Whitney J. Palmer

The Radiological Society of North America (RSNA) announced Tuesday that it has approved $4 million in research and educational grants.

Through the RSNA’s Research and Education (R&E) Foundation Board of Trustees, the group funded 28 percent of grant applications with awards going to radiologists at all stages of their careers.

“We are deeply grateful for the ongoing and generous support of our individual, practice group, and corporate donors who make supporting these researchers and educators possible,” said Thomas M. Grist, M.D., chair of the R&E Foundation Board of Trustees. “Because of the generosity of our donors, the RSNA R&E Foundation is able to support research and education efforts that elevate our specialty and place radiology at the forefront of innovation in medicine.”

All total, the Foundation approved grants to 93 recipients from 47 different institutions across North America. Of the group, 49 are new grant recipients, 26 are new medical student grants, and 18 are continuing grants.

The Foundation also launched an initiative this year to provide additional grants with medical students who identify as being from racial and ethnic groups who are underserved in medicine (UIM). This year’s UIM grants will fund students conducting research on optimizing immune responses for liver and skin cancer patients, as well as investigating how artificial intelligence can be used to classify bone lesions.

More information about the RSNA R&E Foundation and the funded 2020 projects can be found 

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The RSNA Research and Education Foundation awards 93 grants from 47 institutions. 


RSNA Announces $4 Million in Research, Education Grants

Artificial intelligence (AI) tools are not the Dooms Day machines for radiology that many naysayers would have you believe, said one industry expert.

In an opinion article published recently in 

 John Banja, Ph.D., professor and medical ethicist in the Center for Ethics at Emory University, addressed the often negative ballyhoo that has surrounded AI in radiology for several years – that the technology will soon replace the radiologist, putting you out of a job.

“What seems ethically imperative at present…is a steady and informed rebuttal of AI hype, especially as it is aimed at image-dependent technologies like radiology,” he said. “Today’s hospitals simply cannot function without radiologists, who are core to their diagnostic functions.”

It’s True – Interest in AI Is Growing

The past decade has seen an explosion of development around AI tools, Banja said, particularly in research. In 2008, there were only 100 publications in radiology literature that focused on AI tools specific to the industry. But, by 2018, that number had ballooned to approximately 700 papers.

In the same vein, investment in AI has also taken off – since 2010, the market has seen applications for 154,000 patents. Between in 2018 and 2019 alone, organizations that use AI expanded from 4 percent to 14 percent. And, according to the Worldwide Semiannual Artificial Intelligence Systems Spending Guide, the fastest AI growth between 2018 and 2022 is expected to be in healthcare with image recognition software being some of the most familiar models.

Radiology Leaders Urge Proceeding with Caution with Autonomous AI

But, that still does not mean AI is in a position to upset the radiologist.

“It is a long way from observing the success of an AI model in a research setting to implementing it in routine clinical practice,” he explained. “And, it is a much longer way still to replacing human radiologic expertise.”

Even though there is vast potential for AI in radiology, the technology still has some significant limitations. In most cases, the algorithms used in the industry have not been tested either on heterogeneous patient populations or across a variety of modalities. Consequently, the strength of their generalizability is in question.

This means the applications for AI tools are relatively narrow within radiology, lending the technology to be a radiologist’s “amiable apprentice” rather than an “awful adversary,” Banja said.

Additionally, AI’s current function is to identify potential problems and bring them to a radiologist’s attention. The next steps of decision-making, though, are outside its capabilities, keeping the radiologist’s position secure.

“Even if a plethora of models appeared that could detect and evaluate subtle lesions as well as an experienced radiologist,” he said, “those applications wouldn’t be able to determine whether to image or not, how to best provide protocol for an examination, teach, and communicate findings to clinicians and patients.”

