Diagnostic Imaging's Weekly Scan, July 17, 2020

Welcome to Diagnostic Imaging. I’m senior editor Whitney Palmer bringing you the top stories for the week.

Even as COVID-19 cases continue to surge in many areas of the country, radiology practices are steadily finding ways to re-open safely. In some cases, though, it can be difficult to know exactly what to do, and getting a little guidance from colleagues in the industry can be helpful. This week in the Journal of the American College of Radiology, investigators from the Henry Ford Health System, Beth Israel Deaconess Medical Center, and the University of California at San Diego shared the results of a national survey that revealed four take-away messages that can help you on your return to normalcy. According to the survey responses, you should plan for expanded teleradiology to be here long-term. In addition, survey respondents indicated that their practices are all following similar safety measures, including, among other strategies, temperature checks, telephone screening, patient prioritization, and extended hours. Keeping track of your completed exams can also be a quantifiable metric that points to your level of recovery. Overall, they said, you should prepare for all of these changes to be a permanent part of your practice.

And, speaking of recovery for your practice, there are even more things you can do to maximize your bounce back. In an opinion article published in the Journal of the American College of Radiology, an internal medicine physician from the University of Washington Medical Center suggested three tactics that can lead you to more stability as the pandemic continues. First, he said, pay attention to the decisions your patients are making. Not everyone will be ready to return to your office at the same time. It isn’t enough to show your patients all the safety measures you’ve put in place, you must make an effort to help them actually feel safe, as well. Second, there is a chance your patients’ insurance coverage is changing which could lead to a change in your payer mix. If that’s the case, investigate new strategies that could help you fulfill patient needs within their new benefit plans. And, lastly, the dip in patient volume has highlighted the pitfalls of the fee-for-service payment model. Now is the time to figure out if another model might work best for you.

When it comes to that dip in patient volume, you aren’t alone. It’s been well publicized that imaging volume, including CT scans, has dropped globally. But, according to Elad Walach, chief executive officer at AI solutions company Aidoc, those scans are finally on the rebound worldwide. Europe leads the way with CT volumes now above pre-pandemic levels, but practices in the United States aren’t far behind with 95 percent-to-97 percent of their previous volume. Aidoc took a look at the rebound in volume and saw a few trends emerge, such as an increase in scans identifying pulmonary embolism. Walach spoke with Diagnostic Imaging about the highlights of that data and how radiologists should view it.

But, this pandemic isn’t only touching patient care. It is also having a significant impact on radiology education – particularly the radiology residency interview process. With the Association of American Medical Colleges mandating medical students have no patient contact and other governing organizations saying all interview must be conducted remotely, residency programs are now scrambling to re-invent how they select the best candidates. In Academic Radiology, a multi-institutional team discussed several strategies programs can implement so they can not only choose the best candidates, but that applicants can best evaluate which programs fit their preferences and needs, as well. For example, they suggested that residency programs re-vamp their online presence to contain the most up-to-date and thorough details about what their residencies have to offer. Program leaders should also re-evaluate the criteria by which they will assess applicants – many interviewees will not have the typical letters of recommendation from away rotations or even some test scores that have been used to choose residents in the past. It can also be helpful for programs to create short videos that highlight various aspects of resident life, faculty engagement, and professional opportunities as a good replacement for an in-person visit.

On the clinical side this week, research published in Radiology revealed that non-contrast cardiac CT can play a double role in accurately diagnosing patients who have osteoporosis. According to researchers from Denmark, a bone mineral density test can easily be added into the scan that already captures images of the thoracic vertebrae that form the vertebral spine, and including this test doesn’t add any time or additional radiation exposure to the study. To test whether combining these tests was effective, investigators evaluated results from 1,487 patients. Of that group 179 –12 percent of the group – had very low bone mineral density. And, follow-up revealed that 80 people – 5.3 percent – experienced a fracture within three years. Thirty-one of those fractures were osteoporosis related. The relationship between very low bone mineral density and the higher fracture rate, the researchers said, shows that thoracic bone mineral density can be used to guide osteoporosis preventive measures and treatment decisions.

And, finally, this week, Diagnostic Imaging spoke with Dr. Elizabeth Krupinski from Emory University about the need to concentrate on how artificial intelligence tools and solutions are impacting the individual radiologist. As more and more providers turn to these tools to alleviate workload, stress, and burnout, it is important to pay attention to the correct way to implement them and evaluate their clinical impact. Here’s what she shared.