Diagnostic Imaging brings you coverage of ARRS 2022 annual meeting.

Coverage of ARRS 2022 Annual Meeting

Could a new cloud-based suite of imaging apps help radiologists navigate increasing imaging volume in their practices?

apps that target three key aspects of radiology workflow

, according to Bayer, the manufacturer of the new platform. The company said the system includes apps to assist with lesion detection, triage of suspicious findings for expedited review, and automation of routine tasks and measurements.

The artificial intelligence (AI)-powered aspects of the imaging app platform and access to digital tools may be beneficial in improving diagnostic accuracy and efficiency with imaging assessment, according to Ryan K. Lee, MD, MBA, MRMD, chair of the department of radiology with Einstein Healthcare Network in Philadelphia

“AI has the potential to transform health care, and, particularly in medical imaging, it can turn the growing amounts of data into value-adding insights to support radiologists and their teams in their decision-making,” noted Dr. Lee, an associate professor at the Sydney Kimmel College at Thomas Jefferson University.

Offering a variety of applications, ranging from assistance with pulmonary nodule detection to triage of suspected intracerebral hemorrhage, the initial platform for Calantric Digital Solutions is primarily focused on the assessment of thoracic and neurological diseases, according to Bayer. However, the company said it plans to add more disease-specific apps to the platform in the future.

Articles

Calantric™ Digital Solutions reportedly offers artificial intelligence (AI)-powered apps, bolsters lesion detection, facilitates triage priorities and enhances workflow efficiency.

Bayer Launches Medical Imaging App Platform for Radiologists

In a new study presented recently at the 8th European Academy of Neurology (EAN) Congress in Vienna, Austria, researchers from Denmark found that patients who tested positive for COVID-19 were 3.5 times more likely to be diagnosed with Alzheimer’s disease and 2.6 times more likely to have Parkinson’s disease in comparison to patients without COVID-19. 

(Editor's note: For a related article, see "New Study Shows Link Between COVID-19 and Elevated Risks for Neurological Disorders.")

In a recent video interview, neurologist Pardis Zarifkar, MD discussed the findings of the exploratory observational study.

The study authors also found that patients with COVID-19 had a 2.7 times higher risk of ischemic stroke and a 4.8 times higher risk for intracerebral hemorrhage. While the higher prevalence of cerebrovascular disorders was expected given the previously reported association between these disorders and COVID-19, the “extent of the increase (with neurodegenerative disorders) was quite surprising,” noted Dr. Zarifkar, who is affiliated with the Department of Neurology at Rigshospitalet in Copenhagen, Denmark.

That said, Dr. Zarifkar emphasized that “neurodegenerative disorders are a long time in the making” and it is “highly unlikely” that a COVID-19 infection could cause the development of a neurodegenerative disorder at one year.

While maintaining that more research is needed to evaluate potential long-term neurological complications with COVID-19, Dr. Zarifkar is also hopeful that future studies will examine the phenomenon of cognitive and mental health issues after critical illness.

For more insights from Dr. Zarifkar, watch the video below:

Videos

In a recent video interview, neurologist Pardis Zarifkar, MD discussed a new study that found significantly elevated risks for Alzheimer’s disease and Parkinson’s disease among patients who tested positive for COVID-19. 

Video Interview: Is There an Increased Incidence of Neurodegenerative Diseases in Patients with COVID-19?

Eric Postal, MD, is a diagnostic radiologist with the University of Pittsburgh Medical Center. 

How do you like it when people put words in your mouth? In other words, some may claim you have said things you did not, or that you hold opinions you do not hold at all. It’s kind of infuriating, isn’t it?

In a worse scenario, others tell you what to say and could punish you if you don’t. This could range from financial penalties to blots on your professional record. Further, when you obediently parrot whatever you have been given, it is to audiences who have no way to distinguish your assigned utterances from what you actually wanted to say. As far as they know, you came up with and meant every word of it.

Anybody who has been working in radiology for even a little while knows the feeling all too well. Indeed, most of health care is probably like that by now, but I am just focusing on the corner of the profession I have lived in for the past couple of decades. During that time, I’ve seen a slowly rising, evil tide of “Put this in your report or else.” I have even written about it in this blog a couple of times.

