Whether it’s the advent of Smart Noise Cancellation or the enhanced imaging of X-ray systems such as DRX-Compass and DRX-Evolution Plus, Carestream has embraced the technology of artificial intelligence (AI) and what it can do for radiologists.

 sat down with Ron Muscosky, the worldwide product line manager for software solutions for Carestream, to discuss the company’s emerging innovations with AI technology. Watch below:

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RSNA

Innovations with artificial technology (AI) are fueling product advances that offer enhanced image quality, patient positioning and workflow efficiencies.

How Carestream's AI-Enabled Products are Improving Quality and Efficiency for Radiologists

Offering an array of promising benefits including quality imaging, usability across devices and enhanced portability due to lighter weight and an ergonomic design, Carestream’s Lux 35 Detector appears to check off a number of boxes for busy radiologists.

 sat down with Jill Hamman, the global product marketing manager for X-ray solutions for Carestream, to discuss the advantages of the 

The portability and durability of the device may make it an emerging option for bedside imaging.

A Closer Look at Carestream's Lux 35 Detector

It was good (and exhausting) to be back in person at 

. While virtual meetings are sometimes necessary to protect public health, there is no substitute for face-to-face interaction.

As I reflect on my experience at this year’s meeting, I believe that radiology is as innovative as ever, but there appeared to be a more deliberate focus on getting back to basics and focusing our efforts around the patient. Here are a few key themes:

A common theme among my conversations with colleagues is that radiologists feel swamped – too much work, too few people, and no end in sight. Unfortunately, burnout is not a new issue for radiologists, and 

 for years. The demands of the pandemic have only made things worse.

There is also a weariness about adding another tool to the stack. Radiologists need help, but they aren’t looking for the expense and time commitment it takes to get a new technology up and running. Any new solution would need to demonstrate clear value to the radiologist, without making it too difficult to implement and begin using it.

In previous RSNA events, “interoperability” was the buzzword. This year, I heard “orchestration” all week long.

 on how to solve key challenges radiologists are facing. Traditionally, adding tools to bring in insights from artificial intelligence (AI) or improve workflows just resulted in more work for the radiologist and IT teams. AI in radiology is evolving from its early rapid innovation phase and maturing into more collaborative, integrated approaches to improve the technology’s value to the field.

IBM Watson Health is among the companies taking this approach. 

At RSNA, the company launched two orchestration solutions

 to help imaging organizations improve the radiologists’ experience while reducing demands on IT.

3) Consolidation will be a continuing trend.

Four or five years ago at the RSNA annual meeting, you would find aisle after aisle of small vendors offering clinical decision support solutions. It seemed that any person with a dream had a booth that boasted a new way to help clinicians order the right test at the right time.

I didn’t see many of these solutions this year, and I suspect it is because some of the best innovations have been absorbed into companies or options to deliver solutions at scale.

This is yet another symptom of an evolving perspective on technology in radiology: innovation is vital, but likely won’t achieve success in isolation. Rather, innovation needs to measurably impact workflow in a positive way, and it needs to scale.

4) The future of radiology is bright with innovation.

Radiology has seen exponential progress when it comes to better imaging to help us see the detail we need to assess and treat health conditions. Clinicians and technology are better together than either one would be alone.

When compared with previous RSNA meetings, this year’s event seemed to offer fewer examples of specific technical leaps forward – like faster magnetic resonance (MR) screening or advancements in coils. (One possible exception was the exciting buzz around 

.) Instead, people seemed more focused on the innovations that promise to integrate technology in a more cohesive and helpful way.

For all the inspiring innovation we see at RSNA each year, I applaud the satisfying return to our radiology roots. It’s not just about the latest, cutting-edge technology; It’s about being efficient, effective, and doing what’s best for our patients. Imaging should be centered around people, and that was more apparent than ever at RSNA 2021.

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Pertinent perspectives on emerging trends in radiology.

Four Takeaways from RSNA 2021

With the continued rise of patient volume and increasingly complex cases, an emerging computed tomography (CT) platform may provide a viable solution in radiology departments with built-in scalability for detector upgrades, increased efficiency and other technological advancements.

Radiological Society of North America (RSNA) 2021 Annual Meeting

, GE Healthcare unveiled a new modular version of the 

 that enables clinicians to do on-site upgrades of the device’s Gemstone

 Clarity Detector for coverage of 40 mm, 80 mm or 160 mm. The system also offers 0.28 second rotation speed with the ability to increase to an 0.23 second rotation speed via an upgrade to Revolution Apex Elite, according to GE Healthcare.

