Feature|Artificial Intelligence| January 19, 2022 | By Dave Fornell, ITN Editor

AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams

Artificial intelligence can aid PERT activation and enable rapid communication with access to imaging and reports

The Viz.AI pulmonary embolism response team (PERT) app that uses AI to detect PE on images before they go into PACS, alerts the PERT team members and provides a mobile platform to message, review images and other patient data. Photo by Dave Fornell

Artificial intelligence (AI)has found a unique niche to help automate the activation of acute care teams for pulmonary embolism (PE), aortic dissections and abdominal aortic aneurysms (AAA) and allow them access to imaging and immediate communications. This concept was highlighted at the 2019Radiological Society of North America (RSNA)meeting for stroke care, but AI vendors at RSNA 2021 are now rapidly moving into other areas where there is a need for fast acute care team activation. This was one of the key AI takeaway trends at this year's meeting.

In cardiology 30 years ago, cath labs became popular and percutaneous revascularization rapidly replaced thrombolytics as the front-line therapy for ST-elevated myocardial infarction (STEMI) heart attacks. STEMI care teams were created and manually alerted by a pager or cell phone call to all the team members for faster cath lab activation. The goal was, and still is, to get the blocked coronary vessel opened by an angioplasty balloon within 90 minutes to prevent permanent damage to the heart.

That same concept is now becoming mainstream with stroke with centers that have neuro-interventional cath labs, where a catheter-based thrombectomy can be performed. This interventional approach is now becoming a frontline treatment for stroke and replacing thrombolytic therapy where there is access to such care. The same is true in PE care, where thrombectomy is becoming the preferred therapy.

But, while STEMI team activation is still largely driven by ECG results, stroke and other acute conditions like PE, aortic dissections and AAA are driven by computed tomography (CT) imaging. This requires an immediate STAT read by a radiologist to confirm these conditions. However, there are now several AI algorithms trained to identify these conditions and automatically perform a first pass read as it leaves the scanner. The AI can flag these studies for the radiologist and alert the acute care team with no human intervention and before the exam is sent to PACS. Some of the AI systems also can red flag the exam in the PACS and place it at the top of radiologists' reading lists for a STAT read.

This type of image-driven workflow also may become more relevant to cardiology as increasing numbers of chest pain patients are now being scanned on emergency room CT systems. CT for chest pain is expected to see a jump with the new 2021 chest pain imaging guidelines from theAmerican College of Cardiology (ACC)and endorsed by numerous cardiac imaging societies that now places CT as a frontline choice for rapid imaging assessments.

There has been growing interest by hospitals over the past several years to create pulmonary embolism response teams (PERT). AI technology like this can help streamline how these teams are activated and communicate.

Two vendors on the RSNA 2021 expo floor, Aidoc and Viz.AI, demonstrated their new pulmonary embolism AI alert systems. They did not have a shortage of radiologists and hospital executives coming to see them.

Aidoc's artificial intelligence PERT activation app showing how the CT scan can be viewed on a smartphone. The orange dots at the bottom of the page mark key slices were the AI detected pulmonary emboli. Photo by Dave Fornell

Aidoc's artificial intelligence PERT activation app showing how the CT scan can be viewed on a smartphone. The orange dots at the bottom of the page mark key slices were the radiologist detected pulmonary embolism. Photo by Dave Fornell

AI Vendors Finding New Ways to Address Acute Care Bottlenecks

"Vendors are looking for new ways to deliver AI to the customer that helps address some of the challenges they face with integration and deployment," explainedSanjay Parekh, Ph.D., Signify Research senior market analyst who monitors trends in radiology AI. "One of the evolutions we have seen for that is in acute care coordination packages. Viz.AI has done this very well with its stroke imaging AI platform. I have seen several examples of this on the RSNA floor, but now vendors are going down that route for not only stroke, but also pulmonary embolism."

帕尔克表示，在这种情况下，人工智能的应用消除了人类反应延迟的可能性，可以让需要参与紧急情况的人在同一页面上，能够立即、实时地看到相同的图像和患者数据。

"This type of care coordination helps us think beyond radiology. You have an AI imaging analysis component, but for these types of conditions there is a very short turn around that is needed and these types of solutions help address the need to get faster treatment to the patient, get better outcomes for the patient, and it helps make it more cost-effective for the hospital," he said.

How PERT AI Alert Systems Work

帕尔克说，人们对这些新的提醒应用如此感兴趣的原因是，人工智能供应商不仅仅是用人工智能图像分析标记考试。这些应用程序还包括人工智能，它可以收集相关的患者数据、报告、实验室和图像，并将这些数据打包在一起，发送到临床医生的智能手机或移动平板设备上。这消除了团队成员寻找工作站的需要，并允许立即访问团队所需的一切以做出快速诊断和治疗决定。该应用程序还将整个团队集中在一个位置，以共享信息和消息。

Aidoc和Viz.AI系统都具有类似的功能。人工智能检查可能的中风或PE的影像检查，如果发现任何潜在的诊断，它会自动通过应用程序向所有护理团队成员发送警报。此警报包括患者信息和到CT数据集的链接。用户可以打开CT扫描，在切片、窗口和水平之间滚动，并可以使用其他一些基本的图像操作工具。他们可以与团队分享关键图像。放射科医生能够根据扫描做出诊断，并告诉团队这是否是导管实验室的完全激活，或者向团队解释病例的严重程度，以便他们讨论其他治疗方案。

The Aidoc system has the addition of orange dots placed at the bottom of the screen, flagging areas where the radiologist confirmed the AI-detectedpulmonary clots. This can help speed treatment by directing the care team’s attention immediately to key images in the dataset.

Viz.AI aortic dissection response team app enabled by AI at RSNA 2021. — Viz.AI showed an example of an aortic dissection care team alert system at RSNA21. It uses AI to detect a type A or B dissection and immediately alerts the care team before the images are even loaded into the PACS. The AI sends a link for the imaging to show the dissection on the CT.

Viz.AI showed an example of an aortic dissection care team alert system, and pulled up CT cases on cell phones to show the CT images that would initiate an alert. The vendor also said it plans to roll out additional AI-driven care team modules for AAA and acute heart failure. The company current has FDA for ischemic stroke, intracranial hemorrhage, subdural hematoma and is FDA pending for brain aneurysm. They are also FDA cleared for PE and aortic dissection type A and B. A work-in-progress is AAA. All of these care team apps will be offered on the same platform and users can toggle between them. Viz.AI currently has installs in 900 hospitals worldwide.

Aidoc是2017年FDA批准的第一批中风AI检测软件之一。该供应商表示，它开发PE团队应用程序是为了解决它认为无法满足的临床需求。该公司表示，只有大约25%的pe诊断导致PERT激活，主要是由于协调和沟通不良。Aidoc还致力于AAA、深静脉血栓(DVT)和主动脉夹层的人工智能工作流程。

Aidoc's PERT team activation app inludes Imbio's AI RV/LV ratio assessment to help risk stratify the patient.

The Aidoc PERT app also includes AI from partner Imbio for automated right and left ventricle (RV/LV) diameter ratio assessments from the CT scan. This is an added predictor tool for short-term mortality and adverse clinical events in patients with various pulmonary vascular diseases.