Bayer Calantic and Blackford Analysis have teamed up with new artificial intelligence (AI) innovations to address the radiology challenges of today and tomorrow.

Imaging Technology News recently spoke with Thanos Karras, Head of Bayer Digital Solutions Business Americas, and Ben Panter, Founder and CEO of Blackford Analysis, to learn more about this new relationship and their strategy to drive radiology advancements with artificial intelligence.

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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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American College of Radiology (ACR) Launches Contrast-Enhanced Mammography Imaging Screening Trial (CMIST) in Collaboration With GE Healthcare and the Breast Cancer Research Foundation

Bracco Diagnostics and Guerbet recently announced they had formed a strategic, global collaboration for the research, development, and manufacture of a new contrast agent.

Imaging Technology News talked to Jeff Fleming, president and CEO, at RSNA 2022 to learn more about this relationship and find out what Bracco is doing for the future of radiology.

For more information: www.vueway.com

Find more RSNA22 coverage here

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A discussion on macro trends and the future of medical imaging with Jef Williams, managing partner, Paragon Consulting Partners LLC, and Imaging Technology News (ITN) editorial advisory board member. 

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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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What We Know About Cardiac Long-COVID Two Years Into the Pandemic   

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic — Interview with Aaron Baggish, M.D.  

VIDEO: Long-COVID Presentations in Cardiology at Beaumont Hospital — Interview with Justin Trivax, M.D.  

VIDEO: Cardiac Presentations in COVID Long-haulers at Cedars-Sinai Hospital — Interview with Siddharth Singh, M.D.  

Find more COVID news and videos  

PHOTO GALLERY: How COVID-19 Appears on Medical Imaging  

VIDEO: How to Image COVID-19 and Radiological Presentations of the Virus — Interview with Margarita Revzin, M.D.  

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Find more radiology related COVID news and videos  

Arun Nagdev, M.D., director of emergency ultrasound at the Alameda Health System, clinical associate professor, University of California San Francisco (UCSF) School of Medicine, and incoming president for the American College of Emergency Physicians (ACEP) ultrasound section, explains the rise in point-of-care ultrasound (POCUS) since the start of the COVID-19 pandemic. Nagdev has used cart-based and several hand-held systems to the emergency department to triage patients, help sort out COVID and non-COVID patients and identify patients that need more detailed radiology imaging or with issues that need immediate attention, such as pulmonary embolism, heart attacks and aortic aneurisms. 

Nagdev also serves as senior director of clinical education for start-up POCUS company Exo, which is developing a new chip-based, handheld ultrasound system with a high definition transducer.

Watch the related VIDEO: How to Image COVID-19 and Radiological Presentations of the Virus — Interview with Margarita Revzin, M.D.

More COVID-19 content can be found here

At RSNA 2021, Konica Minolta introduced the mKDR Xpress Mobile X-ray system and the Aero DR Carbon flat panel detector. Also on display was nVoq’s cloud-based speech recognition and automation solution and new features for the Exa platform that automate common clinical and administrative tasks.

You can find more RSNA21 content here

At RSNA 2021, Fujifilm launched its new Velocity MRI system. It is designed to streamline workflow and enhance the patient experience with its open gantry, integrated RF coils and reconstruction techniques. Shawn Etheridge, Director, CT and MRI Marketing for Fujifilm, unveiled the system on the RSNA21 show floor.

Fujifilm Launches the Velocity MRI System at RSNA 2021

Additional RSNA21 content

Agfa recently announced the launch of the new Valory digital radiography room, which was designed for health care facilities requiring a highly productive radiography solution. 

ITN stopped by the Agfa booth at RSNA 2021 to learn more about this new system from Georges Espada, Head of Digital Radiography, and Karol Wesolowski, Global Category Leader.

Charlie Hamm, M.D., a radiology resident at the Charité University Hospital of Berlin, Germany, presented a late-breaking study at the Radiological Society of North America (RSNA) 2021 annual meeting on the use of computed tomography (CT) scans to investigate dinosaur bones non-destructively. In the process of examining a tyrannosaurus rex jaw bone that is more than 66 million years old, a bone tumor was found and clearly shown on the CT scans.

This feasibility study to determine if CT can be used to aid paleontology was done in collaboration with the Museum für Naturkunde Berlin. Dual-energy computed tomography (DECT) was used to provide information about tissue composition and disease processes not possible with single-energy CT.

Read more in the article CT Uncovers Bone Disease in Tyrannosaurus Rex Jaw

Find more RSNA news and video

Cynthia McCollough, Ph.D., director of Mayo Clinic's CT Clinical Innovation Center,  explains how photon-counting computed tomography (CT) detectors work and why it is a better technology over conventional CT systems. She helped Siemens develop the Naeotom Alpha, the first photo-counting CT system to be approved by the FDA in the fall of 2021. She spoke to ITN at the Radiological Society of North America (RSNA) 2021 annual meeting.

