Dr. Laurence Klotz discusses micro-ultrasound as a faster, less invasive, more cost-effective screening strategy compared to mpMRI in this podcast. 

Reading Room Podcast: Micro-Ultrasound for Easier Prostate Cancer Screening

Protecting ultrasound providers during the COVID-19 pandemic requires going a step further than simply disinfecting surfaces – the air in ultrasound departments should be disinfected, too.

That’s the recommendation from a group of ultrasound experts from China. Representatives from four medical organizations collaborated this year to produce the first recommendation about air sanitation during the outbreak. They published their guidance in the Oct. 12 

“Given that patients undergoing ultrasound examination might be virus carrying or infected, or suspicious for infection (symptomatic or asymptomatic), it is of great importance to have good protection for the healthcare staff (including doctors, nurses, medical assistants, and technicians) during work,” said the team led by Luo Yukun, Ph.D., professor in the diagnostic ultrasound department at Chinese People’s Liberation Army General Hospital in Beijing. “Since in the department of ultrasound the healthcare workers are close contacted with patients who might be infected or virus carrying, it is extremely important to offer protection to them.”

This new advice underscores how what the industry knows about the COVID-19 virus continues to grow and change.

Lung Ultrasound Reveals COVID-19 Duration and Disease Severity

The team divided their suggestions into two main categories – designated spaces for healthcare providers and patients and personal protective equipment (PPE). They based their recommendations on existing hygiene standards, practitioner experience, and existing literature.

Most importantly, the team said departments must designate certain individual areas to be strictly used by patients or providers. For example, they said, each group should be relegated to separate hallways. In addition, some areas should be off-limits except to providers, and departments should create two buffer zones where providers can put on and take off PPE.

Following these measures is critical, they said because it will help keep track of what resources have been used and contaminated and strengthen the efforts to minimize exposure and transmission. The team also recommends disinfecting all surfaces, such as door handles, keyboards, floors, and ultrasound probes and machines. Using probe and plastic machine covers when it is feasible – especially with patients suspected of infection – could also be beneficial.

The team also offered clarity around the recommendations for greater air disinfection. Rooms reserved for patients without known or suspected COVID-19 infection should be ventilated for at least 30 minutes in both the morning and evening, and ultraviolet light should be added after all patients have been seen for the day, as well.

However, rooms used for patients who are suspected of infection must undergo a more stringent protocol. Alongside the daily ventilation measures, the team also said departments should also use a 3-percent hydrogen peroxide spray or a UV lamp for 60 minutes after each patient. Putting a plasma air disinfection machine in the COVID-19 rooms could also help combat exposure and transmission.

In addition, the authors reiterated existing PPE guidelines, advocating that everyone in the department – not just providers working directly with the ultrasound equipment – wear work coats, latex gloves, surgical masks, and disposable hairnets. These PPE should be changed every 4-to-6 hours, they said. But, they went a step further, recommending that providers wear isolation gowns with patients who have known infection and full-face respirators and other tertiary PPE for the riskiest procedures, ultrasound-guided aerosol-generating procedures.

To dispose of or process this equipment, the team offered this guidance:

Dispose of medical waste items in dedicated trash cans.

Soak anti-fog goggles in electrolyzed-oxidizing disinfectant for 5 minutes or chlorine-containing 1,000 mg/L disinfectant for 30 minutes.

Wipe face shield with 75-percent medical alcohol.

Change working coat every day or put under UV light in dressing room for 30 minutes.

Disinfect work shoes with UV light when necessary.

Despite not being a popular screening method in China, the team said, handheld ultrasound has proven beneficial with COVID-19 patients in other countries in a variety of healthcare settings.

“Ultrasound examination, having the advantages of convenience, quickness, non-invasiveness, radiation free, bedside available,” they said, “is a cost-effective, real-time technique which was reported to be an important role in the diagnosis and treatment of COVID-19.”

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

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Researchers from China recommend disinfecting the air, alongside, sanitizing surfaces, to reduce exposures and transmission.



Don’t Stop with Disinfecting Surfaces – Clean the Air to Decrease COVID-19

Contrary to conventional belief, MRI exams can be performed safely in patients who have non-MR compatible cardiac devices, including patients who are pacemaker-dependent or who have abandoned leads.

More than 2 million patients have cardiovascular implantable electronic devices (CIEDs), such as pacemakers and implantable cardioverter defibrillators (ICDs), and they are a patient group who most often could benefit clinically from having an MRI exam. Until now, though, providers have been forced to choose between finding an alternative, less-effective imaging for the chest or removing a necessary cardiac device.

a multi-institutional team of investigators has outlined it is, in fact, safe to conduct an MRI with these patients – and it can be done without a negative outcome.

