Diagnostic Reading #38: Five “Must Read” Articles on HIT and Radiology from the Past Week

EHRs and security threats for healthIT and rads taking a leadership role are in the news

Articles include: Mamba ransomware is attacking healthcare, crippling computers by encrypting entire hard drives; University of Texas breast radiologists are calling for the creation of a national imaging repository in the cloud; Apple designers work to expand its HealthKit to aid in diagnosis; Electronic health record data could hold the key to predicting the onset of sepsis; and most physicians are using some digital tools and expect to increase the use of assistive technologies in the near future.

 

New virus disables computers by encrypting hard drives – Health Data Management

A new strain of ransomware called Mamba is circulating through multiple industries including healthcare and crippling computers by encrypting entire hard drives. So far there really isn’t much that can be done except pay the ransom to gain a key to decrypt the hard drive, experts say. Ironically, Mamba emulates protections found in commercial data security products, but uses the protections against the victim.open lock

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Carestream OnSight 3D Extremity System Gains FDA 510(k) Clearance

Aunt Minnie Selects OnSight Product as Finalist for “Best New Radiology Device”

September has been a big month for our CARESTREAM OnSight 3D Extremity System. The product received FDA 510(k) clearance and is available for order in the United States. It was also selected as a Finalist for “Best New Radiology Device” by Aunt Minnie. The publication chose the product in part because of the niche it fills – “a small CT scanner designed for extremity studies”.Carestream OnSight Aunt Minnie finalist

This affordable, compact system offers high-quality, lower-dose 3D imaging studies (compared to traditional CT) for use by orthopaedic and sports medicine practices, hospitals, imaging centers, urgent care facilities and other healthcare providers. The system also comes with 3D software from Carestream designed to give orthopedic specialists more information on pathology than what might be possible with 2D imaging.

The extremity imaging system can help in treating a host of orthopaedic conditions that affect the biomechanical behavior of the joints such as arthritis, meniscus loss, instability and malalignment syndromes. The system also offers less radiation than traditional CT systems while delivering excellent image quality.

A key feature of the product is its ability to capture weight-bearing images. Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo recently concluded a study, noting the benefit of weight-bearing images for orthopaedic patellofemoral diagnosis.

Orthopaedic imaging is a major focus for Carestream because of the prevalence of musculoskeletal conditions among people of all ages. Youth and adults often suffer sports-related injuries to their knees, ankles and feet while older adults experience arthritis, joint instability, meniscus loss and other conditions.

Carestream’s new extremity imaging system enables healthcare providers to capture high-quality 3D images and conduct a patient consultation in a single visit—which helps improve productivity and convenience for both specialists and patients. An additional benefit is the ability for patients to view a 3D image that illustrates their condition or injury to help them understand the reason for a treatment or surgical procedure.

The OnSight 3D Extremity System will be demonstrated at the American Society for Surgery of the Hand (ASSH) conference that begins on Sept. 29.

#NHITweek

Editor note: In Europe, the device cannot be marketed or sold until compliant with 93/42/EEC.

 

Helen Titus

Helen Titus is the worldwide X-ray & Ultrasound Solutions Marketing Director at Carestream

Diagnostic Reading #37: Five “Must Read” Articles on HIT & Radiology from the Past Week

Headlines include weight-bearing imaging for knee injuries; and telemedicine saving lives

 

Articles include: weight-bearing X-rays for knee pain could replace MRI as first choice for 40+ patients with knee pain; machine learning might threaten radiology; Americans use their smart phones to send photos of medical issues; telemedicine saves lives in Syria; and QA databases can benefit radiology departments.

MRIs getting ordered for knee pain when weight-bearing X-rays would do just fine – Health Imaging

Physicians treating possibly osteoarthritic patients 40 and older for knee pain can save these patients time, trouble and quite a lot of money—while sacrificing little to nothing on diagnostic accuracy—by sending them for weight-bearing X-ray exams rather than MRI scans.xrays good for knee diagnosis

Does machine learning threaten radiology’s future?– Radiology Business

Radiology is one of the cornerstones of modern healthcare, but according to a new analysis published by the Journal of the American College of Radiology, machine learning could potentially end the specialty as we know it within the next decade. For example, the machines allow data “to speak for themselves,” which can lead to trends being uncovered that could have gone unnoticed otherwise. Also the pixel-by-pixel focus of machines can pick up key predictors. Computers can also quickly digest complex data sets and while even the most trained radiologists will have cognitive limitations, no such issues exist with machine learning. Continue reading

Research: Impact of Weight-bearing Images in Orthopaedic Imaging

Study favors weight-bearing images for orthopaedic patellofemoral diagnosis and surgery

In clinical orthopedics advanced imaging like computed axial tomography (CT) scanning, has become invaluable to the evaluation and management of patients with musculoskeletal disease. Bone detail is much better visualized with 2D and 3D CT renderings of patients with problems like glenoid fracture, failed shoulder instability surgery, and meniscal root avulsions.

