Find actionable insights to achieve sustainability and savings in radiology in this newest of ITN’s “One on One” video series with Reed A. Omary, MD, MS, Vanderbilt University Medical Center (Nashville, TN). Tune in to "Promoting the Planet's Health: Sustainability in Radiology," to hear from a recognized leader about impactful, cost-saving initiatives radiologists, associations, healthcare systems and vendors can take, and why action is imperative.

Omary, the Carol D. and Henry P. Pendergrass Professor in the VUMC Department of Radiology, is a distinguished radiologist whose commitment to driving healthcare sustainability initiatives has gained both attention and momentum. After serving as Chair of the Department of Radiology and Radiology Sciences from 2012-2023, in June, 2023, Omary stepped away from his role as Chair to pursue a sabbatical focused on climate change and sustainable healthcare. He is author of The Green Leap, a blog about making healthcare sustainable, and founder of the Greenwell Project, a sustainable healthcare non-profit. He has presented a Plenary Lecture at the Radiological Society of North America (RSNA) Annual Scientific Sessions and American College of Radiology (ACR) meetings on the topic, and continues to connect with healthcare systems, vendors and colleagues to advance the issue.

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Don't miss ITN's latest "One on One" video interview with AAWR Past President and American College of Radiology (ACR) RAN and RADPAC Chair, Amy K. Patel, MD, discussing advocacy initiatives and innovations in artificial intelligence (AI) for breast imaging. 

Dr. Patel is a breast imaging trailblazer and radiology advocacy leader. In this video,  learn how radiologists can support key initiatives, ways AI is improving patient care, and more.

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Fujifilm recently expanded its enterprise imaging portfolio with Synapse Pathology, the company’s newly acquired and branded digital pathology PACS solution.

Synapse Pathology is an open, vendor-agnostic, end-to-end solution designed for medical facilities that handle large volumes of pathology images and data across multiple locations.

Imaging Technology News recently met with Fujifilm’s Bill Lacy and Mark Lloyd, and Chuck Barkey at West Virginia University Medicine to learn more about this new addition to the Synapse Enterprise Imaging portfolio.

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HIMMS is working to bring empirical knowledge and evidence of value and impact of digital maturity measured by the HIMSS maturity models and the Digital Health Indicator (DHI), which is a blueprint for digital health advancement. The maturity models provide prescriptive frameworks to healthcare organizations to help build their digital health ecosystems. ITN spoke with Anne Snowdon, RN, PhD, FAAN, professor of strategy entrepreneurship, Odette Business School, University of Windsor, CEO of SCAN Health and Chief Scientific Research Officer, HIMSS Analytics, to find out more about these models, and what the latest scientific research is telling us.

Dr. Anne Snowdon is a Professor of Strategy and Entrepreneurship at the Odette School of Business, University of Windsor.  Currently, Dr. Snowdon is the Chief Scientific Research Officer for HIMSS, Vice Chair of the Board of the Directors for Alberta Innovates, and member of the Health Futures Council of Arizona State University (ASU).  She is an Adjunct Faculty at the Department of Computer Science at the University of Windsor, the School of Nursing at Dalhousie University and the Centre for Innovative Medical Technology (CIMT), at the University of Southern Denmark.  Dr. Snowdon is leading a national Community of Practice to advance supply chain resilience across Canada, she has published more than 150 research articles, papers and cases, has received over $24 million in research funding, holds patents and has commercialized a highly successful booster seat product for children traveling in vehicles and is a Fulbright Scholar. She holds a PhD in Nursing from the University of Michigan, an MSc from McGill University, and BScN from Western University.  

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In addition to women with dense breasts, there are also other women for whom mammographic screening is not really enough, which is why research needs to continue in this field. Dr. Wendie Berg, a leading breast cancer specialist, talks with ITN about new research and advancements in breast imaging technology.

Dr. Berg, MD, PhD, FACR, FSBI, is Professor of Radiology at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, specializing in breast imaging. She is also the Chief Scientific Advisor to DenseBreast-info.org. A renowned expert, she writes and co-edits one of the leading textbooks on the topic, Diagnostic Imaging: Breast, currently in its third edition, and has co-authored over 120 peer-reviewed research publications.

