Artificial Intelligence: Imaging’s Next Frontier?

24x7mag.com/2018/05/artificial-intelligence-imagings-next-frontier/

Imaging
Published on May 23, 2018

By Elaine Sanchez Wilson

Type “artificial intelligence” and “radiology” into a Google search, and one can observe how the
sophisticated technology has been increasingly inserted into conversations about the future of the
profession. During last year’s annual meeting of the Radiological Society of North America, for example,
attendees showed they were eager to discuss their impact; more than 100 sessions explored the topics of
AI and machine learning. Despite prominent computer scientist George Hinton’s bold declaration that AI
would replace radiologists in five to 10 years, the radiology community isn’t holding the technology at
arm’s length. Rather, many are embracing its potential to enhance their work.

For example, Srikar Adhikari, MD, MS, section chief

of emergency ultrasound and director of the
Emergency Ultrasound Fellowship at University of
Arizona College of Medicine–Tucson, hoped to
identify AI tools that could simplify time-
consuming cardiac measurements. The department
had a checklist: ease of use, accuracy,
reproducibility, reliability, and impact on workflow.

“With the AI-powered Venue ultrasound system

from GE Healthcare, users with basic ultrasound
skills can use the AI tool and obtain cardiac GE Healthcare’s AI-powered Venue ultrasound system

measurements rapidly,” Adhikari says. “It increases

efficiency, user confidence, and positively impacts
the emergency department workflow.”
To Adhikari, radiologists are more than just image interpreters; in fact, there’s room at the table for both
human and machine. “It will augment what they do by increasing their workflow efficiency and
minimizing errors and variability,” he adds. “As powerful as these tools are, they still need human
oversight to attain the levels of confidence that is required to make a diagnosis.”

Michelle Edler, senior vice president for imaging and care area solutions at GE Healthcare, agrees, saying
that AI offers a host of benefits for a variety of stakeholders. “AI has the potential to transform every part
of healthcare—from improved provider efficiency to increased diagnostic accuracy to more personalized
treatment,” Edler says. “Because of this, and at this early stage, we see individuals across the healthcare
system and at multiple levels benefiting from AI tools—from administrators to radiologists to
technologists.”

GE Healthcare sees much potential in the intelligent scanner, including CTs, ultrasounds, and x-rays that
are embedded with algorithms that can help provide high-quality care more efficiently, Edler
shares. Specifically, the company’s x-ray quality application helps decrease manual work required to
measure reject rates, increase capacity for diagnostic exams, and reduce unnecessary radiation exposure
to patients.

“Previously, it took up to 230 mouse-clicks to access reject data and up to seven hours to calculate a
department’s reject rate,” Edler says. “With the advanced analytics application, which will integrate AI and
be embedded into x-ray machines, radiology departments can automatically identify and analyze the
root cause of rejected x-ray images. This leads to faster, more targeted training and education, so
technologists can quickly improve their skills and, therefore, patient care.”

Early Adopter 
Dolores Dimitropoulos, manager of medical imaging at Ontario, Canada-based Humber River Hospital,
was a beta tester of GE’s x-ray app. Early on, the hospital’s quality team recognized the app’s potential
toward continuous improvement in x-ray. Because the pilot experience was so positive and productive,
the decision to purchase the app once it was officially released was a no-brainer, Dimitropoulos
maintains.

“We had already began to implement educational activities for the technologists targeting specific views
with high-percentage and high-volume acquisitions,” Dimitropoulos says. “Trialing with an individual
technologist, self-awareness was powerful. The level of detail allowed her to review her own practice and
seek support from others to improve her data within three months.”

Dimitropoulos recalls that prior to the app, at least two technologists had to travel monthly to each of
the hospital’s seven DR x-ray rooms over three locations and two floors—as well as to six mobile x-ray
units in four locations on three floors. That’s because they needed to extract the repeat/reject data,
return back to the department, and document manually into a spreadsheet to calculate the overall
repeat/reject rate. “The process was incredibly time-consuming, and the data produced was limited,” she
says. “The outcomes in the past were more generalizations from which it is difficult to provide targeted
education or other initiatives to improve our error rates.”

Since using the app, Humber River Hospital has enjoyed countless benefits, Dimitropoulos maintains. For
one thing, users have instant access to data, with quick insights into repeat/reject trends down to the
exam view. Plus, the time and labor associated with previous manual documentation has been
eliminated. And, finally, the tool tracks the performance of the hospital’s 55-plus technologists,
highlighting opportunities for self-improvement.
“The X-ray Quality App has helped us empower and better train technicians, elevate x-ray as a modality,
and ultimately improve the patient experience,” Dimitropoulos concludes.

