Todd Villines, M.D., FACC, FAHA, MSCCT, explains how coronary plaque assessment will become a new risk assessment tool in cardiac CT. This was a key take away during 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. 

While basic plaque assessments have been available for several years on CT vendor and third-party advanced visualization software, it lacked automation standardization for what various values meant and clinical evidence it was relevant. However, several speakers in SCCT sessions said that is now changing, with more specific analysis being tested clinically and automation using artificial intelligence. 

Several key opinion leaders in cardiac CT said this new information and automation lwill likely lead to a revision of the current CAD-RADS scoring system used by radiologists and cardiologists when assessing the coronary event risk of patients. They are calling for the new CAD-RADS 2.0 to include a detailed plaque assessment.  

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

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

Impact of Cardiac CT During COVID-19

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Pooja Rao, Ph.D., co-founder of Qure.AI and head of research and development for the company, explains how the company's artificial intelligence (AI)-based auto detection software can be used to analyze radiology images. The vendor offers a U.S. Food and Drug Administration (FDA)-cleared emergency room computed tomography (CT) scan automated AI analysis tool to immediately identify areas of suspected intracranial bleeds and cranial fractures. The software offers immediate feedback for suspected areas of interest for the attending physician or stat read radiologist. This can enable faster diagnosis and treatment in neuro imaging cases, especially in meeting door to TPA time in patients with ischemic stroke.

Qure.AI also developed AI-based lung analysis software to detect a variety of abnormalities, which is working its way through FDA review. It is being used in some developing countries for mobile lung screening programs in remote areas. The vendor developed a self-contained unit for the AI to work without a PACS system or internet connection so there is immediate feedback on the image if someone may be positive. This greatly reduces the complexities of patient call backs in low-income areas that might be without out phones or web connectivity for followup. Rao explains how the technology is being implemented in this use case. AI might have its greatest impact on developing countries that do not have adequate healthcare resources of doctors.

qER detects and prioritizes scans containing Intracranial bleeds, cranial fractures, mass effect and midline shift. Image markings, bleed subtypes and labels are not available in the United States.

Related Radiology AI Related Content:

Qure.ai Receives Industry's First 4-in-1 FDA Clearance for Medical Imaging AI

Technology Report: Artificial Intelligence at RSNA 2019

The Radiology AI Evolution at RSNA 2019

Artificial Intelligence Pinpoints Nine Different Abnormalities in Head Scans

Nanox Partners With Qure.ai to Integrate AI-based Algorithms for Medical Imaging

Qure.ai Launches Solutions to Help Tackle COVID19
 

At this year’s RSNA ITN sat down with Dennis Durmis, Senior Vice President, Bayer Radiology to discuss Radiology trends. Discussion topics centered around three key areas where Bayer Radiology is responding to trends; including digitalization, workflow efficiencies and efforts to bring more focus to the Radiology patient experience. During the interview Dennis discussed Bayer’s digital strategy, features and benefits of their new injector, the MEDRAD® Stellant FLEX Injector and Bayer’s education efforts of the imaging needs of women with Dense Breast.

Stephen Bloom, M.D., FASNC, director of noninvasive cardiology (cardiac CT, nuclear cardiology and echocardiography) at Midwest Heart and Vascular Associates, Overland Park, Kansas. He is also a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, explains some of the issues involved and protocols used for cardiac imaging during the COVID-19 pandemic. His discussion includes computed tomography, cardiac ultrasound and nuclear imaging.

Right now, Bloom said it is difficult to test everybody and there is a shortage of masks, gowns and other personal protective equipment (PPE), and the imaging equipment needs to be sanitized each time it is used. He said it is just is not possible to image all the patients who need imaging right now. Hospitals also are trying to limit the number of healthy people people coming into hospitals for routine visits and tests to reduce their potential exposure to the novel coronavirus (COVID-19, SARS-CoV-2) and help containment efforts. 

