Diagnostic Reading #8: Five Must-Read Articles From the Past Week

This week’s articles include: a study examining healthcare IT technology adoption in rural areas; the need for additional training on correct interpretation of digital breast tomosynthesis scans; a study showing remote patient monitoring does not reduce readmissions or mortality for patients with heart failure; a Q&A with radiologist Stamatia Destounis, Healthcare ITMD; and news that more than 100 health industry stakeholder organizations have agreed to push the industry and policymakers to take six steps—many supported by information technology—which they say can immediately improve the nation’s healthcare system.

A study entitled “Variation In Rural Health Information Technology Adoption and Use,” recently published in Health Affairs, noted that while initial health IT adoption and meaningful use achievement were higher among rural providers and hospitals than those in urban areas, these populations were less likely to return in Continue reading

RSNA 2015: Important Presentations and Studies from Day 5

RSNA 2015In today’s RSNA summary, we look at presentations focused on MRI’s effectiveness in detecting adverse reactions, over use of peripheral arterial disease, using Ferumoxytol in MR imaging of children, mammography priors’ effect on recall rates, and the link between heart and brain disease.

MRI Effective in Detecting Adverse Reactions Around Arthroplasties – RSNA Bulletin

According to presenter Hollis G. Potter, M.D., MRI is the most accurate means by which to detect adverse local tissue reaction (ALTR), tissue damage and bone loss around arthroplasties. ALTRs occur with all fixed- or mobile-bearing constructs in symptomatic and asymptomatic patients. Arthroplasties generate a small amount of metallic debris, which in most cases does not affect the patient. But in a small percentage of people, the immune response generated by the host reacts to the particles and creates areas of tissue necrosis.

Overuse of Peripheral Arterial Disease (PAD) Testing Likely – RSNA Daily Bulletin

According to a study presented by David C. Levin, M.D., professor and chairman emeritus of the Department of Radiology at Jefferson Medical College and Thomas Jefferson University Hospital in Philadelphia, tests for peripheral arterial disease (PAD)—including the use of duplex ultrasound of lower extremities—are probably being overused. The study found that while the use of vascular ultrasound, as well as noninvasive physiologic testing (NPT), for PAD has flattened or even decreased since 2010, as of 2013 it was significantly higher than it was in 2001.

Contrast Agent Ferumoxytol Safe for MR Imaging in Children – RSNA Bulletin

In the largest study of its kind, Anne Muehe, M.D., a postdoctoral fellow in the laboratory of Heike E. Daldrup-Link, M.D., associate professor of radiology at Stanford Medicine in Stanford, CA, and her colleagues have found that ferumoxytol is safe to use as an MR contrast agent in children. The findings are critical for the development of new ferumoxytol-based MR imaging techniques with better image quality and less toxicity.

The More Mammo Priors, the Lower the Recall Rate – AuntMinnie

Comparing screening mammography exams with two or more prior exams reduces by 14% the odds that a woman will be recalled, versus comparing the current exam to a single prior study, according to a study presented by lead author Dr. Jessica Hayward of the University of California, San Francisco (UCSF). Hayward and colleagues conducted a retrospective search of UCSF’s mammography database for screening mammograms performed between June 2010 and March 2015, which yielded a dataset of more than 46,300 screening mammograms in about 22,700 women. The group gathered information on the women’s age, dates of the mammograms identified as comparisons in the clinical report, and recall recommendations.

Imaging Finds Link Between Brain, Heart Disease – Diagnostic Imaging

Subclinical cardiac dysfunction is associated with global and microstructural imaging markers of subclinical brain disease, according to a study presented researchers from the Netherlands. The study performed a prospective population-based study to investigate the cardiac/brain connection. The study included 2,432 participants with a mean age of 56.6; 57.4% were women. Participants with overt heart disease, dementia, and brain infarcts were excluded from the analysis.

Diagnostic Reading #48: Five Must-Read Articles From the Past Week

Carestream LogoIn this week’s Diagnostic Reading we look at a new breast screening study, response time for stat mobile x-ray, consumers and healthcare technology, EMR adoption, and gamma imaging dense breast tissue.

BMJ: Dutch Data Show Breast Cancer Screening Works – AuntMinnie

According to the authors of a new study published in BMJ, the Dutch example of breast cancer screening works, and mammography screening is a clear way of detecting cancer early, along with increased breast cancer awareness. Women have a greater chance of five-year survival if breast cancer is detected early while tumors are small, fewer in number, and early-stage, noted the authors from Erasmus University Medical Center in Rotterdam.

