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COVID-19 halted all cancer screening services at the beginning of the pandemic, and slowly those scans have become more and more available -- but, not necessarily for everyone.

In many instances, racial and minority patients continue to face the same healthcare disparities that made it difficult for them to access the services at the outset. Now, the fear and trepidation associated with the pandemic are layered on top. 

Despite these difficulties, there are things healthcare institutions and providers can do to help. In this episode of 

 spoke with Shalmon Kalnicki, M.D., chair of radiation and oncology at Montefiore and Albert Einstein College of Medicine about the challenges these patients continue to face with cancer screenings. Not only did he share with us how COVID-19 has impacted this existing problem, but he also outlined the steps institutions can take to improve this situation.


In this podcast episode, Dr. Shalom Kalnicki, from Montefiore and Albert Einstein College of Medicine, discusses the disparities minority patients face with cancer screenings and what can be done to increase access during the pandemic.

The Reading Room: Racial and Ethnic Minorities, Cancer Screenings, and COVID-19

Current lung cancer screening guidelines could be overlooking African American smokers who are at risk for developing lung cancer.

According to a study published in the Sept. 15 

Journal of the American College of Radiology

 the current guideline based on the 30-pack-year threshold sets the bar too high, as most African American smokers self-report a less than 30 pack-year history. This determination sounds an alarm bell because African Americans have a high incidence of and worse outcomes from lung cancer.

“There is growing concern that there are healthcare disparities in lung cancer screening guidelines and programs,” said lead study author Anupam Basu, M.D., a diagnostic radiologist in Cook County Health. “Evidence suggests that the National Lung Screening Trial (NLST) and Preventive Services Take Force inclusion threshold of a 30-pack-year smoking history excludes a portion of African American patients at risk for lung cancer.”

Even though African Americans are more significantly impacted by lung cancer, the team said, they still only account for 4 percent of the NLST. Based on existing evidence this group does have a smoking duration history similar to their white counterparts – but, they actually smoke fewer packs a day. Consequently, they have a shorter pack history – the benchmark providers use to determine who should undergo lung cancer screening.

The team, therefore, suggested lung cancer screenings would be much more accurate and impactful if they adopted a 20-pack-year threshold.

To subscribe to The Reading Room podcast, click 

To identify a threshold that could better identify more African American smokers who could benefit from lung cancer screening, the team retrospectively reviewed low-dose CT scans from patients in their public hospital between September 2017 to December 2019. 

All total, they reviewed data from 784 patients, 57.5 percent of whom were men with an average age of 62. The majority were African American (66.2 percent), followed by white (20.4 percent), Hispanic (8.3 percent), Asian (4.8 percent), and Native American (0.3 percent).

Of the group, three-quarters – 75.5 percent – were active smokers, and just more than half – 51.5 percent revealed a pack history of fewer than 30 years. Total years smoked did not vary much by race, the team said. But, the African American experience was somewhat different, and it painted a grim picture.

“African Americans smoked fewer packs per day and had fewer pack-years compared with other races,” the team said. “African Americans were more likely to be active smokers but also more likely to report [less than] 30 pack-years compared with other races.”

Low-dose CT findings determined that lung cancer incidence did not vary by race, but African American had an incidence of 2.5 percent while whites experience 1.9 percent. Fortunately, the majority of cancers identified (75 percent) were Stage 1, and all patients had the cancerous tissues successfully removed with surgery.

Looking at lung cancer diagnosis specifically in the context of smoking brought more bad news. African Americans were the only race diagnosed with lung cancer when their self-reported pack-year history was less than 30. For smokers in this group with more than 30-pack-year histories, the incidence rate was 2.2 percent. For those with less than 30 years, it was 2.7 percent.

“We are concerned that the 30-pack-year threshold in the African American population may exclude a portion of patients who are still at risk for lung cancer,” the team said. “We propose prospective study of African Americans with [less than] 30-pack-year histories to determine the potential benefits and harms of [lung cancer screening] in this unique underserved population.”

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter

In this podcast, Dr. Anupam Basu from Cook County Health in Chicago discusses the 30-pack-year threshold for lung cancer screening that overlooks at-risk African American smokers.

The Reading Room: Lung Cancer Screening Misses At-Risk African American Smokers

Lung injuries caused by vaping leave signature marks on CT scans, a follow-up study has revealed, arming radiologists with the details needed to potentially make more accurate diagnoses and help patients avoid unnecessary biopsies.

 a team led by Michael Gotway, M.D., a radiologist at the Mayo Clinic in Arizona, laid out their findings that show these lung injuries – called EVALI (electronic cigarette or vaping product use-associated lung injury) – produce patterns on chest CT scans that correlate with previously observed pathological findings.

