Diagnostic Reading #37: Five Must-Read Articles From the Past Week

Carestream LogoTime for another edition of Diagnostic Reading. This week’s articles focus on enterprise archiving, mobile access to patient data, radiation’s effect on breast cancer, radiation reduction, and clinical decision support.

1) Archiving and the Enterprise – Radiology Today

Traditionally, data backup and disaster recovery were part of an imaging department’s PACS. As a result, business continuity and disaster recovery tended to be compatible exclusively with that PACS. Fast-forward to 2015 and the need to share and access data across departments has grown exponentially. Today, many imaging departments, especially larger ones, are finding that their PACS-based disaster recovery solutions are no longer sufficient.

2) Survey: Docs Going Mobile to Access Patient Data – Healthcare Informatics

More than half of ambulatory practice physicians currently access patient records and/or reference data from a mobile device, according to a new survey from Black Book Market Research. The survey also revealed that 70 percent of all clinicians indicated they aim to use mobile EHR devices and software by the end of 2015.

3) Additional Radiation Reduces Breast Cancer Recurrence for Some Patients – Imaging Technology News (ITN)

A study has found no increase in overall survival but a reduction in breast cancer recurrence when the lymph nodes receive additional radiation beyond the standard treatment of whole-breast irradiation after breast-conserving surgery. The research, which examined the addition of regional nodal irradiation to whole-breast irradiation compared with whole-breast irradiation alone, was published in the New England Journal of Medicine.

4) AHRA: Reducing Radiation Is Simple But Not Easy – AuntMinnie

“Radiation management is becoming more complex,” presenter Robert Pizzutiello of Landauer Medical Physics told AHRA attendees. “Advanced imaging and treatment choices, healthcare consolidation, and tougher regulations and standards are raising the bar for radiation safety. But it is possible to manage dose successfully, especially through a team approach.”

5) AHRA: Is Clinical Decision Support a Blessing or Curse? – AuntMinnie

Imaging has been under scrutiny, with policymakers touting techniques such as prior authorization and clinical decision support (CDS) as ways to reduce inappropriate exams. But how effective are these techniques, particularly CDS? It’s not yet clear, according to a presentation given this week at the AHRA annual meeting in Las Vegas.

Diagnostic Reading #36: Five Must-Read Articles from the Past Week

Carestream LogoTime for a new issue of Diagnostic Reading. This week, we will be focusing on mammography radiation dose, the appropriateness of ordering certain imaging exams, the U.S. House of Representatives passing the 21st Century Cures Act, pain points of big data, and a clinical decision support learning network.

1) AAPM: Mammo Radiation Dose 30% Lower Than Thought – AuntMinnie

Women receive about 30% less radiation during screening mammography than has long been assumed, which suggests that the “harm” of radiation dose in mammography also has been overestimated, according to research presented on July 15 at the 2015 American Association of Physicists in Medicine (AAPM) meeting in Anaheim, CA.

2) JACR: Radiologists Order CT, MR Exams Appropriately – AuntMinnie

According to a new study published in the Journal of the American College of Radiology, radiologists are making good use of all available prior imaging before recommending additional exams, and they aren’t ordering many unnecessary exams. These findings relate to CT and MR exams.

3) House Passes 21st Century Cures Act to Improve U.S. Medical Innovation – Imaging Technology News

The U.S. House of Representatives passed its version of the 21st Century Cures Act, designed to improve the U.S. healthcare innovation infrastructure. The bill calls for providing resources to researchers working on next-generation medical devices and therapies. The legislation is aimed at addressing concerns that U.S. healthcare innovation is lagging behind the rest of the world due to large amounts of time-consuming and expensive regulatory oversight requirements that some feel are stifling innovation and the ability of startup companies to bring new products to market.

4) 7 Pain Points of Big Data – Healthcare IT News

A new report by the BPI Network, “Accelerate How You Innovate: Data Center Evolution in the Era of the Cloud,” examines how organizations are adapting to a new model of business-responsive data centers and networks. Based on this, healthcare IT directors are looking a seven pain points that will need to be addressed as they evolve.

