Interview with Geoffrey Rose, M.D., president of Sanger Heart and Vascular Institute with Atrium Health, in Charlotte, North Carolina, and a board member with the American Society of Echocardiography (ASE). He explains the impact if COVID-19 (SARS-CoV-2) on the cardiovascular service line and cardiac imaging. He said the virus has led to use of computed tomography (CT) not only as the frontline cardiovascular imaging modality to evaluate chest pain, but also for COVID-19 pneumonia imaging.

Rose said cardiac ultrasound is still used, but requires full personal protective equipment (PPE) and often abbreviated exams because of the close proximity of the sonographer and patient when performing echocardiograms. This has given rise to using dedicated point-of-care ultrasound (POCUS) systems to answer specific clinical questions quickly. Smart-phone based POCUS systems that use an app and a transducer plugged into the phone enable basic echo exams or evaluation of other parts of the anatomy quickly without the need to immediately sterilize an entire cart-based ultrasound system. These small systems also can be completely enclosed inside a transducer sheath and the phone and single transducer are much easier and faster to wipe down. He said the quality of the exams are not as good as fully enabled echocardiography systems, but it allows for quick assessments of ejection fractions and to triage if the patient needs more advanced imaging if the basic questions cannot be answered.

Since hospitals have shut down now for about two months, postponing normal checkups, and elective exams and procedures, Rose said doctors still need to visit with patients who have chronic conditions. Sanger and Atrium Heath modified its ambulatory electronic medical record (EMR) and is using video conferencing to perform virtual appointments now for the majority of these patients. He said telemedicine was not widely used before COVID-19 in his hospital system, but the pandemic will likely alter the care model for the future, with more telemedicine visits being used even after epidemic is over. He said use of POCUS and CT as frontline cardiac imaging modalities will also likely remain in place after the pandemic because of the efficiencies in care these technologies offer.

Related Coronavirus Content:

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

Cardiac Imaging Best Practices During the COVID-19 Pandemic

RSNA Publishes COVID-19 Best Practices for Radiology Departments

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

New CT Scoring Criteria for Timely Diagnosis, Treatment of Coronavirus Disease

FDA Issues New Policy for Imaging Systems During COVID-19

VIDEO: COVID-19 Precautions for Cardiac Imaging —  Interview with Stephen Bloom, M.D.

A Review of Studies Cautions Against Chest CT for Coronavirus Diagnosis

New Research Finds Chest X-ray Not Reliable Diagnostic Tool for COVID-19

VIDEO: Radiology Industry Responding to COVID-19

University of Washington Issues Radiology Policies for COVID-19

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic — Interview with Hicham Skali, M.D.

New Research Highlights Blood Clot Dangers of COVID-19

Survey Reveals Most Medical Practices are Now Using Telehealth Due to COVID-19

CMS Offers Recommendations on Reopening Healthcare in Areas of Low COVID-19 Cases

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Radiologists Describe Coronavirus CT Imaging Features

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

Jeffrey Bundy, Ph.D., chief executive officer, United Imaging in the United States, explains the company's efforts to respond to the novel coronavirus (COVID-19) pandemic in the U.S., Europe and China. The company is putting its first semi-trailer based computed tomography (CT) system into service at a hospital in New York City.

United Imaging began working on new solutions for the U.S. after getting requests from its customers and seeing the needs in China and Europe. The company is collaborating with different vendors, including Sea Box and AMST to build both semi-truck trailer CT scanning rooms and those built into customized shipping containers. Other vendors are helping with infection control, ventilation, and easier cleaning/disinfection to help protect healthcare workers and patients.

The first transportable CT scanner was installed at the request of Maimonides Medical Center, the largest hospital in Brooklyn, New York, on the front lines of the current crisis. As the hospital scales its operations to meet the needs of an expected influx of coronavirus patients, doubling its capacity to 1,400 beds, United Imaging’s scanner will help expand its capacity for imaging studies to support diagnosis and treatment.

United Imaging Confirms Rapid Deployment of Transportable CT Scanners

United Imaging Sends Out More than 100 CT Scanners and X-ray Machines to Aid Diagnosis of the Coronavirus

Regina Druz, M.D., FASNC, a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, chairwomen of the American College of Cardiology (ACC) Healthcare Innovation Section, and a cardiologist at Integrative Cardiology Center of Long Island, N.Y., explains the rapid expansion of telemedicine with the U.S. spread of novel coronavirus (COVID-19, SARS-CoV-2).

Druz spoke on the unprecedented expansion of telemedicine in the U.S. under COVID-19, seeing more use in the last two months, as opposed to the past two decades. The Centers for Medicare and Medicaid Services (CMS) previously only reimbursed for Telehealth in rural areas it determined had a shortage of doctors. However, in early March 2020, CMS dropped the geographic requirements and allowed Telehealth usage across th country as a way to mitigate person-to-person contact and keep vulnerable, older patients at home for routine check ups with doctors.

Druz has subspecialty certifications in nuclear cardiology, adult echocardiography and cardiac computed tomography (CT) and explains how Telehealth can be used to pre-screen patients and get patient sign off on procedures prior to coming in for an exam, helping speed the process in the hospital and limit personal contact.

Concerns about the rpaid spread of COVID-19 also has driven many radiology departments to convert to wider use of teleradiology to allow more radiologists to work from home and reduce person-to-person contact within the hospitals. 

Watch the related VIDEO: Use of Teleradiology During the COVID-19 Pandemic — an interview with John Kim, M.D., chairman, Department of Radiology, THR Presbyterian Plano, Texas, and chief technology officer at Texas Radiology Associates.

Related COVID-19 Content:

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

VIDEO: How China Leveraged Health IT to Combat COVID-19 — Interview with Jilan Liu, M.D., CEO for the HIMSS Greater China

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

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

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."

