Marc Succi, M.D., an emergency radiologist at MGH and executive director of the MESH Incubator, an in-house innovation and entrepreneurship center, and  Ottavia Zattra, a fourth-year medical student at Harvard Medical School, explain a study they authored showing there might be higher cancer rates due to lower numbers of CT scans during COVID-19. They presented this study as a late-breaker at the Radiological Society of North America (RSNA) 2021 annual meeting.

COVID caused many people to delay seeing their doctors. Their study found a corresponding 82% drop in CT imaging for cancer screening. CT is also used for initial cancer workups, to monitor active cancer and post procedure surveillance, which all also showed decline since the start of the pandemic.

Read more about the study COVID-19 Fallout May Lead to More Cancer Deaths

Mahadevappa Mahesh, Ph.D., chief physicist, Johns Hopkins Hospital, and professor of radiology and radiological science, explains the basics involved in quality assurance (QA) of radiology imaging systems. He spoke to ITN at the Radiological Society of North America (RSNA) 2021 annual meeting.

He explains the role of the medical physicist in keeping X-ray imaging systems such as CT, angiography and mammography calibrated and checking the device output of radiation. This is performed by imaging phantoms that mimic a simplified representation of the human body. 

Artificial intelligence (AI) use is growing in imaging and medical physics and QA of these systems might also become a duty of the medical physicist in some AI imaging applications.  

Find more content on QA systems

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Emanuel Kanal, M.D., FACR, FISMRM, AANG, director of the department of emergency radiology and teleradiology, director of MRI services, and professor of radiology and neuroradiology at the University of Pittsburgh, explains artificial intelligence (AI) is the biggest over all trend in radiology at  the Radiological Society of North America (RSNA) 2021 annual meeting.

VIDEO: Artificial Intelligence Trends in Medical Imaging — Interview with Sanjay Parekh, Ph.D.

VIDEO: Examples of Artificial Intelligence Pulmonary Embolism Response Team Apps

Technology Report: Artificial Intelligence in Radiology 2021

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Here are two examples of artificial intelligence (AI) driven pulmonary embolism (PE) response team apps featured by vendors Aidoc and Viz.AI at the 2021 Radiological Society of North America (RSNA) 2021 meeting.

The AI scans computed tomography (CT) image datasets as they came off the imaging system and looked for evidence of PE. If detected by the algorithm, it immediately sends an alert to the stroke care team members via smartphone messaging. This is done before the images are even loaded into the PACS. The radiologist on the team can use a link on the app to open the CT dataset and has basic tools for scrolling, windowing and leveling to determine if there is a PE and the severity. The team can then use the app to send messages, access patient information, imaging and reports. This enabled them all to be on the same page and can communicate quickly via mobile devices, rather than being required to use dedicated workstations in the hospital. 

Both vendors showed similar apps for stroke at RSNA 2019. That idea for rapid alerts, diagnosis and communications for acute care teams has now expanded to PE and also for aortic dissection and abdominal aortic aneurysms (AAA). AI.Viz and Aidoc are looking at expanding this type of technology for other acute care team rolls, including heart failure response. 

Read more about this technology in the article AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams.

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Jean Jeudy, M.D., professor of radiology and vice chair of informatics at the University of Maryland School of Medicine, presented a late-breaking study at the 2021 Radiological Society of North America (RSNA) meeting on COVID-19 linked myocarditis in college athletes. 

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle, that can only be seen on cardiac MRI, according to the study Jeudy presented. Myocarditis, which typically occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump and often leaves behind lasting damage in the form of scarring to the heart muscle. It has been linked to as many as 20% of sudden deaths in young athletes. The COVID-19 pandemic raised concerns over an increased incidence of the condition in student-athletes.

For the new study, clinicians at schools in the highly competitive Big Ten athletic conference collaborated to collect data on the frequency of myocarditis in student-athletes recovering from COVID-19 infection. Conference officials had required all athletes who had COVID-19 to get a series of cardiac tests before returning to play, providing a unique opportunity for researchers to collect data on the athletes’ cardiac status.

Thirty-seven of the athletes, or 2.3%, were diagnosed with COVID-19 myocarditis, a percentage on par with the incidence of myocarditis in the general population. However, an alarmingly high proportion of the myocarditis cases were found in athletes with no clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54%) had neither cardiac symptoms nor cardiac testing abnormalities. Only cardiac MRI identified the problem.

