Feature | RSNA | January 16, 2023 | By Melinda Taschetta-Millane

What Lies Ahead in 2023

At RSNA22, conversations revolved around the patient perspective, doing more with less, radiologist burnout, AI’s role, data disconnect and unmet imaging needs

The Radiological Society of North America’s (RSNA) 108th Scientific Assembly and Annual Meeting (RSNA22) took place at Chicago’s McCormick Place Nov, 27- Dec. 1, carrying through its theme of “Empowering Patients and Partners in Care.”

The pace of the conference felt more like its pre-pandemic days, with registration nearing 38,000, in comparison to 23,000 onsite and nearly 7,000 virtual attendees in 2021, and 2020’s completely virtual meeting. “The robust attendance numbers demonstrate that people still want the valuable interaction and networking experiences that a meeting like ours provides,” said RSNA Executive Director Mark G. Watson in a written statement. He added, “We are proud to be able to offer our attendees an exciting in-person experience, as well as virtual access to nearly 100% of all meeting content.”

There were many important takeaways of trends we will be seeing in 2023 from RSNA22. Here are highlights from just a few.

Data Disconnect

During its virtual roundtable at RSNA22, leaders at Philips Healthcare presented an overview that started with a discussion of the primary challenges its customers and partners have been facing as they deliver access to the highest quality care. “We’re seeing the themes of staff shortages, and an explosion of data disconnect … it’s an inefficient and fragmented workflow,” stated Kees Wesdorp, chief business leader for Precision Diagnostics at Philips. He noted, “We already had, over the last few years, tremendous pressure on radiologists and staff, in terms of burnout. And I can tell you that has only increased.”

Wesdorp said it could be argued that data will help provide additional insights. However, he cautioned, the more data available, the more pressure you will have on teams and clinicians to come up with the right diagnosis. “The data needs to be streamlined, and it needs to be orchestrated in a way that provides insights. There’s inefficiency. We need to make sure that we provide access to quality care for the ever-increasing patient volume, increasing chronic diseases, and at the same time, for the customer,” he said.

Gadolinium Solutions

In September, Bracco Diagnostics announced, in collaboration with Guerbet, that the U.S. Food and Drug Administration (FDA) had approved gadopiclenol, a new, highly stable macrocyclic gadolinium-based contrast agent (GBCA). The introduction of VUEWAY injection is the result of a strategic, global collaboration between Bracco and Guerbet in both research, development and manufacturing of the product signed in December 2021. As noted by representatives from Bracco who spoke with the ITN editorial team, these ongoing updates and solutions help to address the contrast agent supply issues, while reinforcing patient safety and supporting clinical workflow. As covered in a Dec. 5 itnonline.com article, Bracco released new information from a recent survey of radiology professionals, uncovering perspectives and expectations, with a focus on magnetic resonance imaging (MRI) contrast agents.

In collaboration, Guerbet spotlighted its novel new drug Elucirem (gadopiclenol) at RSNA22. Gadopiclenol, which was initially invented by Guerbet, with the subsequent contribution of Bracco’s intellectual property, is a new macrocyclic gadolinium-based contrast agent (GBCA) with high relaxivity. The efficacy and safety of gadopiclenol have been evaluated in magnetic resonance imaging of the central nervous system and body.

“It’s very exciting to be back at RSNA, to give the radiology community a first-hand opportunity to experience the clarity of MRI images offered by our new MRI product, Elucirem,” said David Hale, chief executive officer of the Guerbet Group. He added, “We look forward to sharing insights about gadopiclenol, a novel, highly stable macrocyclic gadolinium-based contrast agent offering the highest relaxivity in its class for magnetic resonance imaging.”

Radiologist Burnout

Radiologist burnout was top of mind at RSNA22, which was reiterated by Ioannis Panagiotelis, chief marketing officer, MRI, at GE Healthcare. He echoed the sentiments of the radiology community in his comments: “We’re trying to cope with these 50% increases in patient volume … and, of course, stressed human beings are still human beings at the end of the day. They’re looking at images and trying to decipher pathologies. If they get that wrong, the treatment prescription will not be accurate,” he explained. He further added, “We have this breakthrough technology called Air Recon DL. It’s basically an AI engine based on deep learning, and we’ve trained it to look at hundreds of thousands of images, which basically, number one, sharpens the images, but also speeds up the scan time. Before, those were like opposing attributes — if you wanted more quality, you needed to scan longer.”

A main area of focus for Bayer at RSNA22 was representation of the company’s commitment to help address staff shortages, with solutions that focus on a range of high priorities: patient throughput and workflow efficiencies to drive automation and standardization; scientific investment for the benefit of both patients and their physicians; and leveraging the vast potential of data and AI.