Conventional CT technology requires subject in supine position

High-quality images provide multiplanar 2D and 3D visualization for practitioners who think and work in three dimensions. However, a significant limitation of CT technology has been that it forces image acquisition with the subject in a supine, relaxed position. When imaging an injured knee, for example, the leg is in full extension and the muscles relaxed.

The conventional measures of patellofemoral alignment include the congruence angle, patellar tilt angle, and tibial tubercletrochlear groove offset distance. There are clearly defined limits of normal use for each of these measures, and they are used by surgeons to plan corrective operations on the patellofemoral joint. The degree of knee flexion and activity of the quadriceps are known to influence patellar tracking on the trochlea, but these factors are removed when images are taken with the patient supine.

Some have tried to simulate weight bearing in a CT scanner by custom designing a rig to apply longitudinal  load  through  the  patient  for  imaging  of  the  spine or  lower  extremity. These  methods  are  at worst,  a  poor depiction  of  functional  anatomy;  and  at  best , a cumbersome  and a less-than-accurate simulation of function.

Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo undertake study

Myself and other researchers from the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo are currently performing research on a new  cone  beam CT scanner,  the  CARESTREAM OnSight  3D  Extremity  System,  developed by Carestream Health. The system is designed to offer high-quality, portable,  low-dose  3D  point-of­ care imaging by orthopaedic and sports medicine practices, hospitals, imaging centers, urgent care facilities, and other healthcare providers.

We have been performing institutional IRB-approved clinical trials and basic sciences studies with the prototype model. These studies are being carried out at the Erie County Medical Center, Buffalo’s regional orthopedic tertiary care facility. Based on early data, we are convinced that many imaging studies should be acquired with subjects in positions that represent true human function, such as weight bearing on the lower extremities.

Comparing Carestream OnSight 3D Extremity System to predicate devices

We compared the 2D imaging performance of the CARESTREAM OnSight 3D  Extremity System to the predicate CARESTREAM DRX-1 Detector used with the CARESTREAM DRX-Evolution System. We compared the 3D volumetric imaging performance of the OnSight system to a multiple detector computed  tomography (MDCT) scanner  (“predicate device”). The purpose of the study was to demonstrate equivalent diagnostic  image quality between the investigational and predicate devices, using a Radlex subjective quality rating scale.

The evaluation was performed on equal numbers of knees, ankles, feet, elbows, and hands from 33 cadaveric human specimens and 13 living human subjects. Four independent, board-certified radiologists of varying general reading experience performed evaluations of the images/exams captured using both the investigational and predicate devices.

Results: OnSight 3D Extremity System produced 2D images with equivalent diagnostic image quality to predicate system

In summary, the CBCT system produced 2D images with equivalent diagnostic image quality to the predicate system for a range of exams, and 3D images were rated equal or better when compared to the predicate device for a range of exams on cadaveric specimens and human subjects.

  • More than 80% of all the 2D images were rated diagnostic or exemplary, whereas approximately 98% of all 3D images were rated diagnostic or exemplary.
  • More than 75% of all Radlex rating responses counted for all 2D images were rated equivalent or favored the investigational device.
  • Approximately 85% of the Radlex rating responses counted for the 3D images were rated equivalent or favored the investigational device.

Examples of representative scans are seen below.

2D and 3D orthopaedic renderings generated by the CBCT scanner

Figure 5: 2D and 3D renderings generated by the CBCT scanner

Our conclusion from this study is that for cases of patella instability, it may be desirable to obtain images while the patient is weight bearing on a flexed knee with their quadriceps muscles active. Improvement in objective measures of patella alignment should lead to improved clinical and surgical care of patients with this condition.

New study: comparing measures of ankle stability

A second clinical study is currently under way to take advantage of the unit’s ability to obtain images in weight bearing. The research will compare measures of ankle stability from the investigational weight-bearing cone beam computed tomography scanner to the same measures on gravity stress X-ray in patients who have supination-external rotation ankle fractures.