Automation Enhancements 

Another company that is eager to tap into AI’s potential is Malvern, Pa.-based Siemens Healthineers. At
last year’s RSNA annual meeting, the company showcased its Fully Assisting Scanner Technologies (FAST)
Integrated Workflow with the new FAST 3D camera. The accessory uses artificial intelligence and deep
learning technology to facilitate accurate isocentric positioning of patients, Siemens officials reveal.

Matthew Dedman, CT marketing director

of Siemens Healthineers North America, says it’s a
pretty significant portion of patients who aren’t at
that exact isocentering. This can occur for a
number of reasons: the technologist’s level of
experience, the size of the patient—and even
something as seemingly innocuous as the
technologist’s height.

Regardless of the scan or the environment,

accurate isocentering is a prerequisite to achieving
high diagnostic image quality, Dedman says. After
all, he explains, such accuracy will benefit both Siemens’ Somatom Edge Plus CT system, which features the
patients and CT providers because accurate new FAST 3D camera

positioning is a key input into the output quality.

What Siemens’ FAST 3D camera does, Dedman says, is take both 3D and infrared images of the patient.
From that data, Siemens has an artificial intelligence algorithm that will identify different body regions.
For instance, the algorithm can identify a head versus a chest versus an abdomen—and then based on
the protocol that’s been selected, it will automatically position that patient at true isocenter per the
exam. “Once they take the 3D and infrared image of the patient, with just a simple press and hold of a
move button, the system will automatically move the table up and into the gantry and position the
patient at isocenter,” Dedman adds.

Because if patients are not properly positioned, CT image quality will be compromised. “You’re typically
going to see noisier images that are harder to interpret for the radiologist, and these images will likely
take longer for the radiologist to interpret,” Dedman says. “We know that the workload on radiologists is
ever-increasing, and they’re being measured on ever-decreasing turnaround times.” If it takes
radiologists longer to read a study due to insufficient image quality, he says, their workflow will bear the
consequences.

In other words, Dedman says, the seemingly simple task of positioning a patient can have strong
implications if it’s not done correctly. “And those are the variabilities that we can eliminate now with the
FAST 3D camera,” Dedman says. “We can deliver consistent reproducible patient positioning, which
translates to consistent reproducible image quality.”

Moving forward, he says, Siemens is mulling ways to automatically deliver relevant quantitative
information to the radiologist. Specifically, Dedman says, “We’re looking to enhance the work of the
radiologist, as well as technologists, and make them more efficient in their daily care.”

Man vs. Machine?

Dedman observes that AI is still largely a broad term in the medical world, and certainly within the
radiology world. As a result, healthcare providers who are hoping to improve their workflow processes
with new technology should evaluate their goals internally, rather than adopt AI only for its buzz factor. “I
think it’s a matter of looking at what clinical challenges in your care and in your practice you’re looking
to improve and then seeing what AI solution out there could specifically benefit that,” he says.

Srikar Adhikari, for one, recommends that radiology departments consider well-developed AI tools with
minimal errors that can replace time-consuming measurements or increase diagnostic certainty. “It’s
helpful to have a tool that’s accessible at the bedside, and that fits into your workflow and improves your
efficiency,” he says.

And is machine on its way to replace man? Not so, Dolores Dimitropoulos says. “[Radiology] is evolving
as imaging becomes not just diagnostic, but more therapeutic, and demand for imaging invasive
procedures is rising. AI will be radiologists’ virtual assistant, supporting them in improving the quality of
the diagnosis for high-volume reporting, like chest, abdomen or extremity bone exams, and potentially
highlighting abnormalities that may have been missed due to interruption, distraction, or screen fatigue.”

GE’s Michelle Edler agrees. “The implementation of AI in healthcare will lead to a world of ‘man plus
machine’ not ‘man versus machine,” she says. “AI tools are designed to enhance and empower
radiologists’ work and eliminate mundane or administrative tasks. As such, radiologists’ role will evolve
with the technology—enabling them to become a more integral part of multidisciplinary teams and
closer to their patients.”

Elaine Sanchez Wilson is the former associate editor of 24×7 Magazine. Questions and comments can be
directed to 24×7 Magazine chief editor Keri Forsythe-Stephens at kstephens@nullmedqor.com.