Someone recently posted a thread about it on a radiology social media group I frequently visit. It was a semi-plea for advice about how others were dealing with the ever-increasing volume of required verbiage that was cluttering their reports. This includes stuff like contrast dosage, number of recent scans, radiation dose reduction jargon, the different types of Doppler or maximum intensity projection (MIP)/3D recons utilized, etc.

Other than an insurance company or some other regulator looking for “gotcha!” bait (as in “we found a flimsy excuse not to pay you for the work you’ve done”), who has any interest in how much contrast was used for a scan? If someone really does, the tech’s documentation can be referenced later. Does it clinically impact anybody’s negative DVT study if I don’t specifically say that color Doppler and spectral analysis were utilized?

I thought it was endearing that some respondents to the social media thread expressed a hope/belief that we could do something about this. One poster commented: “What we need to do is join up, all radiologists … and fight this absolute nonsense.”

Folks, the horse is not only out of the barn, he has crossed the country and has established a new life more inaccessible to us than if he has been in the witness relocation program. The time to assert some semblance of control over what went in our reports was back before an army of middlemen and regulators established a stranglehold on our profession. They have got the power now, and if you think you can take it back without severely disruptive change in the health-care field, you have got another thing coming.

Not all of the non-physicians who are putting words in our mouths are doing it for nefarious purposes like clawing back payments. Some are just political types looking to score points in the public eye by saying they “improved safety” in health care, etc. And there are always actual professionals in the field willing, if not eager, to get in good graces with such folks by furthering their agenda. “The (insert leading radiology organization) endorses Senator Blather’s initiative to put an extra paragraph in all CT reports stating that radiation can be bad.” Next week: “The (insert leading radiology organization) hopes that Sen. Blather will stand against these outrageous CMS cuts.”

Heck, some outsiders, who may never have tried to read through radiology reports, might not even understand that they are doing more harm than good. Why 

, they might honestly think, require a statement that going above the speed limit can result in loss of life and limb? Somebody might read it and drive more carefully. What does it matter that they read the advice in a mammo report? Let’s put in an anti-smoking blurb too!

So we add an extra sentence here, and an extra paragraph there. Before you know it, we’ve got a ton of boilerplate info we have to put in our reports. It buries whatever useful information we were trying to convey and makes the whole thing less readable for referring physicians, let alone the occasional patient trying to understand his or her own imaging findings.

A couple of folks responding to that social media thread, myself included, thought it might minimize the damage if we just took all of the required verbiage and put it in a dense little paragraph at the end of our reports, maybe after a page break. In other words, let as much as possible of the required nonsense get automatically populated, or input by techs and clerks, before we even get the study to read. Have the rads waste zero time on it. I suggested that the paragraph have a header like “Required verbiage from non-physician regulators.”

For good measure, I’d say let’s make it the smallest type of font possible and do away with niceties like spaces after periods and commas. Maybe use a super-flowery font that is annoying to read. Why make it easy for the regulator enforcers? Heck, put it in an almost invisibly faint color, like light cyan on a white page.

Does excess boilerplate verbiage hamper the review of radiology reports by referring physicians?

Reining in the Boilerplate Info on Radiology Reports

's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest case quizzes and conference reports. Review the slideshow below to see this week's top content:

Diagnostic Imaging's Weekly Scan: June 19-June 25

Slideshows

Catch up on the top radiology news of the past week.

Patients who tested positive for COVID-19 had significantly elevated risks for developing Alzheimer’s disease, Parkinson’s disease, ischemic stroke, and intracerebral hemorrhage in comparison to people who tested negative for COVID-19, according to the findings of a new study presented recently at the 8th European Academy of Neurology (EAN) Congress in Vienna, Austria.

In the study, which involved over 919,000 people in Denmark who were tested for COVID-19 between February 2020 and November 2021, 43,375 patients tested positive for COVID-19. Researchers found that patients with COVID-19 had 3.5 times the risk of developing Alzheimer’s disease, 2.6 times the risk of having Parkinson’s disease, 2.7 times the risk for suffering ischemic stroke and 4.8 times the risk of having intracerebral hemorrhage in comparison to patients who did not have COVID-19.