The first reports of EVALI surfaced last year from the Centers for Disease Control & Prevention. Within the first six months after this report, almost 3,000 EVALI-related hospitalization were recorded, as well as 68 confirmed deaths. Almost all patients present with complaints of shortness-of-breath, chest pain, and constitutional symptoms that can resemble viral illness. The non-specific nature of these symptoms can make an accurate diagnosis difficult.

 Chest Imaging Reveals Traits of Vaping-Related Lung Injuries in Teens

Based on their findings, he said, 96 percent of patients exhibited multi-focal or diffuse ground-glass opacities and consolidation that involves most or all lobes bilaterally and could involve mild interlobular septal thickening and subpleural sparing. As the illness evolves, imaging findings can suggest mild architectural distortion, intralobular lines, lobular distortion, and traction bronchiectasis.

These findings can be particularly helpful, he said, when providers are imaging younger patients with chest pain and shortness-of-breath. In those cases, a diagnosis of EVALI should be strongly considered.

Even though patients may be reticent to admit they are vaping, he said, if a radiologist recognizes one of these patterns on CT, he or she can advise the clinician, potentially leading to a nicotine metabolite test and further questions about exposure. Employing that approach could help patients avoid the invasiveness, time, expense, and risk associated with unnecessary biopsies.

“These radiological findings will be especially beneficial to physicians to help them determine potentially less invasive treatment options,” Gotway said. “We could potentially make that diagnosis non-invasively through cooperation with our clinical colleagues. By alerting them to a scan pattern that is suggestive of the possibility of EVALI, we may actually save patients from having to meet a surgeon.”

Michael Gotway, M.D., cardiopulmonary radiologist with the Mayo Clinic, discusses the signature signs of EVALI on CT scans in this podcast.

The Reading Room: Signature Signs of EVALI on CT

Emerging research suggests that a deep learning model may offer 92 percent sensitivity in lung tumor detection on CT scans and up to a 59 percent reduction in tumor segmentation time.

Study: CT-Based AI Offers Enhanced Sensitivity and Reduced Segmentation Time for Lung Tumors

In an update of previous guidelines from the European Society of Urogenital Radiology published in 2010, a 21-expert panel offered consensus recommendations on the utility of CT, MRI and PET-CT in the staging and follow-up imaging for patients with ovarian cancer.

Seven Takeaways from New CT and MRI Guidelines for Ovarian Cancer Staging 

In computed tomography (CT) scans for patients with solid non-small cell lung cancer (NSCLC) < 30 mm, emerging research suggests the lollipop sign is associated with a greater than fourfold likelihood of angiolymphatic invasion.

CT Study Reveals Key Indicators for Angiolymphatic Invasion in Non-Small Cell Lung Cancer

Seventy percent of LR-M hepatocellular carcinoma (HCC) cases were associated with rapid growth in comparison to 12.5 percent of LR-4 HCCs and 28.5 percent of LR-4 HCCs, according to a new study.

New CT and MRI Research Shows Link Between LR-M Lesions and Rapid Progression of Early-Stage HCC

A CT-based radiomic model offered over 10 percent higher specificity and positive predictive value for high-risk lung adenocarcinoma in comparison to a radiographic model, according to external validation testing in a recent study.

Can Radiomics Bolster Low-Dose CT Prognostic Assessment for High-Risk Lung Adenocarcinoma?

One of the ongoing trends with the development of artificial intelligence (AI) modalities in radiology is an increasing emphasis on improving efficiencies with non-interpretative tasks.

In a recent interview, Sonia Gupta, MD said the combination of AI and natural language processing can help retrieve and analyze key historical points from a patient’s electronic medical record (EMR). Dr. Gupta emphasized that this technology could help streamline patient triage, radiology reporting and the management of incidental finding follow-up.

“(With) incidental finding follow-up, AI reads the report and detects the findings that need follow-up … and can also insert the follow-up recommendations for you into the report. Again, this is all non-interpretative and natural language processing-based type of AI. I think that is a really great opportunity we can all utilize,” maintained Dr. Gupta, an abdominal radiologist, a board member of the American Board of Artificial Intelligence in Medicine, and the chief medical officer of Change Healthcare.

