Image Storage & Management in Alzheimer Treatment
Editor’s Note: Moderated by Lawrence Tanenbaum, MD, FACR, Applied Radiology hosted a series of conversations with experts on Alzheimer disease imaging and management at the 2024 Radiological Society of North America Annual Meeting and Scientific Exhibition.
In this discussion, Dr. Lawrence Tanenbaum and Dr. Osman Ratib, Founder and CEO of Agora Care delve into the challenges of image management and explore how a more patient-centric approach to image storage and management could offer tangible solutions.
Alzheimer disease creates challenges for patients, their caregivers, and the medical professionals who guide them. From the earliest stages of mild cognitive decline to the heart-wrenching reality of advanced disease, timely and accurate imaging plays a critical role in diagnosis, monitoring, and treatment. However, the current system of image management is fragmented and inefficient, a reality that directly impacts patient care. As Dr. Tanenbaum aptly described, "If you don't have the prior study, the current study can be virtually useless and potentially dangerous."
The Fragmentation of Imaging Data
One of the recurring themes in the discussion was the ‘fragmentation of imaging data’ across different facilities. Alzheimer patients considered for or undergoing anti-amyloid immunotherapies undergo repeated scans, from PET imaging to monitor amyloid plaques presence and perhaps clearance to MRI to detect subtle hemorrhages or brain edema. These patients may visit different hospitals, outpatient clinics, and specialists over the course of their treatment journey.
Dr. Ratib highlighted the frustration inherent in retrieving these images: "As a chair of a Department of Radiology, we try to get these prior studies for comparison with the current. Ready access to imaging studies is even more important for patients with chronic diseases like Alzheimer, cancer, and cardiac disease." He noted that traditional hospital and outpatient systems are ill-equipped to seamlessly access images captured at different institutions, creating delays and inefficiencies in the management of these patients.
For neuroradiologists, the lack of a comprehensive imaging history is more than an inconvenience; it compromises diagnostic accuracy. In Alzheimer care, subtle changes over time—whether in the number of amyloid plaques, the emergence of micro-hemorrhages, or the progression of brain atrophy—are critical for evaluating treatment effectiveness. Missing these subtle changes due to incomplete imaging data can lead to incorrect assessments, unnecessary repeat scans, and misinformed clinical decisions.
The Critical Need for Continuity in Imaging Protocols
Alzheimer patients receiving disease-modifying therapies, require consistent and accurate serial imaging to detect potential side effects like brain edema (ARIA-E) or brain hemorrhage (ARIA-H). Differences in imaging protocols between facilities exacerbate the challenge of longitudinal assessment. As Dr. Tanenbaum emphasized, assessing variability in imaging technique is essential for accurate and sensitive diagnosis., "
Dr. Ratib underscored how critical it is for radiologists to know the exact protocols used in previous studies to ensure meaningful comparisons. As Dr Tanenbaum stated, “As an example, readers need to know if a facility is using susceptibility-weighted imaging to track hemorrhage if prior studies are done with different, simple gradient echo imaging." Without the prior studies readily at hand technical differences might mimic significant clinical changes.” Without this continuity, even the most skilled neuroradiologist may struggle to draw accurate conclusions, jeopardizing patient safety and treatment efficacy.
The Burden on Caregivers and Patients
The logistical challenges of tracking down images place an immense burden on caregivers, who are often managing other aspects of their loved one’s care. "These patients will need multiple surveillance examinations over time," Dr. Tanenbaum noted. "Chasing down images is really problematic." For elderly patients or those with cognitive impairment, this burden can be overwhelming, leading to delays in diagnosis, unnecessary scans, and increased healthcare costs.
Dr. Ratib explained how Agora Care aims to alleviate this burden by giving patients control over their imaging data. "We created Agora Care essentially driven by the patient, but for elderly patients, their caretakers will manage their dossier. They have to be able to collect the data and provide it every time the patient goes for a new study." This centralized repository ensures that imaging data follows the patient wherever they go, eliminating the need to chase down prior studies.
A Patient-Centric Solution
Agora Care’s platform offers a secure, cloud-based solution where all imaging data is stored in a single, accessible repository. Dr. Ratib described its uniqueness: "Most systems today give access to images, but you never have a repository that takes all the images from different centers in one place." Agora Care’s patient-centered approach means that whether a patient visits their regular neurologist or a new imaging facility, their complete imaging history is available at the point of care.
This streamlined access benefits not only patients and caregivers but also radiologists. Dr. Ratib highlighted the impact on workflow efficiency: "In my department, it takes three full-time people just to get data from other centers and prepare it for radiologists. Having everything available when the patient arrives saves time and ensures accurate reporting."
The Role of AI and Future Innovations
Looking ahead, the integration of artificial intelligence (AI) promises to enhance the accuracy and efficiency of Alzheimer imaging. Dr. Ratib noted, "We're going to see AI coming in to help us compare subtle changes that we might miss." However, the effectiveness of AI tools hinges on access to comprehensive imaging datasets. Without prior studies, even the most sophisticated AI algorithms cannot deliver reliable insights.
Dr. Tanenbaum echoed this sentiment, stating, "The key point here is for surveillance situations you need all exams so that you can apply whatever tool—whether it’s human reading or AI—to make the critical determination of interval change." Agora Care’s ability to provide seamless access to prior imaging is a foundational step toward harnessing AI's full potential in Alzheimer's care.
Toward a Future of Integrated Patient Care
The conversation between Dr. Tanenbaum and Dr. Ratib painted a clear vision for the future of Alzheimer imaging—one where patients and caregivers are empowered, radiologists are equipped with the data they need, and imaging continuity is the norm rather than the exception. As Dr. Ratib summarized, "We start with the idea of helping patients in their clinical journey, but ultimately, this model could expand to support research, new treatments, and better outcomes."
For neuroradiologists, supporting patient-centered image management solutions like Agora Care could be a transformative step, easing the complexities of Alzheimer' imaging while ensuring that each patient receives the informed, timely care they deserve.
In Dr. Tanenbaum’s words, "Radiology is the center of the healthcare enterprise." By placing patients and their imaging histories at the heart of that enterprise, solutions like Agora Care can help bridge the gaps that currently hinder Alzheimer’s care, bringing clarity and continuity to a challenging journey.