Middle age male with left sided weakness. What is the most likely diagnosis? What radiology sign is demonstrated?

Image IQ Quiz: Middle-Aged Man Presents with Left-Sided Weakness

Lasting heart damage is unlikely in patients who suffer from mild COVID-19 infection, according to new research, indicating there is little need to screen the hearts of these patients.

a team of investigators from University College London (UCL) showed, based on an analysis of healthcare workers who became infected with the virus while caring for patients, that people who are either asymptomatic or who develop mild symptoms do not suffer the same cardiovascular problems as those with severe disease, such as blood clots or heart inflammation.

“Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals six months post-mild severe acute respiratory syndrome coronavirus 2 infection,” said the team led by Thomas Treibel, MBBS, Ph.D., from the UCL Institute of Cardiovascular Science and Barts Health NHS Trust.

Cardiac MRI Shows Less Myocarditis in Athletes Post-COVID-19 Than Previously Reported

There has been a great deal of research over the past year into how the virus impacts the hearts of patients who suffer severe disease, but, to date, there has been little work into whether patients with mild cases will experience the same lingering, potentially life-long, problems. These findings, the team said, should assuage the cardiovascular concerns of the overwhelming majority of patients who experience mild COVID-19 cases.

“Disentangling the impact COVID-19 has on the heart has been a challenge,” Triebel said. “But, we’re now at the stage of the pandemic where we can really start to get a grip on the longer-term implications COVID-19 has on the health of our heart and blood vessels.”

For their study, the team drew from the pool of healthcare providers who worked most closely with patients who were COVID-19-positive. They selected 149 individuals with mild symptoms from the COVIDsortium, a study from three London hospitals where healthcare workers provided weekly blood, saliva, and nasal swab samples for 16 weeks. Participants had an average age of 37 and 58 percent of the group were female.

The team conducted cardiac MRI exams on 74 healthcare workers six months after their mild infection, focusing on heart structure and function. They compared their findings to scans from 75 healthy age, sex, and ethnicity matched controls who were never infected with the virus.

Based on their analysis, the team determined that between the group with previous mild COVID-19 and those who never contracted the virus, there were no differences in cardiac structure (left ventricular volumes, mass, or atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T

, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide).

Cardiac MRI Reveals Post-Recovery Heart Damage in 78 Percent of COVID-19 Patients

Some small abnormalities were picked up on MRI, but they were not identified more often in patients who had been infected than in those who were not. The changes, the team said, could have been caused by multiple non-COVID-related factors.

By examining a patient population with such close contact with the virus, Treibel said, the team is able to offer some reassurance as the pandemic continues on worldwide.

“We’ve been able to capitalize on our incredible frontline staff who’ve been exposed to the virus this past year, and we’re pleased to show that the majority of people who’ve had COVID-19 seem to not be at increased risk of developing future heart implications,” he said. “We now need to focus our attention on the long-term impact the virus has in those who’ve been hit hardest by the disease.”

Treibel’s colleague Sonya Babu-Narayan, MBBS, associate medical director at the British Heart Foundation (BHF) and consultant cardiologist, agreed these findings are a positive step in the continued fight against the pandemic – and that more work is coming.

“Throughout the pandemic, BHF researchers have made progress investigating the short and long-term effects of COVID-19 on the heart and circulatory system,” she said. “There’s still a lot more work to be done, but for not it seems the good news is that mild COVID-19 illness does not appear to be linked to lasting heart damage.”

Six months post-infection, the hearts of patients who had mild disease appear similar on cardiac MRI scans to the hearts of patients who were never infected.



Lasting Heart Damage Unlikely for Patients with Mild COVID-19

I find it interesting, now and then, to reflect on the peculiar skill sets people develop in the fullness of time. Not things they’d actively pursue, like reading through a CT with greater speed/accuracy or performing a daily exercise regimen more capably.

More like the inadvertent stuff. For instance, suddenly realizing that one’s become an expert at carrying far too many bags of groceries at once, in order to cut down on trips between car and kitchen. Whereas someone else, who hadn’t had occasion to practice, might not have the confidence to hook quite as many plastic-bag handles around fingertips…or might be over-confident, pick up too many things, and drop some of them. Even injure a pinky.