5) Feds Look to Fund Clinical Decision Support ‘Learning Network’ – Health Imaging

The PCOR CDS Learning Network will have three primary objectives: 1) “Engage clinicians, patients, professional associations, health IT developers and other stakeholders who can help promote the incorporation of PCOR findings into clinical practice through CDS; 2) “Identify barriers and facilitators to the use of CDS as a means to disseminate and to implement PCOR findings in clinical practice; and 3) “Provide consensus-based recommendations to the field of CDS developers, CDS implementers, and other stakeholders about CDS design and implementation best practices.”

Diagnostic Reading #35: Five Must-Read Articles from the Past Week

Carestream LogoA new week and a new issue of Diagnostic Reading. This week the articles focus on the 2016 Medicare Physician Fee Schedule (MPFS), another controversial study about breast screening, using SPECT to identify traumatic brain injuries, a new American College of Radiology commission on patient experience, and the U.S. Congress’s telehealth push.

1) Radiology Averts Cuts in Proposed 2016 MPFS – AuntMinnie

Radiology received no payment increases or decreases in the 2016 Medicare Physician Fee Schedule (MPFS) released on July 8 by the U.S. Centers for Medicare and Medicaid Services (CMS). Other subspecialties will see payments increase, but some will see decreases. As of January 1, radiation oncology and radiation therapy payments will be slashed by 3% and 9%, respectively.

2) New Study Again Questions Screening Mammography – AuntMinnie

A new research study published online July 6 in JAMA Internal Medicine is again questioning the effectiveness of widespread breast screening. Mammography screening of the general U.S. population mostly just produces overdiagnosis, with no measurable effect on mortality. Welch and colleagues found that rising rates of screening produced more breast cancer diagnoses, particularly of smaller cancers, but death rates from breast cancer remained the same. The findings indicate that widespread breast screening is ineffective and should be replaced by a program in which screening is more directed to individuals who are at high risk of breast cancer, according to the authors (JAMA IM, July 6, 2015).

3) Traumatic Brain Injuries Can Now Be Identified With SPECT – Imaging Technology News (ITN)

After comparing more than 20,000 brain scans, researchers have identified differences between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) despite both conditions sharing common symptoms. researchers used single photon emission computed tomography (SPECT) to obtain biological differences between TBI and PTSD in the brain. This neuroimaging method and landmark study “demystify” these two conditions that both may appear with symptoms like anxiety, depression, mood dysregulation, irritability and other cognitive breakdowns

4) New ACR Commission on Patient Experience to Advance Patient Centered Radiology – American College of Radiology

The new commission will develop recommendations on how radiology practices can enhance the experiences of patients and their families; provide information regarding how best to measure radiology patient outcomes; work with other ACR commissions to develop tools, metrics and policy that help members meet Merit-based Incentives Payment System and alternative payment model requirements; and, work closely with the RSNA Radiology Cares Campaign.

5) Congress Makes a Big Telehealth Push – Healthcare IT News

A bill was introduced in Congress that, if passed, would mean important advancements for telehealth in the U.S. The bill would add physical therapists, speech language pathologists, audiologists and others to the list of providers eligible to administer telehealth services, as well as include the patient’s home as an allowable care site for specific hospice and home health services.

Diagnostic Reading #34: Five Must-Read Articles from the Past Week

Carestream LogoTomorrow is a holiday in the U.S., so this week’s issue of Diagnostic Reading will be taking place a day early. This focus of this week’s articles include data interoperability, how dense breast tissue affects mammograms, CT radiation dose levels, cybersecurity, and new findings by the Society of Radiologists in Ultrasound.

1) Q&A: A New Diagnosis for Radiologists – Diagnostic Imaging

An article published in Radiology by the Society of Radiologists in Ultrasound recommending that elastography techniques can be used to distinguish patients with no or minimal liver fibrosis and differentiate them from patients with severe fibrosis or cirrhosis. There were two significant outcomes from this recommendation: patients no longer need invasive liver biopsies to diagnose liver fibrosis, and radiologists will play a huge role in diagnosing diffuse liver disease, a part they did not play before.