It is possible that one of the biggest obstacles to wider – and more complex – AI use is technology itself, Banja said. According to Wim Naude, a business professor from The Netherlands, the long-standing pattern of computer power doubling roughly every two year is largely winding down, potentially making it harder for AI to advance to the point where it can take over the wide variety of tasks that fall to the average individual radiologist.

Currently, the technology needed to achieve this level of multi-tasking does not functionally exist, Banja said. Reaching the goal would mean replacing AI’s silicon-based transistors with technologies that are still nascent, such as organic biochips or carbon nanotubules.

Overall, he concluded, there are many unanswered questions about how radiology, as a whole, will be able to seamlessly mesh AI solutions into current workflows and successfully navigate many of the other issues that currently face the industry.

“It remains anyone’s guess as to how AI applications will be affected by their integration with PACS, how liability trends or regulatory efforts will affect AI, whether reimbursement for AI will justify its use, how mergers and acquisitions will affect AI implementation, and how well AI models will accommodate ethical requirements related to informed consent, privacy, and patient access,” Banja said.

Once these issues are addressed, he said, it is possible that, rather than succumb to an AI take-over, radiology could ride the wave to a new height of professional excellence.

One expert makes the case that the negative hype around artificial intelligence is not warranted and the radiologist’s role is secure.

AI Is Not the End of Radiology’s World

COVID-19 can present a myriad of challenges to the clinician, but adopting a methodical, practical approach can make it easier for radiologists and technologists to render services to these patients. A nine-step plan released by providers in Russia details how.

Between mid-April and mid-June 2020, a network of 48 outpatient CT facilities in Moscow conducted more than 170,000 CT scans and identified more than 82,000 cases of COVID-19 pneumonia. A pre-existing plan, developed between 2012 and 2018 at the Moscow Center for Diagnostics and Telemedicine (CDT), has made it simpler for radiologists to read remotely.

“The goals of this innovation were to reduce workload on medical facilities under the conditions of rapidly spreading disease,” explained Sergey Morozov, chief regional radiology officer of Moscow, “and to reduce mortality rates from COVID-19.”

, designed to foster quick, accurate, and standardized radiology diagnostics, includes:

Infrastructure preparation (digital equipment and uniform resource identifiers operation)

Quality training of radiologists and X-ray technicians

Development of methodological materials and diagnostic protocols based on international experience

Integration of new protocols into the RIS in the form of study-report templates

Regular discussion of complicated cases at online meetups and conferences

Using a special dashboard to monitor performance

Implementing AI algorithms to help doctors

In an effort to streamline image reading – and keep technologists and radiologists safe – the CDT divided departments into “green” and “red” zones. Radiologists who read reports and do not have face-to-face contact with patients stay in the clean “green” zone. The CT rooms and all the staff who work there – radiographers, medical volunteers who greet and escort patients, and workers who disinfect equipment – comprise the “red” zone. These staff members are outfitted with Class Three personal protective equipment, and those coming off shift are careful not to overlap duties with those coming on shift.

With more than 1,000 diagnostic devices currently connected to Moscow’s Unified Radiological Information Service (URIS), CDT has designed a workflow that streamlines the diagnostic process. When a radiographer performs a study, a personalized referral is created, and patient-specific images are uploaded to URIS. After the radiologist writes the report, URIS-connected clinicians can access both the report and images in real time.

“This interoperability between different facilities has proven to be invaluable in a pandemic and to isolation restrictions, when a transfer of physical image mediums, [such as CD or films,] became impossible,” Morozov said.

Within 20 minutes, he said, a patient with suspected COVID-19 infection could be imaged, and a referring physician could have a completed radiology report in hand. And, patients can be hospitalized without re-examination. Other benefits include reduced radiation exposure, shortened waiting times, and study reports available in any format.

As part of the effort to facilitate a smoother workflow and prevent further COVID-19 spread, CDT also launched a telemedicine program. This initiative has not only helped facilities that have a shortage of radiologists, but it has also benefited those environments where the number of studies is overwhelmingly high, Morozov said. In these situations, images with suspected COVID-19 are flagged and placed at the top of the worklist.