These and future studies may validate the value of the OnSight 3D Extremity System. Potential benefits include better quality images with a lower radiation dose than conventional computed tomography. The unit is proposed for use in orthopedic offices, but it might have applications to the operating room or at athletic competition sites. The unit is less expensive than a traditional in-hospital or radiology center CT scanner, and can be used with existing electrical systems (220V). Most important however, is the potential to acquire images while bearing weight and in more functionally relevant positions.

Editor’s note: The CARESTREAM OnSight 3D Extremity System received FDA 510(k) clearance in September 2016 and is available for order in the United States.

Dr. John Marzo, UBMD

Dr. John Marzo is a physician with UBMD Orthopaedics & Sports Medicine, Associate Professor of Clinical Orthopaedics, Jacobs School  of  Medicine  and  Biomedical  Sciences,  University at Buffalo and  former  Medical  Director,  Buffalo Bills.

Diagnostic Reading #36: Five “Must Read” Articles on HIT and Radiology from the Past Week

Learn about MRI scans for Zika virus and apps designed by and for radiologists

Articles include: research suggests smartphone use – including apps for radiologists – can lead to better brain function; a new methodology predicts future ER demand; a radiologist developed a smartphone app to help doctors respond to in-flight emergencies; more workloads are headed to the cloud using SaaS technology; and Zika’s rapid spread seen on MRI scans shock cancer researchers.

How Smartphones Can Make Radiologists Even Smarter – Imaging Technology News

Research suggests that smartphone use might warm up the cortex, which leads to better brain function and plasticity. And many smartphone applications have been created specifically for radiologists, including Carestream’s Vue Motion.

Intelligent smart phone

Analytics approach aims to cut overcrowded ERs – Health Data Management

Using data analytics to understand hospital emergency department overcrowding and wait times, two researchers have developed a methodology to predict future ER demand. Hospitals could use the results to reduce wait times for patients by as much as 15 percent, the researchers contend. The methodology uses machine learning technology to assess data on known patterns of ER activity.

Radiologist develops app for helping doctors respond to in-flight emergencies – Radiology Business

A non-profit organization has developed a new smartphone app that helps health professionals deal with in-flight medical emergencies. According to the Chicago Tribune, the app helps doctors treat 23 common emergencies such as chest pain and seizures. The app is available for Apple and Android smartphones and can be used while the phone is in airplane mode. Continue reading

White Paper: Interoperability of Health Information Systems

The challenges and pathways to creating a unified framework for capturing, distributing and accessing clinical information

What is interoperability in healthcare? Interoperability can be described as a well-functioning central nervous system, coordinating the enterprise’s many roles and tasks toward a common end: the well-being of each patient.

illustration depicting connection

But when communications are slow, incomplete, or missing between any two entities — patients and providers, primary-care physicians and specialists, central and remote locations, and so on — the timeliness and quality of patient care can suffer. Many other parts of the total healthcare ecosystem can be affected as well: costs can rise, resources can be allocated inefficiently, and opportunities for constructive collaboration can be lost.

Information generated by different systems, on different networks and for different purposes becomes far more useful when a unified framework is in place for capturing, distributing and using the information. Ideally, with the appropriate security credentials, any individual user or collaborative team should be able to interact with the information they need, in the format they prefer, on their choice of device.

Why is interoperability important to healthcare?

Every stakeholder in the healthcare delivery process stands to benefit from interoperable systems built on interoperability standards that deliver collaborative transparency and efficiency. These stakeholders include patients who want to take more active responsibility for their own health; primary care physicians and specialists who are seeking meaningful collaboration, without information gaps, delays, or redundancies that could compromise quality; and providers in remote and rural areas who need the ability to share clinical images and data with centrally located specialists. Continue reading

Diagnostic Reading #35: Five “Must Read” Articles on HIT and Radiology

Patient portals, teleradiology and healthIT security gaps are in the news

Articles include: use of virtual reality technology to alleviate pain; what patients want in a patient portal; many mobile devices pose security gap; the job outlook for radiologists is bright; and teleradiology is gaining acceptance as demand increases due to better technology and higher ER imaging volumes.