While previous research has noted an association between neurological disorders and COVID-19, lead study author Pardis Zarifkar, MD said the new study findings offer more clarity on the impact of COVID-19 on the incidence of neurological disease.

“These findings will help to inform our understanding of the long-term effect of COVID-19 on the body and the role that infections play in neurodegenerative diseases and stroke,” noted Dr. Zarifkar, who is affiliated with the Department of Neurology at Rigshospitalet in Copenhagen, Denmark.

The study authors also compared patients who tested positive for COVID-19 to patients with influenza or pneumonia and found similar elevated risks for the development of neurological diseases. However, when comparing COVID-19 to influenza and inpatients with pneumonia over the age of 80, the researchers noted a 1.7 times elevated risk of ischemic stroke for patients with COVID-19.

Emerging research showed that patients with COVID-19 had 3.5 times the risk for developing Alzheimer’s disease and 2.6 times the risk for Parkinson’s disease in comparison to those who did not have COVID-19.

New Study Shows Link Between COVID-19 and Elevated Risks for Neurological Disorders

In a recently published systematic review of guidelines for breast cancer screening, researchers assessed 23 guidelines from 11 countries or regions that were published between 2010 to 2021. 

In what may be the largest review to date to examine international breast screening guidelines

, the authors noted common similarities as well as differences regarding recommendations for screening age, intervals and methods for women who have average or high risk for breast cancer.

Here are some takeaways from the research.

1. When should breast cancer screening stop? Three guidelines, including those from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI), emphasized that this decision is subject to health status, noting that breast cancer screening could cease for those with lower than five to 10 years of remaining life expectancy. Other guidelines, including guidelines from the American College of Physicians, said screening can stop after the age of 75 unless projected life expectancy was greater than seven to 10 years. Guidelines from Germany and Singapore suggested an age limit of 70. There was no age limit noted for breast cancer screening in nine of the reviewed guidelines.

2. When it comes to women with dense breasts, the ACR recommended annual magnetic resonance imaging (MRI) screening. Adjunctive use of ultrasound in addition to mammogram is recommended for screening of asymptomatic women with dense breasts, according to Brazilian guidelines as well as those from SBI/ACR. Annual mammography and ultrasound screening are recommended by the National Cancer Center of China for those with dense breasts.

3. For women with genetic susceptibility to breast cancer, guidelines from the SBI/ACR and the Ministry of Health in Singapore recommended annual screening with mammograms or MRI beginning at ages 25-30. For women who have breast cancer susceptibility gene 2 (BRCA2), the European Society of Breast Cancer Specialists (EUSOMA) recommended the start of annual MRI screening between the ages of 25 to 29. For women who have the TP53 gene, EUSOMA encouraged initial screening to begin at the age of 20. When it comes to patients with genetic predisposition who cannot tolerate MRI, the ACR recommended ultrasound as an adjunct to mammograms or digital breast tomosynthesis (DBT).

4. The authors of the systematic review noted that a number of randomized controlled trials from Canada, Sweden, the United Kingdom and other countries revealed higher false positive biopsy results and overdiagnosis with screening in patients aged 40 to 44. However, the majority of guidelines recommended that women at average risk of breast cancer begin mammographic screening at the age of 40.

5. Multiple guidelines recommended annual mammograms or MRI screening for patients diagnosed with invasive breast cancer, ovarian cancer, lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS) or atypical ductal hyperplasia (ADH).

The review of breast cancer screening guidelines from the United States and abroad summarized current recommendations on modalities, intervals, and screening age considerations.

Breast Cancer Screening: Five Takeaways from New Systematic Review of Global Guidelines

A large prospective study of over 45,000 women with abnormal findings on screening mammograms found significant racial and ethnic disparities associated with breast biopsy delays at 30, 60 and 90 days after screening.

, examined data from 45,186 women who had abnormal findings on mammograms between 2009 and 2019.

Culling the data from 109 imaging centers in six states, the researchers noted the study population ranged between 40 and 79 years of age. The study population included 30,053 White women, 6,227 Black women, 5,644 Asian women, 3,055 Hispanic women and 1,206 women of other or mixed races, including native Hawaiian, Alaska natives, American Indians, and Pacific Islander women, according to the study.