One such skill of mine: Sifting through, analyzing, and mentally cataloguing online profiles. It began a couple of decades ago, when online-dating was a new thing. A few years later, my search for a “forever house” (please, God, let me never have to re-locate again) was almost entirely web-based. Between then and now, buying/selling cars, shopping for mortgages and refinances, and, yes, hunting for radiology jobs joined the mix.

These seemingly-disparate pursuits have enough in common that they hone a relevant set of skills. One comes to more proficiently organize numerous options, mentally rank them against one another, and to varying degrees commit them to memory. Recognize the sometimes-hidden meanings of words and phrases—as well as the import of things 

Venues of people, or occasionally their agents, posting profiles and/or browsing through them, are a pretty good example of the supply/demand dynamic at work. Everyone involved has their own ideas about the value of what they are bringing to the table—and, often, what others are presenting. Sometimes, those ideas are sufficiently in sync to result in negotiating, if not an actual completed transaction.

An occasionally amusing offshoot of that: Someone disagrees with someone else’s offer/request sufficiently strongly that they feel the need to inform the other of their wrongness. Or, someone has gotten enough negative feedback that they modify their profile to pre-emptively refute such criticism.

On a dating profile, for instance, a homely individual with nothing on the ball might specifically state that ugly people shouldn’t bother reaching out to him/her, nor anybody earning less than six figures. Someone selling an eyesore firetrap on Zillow might demand twice the price that anybody sane would pay and advise browsers not to waste his time with offers of anything less.

Those familiar with the venue will typically see such gall and have a negative reaction: “Who the heck does he think he is?”

A meme crossed my path this past week that perfectly summed up such attitudes. Showing a picture of a piece of wood, it read: “I have a 4 x 8 sheet of 5/8” thick plywood. Willing to trade for a 2018-2020 Corvette convertible with less than 10k miles and clean title. No low-ballers. I know what I have.”

As mentioned earlier, radiology job-listings are not an exception to the phenomenon of sometimes-drastic differences between expectations of one player and the next. It was the case when I was last job-hunting, and folks who are currently seeking tell me that it has, if anything, increased with the strong job market. Not to mention the increasing prevalence of staffing via teleradiology. There are recruitment-ads asking for similar hours of coverage whose comp-offerings literally differ from one another by more than 6 figures.

Also as mentioned earlier, some of the players feel the need to take a poke at others who point out that their offerings/demands might be out-of-line with the rest of the market. One tale recently related to me regarded a group which was recruiting for both onsite and telerad positions. The seeker had reached out to the group about the latter, and was unpleasantly surprised to be told that the telerad option’s terms were substantially less favorable than the job profile had described.

Still, he politely responded, saying that he had other options offering better terms (one sticking-point being that he didn’t want a 7-on, 7-off schedule), and would thus not be applying. Wished the hiring-rad best of luck. He got a salty response, implying that he was somehow in the wrong for wanting, and indeed having access, to better deals than that rad group was offering.

To my knowledge, that seeker hasn’t as yet pulled the trigger on any particular job-offer; he’s in a good situation where he doesn’t have to act in a hurry. Maybe those better deals won’t pan out for him…but after that unpleasant retort, he’s particularly disinclined to ever reach out to that rad group again.

In addition to maybe putting someone more diplomatic in charge of their recruitment, I’d suggest that rad groups take such interactions as wake-up calls. If folks are reaching out to ask about your recruitment and telling you that it’s not even worth their while to apply when they hear your terms, that’s free information you’re being given. Instead of bitterly dismissing it, might be time to re-examine what other groups are asking/offering in their job-listings…and make some changes to remain competitive.

Of course, that goes for the job seekers, too. If your radiological offerings are tantamount to a sheet of plywood, and you think you’re going to land a cherry Corvette of a gig with them...you probably have an expectation adjustment in your future.

Follow Editorial Board member Eric Postal, M.D., on Twitter, 

Know what you have -- and know how it compares to the market.

Demand and Supply…and More Demands

In this week’s preview, here are some highlights of what you can expect to see coming soon:

Peer review has been widely used as a tactic for identifying diagnostic errors and opportunities for improvement. However, it has fallen short of its goal of helping radiologists learn from mistakes. Consequently, the specialty is shifting toward peer learning – a strategy that allows for anonymous critique of diagnostic oversights and gives providers guidance to avoid future errors. This week, look for an interview with Regan City from RadPartners about how facilities and institutions can implement their own peer learning models.