Hospitals Try Giving Patients a Dose of Virtual Reality – Health Data Management

It’s still a new and experimental approach, but proponents of virtual reality say that it can be an effective treatment for everything from intense pain to Alzheimer’s disease to arachnophobia to depression. The idea is that the worst pain can be alleviated by manipulating the way the human mind works: the more you focus on pain, the worse it feels. Swamp the brain with an overload of sensory inputs and a person’s consciousness of pain, anxiety or depression can be reduced. Virtual Healthcare

What keeps patients from adopting patient portals, health IT? – Health Management Technology
Despite the fact that patient portals often receive industry praise, the technology suffers from a number of user frustrations and critiques. Understanding the differences in patient portal interfaces and using pilot groups to determine which seem most navigable might help healthcare organizations avoid patient complaints about portal usability. Continue reading

Understanding Radiology Exposure Indicators

Knowing how number is used is key to controlling exposure

Imaging in a radiology film environment is much like playing Goldilocks and the Three Bears. You take your image, hold it up to the viewbox and say: “This image is too light”; “This image is too dark”; or, “This image is just right!” If you underexpose your image, it will be too light, and if you overexpose the image, it will be too dark (See figure 1). The density and contrast of the image on film is controlled by the kV, mAs and other exposure factors.

However, with digital imaging devices, brightness and contrast are no longer linked to exposure factors. Digital systems produce images with consistent density and contrast regardless of the exposure factors (See figure 2). So how does a radiographer know if a digital image is over- or under-exposed?

The potential for gross overexposure is one issue we encounter when a radiology department or clinic changes to a digital image receptor. The reason for this increased risk is that we’ve lost the visual connection between the exposure and an image’s appearance. That’s why it’s so important for the radiographer to understand how to read and utilize the exposure indicators.

On digital imaging systems, an exposure indicator provides useful feedback to the radiographer about exposures delivered to the image receptor (ASRT, 2010). An over- or under-exposed image will deliver an incorrect exposure indicator; whereas a correct exposure will provide a corresponding exposure indicator. The indicator is a vendor-specific value that provides the radiographer with an indication of the accuracy of their exposure settings for a specific image (ASRT, 2010). The exposure indicator has as many different names as there are vendors in the market. The names include S-number, REG, IgM, ExI and Exposure Index. Continue reading

Guess the X-ray: September’s Image Challenge

Happy September!!

It is the beginning of the month so it’s time for a new “Guess the X-ray Challenge”! We welcome radiologists, technicians, RAs, MDs, PAs – or anyone who thinks they’re up to the challenge – to guess the subject in this X-ray. Please leave your answer in the comment section below or on our Facebook page. The challenge will stop at the end of the month.

Congratulations to those who correctly guessed the August image challenge!  The correct answer was — a wire stripper!

Happy guessing and good luck!

September Image Challenge Image

 

 

 

 

 

Sorry… Carestream employees and their agencies are prohibited from answering.

Diagnostic Reading #34: Five “Must Read” Articles on Radiology and Healthcare from the Past Week

Healthcare news includes videos that improve radiologists’ ultrasound skills; and concerns about Obamacare

image of hospital patient

 

Articles include: MR-guided ultrasound helped rouse a recovering coma patient to a more alert state of consciousness; incidental and secondary findings are on the rise; use of telemedicine requires “webside” training; 10-minute videos improve pediatric radiologists’ ultrasound skills; and double-digit premium increases and exits by big-name insurers cause some to wonder if “Obamacare” will go down as a failed experiment.

MR-guided brain ultrasound helps rouse coma patient back to consciousness – Health Imaging

Neuroscience researchers and clinicians at UCLA have used MR-guided ultrasound to help rouse a recovering coma patient to a more alert state of consciousness. They’re not certain about the extent to which the novel therapy contributed to the good outcome, but they’re sufficiently hopeful to have begun recruiting participants for a larger trial.

Patient preferences should guide decisions around incidental findings – Health Imaging

Incidental and secondary findings are on the rise, thanks largely to advances in diagnostic technologies and adoptions of value-based practice incentives. As such findings increasingly confound patients as well as clinicians—not to mention medical ethicists and malpractice courts — radiology would do well to follow discussions going on in the field of genetic testing.

At the ‘webside’ – Modern Healthcare

As telemedicine takes root, there’s a growing need to train physicians on how to handle virtual visits with patients and develop a good ‘webside manner.’ Physicians must offer an empathetic and compassionate presence to calm fears and provide hope for patients who may be suffering from anything from serious to common illnesses. Medical schools have always included training in bedside manner in their curricula—now webside training might also be essential. Continue reading