The year in X-ray news saw radiologist shortages, innovations in detector technology, increasing AI adoption, new scanners from the leading OEMs and a pivot closer to the tenets of value-based care. Here, in chronological order, are the nine biggest X-ray stories of the year from our Daily News online.

No-show rate hit 55% in medical imaging during the peak of pandemic
No-shows for imaging soared 55% in 2020, according to a study out of Mount Sinai Health System in February. Researchers at the New York City hospital chalked the trend up to social distancing measures and said it is in line with an 85% drop in total outpatient imaging volumes observed at their facility around the same time. They added that while no-show rates had stabilized, volume was still recovering.

“Presumably, the general public may have been hesitant to visit healthcare facilities for fear of exposure; and a self-imposed ‘social distancing’ with respect to healthcare facilities contributed to the increased no-show rate,” wrote first authors Dr. Amish Doshi and Dr. Shingo Kihira, of the Icahn School of Medicine in Mount Sinai’s department of diagnostic, molecular and interventional radiology.

Doshi, Kihira and their colleagues assessed data from six Sinai outpatient imaging facilities in Manhattan, Queens and Brooklyn between January and July 2020. They broke down no-show rates by modality, but excluded interventional radiology from their retrospective analysis.

No-shows began rising beginning March 10, after the emergency declaration in New York State. The rate peaked on April 9, at which point they saw a fivefold increase in patients failing to appear for their appointments across CT (19% to 64%); MR (29% to 47%); PET (24% to 55%); ultrasound (20% to 43%); DEXA (17% to 78%); and mammography (24% to 70%). While the rate of no-shows for all of these returned to normal by June 1, radiography was slower to recover, with no-shows rising from 3% during the baseline period (Feb. 3 to March 2) to 26% in one month after March 10. Recovery for it was slow throughout June and July.

Coal miner chest X-ray readings vulnerable to financial bias
In March, research published in the Annals of the American Thoracic Society showed that chest X-ray diagnoses for coal miners may be compromised due to financial bias on the part of the doctor reading the results.

The researchers, based out of the University of Illinois Chicago (UIC), investigated assessments of coal worker’s pneumonoconiosis (also known as black lung disease), which is caused by the inhalation of dust. Physicians hired by the U.S. Department of Labor or a miner were found to be less likely to have biased assessments, compared to those hired a miner’s employer.

"Not only are those hired by an employer much more likely to classify a chest X-ray as negative for black lung disease, but it is also much more likely that an employer will have the resources to hire its own expert — at a much higher fee — in the first place,” said senior author Dr. Robert Cohen, clinical professor of environmental and occupational health sciences and director of the Mining Education and Resource Center at UIC.

Diagnoses were made by 264 physicians from 63,780 X-rays of coal miners who filed workers’ compensation claims of total disabling disease with the Federal Black Lung Program, reported the authors. B-readers — individuals certified to review radiographs for black lung disease — who were hired by a coal miner’s employer listed 84.8% of images as negative for black lung disease. Those hired by the USDOL marked 63.2% negative and those hired by a miner labeled 51.3% negative. Sixty-four listed black lung disease as absent in 95% of their classifications. Of these classifications, 93.3% were made by employer-hired B-readers. Fifty-one made negative diagnoses in more than 99% of their assessments.

Shortage of nearly 2,000 radiologists hinders care in UK
A 33% shortage of radiologists in the UK has left patients waiting in long lines to be scanned. And it’s only projected to get worse by 2025 with a 44% shortfall, according to a Royal College of Radiology census published in April, which estimates a need of nearly 2,000 more radiologists in the NHS.

“We cannot deliver adequate services for our patients,” cautioned hospital leaders who conducted the census. “We can no longer provide cancer and acute care safely.”

The NHS requires at least another 1,939 radiology consultants to meet staffing and pre-COVID-19 demands for scans. Exacerbating the shortage is the departure of doctors who stayed on at the height of the pandemic, with 58% of hospital leaders saying they lack enough diagnostic and interventional radiologists to keep patients safe. In addition, 47% of NHS trusts and health boards report not having the staff or transfer arrangements to run safe 24/7 interventional radiology services.

While consultant numbers are increasing, they are not doing so fast enough, with waiting lists at record highs and backlogs for exams such as MR and ultrasound, leaving thousands of patients waiting more than six weeks for a scan, according to the NHS. Stricter infection control and social distancing measures brought on by the pandemic have also made scanning slower.