Read more details in the article COVID-19 Linked to Heart Inflammation in College Athletes.

Find more RSNA news and video

Related COVID-19 Imaging and Myocarditis Content:

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Elizabeth Hawk, M.D., Ph.D., director of innovation Engagement at Rad Partners, a regional president for Matrix Teleradiology, and assistant professor of medicine at Stanford, explains how the COVID-19 pandemic has helped advance home reading and changed radiology.

While teleradiology and remote reading is not new, its expansion was greatly accelerated in 2020-2021 due to COVID. Early in the pandemic, hospitals tried to get as many of their employees as possible to work remotely, and radiologists who wanted to read from home were allowed to do so in large numbers. The past two years has taught many people that remote reading from home is possible and it also can aid the balance between work and family life. Hawk said remote reading will likely be the new normal even after the pandemic.

Hawk presented in a session on this topic at the 2021 Radiological Society of North America (RSNA) annual meeting. She said many radiologists from her practice were already reading from home prior to the pandemic, so they had the experience to quickly ramp up expansion during COVID. She offers advice to hospitals that want to introduce or expand home radiology reading. 

Find more teleradiology news

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Kate Hanneman, M.D., MPH, FRCPC, director of cardiac imaging research JDMI, and the medical imaging site director at Toronto General Hospital, Women’s College Hospital, was an author on a recent overview of cardiac MRI assessments of non-ischemic myocardial inflammation caused by the COVID-19 vaccine. She presented this study and other related data at the 2021 Radiological Society of North America (RSNA) meeting. 

The rare side effect from the COVID vaccine is seen mainly in young men between ages 12-29. It appears to resolve on its own after a couple days, but longer term monitoring is needed to show if there is any lasting cardiac damage. A small number of single cases with follow up MRI imaging so far have not shown long term damage. 

Hanneman noted the incidence of vaccine-related myocarditis is very rare and people have a much high probability of getting much more serious COVID-viral myocarditis is they are not vaccinated. She said so the risk-vs-benefit analysis currently shows it is better to get vaccinated to prevent or lessen the effects of COVID. 

Related COVID-19 Imaging Content:

VIDEO: COVID-19 Linked to Heart Inflammation in College Athletes — Interview with Jean Jeudy, M.D.

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Jeffrey T. Chapman, a medical student at the University of Texas Southwestern Medical Center, Explains how watching movies can be used to help sedate pediatric radiation therapy patients. He presented the results of the Pediatric Radiation Oncology With Movie Induced Sedation Effect (PROMISE) study at the 2021 American Society of Radiation Oncology (ASTRO) annual meeting.

Children usually have to be sedated with anesthesia to keep them immobile each day for weeks for their daily fractions of radiotherapy. This presents problems because the child will have side effects from the anesthesia and face issues with eating only at certain times. UTSW developed a system where the child can watch a movie and if they move the movie and the radiation beam both immediately shut off. This trains the child to stay still during treatments without the need for anesthesia.

7 Trends in Radiation Therapy at ASTRO 2021

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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The Elekta Harmony radiotherapy system gained FDA clearance in the summer of 2021 and was on display for the first time at the American Society of Radiation Oncology (ASTRO) 2021 meeting. It offers fast treatments and the ability to track and treat multiple metastases at the same time. 

It has a large round screen on the machine so the patient's information is immediately available table side. It uses facial recognition to verify the correct patient is in the room for treatment.

The speed of the treatment delivery increased over that of prior systems, so the time a patient spends in the treatment room for lung SBRT went from 30 minutes down to less than 2 minutes. SBRT prostate went down from 5 minutes to 90 seconds. It also can perform hypofractionation lung therapy in a single 20 minute treatment.

Read more on the Harmony system. 

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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Walter Curran, Jr. M.D., FACR, FASCO, GenesisCare global chief medical officer, discusses three technologies that are helping advance radiation oncology care during the American Society of Radiation Oncology (ASTRO) 2021 meeting. These technology advances include:

   • Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging for prostate cancer.

   • MRI-linear accelerator (Linac) systems that allow real-time imaging during radiation therapy.

   • Remote treatment planning to help radiation treatment centers that are in rural areas.

Prostate cancer is one of the most common cancers in men. The new PSMA PET imaging is expected to significantly improve how prostate cancer is detected and treated. The FDA approved the drug for PET nuclear imaging of PSMA-positive lesions in men with prostate cancer. 68Ga-PSMA-11 is a radioactive imaging agent that binds to prostate cancer cells to help localize prostate cancer cells.