Read more about the first commercial photon-counting scanner 

The device uses the emerging CT technology of photon-counting detectors, which can measure each individual X-ray photon that passes through a patient's body, as opposed to current systems which use detectors that measure the total energy contained in many X-rays at once. By "counting" each individual X-ray photon, more detailed information about the patient can be obtained and used to create images with less information that is not useful, such as image noise. 

Current CT technology uses a two-step conversion process to convert X-ray photons into visible light using a scintillator layer in the detector. Then, photo diode light sensors turn the visible light into a digital signal. Due to this intermediate step, important information about the energy of the X-rays is lost and no longer available to aid in diagnosis. Also, contrast is reduced and images are not as clear.

Photon-counting detectors use a single step of direct conversion of X-rays into electrical current, and skips the step of converting X-rays into visible light. This allows the energy thresholds of each pulse to be collected and binned based on different kilovolt (kV) energy levels. This creates data to improve contrast and enable dual-energy, spectral imaging. The direct conversion also helps improve image quality without information loss. This improves image sharpness and contrast.

Photon-counting detectors have already been used for several years in high-energy physics and nuclear imaging. However, these previously generation photon-counting detectors could not be used with a clinical CT scanner because they could not keep up with the high higher rate of photons reaching the detector. The detector on the Naeotom Alpha was designed for this increased speed.

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Mayo Clinic Begins Use of Third-Generation Photon-counting CT Clinical Research Detector

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With the recent launch of the Magnifico Open, Italian company Esaote has entered the open MRI whole body space. ITN had a conversation with Franco Fontana, CEO of Esaote, at RSNA21.

Magnifico Open, which adds to the range of Esaote products unveiled in 2021, is an open magnetic resonance system with the latest technology. The wide choice of receiver coils and state-of-the-art MRI technology offer the user excellent image quality, while the permanent magnet makes it easy to use and lowers operating costs. The open magnet and the easy-to-access patient table also facilitate, speed up and make patient positioning more comfortable, ideal for both the claustrophobic and for children.

View more RSNA21 content here

Esaote North America Receives FDA Approval of the Magnifico Open MRI System

Steve Holloway, company director at Signify Research, explains the trends he has seen over the past couple years in enterprise imaging. He spoke to ITN at the 2021 Radiological Society of North America meeting.

Holloway shared how medical imaging systems are expanding to include all departments in healthcare system enterprises that generate data, images and waveforms, so these items can be stored in a central location, rather than disparate silos or in separate systems requiring multiple logins or specific workstations. Most of these systems are are web enabled or web based, allowing users to work from anywhere as long as they have an internet connection. Most enterprise imaging systems also use a web-based vendor neutral archive, allowing DICOM and non-DICOM images to be stored there. All of these features allow easier and faster access to patient information and images.

He said these systems are becoming more inclusive of ologies outside of radiology and cardiology. Most notably is digital pathology, which was featured by many enterprise imaging vendors at RSNA 2021. 

Enterprise imaging systems are also accepting point-of-care ultrasound (POCUS), which has exploded in use over the past two years with COVID, Holloway said.

Find more RSNA news and video

VIDEO: Trends in Radiology IT seen at RSNA 2021 — Interview with Jef Williams, Paragon Consultants

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

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VIDEO: The New Normal of Home Workstations, Teleradiology and Remote Reading — Interview with Elizabeth Hawk, M.D.

Technology Report: Artificial Intelligence in Radiology 2021

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Stamatia Destounis, M.D., FACR, chief of the American College of Radiology (ACR) Breast Commission, managing partner, Elizabeth Wende Breast Care, Rochester, N.Y., explains some of the key trends in breast imaging at the 2021  Radiological Society of North America (RSNA) meeting.

She discusses the trends of 3D mammography seeing rapid growth, adoption of synthetic 2D breast images from the tomosynthesis datasets, contrast-enhanced mammography, and breast MRI to help women with dense breast tissue. Destounis also discusses the use of artificial intelligence (AI) to help radiologists with finding what they needs with larger datasets in 3D mammography, and to help act as a second set of eyes.

Early in 2021, with the roll out of the COVID vaccines, one of the biggest headlines in radiology was that the vaccine can show false positives for cancer because it may cause inflammation of lymph nodes. Destounis explains this issue and how women's health centers have largely overcome this by asking patients about their vaccination status and planning imaging around the vaccination dates.

