Todd Villines, M.D., FACC, FAHA, MSCCT, explains how artificial intelligence (AI) might be used in the near future to automatically calculate CT calcium scoring and and radiomic feature assessments. This was a key take away during the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. 

Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT),  and SCCT past-president.

AI is already commercially used to improve CT image reconstruction to increase the diagnostic quality of the images, especially from low-dose scans. AI is now being applied to automate time-consuming tasks in CT image reads, such as manually calculated calcium scores and automated contouring and quantification of anatomy and function of the heart.

Another area that is seeing a lot of research in in radiomics, where AI is being used to sift through thousands of CT scans to look for subtle imaging traits that may indicate the early development or worsening of disease. These subtle changes may not be evident to radiologists reading the scans, but AI software can identify similarities in patients as a trend and alert researchers to look at that specific trait as a potential imaging biomarker.

Other Key Trends and Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

Todd Villines, M.D., FACC, FAHA, MSCCT, explains some of more influential cardiac CT clinical papers from the past year at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. Among these were the ISCHEMIA Trial, others showing the value of CT is assessing chest pain patients and its ability to act as a gate keeper to the cath lab, and the 2019 European Society of Cardiology (ESC) guidelines that now list cardiac as a preferred imaging modality.

Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president.

Other Key Trends and CT Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Todd Villines, M.D., FACC, FAHA, MSCCT, explains some of the discussion on CT used for COVID-19 patients at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting in July. He is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia; editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president. 

Early on in the COVID-19 pandemic in China, CT emerged as a key imaging modality and was found to be able to detect COVID ground glass lesions in the lungs sometimes prior to positive genetic PCR test results. Supporters of CT say the modality offers a way to get detailed anatomical and functional information using a short exam time and limits the exposure of staff to potential or known COVID-19 positive patients.

One area where cardiac CT is seeing a lot of increased his is for the evaluation of thrombus in the left atrial appendage (LAA). This is traditionally done using trans esophageal echo (TEE), but it required very close contact with the patient and direct exposure of staff to bodily fluids and potential viral shed from the patient exhaling with each breath.

Related CT During COVID-19 Content:

Cardiac Imaging Best Practices During the COVID-19 Pandemic

VIDEO: CT and POCUS Emerge As Frontline Cardiac Imaging Modalities in COVID-19 Era — Interview with Geoffrey Rose, M.D.,

ASE Guidelines for the Protection of Echocardiography Providers During the COVID-19 Outbreak 

Study Looks at CT Findings of COVID-19 Through Recovery

Experts Stress Radiology Preparedness for COVID-19

ACR Recommendations for the Use of Chest Radiography and CT for Suspected COVID-19 Cases

Other Key Trends and CT Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Jilan Liu, M.D., MHA, CEO for the HIMSS Greater China, explains how health information technology (HIT) was leveraged in China to help fight the outbreak of novel coronavirus (COVID-19, SARS-CoV-2). Her discussion includes use of artificial intelligence, telemedicine to reduce contact between people, using the electronic medical record to help record and track people COVID-19 patients had contact with, apps, internet hospitals, and how 5G networks helped speed up IT systems.

She was previously principal and consulting director of the Greater China Joint Commission International (JCI). As chief executive for HIMSS Greater China, Liu and her team made a significant breakthroughs with hospitals and the HIT industry in the greater China region to embrace international HIT standards, certification requirements and to rethink prudent approaches to IT investments and operations. 

Read the the related article by Liu, "Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic."

In Enterprise Imaging at RSNA 2019, ITN Contributing Editor Greg Freiherr offers an overview of enterprise imaging advances at the Radiological Society of North America (RSNA) 2019 annual meeting.

EIZO medical monitors were showcased recently at RSNA 2019. Learn how the EIZO approach streamlines the effectiveness of your readings. From the NEW 30.9 inch, super-high-resolution, 12 megapixel multi-modality Radiforce RX1270, to the EIZO built-in features such as Point-and-Focus, EIZO holds to the ideal to harmoniously combine performance, ease-of-use and comfort. Learn the Shape of Comfort with EIZO.  Stop by and visit with us at HIMSS, booth #4087.

ProFound AI is an FDA-cleared artificial intelligence (AI) system for reading 3-D breast tomosynthesis images. At RSNA19, ITN Contributing Editor Greg Freiherr spoke with iCad Chairman and CEO Michael Klein about the system, which has been clinically proven in a large reader study to produce an 8% average improvement in sensitivity, 7.2% average reduction in recall rate and 52.7% reduction in average radiologist reading time. 

GE Healthcare's iCenter is a cloud-based management software that provides 24/7 visibility to customers' visual and operational data. In this Conversations video, Contributing Editor Greg Freiherr discusses iCenter with GE and Microsoft Executives at RSNA 2019.

Elizabeth M. Hecht, M.D., professor of radiology, Columbia University, New York, explains the latest advances to help visualize the difficult to image pancreas. She was a moderator of a session on pancreatic imaging advances at the 2019 Radiological Society of North America (RSNA) meeting.

She explained computed tomography is the front line imaging modality, followed by MRI for more detailed examination of the soft tissue details. MRI tissue elastography can also help to differentiate pancreatitis from pancreatic cancer. Hecht also said PET-CT and endoscopic ultrasound also play roles in pancreatic imaging. She said new software is helping automate measurements and artificial intelligence (AI) is in development to help improve pancreatic imaging and to find new radiomic markers that might be missed by the human eye to better detect disease or risk stratify patients.