Hospital Slashes Response Time for Stat Mobile X-ray – AuntMinnie

According to an article in the Journal of the American College of Radiology, A Texas hospital was able to cut radiologic technologist response time to 10 minutes for orders for stat mobile x-ray exams from the facility’s medical intensive care unit (ICU). Implementing a series of improvements that included workflow changes, an equipment upgrade, and — perhaps most importantly — changes in ordering patterns by ICU physicians enabled the radiology department at Memorial Hermann-Texas Medical Center in Houston to reduce technologist response times from over 45 minutes to 10 minutes.

Deloitte: Consumers Using More Healthcare Technology – Healthcare IT News

Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles, according to a new report from The Deloitte Center for Health Solutions. The report, “Health Care Consumer Engagement: No One-Size-Fits-All Approach,” found that 22 percent of respondents used technology to access, store and transmit health records in the last year, up from 13 percent in 2013. Use was higher for those with major chronic conditions: 32 percent compared to 19 percent in 2013.

Study: Full EMR Adoption Can Help Hospitals Overcome “Weekend Effect” – Healthcare Informatics

The weekend effect refers to patients who undergo surgeries on weekends, leading patients to experience longer hospital stays, and hospitals to face higher mortality rates and readmissions. The study, published in the Annals of Surgery, identified five resources that can help hospitals overcome this effect: increased nurse-to bed ratio; full adoption of EMRs; inpatient physical rehabilitation; a home-health program; and a pain management program.\

Gamma Imaging and Dense Breasts: Clinicians Evaluate its Role Along with MRI and Ultrasound – Radiology Today

Looking for the best adjunct imaging to complement mammography for women with dense breasts can be as challenging as reading the mammograms themselves. Comparing the functional imaging that comes with nuclear gamma imaging modalities such as molecular breast imaging (MBI) and breast specific gamma imaging to anatomical imaging of ultrasound and MRI results in debates over the pros and cons of these options. The need for images to drive diagnosis and treatment decisions is continually weighed against the chance of false-positives and the potential long-term effects of radiation exposure.

Diagnostic Reading #40: Five Must-Read Articles From the Past Week

Carestream LogoDiagnostic Reading issue #40! How time flies. This week’s articles focus on mammography exams, big data, doctors’ opinions on EHRs, the exchange of data within hospitals, and a study about contrast-related adverse events.

1) Patient Features Have Most Impact on Mammo Reads – AuntMinnie.com

According to a new study published in the American Journal of Roentgenology, patient features such as breast density, prior mammography, and the presence of symptoms such as a lump have more effect on the interpretive accuracy of diagnostic mammograms than radiologist characteristics. Certain radiologist characteristics do help, including affiliation with an academic institution, years of interpretation experience, and exam reading volume, researchers from the University of Washington in Seattle found.

2) Where Big Data Falls Short – Healthcare IT News

A new report from the National Quality Forum outlined the challenges to making health data and analytics more usable and available in real time for providers and consumers. Whereas big data has supported improvement in certain settings, such as reducing ventilator-acquired pneumonia, data analytics has been largely overlooked in the area of healthcare costs, even though this data can inform and assess efforts to improve the affordability and quality of care.

3) Doctors Like EHRs Even Less Than They Did Five Years Ago – Healthcare IT News

According to the results of a study published by the American Medical Association and the American College of Physicians’ AmericanEHR division, physicians have grown increasingly dissatisfied with their EHR software during the last five years. The survey found that about half of all respondents reported a negative impact in response to questions about how their EHR system improved costs, efficiency or productivity.

4) ONC, AHA Present Findings on Hospital Data Exchange – Healthcare Informatics

Nearly all hospitals have the infrastructure to exchange data, yet just 25 percent of hospitals nationwide are finding, sending, receiving and using data electronically, according to a report from the American Hospital Association (AHA) and the Office of the National Coordinator for Health IT (ONC). Specifically, most hospitals have certified electronic health record (EHR) technology and are exchanging key clinical information:  75.5 percent of hospitals said they had a basic electronic health record system, up from 59.4 percent in 2013; and nearly 97 percent of hospitals with basic EHR systems said they had certified EHR technology, up from 94 percent in 2013.