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VIDEO: COVID Vaccine May Cause Enlarged Lymph Nodes on Mammograms — Interview with Constance "Connie" Lehman, M.D.

COVID-19 Vaccination Axillary Adenopathy Detected During Breast Imaging

VIDEO: COVID Vaccine Adenopathy Can Last Up to 10 Weeks — Interview with Yael Eshet, M.D.

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Find more RSNA news and video

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. 

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Siemens and Philips demonstrated examples of new imaging software to convert MRI datasets into synthetic computed tomography (CT) datasets at the American Society of Radiation Oncology (ASTRO) 2021 meeting. The synthetic CT datasets can be used for radiotherapy treatment planning. This eliminates the need for a separate CT scan, reducing time and cost in patient care. 

The technology uses an algorithm to convert the MRI dataset into a CT grayscale Hounsfield units. The Hounsfield units correlate with the densities of the various tissues and are used to calculate the doses required and beam routes needed in radiotherapy to treat a patient.

Photo Gallery of Technologies at ASTRO 2021

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Find more radiation oncology technology news

Several radiology IT vendors at 2021 Healthcare Information Management Systems Society (HIMSS) conference demonstrated computed tomography (CT) imaging advanced visualization software software to help automatically identify and quantify COVID-19 pneumonia in the lungs. These tools can help speed assessment of the lung involvement and serial tracking can be used to assess the patient's progress in the hospital and during long-COVID observation. 

Examples of COVID analysis tool shown in this video include clips from booth tours at: 
   • Fujifilm
   • Siemens Healthineers 
   • Canon (Vital)

Canon received FDA clearance for its tool under and emergency use authorization (EUA).

Siemens said its tool was part of its lung analysis originally developed for cancer but modified and prioritized to aid in COVID assessments. 
 

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Yael Eshet, M.D., MSc, a diagnostic radiology specialist at Sheba Medical Center in Israel, was the lead author on a recent study that showed COVID-19 (SARS-CoV-2) vaccine adenopathy can persist more than 6 weeks. This swelling of lymph nodes is similar to what is seen cancer and infections and the new findings show it can last longer than 7-10 weeks. The current recommended time people should delay medical imaging is 6 weeks after receiving a COVID vaccine to avoid a misdiagnosis,[2] but this new study shows there is increased inflammation shown on PET-CT imaging for much longer.

These were the findings in the Radiology published study "Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination."[1]

Researchers using fluorodeoxyglucose (FDG)-positron emission tomography (PET) have found increased FDG uptake in the lymph nodes of patients 7-10 weeks past their second mRNA-based Pfizer-BioNTech COVID-19 vaccination. This new information indicates a persistent immune response that could be mistaken on imaging exams for serious conditions like lymphoma over a much longer period of time.

Recent recommendations for post-vaccine lymphadenopathy advise scheduling routine imaging, such as screening mammography, before, or at least 6 weeks after, the final vaccination dose to eliminate false positive results. However, this new research showed that avid axillary lymph node uptake was present beyond 6 weeks after the second vaccination in more than 29% of the patients in the study cohort.

The authors stated “This study shows that avid axillary lymph node uptake on FDG PET/CT can be detected in more than a quarter of our patient population even beyond 6 weeks after the second dose of the mRNA-based COVID-19 vaccination. Compared to a previous study showing normalization of FDG uptake within 40 days of receiving an inactivated H1N1 influenza vaccine, we found uptake persistence even at 70 days. Physicians should be aware of this potential pitfall.”

Some images in this video are from another Radiology study, which showed PET tracer uptake at the COVID vaccine injection site and other examples of axillary adenopathy.[3]

Related COVID Vaccine Axillary Adenapathy Content:

COVID-19 Vaccine Can Cause False Positive Cancer Diagnosis

Help Spread Awareness of Potential COVID-19 Vaccine Imaging Side-effects

VIDEO: COVID Vaccine May Cause Enlarged Lymph Nodes on Mammograms — Interview with Constance "Connie" Lehman, M.D.

COVID-19 Vaccination Axillary Adenopathy Detected During Breast Imaging

PHOTO GALLERY: How COVID-19 Appears on Medical Imaging

CMS Now Requires COVID-19 Vaccinations for Healthcare Workers by January 4

Find more radiology related COVID content 

References:

1. Yael Eshet, Noam Tau1, Yousef Alhoubani, Nayroz Kanana, Liran Domachevsky, Michal Eifer. Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination. Radiology. Published Online:Apr 27 2021https://doi.org/10.1148/radiol.2021210886.

2. Constance D. Lehman, Leslie R. Lamb, and Helen Anne D'Alessandro. Mitigating the Impact of Coronavirus Disease (COVID-19) Vaccinations on Patients Undergoing Breast Imaging Examinations: A Pragmatic Approach American Journal of Roentgenology. 10.2214/AJR.21.25688.