RCR says radiologist staffing is at a “tipping point,” with the shortage threatening NHS recovery and patients facing “long, anxious and inevitable” waits for diagnoses and surgery.

More radiologists joining ACOs, taking up value-based care in practices
A May study by the Harvey L. Neiman Policy Institute found a higher number of radiologists embracing value-based care by joining Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). Participation from the specialty had tripled from 10.4% to 34.9% over five years.

"From an economic standpoint, value-based payment models offer the opportunity for radiologist to receive financial bonuses for high quality care,” first author Stefan Santavicca, of the Georgia Tech Health Economics and Analytics Lab (HEAL), told HCB News. “Also, radiologists are interested in avoiding future penalties and preparing for the future of value-based payments and shifting away from fee for service with renewed attention to advancing alternative payment models through MACRA and MIPS.”

Established by the Affordable Care Act, the shared savings programs shift the basis for awarding economic incentives to providers from how many procedures they perform (volume) to how well they perform them (value) through the creation of quality and cost targets. They also impose financial penalties on those who do not meet these targets.

The researchers linked several separate 100% CMS data sets and found participating radiologists in 2018 in 90% of large ACOs. While this was only up from 88% in 2013, they also found participation increased twofold in small ACOs, from 26% to 52%. Participation in medium-sized ACOs rose from 63% to 66%, but the growth in participating radiologists in small ACOs is significant according to the researchers, because it signifies shared savings programs are impacting radiologists even outside of urban, large specialty ACOs that have greater capacity for coordinating care.

Several international radiology associations, including RSNA, ACR and ESR, have published a paper calling radiology a “key component” in value-based care and laid out nine steps for integration.

Samsung integrates VUNO AI with mobile digital X-ray system for chest diagnosis
As of July, Samsung Electronics’ mobile digital X-ray system, GM85 is equipped with AI developed by South Korean manufacturer, VUNO Inc.

A diagnostic chest X-ray solution, VUNO Med-Chest X-ray is expected to help GM85 users instantly retrieve and deliver AI results upon scanning an image while the patient is still in the hospital.

"Incorporating VUNO's AI technology, we can introduce a more sophisticated mobile X-ray system with AI enabled CAD," said Woo-young Jang, Samsung Electronics' head of its DR business team.

VUNO Med-Chest X-ray is designed to accurately and immediately flag suspected chest abnormalities that indicate major pulmonary diseases such as tuberculosis and pneumonia. It also can identify lung cancer based on five of the most common thoracic findings: nodule/mass, pneumothorax, interstitial opacity, pleural effusion and consolidation. Its AI algorithm has been validated in academic journals and clinical settings for its improved clinical utility and efficiency, as well as its lightweight enabled integration capabilities.

GM85’s lightweight and ultra-compact design combines a broad range of advanced technology including a quick charging and long-lasting battery for enhanced user-convenience and superior image quality. With VUNO’s AI application, the solution is expected to be especially helpful in emergency rooms and intensive care units where real-time analysis is critical, as well as in medical environments with limited or no network connections.

“This collaboration will bring us closer to making our market-ready AI applications more accessible across the globe,” said Hyun-jun Kim, co-founder, and CEO of VUNO, in a statement.

VUNO-Med Chest X-ray is fully deployed in Korea and Europe. It is expected to be commercialized as part of GM85 in Korea and other major markets worldwide later this year.

Novel X-ray detector could point toward future with more flexibility, less toxicity
In August, scientists in the U.S. and China announced they had developed a new X-ray radiation detector composed entirely of non-heavy metals.

In place of metals like lead and cadmium found in traditional detectors, the proof-of-concept wearable solution is made of nontoxic metal-organic frameworks (MOFs) layered between flexible plastic and gold electrodes for high-sensitivity sensing and imaging.

“Heavy metals are generally toxic and could pose serious health risks,” Shenqiang Ren, a developer of the detector and a professor in the department of mechanical and aerospace engineering and department of chemistry at University of Buffalo, State University of New York, told HCB News. “Lead may cause anemia, weakness, and kidney and brain damage. Cadmium can affect the kidney and lungs, especially to the proximal tubular cells, and increased risk of cancer.”