“We found no serious adverse consequences of performing MRI examinations, including cardiac MRI examinations, in a large consecutive cohort of patients with non-MRI-conditional CIEDs,” said the team led by Sanjaya K. Gupta, M.D., a cardiologist with Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.

3 Tips to Improve MR Safety with Implants and D

Previous studies have shown MRIs can be safely conducted in patients with non-MR conditional devices, but this study goes further to include patients whose hearts will stop beating if their defibrillator ceases to work, as well as those who have abandoned or fractured wires that are no longer connected to their heart.

While many CIEDs have been deemed safe for MRI imaging by the U.S. Food & Drug Administration, pacemakers and ICDs have fallen outside this category. This study opens the door for more imaging options, Gupta said.

“While all devices implanted in patients today are MRI compatible, millions of people worldwide, including many young people, have older devices considered not compatible,” he said. “It’s unfair to tell these people that they can’t get an MRI for the rest of their lives.”

In fact, he added, the impetus behind this study was a patient with a brain tumor who was unable to undergo MRI exams that were critically needed during her treatment because her pacemaker was not MR conditional. Due to the lack of scans, the patient were forced to undergo several risky surgical procedures, he said.

Consequently, to better understand the risks posed by MRI to these patients, Gupta’s team created the Patient Registry of Magnetic Resonance Imaging in Non-Approved Devices (PROMeNADe) that included 532 patients who underwent 608 MRI exams, including 61 cardiac MRIs between September 2015 and June 2019. Participants in this study included individuals from groups that had not been incorporated into previous studies.

Notably, the team said, their registry is the largest series of MRI exams collected in patients with pacemaker-dependent ICDs, the second largest for patients with abandoned or fractured leads, and the third largest in non-compatible devices.

Of the participant group, 36 percent were referred for an MRI by a neurologist, and 20 percent were referred by a cardiologist. In particular, 161 exams (26 percent) were conducted on pacemaker-dependent patients – 43 were defibrillator, 14 were dual-chamber ICDs, and 29 were cardiac resynchronization therapy defibrillators. These devices were manufactured by Medtronic, Abbott/St. Jude Medical, and Boston Scientific. The remaining patients had pacemakers and CRT pacemakers.

Throughout the study, not only did a nurse closely monitor each patient’s vital signs during their time in the scanner, but the team also evaluated every device both before and after the MRI. Pacemaker-dependent patients had their devices turned to asynchronous mode before entering the scanner, and tachycardia therapies were disabled in ICD patients during the MRI.

The team also followed up with the patients after six months post-MRI. According to their results, MRIs – including chest MRIs – are safe to conduct in pacemaker-dependent ICD patients, as well as those who have non-MR conditional devices or abandoned leads.

“There were no adverse events,” Gupta said, noting that 14 percent of patients had multiple MRI exams. “The protocol worked amazingly well. We had no issues with any of the patients and no harm to the devices.”

Alongside being safe to perform, the team determined these exams also had a clinical impact that altered patient care. Based on a survey conducted with 150 of the referring physicians, the outcomes of the MRI exams for both patients undergoing cardiac and non-cardiac MRIs changed a suspected diagnosis 25 percent of the time and the suspected prognosis in 26 percent of participants. In addition, the scans led to different medical or surgical treatment plans 42 percent of the time.

The team did note their study had some limitations. It was not able to determine the safety of MRI studies in patients who had their devices implanted within six weeks of the scan. They also did not examine hemodynamically unstable patients, patients who required recent defibrillator therapy, or patients for whom the referring clinician felt it unwise to turn off arrhythmia detection during the scan.

Still, they said, these results could open the door for more people who could benefit from these studies to undergo them without fear of safety risks.

“We’re hopeful that our work will add support to expand the FDA’s indications for devices that are considered MRI-compatible,” Gupta said. “A lot of work went into this study, but it’s worth it when you consider all the lives impacted.”

Study shows MRI exams can be safely performed with no adverse events in patients who have non-MR compatible devices, making the exams available for patients who frequently needs these studies the most.

MRI Is Safe for Pacemaker Patients, Opening the Door for Needed Exams

A recently published study from the United Kingdom (UK) confirms that mammography screening, beginning at age 40, significantly reduces breast cancer mortality. The results appeared in 

 in August 2020. These study results reaffirm the recommendations of the American College of Radiology and the Society of Breast Imaging. Both organizations recommend that most women begin annual mammography at age 40 – earlier than when most women have their first screening.

What does this UK study mean to us here in the United States?

The UK study provides valuable additional data for those of us in the breast imaging field. This recent update confirms, again, that annual breast cancer screening beginning at age 40 saves lives. Breast cancer death rates were reduced by approximately 25 percent for women who began screening at age 40, averting one death per 1,000 women screened, and this absolute gain remained constant until the end of the study. The UK study also confirmed that there is little fear of over-diagnosis in the 40-to-49 age category with a rate similar to what is commonly encountered in women over 50.