In addition to technology that provides high-definition, low-noise imaging, the Revolution Apex reportedly enhances speed and precision by automating time-consuming tasks prior to, during and after CT scans.

GE Healthcare says the device offers an auto-positioning system, enabled by a 3D camera and an artificial intelligence (AI) algorithm, that helps ensure optimal patient positioning. Other features of the Revolution Apex include a virtual scan assistant to tailor parameters to patient size and indications, as well as the post-scan ability to simultaneously process multiple reconstruction tasks so clinicians can view the images before the patient leaves the room. GE Healthcare says this is particularly advantageous in cases involving polytrauma workup and asserts that one may rule out acute stroke in less than five minutes.

According to GE Healthcare, other benefits of the Revolution Apex CT platform include:

High-resolution imaging in patients with heavily calcified coronaries, plaque and stents

CT planning for transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) procedures via a single scan and single injection with low-contrast volume

Reduced need for table movement or sedation with lowest dose possible

New MRI System May Provide Enhanced Imaging and Reduced Scan Times

In addition to advancements in the Revolution Apex CT system, GE Healthcare also introduced 

, a new 3.0T magnetic resonance imaging (MRI) system, citing advances in imaging quality, efficiency and patient comfort.

Leveraging AI to bolster image clarity and increase efficiency, the SIGNA Hero device offers AIR Recon DL, a deep learning image reconstruction technology that enables anatomical adaptability and facilitates a 30 to 50 percent reduction in exam times, according to GE Healthcare.

New extensions of this technology, presented at the RSNA conference, include 3D sequences and PROPELLER for motion robustness that reportedly provide “sharper images with better signals in half the time for nearly 90 percent of the daily clinical scans done, regardless of the anatomy being imaged,” according to GE Healthcare.

In combination with the company’s patented AIR Coils, the SIGNA Hero device allow clinicians freedom in positioning the lightweight and flexible coils to help ensure optimal imaging of patients. GE Healthcare says the SIGNA Hero platform enables simultaneous scans of multiple organs with fewer patient adjustments during whole body imaging. The company adds that the device’s One Stop Prostate imaging with AIR Coils and AIR Recon DL make prostate imaging much more comfortable and efficient for patients, allowing for completion of scans in less than 15 minutes.

GE Healthcare notes that the SIGNA Hero device as well as the AIR Recon DL 3D and PROPELLER technologies are currently pending 501(k) approval from the Food and Drug Administration.

GE Healthcare unveils on-site detection upgrades and other advances with CT system as well as a new MRI device.

New Version of Revolution Apex CT Platform Offers Increased Scalability and Efficiency

 (AI) adoption in radiology has, surprisingly, taken longer than many of us had hoped and anticipated. Many in the industry have learned with experience that this journey is not a sprint, but a rather a marathon with a relay-race component, because it requires a broad ecosystem of stakeholders committed to teamwork and collaboration. As a result, the industry’s perspective on AI in radiology is continuously evolving and maturing.

Five years ago, people were focused on how AI could address and relieve physician burnout, by helping the radiologist who was facing an ever-expanding workload. But, despite intense levels of burnout, increasing case volume and complexity and staffing shortages, AI adoption has not accelerated as originally expected. The American College of Radiology (ACR) Data Science Institute (DSI) conducted a study

 in spring 2020 and found about one-third of survey respondents reported using AI in their practice. Of those respondents who were not using the technology, only 20% planned to purchase it.

When ACR DSI dug a little deeper into why radiologists were not adopting AI, they found that 80% of survey respondents not using AI in their practices said that they “see no benefit” to using the technology.

 I believe this illustrates the crux of the matter: Is AI valuable to radiologists?

Transitioning from Entrepreneurial to Ecosystem Approaches

Early on, AI in radiology was driven in a very entrepreneurial way—similar to an “if you build it, they will come” model. Many developers built innovative solutions quickly, without necessarily assessing market needs or budget availability.

However, healthcare leaders will put any new innovation to the test, asking: Will it improve quality of care and outcomes? Will it reduce costs or make money? Will it make work easier, faster or better in some way? If it’s not doing any of those things, then the answer will likely be “no, thank you.”

So, despite the fact that many early AI algorithms were innovative and impressive, they may not have targeted common pain points well enough to succeed. I think the industry has also learned from this early, exciting innovation phase that developing and adopting AI is not a standalone process. Technologies must be integrated with existing platforms and workflows, as well as demonstrate value.