The researchers found that 48 percent of Asian women, 43.3 percent of Black women, 42.8 percent of Hispanic women and 38.8 percent of women of other or mixed races did not have a biopsy 30 days after having abnormal findings on mammogram in comparison to 29.2 percent of White women.

While the differences declined with time, the researchers noted that 21.7 percent of Asian women, 19.5 percent of other or mixed races, 19.1 percent of Black women and 18.8 percent of Hispanic women had no biopsy 60 days after mammography screening in comparison to 14.2 percent of White women. At 90 days after mammography, 14.1 percent of Black women and 13.7 percent of women did not have a biopsy, according to the study.

“Although almost 90 percent of women in our cohort received a biopsy within 90 days of screening, the increased adjusted risk of no biopsy at 90 days for Black and Asian women is of particular importance in light of the Cancer Intervention and Surveillance Modeling Network study showing a decline in life-years gained with screening mammography after a 3-month delay in diagnostic testing,” wrote lead author Marissa B. Lawson, MD, an acting instructor of radiology at the University of Washington School of Medicine.

 “Together, these findings suggest that racial and ethnic disparities in time to diagnosis may exacerbate disparities in breast cancer outcomes.”

The study authors speculated that factors specific to different health-care systems may have contributed to the racial and ethnic disparities observed with biopsy delays, noting that adjustment for imaging facilities comprised close to 30 percent of the additional risk of no biopsy 90 days after screening mammography.

“Our findings highlight an opportunity for radiology departments to consider where they can commit resources to improve wait times for biopsy,” noted senior author Christoph Lee, MD, a professor of radiology at the University of Washington School of Medicine. “This could include implementing changes in that diagnostic pathway such as using navigators to help guide patients through the process of scheduling exams and procedures.”

, Randy C. Miles, MD, MPH, said feedback from minority groups about their mammography screening experience, increased hours for breast imaging services and consolidation of those services into fewer visits can have a considerable impact.

“Access to same-day care, in particular, has been shown to eliminate previously seen disparities in time to biopsy between White and non-White patients following implementation,” noted Dr. Miles, division chief of breast imaging and associate director of radiology for research at Denver Health.

In regard to study limitations, the authors noted the exclusion of breast imaging facilities with less than 75 percent biopsy capture may have contributed to underestimation of breast biopsy delays in racial and ethnic groups. According to Lawson and colleagues, other possible limitations include no assessment of the type of first biopsy performed and a lack of adjustment for the availability of on-site diagnostic services, factors that can affect the timing with biopsies.

1. Lawson MB, Bissell MCS, Miglioretti DL, et al. Multilevel factors associated with time to biopsy after abnormal screening mammography results by race and ethnicity. 

 Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1990. Available at: 

https://jamanetwork.com/journals/jamaoncology/article-abstract/2793713

2. Rutter CM, Kim JJ, Meester RGS, et al. Effect of time to diagnostic testing for breast, cervical, and colorectal cancer screening efficacy: a modeling study. 

3. Miles RC. Addressing racial and ethnic differences in diagnostic resolution of abnormal mammographic findings. 

 Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1864 . Available at: 

https://jamanetwork.com/journals/jamaoncology/article-abstract/2793717

4. Dontchos BN, Narayan AK, Seidler M, Miles RC, Ebert E, Lehman CD. Impact of a same-day breast biopsy program on disparities in time to biopsy. 

Forty-eight percent of Asian women, 43.3 percent of Black women and 42.8 percent of Hispanic women did not have a biopsy 30 days after abnormal findings on mammography, according to newly published research.

Large Post-Mammography Study Shows Significant Racial and Ethnic Disparities with Breast Biopsy Delays

American Registry for Diagnostic Medical Sonography® (ARDMS®) Chair

Work-related musculoskeletal disorders (WRMSD) lie at the root of chronic injury for diagnostic imaging professionals. Normal, everyday practice demands physicality, and this can lead to significant challenges with pain and musculoskeletal disorders. It has been reported that up to 90 percent of practitioners work in pain at some point with WRMSDs costing employers $120 billion annually.

Just one major area of stress or weakness can result in injury. Some causes may include a lack of flexibility or strength, fatigue after lengthy or intense shift scheduling, skipping ergonomic tool adjustments in daily practice, or even seemingly small habits, like routinely turning to a poorly adjusted monitor.