"The tests should be done, very simply, if it changes the care of the patient. If it doesn't change the care of the patient, and it can be postponed, it should be postponed," Bloom explained. "I would say 80 percent of our cardiac imaging exams have stopped. It has been very dramatic."

Related Imaging Precautions During COVID-19 Content:

Cardiac Imaging Best Practices During the COVID-19 Pandemic

Best Practices for Nuclear Cardiology Laboratories During the Coronavirus (COVID-19) Pandemic

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

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

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D. 

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.  

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

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

Study Looks at CT Findings of COVID-19 Through Recovery

Experts Stress Radiology Preparedness for COVID-19

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

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

Hicham Skali, M.D., a staff cardiologist and member of the Non-invasive Cardiovascular Imaging Program at Brigham and Women’s Hospital (BWH), and at Brigham and Women’s / Massachusetts General Health Care Center at Foxborough, explains the new recommendations from the American Society of Nuclear Cardiology (ASNC) and from imagers in China and Singapore. The ASNC created a best practices document for nuclear cardiology laboratories during the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. The suggestions in the guidelines can ally to any imaging modality, including computed tomography (CT), MRI and ultrasound. 

Skali elaborates on the following points in his discussion, which are specific recommendations in the ASNC and SNMMI COVID-19 guidance document:
   • Rescheduling non-urgent visits
   • Rescheduling elective surgeries and procedures
   • Using separate spaces for patients with known or suspected COVID-19 to prevent spread
   • Ensuring supplies are available
   • Promoting use of telehealth
   • Screen staff, patients and visitors before they enter the department
   • Minimize non-essential visitors into the department
   • Record symptoms at the start of the shift
   • Use personal protective equipment (PPE)for healthcare personnel
   • If available, use PPE for patients due to concern of asymptomatic transmission of COVID-19
   • Maintain strict hand hygiene
   • Maintain 6 feet distance in all patient/staff interactions when possible
   • Work remotely whenever feasible, especially with ready studies
   • Rotating staff schedules for on-site and off-site work
   • Use of rest only studies if possible
   • Use of half-time SPECT to speed exam times
   • Use of PET if available to speed exam times

Skali served as the moderator in for the ASNC on demand webinar COVID-19 Preparedness for Nuclear Cardiology Labs: Insights from the US, China and Singapore.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D., an ASNC Board member and also a speaker during the ASNC webinar.

Find more news and video on relating to COVID-19 and its impact on radiology

John Kim, M.D., chairman, Department of Radiology, THR Presbyterian Plano, Texas, and chief technology officer at Texas Radiology Associates, explains the use of teleradiology during the novel coronavirus (COVID-19) outbreak in the U.S. The radiology group is part of Collaborative Imaging, a radiologist owned teleradiology alliance that enables radiologists to read studies using secure web links and an app.

The rapid spread of coronavirus has increased the value telemedicine solutions to help prevent person-to-person contact and take some clinicians out of the hospitals to work at home or office locations. This includes the use of teleradiology tools to read images and communicate with referring physicians.

Telemedicine allows for the continuity of care within healthcare facilities and patients and allows for safe distance without sacrificing the quality of care. It also saves patients from spreading germs to others, like while on public transportation or in the doctor’s waiting room, and to the healthcare providers who tend to them. Televisits also only last an average of 10 minutes, allowing physicians to assess patients more quickly and easily. 

Interview with Mike Stone, M.D., an emergency physician at Northwest Acute Care Specialists in Portland, Ore., director of point of care ultrasound education at Butterfly Network Inc., and and former chief of the division of emergency ultrasound at Brigham and Women's Hospital, Boston. He explains what clinicians look for in lung ultrasound to evaluate patients for plural wall thickening and areas of congestion inside the lung typical of pneumonia and seen in patients with novel coronavirus (COVID-19, also referred to clinically as SARS-COV-2). 