Defining value will require thinking deeply about the radiologist’s day-to-day experience and workflow. When I think about my own experience as a practicing radiologist, I can think of a couple of specific areas where AI could bring value to me. First, I look at a recurring task— oncology follow-ups—that show up consistently on my worklist. While not a difficult task, it is repetitive and time-consuming to do it well. Could AI help automate this task on my list? Another way I would find value in AI is in helping identify 

, especially if this capability is just part of my workflow and doesn’t require me to open yet another solution. And from my perspective, AI has real potential value to help with time-consuming, costly and important non-clinical tasks, such as workflow, quality assessment, patient tracking and follow-up, data summarization (especially unstructured data), and appropriate use. Those are a few of the places where I’d love AI to step in, working well with all of my existing tools, and help me. 

Defining the areas where AI can bring value to the radiologist is a critical first step. But when the definition of AI value flows this direction—from clinician to the developer—instead of the other way around as it did in the entrepreneurial model, we also need to re-think how we’re delivering AI.

Orchestration: An Evolving Approach to AI in Radiology

Enter AI orchestration, which is one way 

IBM Watson Health is evolving our approach to AI in imaging

. AI orchestration is a new way to help imaging organizations to experience the benefits of AI with the goal of having the AI applications working seamlessly together. This approach simplifies the end-to-end process of finding, procuring and implementing diagnostic imaging AI-enabled solutions. 

Because each AI application is developed in a unique way with a specific purpose, it can be challenging for organizations to review and assess each one, and then to deploy them in a way that’s beneficial to users. Orchestration offers a single platform that makes it easier to deploy a curated selection of AI applications, to consume their results, and to manage new innovations over time. This approach helps integrate the right toolset—both in the physician’s workspace as well as the IT environment.

, IBM Watson Health officially launched our IBM Imaging AI Orchestrator, a cloud-based imaging AI service that provides scalable access to regulatory-cleared AI applications. It is designed to help organizations manage imaging worklists by indicating status of AI processing and returning consolidated results from AI applications directly into the PACS. Physicians can use it to control their access to AI insights within the reading process, while IT can outsource the management of multiple applications to IBM.

Ultimately, I believe radiology will be better off when AI development and adoption engages all stakeholders—clinicians, developers, executive leaders, administrators, academia, organized medicine and other experts across the industry. If we think about the problems we need to solve together, we can bring greater value. The industry is starting to get there, and I expect great things yet to come.

Technologies must be integrated with existing platforms and workflows, as well as demonstrate value.

Changing and Maturing Perspectives on AI 

Low-field magnetic resonance imaging (MRI) offers comparable performance to routine computerized tomography (CT) and MRI for following hydrocephalus. This is according to initial results from an ongoing trial presented at the 

, which also found that deep-learning based lateral ventricle volume estimates from low-field MRI are accurate.

“Patients with hydrocephalus require repeated neuroimaging to monitor ventricular volumes and avoid complications,” the authors wrote. “Low-field MRI may offer a cost-effective, radiation-free alternative to monitor ventricular volume changes in patients with hydrocephalus.”

The results were presented by Thomas Campbell Arnold, DPhil, department of bioengineering at the University of Pennsylvania in Philadelphia.

Standard of care imaging for patients with hydrocephalus includes routine CT or MRI. However, CT uses ionizing radiation and provides less soft-tissue contrast and MRI is more expensive, less widely available and is subject to imaging artifacts from commonly used programmable ventricular shunts. Further, strong magnetic fields change programmable shunt settings.

“We hypothesized that low-field imaging would provide a comparable and more convenient point-of-care assessment for alterations in ventricle size, less shunt-related artifact and less need for programmable shunt checks,” the authors wrote.

In this ongoing study, the researchers assessed a recent US FDA cleared, portable, low-field strength (64mT) MRI scanner (Hyperfine, Guilford, Connecticut) that was used to monitor 22 patients with known or suspected hydrocephalus. Same-day low-field MRI and standard of care imaging, with CT or MRI, were collected for each patient. A neuroradiologist assessed ventricles as abnormally increased, decreased or within expected limits. Additionally, semi-automated ventricular volume segmentations were generated for clinical MRI scans and compared with deep-learning based volumes that were provided automatically by the low-field device.

Radiological assessments were comparable between low-field MRI and standard of care imaging. One patient presented with a shunt related hemorrhage on both imaging modalities. A strong correlation (R=0.97, p<0.001) was found between lateral ventricle volume measurements on low-field and clinical MRI.

Settings for programmable shunts, which were present in 10 patients, were recorded before and after low-field imaging. Shunt settings were altered in nine of these cases.

