2026 Blog Entries

4/18/2026

Certificate of Need laws were established in 1974 under a federal mandate to control healthcare costs. That mandate was repealed in 1986, yet 35 states - including Georgia - still enforce them. A recent Becker's ASC article titled "It's antitrust. We all know it": The case for killing certificate of need captures what many of us in healthcare have long observed: CON laws don't control costs, they control competition. Research shows patients in CON states pay roughly 11 percent more for care and have access to 30 percent fewer hospitals per capita. These aren't safeguards. They're monopolies.

Georgia is a textbook example. Despite incremental reforms like HB1339's ASC exemptions, the state's CON framework remains largely intact. As I wrote on my blog in March 2024 (r-paul.com/blog/2024), Georgia's rule 111-2-2-.21 still prevents private cardiology practices from performing cardiac catheterization or EP procedures in an outpatient setting, not for patient safety, but for market protection. Meanwhile, 10 Georgia rural hospitals are at immediate risk of closing, and the state carries one of the highest uninsured rates in the country. These communities aren't suffering from too much competition. They're suffering from too little.

The FTC has repeatedly condemned CON laws as categorically harmful, and the current administration has tied Rural Health Transformation funding to their elimination. Georgia's legislature has discussed CON reform since the mid-2000s. The conversation is long overdue for action. It's not complicated. It's antitrust. We all know it and it's time for change!

4/15/2026

Let me start this post by stating: I've had the privilege of interacting with both HeartFlow and Cleerly on literally a day-to-day basis. Genuinely great teams on both sides, doing meaningful work to advance coronary artery disease diagnostics for patients.

But now that HeartFlow has filed a patent infringement lawsuit against Cleerly… I feel like I'm living in a cardiology Twilight saga.

You've got HeartFlow, with over 600 patents, mysterious FFR powers, went public, sparkles under the Nasdaq sunlight. That's Edward energy.

Then there's Cleerly: the scrappy newcomer who showed up and immediately started turning heads with AI plaque analysis. Younger, aggressive. Pure Jacob energy.

But I do have to give kudos to HeartFlow's legal team because this filing isn't just a complaint, it's a screenplay. It literally opens with:

"Heartflow's story began not in a boardroom, but in a hospital bed. In 1978, a fifteen-year-old boy named Charles Taylor lay near death from a ruptured appendix…"

That's not a patent filing. That's the first chapter of a medical thriller.

I fully expect Cleerly's response to open with a dramatic childhood flashback of its own.

So.....Team HeartFlow or Team Cleerly?

**In all seriousness the claims in this lawsuit are significant, and the outcome could have real implications for innovation, intellectual property, and competition in the cardiac AI space. Both companies have contributed to advancing patient care, and how this plays out matters.**

***Or hear me out, plot twist: Cleerly just buys out HeartFlow's debt, they merge, and we get the ultimate crossover nobody asked for but every cardiologist secretly wants. One platform. All the AI. No more choosing sides. Call it ClearFlow. HeartLeerly. I don't care. Just stop making me log into two portals.***

4/1/2026

"A Harvard University economist claims that imaging volumes are falling in the U.S., blunting the need for more radiologists."

As someone with nearly two decades in cardiac imaging overseeing SPECT, PET, ECHO and CT, I'd challenge this claim based on everything I've witnessed firsthand in a post-COVID clinical environment. Volumes have not declined; in most modalities, they've grown substantially.

The rural access angle deserves serious consideration, too. Rural access disparities are a well documented pressure point. Smaller hospitals and imaging centers in less populated regions struggle to attract and retain radiology talent, widening the care gap.

It's reasonable to ask whether rural hospital closures are effectively funneling patients and their imaging demand into suburban and urban centers, creating a concentration effect that inflates volume in some markets while masking a utilization drop in others. That kind of geographic redistribution could look like "falling volumes" in aggregate data while clinical staff in high-volume centers are stretched thin.

3/3/26

RadNet just earned European certification for TechLive, technology that lets techs remotely operate multiple imaging machines from a single location. The pitch is: address workforce shortages, boost efficiency (they're seeing 42% fewer room closures). But here's what keeps me up at night: one technologist managing multiple CT, MR, and ultrasound machines across different sites remotely.

