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This is an overview of trends and technologies in radiology artificial intelligence (AI) applications in 2021. Views were shared by 11 radiologists using AI and industry leaders, which include:

• Randy Hicks, M.D., MBA, radiologist and CEO of Reginal Medical Imaging (RMI), and an iCAD Profound AI user.

• Prof. Dr. Thomas Frauenfelder, University of Zurich, Institute for Diagnostic and Interventional Radiology, and Riverain AI user. 

• Amy Patel, M.D., medical director of Liberty Hospital Women’s Imaging, assistant professor of radiology at UMKC, and user of Kios AI for breast ultrasound. 

• Sham Sokka, Ph.D., vice president and head of innovation, precision diagnosis, Philips Healthcare.

• Ivo Dreisser, Siemens Healthineers, global marketing manager for the AI Rad Companion.

• Bill Lacey, vice president of medical informatics, Fujifilm Medical Systems USA.

• Karley Yoder, vice president and general manager, artificial intelligence, GE Healthcare.

• Georges Espada, head of Agfa Healthcare digital and computed radiography business unit.

• Pooja Rao, head of research and development and co-founder of Qure.ai.

• Jill Hamman, world-wide marketing manager at Carestream Health.

• Sebastian Nickel, Siemens Healthineers, global product manager for the AI Pathway Companion. 

There has been a change in attitudes about AI on the expo floor at the Radiological Society of North America (RSNA) over the last two years. AI conversations were originally 101 level and discussed how AI technology could be trained to sort photos of dogs and cats. However, in 2020, with numerous FDA approvals for various AI applications, the conversations at RSNA, and industry wide, have shifted to that of accepting the validity of AI. Radiologists now want to discuss how a specific AI algorithm is going to help them save time, make more accurate diagnoses and make them more efficient.

With a higher level of maturity in AI and the technology seeing wider adoption, radiologists using it say AI gives them additional confidence in their diagnoses, and can even help readers who may not be deep experts in the exam type they are being asked to read. 

With a myriad of new AI apps gaining regulatory approval from scores of imaging vendors, the biggest challenge for getting this technology into hospitals is an easy to integrate format. This has led to several vendors creating AI app stores. These allow AI apps to integrate easily into radiology workflows because the apps are already integrated as third-party software into a larger radiology vendors' IT platform.  

There are now hundreds of AI applications that do a wide variety of analysis, from data analytics, image reconstruction, disease and anatomy identification, automating measurements and advanced visualization. The AI applications can be divided into 2 basic types — AI to improve workflow, and AI for clinical decision support, such as diagnostic aids.

On the workflow side, several vendors are leveraging AI to pull together all of a patients' information, prior exams and reports in one location and to digest the information so it is easier for the radiologist to consume. Often the AI pulls only data and priors that relate to a specific question being asked, based on the imaging protocol used for the exam. One example of this is the Siemens Healthineers AI Clinical Pathway and Siemens AI integrations with PACS to automate measurements and advanced visualization.

AI is also helping simplify complex tasks and help reduce the reading time on involved exams. One example of this is in 3-D breast tomosythesis with hundreds of images, which is rapidly replacing 2-D mammography, which only produces 4 images. Another example is automated image reconstruction algorithms to significantly reduce manual work. AI also is now being integrated directly into several vendors' imaging systems to speed workflow and improve image quality.

Vendors say AI is here to stay. They explain the future of AI will be automation to help improve image quality, simplify manual processes, improved diagnostic quality, new ways to analyze data, and workflow aids that operate in the background as part of a growing number of software solutions. 

Several vendors at RSNA 2020 noted that AI's biggest impact in the coming years will be its ability to augment and speed the workflow for the small number of radiologists compared to the quickly growing elder patient populations worldwide. There also are applications in rural and developing countries were there are very low numbers of physicians or specialists.

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Cree Gaskin, M.D., professor, vice chair and associate chief medical officer, University of Virginia Health System, explains how new technology can be used to improve radiology reports without additional workload. His health system uses a new generation integrated RIS/PACS system that allows URL links and new graphical data presentations to be embedded into radiology reports to make them more interactive. This information can include quantifications, key images from the exam, access to full datasets, 3-D reconstructions and ability to immediately link to prior exams. He spoke is sessions on this topic at the 2019 Healthcare Information Management and Systems Society (HIMSS) conference.

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Andrew Deutsch, M.D., MBA, chairman and CEO of Renaissance Imaging Medical Associates (RIMA), an affiliate of Radiology Partners, describes RIMA’s use of an artificial intelligence (AI) based worklist workflow to manage reads across 70 sites and load balance between 120 radiologists. He spoke in sessions on this topic at the 2019 Healthcare Information Management and Systems Society at (HIMSS) conference.  

Deutsch, a nationally respected expert in skeletal radiology and magnetic resonance imaging (MRI) and in addition to his roles at RIMA, serves as medical director of the imaging departments at Northridge Hospital Medical Center and Valley Presbyterian Hospital.

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