2) How Breast Density Can Affect Cancer Screenings – Imaging Technology News (ITN)

Susann Schetter, DO, co-medical director of Penn State Hershey Breast Center recently published comments in an edition of The Medical Minute, a weekly health news feature produced by Penn State Milton S. Hershey Medical Center, on how when it comes to breast cancer screening, the fibroglandular density of breasts affects how well a mammogram can detect cancerous tissues.

3) Cybersecurity is an Increased Business Priority for Healthcare Leaders, Survey Finds – Healthcare Informatics

“The Healthcare Information and Management Systems Society (HIMSS) surveyed nearly 300 healthcare leaders across the industry on the issue of securing patient data. Nearly every single one, 87 percent in all, said cybersecurity was increased business priority over the past year due to the increasing threats to PHI. Two-thirds of the respondents said their organization had experienced a significant security incident.”

4) CT Radiation Dose Levels in Clinical Trial Surprise Researchers – AuntMinnie

“A group of researchers studying the use of CT for kidney stones were surprised by the radiation dose levels they discovered in their multicenter clinical study. Not only were many doses too high, they also varied widely between centers, concludes a research letter published June 29 in JAMA Internal Medicine.”

5) Innovation Pulse: A Better Road to Data Interoperability? – Healthcare IT News

Tom Sullivan, executive editor, HIMSS Media, takes a look at how enabling one doctor to use one EHR to access patient information residing in a different hospital’s EHR from a different vendor may not be best way to give doctors the data they need. He looks at the ability to overlay technologies, one on top of the other, as it might bring us close enough to interoperability.

Video: What the Future Holds for Digital Breast Tomosynthesis (DBT)

At SIIM 2015, Carestream’s own Ron Muscosky, worldwide product line magager, Healthcare Information Solutions, participated on a panel about digital breast tomosynthesis (DBT).

We covered the audience questions in more detail in an earlier blog post, but in the video below, Muscosky explains the purpose behind the panel, the challenges DBT presents, how vendors are addressing these challenges, his comments on the audience’s participation, as well as what he believe the future holds for DBT.

Diagnostic Reading #30: Five Must Read Articles from the Past Week

Carestream LogoAnother week means another edition of Diagnostic Reading where we highlight five must-read articles published in the last seven days. This week’s articles focus on Stage 3 Meaningful Use, dense breast tissue, VNAs, breast cancer screening, and mobile app adoption among radiologists.

1) Proposed Rules for Stage 3 Meaningful Use – Imaging Technology News (ITN)

Dave Fornell of ITN goes into details for each of the eight objectives for Stage 3 Meaningful Use set in place by the Centers for Medicare and Medicaid Services (CMS). The eight objectives include: 1. Protect Patient Electronic Health Information; 2. Electronic Prescribing; 3. Clinical Decision Support (CDS); 4. Computerized Provider Order Entry (CPOE); 5. Patient Electronic Access to Health Information; 6. Coordination of Care Through Patient Engagement; 7. Health Information Exchange (HIE); and, 8. Public Health Reporting.

2) Making Sense of Dense Breasts – Imaging Technology News (ITN)

Jeff Zagoudis of ITN discusses how as states continue to mandate patient notification of dense breast tissue, the technology for analyzing and reporting continues to evolve. A big issue today is how almost all in the medical community know about the impact of breast density, but that knowledge has not been passed down to patients. The article dives into the how many states in the U.S. are working to notify patients about dense breast tissue, and other modalities to get a second read of the exam.

3) NEJM: Breast Cancer Screening Reduces Mortality by 40% – AuntMinnie

“Researchers from the World Health Organization’s International Agency for Research on Cancer (IARC) found that women ages 50 to 69 who regularly receive mammography screening reduce their risk of dying from breast cancer by 40%, compared with women who are not screened. This translates into about eight deaths prevented per 1,000 women regularly screened, according to the group.”