The flexible detector was made by placing the nickel-containing MOF between gold film electrodes, one of which was on a flexible plastic surface. Used copper wires transmit current from each pixel of a 12x12 array and the whole device is covered with a silicone-based flexible polymer.

Fujifilm inks 10-year digital X-ray contract with US Navy
In August, Fujifilm Healthcare Americas Corporation announced it would soon be casting its digital radiography systems out to sea on U.S. naval ships through a new 10-year sole source contract signed with the U.S. Navy and Defense Logistics Agency.

The diagnostic imaging and medical informatics provider will outfit these vessels with its clinical DR X-ray room systems, which include next-generation detector technology and a high quality compact floor mounted room, along with advanced features. The first system is set to be installed on one of the ships later this year.

“Our latest floor-mounted systems are streamlined and compact to nicely accommodate limited spaces, while providing fast, easy positioning flexibility to help ensure accuracy and patient comfort for every exam,” Lou Cavallaro, director of government business sales at Fujifilm Healthcare Americas Corporation, told HCB News at the time.

Fujifilm’s fixed Digital Radiographic Suites are designed to offer real-time imaging and reduce waiting times. They are equipped with a smart touch screen display at the X-ray tube head that clinicians can use to adjust the exam parameters to ensure patients are properly positioned. The entire system is integrated with Fujifilm’s FDX Console advanced acquisition workstation, which offers automatic features to simplify workflow, reduce dose delivery and generate quality images.

GE launches fixed digital X-ray system, Definium Tempo
To reduce work-related injuries and lessen the burden technologists face when setting up digital X-ray scans, in September GE Healthcare introduced a new fixed system designed to automate imaging processes and reduce workflow burdens.

Definium Tempo is designed to allow radiologists and technologists to spend more time with patients while still ensuring that images produced are of high-quality and usable for making diagnoses and decisions about treatment. The solution is expected to maximize ergonomic operations for the technologist, while lowering patient anxiety.

"Our next-gen fixed X-ray system, Definium Tempo was designed to be a personal assistant to radiologists and technologists - acting much like an in-room 'command center' and enabling the technologist to finish all exam setup and positioning work without having to leave the patient's side helping radiology departments deliver the best patient care possible," Tanya Lancaster, GE Healthcare - General Manager for Fixed X-ray, told HCB News.

Technologists, radiologists and radiology administrators are facing increased workloads and often endure heavy lifting, repetitive motions, uneasy patients and long hours in their daily work environment. More than 70% of technologies experience work-related injuries. In addition, variability in patient positioning and exam set up can lead to extra dose with retake imaging rates as high as 25%.

The console oversees all functionality, including patient selection, protocol selection, technique modification and positioning setup. With it, the technologist can set up the exam and position work without having to leave the patient’s side. Automated workflows support the exam, with auto positioning, auto centering and auto tracking.

Intermountain Healthcare launches Tellica Imaging for outpatient services
Intermountain Healthcare launched Tellica Imaging in October, a subsidiary company that will open stand-alone outpatient imaging centers.

Equipped to provide noninvasive MR and CT imaging, the centers will be located at three Utah locations in Ogden, West Valley City and Orem, starting in late 2021. An additional five will be set up in 2022, with more to come in the following years. Costs for both services at Tellica locations will be flat-rate and below those of hospital-based imaging.

“While hospital-based imaging services remain an important part of the care process, particularly in emergency situations and when complex imaging services are needed, many patients prefer to access CT scan and MR imaging services in convenient settings closer to home,” said Nannette Berensen, vice president and chief operating officer of clinical shared services at Intermountain.

The company plans to hire approximately 20 employees to manage all three centers. Berensen will serve as the chair of the board and interim chief executive officer of Tellica Imaging, while Brad Isaacson, who joined Intermountain in 2015, will be its chief operating officer. Dr. Douglas Greally, who has served as associate medical director of imaging operations at Intermountain since 2018, will be the company’s chief medical officer.

The launch of Tellica Imaging may especially be beneficial for patients insured by UnitedHealthGroup, Anthem and Cigna, all of which are among insurance providers who have stopped covering MR and CT scans in hospital settings over the last few years and instead encourage patients to seek care at lower-cost stand-alone facilities, according to Modern Healthcare. Following “thoughtful” discussions with radiologists and radiology groups like ACR and SPR, Anthem recently adjusted this policy back in August by agreeing to cover children under 19 for imaging in hospitals.