(Editor’s note: For related content, see “

Emerging Insights on Improving Radiology Workflows

Assessing the Value Proposition of AI in Radiology

AI in Radiology: Top Five Articles of 2022

Dr. Gupta said the hope is that this emphasis on simplifying non-interpretative tasks could reduce time-consuming elements of radiology workflows and help curtail burnout.

Noting that approximately one-third of radiologists are currently utilizing some form of AI in practice, Dr. Gupta said the combination of cancer screening with AI and appropriate reimbursement could accelerate AI adoption in radiology.

Pointing out there are currently upward of 200 Food and Drug Administration (FDA) 510(k) clearances in radiology, Dr. Gupta said the ongoing consolidation of AI vendors may make it easier for radiologists to choose among relevant systems for their practice. She added that consolidation could be a boon for early adopters, who may gain access to more AI offerings than they originally signed up for.

For more insights from Dr. Gupta, watch the video below.

In a recent video interview, Sonia Gupta, MD discussed a number of ongoing developments with artificial intelligence (AI) in radiology, ranging from market consolidation of AI vendors to maximizing automation and efficiency with patient triage, reporting and follow-up of incidental findings.

Emerging Trends with AI in Radiology in 2023

The purchase of new and cutting-edge imaging equipment comes with a lot of excitement—and a learning curve. That's where Canon Medical Education comes in, providing a host of education solutions for clients that include both in-person and virtual training and continuing education opportunities.

The education arm of Canon Medical Systems USA provides a customizable plan to ensure that all imaging associates are well-trained and comfortable operating advanced equipment including MR and CT, as well as vascular and cath applications, among others. 

Understanding that every learner is different, Canon offers educational opportunities that include in-person, at their Institute of Advanced Imaging in Irvine, California; on-site training at a client facility; online and instructor-led courses in their Canon Learning Center; as well as CE and non-CE webinars and special programs.

To learn more about Canon's educational offerings, 

Canon Medical Systems offer a range of in-person and virtual educational opportunities for their clients. 

Education in Radiology: Canon's Customized Approach

Morris Panner didn’t want to call the familiar PACS system outdated or antiquated. However, he did suggest that radiology is on the cusp of a revolution with medical image and data management that parallels the ongoing emergence of the radiologist from the reading room to being a key member of the interdisciplinary team in facilitating optimal patient outcomes.

“The PACS system is no longer a new invention. It is important and you can always improve it but what people are really looking for now is how to free that data, take that pixel information, share it, use it with other types of data and advance the liquidity and flexibility in data management. That was the revolution that came out of the SIIM (Society for Imaging Informatics in Medicine) meeting this year,” noted Panner, the president of Intelerad Medical Systems, in a recent video interview.

recent survey research showing an increasing patient acceptance of artificial intelligence (AI)

, and the more gradual “try it” phase for many radiologists as they discern the most optimal fit for AI in their current workflows. To that end, Panner also reviewed key aspects of Intelerad’s Enterprise Imaging and Informatics Suite. It is Panner’s hope that by emphasizing improved efficiency and quality in radiology workflows, the system can “free up brain space for great diagnostics.”

For more insights from Morris Panner, watch the video below.

In a video interview, Morris Panner, the president of Intelerad Medical Systems, discussed key observations from the recent Society for Imaging Informatics in Medicine (SIIM) conference, recent research about artificial intelligence (AI) adoption and emerging goals for enhancing the efficiency of radiology workflows.

What's Next in Medical Image and Data Management in Radiology?

Is exposure to iodinated contrast media (ICM) a potential issue for young pediatric patients? The Food and Drug Administration (FDA) recently advised clinicians to ensure thyroid monitoring for patients three years of age and younger within three weeks after exposure to ICM. However, a 

recently published statement from the American College of Radiology (ACR)

 has raised questions about the FDA guidance.

In a recent video interview, Jonathan R. Dillman, M.D., MSc, who co-authored the ACR statement, noted 

several issues with the 11 studies the FDA used to support the guidance

In addition to a lack of prospective data and a lack of control groups in most of the studies cited by the FDA, the majority of the studies focused on high-risk pediatric patients such as low birth weight premature babies, neonates and those with congenital heart disease, according to Dr. Dillman, the associate chief of research in the Department of Radiology and the medical director of the Imaging Research Center within the Division of Radiology at the Cincinnati Children’s Hospital Medical Center.

Dr. Dillman said the FDA guidance is too broad and not supported by the current research.