The UK Breast Screening Age Trial recruited 53,883 women to begin annual mammography screenings at age 40. Researchers placed twice as many women (106,953) in the control group. The control group participated in the UK’s National Health Service (NHS) standard breast cancer screening. The NHS provides breast cancer screenings to women aged 50 until age 71 every three years.

Women Who Survive Childhood Cancer Benefit From Earlier Breast Screening

Researchers sent randomly selected women invitations through the mail, offering annual breast cancer screening beginning at age 40. These women were recruited from general practitioners’ lists, held by Family Health Services Authorities. The women who responded were ages 39-to-41, from 23 breast screening sections in England, Scotland, and Wales.

Researchers also randomly chose women for the control group. These women were not aware of the research project and received the standard breast cancer screening with no departure from standard care.

The younger annual mammogram group received annual mammograms until they received their invitation from NHS for breast screening. The control group of women began their breast cancer screenings once they reached age 50, following NHS recommendations.

Recruitment began on October 14, 1990, and ended on September 24, 1997. Researchers followed patients for a median time of 22.8 years.

The trial used two-view film (analog) mammography for each participant’s first screening. Afterward, single view was utilized. The local facility staff double-read each participant’s mammogram. If a woman moved, she could self-refer to the nearest center taking part in the trial. Women in the trial transitioned to the regular NHS breast cancer screening program once they received their invitation around age 50.

The NHS Central Register and all trialists were notified of every breast cancer diagnosis, breast cancer death, and other death causes for trial members through February 28, 2017.

The primary endpoint for the UK Breast Screening Age Trial was death by breast cancer in both groups. Researchers compared deaths from both groups that occurred before their invitation to the standard NHS breast screening program.

Participation from screening invitations was similar in both groups of women:

68.1 percent (36,622 women out of 53,801 women invited in the interventional group) had their first mammogram.

69.1 percent (176,746 women, out of 255,618 women invited in the control group) had their first mammogram.

False-positive results in the interventional group were modest. Researchers saw a 4.9 percent false-positive rate for participants’ first screen mammogram, and a 3.2 percent false-positive rate occurred for later screenings in the interventional group. Breast cancer incidence rates between the interventional group and the control group showed similar incidence rates.

Researchers saw a significant difference in death rates from breast cancer by 10 years. The interventional group experienced just 83 deaths compared to 219 deaths in the control group. There was no significant difference during the next 10-plus years of follow-up. Of the breast cancer deaths, 126 occurred in the early intervention study group and 255 in the control group.

The newest study update comes 23 years after recruitment ended. The study confirms that annual breast cancer screenings that begin at age 40 reduce breast cancer mortality.

In summary, the UK study confirms that screening mammography beginning at age 40 significantly reduces breast cancer mortality as compared to women who wait to begin screening mammography until age 50. These findings validate both the ACR and the SBI recommendations that women of average risk begin having annual mammograms beginning at age 40.

“Breast cancer screening saves lives, annual screening mammography beginning at age 40 saves the most lives.”

Daniel Shekleton, M.D., is a breast imaging radiologist and breast intervention specialist with Raleigh Radiology. He is a member of the RSNA, ACR, and SBI. He earned his bachelor’s degree at the U.S. Military Academy at West Point and completed his medical degree and residency in radiology and internal medicine at the Southern Illinois University School of Medicine. He joined Raleigh Radiology in 2019.

Screening mammography begins to reduce breast cancer mortality at an age earlier than when most women begin screening.

UK Study: Benefits of Breast Cancer Screening Begins at 40

Even though CT scans have not been widely used to diagnose COVID-19 infection, new research shows that using spectral CT with electron density (ED) imaging can make it much easier to assess the extent of lung lesion in patients who have early-stage disease.

Using a small group of case studies, published Oct. 21 in the 

a team of clinicians from Antony’s Private Hospital in France showed that electron density (ED) imaging can improve ground-glass opacity (GGO) visualization compared to conventional CT studies.

“ED imaging may improve the detection of early-stage COVID-19, a stage for which conventional CT has shown limited sensitivity for detection,” said lead study author Beatrice Daoud, an associate radiologist at Antony's. “Spectral CT may also provide a better assessment of the extent of the lung lesions.”

Deep Learning Plus CT Produces Spectral Images Without Higher Radiation

Although GGOs do show up on conventional CT scans, the visualization is subtle, Daoud’s team said, revealing only very small increases in attenuation compared with normal lungs. Consequently, accurate identification can be difficult, particularly during early infection. This study marks the first time investigators have looked into whether spectral CT scans can improve providers’ abilities to assess lung lesion extent.

To make this determination, the team retrospectively examined data from spectral CT scans conducted in four patients who have had confirmed COVID-19 cases with an RT-PCR test, they said. They reconstructed the spectral CT images using the same standard soft kernel (filter B) and a similar iterative method that is used to capture conventional CT images. They, then, compared initial conventional CT images with the follow-up conventional CT scans.