Jennifer May, associate director of communications for Bayer, outlined how the company is trying to ease burnout for its clients in a discussion at RSNA22, noting, “We are trying to assist our customers with innovative solutions to really provide them with data that create insights. So, it’s all about efficiency, automation and standardization.”

May added, “We’re focusing on really taking on this year’s RSNA motto of ‘empowering the patient’ to try to position the role of patients and radiologists in the whole healthcare continuum a little bit better. We are seeing recurring themes here. We have staff shortage, we have the increasing amount of data that is being generated and has to be processed, and there is this this real need — this demand for more automation for standardization … we’re trying to really come from that perspective of what do the customers need, and we then build more of a realistic portfolio of what can be offered to help solve those problems …helping create solutions for the customer.”

David R. Gruen, MD, MBA, FACR, chief medical officer at Merative, summarized the burnout crisis well. “One of the big trends is there really is a crisis of radiologists. There are just not enough of us to get the work done,” he stressed, adding, “And so, we need to think about as an industry, ‘What we do and how do we do it?’ We’re not looking for more machinery to take care of more patients, because we don’t have the people to actually push the buttons on a scanner … we’ve tried to figure out a way to get more people through our system and added machines to do that, we as an industry. I think one of the major themes the industry is looking for is technology solutions that we can invest in to help with a problem. We kind of anticipated this, but not to the extent that it has panned out,” explained Gruen.

So what are the workflow solutions? “We need smarter workflows. We need to move to the cloud so that we can look at images wherever we are, wherever they are,” suggested Gruen. “Instead of turning on Jeopardy at seven o’clock, I can sit at home and read for an hour and make a little bit of a dent in the work list. And yes, I don’t want to take my work home. But because of this concept of universal viewing or universal workflow — seamless workflow wherever we are, which is very much the mission that we’re on — we can make life better for radiologists on their grounds. And I think that’s the pain point that we as an industry need to address. So, I feel like we’re ahead of the curve, which is really delightful, but I think there’s a lot that still has to change in our industry.”

The Power of AI

Artificial intelligence (AI) was prominently on display at RSNA 2022, playing a key role in hundreds of research papers, courses and education exhibits. Advances in AI applications and technologies were abundant on the technical exhibition floor.

“AI is proving to be an important tool to assist radiologists in disease detection and improve radiology workflow,” said RSNA’s Watson. “RSNA will continue to provide its attendees a wide variety of AI sessions and showcase AI-based solutions on the exhibit floor.”

As demand for minimally invasive surgery continues to grow, GE Healthcare is committed to helping clinicians use image guidance technologies to their full potential by removing barriers to provide quality care to patients, for better clinical and operational outcomes. The company noted that its new Allia Platform represents the culmination of a multi-year collaboration with interventionalists and surgeons with the goal of enhancing user experience, improving workflow efficiency, and increasing the adoption of advanced image guidance in daily practice, all of which are important factors in today’s constrained healthcare environment.

Unmet Breast Imaging Needs

Hologic’s Affirm Contrast Biopsy software was being displayed for the first time since becoming commercially available in the United States at RSNA22, which Erik Anderson, president of Hologic’s Breast and Skeletal Health Solutions Division, described as being a great example of the company’s commitment to physicians and patients in action.

Affirm Contrast Biopsy software allows clinicians to target and acquire tissue samples in lesions identified with I-View Contrast-Enhanced Mammography software. The contrast solution provides healthcare facilities with a viable and attractive alternative to breast MRI, which historically has been used to find and biopsy more elusive lesions, such as those that cannot be seen via mammography or ultrasound. While breast MRI can be time-consuming and costly, contrast technology gives radiologists another option in the mammography suite that addresses these shortcomings, according to the company, which also reported that in a recent clinical study, 98% of patients had an overall positive opinion of their procedure experience with Affirm Contrast Biopsy software.

“Through our partnership with Mary J. Blige, and continued partnerships with Sheryl Crow and Katie Couric Media, we feel it’s our responsibility to reinvest more not just back into more staff, innovation and technology, but also into awareness, access and advocacy,” said Paola Wisner, vice president, global research and development, for Hologic. She added, “Health equality has been a big initiative and includes our $20 million initiative into Project Health Equality to help address those gaps.” The program addresses structural and cultural barriers to high-quality, culturally competent healthcare for black and Hispanic women.