4) SIIM 2015: VNA Adoption Yields Workflow, Cost Benefits – AuntMinnie

In this session from SIIM 2015, Wake Radiology was able to realize the benefits of a vendor-neutral archive (VNA) such as improved workflow, better management of digital breast tomosynthesis (DBT) images, and reduced storage costs.

5) Q&A: Radiologists at the Forefront of Mobile App Use – Diagnostic Imaging

The Q&A is with David Hirschorn, MD, director of radiology informatics at Staten Island University Hospital, in which he discusses a panel he participated on at ACR 2015 called, “Reshaping Radiology Through Mobile: Apps, Technologies, and FDA Regulations.”

DBT: Is It Ready for PACS Prime Time?

SIIM 2015 LogoOn the final day of SIIM 2015, a vendor panel took place that looked at the evolution and adoption of digital breast tomosynthesis (DBT), and whether or not facilities were prepared to handle the influx of these 3D images on their PACS, as well as across their IT networks.

The panel was led by David A. Clunie, PixelMed, and consisted of Ron Muscosky, MSEE, Carestream, Steve Deaton, Viztek, Mark Bronkalla, MBA, Merge, and Bobby Roe, Visage.

After the vendors each took turn describing their own offerings and advice to those who currently use DBT or are planning to, we segued into an audience Q&A that dived into more detail among the seven audience questions. Below are the questions asked, as well as answers provided from the panel.

Question #1: Secondary capture–should facilities be talked out of it?

Answer: The option exists to store in a standalone archive, or in a PACS and then have the DBT images converted. The issue is that once converted into a PACS, facilities now have double the storage needs as two images now exist. Among panel attendees, they all either had DBT in place, and planned to have it within the next 12 months. However, few who were planning deplpy DBT had a plan in place. Essentially, facilities need to put priority on BTO (Breast Tomosynthesis Object) over SCO (Secondary Capture Object) for improved flexibility in storing and sharing images.

Question #2: What is the clinical impact of DBT? Does it take three times as long to read the exams?

Answer: This answer to this question was diverted to the audience, where one attendees traditional 2D mammography took 10-20 seconds to read, versus DBT exams which took 20 minutes. Attendees knew reading DBT exams took longer, but not that long. The panel responded to this answer by saying that DBT was still relatively new and as adoption and familiarity increased, reading time would become more efficient.

Question #3: Will reimbursement for DBT improve? Especially after the stick-shock for installation?

Answer: When DBT was not reimbursed, few were using the technology. Now that more are using the technology, reimbursement is in place, though it is consider poor. For improved reimbursement, the introduction of new competitors will drive purchase and installation prices. Carestream’s Muscosky said that he has been seeing many facilities adding DBT for competitive reasons, because they do not want to lose patients to other facilities that have it installed. There are of course diagnostic benefits to DBT, and in turn providing better patient care. Essentially, facilities should be installing DBT to maintain an edge on the competition, and use it as a marketing device for the facility. A large majority of the audience agreed with this and are currently practicing this themselves.

SIIM 2015 DBT PanelQuestion#4: Regarding size of images–how can DICOMweb help with performance issues?

Answer: One response was that is does not matter one way or the other if facility is handling everything on the server side. Another response was that any image being view for mammography is either lossless or not. High resolution, no bandwidth advantage to the client, because you want to have a viewer that does not need the entire study to start display or the entire object to start display. Server-side issues have advantages but is not a silver bullet. Facilities can user server-side for non-diagnostic, or offer a choice on whether facilities want loss or lossless, and server-side is not truly offering bandwidth advantages.

Question #5: This audience member asked about digital mammography priors for comparison reasons that has resulted in a struggling workflow. She had to alter workflow because her facility cannot get to prior to workstations fast enough. Has this problem been fixed with digital mammography?

Answer: The issue with the attendee’s facility was that there are multiple offices, but read at one central workstation. The facility is sending all studies to all workstation, creating three or four copies. Routers would send study once across, and central location would route once. The solution to this is that intelligent routing would mitigate the issue. Technology that is zero-footprint has not been available, whether supporting server-side rendering or not, but it is moving in that direction. All of this re-routing goes away once facilities move to the cloud. Panelists commented how it is important to focus on not just getting diagnostic tools to diagnosing physician, but also having good bedside manner with patients. Carestream’s Muscosky added that many facilities are converging multiple sites, and data needs to be accessed quickly no matter where from. Data cannot be sent around among facilities and re-routed.