Medical breakthroughs, including those with imaging technologies, are critical to bringing patients the most cutting-edge treatments possible, particularly those who live with debilitating and unmet health needs. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare Coverage of Innovative Technology program, an initiative designed to close the gap between the Food & Drug Administration approval process and CMS’s approval of insurance coverage. Full implementation of the program has been delayed, however. Later this week, look for a column from 

, Ph.D., chief science officer from the Focused Ultrasound Foundation and Patrick Hope, executive director of MITA, calling for and explaining the need for swift program implementation.

For additional thought leadership on the importance of medical innovation

Breast imaging services – mammography and digital breast tomosynthesis – are effective in detecting breast cancers, leading women to get the services they need for treatment. However, access to these studies is not even across all patient populations. Ensuring that all women have equal access requires a well designed strategy. Look for a column later this week from Christine Murray, women’s health product manager from Fujifilm Medical Systems U.S.A., Inc., about the multi-pronged approach that help increase access for all women to these life-saving services.

Here's what to expect this week on Diagnostic Imaging.

Diagnostic Imaging's A Look Ahead: May 10, 2021, to May 14, 2021

In an effort to improve radiology performance and understanding, several years ago the industry launched the idea of peer review – a method where radiologists policed each other, calling out mistakes on images in an effort to improve patient care. But, this strategy has been criticized as being largely punitive.

Instead of spotlighting providers who make errors, there’s now an effort underway within the specialty to offer feedback and guidance – a chance to learn with context. Called peer learning, this system uses anonymous reads to evaluate images for errors and near misses, creating an environment where everyone can improve their understanding without blame.

 speaks with Regan City, the director of national subspecialty division and patient safety organizations at RadPartners, about how institutions can successfully pivot to the peer learning model, who needs to be on board with the idea, and the challenges that can exist.

Videos

When it comes to improving radiology understanding and performance, there’s a shift underway from peer review to peer learning.



What Practices Show Know about Implementing Peer Learning

Every two minutes a woman in the United States is diagnosed with breast cancer. In fact, 

 one-in-eight women will be diagnosed with invasive breast cancer in their lifetime and one-in-39 will die from the disease. We know that consistent annual mammography screenings can catch cancers earlier—improving the chances for effective treatment and saving women’s lives.

 percent of women receive their screening mammograms on schedule, according to the American Cancer Society. Some women simply fail to comply due to fear of pain, getting a bad result, or other anxieties.

However, there is also a much deeper problem: lack of access. Across the nation, there are far too many women who continue to miss out on preventive imaging like mammography due to cost, lack of insurance, and/or living in a medically underserved community.

 find that there are disparities in the healthcare system. For example, a woman’s race, income level, and education level can sometimes affect whether she has access to the highest standards of care in preventive imaging. If we are to win the battle against breast cancer, it is imperative to rectify inequalities in the system and increase access to preventive imaging for 

Reaching this goal necessitates a three-pronged strategy to improve access to mammography and digital breast tomosynthesis (DBT) for women from every corner of the country, and every walk of life. The strategy requires the dedicated participation and collaboration of multiple stakeholders—public health advocates, legislators, providers, vendors, and the media.

The first step is ongoing advocacy efforts on behalf of women’s health rights. Time and again, we have witnessed the power of “grass roots” community advocates as well as those who push for change on Capitol Hill. Public health advocates challenge the social, political, and economic systems that perpetuate disparities in women’s healthcare. They help bring about positive reforms, including expanding access to preventive imaging for more women.

Fewer African American Women Screened with Digital Breast Tomosynthesis

Legislation is critical, and we have already made significant strides. For example, The Affordable Care Act (ACA) set a new precedent by providing women—for the first time—with assurance to breast cancer screening. The ACA requires that Medicare and all private health insurance plans fully cover screening mammograms without any out-of-pocket expense for patients. It was an enormous “win” for women, yet the ACA does not solve the screening problem for the many women who remain uninsured.

Breast density legislation is another area where we’ve seen progress, thanks to groups, such as 

After a decade of advocates initiated by the late Nancy Cappello pushing for legislation, in late March of this year the Department of Health and Human Services announced changes to the Mammography Quality Standards Act (MQSA). The changes mandate that mammography reports include reporting of dense breast tissue to the patient. This is critical because dense breast tissue can potentially mask cancers, making them hard to spot on a mammogram. Now, women who are notified that they have dense breast tissue can discuss it with their physician and determine whether they undergo additional testing to look for hidden cancers.