Wisner stressed the importance of communicating with women to get their annual mammograms, a big priority now after the pandemic. “Our partnerships help us amplify that message,” she noted. “We are seeing more women coming back to get their mammograms, and radiologists need to have better workflow efficiencies. So, our focus has been on better imaging, more accuracy, and the use of AI to increase that workflow efficiency for radiologists … then to support them through that to improve workflow, detect more cancers and make it easier for the staff in the system. We’re also looking at their whole continuum, the whole breast cancer journey, making sure that we are the go-to for women.”

Pushing Imaging Boundaries

According to Felix Mueller Witt, global head of product marketing and MRI for Siemens Healthineers, it’s all about pushing the boundaries of what is clinically possible with MRI images. “That means looking into those challenging diseases with clinicians who right now don’t have an answer … especially with scans, as we’re looking at neuroscience, and oncology neuroscience, or degenerative diseases in general, where researchers and clinicians are still looking for the right answer, and to be able to diagnose early enough, we’ll be able to track the treatment progress,” he said.

To that end, at RSNA22, Siemens Healthineers showcased three works-in-progress that are pushing these boundaries. The Magnetom Cima.X 3T MRI system provides deeper insights into the human body, featuring Gemini Gradients with 2001 mT/m at 200 T/m/s for an unparalleled whole-body performance. The Gemini Gradients will reportedly empower clinical care and push the boundaries of MR innovation.

Magnetom Viato.Mobile 1.5T offers the flexibility to decide, every day, where MRI services are needed most. Built on Siemens’ most powerful 1.5T platform, it puts cutting-edge AI at the fingertips to accelerate and enhance clinical performance. With its intelligent assistance, the system guides through every step of the workflow, while also putting patients at ease.

Magnetom Terra is the first 7T MRI scanner for diagnostic imaging, designed for unprecedented breakthroughs in clinical care. Its dual mode allows the user to switch between clinical and research operations, with separate databases to distinguish between clinical and research scans, noted company representatives.

Stay tuned, as these new systems possibly could be on display at RSNA23.

Changes in PACS

Vendors are talking about flipping their PACS systems. “This was reaffirmed to me when I read the KLAS PACS report that was just released in November,” said Michael Valante, Dell’s global business development lead-healthcare UDS and chief technology officer-digital pathology. He added, “The KLAS report said that 30% of the people they surveyed were either actively switching or engaged in the process of picking a new vendor to switch their PACS. And if you think about that, that is probably two and a half to three times more than you might expect.”

Valante said he feels this is good news for the industry. “It can help snap it out of its hibernation for the last couple of years. And that also could be a reason for the 30% versus 10-15% over the last couple of years … I think there’s probably some of that pent-up demand that would drive that 30%, too. I don’t think it’s just the replatforming. I think there are probably a lot of busy PACS vendors this week [at RSNA22].”

Cybersecurity

There are many clinical benefits of cloud native technology. One of the bigger ones is cybersecurity. “We know that in the last two years, especially during the pandemic, there were more ransomware attacks,” said Sonia Gupta, MD, chief medical officer at Change Healthcare. She added, “In the hospitals that experienced those attacks, many of them, the cost of all the aftermath was over $9 million per security incident. So cloud native imaging and cloud native storage makes everything more secure. It makes it harder for those types of attacks to occur.”

Gupta commented that another big hurdle is the recent volume of consolidation, noting: “You may have a practice that has multiple different imaging centers, geographically separated, and they’re on a different system. So now you have to have a radiologist or a cardiologist that has to travel to multiple sites and have multiple different logins, and has to learn how to use multiple different systems … all of those things impact the ability to be efficient and accurate with patient care,” she said. “If you’re able to bring all those systems onto one, then it just makes it easier for everyone involved at all the different sites, and they can all work more as a team, like you’re unifying all the workflows.”

Efficiency and Ergonomics

According to Eric Mahler, business marketing manager at Philips Healthcare, it’s all about time-savings now. “You have less staff, with more work being thrown at the staff,” he stated. “So, we really need to standardize and decrease the amount of time we’re working on. Be more efficient on the ergonomics … even the clicks add up with technicians, and if we can make this faster this means more time.”

An example is the new Philips compact ultrasound 5000 series, which gives the same image quality as the others, but in a compact system. Philips also offers a solution called Collaboration Live, noted Mahler, who explained, “So essentially, if you have a tech on site, they can remotely connect with an expert and the expert tech can provide real time, over-the-shoulder support. This is especially important in today’s environment, where you have a lack of technologists in a big way.”

In Case You Missed It

Virtual Access to RSNA 2022 is available on-demand until May 1, 2023. And mark your calendars now for RSNA 2023, RSNA’s 109th Scientific Assembly and Annual Meeting, which will take place Nov. 26-30, 2023, in Chicago.