Find more news and video from RSNA

An experienced technologist and two Agfa executives talk about what distinguishes the new Agfa 100s. Three key highlights include the quality of images that users can get out of the system for the certainty of the diagnostic; more flexibility that has been designed around the user; and its revolutionary platform.

Hitachi announced the FDA clearance of its newest CT – Scenaria View – at RSNA2019. The View offers an 80 cm wide bore, 550 lb table capacity and powerful 84 kW generator as well as a 200 mm lateral shifting table. Installs in Georgia, Ohio and Florida are underway with more to come in the new year.

In this Conversations video at AHRA, Ryan K. Lee, M.D., describes the harm extravasation can do and why using power injectors to administer saline beforehand increases patient safety based on his experiences at the Einstein Healthcare Network. 

This is a hologram of a fracture from a computed tomography (CT) scan displayed by the start up company Voxon at the 2019 Radiological Society Of North America (RSNA) meeting. The technology uses a half millimeter thick glass plate that pulses up and down very rapidly while projecting 4,000 images per second. It can display standard DICOM radiology files or STL files used for 3-D printing.

There were at least four vendors showing holographic screens to display advanced visualization 3-D renderings of anatomy from medical imaging. All four of these screens could be viewed in true 3-D using normal vision without the need for special glasses or a virtual reality visor.

The images in this example flickers because of the different frame rates of the system and the iPhone used to film it, but the actual images appears much more stable.

This technology was also included in the VIDEO: Editors Choice of the Most Innovative New Radiology Technology at RSNA 2019

Photo Gallery of New Imaging Technologies at RSNA 2019

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Kevin Little, Ph.D., assistant professor and medical physicist, Department of Radiology, at The Ohio State University, explains how hospitals can better manage their computed tomography (CT) imaging protocols across their fleet of CT scanners from various vendors. He moderated a session on this topic at the 2019 Radiological Society of North America (RSNA) meeting.

He stressed the importance of CT protocol management to an imaging practice and showed examples of tools that can be used to develop consistent protocols across multiple systems. Little said it is important to develop awareness of the Management of Acquisition Profiles (MAP) IHE profile and features that should be requested from CT scanner vendors.

CT protocols, which include all clinical and technical parameters for a given study, are the starting point for achieving high-quality images with reasonable radiation and contrast doses. An imaging practice that desires to follow the "as low as reasonably achievable” (ALARA) principle and produce high-quality images should have standardized protocols across their enterprise. Accreditation standards require a periodic review of all scanner protocols. However, variations among vendors, models, and clinical indications mean that managing and optimizing dozens of parameters for each protocol on every scanner in a health system is challenging. Even when variations between systems are limited, managing protocol names and parameters across multiple systems can be difficult. The purpose of this symposium is to identify tools and techniques that may be used to manage protocols across multiple systems and to provide a framework for protocol optimization.

Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.

The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.

Key findings of the study include:

   • CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;

   • Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures being performed;

   • A 15-20 percent decrease across X-ray imaging modalities.

Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of Radiology (ACR) Dose Index Registry.

He said there was growing concern a decade ago when the last council report was published, which showed a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR to create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline over all was in nuclear imaging.

Related Medical Imaging Radiation Dose Resources:

VIDEO: Radiation Dose Monitoring in Medical Imaging — an interview with Mahadevappa Mahesh, Ph.D.

The Basics of Radiation Dose Monitoring in Medical Imaging

How to Understand and Communicate Radiation Risk — Image Wisely

Radiation in Medicine: Medical Imaging Procedures

FDA White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging

Radiation Dose in X-Ray and CT Exams

Radiation Dose from Medical Imaging: A Primer for Emergency Physicians

Radiation risk from medical imaging

FDA: Medical X-ray Imaging

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ITN Editor Dave Fornell and ITN Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging. 

VIDEO: Editors Choice of the Most Innovative New Radiology Technology at RSNA 2019

Photo Gallery of New Imaging Technologies at RSNA 2019

Find RSNA news and other videos

David Sjostrom, Ph.D., deputy chief physicist, Herlev Hospital, Department of Oncology, Division of Radiotherapy, Herlev, Denmark, shares the first clinical experience treating cancer patients with the Varian Ethos radiation therapy system. He spoke to ITN at ASTRO 2019, where he presented information on the first 5 patients in the world being treated with this new technology. It uses artificial intelligence to take the onboard cone beam CT scans to automatically create an adaptive plan for any changes in patient weight loss, bladder volume, or change in tumor size. The plan can be available in minutes while the patient is on the table. It enables sparing of more healthy tissue and makes adaptive therapy much easier to use. 

Kristin Higgins, M.D., medical director of radiation oncology, Emory Clinic at the Winship Cancer Institute, explains considerations when treating previous radiation oncology patients again at the same or other tumor sites. She spoke on this topic at the American Society for Radiation Oncology (ASTRO) 2019 annual meeting in Chicago.

More coverage of ASTRO 2019

Candice Johnstone, M.D., MPH, Medical College of Wisconsin explains the need for palliative radiotherapy and patient selection considerations at the American Society for Radiation Oncology (ASTRO) 2019 annual meeting. 

Despite improvements in the survival of some populations of cancer patients, some patients are not candidates for ablative therapy and need symptom relief. Cases will be used to highlight evidenced based approaches to palliative radiation therapy. A significant proportion of patients do not benefit from immunotherapy and need standard palliative radiation. The best palliative radiation utilizes the fewest number of fractions to achieve the desired effect, minimizes side effects of treatment and treatment related costs.

More coverage of ASTRO 2019