For example, DBT is engineered to help radiologists better detect cancers on women with dense breast tissue. This modality—a 3D mammogram—can be used for annual screenings on any woman, but is especially helpful for women with dense breast tissue.

Stakeholders need to find ways of extending to more women access to new standards of care, such as DBT. 

 of all women with dense breasts benefit from the advanced capabilities of DBT compared to traditional mammography, according to the Medical Imaging & Technology Alliance (MITA). But, not all women have access to DBT.

 in 2021 notes that during the span of its study, DBT use increased from 3.3 percent in 2011 to 82.6 percent in 2017. Yet, the study found disparities in access:women of minority race, less education, and lower income were less likely to attend a facility offering screening DBT or to obtain DBT rather than digital mammography when both modalities were available at the time of imaging.

Q&A: Breast Cancer Screening Shortfalls for African American Women

Advocacy efforts can help drive expanded access to DBT. There has been some progress for select groups. In December 2020, Congress voted to pass a new defense bill that would extend U.S. military service members and veterans permanent access to advanced breast screening. The 2021 National Defense Authorization Act (NDAA) mandates that Tricare beneficiaries receive permanent coverage for DBT.

We’ve made strides, but continued advocacy initiatives and a push for new and better legislation remain paramount. We must give voice to women in less privileged positions, so that they, too, gain access to the best possible care.

Increasing access also requires building awareness through education aimed at three key groups: the public, referring physicians, and radiologists.

Reaching women with the message that annual screenings can save lives is critical. There are multiple ways healthcare providers can help spread this message, whether they serve an affluent or an economically challenged community.Physicians can use their websites, social media, and community health fairs to educate women about the importance of compliance with annual screening and the benefits of early detection of breast cancer.

Vendors can help, too, by collaborating on events and programs with hospitals or imaging facilities, or sponsoring their own events for women.

For example, Fujifilm has a tradition of sponsoring an employee breast cancer walk that also includes a session about the importance of screening and understanding breast density.A representative from the Are You Dense organization teams up with Fujifilm to give the educational talk. In addition, Fujifilm has held several special events for breast cancer survivors. Programs like these not only help inform attendees but also often generate local media coverage, helping to spread the message about the value of screening with even more women.

While women are a primary audience, referring physicians require education, too. Primary care physicians and OBGYNs are often the only doctor a woman sees for an entire year. These clinicians need to stay current on new imaging technologies, issues like breast density, and the latest research. And, of course the patient benefits in detecting cancers earlier and advances in exam comfort.

Breast imagers can play a key role in keeping referring physicians informed through simple emails urging doctors to remind patients to get their annual screening. More sophisticated communications might include creating a breast cancer newsletter, special event, and/or webinars.

Finally, even radiologists need ongoing education. Women’s imaging is a constantly evolving field, and it’s critical to stay current. Vendors can play a significant role in the education process at industry meetings, for example. Here, they can sponsor programs, partnering with breast imaging experts who can discuss the latest research and demonstrate the latest technology.

Another avenue is vendor-sponsored online CME courses aimed at radiologists. For example, Fujifilm recently teamed up with a recognized radiology media outlet to offer a series of CME courses that covered the latest topics like “Implementing DBT into Your Practice,” “DBT, Breast Density and Artificial Intelligence,” and, “A Clinical Review: Benefits of Tomosynthesis in Daily Practice.”

The third step in the strategy is increasing the availability and affordability of mammography and/or DBT screenings.

Screening mammography is the most effective tool for detecting breast cancer in its early stages, yet many women from medically underserved communities do not have adequate access.

 reviewed data from 10 earlier investigations on mobile mammography. The key finding: Mobile mammography may be able to bridge this gap by providing screening mammograms at no cost or low cost and delivering services to women in their own neighborhoods, thus eliminating cost and transportation barriers.

Findings from the 10 studies examined in this review suggest that mobile mammography programs do reach underserved women. Most women using mobile mammography lacked insurance and were from racial/ethnic minority backgrounds (mainly African Americans and Hispanic) and low-income households.