3. Can Özütemiz, Luke A. Krystosek, An L. Church, Anil Chauhan, Jutta M. Ellermann, Evidio Domingo-Musibay, Daniel Steinberger. Lymphadenopathy in COVID-19 Vaccine Recipients: Diagnostic Dilemma in Oncology Patients. Radiology. Published Online:Feb 24 2021https://doi.org/10.1148/radiol.2021210275.

Constance "Connie" Lehman, M.D., Ph.D., chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital, and professor of radiology at Harvard Medical School, explains issues and suggested guidelines for women who receive the COVID-19 vaccine and need to get a mammogram. In the first three months since the vaccines have been released, there have been numerous case reports of the vaccine causing swollen lymph nodes. This is would usually raise a red flag for breast cancer, but is normal for many women receiving the vaccine as their body's immune system gears up against the virus. 

Lehman said cases reports of axillary adenopathy have been identified on breast imaging after coronavirus disease (COVID-19) vaccination and are rising. Lehman et al. proposed a pragmatic management approach in a recent article in the American Journal of Roentgenology (AJR).[1]

In the settings of screening mammography, screening MRI and diagnostic imaging work-up of breast symptoms, with no imaging findings beyond unilateral axillary adenopathy ipsilateral to recent (prior six weeks) vaccination, they report the adenopathy as benign with no further imaging indicated if no nodes are palpable six weeks after the last vaccine dose. 

For patients with palpable axillary adenopathy in the setting of ipsilateral recent vaccination, clinical follow-up of the axilla is recommended. In all these scenarios, axillary ultrasound is recommended if clinical concern persists six weeks after vaccination. 

In patients with recent breast cancer diagnosis in the pre- or peri-treatment setting, prompt recommended imaging is encouraged as well as vaccination (in the thigh or contralateral arm). The recommendations align with the ACR BI-RADS Atlas and aim to: 1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination, and 2) avoid further delays in vaccinations and breast cancer screening during the pandemic.

Related Medical Imaging of COVID Content:

COVID-19 Vaccination Axillary Adenopathy Detected During Breast Imaging

CMS Now Requires COVID-19 Vaccinations for Healthcare Workers by January 4

PHOTO GALLERY: How COVID-19 Appears on Medical Imaging

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS) — Interview with Mike Stone, M.D.

VIDEO: Use of Teleradiology During the COVID-19 Pandemic — Interview with John Kim, M.D.

Find more radiology related COVID content 

Reference:

1. Constance D. Lehman, Leslie R. Lamb, and Helen Anne D'Alessandro. Mitigating the Impact of Coronavirus Disease (COVID-19) Vaccinations on Patients Undergoing Breast Imaging Examinations: A Pragmatic Approach American Journal of Roentgenology. 10.2214/AJR.21.25688

Margarita Revzin, M.D., MS, FSRU, FAIUM, associate professor of radiology and biomedical imaging, Yale University School of Medicine, abdominal and emergency imaging, radiologist, explains how different medical imaging modalities are used to image manifestations of the COVID-19 (SARS-CoV-2) virus in patients. She is the lead author on a two-part article in the RSNA journal Radiographics that provides a comprehensive overview of coronavirus imaging. 

The articles offer numerous case images from X-ray, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Revzin also discusses some of the radiology presentations and complications of the virus and which modalities can best image these features. Here are links to the two articles:

Manifestations of COVID-19, Part 1: Viral Pathogenesis and Pulmonary and Vascular System Complications. 

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

Although COVID-19 predominantly affects the respiratory system, other organs can also be involved. The authors of the articles said imaging plays an essential role in the diagnosis of all manifestations of the disease, as well as its related complications, and proper utilization and interpretation of imaging examinations is crucial. As the virus continues to spread, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystemic involvement, and evolution of imaging findings is essential for effective patient management and treatment. Only a few articles had been published that comprehensively describe the multisystemic imaging manifestations of COVID-19 prior to this article series, published in the fall of 2020. The authors provide an inclusive system-by-system image-based review of this life-threatening and rapidly spreading infection. In part 1 of this article, the authors discuss general aspects of the disease, with an emphasis on virology, the pathophysiology of the virus, and clinical presentation of the disease. Part 2 focuses on key imaging features of COVID-19 that involve the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as pediatric and pregnancy-related manifestations of the virus.

Most of the images in the video are from the articles. Find more COVID medical imaging in the PHOTO GALLERY: How COVID-19 Appears on Medical Imaging.

VIDEO: Example of COVID Thrombosis on Ultrasound Imaging