Based on their analysis, all 45 GGOs identified in the four patients showed up better on the ED images than the conventional CT scans, and the follow-up conventional CT images confirmed their presence. In addition, the lesion extent, which they assessed with semi-quantitative reporting scale denoting surface area involvement for each lobe, was much easier to determine on ED images, the team said.

“We reviewed conventional chest CT images obtained with a parenchyma kernel and standard lung window setting, as is usually the case in everyday radiology practices,” Daoud said.

The team compared the ED images to conventional images obtained using a soft mediastinum kernel and standard lung window setting, as well as conventional images captured with a soft mediastinum kernel and narrow lung window setting, virtual low-monoenergy images, virtual high-monoenergy images, and electron density images.

Based on these comparisons, the team discovered ED images made a difference in evaluating each of the four patients:

 A 39-year-old man diagnosed via conventional CT with lesions in both the right upper and lower lobes was found – with ED imaging – to have lesions in the upper left lobe that were barely noticeable previously.

 A 41-year-old woman with GGOs in both lower lobes discovered with conventional CT had additional lesions identified in the upper right lobe with ED imaging.

 A 64-year-old man had a conventional CT that showed peripheral bilateral diffuse GGOs. ED imaging revealed the GGOs to be more extensive and conspicuous than initially believed.

 An 80-year-old man had barely noticeable peripheral GGOs in the left upper lobe. Follow-up ED imaging showed the extent of these GGOs.

Overall, these results show that ED imaging offers greater detail for early assessment of GGOs that can be overlooked with conventional CT. The results are most promising, they said, by enhancing the contrast of GGOs compared with the normal lung.

“Our results suggest that the better ground-glass opacity visualization obtained using electron density imaging may be chiefly related to the increased visual noise in the image with soft kernel reconstruction and narrow lung window setting compared with electron density imaging, for which narrowing the window does not impair image quality,” they said.

Still, they said, a more systematic analysis of the different available image reconstruction is needed.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter

Spectral CT provides greater detail about the extent of ground-glass opacities than conventional CT scans.

Spectral CT Makes Detecting Early-Stage COVID-19 Easier

CT colonography (CTC) exams occur less often in patients over age 65, a new study has found, and this downward trend could affect racial and ethnic minority patients the most.

Journal of the American College of Radiology

 a team of investigators from Emory University School of Medicine, led by Courtney Moreno, M.D., associate professor of radiology and imaging sciences in the Winship Cancer Institute, revealed the impetus for this drop could be because Medicare does not cover the exam.

“We observed that the relative utilization of screening CTC in individuals typically eligible for Medicare coverage decreased after age 65, suggesting access barriers related to a more restrictive Medicare coverage policy,” the team said.

Despite being a preventable condition with appropriate screening, colorectal cancer remains the second leading cause of cancer death in the United States. CTC is designed to detect colorectal cancer, as well as other types of colon cancer, but the Center for Medicare & Medicaid Services (CMS) announced in 2009 that evidence on the efficacy of CTC was lacking.

CT Colonography Has Higher Cancer Detection Rate Among S

Given the agency’s position, Moreno’s team set out to determine whether this stance is detrimentally impacting the quality of care given to patients. To do so, they examined CTC use, pulling 12,648 screening exams from the American College of Radiology’s CTC registry. They looked at both the age of patients, as well as any association between use of the exam and Medicare-eligible patient race.

Based on their analysis, the team identified a significant uptick in colon cancer rates in patients over age 50 – an annual increase of 5.3 percent in individuals between ages 52 and 64. On the flip-side, though, CTC screening rates began a noticeable decline after age 65, falling off by 6.9 percent for each additional year of age.

In addition, they noticed a difference in the screening rates between white and African American patients. For white patients, the CTC screening rate was highest between ages 65 and 69, but the test was administered most often in African American patients between ages 55 and 59.

This difference, the team said, could be attributed to Medicare’s lack of CTC coverage for patients over age 65. The average out-of-pocket expense for CTC screening, according to Costhelper.com, is $2,400, they said. Consequently, by not covering the test, the agency is likely making it harder for patients who cannot afford to pay for the test without insurance to secure the screening.

The factors behind this disparity are largely social and structural in nature, the team concluded, and they equate to a reduced ability to afford effective screening services. Not only is the average annual income lower for African American patients than it is for white patients, but African American Medicare beneficiaries also have, on average, lower levels of savings.

Due to these factors, the team determined, Medicare should change its course and move to cover CTC.

“Medicare coverage of screening CTC is needed so that Medicare patients who cannot afford to pay for this test out of pocket can undergo screening CTC,” they said.

African American, as well as other racial and ethnic minority, patients likely have lower levels of CTC screening due to out-of-pocket costs.