At RSNA19, Philips discussed with ITN Contributing Editor Greg Freiherr how its IntelliSpace Enterprise Edition fits into the Philips portfolio, and how the corporate acquisition of Carestream Health IT might affect the company. The video also discusses how Philips will help prospective customers acquire its products.

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 demo of the EOS orthopedic X-ray imaging system at the recent 2019 Radiological Society of North America (RSNA) meeting. The system allows for weight bearing exams. EOS Imaging System the first technology capable of providing full-body, 2-D and 3-D images of pediatric patients in a standing position at a low dose of radiation. The vendor said the scans are much lower dose than computed tomography (CT).

EOS captures bi-planar images with two perpendicular X-ray beams that travel vertically while scanning the patient from head to toe. In less than 20 seconds, the EOS exam produces simultaneous frontal and lateral, low dose images. The two resulting digital images are processed by EOS' proprietary sterEOS software to generate a 3-D model of the patient's spine and/or lower limbs. These detailed images with only 20 seconds of radiation were previously unachievable before EOS technology.

Read more about the system and a recent install

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

Photo Gallery of New Imaging Technologies at RSNA 2019

Find more news and video from RSNA 2019

Gillian Newstead, M.D., director of global breast imaging and former professor at the University of Chicago, explains a large breast MRI screening study presented at the 2019 Radiological Society of North America (RSNA) meeting. 

The DENSE Trial Study Group included 40,000 women from the Netherlands who underwent standard mammography. Of these, 8,061 women were identified as having dense breasts and were offered supplemental MRI screening, and about half took advantage of the additional screening. Dense breast tissue which can obscure cancer on conventional mammograms but not on MRI. The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1,000 screenings.

The use of supplemental magnetic resonance imaging (MRI) screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a two-year screening period. The results were published in the Nov.  28, 2019, issue of The New England Journal of Medicine and presented earlier at the European Congress of Radiology (ECR) 2019.

Related Breast MRI and Dense Breast Content:

Breast Density Explained

Animation to Bring Clarity to Dense Breasts

Improving Clinical Image Quality for Breast Imaging

Breast Imaging in the Age of Coronavirus

Abbreviated MRI Outperforms 3-D Mammograms at Finding Cancer in Dense Breasts

VIDEO: Explaining Dense Breasts — Interview with Christiane Kuhl, M.D.

Technologies to Watch in Breast Imaging

Screening MRI Detects BI-RADS 3 Breast Cancer in High-risk Patients
 

Reference:

Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 2019; 381:2091-2102. DOI: 10.1056/NEJMoa1903986.

James Carr, M.D., chair of the Department of Radiology, Northwestern University, and incoming 2020 President of the Society of Cardiac Magnetic Resonance (SCMR), explains why MRI is an ideal cardiac imaging modality, at the 2019 Radiological Society of North America (RSNA) meeting.

Heart MRI offers advantages over computed tomography (CT) and echocardiography because of its excellent soft tissue delineation and its ability to offer information beyond anatomical imaging, such as perfusion, morphology and metabolism. MRI can be technically challenging and the exams requiring a long time, but recent advances have helped cur cardiac imaging times down significantly. Automation and artificial intelligence (AI) also is making post-processing and quantification mush faster, brining it closer to the time it takes to scan and post-process CT imaging.
 
Northwestern is was one of the early adopters of cardiovascular MRI. Carr said heart MRI was not common in regular clinical use until the past decade at some luminary centers. In 2005, Carr was given the opportunity to develop a clinical cardiac MRI program at Northwestern.
 
He said MRI scanners have improved, and now much faster than a decade ago. They are also more optimized for cardiac imaging. While heart MRI is well known in large hospital centers, Carr said it still needs to develop and expand to community hospitals and rural hospitals outside major population centers. 

Artificial intelligence is playing a significant role in cardiac MRI automation of speeding workflow and quantification. Carr said these technologies will become mainstream in the next few years. AI also will play an increasing role in risk prediction based on new image analysis algorithms in development.

For more information on cardiac MRI, visit SCMR's website www.heartmri.org.

This is an example of an augmented reality (AR) training system for transesophageal echo (TEE) created by the simulation company CAE. Rather than just looking at an overhead screen, this system allows the user to use a HoloLens visor to see the impact their probe manipulation has on the cardiac ultrasound imaging and better shows the orientation of the ultrasound probe, the 2-D ultrasound image slice and the relation to the anatomy. It was displayed at the 2019 Radiological Society Of North America (RSNA) meeting.

Read more about this technology.

Find more technology news and video from the RSNA meeting

Join Chris Toth, president of Varian’s Oncology Systems business, for a peek at the history of machine learning/AI in radiation oncology, plus other highlights in 2019:

• Ethos therapy: the world’s first AI-powered adaptive radiotherapy.
• Noona cloud-based application for capturing patient-reported outcomes.
• Varian’s multi-room configuration for ProBeam 360 proton therapy.
• The promise of FLASH, an ultra-high-speed treatment that is in pre-clinical testing, and represents an exciting and potentially promising new direction in the treatment of cancer. 

Modus QA is proud to offer a superior phantom for quantifying geometric distortion in modern MRgRT applications. Watch this video to discover how the entire QA process including set-up and data analysis can be completed in under 10 minutes.

Lorraine Drapek, DNP, nurse practitioner, radiation oncology, GI service, Massachusetts General Hospital, explains the roles of advanced practice providers in radiation therapy. She spoke on this topic at ASTRO 2019 at a session that reviewed the integration of APPs into radiation oncology practice to enhance clinical care. This includes but is not limited to: on-treatment management, symptom and acute toxicity management during treatment, inpatient consultations, procedural assistance, treatment planning, follow-up, survivorship and research.