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“Our practice has embraced the concept of artificial intelligence [AI] as a tool that improves physician performance for better outcomes—placing patients at the centre of the equation,” shares Jayson S Brower, interventional radiologist and president of Inland Imaging in Spokane, USA. Translating treatment from a hospital setting to an office-based lab (OBL), Brower describes their unique setup using GE HealthCare’s Embo ASSIST AI software, which he claims streamlines procedures and ensures cost-effectiveness when treating increasingly complex cases in an outpatient interventional setting.
Opening their outpatient interventional radiology (IR) clinic during COVID-19, Brower and colleagues’ initial aims were to sustain treatment of immunosuppressed patients—often those attending for oncology procedures—while reducing exposure to illnesses found in hospitals. Hospitals in the USA, Brower points out, are “cash strapped”, meaning equipment can often be “outdated”. Shifting away from the traditional hospital setting, outpatient treatment centres, or OBLs, have become more common in the USA in recent years. As Brower explains, “it has been a bit of a journey— we opened in 2019 after planning for about a year and half to two years prior to that. If you rewind all the way to 2017, there were maybe a handful of OBLs in the country—it was really a novel concept”.
As a champion for the OBL model, Brower believes that the translation of treatment to an outpatient environment is the “next best evolution in patient care, primarily due to the cost, quality and patient experience”, he asserts. “Outpatients can be seen on a timely basis—if we say we will treat you at 9am, we are going to treat you at 9am. Whereas, when you come to the hospital, emergencies arise, thereby delaying scheduled procedures.” Opening their OBL to ensure patients can receive timely, efficient treatment, Brower was confident that patients were going to have “the same great quality [treatment] by our team, with significantly less cost to the system”, a benefit which is then passed on to the patient. “Those were the elements that really motivated us to start pushing this down the path,” he says.
Brower and his team opted for the latest generation of imaging equipment, “opening the door for us to improve patient experience, with less radiation and overall improved patient experience” he says. Choosing GE HealthCare’s “exceptional” equipment for their interventional suite, Brower and his team’s focus was on their “strong” concurrent alignment on AI as a tool that aims to improve patient care, which formed the foundations of their current collboration. Brower states that the incorporation of Embo ASSIST AI into their practice has proven to “tangibly benefit both the physician and the patient” in both diagnostic and interventional settings.
After setting up their outpatient interventional suite, Brower tells Interventional News, their team’s focus on how best to integrate AI with their practice continued. “We invested in the software and software upgrades alongside the evolution of the technology, such as the Liver ASSIST Virtual Parenchyma [GE HealthCare] solution, which we have incorporated into our practice.”
In helping to reduce procedure times, Brower defines the “spill-over” benefits, such as reduced sedation and radiation, which also come with using the Embo ASSIST AI solution. However, his team will “continue to evaluate emerging AI tools to determine their value to patients”.
“There are many tools out there,” Brower explains, “but the question is does it bring value or is it just a flashy, ‘Hey, we can do this’, type of situation—it must bring value and then it must be applicable and reproducible.” Often performing liver-directed therapies such as Y90, Brower highlights the “highly reliable” Embo ASSIST AI, which has enabled his team to simplify procedural workflow and improve mapping via its three-dimensional (3D)-augmented image visualisation.
Facilitated by the software’s augmented imaging capabilities, Brower and his team are of the belief that AI will only “continue to improve and grow” as one of the “primary tenets” on opening their OBL.
With this, Arnaud Marie, GE HealthCare CEO and general manager of interventional image-guided systems agrees, saying “nothing will be untouched by AI”. Speaking to Interventional News, Marie sets out the company’s three-fold intent with the development of Embo ASSIST AI. First, by enabling augmented imaging to support embolization strategy planning, the technology allows users to simulate injection points, visualising arterial details. Designed to automatically track vessel pathways to anticipate navigation challenges, Marie asserts that interventional radiologists can “[define] the impact of any decision they make, to decide what treatments are best and to guide them during procedures”.
“The second element is to drive workflow efficiency—how can we eliminate steps during procedures? How can we make it as simple and as intuitive as possible?” Marie expands that a key focus in developing the technology was to remove “unnecessary” procedural touchpoints or clicks. Embo ASSIST AI does this by exporting automatically segmented vessels and landmarks of potential embolization points for augmented 3D fusion guidance. Then, interventionists are able to overlay this information via live fluoroscopy on the frontal or lateral plane. Previously, several steps were necessary to segment vessels to remove pollution from the 3D model Marie describes. Now however, “there are no steps, there is almost nothing to do”, he says.
Marie then defines the third tenet that shaped the development of Embo ASSIST AI—to provide integrated patient care—and explains how the software brings together the “silos” which he states make up healthcare. By speeding up data consolidation, Marie hopes the AI technology can “link those different silos—from the doctor, the technician, the nurses—through information sharing, to revolutionise” the patient care pathway. Throughout this process, Marie states that the company’s overarching refrain was to ask: How can it be summarised? How can it be accelerated? “We are all patients, or have been patients,” he states. “We want interventionists to have access to the best data and tools.”
Embo ASSIST AI’s imaging potential is of central importance to Brower, who describes the “community benefit” patients in Spokane have gained when attending their OBL clinic and imaging centre, which is operated with their joint venture partner Providence Healthcare.
“As imaging volumes continue to grow and have increased from 6 to 9% just through organic growth over the past year, then spin off from just diagnostic, to interventional, OBL practice should mirror that,” Brower says, highlighting their ability to consult and treat patients more efficiently today.
“Change is not easy,” Marie comments, commending OBLs like Brower’s that are successfully modifying their practice while “demonstrating how Embo ASSIST AI may enable a reduction of procedural time for interventionists, enabling them to solve problems that could not previously be solved”. Brower believes that their OBL has “removed some of the politics”, creating a space where doctors from “any group, practice, or hospital setting can feel comfortable sending patients”. Although “biased”, Brower believes that they provide the “best patient care” in their market, working to ensure their “reputation and service stays intact—it all comes back to the patient”.
In light of increasing demands, Brower is in agreement with Marie, that “the simple fact is AI will continue to play a major role in what we do across the board, but particularly in imaging—I would imagine that the role of AI is only going to increase within our specialty”. Installing Embo ASSIST AI has been “pivotal” in getting their OBL to where it is now, Brower avers, “they have been fantastic, their equipment in my mind is exceptional—I am a firm believer that [OBL clinics] are the best way to treat patients”.
*Disclaimer: Jayson Brower is not a paid consultant for GE HealthCare. The statements made by Jayson Brower described here are based on his own opinions and on results that were achieved in his unique setting.
Embo ASSIST AI solution includes FlightPlan for embolization and requires AW workstation with Volume Viewer, Volume Viewer Innova, Vision 2, VesselIQ Xpress, Autobone Xpress. These applications are sold seperatley and may not be available in all countries.