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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Anthony Zietman, M.D., interim chief, radiation oncology, Mass General Cancer Center, and former president of the American Society of Radiation Oncology (ASTRO), explains some of the recent technology trends to watch in radiation oncology at the ASTRO 2021 meeting.

He said four technologies to watch include:
   • Proton therapy
   • FLASH therapy
   • Image guided radiotherapy
   • PET guided radiotherapy

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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An example of the Varian Noona software used by clinicians to interface with oncology patients demonstrated at the American Society of Radiation Oncology (ASTRO) 2021 meeting. It allows bi-direction communication between the care team and the patient’s smartphone. This included reporting complains about side effects, pain, questions for the physician and surveys. The data the interfaces with the patient record so anyone on the care team can access it or reach out to the patient.

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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An example of flexible bolus made from silicone on molds that were 3-D printed from patient CT scans. These are very flexible, so more comfortable for the patient than 3D printed plastic. These are used to attenuate electron beam radiation therapy (EBRT) doses in treating skin cancers. This a new product, FlexiBol,  from Decimal shown for the first time at the American Society of Radiation Oncology (ASTRO) 2021 meeting. 

Photo Gallery of Technologies at ASTRO 2021

Radiation Oncology Research Featured at ASTRO 2021

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ITN Editor Dave Fornell collected numerous examples of how PACS and enterprise imaging vendors are improving the speed and workflow of their systems during booth demonstrations at the 2021 Healthcare Information Management Systems Society (HIMSS). The 11 minute video condenses down the highlights of workflow efficiencies seen during two days o vendor booth tours.

There was a clear trend of many vendors moving to new platforms that leverage more modern cloud-platform interfaces. This enables faster study loading speeds over web connections. These platforms are also using deeper integration of third-party applications and artificial intelligence (AI) software that do not require separate logins or workflows. Read more about these key trends observed at HIMSS 2021.

Vendors also showed various ways they have speed up radiology workflows. These included easier to customize hanging protocols, automated fetching of prior exams, synchronizing views and scrolling between a current a prior exams, use of timeline views of patient priors and procedures to make it easier to find relevant images and reports, and integration of all types of images into one unified viewer. 

Specific examples in this video include: 
   • Visage Imaging: Example of high speed cloud PACS access to 3D mammograms and and priors. This first video clip shows a demonstration of opening large datasets in a matter of a couple seconds over a network connection from a tethered cellphone.
   • Visage Imaging: Ability to access multiple modalities on one PACS viewer
   • GE Healthcare: Examples of fast access to priors and location on screen 
   • GE Healthcare: Example of deep integration of third-party AI software
   • Siemens: Overview of its Lung AI Pathway Companion workflow  
   • Change Healthcare: Enabling fast ability to free rotate around lung anatomy rather than going slice by slice manually 
   • Change Healthcare: Color-coded bar shows loading progress of an image or data set
   • Infinitt: Hanging protocol automation to find same view on prior and link for synchronized scrolling   
   • Infinitt: Use of timeline to get quick view of prior reports and images without needing to open whole exam 
   • Siemens: Example of deeper integration with third-party apps, in this case Epsilon strain echo analysis  
   • Fujifilm: Integrated advanced visualization in the radiology workflow for liver segmentation used for surgical or embolization planning 
   • Fujifilm: Example of life-like cinematic rendering of a CT scan offers new ways to view anatomy and explain it to a patient 
   • Visage Imaging: Example of enterprise platform able to bring in full original format advanced visualization reconstructed images on a single platform viewer

Related Medical Imaging IT Content From HIMSS 2021:

Advances in CVIS and Enterprise iImaging at HIMSS 21

Photo Gallery of New Technologies at HIMSS 2021

VIDEO: Importance of Body Part Labeling in Enterprise Imaging — Interview with Alex Towbin, M.D.

HIMSS 2021 Showed What to Expect From In-person Healthcare Conferences During the COVID Pandemic

VIDEO: Coordinating Followup for Radiology Incidental Findings — Interview with David Danhauer, M.D.