“Programmable shunts must still be checked by the clinical care team after low-field imaging,” the authors wrote.

Early study results suggest that low-field MRI may offer a cost-effective, radiation-free alternative to monitor ventricular volume changes in patients with hydrocephalus. 

Low-field MRI Matches Standard-Of-Care Imaging for Hydrocephalus

 describes a community-based outreach intervention that was effective at identifying and addressing barriers to lung cancer screening, such as cost, lower literacy levels and fear of diagnosis.

“Radiologists can partner with patients and key community stakeholders in the development of effective lung cancer screening outreach interventions aimed to increase equitable lung cancer screening participation among low socioeconomic status communities,” the authors wrote.

The results were presented by Efren Jesus Flores, M.D., department of radiology at Massachusetts General Hospital, in Boston.

Community-based lung cancer screening outreach can help individuals from low socioeconomic status communities, who experience worse lung cancer outcomes, by addressing barriers to digital health and promoting trust. In this study, the researchers aimed to develop a tailored digital health outreach intervention to promote lung cancer screening and understand related social needs among low socioeconomic status communities.

Focus groups were conducted at an urban academic medical center with affiliated community health centers with 12 representative primary care physicians, eight advocates, seven lung cancer screening patients and eight non- lung cancer screening patients. Three tailored lung cancer screening outreach video conditions were developed with messaging by a radiologist, patient and patient/radiologist together. 

A national sample of 315 current smokers with Medicaid who were eligible for lung cancer screening were randomized to watch one of the three video messages to determine satisfaction, preferred source, intent to screen and attitudes about lung cancer.

The focus groups cited transportation and fear about lung cancer as major barriers to screening. Patients reported confusion about screening eligibility criteria, the screening process and insurance coverage. The outreach video was modified to emphasize the treatability of early lung cancer, adopted clear language for eligibility and insurance coverage, and displayed a patient undergoing lung cancer screening and receiving results. 

Of the 315 participants, 67% reported satisfaction with the video, with those watching the video messaging from the patient reporting the greatest intent to speak to a physician about lung cancer screening. Participants reported limited social needs.

“Greater social need was associated with significantly lower health literacy, smoking-related stigma, lower confidence in arranging transport to lung cancer screening, greater cost concerns about screening, perceived severity of lung cancer and greater worry about developing lung cancer,” the authors wrote.

Cost, lower literacy levels and fear of lung cancer diagnosis were highlighted as concerns with lung cancer screening. 

Community-Based Intervention May Increase Lung Cancer Screening 

 suggest that diffusion-weighted imaging was a sensitive and effective screening method for breast cancer detection in asymptomatic women with dense breasts. 

“Mammography has low sensitivity in dense breasts and needs to be supplemented with another screening method for women with dense breasts,” the authors wrote. “Diffusion-weighted imaging may be useful as a safe and effective screening tool for the supplementation of mammography in women with dense breast tissues.”

The results were presented by Hee Jeong Kim, M.D., breast cancer center at Asan Medical Center in Seoul, Korea.

In the study, the researchers assessed the diagnostic performance of diffusion-weighted imaging for breast cancer detection in asymptomatic women with dense breast tissue on mammography. The researchers also compared the diagnostic performance of mammography, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging.

From August 2018 to January 2019, the researchers retrospectively reviewed 297 consecutive asymptomatic women, mean age of 51 years, with dense breast tissue on mammography who underwent breast MRI including diffusion-weighted imaging and DCE protocols and mammography. Three readers independently reviewed the lesion visibility and level of suspicion on each imaging modality. Histopathologic features of the tumors on surgical specimen served as the standard of reference.

A total of 233 breast cancers were identified in 230 women, benign lesions were identified in 11 women and normal breasts were identified in 56 women. Of the 233 cancers, 15% presented as ductal carcinoma in situ, 12% as microinvasive ductal carcinoma and 73% as invasive carcinoma. The overall sensitivity was 61.4% in mammography, 79.4% in diffusion-weighted imaging, 86.3% in DCE-MRI and 91.8% in the combination of mammography and diffusion-weighted imaging. The sensitivities for noninvasive cancer in mammography, diffusion-weighted imaging, DCE-MRI, and the combination of mammography and diffusion-weighted imaging were 73%, 68.3%, 74.6% and 92.1%, while the sensitivities for invasive cancer smaller than 20 mm were 51.9%, 81.5%, 88.9% and 89.6%, and the sensitivities for invasive cancer larger than 20 mm were 77.1%, 91.4%, 97.1% and 100%, respectively. 