Question #6: Is the industry moving toward supporting motion detection and correction?

Answer: Panelists all agreed that this advancement would need to be completed on the image acquisition side, since these vendors are the ones creating the hardware. They all agreed that it would great to see projection when there is motion, but have not heard of anyone released a motion detector.

Question #7: How do facilities correct hanging protocols that are not working?

Answer: One true way to identify an image according to view, and every view port has to give the user an option to toggle between C-view, and others. Facilities should refer to the IHE DBT framework. There was an idea presented that in the future, vendors should allow hanging protocols that make more sense and are deterministic. Users still want to hang right, regardless of vendor, and new modality gives a chance to hope for the best compliance. In the future, there will need to be a right code that allows users to apply logic and alternate paths to identify mishaps.

PulvinoRich Pulvino is the digital media specialist for Carestream. He attended SIIM 2015 from May 28-30 at the National Harbor in Maryland.


Diagnostic Reading #29: Five Must Read Articles from the Past Week

It’s Friday, which means it’s time for another Diagnostic Reading! This week’s articles focus on the expanding purposes of VNAs, a study from the Annals of Internal Medicine about breast cancer risk factors, an article about the ICD-10 grace period and updates about presentations from ACR 2015.Carestream Logo

1) Time to Retire the term “VNA”? – Healthcare Informatics

This article addresses the acronym, VNA, and its definition: Vendor Neutral Archive. The growth of health IT products has also expanded their responsibilities. The author claims that a VNA is neither ‘vendor neutral’ nor an ‘archive.’ He goes on to explain, saying that these applications manage data rather than simply archive it.

2) Study: There’s More to Breast Cancer Risk than Density – Aunt Minnie

A study in the Annals of Internal Medicine noted that breast density is not the only factor that should be considered when determining which women should receive supplemental breast screening in addition to mammography. The researchers looked at a variety of factors including age and a consortium of risk factors. The authors writes, “Density information combined with breast cancer risk could be used to prioritize women who could benefit from breast imaging tests with better specificity than digital mammography, such as tomosynthesis.”

3) Number of Female Radiologists, Field Leaders Remains Low – Diagnostic Imaging

According to a presentation this week at ACR 2015, the number of women in radiology has not grown in the last 10 years. This research was done to see if the raised awareness of gender disparity has caused any change in gender representation in radiology. They found that women have consistently made up about 27% of the radiology field since 2004.

4) Newly Introduced Bill Looks to Establish ICD-10 Grace Period – Health Imaging

The US House is moving forward with the ICD-10 bill. The upgrade will take place on October 1. However, some healthcare executives and politicians were concerned that transition to the new coding from ICD-9 would cause confusion. For this reason, a bill was passed that says nobody can be denied Medicare reimbursement solely for using inaccurate codes during the first 18 months of implementation.

5) Medicare Imaging Spending is Down, with Some Variation by State – Radiology Business

At ACR 2015, presenters shared their findings on the trends of Medicare spending when it comes to imaging. They found that overall, national Medicare expenditures for imaging have fallen since 2006. They attribute this to factors based on education about radiation dose and the recession as well as policies instituted by the government. Some states did not follow these trends, read more to find out why.



Diagnostic Reading #26: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, it’s almost the weekend, and that means it’s also time for a new Diagnostic Reading. This week’s articles include an article about technology and connectivity written by a Carestream’s director of IT, more questions about the USPSTF breast screening recommendations, tips to improve healthcare quality, the new CMS quality-based standards and how patient portals might cause disparities.

1) Is Technology Still the Main Road to the CustomerCIO Review

The growth of new media has been obvious in recent history. David G. Sherburne, Director of IT for Carestream, provides his insight on the growth of media when it comes to “C-Level executives.” Sherburne makes the initial observation that technology has created connectivity and ease of access across several levels. He notes that for this reason, he states that executives should abandon the old-fashioned silo system and work more closely with their “C-Level” peers.