Shifting how we work to take care of ourselves is part of doing a good job. We must empower our community to value personal wellness, both in our individual practice and management strategies, as necessary to helping patients attain health. We must embrace self-care in the workplace.

Emphasizing Optimal Positioning for Daily Scanning

Each unique practice or area of specialty presents different opportunities for injury. However, all clinicians can apply proactive strategies to mitigate pain.

For example, practitioners who choose to scan left-handed can set up working positions that alleviate a lot of physical stress. Adjusting monitors for easier viewing and adjusting chair height or tables for a shorter reach can result in a better scan for both the patient and practitioner.

Do all you can to practice within your personal reach. By adjusting our workspaces to fit individual needs, we establish a foundation for our success.

Incorporating Regular Movement to Reduce Static Posture

Static posture is one of the worst offenders in provoking injury in diagnostic imaging. We must move.

• Stretch before you scan and throughout the day. Several short stretches have greater impact than one long stretch.

• Keep compression bands or a stress ball at your desk for quick exercise or subtle movement during lunch.

• Add a set of lunges to the end of a coffee break.

• Climb one flight of stairs instead of taking the elevator.

• Park further away from the door to give yourself a reason to walk.

At the end of the day, any 30 minutes of movement during the workday may lead to better overall health. There are many opportunities throughout the day for us to choose to move, and each choice leads us toward health and away from injury.

Where Strategic Resource Management Can Play a Role in Mitigating Injury Risk

Health care, much like any great partnership, demands teamwork at every level and every facility to secure success. Today’s diagnostic imaging professionals hope to strike a nearly impossible balance: provide quality care for as many patients as possible with limited time in our day. The hours may feel short, but the days – and shifts – can become far too long.

We all want to care for as many patients as possible, but the list can be overwhelming. It’s essential for teams to work together to balance patient demands and allow enough space for individual practitioners to find time for themselves amidst the noise.

With mindful planning, facility and team leaders can protect and preserve practitioner wellness so clinicians can function at their maximum capabilities to enhance patient care. We look to leadership to advocate for healthful and appropriate scheduling as well as strategic resource management that emphasizes practitioner wellness.

Taking Advantage of Ergonomic Solutions and Monitoring the Use of Mobile Imaging Devices

Supported by years of research, study and informed design, ergonomic and adjustable tools are more widely available to health-care practitioners than ever before. It is essential for leadership to understand the value of not simply providing these tools but managing their incorporation into the workflow as well.

For example, mobile scan equipment can significantly contribute to musculoskeletal injuries. Portable tools offer incredible flexibility for patient care but can be very difficult to manage. Accessing patient rooms is often a juggling act. When managers rotate sonographers through portable service, their bodies get a break between sprints. This seemingly small choice in resource management and scheduling can significantly reduce the risk of injury.

Holistic Wellness: Embrace Self-Care Off the Clock

In medicine, we commit to lifelong learning. Exercise is also a lifelong activity. Caring for your body cannot be compromised on or off the clock. The habit of committing to strength and movement minimizes risk and injury over time. Consider yourself an athlete. Professional athletes train with intention, care for their bodies and warm up to avoid injuries.

Remember there is no right and wrong exercise. There are only different strategies to build strength and make time for our personal health.

• Take a walk. Walk across the hospital parking lot, at your kid’s sports practices, and after dinner. These steps add up.

• Practice with Chinese medicine balls or strength putty to build hand strength for more confident, controlled scanning.

• Explore exercise that interests you. Look up walking groups, dance activities, the gym or personal trainers in your area. Some trainers will come to your home.

Above all, build exercise into your life on your terms. Find movement that gives you joy and make it a priority. We tend to compartmentalize our lives, but our experience proves cumulative. Good habits at home impact how we feel at work and vice versa. Health comes from working to strike a balance.