Several cancer centers, imaging facilities, and hospitals throughout the nation offer free screenings via mobile mammography units.

In addition, both the National Mammography Program and the CDC’s National Breast and Cervical Cancer Early Detection Program offer mammography services for low-income, uninsured, and underserved women. These organizations match up women with a provider facility in their area, ensuring free mammograms and diagnostic services for those most in need.

Manufacturers, too, are doing their part. Fujifilm’s 

 mobile coach provides educational information to both women and professionals in underserved areas.

Since its inception in 2019, the ASPIRE mobile coach—which is equipped with 

 digital mammography unit with DBT—has made 90 visits across 45 states. The coach stops at imaging facilities and hospitals. Radiologists, mammography techs, and staff tour the unit and receive valuable education on the latest screening technologies.

Women also visit the ASPIRE Coach, which also often makes stops in locations near Breast Cancer Walks and events. While on-site screenings are not presently part of the initiative, women tour the coach, learn about the importance of annual screenings and early detection, and are offered educational materials. The ASPIRE mobile coach is one more way of reaching underserved communities with a life-saving message about the importance of annual mammograms.

Breast cancer is the most common cancer diagnosed among U.S. women and is the second leading cause of death among women after lung cancer. Simply put, breast cancer is a beast—but it’s one we have the power to conquer.

Here’s the good news: there are more than 3.5 million breast cancer survivors in the United States. That’s a statistic we can all help grow.

Stakeholders, working in concert and independently to improve access to screening, can help boost that number significantly. The earlier we catch cancers, the greater the chances for women to get effective treatment and ultimately, lead healthy, rewarding lives.

An effective strategy requires participation by public health advocates, legislators, providers, vendors, and the media.

Women’s Preventive Imaging: A 3-Pronged Strategy for Improving Access

In a $20-million, multi-year move, Hologic, Inc., announced Tuesday it is partnering with Black Women’s Health Imperative, National Alliance for Hispanic Health, and RAD-AID to attack the racial disparities that exist for women in the U.S. healthcare system.

Through Project Health Equity (PHE), this group will pour time and resources into improving access to care, augmenting awareness and education, and conducting more race-specific research. It is an effort designed to create culturally competent care and improve public policy so Black and Hispanic women can get the healthcare services they need.

“Our goal is to end the disconnect between the care Black and Hispanic women receive and the care they should receive,” said Karleen Oberton, Hologic’s chief financial officer. “Project Health Equity is about doing the big, bold work necessary to create equity in the here and now that can reverberate across women’s lives and society for generations to come.”

Currently, Black and Hispanic women face significant healthcare hurdles in the United States. Not only are Black women 40 percent more likely to die from breast cancer, but they area also twice as likely as white women to die from cervical cancer. They also experience three times the number of fibroids as other racial groups. In addition, Hispanic women are 40 percent more likely to receive a cervical cancer diagnosis, and they are 20 percent more likely to die from the disease.

To help improve this situation, through PHE, Hologic and RAD-AID plan to partner with Federally Qualified Health Care Centers, local community health clinics, and tertiary care institutions to deliver state-of-the-art care – from screenings to treatment – to women in underserved areas.

With Black Women’s Health Imperative and the National Alliance for Hispanic Health, the company is creating a dedicated website, printed materials, social media assets, and celebrity partnership that can help healthcare professionals, policymakers, and community health workers meet the needs of these groups.

And, lastly, Hologic plans to conduct race-specific research that can lead to actionable insights into cultural, social, and economic disparities.

Although Hologic has a long history of improving healthcare services for women, making an actionable change for women in racial minority groups will take collaboration, said company leaders.

“We cannot reach the goals of PHE without partnering with other effective organizations whose values, vision, and expertise complement our own, and who have unique insights into these communities,” said Meg Eckenroad, Hologic’s vice president of women’s health. “Our ongoing partnerships with the Black Women’s Health Imperative, the National Alliance for Hispanic Health, and RAD-AID will be critical to our success.”

In collaboration with Black Women’s Health Imperative, National Alliance for Hispanic Health, and RAD-AID, Hologic has launched Project Health Equity.



What Practices Show Know about Implementing Peer Learning

Women’s Preventive Imaging: A 3-Pronged Strategy for Improving Access

Hologic Announces $20-Million Initiative to Address Racial Health Disparities