Lack of Medicare Coverage Limits CT Colongraphy Use in Minority Patients

New York-based start-up Ezra, a company focused on early cancer screening with MRI, has secured 510(k) clearance for its artificial intelligence (AI) tool for prostate cancer screening.

As the first prostate AI algorithm to receive clearance from the U.S. Food & Drug Administration, Ezra Prostate AI is designed to help radiologists analyze and segment prostate MRI while simultaneously reducing time and cost associated with MRI-based prostate cancer screening.

“Over the past two years, our team has worked tirelessly on building Ezra’s Prostate AI, and I’m thrilled to bring it to our imaging partners across the U.S.,” said Emi Gal, chief executive officer and co-founder of Ezra. “We will continue to work towards making the interpretation of prostate MRI scans faster and more affordable, in order to support the millions of men who are at risk of prostate cancer.”

Overall, company officials said, the prostate AI tool offers three capabilities:

Automatic lesion quantification: This tool helps providers segment lesions and can display lesion size automatically.

Automatic 3D volume rendering: Via the segmentation capabilities, radiologists can automatically render prostate gland and lesions 3D volumes, improving workflow efficiency.

According to company representatives, Ezra Prostate AI requires no software installation – the Ezra Plexo, a cloud-based PACS, has also received FDA clearance, and works directly in a web browser.

Ezra launched its MRI-based prostate cancer screening service in January 2019 and its full-body MRI scan in May 2019. In response to this FDA clearance, the company is dropping the price of an Ezra scan by 15 percent to $575.

Algorithm cleared to help radiologists analyze and segment prostate MRI.

Industry-First Prostate AI Cleared by FDA

Pre-operative MRI can catch more breast lesions in women with dense breasts who have receive their initial breast cancer diagnosis via digital breast tomosynthesis (DBT).

Together, investigators from a multi-institutional team determined that pre-operative MRI does perform differently between women who undergo DBT and those who have digital mammography (DM). They shared their results in the Oct. 13 

“In our study, we found a trend of increasing detection by MR of additional sites of malignancies in patients with dense breasts compared to those with non-dense breasts, irrespective of initial imaging modality – DM versus DBT,” said the team led by Elizabeth McDonald, M.D., Ph.D., assistant professor of radiology at the Hospital of the University of Pennsylvania.

Pre-Operative Breast MRI Diagnoses More Cancers in Women with DCIS

Based on their results, McDonald’s team discovered MRI detected additional malignant lesions in 57 percent of all women with dense breasts included in their study. This finding can be potentially critical because approximately 43 percent of American women between the ages of 40 and 74 have dense breasts, and evidence continues to mount that they could benefit from supplemental screening.

DBT is known to have a higher cancer detection rate in women regardless of their breast density, but little is know about how it compares to MRI in this regard.

“To optimize the use of breast MR in pre-surgical planning, it is necessary to identify a subset of patients who will benefit most from this exam,” they said.

To determine the impact of pre-operative MRI in detecting more cancers, the team conducted a retrospective analysis of 388 consecutive breast MRIs captured for newly diagnosed breast cancers between Oct. 1, 2013, to July 31, 2015. The original diagnosis was made either by DM or DBT, and the team stratified identified disease by modality, breast density, and background enhancement.

According to their analysis, pre-operative MRI picked up 50 additional malignancies – 37 ipsilateral and 13 contralateral. While there was no difference in MRI detection of additional disease between women imaged with either modality, MRI did detect more cancers in women with dense breasts who underwent DBT.

“There were significantly higher discordant MR findings in patients with dense breasts (p=0.004) with a trend toward significance for true-positive exams (p=0.06),” the team said. “In patients imaged with DBT, those with non-dense breasts had significantly fewer additional cancers detected by MR.”

Overall, they said, 7 percent of women with non-dense breasts had additional cancers identified versus 18 percent of women with dense breasts. In addition, background parenchymal enhancement on MRI was also significantly higher in patients with mammographically dense breasts.

“These findings suggest that in women imaged with DBT, MR may have less value for determining extent of disease in women with non-dense breasts,” the team said. “Among patients with DBT imaging at cancer diagnosis, women with dense breasts appear to benefit more from pre-operative MR than non-dense women.”

MRI catches more malignant lesions in women with dense breasts who undergo digital breast tomosynthesis than those who have digital mammography alone.

Pre-Operative MRI Catches More Cancers in Women with Dense Breasts

Adding a deep learning algorithm to standard CT technology can produce images that offer greater detail without the added radiation, new research has revealed.

a team of engineers from Rensselaer Polytechnic Institute demonstrated how using this type of algorithm with conventional CT scans can capture images that typically require dual-energy CT (DECT).