Small hand-held ultrasound systems may offer advantages over X-ray or computed tomography (CT), because the entire system can be contained inside a protective sheath, making it easier to disinfect the device rather than an entire imaging room. Point of care ultrasound (POCUS) systems also allow triage of patients in tents or other areas outside of the hospital where other imaging modalities are not available. 

Stone shares examples of COVID-19 ultrasound images from Butterfly Network POCUS system technology, which turns an iPhone into an FDA-cleared ultrasound device for multiple POCUS exam types. It is the first POCUS system reported to be used for triage and monitoring COVID-19 patients. 
 

Related Coronavirus Content:

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

Wuhan CT Scans Reliable for Coronavirus Diagnosis, Limited for Differentiation

The Cardiac Implications of Novel Coronavirus

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

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

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

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

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

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

Find more related clinical content Coronavirus (COVID-19)

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments

In Artificial Intelligence at RSNA 2019, ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence (AI) advances at the Radiological Society of North America (RSNA) 2019 annual meeting.

Bill Lacy, vice president, Medical Informatics at FUJIFILM Medical Systems U.S.A., Inc. discusses Synapse 7x, a convergence of the company’s server-side technology designed to cover all the different areas of diagnostic visualization, as well as overall enterprise viewing, with ITN Consulting Editor Greg Freiherr. For more information on Fujifilm's Enterprise Imaging solutions, visit ei.fujimed.com. 

At RSNA19, GE Healthcare introduced its Edison Open AI Orchestrator. The software has been designed to operate smart algorithms that might save radiologists time. ITN Contributing Editor Greg Freiherr discusses its benefits with Karley Yoder, vice president and general manager of artificial intelligence for GE.

Related GE Edison Platform Content:

GE Healthcare Unveils New Applications and Smart Devices Built on Edison Platform

VIDEO: itnTV Conversations — What is Edison?

Imaging Technology News Contributing Editor Greg Freiherr interviewed Henry Izawa, vice president of modality solutions, Fujifilm Medical Systems U.S.A., Inc. about Fujifilm's latest innovations in mammography.

In this video, Izawa announces the latest imaging advancements available for the Aspire Cristalle digital mammography system with digital breast tomosynthesis, including S-View, a synthesized 2-D image reconstructed from DBT and other patient enhancements such as the comfort paddle to provide a noticeably more comfortable exam for the patient.

Watch the video to hear all about Fujifilm's updates.

To learn more, visit www.fujimed.com

The Arietta 850SE provides facilities with numerous features and functionality to get the most out of a system. The CMUT probe performs the role of multiple probes while the single-crystal C252 probe gets increased penetration. eFocusing simplifies scanning techniques and shearwave elastography provides unique feedback on tissue stiffness.

At RSNA19, David Widmann, president and CEO of Konica Minolta Healthcare Americas, discussed innovation, stressing the importance of academic relationships. 

Ajay Choudhri, M.D., chairman of radiology, Capital Health, Hopewell, N.J., explains his center's experience using an artificial intelligence (AI) application to help auto detect intracranial hemorrhage. There are several AI stroke auto detection apps now available with FDA clearance or in development that were shown at the Radiological Society Of North America (RSNA) 2019 meeting. These are being adopted by hospitals and multi-center radiology practices the U.S. to flag suspected cases of ischemic stroke or brain bleeds for immediate reads. 

The software also offers a second set of eyes for more difficult to detect cases. Quickly determining is a stroke is ischemic or hemorrhagic is critical to the path of treatment. If caught early enough, TPA can be injected into patients to clear clots causing an ischemic stroke, but can cause massive brain damage or death if injected into a patient with a brain bleed. At advanced neuro-interventional centers, quickly determining the type of stroke is needed to know if they need to revascularize a patient or manage a hemorrhage. 

Related Content:

How Artificial Intelligence Can Predict and Detect Stroke

MaxQ AI's Intracranial Hemorrhage Software to be Integrated on Philips CT Systems

Find more news and video from RSNA

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

Find more news and video from RSNA

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

Find RSNA news and other videos

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