VIDEO: Cardiology AI Aggregates Patient Data and Enables Interactive Risk Assessments

VIDEO: Examples of COVID-19 CT Scan Analysis Software

David Danhauer, M.D., FAAP, FHIMSS, chief medical information officer, Owensboro Health, Owensboro, Ky., explains the implementation of healthcare information technology (IT) to coordinate followup on incidental radiology findings. He presented on this topic in a session at the Healthcare Information Management Systems Society (HIMSS) 2021 meeting. 

Their system starts with key words being identified to flag incidental findings by the voice recognition system used to enter radiology report information. IT interfaces with the electronic medical record create a list of patients that need followup and what departments the incidental findings relate to so a coordinator can connect the patient with the proper subspecialty.

Danhauer said many of the incidental findings at his center include lung nodules and abdominal aortic aneurisms. In the past, many of these were lost to followup, but the new system now promotes follow through to get the patient the care they need. This has helped increase revenue, improve patient care and lowers the health system's liability profile. 

The system experienced several patient safety events due to gaps in care coordination with incidental findings documented in the radiology report, but missed by referring physicians. A patient safety initiative he helped implement automating the workflow resulted in a nine-fold increase in identifying and communicating incidental findings for improved patient safety. 

Read about more advances in PACS and enterprise imaging at HIMSS 21.

Photo Gallery of New Technologies at HIMSS 2021

VIDEO: Importance of Body Part Labeling in Enterprise Imaging — Interview with Alex Towbin, M.D. 

Integrated Speech recognition solutions are becoming a necessary part of radiology reporting platforms. Konica Minolta recently announced a partnership with nVoq to integrate a speech to text solution into their Exa Platform. 

ITN recently spoke with Kevin Borden, Vice President of Product, Healthcare IT for Konica Minolta and Chad Hiner, Vice President of Customer Experience for nVoq, to talk about how this integration is improving the Exa user experience.

Related enterprise imaging content:

This is an example of a COVID-19 (SARS-CoV-2) positive patient's lung computed tomography (CT) scan. The video scrolls through the image slices of the scan and shows the typical white, ground glass opacities (GGO) caused by COVID pneumonia. The pneumonia typically appears along the walls of each lobe of the lung, especially the chest wall and the lower portions of the lungs. This scan is from a Canon Aquilion Prime SP CT scanner and used Advanced intelligent Clear-IQ Engine (AiCE), an artificial intelligence-driven image reconstruction software to improve image quality of lower-dose scans. This was shown by Canon Medical as an exmaple of CT image quality for the virus at the 2020 Radiological Society of North American (RSNA) meeting. 

Read more about this system and its launch in 2020 to address COVID, Canon Medical Launches CT Solution for Patients with Viral Infectious Diseases.

VIDEO: How to Image COVID-19 and Radiological Presentations of the Virus interview with Margarita Revzin, M.D., associate professor of radiology and biomedical imaging, Yale School of Medicine.

Find more radiology clinical images of coronavirus in this photo gallery.

Find more radiology related COVID news and video

Treating cancer effectively often includes a combination of patient therapies. In recent years, technology advancements have led to a more efficient and personalized approach to treatment. Andrew Wilson, President of Oncology Informatics at Elekta, discussed the latest software advancements with ITN.

Agfa is looking to transform X-ray with new advancements in volumetric imaging, and with new mobile concepts and implementation of intelligent tools. ITN had a conversation with Georges Espada on Transforming X-ray with Intelligent Tools. 

Artificial Intelligence (AI) is becoming more common place in radiology practices, and emerging technologies are providing radiologists with sophisticated detection software to aid their reading and provide support for a busy workflow. With the progression of AI technology, vendors must look not only at what AI can do for the radiologist, but how the radiologist and the technician interact with that technology –  the goal should be increasing accuracy while also positively improving workflow. GE Healthcare is working to improve radiology AI workflow in its Centricity Universal Viewer.

Three key opinion leaders offers their views on what is needed to make AI more valauble and accessible to radiologists. These include:

   • Amy Patel, M.D., breast radiologist, medical director, Liberty Hospital Women's Imaging, assistant professor of radiology, University of Missouri-Kansas City.

   • Prof. Dr. Thomas Frauenfelder, M.D., vice chairman and professor of thoracic radiology, Institute for Diagnostic and Interventional Radiology, University of Zurich.

   • Randy Hicks, M.D., chief executive officer, Regional Medical Imaging.

Learn more about the Centricity Universal Viewer in the VIDEO: How GE Healthcare’s Zero Footprint Remote Image Viewer Supports Clinical Care