“We hope that this technique will help extract more information from a regular single-spectrum X-ray CT scan, make it more quantitative, and improve diagnosis,” said study co-author Ge Wang, an endowed professor of biomedical engineering and director of the Biomedical Imaging Center in the Center for Biotechnology and Interdisciplinary Studies (CBIS).

Although CT scans are widely used in the United States – studies have spiked nearly 30-fold in the past 40 years to more than 80 million annual exams – they cannot give providers enough detail about the composition of imaged tissues. DECT can offer that information, but it comes with both higher radiation dose and cost.

Dual-Energy CT in the ED Brings Greater Confidence

To avoid these issues and still give radiologists the information necessary for more informed interpretations, Wang’s team trained their neural network, dubbed ResNet DL, on DECT-derived virtual monoenergetic (VM) images. Their deep learning approach is designed for extraction of a non-linear transform from a single-spectrum CT image training dataset to reconstruct VM images using only a single-spectrum dataset.

According to their tests, this trained neural network produced high quality approximations of VM images with a relative error rate of less than 2 percent, Wang said. The structural similarity was 0.9991 +/- 0.0018, and it showed structural information, particularly texture features, were well preserved by the machine learning method. In addition, bone images were clearly separated from reconstructed VM images.

“It has been clearly demonstrated in our study that a conventional CT energy-integrating dataset coupled with [deep learning] can deliver a close approximation of DECT images,” the team said. “Thus, it is potentially feasible to just use conventional CT to perform some important tasks of DECT.”

Ultimately, from a clinical perspective, they said, the potential exists for this VM imaging method to significantly reduce scan times and radiation dose associated with a photon-counting micro-CT scan.

“Professor Wang and his team’s expertise in bioimaging is giving physicians and surgeons ‘new eyes’ in diagnosing and treating disease,” said Deepak Vashishth, CBIS director. “This research effort is a prime example of the partnership needed to personalize and solve persistent human health challenges.”

Training a neural network with images captured by dual-energy CT can produce high quality studies without the added dose or expense.

Introduced during RSNA 2019, GE Healthcare’s Serena Bright™ -- the industry’s first contrast-enhanced biopsy solution for mammography – received 510(k) clearance Tuesday from the U.S. Food & Drug Administration.

This technology enables providers to perform contrast-guided breast biopsies without changing mammography equipment, rooms, or staff after a screening or diagnostic mammogram. Results, company officials said, can be available a few days rather than the several weeks needed for an MRI biopsy.

These biopsies and malignant lesions identifications are possible, the company said, because Serena Bright™ uses GE Healthcare’s SenoBright™ HD Contrast Enhanced Spectral Mammography. This diagnostic breast exam performed with iodine-based contrast pinpoints unusual blood flow areas, helping to localize lesions requiring biopsy. In doing so, the tool can improve a radiologist’s diagnostic confidence and accelerate patient care.

GE Healthcare Introduces First Contrast-Enhanced Mammography Biopsy

“Now, more than ever, it is critical we put the comfort of patients first and get them answers as fast as possible,” said Agnes Berzsenyi, president and chief executive officer of women’s health and X-ray at GE Healthcare. “We hope this technology can help improve breast cancer outcomes for women during this time of uncertainty.”

In fact, according to one published study, the United States can anticipate a potential increase of 33,890 cancer deaths. It is in the climate of the lingering pandemic that the quicker turn-around of biopsy results can be particularly valuable, said one physician familiar with Serena Bright™.

“In the current COVID-19 environment and requirements for shorter appointments to allow physical distancing, time has become our most precious asset,” said Anat Kornecki, M.D., head of the division of breast imaging in the St. Joseph’s Health Care London Breast Care Program and scientist with Lawson Health Research Institute in Ontario. “This new mammography-guided biopsy technique is a game changer, and patients tell us it’s a very tolerable experience.”

Overall, she said, the technology enables a woman to stay in a setting that is more familiar and comfortable than an MRI machine where she must lie face down for the exam.

Serena Bright™ has already been tested in clinics in France and Spain, and Jefferson Health in Philadelphia is slated to be the first healthcare system in the United States to begin offer this technology to its patients later this year.

Serena Bright™ shortens time to biopsy results, a critical capability during the COVID-19 pandemic.

GE Healthcare Captures FDA Clearance for Industry-First Contrast-Enhanced Mammography Biopsy

BI-RADS, LI-RADS, and Lung-RADS have helped countless radiologists classify breast, liver, and lung lesions. But, to date, little has been done to improve how providers understand the every-growing volume of artificial intelligence (AI) algorithms.

Dartmouth-Hitchcock Medical Center recently addressed this problem head-on by launching AI-RADS – an artificial intelligence curriculum for its radiology residents. Through a specifically designed set of lectures, residents not only reported they have a much greater understanding of AI, but they also indicated they were extremely satisfied with the program. Faculty shared these outcomes in an Oct. 17 article published in 

“As artificial intelligence continues to reshape the world of medicine, it will become imperative that physicians are familiar with fundamental algorithms and technique in artificial intelligence,” said the team led by Petra J. Lewis, MBBS, professor of radiology and vice chair of radiology education. “This will become an essential skill for interpreting medical literature, assessing potential clinical software augmentation, formulating research questions, and purchasing equipment.”