When diagnostic performance was assessed by using areas under the receiver operating characteristic curves, diffusion-weighted imaging was superior to mammography (

 < .001) and comparable to DCE-MRI when combined with mammography (

Diffusion-weighted imaging may be useful as a safe and effective screening tool to supplement mammography in women with dense breast tissues. 

Diffusion-Weighted Imaging Helps Detect Breast Cancer in Dense Breasts 

 found that racial ethnic minorities, and patients with low socioeconomic status, lower access to broadband internet or limited English proficiency were less likely to use a patient-portal self-scheduling pathway for screening mammograms.

“Understanding the factors associated with patient use of technology and patient portals for access to care can guide interventions to bridge the existing digital divide and promote health equity in radiology,” the authors wrote.

The results were presented by Patricia Balthazar, M.D., assistant professor of abdominal radiology and imaging informatics at Emory University in Atlanta, Georgia.

While patient portals can increase patient access and engagement, they can create potential barriers to care. In this study, the researchers aimed to identify potential sociodemographic disparities in the use of an online patient portal to self-schedule screening mammograms compared with traditional scheduling pathway, such as a scheduler phone call and referral system. The researchers hypothesized that patients with limited English proficiency or low socioeconomic status, along with racial/ethnic minorities would be less likely to use the online self-scheduling pathway.

This retrospective cohort study included 46,268 female patients undergoing screening mammograms from Jan. 1, 2019, to Dec. 31, 2019, at an urban quaternary-care academic medical center. The following data were extracted: patient scheduling pathway, age, language, race, health insurance provider and zip code, with the latter linked to Census data to extract the following demographic information: internet access, median household income and education level.

Of the patients, 0.7% used the online self-scheduling pathway. Those using the self-scheduling pathway had higher odds of being younger (OR for age in year: 0.94; 95% CI: 0.93-0.96), English-speakers (95% CI: 21.6, 3.0-156.5), White (95% CI: 1.7, 1.2-2.5), have private insurance (95% CI: 1.5, 1.0-2.1) and to live in zip code areas with higher percentage of access to broadband internet (95% CI: 1.2, 1.1-1.3).

Unlike racial ethnic minorities, patients with low socioeconomic status, lower access to broadband internet and limited English proficiency, “patients living in zip code areas with higher median household income, education level or with any type of internet access were not significantly associated with the online self-scheduling pathway,” the authors wrote.

This study discloses the characteristics of patients using self-scheduled online patient portal screening mammography. 

Online Patient Portals for Screening Mammograms May Widen Health Disparities 

68Ga prostate specific membrane antigen (PSMA) positron emission tomography (PET) has high utility in the detection of suspicious lesions in biochemically recurrent prostate cancer. This is according to study results presented at the 

“PSMA PET is a more robust modality for biochemical recurrence with the potential of identifying small lesions which would otherwise be dismissed on MRI alone,” the authors wrote. “We recommend the use of 68Ga PSMA PET/MR for biochemical recurrent prostate cancer with potential to be the new standard of care for this indication.”

The results were presented by Juana Martinez, M.D., fellow in radiology at Weill Cornell Medical College in New York. 

PSMA PET combined with magnetic resonance imaging (MRI) is a promising technique in the evaluation of patients with prostate cancer. In this study, the researchers compared PSMA PET with concomitant multiparametric MRI in detecting lesions suspicious for biochemical prostate cancer recurrence. 

A review was performed of all patients with prostate cancer who prospectively enrolled in a clinical trial of 68Ga PSMA PET/MRI at New York Presbyterian Hospital - Weill Cornell campus from April 2018 to January 2021. Nuclear medicine physicians read the PSMA PET portion of the study and a radiologist with fellowship training in cancer imaging read the MRI of the skull base to thigh, independent of each other. Patient demographics, the indication for PSMA PET/MRI and serum prostate specific antigen (PSA) levels closest to the PSMA PET/MRI were extracted from patient charts.

Of the 165 patients who had a PSMA PET/MRI, 109 where imaged for biochemical recurrence. PSMA PET was able to detect more lesions suspicious for recurrence than MRI at all PSA levels. When assessing only patients who had PSMA PET/MRI for biochemical recurrent disease, PSMA PET fared superiorly at all PSA levels in comparison with MRI. 

“When compared with MRI, PSMA PET is highly robust in identifying lesions which are otherwise deemed unremarkable,” the authors wrote.

PSMA PET is highly robust in identifying prostate cancer lesions which are otherwise deemed unremarkable. 

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