“Wherever the science takes us, that is where we want to go. The science at this time we do not believe calls for universal thyroid monitoring after intravascular CT (computed tomography) in children three months of age and up. … There is really no evidence to support that,” maintained Dr. Dillman, who has served on the ACR’s Drugs and Contrast Committee since 2007.

For more insights from Dr. Dillman, watch the video below:

In a video interview, Jonathan Dillman, MD, MSc discussed a recently published statement from the American College of Radiology (ACR) that questioned the literature support for a March guidance from the Food and Drug Administration (FDA) about thyroid monitoring for children three years of age or younger within three weeks of exposure to iodinated contrast media (ICM).

Iodinated Contrast Media Exposure: Is Subsequent Thyroid Monitoring Warranted for Young Pediatric Patients?

The temporary shortage of iodinated contrast media (ICM) has been a huge issue in the radiology community, not to mention the overarching impact on the health-care field. While there is proverbial light at the end of the tunnel with the 

recent announcement from GE Healthcare about resuming full production of Omnipaque products

, Sean Bryant, M.D. said there are key takeaways that radiologists can utilize in the next couple of weeks as contrast supply begins to be restored and moving forward.

In a recent video interview, Dr. Bryant, the owner and president of Diversified Radiology, discussed the impact of the ICM shortage in the neuroradiology space. In addition to appropriate use of alternative imaging, such as substituting magnetic resonance imaging (MRI) or non-contrast computed tomography (CT) for contrast-enhanced CT scans, Dr. Bryant said the guidelines from the American College of Radiology (ACR) and the American Society of Health-System Pharmacists (ASHP) have been helpful in managing the ICM shortage.

Dr. Bryant said the ICM shortage also was an opportunity to reassess imaging protocols and educate patients as well as referring clinicians on alternatives to high contrast imaging. In emergency departments, oncology care and in-patient services in a hospital, Dr. Bryant noted that clinicians at times opt for high contrast without knowing the most optimal study to order for a given clinical scenario.

For additional insights from Dr. Bryant, watch the video below.

In a recent video interview on the current iodinated contrast media shortage, neuroradiologist Sean Bryant, MD discussed imaging alternatives, emphasized communication with referring physicians on optimal studies, and discussed the ongoing need to prevent “protocol creep” with timely updates of imaging protocols.

Lessons Learned from the Iodinated Contrast Media Shortage: A Neuroradiologist's Perspective

Perhaps the biggest challenge in radiology right now is the current global shortage of iodinated contrast media (ICM), which is most commonly utilized for computed tomography (CT) exams. With the temporary shortage expected to last until the end of June, radiology departments and larger medical facilities are scrambling to address this issue, which can have a significant impact on patient care.

With this in mind, we recently spoke with two professors from the Yale School of Medicine: Dr. Joseph Cavallo, an Assistant Professor of Radiology and Biomedical Imaging, and Dr. Jay Pahade, an Associate Professor and Vice-Chair of Quality and Safety for Radiology and Biomedical Imaging.

co-authored an article on strategies that imaging facilities may take to address this acute shortage of iodinated contrast media.

 They outline three central strategies including ICM dose reduction, utilization of alternative imaging modalities and possible deferment of imaging deemed to be non-urgent in nature.

Dr. Pahade called ICM a mission critical agent.

“Most institutions rely heavily on contrast-enhanced CT for the management of their patients both inside and outside of the emergency department (ED). Almost every critical diagnosis in medicine has some arm tied to CT imaging in one fashion or another,” emphasized Dr. Pahade.

For additional insights on the shortage of iodinated contrast media, watch the video below.

In a recent video interview, two radiology professors from the Yale School of Medicine discussed the impact of the iodinated contrast media (ICM) shortage and potential strategies, ranging from ICM dose reduction to possible deferment of non-urgent imaging, that may provide a viable path moving forward. 

Emerging Strategies for Managing the Acute Shortage of Iodinated Contrast Media

Despite a number of practical benefits for patients and having comparable detection rates to conventional colonoscopy for colorectal cancer, computed tomography colonography (CTC) remains significantly underutilized. In fact, a recently published survey of over 13,700 people between the ages of 50 to 75 found that 

only 1.4 percent of respondents had CTC for colorectal cancer screening

Various authors have pointed to the lack of Medicare coverage as a key factor in the limited access and use of CTC. Noting the potential impact CTC could have in improving colorectal cancer screening rates in at-risk populations, the 

American College of Radiology recently wrote a formal request to the Centers for Medicare and Medicaid Services (CMS)

, urging the organization to reconsider non-coverage of CTC for Medicare and Medicaid beneficiaries.