5) Study of Contrast-Related Adverse Events Leaves Some Questions Lingering – Radiology Business Journal

Research in  Annals of Emergency Medicine showed that patients who develop an acute kidney injury after contrast-enhanced CT are at an increased risk of major adverse effects within a year. The findings could be substantial, but Richelle J. Cooper, MD, of the UCLA Emergency Medicine Center argues that there are still too many questions to be sure.

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) 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.

4) 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 #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.

 

 

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

 

 

Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.

1) A LOOK AT THE NEW CARESTREAM TOUCH ULTRASOUND SYSTEM

Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.

2) INFOGRAPHIC: THE EVOLUTION OF RADIOLOGY REPORTING

This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.

3) UNCOMPROMISED QUALITY: BONE SUPPRESSION AND CHEST X-RAY IMAGES

Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.

4) DREAM JOB: APPLICATIONS ENGINEER, DIGITAL MEDICAL SOLUTIONS

This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.

5) IMPLEMENTING EFFECTIVE WAYS TO REDUCE AND TRACK RADIATION DOSE FOR X-RAY EXAMS

El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.

6) DIGITAL BREAST TOMOSYNTHESIS NECESSARY FOR IMAGING DENSE BREAST TISSUE

This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.

7) RADIOLOGY’S RESPONSE TO HEALTHCARE CONSOLIDATION – STEP ONE: THE GLOBAL WORKLIST

With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.

8) THE ROLE OF A FULLY INTEGRATED RIS-PACS: DREAM OR REALITY?

Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”

9) RADIOLOGY AND MACRO HEALTHCARE TRENDS PART II: COST

In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.

10) THE THREE-PHASE PROCESS TO IMPLEMENT A PACS-DRIVEN TELERADIOLOGY SERVICE

Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Digital Breast Tomosynthesis Necessary for Imaging Dense Breast Tissue

Digital Breast Tomosynthesis

The image on the left is a DBT image, and the image on the right is traditional 2D mammography.

Digital breast tomoysnthesis (DBT), or 3-D mammography, has often been referred to as being the key to advancement in breast imaging. With more and more states passing laws requiring that women be notified if they are classified as having dense breast tissue, DBT is proving to be beneficial in accurate detection—a JAMA study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers.

Dense breast tissue and the accompanying notifications to women who possess it has become a frequent conversation topic over the past couple years. As of now, 20 states have enacted laws that require medical professionals to notify women if their mammograms reveal them to have dense tissue. Organizations such as Are You Dense Advocacy are fighting the good fight trying to get more states on board with these notifications because of the major risk dense breast tissue presents— making it more difficult to detect cancer in a mammogram than normal tissue.

At the International Congress of Radiology (ICR) in September 2014, Dr. Marwa Adel from Misr University for Science and Technology and Cairo Scan in Egypt presented two cases:

  1. The first case, Dr. Adel and company compared breast cancer visibility in digital mammography with that of DBT. Cancer visibility was ranked higher for DBT than for digital mammography in 52% of cases and was equivalent in 49 cases (33.6%). When observing the group with higher breast tissue density, the cancers were rated more visible in 64.6% of the cases.
  2. In the second study, DBT also proved better than digital mammography in image quality of masses. DBT was rated as equivalent or superior to digital mammography in 96% of the total findings.

Dr. Adel and the other authors of the studies concluded that DBT is superior to digital mammography in diagnostic performance. Particularly when it comes to dense breast tissue, it is clear that the use of DBT is vital to providing improved diagnosis to patients.

There are important questions regarding financial, technical, product, and workflow issues related to DBT that should be answered before a facility installs a system. As women’s healthcare continues to evolve, more and more facilities are able to implement DBT machines and be in a position to provide the highest quality of care to their patients.

At RSNA 2014, Carestream will showcase enhancements to its DBT module including a DBT image map that indicates the location and orientation of the currently displayed slice in the breast, a slabbing tool that allows  adjust of the slab thickness , improved workflow settings and the display of DICOM-compliant 2D synthetic views, which are calculated from the 3D dataset.  For more information, you can visit us in South Hall at booth #4735.

UPDATE, NOVEMBER 10, 2014: According to an article published last week by Health Imaging, “the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.”  You can click the link to get more details about the designated codes and payment amounts for DBT. CMS said it will also “revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.”

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream Ron Muscosky, Worldwide Product Line Manager, Healthcare Information Solutions, Carestream