The field of AI in radiology is constantly shifting, Lewis’s team said, and the level of instruction radiologists have received in how to understand and implement these tools has been uneven at best. In their pilot course, they designed a series of lectures that offer guidance on the strengths and limitations of machine learning with the goal of helping providers better understand the scientific literature being published on the subject.

To maximize AI understanding, the team crafted each of seven lectures around specific algorithms and supporting fundamental concepts in computer science. The team selected which algorithms to include based upon how commonly they are used and the problems they were designed to solve, using them to build an intellectual foundation for data representation. Lectures were held monthly for seven months.

Simultaneously, residents participated in a journal club where participants discussed each lecture’s algorithm. These two-hour meetings were held within two weeks of each lecture and included study guides that defined unfamiliar terms and broke down complicated mathematical expressions into simpler terms.

Overall, the team said, after attending the lecture series, residents were expected to be able to:

Describe the foundational algorithms, intellectual underpinning, and clinical radiology applications of AI.

Read journal articles on AI in radiology proficiently.

Pinpoint potential weaknesses in the design, database features, and performance reports of these AI algorithms.

Identify instances where AI techniques can be employed to address problems.

Describe the different ways information can be abstractly represented and exploited.

Showcase their fluency in AI “buzzwords.”

The team surveyed residents with content questions to assess how much their understanding of AI improved after the lectures, and they also asked participants to rate their satisfaction with lecture series. Exit surveys indicated a high level of happiness – 9.8 out of 10.

“Trainees overwhelmingly feel that the content depth of the AI-RADS lecture series is ideal, and the examples used are helpful vehicles to understand the key concepts in artificial intelligence,” the team said.

Although the pilot program was implemented as an in-person curriculum, the team said there are plans underway to transition it to an online curriculum. In this way, they said, it can better accommodate the scheduling needs of a wider group of residents. In fact, they said, videos will be uploaded to the medical center’s 

Ultimately, the team said, their goal is to ensure the highest level of training for the next generation of radiologists.

“Residency programs are only beginning to employ basic computing concepts in their training, a skill that will become essential for the radiologists of tomorrow,” they said. “Proficiency in artificial intelligence will be a required skill in the near future of imaging services.”

A pilot lecture series at one medical center is designed to provide residents with in-depth instruction in commonly used artificial intelligence algorithms.

Mastering AI-RADS: Resident Curriculum Introduces Standardized Artificial Intelligence Instruction

A substantial international effort, bringing together experts from a variety of specialties, is now in motion with the goal of augmenting the use of MRI to better determine the long-term impacts of traumatic brain injury.

Dubbed ENIGMA, this initiative based at the University of Southern California and conducted in conjunction with the Norwegian University of Science and Technology (NTNU), is designed to collect, combine, and analyze large brain imaging data sets from around the world, searching for connections that cannot be identified on single studies.

The team shared the specifics of this initiative in 

“A major challenge in the research is to figure out which injury characteristics and which changes in the brain caused by the injury can predict how patients will recover and what follow-up they need,” said Alexander Olsen, Ph.D., associate professor of psychology and head of the Clinical Neuroscience Laboratory at NTNU. “A big part of the challenge is that individual patients are so different.”

The Value of MRI After Traumatic Brain Injury

Progress into understanding how the brain responds after a traumatic brain injury has been stymied, largely because most previous studies were small and they had no standard way for sharing and analyzing data across institutions because patient populations are heterogenous. The hope now, according to this group comprised of 170 researchers from 13 countries, is that investigations into newer and more advanced MRI methods will provide some clinical benefit.

“By pooling our resources, in terms of data, computational power and intellectual expertise,” said Emily Dennis, Ph.D., co-principal investigator for ENIGMA’s main group on brain injuries, “we’ll be able to tackle some of the big unanswered questions in our field, such as how sex impacts outcome, whether there are subtypes within the broader patient population, or how to handle lesions in neuroimaging data.”

While MRI images can reveal the size and type of injury, Olsen’s group will work with research-based MRI methods that use advanced algorithms and statistics. They intend to apply those methods to MRI data that has already been collected from investigators across the globe, including the United States, Europe, Australia, the Middle East, South Africa, and South America.

“We’re working to develop better and more standardized ways of summarizing and making sense of the MRI data.” Olsen said, noting that only an international collaboration can handle data of this magnitude. “We hope to contribute to breakthroughs in research that will benefit patients.”

Worldwide effort will amass large datasets from institutions  that can be used to identify long-term traumatic brain injury and augment therapies. 