What happens when you need hands-on intervention in an emergency? What about connection delays or cybersecurity vulnerabilities? And let's be honest, patient monitoring and liability become murky when your tech isn't physically present.

I'm not saying remote operations are inherently bad. But before we normalize this across healthcare, we need to ask hard questions about safety protocols, backup systems, and who's liable when things go wrong. Efficiency matters, but not at the expense of patient care.

What's your take? Are we moving too fast on this, or am I overthinking it?

2/28/26
Researchers at Japan's QST have achieved a remarkable milestone in PET technology: the first scanner to break the sub-0.5 mm resolution barrier, reaching 0.67 mm. To put this in perspective, most modern clinical PET scanners used in hospitals today operate at around 4–5 mm resolution, optimized for whole-body human imaging. The team's next goal? Sub-0.3 mm resolution.

2/18/26

Attached is a significant policy document, a DOE memo from January 9, 2026, that approved removing the "As Low As Reasonably Achievable" standard from its radiation rules, arguing that the Linear No-Threshold model it's based on lacks scientific support and creates unnecessary costs for the nuclear industry. They're citing an INL report suggesting doses under 5,000 mrem/year haven't shown detectable health effects. Curious where people land on this: overdue course correction backed by evidence, or risky erosion of precautionary standards?

2/9/26

The American Society of Nuclear Cardiology (ASNC) has reported a significant shortage of key radiotracers used for the noninvasive diagnosis of transthyretin (ATTR) cardiac amyloidosis, including technetium-99m pyrophosphate (Tc-99m PYP) and Tc-99m hydroxymethylene diphosphonate (Tc-99m HMDP/HDP). This supply disruption, driven by vendor issues such as unavailable stock from Sun Pharmaceutical and limited production from Curium due to active ingredient challenges, is expected to continue for months—potentially into at least Q2 2026. With rising demand fueled by effective new therapies that improve patient outcomes, this shortage is frustrating clinicians and threatening timely access to a diagnostic pathway that has revolutionized early detection of ATTR cardiac amyloidosis, avoiding more invasive procedures like endomyocardial biopsy.

2/3/26

The International Atomic Energy Agency (IAEA) has released key findings from its major MEDBIODOSE coordinated research project, which united 31 institutions from 27 countries—including Australia, Brazil, Ghana, the United Kingdom, and many others across all continents. Running since 2017, the initiative focused on biodosimetric markers and methods in radiation oncology, nuclear medicine, and diagnostic/interventional radiology. Researchers collected and analyzed real-world patient data, including cytogenetic markers (such as chromosomal aberrations) and molecular indicators (DNA damage proteins and gene expression changes), to improve the accuracy of radiation exposure estimation and biological response assessment.

This truly international effort has produced one of the largest harmonized datasets in the field, validated promising new biomarkers, and laid critical groundwork for more personalized and safer radiation treatments. The results support better prediction of side effects, identification of radiosensitive individuals, and enhanced clinical decision-making—potentially integrating future AI-assisted tools.

1/15/2026
Leveraging the SEC's EDGAR database, savvy professionals can dissect a competitor's 10-K (annual) and 10-Q (quarterly) filings to craft targeted strategies. These documents reveal critical financials like revenue trends, debt levels, and profitability metrics, exposing vulnerabilities such as overreliance on specific markets or rising operational costs that one can exploit through competitive pricing or innovation.



 

1/10/2026

The FDA has approved Cardamyst (etripamil) nasal spray from Milestone Pharmaceuticals—the first self-administered treatment for acute episodes of paroxysmal supraventricular tachycardia (PSVT) in adults. This innovative calcium channel blocker allows patients to rapidly restore normal sinus rhythm at home, with clinical trials showing a median conversion time of just 17 minutes versus 53-54 minutes for placebo. By empowering patients to manage unpredictable episodes outside clinical settings, Cardamyst has the potential to reduce emergency visits and improve quality of life for millions living with PSVT.