2) Should women over 75 be screened for breast cancer?AuntMinnie

Many questions have been raised about the recent update by the USPSTF concerning recommendations for breast imaging. One of the disputed topics is about the recommendation for women over 75 years-old. This article explores the importance of continuing breast screening when women are older, highlighting how other organizations such as the American Cancer Society and the American College of Radiology have recommended that women should have annual screenings starting at age 40, and as long as they are in good health.

3) 15 ‘Vital Signs’ to Improve HealthcareFierce Healthcare

Quality healthcare is a point of emphasis at just about any facility. This article lists 15 metrics, as determined by the Institute of Medicine (IOM) that can affect the overall health of Americans and lead to better health care provision. These factors include patient safety, care access, community health, addictive behavior, preventative services, etc.

4) CMS Releases Strategic Vision for Physician Quality Reporting Programs – Healthcare Informatics

The Centers for Medicare and Medicaid Services have released standards for quality care reporting programs. This initiative moves the payment system away from the fee-for-service model and begins the shift toward reward incentives for providing quality care. Quality reporting and patient feedback are emphasized by the new plan.

5) Study: Patient Portals Could Widen Health Disparities – Healthcare Informatics

A recent study at Northwestern Medical has found that patient portals might widen disparities by race, education and health literacy. The study concluded that people who are not health literate are 3.5 times less likely to register for patient portals than their counterparts.




The USPSTF Misses Again on Breast Screening Guidelines

In a recent move that is drawing much ire from the medical and women’s health communities, the U.S. Preventive Services Task Force (USPSTF) declined to expand its recommendation on which women should receive regular mammography screening. What was offered upon this rejection was essentially the reinforcement of the conservative guidance from 2009.

The new guidance states that women in their 50s should only receive mammography screening every two years, rather than annually as is advocated by many women’s health and medical groups. Advocates for annual screening are also upset that the USPSTF did not recommend screening for women in their 40s, because of its belief that the benefits of screening in this age group do not outweigh the purported harms of screening.

To be blunt—this is questionable advice at best. The guidelines will do nothing but confuse women as again they are not emphatic, but leave decisions up to the women’s general physicians or OB-GYN.

Many women in the 40 to 49 group have dense breasts. Having regular screening mammograms can help this group be sent for further screening with adjuncts such as full breast ultrasound and MRI—helping to find earlier cancers.

Many countries, such as Sweden, Norway, Australia and Canada have adopted the approach that if you have dense breasts (or a certain amount of glandular tissue,) the woman should be screened yearly. Women with fatty breasts are screened every 2 years. This is without arbitrary age grouping.

The U.S. is getting better about dense breast notification, as 22 states have enacted laws about notifying women who possess dense tissue, and a number of other states have bills introduced about these notifications, but these new guidelines from USPTF could hinder this progress.

Breast cancer is heterogenous, i.e. ,many different types with some being much more aggressive than others. Finding cancers later may do more harm as treatments will be ineffective, more toxic and of course more expensive

Another one of the biggest pain-points in the new guidelines was that women over 70 were excluded. This is just not right. Many women in this age group are active, healthy and go on to live very long lives. Finding breast cancer in this age group can be easier due to the fact many women in this age group have fatty breast tissue, making cancer show up much easier. Small cancers can be treated and women can go on to live very productive lives.

On a personal note, two of my aunts had small cancers found when they were over 75. One lived to be 93, being cancer-free for almost 20 years, and the other lived to be 103!

As a woman, I am lucky I have had the opportunity to have advisors and the education to know what to do. There are many out there who are not so lucky. Much has been done to educate women on the importance of screening, and what the USPSTF is doing by confusing them will not help.

For an addition helpful viewpoint on this issue, please read Dr. Daniel Kopans opinion that was published on AuntMinnie.

Anne Richards, CarestreamAnne Richards, Clinical Development Manager, Women’s Healthcare, Carestream