Given the large number of studies generated during the pandemic, artificial intelligence tools have been vitally important, Morozov explained.

URIS is equipped with algorithms to process CT scans as soon as they are received, and the radiologist has the opportunity to review both the original study and the one processed by artificial intelligence which includes pathological findings marked in red. The tools can also generate a report on spots of probable viral pneumonia, but final diagnostic and treatment conclusions still come from the radiologist, he said.

A network of nearly 50 CT facilities and the Moscow government reveal how their collaboration is working to promptly diagnose patients with COVID-19.


A 9-Step Plan to Confront COVID-19

Patients with COVID-19 pneumonia who must be placed on a ventilator are more likely than other patients to experience an injury from increased air pressure in their lungs, placing them at a higher risk of death, new research has found.

 investigators from New York University (NYU) Langone Health discussed their observation that more patients with COVID-19 infection on ventilators developed barotrauma – an injury associated with elevated air pressure in the lungs – than did other patients who required intubation. Being aware of this risk can be vital for optimizing patient care, the researchers said.

“High barotrauma rates in patients with COVID-19 infection on [invasive mechanical ventilation] is associated with longer hospital stay and is a risk factor for higher mortality,” said the team led by Georgeann McGuinness, M.D., senior vice chair of the NYU Langone Health radiology department. “Barotrauma risk is particularly important to recognize as these critically ill patients may be managed by staff less familiar with the management of ventilator settings.”

Chest X-rays Can Predict COVID-19 Severity in Young and Middle-Age ER Patients

To determine the rate of barotrauma in COVID-19 patients, the team evaluated chest X-rays from 601 patients over age 18 who were positive for the virus and were also put on a ventilator. Of that group, 89 patients – 15 percent – developed at least one barotrauma event. All total, this group experienced 145 barotrauma episodes for an overall barotrauma rate of 24 percent. Specifically, the team identified:

11 patients with bilateral pneumothoraces

54 patients with either unilateral or bilateral pneumothorax

59 patients with pneumomediastinum (the most common barotrauma event)

They compared these results to the incidence of barotrauma in a group of 196 intubated patients who were negative for the virus. In that group, investigators identified only one event. The team also compared these findings to 285 intubated patients with acute respiratory distress syndrome (ARDS) from 2016 to 2020. During that time, 28 patients had 31 barotrauma events – a rate of 11 percent.

These findings fall in line with previous research that examined barotrauma rates during the SARS and MERS outbreaks. According to that data, between 12 percent and 34 percent of SARS patients developed barotrauma, and 30 percent of intubated MERS patients in the intensive care unit experienced pneumothorax. These rates, the team said, beg the question of whether coronavirus infections present a unique barotrauma risk.

X-ray as a New Frontline Tool in COVID-19 Pandemic

Overall, the team determined that the COVID-19 patients who develop barotrauma were younger than intubated ARDS or COVID-19-negative patients (63 years versus 68 years), suggesting that younger age in these patients after ventilation is an independent barotrauma risk factor. Additionally, a multivariate analysis revealed that alongside barotrauma, mortality in COVID-19-positive patients in this study was associated with greater age, shorter hospital length of stay, and Hispanic ethnicity.

Ultimately, the team said, they hope these findings can be used clinically to improve patient outcomes.

“Our observed high rate of barotrauma in patients with COVID-19 infection on [invasive mechanical ventilation] may support emerging theories of lung damage in SARS-CoV-2 infection,” they said.

Patients positive for the virus are more likely to experience barotrauma, putting them at risk for longer hospital stays and mortality.


Author | Whitney J. Palmer

Articles

RSNA Announces $4 Million in Research, Education Grants

AI Is Not the End of Radiology’s World

A 9-Step Plan to Confront COVID-19

X-ray Identifies More Air Pressure Lung Injuries in COVID-19 Patients