Global MRI Initiative Looks to Improve Brain Injury Treatment

The radiation oncology (RO) payment model from the Centers for Medicare & Medicaid Services (CMS) has been pushed back from its original Jan. 1 start date.

In a statement released Thursday, Oct. 21, via Twitter, the CMS Administrator Seema Verma said the agency would postpone the payment model launch until July 2021. The decision was made based on the response from the RO community that indicated they needed more time to prepare.

The move earned gratitude from the RO community. The leadership of the American Society of Radiation Oncology published a comment, expressing their appreciation that CMS paid heed to their requests, joining the American College of Radiology in resisting the initial Jan. 1 start date. In particular, they said, COVID-19 has presented significant challenges to the specialist community.

“We are hopeful that the delay represents the first step toward full, open engagement with ASTRO on ways to ensure that the RO Model achieves our shared goals on higher quality, lower-cost cancer care,” said Theodore L. DeWeese M.D., the chair of ASTRO’s Board of Directors. “We remain seriously concerned with excessive payment cuts in the model that will cause significant financial strain on practices and risk patient access to radiation treatments.”

Once implemented, the RO model will bundle payments for a 90-day episode-of-care to radiotherapy provides who treat patients with one of 16 different types of cancers. Over five years, the anticipation is that it will save approximately $230 million.

CMS pushes launch from January 2021 to July 2021.



Radiation Oncology Payment Model Start Date Delayed

’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview with Drs. Rich Heller and Nina Kottler from Radiology Partners about corporatization in radiology practices, here are the top stories of the week.

Think back for a moment to being a medical student – what one tool was always at your side. No doubt, you immediately thought of your stethoscope. Well, there’s a potential paradigm shift underway in medical education that could have point-of-care ultrasound taking over that coveted spot. Together in partnership, ultrasound manufacturer Vave Health and the College of Osteopathic Medicine at Touro University in Nevada have launched a new ultrasound curriculum that weaves image acquisition and interpretation instruction into nearly all levels of didactic training. At the same time students will be learning about anatomy and disease presentation, they will also be using hand-held ultrasound probes for visualization. In addition, students are getting a Vave EduPlus Membership that will give them access not only to ultrasound experts, but also to in-app content that can both help them prepare for medical exams and provide clinical context. The goal, according to Vave Health leaders, is to make the program available to other institutions who can then customize the curriculum to meet their program needs.

Throughout this year, there has been a lot of news emerging around pre-operative MRI and in what situations and for which women it works best. In an multi-institutional study published in 

investigators determined that this scan performs best in women who have dense breasts who have undergone digital breast tomosynthesis rather than digital mammography alone. In these situations, pre-operative MRI is able to identify more overlooked malignant lesions. To make this determination, researchers conducted a retrospective study of 388 consecutive breast MRIs captured for newly diagnosed breast cancers between Oct. 1, 2013, to July 31, 2015. Based on their results, the team discovered MRI detected additional malignant lesions in 57 percent of all women with dense breasts included in their study. Specifically, pre-operative MRI identified 50 additional malignancies, more of which were in women with dense breasts who had undergone digital breast tomosynthesis. These findings are clinically important, the researchers pointed out, because 43 percent of women in the United States between the ages of 40 and 74 have dense breasts, and evidence continues to mount that they could benefit from supplemental screening.

Since the beginning of the pandemic, the American College of Radiology and other industry professional organizations have recommended against using CT to diagnose COVID-19. But, research published by a team of France this week in the 

showed that spectral CT with electron density imaging can make it easier for providers to assess the extent of lung lesions in patients who have early-stage disease. The team used a small group of four case studies from patients diagnosed and treated in their hospital to show that electron density imaging improves the visualization of ground-glass opacities compared to conventional CT scans. The team reconstructed the spectral CT images using the same standard soft kernel (filter B) and a similar iterative method that is used to capture conventional CT images. Then, they compared initial conventional CT images with follow-up scans. They found that all 45 ground-glass opacities identified in the four patients showed up better on the electron density imaging, and the lesion extent was much easier to determine. Overall, they said, these results show that it is possible to gather greater detail for earlier assessment of ground-glass opacities, potentially impacting treatment for COVID-19.

 spoke with Drs. Rich Heller and Nina Kottler from Radiology Partners about the growing trend of corporatization in the industry. They shared with us not only their experiences within Radiology Partners, but the impact that corporatization is having on radiology at the local level and as a specialty overall. Here’s what they had to say.

Videos

Ultrasound as the New Stethoscope; Pre-Operative MRI and Dense Breasts; Spectral CT and COVID-19; Corporatization in Radiology

Global MRI Initiative Looks to Improve Brain Injury Treatment

Radiation Oncology Payment Model Start Date Delayed

Diagnostic Imaging's Weekly Scan: Oct. 23, 2020