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With the help of artificial intelligence, cutting-edge technology is being developed that will help improve patient outcomes and build efficiencies in healthcare, which will help transform the future of healthcare delivery. ITN sat down with Julius Bogdan, a leading expert in Digital transformation, Data and analytics, and Artificial intelligence and machine learning, to find out more about the inroads AI is making.

Julius is Vice President and General Manager, Digital Health Advisory Team for the Healthcare Information and Management Systems Society (HIMSS). In that role, he leads sales, business development, product management, product marketing and advisory services teams across the continent on digital health transformation. He is responsible for the growth of the HIMSS Analytics portfolio adoption, channel strategy, and cultivating relationships across the provider, payer and public sector health landscape. He also serves on the advisory council of various start-ups and early stage firms in finance and healthcare on technology trends, architecture and market analysis.

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It has long been said that a national reporting standard is needed in order to ensure all American women receive at least the same basic information regarding breast density, and a spotlight put on the importance of routine breast imaging. Dr. Wendie Berg, a leading breast cancer specialist, shares with ITN what is being done in the fight against breast cancer and the importance of this standardization in reporting for women.

Dr. Berg, MD, PhD, FACR, FSBI, is Professor of Radiology at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, specializing in breast imaging. She is also the Chief Scientific Advisor to DenseBreast-info.org. A renowned expert, she writes and co-edits one of the leading textbooks on the topic, Diagnostic Imaging: Breast, currently in its third edition, and has co-authored over 120 peer-reviewed research publications.

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Kim Sandler, MD, Co-Chair of the American College of Radiology (ACR) Lung Cancer Screening Steering Committee, and Associate Professor, Department of Radiology at Vanderbilt University Medical Center, recently shared updates on research and initiatives for expanding life-saving lung cancer screenings. This video is part of ITN's Special Report on Lung Cancer Screening, a 3-part series focused on news and resources addressing the leading cause of U.S. cancer deaths.

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John C. Breneman, M.D., medical director of the Cincinnati Children's/UC Health Proton Therapy Center, and the principal investigator of the FAST-01 trial, explains FLASH therapy and details on the trial. This study is testing the use of a single FLASH proton therapy session, rather than weeks of fractionated doses.

FLASH and hypo fractionated therapy have been among the hottest topics in radiation oncology. The premise of FLASH is to deliver extremely high doses of radiation to a tumor in one, short dose. Lab testing has shown this actually has a healthy tissue sparing capability and may help in reducing collateral damage.  

If this and other trials show benefit and improved outcomes from FLASH, it is possible this may become the primary treatment method for many cancers in the years to come. Reducing therapy to one treatment session also would open up much more time for proton centers so many more patients could be treated. It also would be a significant time and cost savings for patients and their families, who would not be required to stay at nearby hotels for extended stays during their course of treatment.  

Cincinnati Children's/UC Health Proton Therapy Center announced the completion of enrollment in FAST-01 (FeAsibility Study of FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases) in October. This is the first human clinical trial of FLASH therapy, which centered on patients with metastases in arms and legs to avoid irradiating critical structures. If this trials shows benefits and low toxicity, followup studies will attempt more complex treatments in other parts of the body.

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Elekta’s latest linear accelerator, Harmony, is designed to provide a productive and versatile radiotherapy solution for both mature and developing markets. ITN recently spoke with Chris Gilpin, Global Product Marketing Manager, and Emily Basset, Global Clinical Marketing Manager, to learn more about the treatment system. 

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Brian S. Bingham, M.D., chief resident in radiation oncology at the Vanderbilt University Medical Center, explains the practice-level and national cost burden of treatment-related prior authorization for academic radiation oncology practices. This was a highlighted study presented at the 2021 American Society of Radiation Oncology (ASTRO) annual meeting.

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Bridget F. Koontz, M.D., chief medical officer at GenesisCare USA explains how to manage the complex needs of pelvic radiotherapy survivors. She offers an. overview of published evidence about the various toxicity types and approaches for managing them.

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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.

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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. 

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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.

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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

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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.

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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. 

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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

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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. 

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