1. Murphey S. Work related musculoskeletal disorders in sonography. 

https://www.sdms.org/docs/default-source/Resources/work-related-musculoskeletal-disorders-in-sonography-white-paper.pdf?sfvrsn=8

1. American Registry for Diagnostic Medical Sonography (ARDMS). WRMSD grand challenge. Available at 

https://www.ardms.org/wrmsd-grand-challenge/

2. Society of Diagnostic Medical Sonography. Sonographer responsibilities. Available at: 

https://www.sdms.org/resources/careers/work-related-musculoskeletal-disorders/sonographer-responsibilities

Recognizing the significant potential for workplace injuries in the radiology field, these authors discuss the proactive benefits of optimal positioning and disruptions of static posture as well as a heightened management awareness of ergonomic solutions and potential issues in maneuvering mobile imaging units.

Combatting Workplace Musculoskeletal Injuries in the Radiology Community

Case submitted by Ellie Goulding, MD via the 

Image IQ Quiz: 65-Year-Old Patient with Pneumonia and Repeat Hospital Admissions

Estimates suggest that more than six million people in the United States have Alzheimer’s disease, and the COVID-19 pandemic may have triggered a 17 percent increase in the number of deaths related to Alzheimer’s disease and dementia in 2020.

However, emerging research suggests the combination of a machine learning model and a single T1-weighted magnetic resonance imaging (MRI) scan could facilitate enhanced detection of Alzheimer’s disease and possibly earlier intervention.

, examined a predictive machine learning model that ascertains mesoscopic traits from T1-weighted MRI scans of the brain and facilitates subsequent use of a predictive biomarker to help diagnose Alzheimer’s disease.

The researchers found that the biomarker had a 98 percent accuracy in detecting Alzheimer’s disease in comparison to 62 percent accuracy with the measurement of cerebrospinal fluid beta amyloid and 26 percent accuracy with the measurement of hippocampal atrophy.

“Currently, no other simple and widely available methods can predict Alzheimer’s disease with this level of accuracy so our research is an important step forward,” noted Eric Aboagye, FMedSci, a professor of cancer pharmacology and molecular imaging at Imperial College London in the United Kingdom. “ … Our new approach could also identify early-stage patients for clinical trials of new drug treatments or lifestyle changes, which is currently very hard to do.”

Employing established software for the segmentation of the brain and radiomics analysis, the MRI-based predictive biomarker “does not require a subject matter expert,” according to the study authors. They noted that the biomarker is based upon the weighted sum of 20 extracted features derived from 14 out of 115 regions of the brain.

“The algorithm computes manually engineered features, allowing an easy interpretation of the (biomarker) and facilitating clinical translation. To avoid overfitting, the dimensionality of the model is reduced with the ‘least absolute shrinkage and selection operator (LASSO),’ which selects the most informative and less redundant features corresponding to specific brain regions,” wrote Aboagye and colleagues.

Noting that the machine learning model identified changes in the cerebellum and ventral diencephalon that had not been associated with Alzheimer’s disease in the past, the study authors suggest that the new algorithm could enhance neuroradiologist assessment of MRI brain scans in this patient population.

“Although neuroradiologists already interpret MRI scans to help diagnose Alzheimer’s (disease), there are likely to be features of the scans that aren’t visible, even to specialists,” suggested Paresh Malhotra, MD, a co-author of the study and a consultant neurologist at the Imperial College Healthcare NHS Trust. “Using an algorithm able to select texture and subtle structural features in the brain that are affected by Alzheimer’s could really enhance the information we gain from standard imaging techniques.”

1. Alzheimer’s Association. Alzheimer’s disease facts and figures. Available at: 

https://www.alz.org/alzheimers-dementia/facts-figures?utm_source=google&utm_medium=paidsearch&utm_campaign=google_grants&utm_content=alzheimers&gclid=CjwKCAjw-8qVBhANEiwAfjXLrqaFewnIi2l9vCjpgb4bXws3TAjpkUTSH2QD6VZw4hVbP_xU_6YjfRoC2sQQAvD_BwE

2. Inglese M, Patel N, Linton-Reid K, et al. A predictive model using the mesoscopic architecture of the living brain to detect Alzheimer’s disease. 

https://doi.org/10.1038/s43856-022-00133-4

 . Published June 20, 2022. Accessed June 22, 2022.

New research suggests that an emerging predictive biomarker, derived from a combination of magnetic resonance imaging (MRI) brain scans and a machine learning algorithm, has significantly greater accuracy than previously established measurements for diagnosing Alzheimer’s disease.