With this in mind, Syam Reddy, MD, Judy Yee, MD and Anand Narayan, MD, recently spoke with 

 to discuss the benefits of CTC, limitations of access to the procedure and suggested steps for potentially resolving this issue.

In recent video interviews, Syam Reddy, MD, Judy Yee, MD and Anand Narayan, MD, discussed various benefits of computed tomography colonography (CTC) for colorectal cancer screening, the underutilization of the CTC procedure and steps moving forward to improve access to this procedure.

Emerging Perspectives on Computed Tomography Colonography

Despite the technological advances in transferring electronic health information, medical imaging data, to this day, is predominantly exchanged between instiutions via physical media (such as a CD or flash drive) that patients carry to an appointment at another facility.

Emphasizing the impact of this seemingly dated practice on workflow efficiencies within radiology and the broader field of health care, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, said the continued reliance on patients to transport medical images via physical media (such as a CD or flash drive) can lead to delays in patient care.

In their quest to change this dynamic, Drs. Krishnaraj and Larson recently co-authored a provocative article, “

Moving Toward Seamless Interinstitutional Electronic Image Transfer

ournal of the American College of Radiology (JACR)

. In the article and in a video interview with 

, Drs. Krishnaraj and Larson discussed the potential creation of a “linked multi-hub model” that would facilitate electronic transmission of medical images through image exchange companies that would connect different health-care facilities.

“Everyone in the imaging community should really see this as a call to arms to work with our imaging vendor exchange communities to solve this problem for the benefit of patients,” emphasized Dr. Krishnaraj, Chief of the Division of Body Imaging with the Department of Radiology and Medical Imaging at the University of Virginia School of Medicine.

For more insights from Drs. Krishnaraj and Larson, watch the video below:

In a recent video interview, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, discussed the continued use of physical media to transport medical images between different health-care facilities, resulting inefficiencies and delays with patient care, and the initiative to create a linked multi-hub model to end this dated practice once and for all.

'A Call to Arms' for Electronic Transfer of Medical Images Between Institutions

Preventive screenings decreased significantly during the COVID-19 pandemic and colorectal cancer screening was no exception. While the number of people getting colorectal cancer screening will likely rise with increasing numbers of people receiving full vaccination for COVID-19, there are still significant screening gaps, according to Syam Reddy, MD, the Clinical Chairman at UChicago Medicine Ingalls Memorial Hospital.

In a new video interview, Dr. Reddy said the use of computed tomography (CT) colonography can provide an array of benefits in the realm of colorectal cancer screening.

Dr. Reddy said CT colonography provides better detection of cancerous and pre-cancerous lesions than other non-invasive testing measures such as stool testing, He noted CT colonography has comparable detection rates to conventional colonoscopy but offers patients the practical benefits of no sedation and milder preparation prior to the procedure.

Researchers have also demonstrated that preoperative use of CT colonography changed surgical management in over 20 percent of patients with occlusive colorectal cancer, which Dr. Reddy pointed out during a recent lecture on CT colonography at the Society of Abdominal Radiology (SARS) meeting.

Dr. Reddy also noted that CT colonography enables clinicians to perform simultaneous screening for osteoporosis and non-alcoholic fatty liver disease (NAFLD).

For more insights from Dr. Reddy on CT colonography, watch the video below:

In a recent video interview, Syam Reddy, MD discussed the merits of computed tomography (CT) colonography, a non-invasive alternative to conventional colonoscopy, which may help reduce gaps in screening for colorectal cancer.

Assessing the Benefits of CT Colonography

As the country--and the world--continues to grapple with the ongoing COVID pandemic, the imaging industry is looking to re-find its footing in an evolving landscape where customized solutions are key to success. 

Enter Canon Medical's Cartesion Prime digital PET/CT, introduced in 2019, which provides a high-performance, adaptable system for today's evolving imaging technology. Optimizing both workflow and image quality via advanced silicon photomultiplier design with 

one-to-one coupling, fast time-of-flight and deep learning reconstruction technology, 

his advanced technology has led to image quality improvements, while optimizing dose efficiency to reduce patient risk and speeding up acquisition time for improved throughput," said Tim Nicholson, managing director, Molecular Imaging Business Unit, Canon Medical Systems USA. 

, Nicholson expanded on the needs of the industry and how Canon is answering the call. 

Canon's latest entry into the PET/CT market is a digital, air-cooled system that provides customizable solutions for a range of clients. 

Oncology CT

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