At RSNA, HCB News sat down with Dennis Durmis, head of commercial operations, Radiology Americas at Bayer to discuss a wide range of topics that were being discussed at the annual meeting and could have big implications for the future of health care.

HCB News: Let's talk about gadolinium. We're seeing a lot of concern about retention but no evidence of side effects. As a manufacturer of the contrast agent, how has this impacted Bayer?

Dennis Durmis: We've been actively working with the PRAC in Europe to understand what's transpiring there, working with them to provide whatever evidence we have with regards to retention. In the U.S. it's been a little different with the FDA looking and saying, 'we're monitoring and will continue to monitor but we don't see any evidence that there's a cause for clinical concern.'

So it depends on geography but overall we take the position that the benefit-risk profile on gadolinium is positive — whether it be a macrocyclic agent or a linear agent — and it's up to the physician to make the best choice for their patient. That's how we've been approaching it and we work locally so whatever guidelines the local regulatory bodies have, we will continue to follow that.

HCB News: When we think about the third-party debate taking place with the FDA's investigation of equipment safety and who can safely service medical equipment, what is Bayer's stake in that conversation?

DD: We have tens of thousands of vascular injectors in the U.S. These are electromechanical devices that are connected to patients and are pushing some form of pharmaceutical product, so we actually think this is a pretty important issue. We participate in angiograph,y so you're looking at the arterial side of the body and the importance of pressure and flow rates. We're not a scanner company so we're not as big as some of those but we do have some pretty complex and intricate electromechanical devices that need to be calibrated, need to be tested...

HCB News: So it's a lot of very delicate equipment requiring precise management and handling.

DD: Exactly. Also, you have to remember that it doesn't matter what part of the suite goes down. For example, CT contrast enhancement is almost always power injected so if your CT injector is down then you're going to miss out on a lot of your procedures,... so this subject is important with regard to throughput and up time and those types of things.

Until recently, Bayer had a multi-vendor service (MVS) business where we manufactured MR coils and serviced coils for a lot of the big scanner companies and hospitals directly and we also did ultrasound transducers. In fact, I was employee #14 back in 2003 with that group so I'm pretty passionate about the third party space and I know there are some really good third party companies out there that have quality systems and trained personnel who reverse engineer equipment to understand technically how it operates — and how replacing a particular resistor with the exact same wattage is critical — versus someone who doesn't.

Our position as a company, even when we had MVS, was that we supported some level of quality system requirements for third parties because it doesn't take many bad apples in the cart to put patients at risk. We think some level of consistency or standard would help drive better patient care and improve what the customer is paying for.

For instance, if the patient is paying for a particular service and is not aware that they're receiving a compromised version - that's a challenge. How do you demonstrate that you missed a diagnosis because something wasn't serviced properly? Statistically that's difficult to capture, because you simply don't know what you don't know.

HCB News: Speaking of what we know and don't know. Let's talk a little bit about artificial intelligence - it seems to have formally staked its claim at RSNA this year.

DD: It's fascinating how things are changing with AI and it's not a question of "if" but "when" - so we see AI being embraced more regularly. Is that helping a physician make a diagnosis? Is that going to be niche with regards to the disease state? I think those things will happen sooner than later and geography will a big factor in how it comes around.

For Bayer, looking at AI from an imaging perspective, image consistency is important for enabling AI to reliably read an image. So, what we specialize in with contrast administration; the amount, pressure, flow rate, protocol delivery depending on weight or age - these are areas where we play an important role because the software demands consistency.

HCB News: Could you imaging AI someday impacting how injections are performed?

DD: I think it depends on the sophistication of AI. We will be able to detect shades of grey better than the human eye so does that change the enhancement rate requirements of the scan? I think that's more of a long term idea and pretty far out. Near term, obviously interoperability with the scanner, hospital information system, PACS, RTLS, where the patient is at in their journey... those types of things will become more integrated and more sophisticated AI tools will follow.